European Urology Today Vol. 31 No.3 - June/July 2019 by European Association of Urology (EAU)

European Urology Today Official newsletter of the European Association of Urology

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Vol. 31 No.3 - June/July 2019

Redefining the spectrum of RCCs

Fistula repair in Sudan

EAU Section of Uropathology provides an up to date overview of tumour types

Report from an ICS workshop supported by the Global Philanthropic Fund

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Urology Week 2019 is coming Find out how you and your department can take part!

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EAU uniquely placed to help European urologists' ambitions '2019 EAU meets National Societies' meeting: European Union, education and science By Loek Keizer Every year, the EAU meets with representatives from Europe’s national urological societies in Noordwijk, on the Dutch coast, for a discussion on how the EAU and the societies can help each other raise urological care across the continent. Topics like European regulations, transnational research, specific needs for training, and even the very definition of urology itself were discussed on 21 and 22 June, 2019. This year, discussions were structured around four themes: the EAU and the European Union; urological education in Europe; patient engagement and Guidelines; and science and research. After an initial presentation by the responsible EAU board member(s) and other experts, the groups dispersed for break-out sessions where the topics were discussed further. The next day, highlights and conclusions were presented from these sessions, and further discussed. Helping urology through the EU EAU Secretary General Prof. Chris Chapple was joined by Adjunct Secretary General (Education) Prof. Hein Van Poppel and Sarah Collen (Brussels, BE), EU Policy Coordinator EAU for the first series of talks on the EAU’s activities and goals in Brussels.

European Reference Network for rare urogenital diseases and complex conditions, which currently counts 29 healthcare providers in 11 EU member states, as well as several affiliated partners. “The platform offers a multidisciplinary approach for rare cases, allowing for highly specific advice to be brought in. The network is set up and run by the EAU, and now self-supporting. We encourage you all to share information and get free advice." Following the break-out sessions, Prof. Chapple noted interest from a number of participants. “We’re happy to see interest in eUROGEN. This is a free service that your members might find helpful. It’s a powerful tool, the funding is there and we must keep supporting it.” Participation is limited to EU and EEA member states. Prof. Van Poppel spoke at the EU session about the need for improved and comprehensive screening for prostate cancer, taking the opportunity to fact find among the national societies about current national policies on (PSA-based) screening. “Since the introduction of PSA-based testing in the 1980s, we have seen a tremendous decrease in mortality,” Prof. Van Poppel said. “But in recent years, this trend has threatened to reverse. Smart use of PSA, novel biomarkers, mpMRI and active surveillance can avoid the risks of overdiagnosis while also decreasing PCa-related mortality.”

Participants of the National Societies Meeting in Noordwijk, June 2019

EAU Guidelines Office Chairman Prof. James N’Dow focused his presentation not on the quality or the wide use of the EAU Guidelines, but rather on their implementation. “Studies from different parts of the world reveal that 30-40% of patients do not receive care according to the current scientific evidence, and in fact 20-25% of care is potentially harmful,” said Mrs. Collen gave the audience a refresher on how the Prof. N’Dow. “Eminence-based medicine, in direct European Union is organised, and how EU policy does contradiction to our Guidelines is unfortunately still and can impact urology in each European country. The EAU is actively lobbying the EU for continent-wide practised, including in larger European countries.” “While healthcare is often a national matter, with a N’Dow highlighted the efforts of the Guidelines attention for PCa and men’s health, through the ministry that makes strategic and funding decisions, aforementioned EPAD and white papers. Talks during Office’s IMAGINE Group in quantifying the adherence the EU has a mandate to protect its citizens and to the Guidelines, identifying possible obstacles and the break-out sessions revealed national societies’ promote public health,” Mrs. Collen said. “EU coming up with possible interventions to effectively interest in increased or more effective screening legislation impacts how you work: quality standards, through international cooperation, although in some implement prioritised recommendations. tobacco legislation, cross-border health threats and countries terms like “PSA screening” are legal red the freedom of movement for your staff.” Prof. N’Dow also gave an update on the first year of flags with implications of overtreatment. It was the PIONEER European Network of Excellence, an decided to use the term 'PCa Early Detection The EAU is targeting the European Union on behalf of Programme' to refer to the EAU's efforts in this field. international big data prostate cancer network, partly the continent’s urologists on three levels: the funded by the European Union. National societies are European Commission (which proposes legislation), very much encouraged to disseminate the project’s Education, Guidelines and patient engagement the European Parliament (elected MEPs) and the objectives to their members in an attempt to increase The EAU and the national societies can find further European Council (representing member states’ the number of participating centres. One national areas of cooperation when it comes to urological governments). The EAU participates in the European education (certification and training), the widely-used society was planning to include PIONEER leaflets in Prostate Cancer Awareness Day (EPAD), has published EAU Guidelines (specifically their adherence, which their annual meeting’s congress bags. policy white papers and has developed the varies greatly), and in reaching urology patients. #EUpledge4prostatecancer, a tool that encourages Dr. Mark Behrendt (Amsterdam, NL), Chairman of the MEPs to voice their support for prostate cancer ESU Chairman Prof. Joan Palou summarised the EAU’s Patient Information Working Group, highlighted the research, screening and raising the topic in large range of educational programmes that Europe’s EAU's work on producing innovative Patient parliament. Information. Patient-oriented materials are currently urologists can take part in, both at the EAU’s events, available in several languages and the national and when offered at national societies’ own annual “National societies and individual urologists can societies were invited to contribute. Other outreach meetings. Prof. Palou mentioned the increasing reach out to their country’s European Members of popularity of e-courses and webinars (often as a first campaigns include Urology Week (see page p16). Parliament. Upcoming EU presidencies can offer step to further on-site training), the development of high-profile events for raising attention around Science and Research standardised curricula (for instance for robotic urology,” Collen suggested. Countries with Prof. Stenzl, in his new role as Adjunct Secretary surgery) and the possibility of a “Urology bootcamp” upcoming six-month terms of Presidency are General in charge of Science, introduced the EAU’s for first-year residents. Finland, Croatia, Germany, Portugal, Slovenia and France. The EAU is also paying close attention to who is qualified to lead training sessions, the so-called Prof. Chapple also pointed to the potential for funding “training the trainers” programme. Considering the and research for urology that could potentially be many possibilities for implementing the ESU’s secured with the help of national societies. Horizon education know-how around Europe, Palou quipped Europe is a new research and innovation framework “USE ESU.” programme that had a budget of €100 billion, €7.7 The break-out sessions revealed that in some billion of which is earmarked for healthcare and a countries, the requirement for potential clinical ‘cancer mission’. fellowships of having at least three PubMed publications is a hurdle. Prof. Palou suggested a eUROGEN is one of the major initiatives that the EAU course on how to write scientific papers, perhaps has with the European Union. It is an ongoing also making more research data available for potential authors. Prof. Jens Sønksen raised the idea of EAU Educational Ambassadors: members of each national society who could represent the European School of Urology and disseminate materials on a national level. This idea was further discussed in the break-out sessions and was met with enthusiasm. June/July 2019

efforts in maintaining and improving the high level of urological science in Europe. He cited the Scientific Congress Office, the variety of active EAU Sections and the Research Foundation as the major tools to achieve this. Prof. Morgan Rouprêt (Paris, FR), the new chairman of the EAU Section for Onco-Urology was invited to speak on the EAU’s efforts in this field. Rouprêt spoke of the ESOU’s ambitions to go beyond an annual section meeting, but also work with the ESU in educational activities and contribute heavily to the journal EU Oncology. The ESOU will also offer its services to have sessions at national society meetings across Europe, and national societies should reach out to explore the possibilities. Much of the EAU’s efforts on onco-urology stem from the changing role of the urologist, a topic that regularly came up in the break-out sessions. In some countries, urologists might see their primary duties going to gynaecologists or oncologists, and vast differences in what a urologist is allowed to prescribe in treating urological cancers also exist. Prof. Wirth emphasised that urologists are “not robot technicians, but organ specialists.” A special Task Force was recently convened to deal with this challenge. Its major conclusions, also presented by Profs. Stenzl and Rouprêt at the National Societies meeting was that the EAU should get a clear grasp of each European country's rules on urologists prescribing oncological drugs, and possibly assist in education and certification. Training through new and existing masterclasses, the EAU's Oncology Update meetings and structured examination would be major steps toward oncology certification for urologists.

www.eau20.org

Abstract submission now open! Deadline: 1 November 2019

European Urology Today

Annual platform for EAU top academics (Re-)introducing the Association of Academic European Urologists By Loek Keizer The EAU is well-known for the cutting-edge science presented in European Urology, or at the Association’s many meetings, or its annually-updated Guidelines. One of the somewhat less publicised and more exclusive activities that the EAU organises is the Association of Academic European Urologists (AAEU). “We nevertheless would like to make use of European Urology Today to introduce its readers to our Association,” says its Honorary Communication Officer, former EAU SecretaryGeneral Prof. Frans Debruyne (Nijmegen, NL). Prof. Frans Debruyne AAEU Honorary Communication Officer

The AAEU’s board is otherwise composed of Secretary General Mr. Ian Eardley (Leeds, GB), President-elect Prof. Jan Breza (Bratislava, SK), and Prof. Per-Anders Abrahamsson (Malmö, SE) as members’ representative.

Introducing the AAEU Debruyne: “We are an association of leading academic urologists from Europe, dedicated to the study of disorders of the urinary tract system. Our objectives are to promote the role, position, and activities of academic urology in Europe.” The AAEU works to achieve this goal by using its influence to strengthen the position and value of academic urology and urologists in Europe and promote clinical and fundamental scientific urological programmes and achievements in academic urological departments.

European Urology Today Editor-in-Chief Prof. M. Wirth, Dresden (DE) Section Editors Prof. T.E. Bjerklund Johansen, Oslo (NO) Mr. Ph. Cornford, Liverpool (GB) Prof. O. Hakenberg, Rostock (DE) Dr. D. Karsza, Budapest (HU) Prof. P. Meria, Paris (FR) Dr. G. Ploussard, Toulouse (FR) Prof. J. Rassweiler, Heilbronn (DE) Prof. O. Reich, Munich (DE) Dr. F. Sanguedolce, Barcelona (ES) Prof. S. Tekgül, Ankara (TR) Special Guest Editor Mr. J. Catto, Sheffield (GB) Founding Editor Prof. F. Debruyne, Nijmegen (NL) Editorial Team E. De Groot-Rivera, Arnhem (NL) L. Keizer, Arnhem (NL) H. Lurvink, Arnhem (NL) EUT Editorial Office PO Box 30016 6803 AA Arnhem The Netherlands T +31 (0)26 389 0680 F +31 (0)26 389 0674 EUT@uroweb.org Disclaimer No part of European Urology Today (EUT) may be reproduced without written permission from the Communication Office of the European Association of Urology (EAU). The comments of the reviewers are their own and not necessarily endorsed by the EAU or the Editorial Board. The EAU does not accept liability for the consequences of inaccurate statements or data. Despite of utmost care the EAU and their Communication Office cannot accept responsibility for errors or omissions.

European Urology Today

It provides an annual forum for the presentation and discussion of academic achievements in the field of urology and related areas, and it develops educational programmes aimed at the advancement of academic urology in Europe. Finally, the AAEU organises exchange and collaboration between academic urological centres throughout Europe. “By providing a forum for the presentation and discussion of academic achievements in the field of urology and related areas, the AAEU aims to enforce the position and value of academic urology and urologists in Europe,” says Prof. Debruyne. History of the AAEU “The idea of the AAEU commenced at the beginning of this century, with discussions between Profs. Laurent Boccon-Gibod, Michael Marberger, John Association of Academic European Urologists (AAEU)

Michael Fitzpatrick, and myself as Secretary General of the European Association of Urology (EAU),” Debruyne remembers. “We agreed to create an exclusive scientific and clinical platform for exchange at a European level. Leading experts were invited to join together as we held the first AAEU meeting in Vienna in 2002, under the presidency of Professor Michael Marberger.” The first meeting was attended by around 45 academic invitees from all over Europe, representing almost all leading urologic academic centres. Having been found a success, it was decided that the meeting should be continued in a structured way, on an annual basis. The steering committee, consisting of Profs. Boccon-Gibod and Debruyne drafted the first constitution of the organisation and it was decided to organise an annual three-day meeting, taking place each year in the first weekend of December. Debruyne: “The initial idea was to create a society independent of any urological society. However, since the majority of the first-accepted AAEU members were also active in the EAU, a rapid collaboration between the AAEU and the EAU emerged.” Since the initial meeting in 2002, 17 meetings have been organised. Most recently, the AAEU met in Warsaw (2016), Dresden (2017) and Rome (2018). Membership Membership of the AAEU is limited and consists of Active, International, Emeritus, Inactive and Honorary members. Active members are certified European urologists under the age of 65, recognised for their academic expertise and achievements. This group is limited to 100 members. Non-European urologists who meet these criteria may become International members. Emeritus members consists of Active or International members who have reached the age of 65 or at an earlier age on their own request. They, however, still want to remain actively involved in the AAEU. Inactive members are retired active, international or emeritus members, whose membership status is changed at their own request. Finally, Honorary members are selected from the above groups based on outstanding contributions to the AAEU and academic urology. Nomination of new members is restricted and exclusive. Candidate members should have a clear and impeccable academic urological profile. Candidate members can be proposed to the Membership and Nomination Committee through

The group of members and invited guests at the 17th Annual AAEU Meeting in Rome, December 2018.

a written recommendation from active members, emeritus members, international members or honorary members. If accepted, the candidate will be invited as a guest to the next annual meeting of the AAEU, present a paper and actively involve his- or herself in the discussion. Format of the meeting Each annual meeting consist of six sessions, each featuring a presentation on a variety of topics, and a long discussion with AAEU members. Presentations can also include unpublished and unpresented clinical or scientific work of the presenter. Debruyne: “All invited guests have to present. Moreover each session begins with an invited state-of-the-art lecture. The meeting also contains special presentations, award lectures and a presentation of the EAU’s annual Matula award winner who is always invited as a special guest.” “Apart from the always stimulating and challenging scientific programme, the annual AAEU meeting is characterised by its cultural activities for accompanying partners and its annual welcome party, gala dinner and farewell party where members and guests have an unique opportunity to socialise and network,” says Debruyne. The 2019 meeting will take place in Bratislava (SK) on 28 November - 1 December under the presidency of Jan Breza. In 2020 and 2021, the meetings will take place in Malmö (SE) and Lucerne (CH), respectively. “While one cannot apply for membership of our association, we nevertheless welcome your interest,” says Debruyne. “You can ask me anything related to the AAEU or send your comment to: f.debruyne@andros.nl For more information on the AAEU, please visit aaeu.uroweb.org

ANNOUNCEMENT

Online In-Service Assessment

Fellow of the European Board Examinations, Part 1 and 2

Thursday 12 & Friday 13 March 2020 In-Service Assessment This online self-assessment allows candidates to evaluate their current knowledge base against the current European standards. It encourages both teacher and student to reflect upon their training scheme. Residents and programme directors use it to identify deficiencies related to specific urological topics and target those areas in future training. The assessment consists of 100 Multiple Choice Questions (MCQs) and is offered as an online test.

www.ebu.com

Part 1: Online Written Examination Thursday 14 November 2019

Part 2: Oral Examination Saturday 27 June 2020

The purpose is to assess whether the candidate demonstrates the minimum level of knowledge recognised by the EBU Examination Committee. The examination consists of 100 Multiple Choice Questions (MCQs) and concerns the entire range of urological topics including basic science. Participation is subject to eligibility.

The objective is to test the candidate’s ability to evaluate and manage common cases in every day practice. The candidate is examined in four clinical cases in a timeframe of maximum 55 minutes by a team of two urologists. Participation is subject to eligibility. Successful candidates are awarded the prestigious FEBU title.

Further information: www.ebu.com

The examination is offered at secured Pearson VUE test centres in Europe

Dr. Panagiotis Levis (left) and Dr. Andreas Karagiannis (right) from Greece were granted the FEBU diploma at the Oral Examination 2018 in Warsaw

June/July 2019

"Backbone of the EAU" to get new chairman Peter Albers set to be next head of the Scientific Congress Office By Loek Keizer

accept a single four-year term, with an option of one more four-year term.”

EAU Secretary General Prof. Chris Chapple, in his capacity as head of the EAU’s Search & Nomination Committee announced the selection of Prof. Peter Albers for the position of Chair of the EAU Scientific Congress Office (SCO).

“Secondly, the composition of the group has to correlate with the submitted abstracts, currently over 5,000 each year in different areas of interest.”

“Clearly, Prof. Albers’s nomination will need to be officially approved during the EAU General Assembly at the occasion of the 35th Annual EAU Congress in Amsterdam in March 2020,” said Prof. Chapple. “Nevertheless, he will fulfil his role as SCO Chair with immediate effect and shall be actively involved in the EAU Board from now on as well.”

“Thirdly, a good variety of nationalities, specialities and younger urologists should also be represented in the SCO. What we did not achieve so far is a higher number of women! We'll work on this and will need applications. In my opinion, it should be possible to apply for a position on the SCO and this should be handled transparently. I would strongly support a transparent selection process based on the aforementioned requirements.”

Prof. Albers’s first task is to design the scientific programme for EAU20 in Amsterdam. Following his final approval in 2020, Prof. Albers is formally succeeding Prof. Arnulf Stenzl, whose last job as SCO Chair was EAU19 in Barcelona. Prof. Stenzl has since joined the EAU’s Executive Committee as Adjunct Secretary General – Science. Reflecting on his new position, Prof. Albers considers the importance of the Scientific Congress Office within the association: “The SCO is one of the EAU’s backbones. The thoughtful preparation of the EAU’s Annual Congress by all members of the SCO in the past years has made this meeting the largest urology meeting worldwide.” “Taking over this job from Arnulf Stenzl means, first of all, a very large responsibility to maintain the success of this group. I have worked in this group over the last seven years, and before that I served on the SCO’s Video Committee and led the Guideline group for testicular cancer for a considerably long time. All this gave me the opportunity to get to know a lot of interesting and knowledgeable people in the EAU.” Ambitions Prof. Albers sees potential in diversifying the composition of the Scientific Congress Office. “In the SCO, the EAU tries to reflect not only the best scientific people based on their publications in their special fields, but it also tries to balance its members based on nationality. My ambition would be to further streamline this process of SCO membership: the best scientists and clinical researchers should be willing to

Other considerations in the coming years are, according to Albers, the relationship with the EAU Executive, and managing the big names that are attached to the SCO: “To be successful, we need to have a more than close contact with the Executive Committee and to the Sections. A new way of working would be to have the editors of the EAU’s scientific journals as ex-officio members in order get a grasp of the freshly published papers and authors.” “But finally, it comes down to a pleasant and constructive atmosphere of the SCO which has been perfectly developed over the last years, most recently under the leadership of Arnulf Stenzl. It can sometimes be interesting to see what happens when all the leaders of the field have to work together. This needs good leadership skills and high motivation to develop the scientific part of the EAU further.” “I am very confident that we can maintain and improve this further in the next years with all the brilliant people committed to this special group. So I foresee a bright future for the scientific quality and acceptance of the EAU represented by the largest annual meeting in urology world-wide.” Experience Peter Albers (1963) has been Professor and Chairman of the Department of Urology at the University of Düsseldorf, Germany since 2008. His early positions included Chairman of the Department of Urology, Klinikum Kassel, Marburg

Prof. Peter Albers, Chairman, EAU Scientific Congress Office

University from 2003-2008, as well as Vice Chairman of the Department of Urology, University of Bonn, Germany from 1998-2003. He received his medical degree at Mainz University in 1988, passed his urology residency at Mainz University with Prof. R. Hohenfellner and at Bonn University with Prof. S. C. Müller. In 1993 and 1994 he was research fellow at the Department of Urology, Indiana University, Indiana, USA with Prof. J. P. Donohue and Prof. R. S. Foster. In 1998 he passed a clinical observership at MSKCC with Prof. P. Scardino. Professor Albers’s interests are in the field of uro-oncology with a focus on testicular, bladder, and prostate cancer. He is a member of the American Urological Association (AUA) and the American Society of Clinical Oncology (ASCO). He is member of the European Organisation for the Research and Treatment of Cancer (EORTC) GU Group, and former Chairman of the EAU Testis Cancer Guidelines Group. He was president of the German Cancer Congress in February 2012. From 2016-2018 he served as president of the German Cancer Society. In 2018 he was elected as Director of the Comprehensive Cancer Center Düsseldorf. Albers has authored more than 300 peer-reviewed publications, mainly in the field of uro-oncology.

EAU uniquely placed to help European urologists’ ambitions. . . . . . . . . . . . . . . . . . . 1 Annual platform for EAU top academics. . . . . 2 “Backbone of the EAU” to get new chairman . . . . . . . . . . . . . . . . . . . . . . . . 3 Vienna EBU In-Service Assessment Meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 4 First MMISU in Egypt attracts great interest. . . 4 Are new techniques ready to replace TURP?. . .5 Documenting and redefining the spectrum of RCCs. . . . . . . . . . . . . . . . . . . . 6-7 Key articles from international medical journals. . . . . . . . . . . . . . . . . . . . . 8-11 HPV vaccination for males: Science and practice. . . . . . . . . . . . . . . . . . . 12 Spot-on Bladder Cancer Care. . . . . . . . . . . . 12 ICS hosts workshop for fistula repair in Sudan. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Call for EAU RF VENUS registry. . . . . . . . . . . 15

Vienna EBU In-Service Assessment Meeting Discussion adds educational value to written assessment Stephan Brönimann Resident Dept. of Urology Medical University of Vienna Vienna (AT)

discussion of the questions with Prof. Stephan Madersbacher, head of the urological department of the Sozialmedizinisches Zentrum Süd in Vienna (AT) and two senior residents (Maximilian Seles and Philip Stolzlechner), who scored the highest in the EBU written exam in Austria in 2018.

stephan. broenimann@ meduniwien.ac.at

This discussion, which can also been seen as a form of feedback, extended, refined and deepened the underlying background, knowledge and understanding. It helped us reach a more sophisticated level of expertise in some fields and added additional educational value to the written assessment.

The annual EBU-ISA 2019 meeting was held in a spacious conference room with vaulted ceilings in the lovely hotel Das Triest in the centre of Vienna (AT) on 8 March 2019. It all started around 15.15 hours with a small-scale reception, where coffee, tea and some appetizers were served to the participants. Eighteen residents from approximately seven Austrian hospitals gathered together at this hotel to take the assessment. After we talked with the other residents for a while, we were asked to gather at the conference room, boot our laptops which we had to bring with us and start the test. The official time we had to complete the assessment was from 16.00 to 18.00. It consisted of 100 multiple choice questions, covering various fields of urology. Joint review After finishing the assessment, we had a 15-minute coffee break, followed by a joint review and EBU Certified Centres

June/July 2019

“...self-assessment and discussion afterwards is an opportunity that allows candidates to evaluate their current knowledge against the current European standards.”

assessment as it was organised in Vienna is an opportunity to get to know residents working in other hospitals. It is a great chance not just to widen one’s personal network but also one’s horizon, since the dinner afterwards - which took place in one of the restaurants in the same hotel - served as an informal meeting to discuss ideas, problems and cases other residents face in their daily life. Take the assessment properly prepared In summary, I can really recommend taking part in the assessment the way it was organised in Vienna. If you take the assessment properly prepared, e.g. by repeating the EAU Guidelines or by working out the published EBU questions or the questions from Campbell-Walsh Review, it facilitates taking the EBU exam or the Austrian Certificate of Completion of Training by identifying deficiencies related to specific urological topics and targeting those areas in future. Good luck!

Assess your progress Moreover, I think that this kind of self-assessment and discussion afterwards is an opportunity that allows candidates to evaluate their current knowledge against the current European standards. The candidate can compare his level of knowledge, not only with other candidates but also with his results of last year, hereby assessing his own progress. In addition, a test such as the EBU In-Service Assessment must not just be seen as a sole event, but as a process consisting of phases that precede it as well as result from it. Furthermore, attending the

Don’t miss it:

EBU In-Service Assessment 2020 Thursday 12 & Friday 13 March

www.ebu.com

Erectile dysfunction and cardiovascular disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 CEM19 features dynamic urology work in Central Europe. . . . . . . . . . . . . . . . . . . . . . . 18 ESU section: Successful ESU Course on urothelial cancer in Kyiv. . . . . . . . . . . . . . . . . . . . . . . . 23 BPO masterclass features minimallyinvasive techniques . . . . . . . . . . . . . . . . . . . 23 Test your knowledge on MIBC, NMIBC and PUC. . . . . . . . . . . . . . . . . . . . . . 25 Japanese Tour 2019 - Academic Exchange Programme . . . . . . . . . . . . . . . . . . . . . . . . . 27 Where in the world . . . . . . . . . . . . . . . . . . . 28 Turin hosts successful second edition of BCa Update. . . . . . . . . . . . . . . . . . 29 Obituary Paul Van Cangh . . . . . . . . . . . . . . . 29 2019 EAU/JUA Resident Programme Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 7th Female Urology and Voiding Dysfunction Workshop. . . . . . . . . . . . . . . . . 30 ERUS Section co-organises first ‘ERUS in Asia Pacific’ . . . . . . . . . . . . . . . . . . 31 Highlights of the ESUT live event . . . . . . . . . 31 YUO section: Nightmare case: Obstructive lithiasic pyelonephritis . . . . . . . . . . . . . . . . . . . . . . . 32 Top-notch research at EAU19 . . . . . . . . . . . . 32 EAUN section: A decade of educational collaboration. . . . . 39 EAUN19 Poster Sessions: Food for thought. . 39 Self-care in ostomy patients and their caregivers. . . . . . . . . . . . . . . . . . . . . . . . . . . 40

European Urology Today

Clinical challenge Prof. Oliver Hakenberg Section editor Rostock (DE)

The Clinical challenge section presents interesting or difficult clinical problems which in a subsequent issue of EUT will be discussed by experts from different European countries as to how they would manage the problem. Readers are encouraged to provide interesting and challenging cases for discussion at h.lurvink@uroweb.org

Oliver.Hakenberg@ med.uni-rostock.de

Case study No. 61 This 33-year-old Libyan soldier suffered a blast injury during the civil war in 2011 which resulted in the loss of the left testicle together with a urethral injury. Meatus and distal penile urethra are normal up to the penile base (fig.1). The patient has normal continence and urinates from a perineal urethrostomy. He also complains of erectile dysfunction since the trauma. He is not married yet and wishes to father his own children.

Case study No. 60 This 28-year-old man was referred with the incidental diagnosis of bilateral renal tumours. He was completely asymptomatic and there was no relevant personal or family history. Urine examination including urine cytology was negative, routine blood chemistry was also normal. Figs. 1A and 1B: Abdominal According to the radiologists the tumours are not CT scan and MRI of the right typical of renal cell carcinoma. kidney

Discussion points: 1. What is the diagnosis? 2. What treatment is advisable? 3. Is there a genetic background?

Case provided by Oliver Hakenberg, Dept. Of Urology, Rostock University, oliver.hakenberg@ med.uni-rostock.de

More information needed Comments by Prof. Milan Hora Plzen (CZ) In consultation with pathologist Prof. Ondrej Hes We are missing some important data about the patient: 1) CT of the chest as a part of routine staging, as recommended by the EAU RCC guidelines for renal tumours. I suspect the result will be negative. 2) Status of retroperitoneal lymph nodes. Probably no enlarged LNs. So we can conclude bilateral renal tumour, right cT3a (about 10 cm) cN0 cM0, RENAL score 12x, left cT1a (about 4 cm, RENAL score 10x). More slides are needed to access the operability of the left side tumour. Generally, CT and/or MRI are not able to differentiate the histological type of the tumour with exception of typical angiomyolipoma. Of course, we can predict some types, but only histology is reliable. The first step should probably be CT guided biopsy of the both sided with coaxial technique. We have some next theoretical options: 1) RCC – clear, chromophobe, papillary (less probable). What to do? Surgery on both sides. Left side

resection. Right side? Probably high risk of nephrectomy, but we must attempt to resect the tumour as well. Approach? Minimally invasive (laparoscopic, robotic) or open? One-step or two steps? I personally prefer in this case two steps, open by flank incision. If bilateral and one side has indication for nephrectomy and the second one for a partial resection, I would prefer to start with the partial resection, as the contralateral kidney helps in postoperative recovery. In this case: First the right side resection. In resection, there is a high risk of positive margins on both sides. 2) Oncocytoma. Probably the same strategy, but more focused on resection/enucleation. 3) Less common diagnoses: angiomyolipoma – the same strategy. Lymphoma? Therapy by haemato-oncologist. Following surgery and final histopathological investigation, genetic testing of specimen is needed. A genetic background at this age is suspicious. However, the question remains what we can do for this patient and/or for his family. It will not change fate and treatment options for him. It may be more beneficial for his relatives. What are the possible outcomes of genetic testing: M. Von Hippel—Lindau (histology with

gene analysis – germ line mutation), Birt-HoggDubé syndrome (histology and folliculin gene analysis), tuberous sclerosis (possibility here if angiomyolipomas are epitheloid or with dominant smooth muscle tissue), “oncocytosis/ oncocytomatosis”, or, a less common diagnosis hereditary papillary renal cell carcinoma (type 1 papillary) with c-met mutation.

Case study No. 60 continued Figure 1

The patient underwent open bilateral partial nephrectomy in a two-stage procedure without complications. Histology for both tumours was that of a succinatedehydrogenase (SDH)-deficient renal cell carcinoma. It has been estimated that 0.05% to 0.2% of all renal carcinomas are SDHdeficient. It occurs usually in younger patients, 26% have been reported to be bilateral, metastatic disease is uncommon (Gill et al, Am J Surg Pathol. 2014, 38(12): 1588–1602). A genetic background seems likely. Genetic counselling was initiated for this patient.

Discussion points: 1. How should the bulbar urethra be assessed? Ultrasound? MRI? Intraoperative exploration? 2. How should the urethral reconstruction be done? And should it be a one- or two-stage procedure? 3. How can the erectile dysfunction be managed? 4. What should be done about the fertility issue?

Case provided by Dr. Amin Bouker, Dept. of Urology, Clinique Taoufik, Tunis, Tunisia. email: aminbouker@gmail.com

First MMISU in Egypt attracts great interest ESUT, EULIS and EAUN jointly organise new meeting Prof. Aly M. AbdelKarim General Secretary MMISU2019 Alexandria (EG)

alym_68@yahoo.com The First Annual Conference of Mediterranean Minimally Invasive Surgery in Urology (MMISU2019) was held in the historical Bibliotheca Alexandrina, Alexandria (EG) from 18-20 April 2019. The meeting was organised thanks to active collaboration between ESUT, EULIS and EAUN. Distinguished faculty members Although the meeting was held for the first time, there were 806 attendees from all over Egypt and many other countries in Africa, Asia and Europe. Sixteen distinguished international faculty members from all over the world participated in MMISU2019. It offered a very informative educational programme as it included 12 live surgery sessions in minimally invasive surgery. ESUT Chairman Prof. Evangelos Liatsikos (Patras, GR) performed laparoscopic radical prostatectomy and non-papillary PCNL while Prof. Ali Gözen performed retroperitoneal partial nephrectomy. A RIRS treatment and a combined RIRS-PCNL were carried out by Prof. Andreas Skolarikos (Athens, GR) 4

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and Prof. Bhaskar Somani (Southampton, GB) performed another RIRS. Prof. Gunter Janetschek (Salzburg, AT) did a case of transperitoneal partial nephrectomy for an 8-cm renal tumour. Hands-on training courses During MMISU2019, the ESUT conducted many hands-on training courses for different minimally invasive urological procedures such as E-BLUS (25 trainees), urological abdominal ultrasound course (21 trainees), ESU/ESUT/EULIS hands-on ureterorenoscopy course (20 trainees), PCNL course (22 trainees) as well as a laparoscopic nephrectomy instructional course. The EAUN organised their first workshop during MMISU2019. Mr. Harold Omana from London, England served as a representative of EAUN, in collaboration with the Alexandria Faculty of nursing. A total of 45 urology nurses from all over Egypt attended the workshop on minimally invasive surgery in urology. Training young urologists As one of ESUT’s main goals is training young urologists, on Friday, 19 April Prof. Liatsikos, Prof. Ali Gözen and Prof. Skolarikos as well as Prof. Aly M. Abdel-Karim (General Secretary of MMISU2019) had a meeting with about 100 young urologists from all over Egypt where they discussed the training opportunities that ESUT can provide for those young urologists and how to be included in different ESUT activities. For further information on this meeting please visit the website: http://mmisu.org/

Twelve live surgery sessions were broadcasted in the meeting room in Alexandria

Concentration at the EBLUS hands-on training

Faculty participants and chairs Prof. A. Abel-Karim and H. Omana of the nurses’ workshop

The first MMSIU conference knew an exceptional high attendance

June/July 2019

Are new techniques ready to replace TURP?

- thermotherapy or aquablation expand options Prostate artery embolisation, Rezum Dr. Silvia Bassi Sorbonne Université Academic Hospital Pitié-Salpétrière Paris (FR) University of Verona (IT) bassilviamd@ gmail.com

Rezum thermotherapy: Steam power needs more data The Rezum system (Boston Scientific, USA) uses thermal energy through the convection of radiofrequency water vapour into the prostate. Multiple injections of water vapour into the prostate tissue disrupt the cell membranes, leading to cell death. It is a quick procedure, taking from between 15 to 20 minutes, and can be performed under local anaesthetic in an office-based setting in prostates of various shapes and sizes, with or without median lobe.

haematuria (CD IIIb). One patient revisited hospital ER due to UTI, was treated with antibiotics and one suffered from haematuria but did not need intervention. This data describe aquablation as a safe surgical option and a reproducible treatment for BPO independent of prostate size (up to 150 ml), with non-inferiority hypothesis satisfied; long term follow-up will show whether further modifications are necessary.

Conclusions Prostates are different, patients are different and so are the treatments of BPO. Urologists should not Prof. Emmanuel only master a technique, but primarily offer a In a recent prospective multicentre double-blind Chartier-Kastler RCT5 188 subjects were treated with Rezum System portfolio of procedures in order to select the ideal Board Member, EAU (vs sham/control cystoscopy) and followed for 4 years: one for each patient, encouraging the dialogue to Section Female and LUTS were significantly improved within ≤ 3 months better understand their individual issues. Therapy Functional Urology and remained consistently durable (IPSS 47%, QoL should be individualised (customised) and the new Paris (FR) 43%, Qmax 50%, Benign Prostatic Hyperplasia Impact minimally invasive therapies expand the range of Index 52%) throughout 4 years (p < .0001), with a options available. At the moment the lack of emmanuel. surgical retreatment rate of 4.4%. long-term follow-up and real-life experiences do chartier-kastler@ not permit a solid indication. TURP is still sitting on aphp.fr throne, but it should not sleep peacefully. “Urologists should not only master its Whatever the future of these new techniques may For decades TURP has been the surgical standard bring, the past taught us to be careful regarding a technique, but primarily offer a for small prostates (< 80 g) determining BPO. innovative techniques to reduce BPH. Comparing portfolio of procedures in order Literature showed that this procedure is associated them to TURP and looking at the cost/benefit ratio, with a short-term morbidity of 11%, including the TURP may still have some advances (whether it is to select the ideal one for each need for blood transfusion, surgical revision, UTI mono or bipolar). Moreover, the point of surgical patient...” and UR, and late complications such as bladder expertise is questionable as no urologist will be neck contracture (9,8%) and urethral stricture able to learn all these techniques and can skip the (9,2%)1. Sometimes TURP is accepted with Adverse events learning curve to offer it to his well-selected hesitation due to the high risk of post-procedural The most common adverse events were dysuria patients. retrograde ejaculation. (16.9%), haematuria (11.8%), frequency and urgency (5.9%), UR (3.7%) and UTI suspected (3.7%); all were Abbreviations trans-urethral resection of the prostate Many attempts have been made to challenge this treated routinely or resolved without treatment within TURP: benign prostate obstruction supremacy, addressing the research to more effective 3 weeks. One subject had a bladder neck contracture BPO: and safer alternatives. The ideal technique should be and bladder stone reported 6 months after the UTI: urinary tract infections urinary retention minimally invasive, should preserve sexual function and procedure. No late occurring related adverse events or UR: provide a satisfying and durable functional outcome. de novo erectile dysfunction were reported. When PAE: prostatic artery embolization A plethora of new procedures have appeared in the compared indirectly with medical therapy, Rezum was PVR: post-void residual IPSS: International Prostate Symptom Score urological practice, but are they ready to remove TURP superior to monotherapy. The most bothering from its throne? disadvantage of the procedure seems to be a high RCT: randomised controlled trial rate (> 50%) of patients requiring post-operative Prostate artery embolisation: The need for a catheterisation, with a median duration of catheter multidisciplinary team use of 4.1 days6. Convective therapy seems a promising, minimally invasive technique but the lack Prostatic artery embolisation (PAE) is a new technique for treatment of BPO. It is performed by of data in comparison with other procedures requires caution. interventional radiologists under local anaesthesia, with a catheter introduced through the right femoral artery and the internal iliac artery into selective Aquablation: Encouraging results with a short arterial branches for the prostate. The procedure learning curve takes 60–90 minutes. Two prospective studies were Aquablation is a novel, minimally invasive, conducted to compare PAE with TURP2,3: while an water-based therapy which selectively ablates improvement of functional outcomes was observed prostatic glandular tissue using a high-velocity for both procedures compared to baseline, saline stream. Thanks to combining image guidance urodynamic outcomes such as Qmax and PVR were and robotics, only a short learning curve is required. superior after TURP. Literature provides Ablation time is just over 7 minutes average, which inhomogeneous trials with respect to patient increases up to that for TURP and laser technologies selection, embolisation technique and timing of if the set-up period is added7. The 2019 Cochrane follow-up. systematic review8, actually based on short-term data and a single randomised trial, showed similar Systematic review improvement in urological symptom scores and A systematic review and meta-analysis by Malling quality of life for the aquablation compared to TURP. et al.4 showed a 16.2-point IPSS mean reduction Most of the findings are uncertain: aquablation may result in little to no difference in major adverse and improved quality of life of 3.0 points (95% CI, events, little to no difference in retreatments (RR -3.7, -2.3) after PAE and a mean prostate volume significantly reduced by 20.3 cm3 one year later. 1.68), little to no difference in IIEF questionnaire The most frequent minor post-operative Erectile Function domain compared to TURP and complications were transient dysuria and may cause slightly less ejaculatory dysfunction than increased urinary frequency (10% and 16%, TURP. Longer-term data and comparisons with other respectively). A peculiar, commonly reported modalities appear critical to a more thorough assessment of the role of aquablation for the side-effect was the post-embolisation syndrome (36%), consisting of fever, nausea, pain and treatment of LUTS in men with BPH. transient worsening of LUTS. Prospective cohort study An interesting real-life prospective cohort study9 on Major post-operative complications were reported in three cases (0.3%): bladder ischaemia due to 118 consecutive patients aimed to evaluate if non-targeted embolisation, persistent UTI, published results could be transferred into the clinical persistent perineal pain. Rates of clinical and routine, enrolling non-selected patients treated with technical success were reported between 76.3 to aquablation due to symptomatic BPO with as only 100% and 76.7 to 100%, respectively, even if the exclusion criterion anticoagulation therapy other than definition of clinical success fairly varied among the aspirin 100 mg. Previously reported data were trials. confirmed: a statistically significant improvement of IPSS, Qmax, QoL, and PVR were found, and a prostate According to these results, PAE should still be volume reduction of 65% suggested complete considered an experimental treatment modality removal of the adenoma. Mean operative time was and patients selection still needs to be defined, but 20 ± 7.91 minutes with a steep learning curve. there is no doubt that a multidisciplinary team approach of urologists (indication) and radiologists Intraoperative electrocautery was used in four is the key to permit this treatment to be integrated patients (3.4%). The urethral catheter range time was into the spectrum of minimally invasive treatment 2–4 days and 95% of patients were discharged options for LUTS. without it. Perioperative adverse events occurred overall in 10 (8.5%) patients, nine events were Research through a new lens categorised CD scale II (re-catheterisation, transfusion), 3.4% underwent a secondary surgical EAU Section of Female and Functional Urology intervention needing electrocautery due to delayed

QoL: IIEF: CD:

quality of life International Index of Erectile Function Clavien-Dindo

References 1. Reich O, Gratzke C, Bachmann A et al (2008)Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180:246–249. 2. Gao, Y.A., et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial. Radiology, 2014. 270: 920 3. Carnevale, F.C., et al. Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis. Cardiovasc Intervent Radiol, 2016. 39: 44. 4. Malling, B., et al. "Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis." European radiology 29.1 (2019): 287-298. 5. McVary, Kevin T., Tyson Rogers, and Claus G. Roehrborn. "Rezüm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study." Urology(2019). 6. Dixon, Christopher M., et al. "Two-year results after convective radiofrequency water vapor thermal therapy of symptomatic benign prostatic hyperplasia." Research and reports in urology 8 (2016): 207. 7. Yassaie, Omid, Joshua A. Silverman, and Peter J. Gilling. "Aquablation of the prostate for symptomatic benign prostatic hyperplasia: early results." Current urology reports 18.12 (2017): 91. 8. Hwang, Eu Chang, et al. "Aquablation of the prostate for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia." Cochrane Database of Systematic Reviews 2 (2019). 9. Bach, T., et al. "Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort." World journal of urology (2018): 1-7.

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With high-quality, high-impact primary research articles

June/July 2019

European Urology Today

Documenting and redefining the spectrum of RCCs Histological images present wide variety and variants of adult renal epithelial tumours Prof. Rodolfo Montironi Chair EAU Section of Uropathology (ESUP) Section of Pathological Anatomy United Hospitals Ancona (IT) r.montironi@ univpm.it In collaboration with: Alessia Cimadamore, Roberta Mazzucchelli and Marina Scarpelli, Section of Pathological Anatomy, United Hospitals, Ancona (IT); Liang Cheng, Dept. of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis (US); Antonio Lopez-Beltran, Pathology Service, Champalimaud Clinical Centre, Lisbon (PT)

Tubulocystic carcinoma It is a quite rare neoplasm with a strong male predominance. Approximately 60% are incidentally discovered. Macroscopically it appears as a renal epithelial malignancy with a sponge-like pattern and pure tubulocystic architecture. Rare cases may have poorly differentiated areas. The great majority are grade 3. By immunohistochemistry, CD10 and AMACR are positive in more than 90% of tumours; CK7 is weak and focal, whereas CK20 is negative. Some show gains of ch 7 and 17 and loss of Y, suggesting a close relationship with papillary RCC. Usually it is a neoplasm that shows low malignant behaviour. Few cases have recurred and 4 metastasised. Previously it was considered as low-grade collecting duct carcinoma of the kidney10. In the 2004 WHO classification5 it was considered renal cell carcinoma, unclassified. However, sporadic case reports in the literature have indicated that TCRCC with sarcomatoid differentiation or poorly differentiated foci may behave aggressively11-12. The tubulocystic carcinoma of the kidney with poorly differentiated foci can also frequently be seen as a morphological pattern of fumarate hydratasedeficient renal cell carcinoma13 (Figure 3).

The current WHO classification1 of the renal cell tumours is based on the 2013 International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia2. The terminology adopted for the designation of the variations and variants of renal cell tumours has been based on descriptive or characteristic features. Variants have been named based on prevalent cytoplasmic and staining features, Acquired cystic disease-associated RCC architectural characteristics, cell type or combinations It occurs exclusively in patients with acquired cystic of such characteristics. disease (ACD), most commonly in patients undergoing long-term haemodialysis (> 10 years). It is the most The names of renal cell tumours have also been common tumour in kidneys of patients with ACD and based on their anatomical location or correlation with ESRD (36% of the largest tumours)14. Histologically it kidney disease. Names related to molecular changes shows variable morphological patterns: acinar, tubular, and alterations, in some cases pathognomonic, have solid-alveolar, microcystic (sieve-like), solid sheet-like, also been adopted. Familial predisposition has also papillary. The cells are large with granular eosinophilic been included in the name of some tumours. cytoplasm and prominent nucleoli. Intercellular and intracellular microscopic lumina are present as well as Expanding the spectrum abundant intratumoural oxalate crystals. Sarcomatoid Hereditary leiomyomatosis and renal cell carcinoma or rhabdoid features are rare and with typical features (HLRCC) syndrome-associated RCC may occasionally metastasise. It occurs in younger patients (average 36-46y) and in patients showing cutaneous or uterine smooth There is no specific IHC profile (racemase +, CK7 –). It muscle tumours. It is an autosomal dominant shows gains in Ch 3, 7, 16, 17 and Y. The main hereditary syndrome with germline mutation in the differential diagnosis is Papillary RCC Type 2. It follows fumarate hydratase gene located at 1q42. RCCs an indolent clinical behaviour, likely because of early associated with this syndrome can show a detection of tumours in patients with periodic morphological spectrum of architectural patterns: follow-up imaging for chronic renal failure. overlapping morphologically with type 2 papillary RCC (pRCC), tubulocystic RCC, collecting duct carcinoma The background kidney is characterised by multiple and medullary carcinoma. A prominent eosinophilic cysts mostly unilocular. Cysts lined by large cells with nucleolus with a clear halo is seen, similar to the eosinophilic cytoplasm and large nuclei with cytology of a cytomegalovirus inclusion. prominent nucleoli, and multilayering and papillary proliferations are not infrequent. Some of these By immunohistochemistry, the tumour cells are changes might represent incipient preneoplastic negative for fumarate hydratase (FH) and positive for lesions15-16 (Figure 4A). S-(2-succino)cysteine (2SC). The prognosis is poor, with a tendency to early widespread dissemination; Redefining the spectrum metastasis reported in small tumours. Cutaneous or Not all neoplasms with clear cells are carcinoma uterine smooth muscle tumours. In the 2004 WHO Multilocular cystic renal cell neoplasms of low malignant potential, formerly called multilocular classification it is viewed as the hereditary cystic clear cell RCC, account for approximately 4% counterpart of type 2 pRCC3-5 (Figure 2A). of all clear cell RCCs, and affect mid-age adults Succinic dehydrogenase B mutation associated renal with a male to female ratio of 1.2-2.1:117. From a cell carcinoma macroscopic point of view, it consists of variably It occurs in patients with germline mutation in SDH sized cysts separated by thin septa and containing genes, most commonly SDHB (double hit clear, serous, or gelatinous fluid. The cysts are inactivation). It is most common in young adults lined by a single layer of cells with clear cytoplasm (mean 35 years old). The patients may have a and small nuclei without nucleoli (ISUP grade 1). In personal or family history of SDH-deficient RCC, rare cysts the cells, multilayered, show granular paraganglioma, pituitary adenoma or SDH-deficient cytoplasm. The septa consist of fibrous tissue with GIST. It is strongly hereditary. Histologically, it shows calcification or ossification. Within the fibrous the features of a monomorphic oncocytic renal septa, small clusters of cells similar to those lining tumour with solid architecture, cytoplasmic vacuoles the cysts are seen. Grossly visible tumour mural or inclusions of flocculent material, and nodules are not compatible with the diagnosis. intratumoural mast cells, often resembling renal Vascular invasion and sarcomatous changes have oncocitoma. Ultrastructurally the latter correspond to not been seen. The cells are strongly positive for giant mitochondria. PAX2 and CAIX, similar to clear cell RCC18. Chromosome 3p deletion has been identified in By immunohistochemistry, tumour cells are 74% of cases. The prognosis is excellent19 (Figure characteristically negative for SDHB and rarely for 4B). SDHA. Loss of SDHB protein expression by immunohistochemistry is considered to be a specific marker for this neoplasm. By sequencing, SDHB mutation and loss of the second allele are present in most of the tumours. The majority (75%) are low-grade and have a favourable prognosis with a metastatic rate of 11%. The outcome is less favourable in cases with dedifferentiation or coagulative necrosis. A distinctive, low-grade oncocytic fumarate hydratase-deficient renal cell carcinoma, morphologically reminiscent of succinate dehydrogenase-deficient renal cell carcinoma, has been described6-9 (Figure 2B). EAU Section of Uropathology (ESUP)

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Figure 1: Evolution of RCC classification from the early 1970s to 2016

Not all neoplasms with a papillary architecture behave like carcinoma Clear cell papillary renal cell carcinoma (CCPRCC) was initially reported in patients with end stage renal disease20-21; however, the majority of cases reported subsequently have been sporadic. The cut surface, tan-white to yellow with grossly apparent fibrotic areas, ranges from completely solid to predominantly cystic. CCPRCC shows a variable tubular/acinar, papillary and cystic architecture. The cells show a clear cytoplasm with a low nuclear grade (i.e. ISUP nucleolar grade 1 or 2). One feature that is characteristic of this tumour is the fact that there is linear arrangement of the nuclei away from the basal aspect, towards the middle or the apex of the cells22-24.

chromophobe cells in the background of a RO, and large eosinophilic cells with intracytoplasmic vacuoles. The nuclei are often more pleomorphic than other subtypes of HOCT and occasionally have a “raisinoid” morphology39-40. It shows variable genetic profiles. HOCT, regardless of its clinical association, seems to behave in an indolent manner. There is no documented evidence of aggressive behaviour. The designation oncocytic neoplasia of uncertain malignant potential has been proposed2 (Figure 4D). Additional renal cell tumours not yet included in or excluded by the current classification

Cases of clear cell renal cell carcinoma (CCRCC) with haemangioblastoma-like features have been reported Some tumours show extensive myoid metaplasia of the by Montironi et al.41. The clinical significance is not yet capsule with extensions of smooth muscle into the known. tumour mass and encasing nests of tumour cells (See below). From an immunohistochemical point of view Unclassified renal cell carcinoma with medullary the tumour shows diffuse and intense staining for CK7, phenotype in all the cells. The cells also express carbonic Scarpelli et al.42 have described a case of a RCC with anhydrase (CA-IX) diffusely in a membranous rhabdoid features and loss of nuclear expression of distribution, staining being absent along the luminal the transcriptional regulator INI1 in a patient without borders of the cells (i.e. cup-shaped distribution)25. sickle cell trait or other haemoglobinopathy. The CCPRCC lack deletions of 3p25, VHL gene mutations, tumour was considered an “unclassified renal cell VHL promoter hypermethylation, or trisomies of carcinoma with medullary phenotype”. chromosomes 7 and 1726-27. No cases with metastasis have been reported20-29. Pure CCPRCC should be Renal angioadenomyomatous tumour renamed "clear cell papillary neoplasm of low malignant This tumour shows "collapsed" acini, variable tubular/ potential" to reflect their biology28-30 (Figure 4C). acinar architecture, myoid stromal metaplasia, and diffuse CK7 positivity, identical to that seen in CCPRCC; Not all oncocytic/chromophobe tumours behave like this is part of its morphologic spectrum43. carcinoma Hybrid oncocytic/chromophobe tumours (HOCT), also Eosinophilic solid and cystic renal cell carcinoma called hybrid oncocytic tumours, are well Eosinophilic solid and cystic renal cell carcinoma circumscribed and non-encapsulated. They show a (ESCRCC) was recently described as an indolent mixture of cells with the morphological appearance of renal neoplasm, in female patients (median age those seen in renal oncocytoma (RO) and was 55 years; range: 32 to 79 years) with and chromophobe RCC (CHRCC)2. HOCT is seen in three without tuberous sclerosis complex. These neoplasms are yellow-grey with a median size of 31 clinicopathological settings, i.e. sporadic, associated mm with solid and cystic gross appearance. Such with renal oncocytosis/oncocytomatosis, and in tumours show typical histological features with patients affected with the Birt-Hogg-Dubé syndrome solid areas and variably sized microcysts and (BHD)31-32. Sporadic HOCT is usually solitary and macrocysts. The cells show eosinophilic cytoplasm, unilateral. HOCTs in association with BHD or with occasionally granular, and round-to-oval nuclei. oncocytosis/oncocytomatosis are basically bilateral and multiple33-48. CK20 is positive in 74% cases. ESC RCC demonstrates common molecular alterations, further supporting a distinct nature. ESC RCC has HOCT in BHD shows three histological patterns, i.e. metastatic potential44-47 (Figure 5). admixture of areas of RO and CHRCC; scattered

Figure 2A: Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome-associated RCC, with a uterine leiomyoma in the detail; 2B: Succinic dehydrogenase B mutation associated renal cell carcinoma. Loss of SDHB protein expression in the detail

Figure 3: Tubulocystic carcinoma

June/July 2019

Figure 4A: Acquired cystic disease-associated RCC with an incipient preneoplastic lesion in the detail; B: Multilocular cystic renal cell neoplasms of low malignant potential; C: Clear cell papillary renal cell carcinoma, immunohistochemistry positivity for citokeratin 7; D: Hybrid oncocytic/chromophobe tumours (High magnification in the detail)

Table 1: 2016 WHO classification of renal cell tumours • Clear cell renal cell carcinoma • Multilocular cystic renal neoplasm of low malignant potential • Papillary renal cell carcinoma • Hereditary leiomyomatosis and renal cell carcinoma (HLRCC)-associated renal cell carcinoma • Chromophobe renal cell carcinoma • Collecting duct carcinoma • Renal medullary carcinoma • MiT Family translocation carcinomas • Succinate dehydrogenase (SDH)-deficient renal carcinoma • Mucinous tubular and spindle cell carcinoma • Tubulocystic renal cell carcinoma • Acquired cystic disease associated renal cell carcinoma • Clear cell papillary renal cell carcinoma • Renal cell carcinoma, unclassified • Papillary adenoma • Oncocytoma

References 1. Moch H, Humphrey PA, Ulbright TM, Reuter V. WHO Classification of Tumours of the Urinary System and Male Genital Organs. Lyon, France: International Agency for Research on Cancer; 2016. 2. Srigley JR, Delahunt B, Eble JN, et al. The International Society of Urological Pathology (ISUP) Vancouver classification of renal neoplasia. Am J Surg Pathol 2013;37:1469–89. 3. Trpkov K, Hes O, Agaimy A, et al. Fumarate Hydratasedeficient Renal Cell Carcinoma Is Strongly Correlated With Fumarate Hydratase Mutation and Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome. Am J Surg Pathol. 2016;40(7):865-75. 4. Smith SC, Trpkov K, Chen YB, et al. Tubulocystic Carcinoma of the Kidney With Poorly Differentiated Foci: A Frequent Morphologic Pattern of Fumarate Hydratasedeficient Renal Cell Carcinoma. Am J Surg Pathol. 2016;40(11):1457-1472. 5. Eble JN, Sauter G, Epstein JI, Sesterhenn IA. Pathology and genetics. Tumors of the urinary system and male genital organs. IARC Press, Lyon (2004) 6. Gill AJ, Pachter NS, Chou A, et al. Renal tumors associated with germline SDHB mutation show distinctive morphology. Am J Surg Pathol 2011;35:1578– 85. 7. Housley SL, Lindsay RS, Young B, et al. Renal carcinoma with giant mitochondria associated with germ-line mutation and somatic loss of the succinate dehydrogenase B gene. Histopathology 2010;56:401–10. 8. Van Nederven FH, Gaal J, Favier J, et al. An immunohistochemical procedure to detect patients with paraganglioma and phaeochromocytoma with germline SDHB, SDHC, or SDHD gene mutations: a retrospective and prospective analysis. Lancet Oncol 2009;10:764–71. 9. Williamson SR, Eble JN, Amin MB, et al. Succinate dehydrogenase-deficient renal cell carcinoma: detailed characterization of 11 tumors defining a unique subtype of renal cell carcinoma. Mod Pathol 2015;28:80-94. 10. MacLennan GT, Farrow GM, Bostwick DG. Low-grade collecting duct carcinoma of the kidney: report of 13 cases of low-grade mucinous tubulocystic renal carcinoma of possible collecting duct origin. Urology. 1997;50(5):679-84. 11. Al-Hussain TO, Cheng L, Zhang S, Epstein JI. Tubulocystic carcinoma of the kidney with poorly differentiated foci: a series of 3 cases with fluorescence in situ hybridization analysis. Hum Pathol. 201;44(7):1406-11. 12. Smith SC, Trpkov K, Chen YB, Mehra R, Sirohi D, Ohe C, et al. Tubulocystic Carcinoma of the Kidney With Poorly Differentiated Foci: A Frequent Morphologic

June/July 2019

Figure 5: Eosinophilic solid and cystic renal cell carcinoma. (A: Low magnification; B: High magnification; C: IHC for CK20)

Pattern of Fumarate Hydratase-deficient Renal Cell Carcinoma. Am J Surg Pathol. 2016;40(11):1457-1472. 13. Trpkov K, Hes O, Agaimy A, et al. Fumarate hydratasedeficient renal cell carcinoma is strongly correlated with fumarate hydratase mutation and hereditary leiomyomatosis and renal cell carcinoma syndrome. Am J Surg Pathol 2016;40:865–75. 14. Enoki Y, Katoh G, Okabe H, Yanagisawa A. Clinicopathological features and CD57 expression in renal cell carcinoma in acquired cystic disease of the kidneys: with special emphasis on a relation to the duration of haemodialysis, the degree of calcium oxalate deposition, histological type, and possible tumorigenesis. Histopathology 2010;56:384–94. 15. Foshat M, Eyzaguirre E. Acquired Cystic DiseaseAssociated Renal Cell Carcinoma: Review of Pathogenesis, Morphology, Ancillary Tests, and Clinical Features. Arch Pathol Lab Med. 2017;141(4):600-606. 16. Sun Y, Argani P, Tickoo SK, Epstein JI. Acquired Cystic Disease-associated Renal Cell Carcinoma (ACKD-RCC)like Cysts. Am J Surg Pathol. 2018;42(10):1396-1401. 17. Mazzucchelli R, Scarpelli M, Montironi R, Cheng L, Lopez-Beltran A. Multilocular cystic renal cell neoplasms of low malignant potential. Anal Quant Cytopathol Histpathol 2012;34:235-8. 18. Tretiakova M, Mehta V, Kocherginsky M, et al. Predominantly cystic clear cell renal cell carcinoma and multilocular cystic renal neoplasm of low malignant potential form a low-grade spectrum. Virchows Arch. 2018;473(1):85-93. 19. Li T, Chen J, Jiang Y, et al. Multilocular Cystic Renal Cell Neoplasm of Low Malignant Potential: A Series of 76 Cases. Clin Genitourin Cancer. 2016;14(6):e553-e557. 20. Tickoo SK, dePeralta-Venturina MN, Harik LR, et al. Spectrum of epithelial neoplasms in end-stage renal disease: an experience from 66 tumor-bearing kidneys with emphasis on histologic patterns distinct from those in sporadic adult renal neoplasia. Am J Surg Pathol, 2006; 30:141-153 21. Montironi R, Gasparrini S, Cimadamore A, et al. Variants and Variations in Epithelial Renal Cell Tumors in Adults: The Pathologist's Point of View. Eur Urol Suppl 2017;16(12):232–240. 22. Gobbo S, Eble JN, Grignon DJ, et al. Clear cell papillary renal cell carcinoma: a distinct histopathologic and molecular genetic entity. Am J Surg Pathol 2008;32:1239–45. 23. Aydin H, Chen L, Cheng L, et al. Clear cell tubulopapillary renal cell carcinoma: a study of 36 distinctive low-grade epithelial tumors of the kidney. Am J Surg Pathol,2010;34:1608-1621. 24. Adam J, Couturier J, Molinié V, Vieillefond A, Sibony M. Clear-cell papillary renal cell carcinoma: 24 cases of a distinct low-grade renal tumour and a comparative genomic hybridization array study of seven cases. Histopathology, 2011;58:1064-1071. 25. Tickoo SK, Reuter VE. Differential diagnosis of renal tumors with papillary architecture. Adv Anat Pathol, 2011;18:120-132. 26. Gobbo S, Eble JN, Grignon DJ, et al. Clear cell papillary renal cell carcinoma: a distinct histopathologic and molecular genetic entity. Am J Surg Pathol, 2008;32: 1239-1245 27. Rohan SM, Xiao Y, Liang Y, et al. Clear-cell papillary renal cell carcinoma: molecular and immunohistochemical analysis with emphasis on the von Hippel-Lindau gene and hypoxia-inducible factor pathway-related proteins. Mod Pathol, 2011;24:12071220. 28. Diolombi ML, Cheng L, Argani P, Epstein JI. Do clear cell papillary renal cell carcinomas have malignant potential? Am J Surg Pathol 2015;39:1621-34. 29. Kryvenko ON. Do clear cell papillary renal cell carcinomas have malignant potential? Diolombi ML, Cheng L, Argani P, Epstein JI.Am J Surg Pathol. December 2015;39(12):1621-1634. Urol Oncol. 2017 Jun;35(6):451-452. doi: 10.1016/j.urolonc.2017.03.020. Epub 2017 Apr 14.

30. Moch H. Cystic renal tumors: new entities and novel concepts. Adv Anat Pathol 2010;17:209-214. 31. Adley BP, Smith ND, Nayar R, Yang XJ. Birt-Hogg-Dube syndrome: clinic-pathologic findings and genetic alterations. Arch Pathol Lab Med 2006;130:1865-70. 32. Pavlovich CP, Walther MM, Eyler RA, et al. Renal tumors in the Birt-Hogg-Dube syndrome. Am J Surg Pathol 2002;26:1542–52. 33. Delongchamps NB, Galmiche L, Eiss D, et al. Hybrid tumour ‘onco-cytoma-chromophobe renal cell carcinoma’ of the kidney: a report of seven sporadic cases. BJU Int 2009;103:1381–4. 34. Gobbo S, Eble JN, Delahunt B, et al. Renal cell neoplasms of onco-cytosis have distinct morphologic, immunohistochemical, and cy-togenetic profiles. Am J Surg Pathol 2010;34:620–6. 35. Mai KT, Dhamanaskar P, Belanger E, Stinson WA. Hybrid chromo-phobe renal cell neoplasm. Pathol Res Pract 2005;201:385–9. 36. Petersson F, Gatalica Z, Grossmann P, et al. Sporadic hybrid onco-cytic/chromophobe tumor of the kidney: a clinic-pathologic, his-tomorphologic, immunohistochemical, ultrastructural, and molecular cytogenetic study of 14 cases. Virchows Arch 2010;456:355–65.

37. Waldert M, Klatte T, Haitel A, et al. Hybrid renal cell carcinomas containing histopathologic features of chromophobe renal cell carcinomas and oncocytomas have excellent oncologic outcomes. Eur Urol 2010;57:661–5. 38. Tickoo SK, Reuter VE, Amin MB, et al. Renal oncocytosis: a morpho-logic study of fourteen cases. Am J Surg Pathol 1999;23:1094–101. 39. Klomp JA, Petillo D, Niemi NM, et al. Birt-Hogg-Dube renal tumors are genetically distinct from other renal neoplasias and are associated with up-regulation of mitochondrial gene expression. BMC Med Genomics 2010;3:59. 40. Murakami T, Sano F, Huang Y, et al. Identification and characterization of Birt-Hogg-Dube associated renal carcinoma. J Pathol 2007;211:524–3. 41. Montironi R, Lopez-Beltran A, Cheng L, et al. Clear cell renal cell carcinoma (ccRCC) with hemangioblastomalike features: a previously unreported pattern of ccRCC with possible clinical significance. Eur Urol. 2014;66(5):806-10. 42. Scarpelli M, Mazzucchelli R, Lopez-Beltran A, et al. Renal cell carcinoma with rhabdoid features and loss of INI1 expression in an individual without sickle cell trait. Pathology, 2014;46(7):653-655. 43. Deml KF, Schildhaus HU, Compérat E, et al. Clear cell papillary renal cell carcinoma and renal angiomyoadenomatous tumor: two variants of a morphologic, immunohistochemical, and genetic distinct entity of renal cell carcinoma. Am J Surg Pathol. 2015;39(7):889-901. 44. Trpkov K, Hes O, Bonert M, et al. Eosinophilic, Solid, and Cystic Renal Cell Carcinoma: Clinicopathologic Study of 16 Unique, Sporadic Neoplasms Occurring in Women. Am J Surg Pathol. 2016;40(1):60-71. 45. Trpkov K, Abou-Ouf H, Hes O, et al. Eosinophilic Solid and Cystic Renal Cell Carcinoma (ESC RCC): Further Morphologic and Molecular Characterization of ESC RCC as a Distinct Entity. Am J Surg Pathol. 2017;41(10):1299-1308. 46. Parilla M, Kadri S, Patil SA, et al. Are Sporadic Eosinophilic Solid and Cystic Renal Cell Carcinomas Characterized by Somatic Tuberous Sclerosis Gene Mutations? Am J Surg Pathol. 2018;42(7):911-917. 47. Palsgrove DN, Li Y, Pratilas CA, et al. Eosinophilic Solid and Cystic (ESC) Renal Cell Carcinomas Harbor TSC Mutations: Molecular Analysis Supports an Expanding Clinicopathologic Spectrum. Am J Surg Pathol. 2018;42(9):1166-1181.

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Key articles from international medical journals Mr. Philip Cornford Section editor Liverpool (GB)

philip.cornford@ rlbuht.nhs.uk

Treating oligometastatic disease: Does it work? Traditionally, patients with metastatic solid tumours were thought to be incurable. In part because current imaging fails to identify all the sites of tumour deposit. However, several small non-randomised observational studies have suggested that treatment of oligometastatic disease with ablative therapies can lead to a better-than-expected survival. As a consequence, interest in treating oligometastatic disease has risen.

13-month improvement in median overall survival and a doubling of median progression-free survival, although at the cost of increased toxicity and treatment-related mortality. In addition, because it included a variety of tumour types it is possible that histology-specific differences in tumour biology may explain the observed effect, especially the excess number of prostate cancer patients in the SABR arm. To become standard of care it requires a confirmatory phase 3 study but this data is encouraging.

Key articles

Lancet 2019; http://dx.doi.org/10.1016/S01406736(19)30723-8

Source: Atezolizumab plus bevacizumab versus sunitinib in patients with previously untreated metastatic renal cell carcinoma (IMmotion151):

Prof. Truls Erik Bjerklund Johansen Section editor Oslo (NO)

Can we identify unilateral prostate cancer? tebj@medisin.uio.no

Radical prostatectomy and radiotherapy are effective treatment for patients with organ-confined prostate Source: Stereotactic ablative radiotherapy versus standard of care palliative treatment in cancer requiring curative intervention. However, both are associated with significant complications. In the patients with oligometastatic cancers (SABRCOMET): a randomised phase 2, open-label trial. past decade urologists have incorporated multiparametric MRI (mpMRI) in the belief that Palma DA, Olson R, Harrow S, et al. clinically significant prostate cancer can be identified Lancet 2019; 393: 2051-58. by scanning. This has been particularly important for those patients and clinicians exploring the option of New first-line treatments for focal treatments or haemiablation in order to limit mRCC side-effects of treatment.

Tyrosine kinase inhibitors such as sunitinib have been the standard of care for patients with metastatic renal cell carcinoma (mRCC) for a decade. However, many patients have disease that is resistant to this approach Stereotactic ablative radiotherapy (SABR) is a modern and many others develop resistance. In addition, use radiation technique that delivers high doses of of these drugs can be limited by adverse events such as diarrhoea, fatigue and mucositis. Treatment with radiation to small tumour targets with the use of highly conformal techniques. This paper reports the checkpoint inhibitors, including the anti-PD-L1 antibody atezolizumab, has resulted in durable results of the first randomised controlled trial assessing standard of care palliative treatments with responses and improvements in overall survival in or without SABR in patients with a controlled primary pre-treated patients with metastatic renal cell tumour and up to five metastatic lesions. carcinoma. Its effectiveness may be enhanced through reversal of VEGF-mediated immunosuppression Patients were enrolled at ten hospitals located in mechanism by the addition of bevacizumab. This Canada, the Netherlands, the UK and Australia. Those paper reports the primary analysis of the efficacy and aged 18 or older with a controlled primary tumour safety of the combination versus sunitinib as and one to five metastatic lesions, Eastern Cooperative treatment for patients with mRCC. Oncology Group score of 0–1, and a life expectancy of at least 6 months were eligible. Pre-enrolment In this multicentre, open-label, phase 3, randomised imaging requirements included: (1) imaging of the controlled trial, patients with a component of clear brain, for tumours with a propensity for brain cell or sarcomatoid histology and who were metastasis, with CT or MRI; (2) body imaging with previously untreated, were recruited from 152 academic medical centres and community oncology either a PET-CT or CT of the neck, chest, abdomen, practices and were randomly assigned 1:1 to either and pelvis plus bone scan; and (3) MRI of the spine atezolizumab 1200 mg plus bevacizumab 15 mg/kg for patients with vertebral metastases. Biopsy of a metastasis was not required but was preferred. After intravenously once every 3 weeks or sunitinib 50 mg stratifying by the number of metastases (1–3 vs. 4–5), orally once daily for 4 weeks on, 2 weeks off. Study investigators and participants were not masked to patients were randomly assigned (1:2) to receive treatment allocation. Patients, investigators, either palliative standard of care treatments alone independent radiology committee members, and the (control group), or standard of care plus SABR to all sponsor were masked to PD-L1 expression status. metastatic lesions (SABR group), using a computergenerated randomisation list with permuted blocks of Co-primary endpoints were investigator-assessed nine. Neither patients nor physicians were masked to progression-free survival in the PD-L1 positive population and overall survival in the intention-totreatment allocation. The primary endpoint was treat (ITT) population. overall survival. They used a randomised phase 2 screening design with a two-sided α of 0∙20 (wherein Of 915 patients enrolled, 454 were randomly assigned p < 0∙20 designates a positive trial – accepting this to the atezolizumab plus bevacizumab group and 461 will need a confirmatory phase 3 trial). to the sunitinib group. 362 (40%) of 915 patients had PD-L1-positive disease. Median follow-up was 15 Median overall survival was 28 months at the primary progression-free survival months (95% CI 19–33) in the analysis and 24 months at the overall survival interim analysis. In the PD-L1-positive population, the median control group versus 41 months progression-free survival was 11·2 months in the (26–not reached) in the SABR group atezolizumab plus bevacizumab group versus 7·7 months in the sunitinib group (hazard ratio [HR] 0·74 (hazard ratio 0∙57, 95% CI 0∙30– [95% CI 0·57–0·96]; p = 0·0217). In the ITT population, 1∙10; p = 0∙090) median progression-free survival was also better with the combination (11.2 months vs. 8.4 months), which 99 patients were randomised between 10 February had an HR of 0·83 (0·70–0.97). At data cut-off 386 2012 and 30 August 2016. Of these 99 patients, 33 patients had died but there was no detectable (33%) were assigned to the control group and 66 difference in overall survival and survival follow-up is (67%) to the SABR group. The SABR group has a continuing to the next planned survival analyses. 182 preponderance of patients with prostate cancer. Two (40%) of 451 patients in the atezolizumab plus (3%) patients in the SABR group did not receive bevacizumab group and 240 (54%) of 446 patients in allocated treatment and withdrew from the trial; two the sunitinib group had treatment-related grade 3–4 (6%) patients in the control group also withdrew from adverse events. 24 (5%) in the atezolizumab plus the trial. Median follow-up was 25 months (IQR 19–54) bevacizumab group and 37 (8%) in the sunitinib in the control group versus 26 months (23–37) in the group had treatment-related all-grade adverse SABR group. Median overall survival was 28 months events, which led to treatment-regimen (95% CI 19–33) in the control group versus 41 months discontinuation. (26–not reached) in the SABR group (hazard ratio 0∙57, 95% CI 0∙30–1∙10; p = 0∙090). Adverse events of grade These are interesting results. Certainly, the 2 or worse occurred in three (9%) of 33 controls and 19 combination appears to prolong progression free (29%) of 66 patients in the SABR group (p = 0∙026), an survival and the combination has a favourable safety absolute increase of 20% (95% CI 5–34). Treatmentprofile compared to sunitinib. Overall survival data is related deaths occurred in three (4∙5%) of 66 patients still awaited but it is possible that patients with after SABR, compared with none in the control group sarcomatoid differentiation or tumours that express (due to radiation pneumonitis, pulmonary abscess and PD-L1 ligand which tend to do badly may be subdural haemorrhage after surgery to repair an considered for this regime as first line therapy. SABR-related perforated gastric ulcer). This study was the first to show randomised evidence that SABR might improve overall survival. It led to a

a multicentre, open-label, phase 3, randomized controlled trial. Rini BI, Powles T, Atkins MB, et al.

empirically with pivmecillinam. Regimens of 3, 5 and 7 days were compared using clinical treatment failure (i.e. redemption of a new antibiotic or hospitalisation due to UTI) within 14 and 30 days as outcome. HR and risk difference with 95% CI were estimated for treatment failure. Results were stratified by age (18-50, 51-70, > 70 years) and sex.

Of the 21,864 cases of E. coli UTI that were analysed, 2,524 (11.5%) were in men. In 954 cases (4.4%) E. coli A retrospective analysis of patients undergoing 3-tesla produced ESBL and 125 (13.1%) of these cases were in MRI and MRI-fusion prostate biopsy, including full men. The 3-day regimen increased the risk of systematic template biopsy, prior to radical treatment failure for all groups. The risk differences prostatectomy in a single tertiary academic institution between the 3 and 5-day regimens were < 10% for between June 2010 and February 2018 was women, but > 10% for men. Comparing the 7-day and performed. Patients were deemed to have been 5-day regimens, only women aged > 50 years candidates for haemiablation if they had unilateral demonstrated an increased risk of treatment failure intermediate-risk PCa (Gleason score [GS] of 3 + 4 or within 14 days with the 5-day regimen, but not within 4 + 3, clinical T-classification ≤ T2, and PSA < 20 ng/ 30 days. dL) on MRI-fusion biopsy and no contralateral PI-RADS 4 or 5 lesions. Men were considered to have A 3-day regimen seems sufficient for been inappropriately selected for haemiablation if non-pregnant women < 50 years old pathologists identified contralateral GS ≥ 3 + 4 or high-risk ipsilateral PCa on prostatectomy. The authors tested a range of haemiablation inclusion The authors conclude that with the current data (data criteria and performed multivariable analysis of on clinical classification of the E. coli UTI were missing), preoperative predictors of undetected contralateral a 5-day treatment with pivmecillinam at 400 mg three disease. times daily seems to be the rational recommendation for lower UTI in men, pregnant women and women > .... men with anterior index tumours 50 years old. A 3-day regimen seems sufficient for non-pregnant women < 50 years old.

were found to be 2.4 times more likely to harbour undetected contralateral GS ≥ 3 + 4 PCa compared with men with posterior lesions (p < .05)

Of 665 patients, 92 met primary haemiablation criteria. 44 (48%) of these 92 patients were incorrectly identified due to ipsilateral GS ≥ 3 + 4 tumours crossing the midline (21 patients), undetected distinct contralateral GS ≥ 3 + 4 tumours (20 patients), and/or ipsilateral high-risk PCa (3 patients) on prostatectomy. The rate of undetected contralateral disease ranged from 41% to 48% depending on inclusion criteria. On multivariable analysis, men with anterior index tumours were found to be 2.4 times more likely to harbour undetected contralateral GS ≥ 3 + 4 PCa compared with men with posterior lesions (p < .05). This study suggests that even with high resolution MRI scanning and fusion biopsy, significant cancer defined as ≥G3+4 may be left undetected elsewhere in the gland. It might help explain why some patients after focal treatment need further intervention and patients and clinicians should be aware of this risk. Whether this is enough to convince men to have more radical intervention and cope with the increased side effects is a personal choice.

Source: Do contemporary imaging and biopsy techniques reliably identify unilateral prostate cancer? Implications for hemiablation patient selection. Johnson DC, Yang JJ, Kwan L, et al. Cancer 2019; http://dx.doi.org/10.1002/ cncr.32170.

Pivmecillinam daily for 5 days optimal for lower UTI in men, pregnant women and women > 50 yrs The objective of this study was to evaluate the importance of treatment duration for therapeutic efficacy of pivmecillinam for community-acquired urinary tract infections (UTIs) caused by Escherichia coli. A retrospective cohort study was conducted between 1 January 2010 and 30 September 2016 in adults with community-acquired E. coli bacteriuria, treated

Source: Treatment duration of pivmecillinam in men, non-pregnant and pregnant women for community-acquired urinary tract infections caused by Escherichia coli: a retrospective Danish cohort study. Boel JB, Jansåker F, Hertz FB, Hansen KH, Thønnings S, Frimodt-Møller N, Knudsen JD. J Antimicrob Chemother. 2019 May 16; DOI: 10.1093/jac/ dkz211 PMID: 31098630

Most single agent antibiotic choices have limited coverage for HAUTIs, combination choices have improved chance of coverage Healthcare associated urinary tract infections (HAUTI) are a common complicating factor of urological practice. It is unclear what the appropriate empirical antibiotic choices are and how infection control policies (ICP) influence this.

Departments with compliance to both ICPs were estimated to have 66% (2006) to 44% (2015) more antibiotic choices…. The aim of this study was to use probabilistic approaches towards the problem, i.e. to determine the chances of coverage of empirical antibiotic choices in HAUTIs and their annual trends in Europe. In addition, the impact of departmental self-reported compliance with catheter management and regulated usage of prophylactic antibiotics policies was tested. The estimated chances of coverage of antibiotics and further probabilistic calculations were carried out using European data from the Global Prevalence of Infections in Urology (GPIU) annual surveillance study. In this analysis the cohort from 2005 to 2015 was used. The estimated chance of coverage for each antibiotic choice in HAUTIs was calculated using the Bayesian Weighted Incidence Syndromic Antibiogram (WISCA) approach. Annual trends of the overall cohort and number of appropriate antibiotic choices were estimated. Departments were compared according to their self-reported

EAU EU-ACME Office

European Urology Today

June/July 2019

Prof. Oliver Reich Section editor Munich (DE)

oliver.reich@ klinikum-muenchen.de compliance to ICPs to determine if there was an impact on chances of coverage and appropriate antibiotic choices. Investigators estimated that in most study years less than half of the single-agent antibiotics and all combination options were appropriate for empirical treatment of HAUTIs. Departments with compliance to both ICPs were estimated to have 66% (2006) to 44% (2015) more antibiotic choices compared to departments with complete lack of compliance to the ICPs. In the present estimates, departments with adherence to a single policy were not superior to departments with complete lack of adherence to ICPs. Most single-agent choices had limited coverage for HAUTIs and combination choices showed improved chance of coverage. Optimal antibiotic selection decision should be part of decision experiments and tested in local surveillance studies. Departments with self-reported compliance to ICPs have more antibiotic choices and details of compliance should be evaluated in future studies. The analysis in the current study shows that over the 10-year course there was no clear time trend in the chances of coverage of antibiotics (Bayesian WISCA) in European urology departments.

Association of delivery mode with pelvic floor disorders after childbirth The aim of this trial was to describe the incidence of pelvic floor disorders after childbirth and identify maternal and obstetrical characteristics associated with patterns of incidence 1 to 2 decades after delivery. Women were recruited from a community hospital for this cohort study 5 to 10 years after their first delivery and followed up annually for up to 9 years. Recruitment was based on mode of delivery; delivery groups were matched for age and years since first delivery. Of 4,072 eligible women, 1,528 enrolled between October 2008 and December 2013. Participants were categorised into the following mode of delivery groups: caesarean birth (caesarean deliveries only), spontaneous vaginal birth (≥ 1 spontaneous vaginal delivery and no operative vaginal deliveries), or operative vaginal birth (≥ 1 operative vaginal delivery).

.... caesarean delivery was associated with significantly lower hazard for stress urinary incontinence,…

Stress urinary incontinence (SUI), overactive bladder (OAB) and anal incontinence (AI) were defined using validated threshold scores from the Epidemiology of Prolapse and Incontinence Questionnaire, and pelvic organ prolapse (POP), measured using the Pelvic Organ Prolapse Quantification Examination. Cumulative incidences, by delivery group, were estimated using parametric methods. Hazard ratios, Source: Appropriate empiric antibiotic choices in by exposure, were estimated using semiparametric healthcare associated urinary tract infections in models.

urology departments in Europe from 2006 to 2015: A Bayesian analytical approach applied in a surveillance study. Tandogdu Z, Kakariadis ETA, Naber K, Wagenlehner F, Bjerklund Johansen TE. PLoS ONE. 2019; 14(4):e0214710 DOI: 10.1371/journal. pone.0214710 PMID: 31022187

Toilet behaviour and bladder symptoms in women who limit restroom use at work: a crosssectional study While LUTS and bladder behaviour are known to be associated with certain occupations, little is known about restroom access or environmental factors that may contribute to this relationship. This study aimed to identify reasons why women limit restroom use at work and to determine whether women who limit use at work report more unhealthy bladder habits and LUTS. The investigators conducted a cross-sectional study of full-time working U.S. women. Women completed validated questionnaires recording toilet behaviour, LUTS, and perceptions of their occupational toilet environment. Women who limited restroom use at work ‘most’ or ‘all of the time’ were compared to those who either did not limit or did so ‘occasionally’ or ‘sometimes’.

Among 1,528 women (778 in the caesarean birth group, 565 in the spontaneous vaginal birth group, and 185 in the operative vaginal birth group), the median age at first delivery was 30.6 years, 1,092 women (72%) were multiparous at enrolment (2,887 total deliveries), and the median age at enrolment was 38.3 years. During a median follow-up of 5.1 years (7,804 person visits), there were 138 cases of SUI, 117 cases of OAB, 168 cases of AI, and 153 cases of POP. For spontaneous vaginal delivery (reference), the 15-year cumulative incidences of pelvic floor disorders after first delivery were as follows: SUI 34.3% (95% CI, 29.9%-38.6%); OAB 21.8% (95% CI, 17.8%-25.7%); AI 30.6% (95% CI, 26.4%-34.9%), and POP 30.0% (95% CI, 25.1%-34.9%). Compared with spontaneous vaginal delivery, caesarean delivery was associated with significantly lower hazard of SUI (adjusted hazard ratio [aHR], 0.46 [95% CI, 0.32-0.67]), OAB (aHR, 0.51 [95% CI, 0.34-0.76]) and POP (aHR, 0.28 [95% CI, 0.19-0.42]), while operative vaginal delivery was associated with significantly higher hazard of AI (aHR, 1.75 [95% CI, 1.14-2.68]) and POP (aHR, 1.88 [95% CI, 1.28-2.78]). Compared with spontaneous vaginal delivery, caesarean delivery was associated with significantly lower hazard for stress urinary incontinence, overactive bladder, and pelvic organ prolapse, while operative vaginal delivery was associated with significantly higher hazard of anal incontinence and pelvic organ prolapse.

symptoms, prostate-specific antigen (PSA) levels, prostate volumes (PVs), and five-item version of the International Index of Erectile Function (IIEF-5) scores were compared statistically between the NAFLD grades.

Dr. Francesco Sanguedolce Section editor Barcelona (ES)

The investigators conclude that NAFLD was an independent predictive factor for IPSS, PV, Qmax, PVR and IIEF-5 score

fsangue@ hotmail.com

PSA levels did not differ between the groups. The International Prostate Symptom Score (IPSS), PV and post-voided residual urine volume (PVR) were significantly greater in men with higher NAFLD grades. Conversely, the maximum urinary flow rate (Qmax ) and IIEF-5 score were lower in men with higher NAFLD grades. The NAFLD grade, rather than being metabolic syndrome (MetS) positive, affected prostate parameters and IIEF-5 scores. NAFLD grade correlated positively with IPSS, PV and PVR, whereas there was a negative correlation with Qmax and IIEF-5 score. Age and NAFLD were independent predictors of IPSS, PV, Qmax and PVR on multivariate analysis.

The implications of these findings are multiple. First of all, a standardised modular curriculum is now available for contemporary trainees to follow in order to safely and effectively perform the RAPN, although the curriculum needs to be validated on a larger number of trainees. Only centres with sufficient RAPN The investigators conclude that NAFLD was an capacity, weighted as a minimum of 50 procedures independent predictive factor for IPSS, PV, Qmax , PVR per year, and relevant resources can offer a training and IIEF-5 score. MetS was only a significant programme compliant with the curriculum. predictive factor for IIEF-5 score, thus NAFLD may identify patients at high risk of LUTS better than MetS. Source: The ERUS Curriculum for Robot-assisted

Source: The independent association of non-alcoholic fatty liver disease with lower urinary tract symptoms/benign prostatic hyperplasia and erectile function scores. Eren H, Horsanali MO. BJU Int. 2019 Mar 22. doi: 10.1111/bju.14753 [Epub ahead of print]

ERUS develops standardised curriculum for robot-assisted partial nephrectomy training Nowadays, there is an urgent need to standardise training processes in surgery, especially in the context of complex procedures, in which development of skills may not be detrimental to the patients nor compromise hospital budget/time-flow. This difficult balance is even more challenging to achieve when it comes to surgery for oncologic diseases which may involve costly technology. Robotic surgery has been introduced in urology at the beginning of 2000 by a small group of pioneers who spread the relevant techniques and technology in the following years to those (experienced) surgeons who had the chance to learn “in situ” or via exchange programmes. This first generation of robotic surgeons could disseminate the techniques locally by using training programmes or fellowships for younger surgeons or residents, which, however, could vary significantly from site to site. In the last few years, significant efforts have been made by the EAU Section in Robotics (ERUS) to identify and standardise the appropriate curricula to develop skills in urological robotic surgery, namely in the robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN). These are considered the robotic procedures that mostly benefit patients in urology.

Of the 3,062 women in the final analytic sample, 11% reported limiting restroom use at work 'most' or 'all of the time'. This group reported lower satisfaction with restroom cleanliness and privacy, in particular, and more frequently identified the toilet of poor quality, limited accessibility, and restricted use by employer. The prevalence of unhealthy bladder habits was significantly higher among women who limited restroom use, as was the prevalence of urgency, monthly urinary incontinence, and infrequent voiding.

Source: Association of delivery mode with pelvic floor disorders after childbirth. Blomquist After establishing a network of centres of excellence for training in robotics and standardising the JL, Muñoz A, Carroll M, Handa VL.

In this cross-sectional study of women working full time, those who limit restroom use at work reported higher prevalence of unhealthy bladder habits and certain urinary disorders. Future studies should determine if limited restroom use at work is a modifiable risk factor for unhealthy bladder habits and bladder health outcomes.

Different phases were identified, including preclinical and clinical modules. While the former The aim of this study was to evaluate the association involved the development of soft skills (theory, videos between non-alcoholic fatty liver disease (NAFLD) and and simulations), the latter consisted of trainee lower urinary tract symptoms (LUTS)/benign prostate exposure to different surgical steps (n = 10) with hyperplasia (BPH) and erectile function. different levels of difficulty. Outcomes of 40 RAPN in which the trainee performed at least one of the 10 In all, 356 men diagnosed with LUTS/BPH were steps were tested against the results from a historical evaluated retrospectively between January 2016 and series of 160 RAPN performed independently by the March 2018. Anthropometric and laboratory data were mentor. collected. According to the liver echogenicity degree, patients were divided into four NAFLD groups: Grade Overall, no differences in terms of complication rates, 0 was considered as normal with no NAFLD, whilst surgical margins, ischemia time and post-op eGFR Grades 1-3 NAFLD had increasing fat deposits. LUTS drop were found. Interestingly, authors noted that the

Source: Toilet behaviour and bladder symptoms in women who limit restroom use at work: a cross-sectional study. W Stuart R, Casey K, Sophia D D, Melissa K, Jay H F, Roger D. J Urol. 2019 May 6:101097JU0000000000000315. doi: 10.1097/JU.0000000000000315. [Epub ahead of print] Key articles

June/July 2019

JAMA. 2018 Dec 18;320(23):2438-2447. doi: 10.1001/ jama.2018.18315.

The independent association of non-alcoholic fatty liver disease with LUTS/BPH and erectile function scores

mean operative time was 60 minutes longer in the trainees series (although this was not statistically significant), which would correspond to nearly €2,000 extra costs for training purposes. Also, the 40 procedures were insufficient for the trainee to reach a proficiency level to complete the entire RAPN independently.

curriculum for RARP, a long-awaited curriculum for training in RAPN was recently developed and published. The same methodological process adopted for the validation of the RARP curriculum was followed: the structure of the curriculum was established through a Delphi consensus methodology by 30 expert robotic surgeons in RAPN.

Partial Nephrectomy: Structure Definition and Pilot Clinical Validation. Larcher A, De Naeyer G, Turri F, Dell'Oglio P, Capitanio U, Collins JW, Wiklund P, Van Der Poel H, Montorsi F, Mottrie A. ERUS Educational Working Group and the Young Academic Urologist Working Group on Robot-assisted Surgery. Eur Urol. 2019 Jun;75(6):1023-1031. doi: 10.1016/j.eururo.2019.02.031. Epub 2019 Apr 9.

Robotic transperineal radical prostatectomy: An old technique resurfaces with new technology Around two to three decades ago, in the ‘open’ era, there were intense debates about which technique was better to radically remove a neoplastic prostate: the retropubical or transperineal approach. The latter allowed for more direct access to the prostate without the need of violating the Retzius space, the endopelvic fascia and other relevant pelvic anatomical structures. With the advent of laparoscopy, the transperineal approach was totally abandoned for technical reasons. Only recently, a revival of the transperineal radical prostatectomy was seen because of the use of the latest generations of the Da Vinci robotic platforms, with interesting technical innovations that may even push the boundaries of the former open approach. In a recent paper, a Turkish group has published the first head-to-head experience comparing 80 consecutive radical prostatectomies approached either with transperineal or transperitoneal techniques (r-PRP vs RARP) with the Da Vinci robotic system. Although no randomisation was adopted, the groups were comparable with regard to most of the clinical and pathological characteristics. Interestingly, statistically significant differences included prostate size and patients’ BMI, which were larger and higher in the r-PRP group, respectively. If a higher BMI was an obvious advantage for the r-PRP approach (as well as in the presence of previous abdominal surgeries), large prostate size was a limitation of the open PRP. Nevertheless, the authors have reported and described that, thanks to the dexterity of the Da Vinci platform, they were able to remove prostates up to the size of 140 gr.

These encouraging data may pave the way for a revival of the perineal approach The authors described how to create sufficient space to place the robotic trocars: first by making an open dissection of the perineum in order to apply a gelpoint with the robotic arms. The camera trocar was placed at the centre and the other trocars at 5-7-12 o’clock. The assistant trocar was finally inserted at 6 o’clock. The main advantages of the r-PRP approaches included the ability to dissect the nerves from the

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Dr. Guillaume Ploussard Section editor Toulouse (FR)

g.ploussard@ gmail.com apex more effectively when performing nerve-sparing surgery, better visualisation of the bladder neck especially while performing anastomosis, the lack of interference with the Santorini plexus and/or the epigastric vessels, the lack of bowel/peritoneum manipulation and a less stressed Trendelenburg position (150 vs 400). All of this translates into a higher rate of potency recovery (at 9 months, 75 vs. 66%, p = 0.001), a quicker recovery of continence (at 3 months, 94 vs. 63%, p = 0.001), less estimated blood loss (65 vs. 82 cc, p = 0.002), less complications (especially ileus, 0 vs. 4 cases, respectively) and shorter hospital stay (1.8 vs. 3.9 days, p = 0.001). Moreover, no difference in terms of positive surgical margin rates was found. The authors mentioned that even a pelvic lymphadenectomy could be performed, even though none of the patients of the present cohort underwent nodes removal. These encouraging data may pave the way for a revival of the perineal approach, which indeed needs to be standardised and validated first. If the same outcomes are confirmed, r-PRP may become a new standard for modern radical prostatectomy.

of the cohort, with sepsis being reported in only 0.6% of the cases. These figures are comparable to the three largest randomised controlled trials published in the last years.

generated worse urinary symptoms at 3 months and worse bowel symptoms at 3 and 24 months. SBRT patients had similar scores as active surveillance patients in all domains and across all time points. However, the possibility of SBRT resulting in worse Although in univariate analysis multiple variables urinary incontinence compared with active surveillance showed to be associated to the SSP (including WBC, cannot be ruled out completely, given a high upper MET and hydronephrosis), in multivariate analysis bound of the 95% confidence interval. only size and site of ureteric stones showed a To date, randomised trials have demonstrated good significant association with SSP. More specifically, cancer-control outcomes after moderately stone sizes of 5-7 and > 7 mm had a 5.5 and 12.5 hypofractionated regimens, although some trials have higher likelihood of needing active intervention than shown increased toxicity. Currently, multiple ongoing smaller stones, respectively. Similarly, upper ureteric trials assessed extreme hypofractionation (1 to 2 weeks) stones had 4 times less chance of SSP (OR 0.25, with firm data regarding the safety of these protocols. p<0.001) in comparison to stones located in the lower The present study suggests that SBRT does not add ureter. significant toxicity and does not impact on quality of life compared with active surveillance. SBRT seems better Conversely to previous findings, no effects of MET tolerated than conventional EBRT. However, because were found, not even in the setting of different patient recruitment was state-wide, details of interactions stones size and site. On the other hand, it radiotherapy such as doses, fractionation, seminal is interesting to note the authors suggest that their vesicle coverage were not available. No data on findings may be more reliable than those of the RCTs, moderately hypofractionated regimens were reported. as they are based on real-life clinical practice. The More importantly, the study only presents 2-year debate is still open! quality-of-life outcomes. Extreme hypofractionated regimens may have significant long-term adverse effects and a longer follow-up is needed before we can Source: Factors associated with spontaneous definitively conclude on the safety profile of SBRT. stone passage in a contemporary cohort of

patients presenting with acute ureteric colic: results from the Multi-centre cohort study evaluating the role of Inflammatory Markers In patients presenting with acute ureteric Colic (MIMIC) study. Shah TT, Gao C, Peters M, Manning T, Cashman S, Nambiar A, Cumberbatch M, Lamb B, Peacock A, Van Son MJ, van Rossum PSN, Pickard R, Erotocritou P, Smith D, Kasivisvanathan V, British Urology Researchers in Surgical Training (BURST) Collaborative MIMIC Study Group.

BJU Int. 2019 Apr 18. doi: 10.1111/bju.14777. [Epub ahead

Source: Robotic-assisted perineal versus of print] transperitoneal radical prostatectomy: A matched-pair analysis. Tuğcu V, Akça O, Şimşek A, Yiğitbaşı İ, Şahin S, Yenice MG, Taşçı Aİ. PROs Turk J Urol. 2019 Apr 3. doi: 10.5152/tud.2019.98254. [Epub ahead of print]

in prostate cancer treatment decision-making: the new endpoint?

Ureteric colic management: Which features predict spontaneous stone passage?

The reduction of a radiotherapy course has proven to be effective. Hypofractionated regimens are now recommended as treatment option in localised prostate cancer management. The stereotactic body Acute ureteric colic is a common reason for Accident & radiotherapy (SBRT) represents the most extreme Emergency (A&E) department referral. It is also the hypofractionated treatment using large daily doses beginning of a potentially long and painful journey for and only five daily treatments. Some concerns remain stone patients, which may end with invasive about its safety profile and the potential higher risk of interventions or rather in long waiting periods for genito-urinary and gastro-intestinal toxicity compared spontaneous stone passage (SSP). with conventional radiotherapy (EBRT). The goal of the present study was to compare the patientIn the last two decades, an extensive body of reported quality of life among the three modalities: literature was published in an attempt to find factors SBRT, conventional radiotherapy, and active to predict the need of intervention and/or the clinical surveillance. response to medical expulsive therapy (MET). However, because of small study samples and/or A population-based cohort of 680 men was different outcomes measurements, there are no prospectively enrolled from 2011 to 2013. Quality of life definitive answers to these clinical questions yet. The was assessed using the validated Prostate Cancer results are inconsistent and sometimes contradictory. Symptom Indices (PCSIs) which evaluates four domains (sexual function, urinary obstruction and In order to shed some new light on useful clinical irritation, incontinence, bowel problems). Surveys factors to distinguish between patients who may pass were conducted by telephone at 3, 12, and 24 months stones spontaneously vs. those who may need help of after completion of treatment or 3 months after the MET vs. those who may require invasive intervention, initiation of active surveillance. No patient received a large collaborative network involving 4 countries concomitant androgen deprivation therapy. Given the (UK, Ireland, Australia and New Zealand) has been set nonrandomised design, a propensity score weighting up to review data of more than 3,000 patients treated was used including the main clinical, social and at A&E for ureteric colic. biological potential confounders. SBRT patients (n = 104) were treated by the accuracy Cyberknife system, One of the strengths of the study is that all patients and 75% of patients treated by conventionally had a baseline evaluation with CT scan, so that the fractionated EBRT (n = 189) received intensitysize of ureteric stones was homogenously assessed. modulated regimens. However, different schedules of follow-up and interventional criteria have been adopted according to .... study suggests that SBRT does local protocols. The quality of data was reviewed not add significant toxicity and centrally in 10% of the cohort. A study sample was calculated so that 10 patients were available for each does not impact on quality of life variable; a minimum number required to run a compared with active surveillance multivariate analysis appropriately.

…only size and site of ureteric stones show a significant association According to the study design, the authors were able to evaluate several variables at the same time. Primary endpoint was the role of inflammatory markers (namely white blood cell count and c-reactive protein) in predicting the SSP, whilst secondary endpoints included the relationship of site, size and MET with the event. Overall, conservative management was effective in nearly 3/4 Key articles

A majority of active surveillance patients had low-risk disease, while 57% and 41% of EBRT and SBRT patients, respectively, had intermediate-risk prostate cancer. Propensity weighting incorporated age, race, health insurance status, education level, household income, marital status, but did not take into account PSA, risk group or pathological features. At 3 months, patients who received EBRT had significantly worse sexual function compared with active surveillance patients. No difference at baseline, 12 months, or 24 months was reported. For patients treated by SBRT, no difference was seen. EBRT also

Source: Patient-reported quality of life following stereotactic body radiotherapy and conventionally fractionated external beam radiotherapy compared with active surveillance among men with localized prostate cancer. Moon DH, Basak RS, Usinger DS, et al. Eur Urol. 2019 Mar 8. pii: S0302-2838(19)30169-1. doi: 10.1016/j.eururo.2019.02.026. [Epub ahead of print] PubMed PMID: 30857758.

Correlation between upstaging and molecular subtypes of urothelial carcinoma The risk of upstaging between clinical stage T1-T2 to pathologically confirmed T3-T4 disease remains important (approximately 40%) in the absence of neoadjuvant chemotherapy. Whereas neoadjuvant chemotherapy may lead to overtreatment in low-burden disease with negative nodes, its use showed a median survival increase from 2 to 5 years in clinical T3-T4 disease. The survival benefit seen in T2 cancer may be due to a risk of understaging and extension beyond the bladder wall. Identification of molecular markers predictive for upstaged disease at bladder cancer diagnosis could improve the selection of patients who would benefit the most from this neoadjuvant chemotherapy. In the present study, the authors assessed the association of genomic subtyping classifier (GSC) with pathological upstaging in radical cystectomy specimens. Analyses have been conducted in a multi-institutional cohort of 206 cT1-T2 patients who were treated by radical cystectomy without any form of neoadjuvant systemic treatment. All patients underwent surgery with concomitant bilateral lymph node dissection within 3 months of diagnosis. The primary endpoint was the presence of T3-4 and/or pN1-3 disease at the time of radical surgery. Cancer-specific mortality was also assessed as secondary endpoint.

This study suggests that molecular classification may help identify better candidates for neoadjuvant chemotherapy Pathological upstaging was observed in 23% of T1 patients, and 57% of T2 patients. Positive lymph nodes were reported in 24% of cases. In the overall cohort, GSC classified tumours as luminal and nonluminal in 48% and 52% of cases, respectively. Luminal tumours had a lower expression of basal, EMT, stromal and immune-associated markers. The risk of upstaging was significantly lower in luminal tumours (34%), compared with nonluminal tumours (51%, p = 0.02). No correlation was observed between nodal status and GSC analysis. Multivariable analysis confirmed the independent predictive value of the genomic analysis, in addition to smoking status and clinical stage. Adding genomic information to the clinical risk factor improved the prediction of upstaged disease (AUC from 0.67 to 0.72). When stratified by subtypes, patients with luminal tumours had lower cancer-specific mortality than patients with nonluminal tumours.

This study suggests that molecular classification may help identify better candidates for neoadjuvant chemotherapy. It could reduce the rate of overtreatment by inappropriate systemic treatment in real organ-confined disease. Conversely, a not negligible rate of patients with cT1 disease had T3-T4 disease at the time of surgery (30%). Utilisation of neoadjuvant chemotherapy in these patients could be justified and the decision guided, at least for a part, by the genomic classification, probably in addition to the clinical risk stratification. The main limitations of the study were the retrospective design, the relatively small sample size (limiting the multivariable analyses), and the lack of pathology centralised review. Moreover, the quality of initial resection (and of clinical staging) could not be assured. Independent validation of these findings as well as a cost-effective analysis are required before integrating this genomic classifier in daily practice.

Source: Molecular subtyping of clinically localized urothelial carcinoma reveals lower rates of pathological upstaging at radical cystectomy among luminal tumors. Lotan Y, Boorjian SA, Zhang J. Eur Urol. 2019 May 12. pii: S0302-2838(19)30352-5. doi: 10.1016/j.eururo.2019.04.036. [Epub ahead of print] PubMed PMID: 31092337.

Monitoring of cavernous nerve during robot-assisted radical prostatectomy Prevention of nerve damage during radical prostatectomy remains difficult. Indeed, the surgical plan may be considered hazardous due to the invisibility of cavernous nerves. Thus, potency preservation often does not meet expectations despite extensive nerve-sparing techniques. In the present study, the authors performed an intraoperative monitoring and mapping of the cavernous nerve during baseline. They evaluated the corpus cavernosum electromyography (CC-EMG), the pudendal somatosensory evoked potential (SEP), the bulbocavernous reflex (BCR) during baseline and final tests, which were performed just before trocar insertion and just after drain insertion, respectively. Spontaneous and neurovascular bundle-triggered CC-EMGs with various stimulation protocols were assessed just before bundle dissection and just after prostate removal. Stimulation was performed using the robot forceps connected by an electric cable to the control console. Two types of electrodes were used: surface and intracavernous subdermal with reference electrodes in the ipsilateral suprapubic area. The primary outcome was the completion rate of planned intraoperative monitoring and mapping and surgery.

.... subjective preservation of the nerves evaluated by the surgeon was not correlated with the objective preservation assessed by CC-EMGs As secondary endpoints, the authors also assessed the quantification of neurovascular bundle preservation and postoperative potency recovery rate at 12 months. Twenty-two patients were included in the efficacy analysis. The completion rate was 100%. The extra time for preparation was approximately 45 minutes and the time for intraoperative monitoring and mapping during surgery was 40 minutes. Bulbocavernous reflex was observed in all cases, except one patient with myelitis. Pudendal SEP was reported in only 18.2% of patients without postoperative change. CC-EMG signals were observed during and/or after stimulation, and were quantified as 0 (not observed), 1 (weak), and 2 (strong). The results of neurovascular bundle-triggered CC-EMG stimulations were graded from 0 to 4 by adding the results of both sides (bilateral stimulation). CC-EMGs before prostate removal were associated with the pre-operative erectile function. Interestingly, subjective preservation of the nerves evaluated by the surgeon himself was not correlated with the objective preservation assessed by CC-EMGs. Quantification of CC-EMGs after prostate removal was significantly associated with potency recovery and IIEF-5 scores. There was a trend towards faster continence recovery in patients with higher grade on CC-EMGs. This preliminary study shows the feasibility of the intraoperative monitoring of cavernous nerve during radical prostatectomy, at the expense of (not negligible)

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June/July 2019

Prof. Oliver Hakenberg Section Editor Rostock (DE)

Oliver.Hakenberg@ med.uni-rostock.de extra time (one hour and half approximately). Due to time constraints, operators discarded the cavernous nerve localisation test during the study period. The appreciation of nerve sparing by the surgeon seems inaccurate and not correlated with the objective CC-EMG measurements, reinforcing the clinical usefulness of intraoperative mapping. Thus, such intraoperative measurements could help to better preserve invisible nerves and to improve/shorten potency recovery after robot-assisted radical prostatectomy. Some improvements are also suggested by the authors, mainly concerning the future use of lower frequency devices (< 1Hz) in order to gain in terms of CC-EMG amplitude and sensitivity. Nevertheless, this feasibility study is a first step before imaging to check intraoperatively nerve-triggered CC-EMG prior to cutting or electrocautery to the peri-prostatic tissue.

Source: Establishment of novel intraoperative monitoring and mapping method for the cavernous nerve during robot-assisted radical prostatectomy: Results of the phase I/II, first-in-human, feasibility study. Song WH, Park JH, Tae BS, et al. Eur Urol. 2019 May 15. pii:S0302-2838(19)30359-8. doi: 10.1016/j.eururo.2019.04.042. [Epub ahead of print] PubMed PMID: 31103393.\

Retrospective analysis of factors associated with delayed graft function identifies intraoperative risk factors associated with anaesthesiological management Delayed graft function is a common and important complication after kidney transplantation affecting patients' long-term outcome. The aim of this study was to identify modifiable risk factors for delayed graft function after deceased donor kidney transplantation. The study is retrospective and single-centre. Univariate and multivariate step-wise logistic regression analyses of patient-specific and procedural risk factors were conducted.

…patients undergoing deceased donor kidney transplantation … without requiring excessive fluid therapy … are less likely to develop delayed graft function 380 deceased donor kidney transplantation patients undergoing transplantation between October 2008 and December 2017 were analysed. The incidence of delayed graft function was 15% (58/380). Among the patient-specific risk factors recipient diabetes (odds ratio 2.8 [1.4-5.9 95% confidence interval, American Society of Anesthesiologist score of 4 (OR 2.7 [1.2-6.5 95% CI]), cold ischemic time > 13 hours (OR 2.8 [1.5-5.3 95% CI) and donor age > 55 years (OR 1.9 [1.01-3.6 95% CI) were significant factors. Significant intraoperative factors included the use of colloids (OR 3.9, 95% CI 1.4-11.3), albumin (OR 3.0, 95% CI 1.2-7.5), crystalloids > 3,000 mL (OR 3.1, 95% CI 1.2-7.5) and mean arterial pressure < 80 mm Hg at the time of reperfusion (OR 2.4, 95% CI 1.2-4.8).

National registry analysis highlights difference in cold ischemia time tolerance in brain death versus circulatory death donor kidneys

80% of children with GU malignancies are longterm survivors, but 20% of those develop a new malignancy during 40 years of follow-up. These patients are often non-compliant with their followup protocols and unlikely to see a doctor unless they have complaints. Most often these patients present Cold ischemia time (CIT) is known to impact kidney to urologists with complaints of infertility (46%), graft survival rates. In this retrospective registry erectile dysfunction (2.5 fold increase compared to analysis, the authors compared the impact of CIT on normal), symptoms of androgen deprivation (14%), graft failure and mortality in circulatory death versus lower urinary tract symptoms (5-40%) or to followbrain death donor kidneys and how it relates to donor up on a urinary diversion. Therefore, urologists are age. The prospective Dutch Organ Transplantation in a unique position to guide the patients deferring Registry was used to include 2,153 adult recipients of from follow-up protocols and establish followbrain death (n = 1266) and circulatory death (n = 887) up surveillance for long-term childhood cancer donor kidneys after static cold storage from survivors. transplants performed between 2005 and 2012. CIT was modelled nonlinearly with splines. Associations and interactions between CIT, donor type, donor age, The degree of risk for developing an SMN is variable 5-year (death censored) graft survival and mortality and directly related to the agents and the protocols were evaluated. employed. This risk ranges from a 6 to 29-fold increase over normal controls. Within the first decade after chemotherapy for childhood GU cancers, At > 12 hours of CIT, an increased haematology-based malignancies are more common risk of graft failure in kidneys and delayed SMNs are predominantly solid malignant neoplasms. The risk of developing these delayed SMN donated after circulatory death results from inherent genotype abnormalities, versus after brain death was persistent non-malignant masses, chemotherapy received before the age of 2 (chemotherapy-induced observed. DNA damage is the highest at this age), tumour type The median CIT was 16.2 hours (interquartile range (retinoblastoma, Hodgkin’s lymphoma, and sarcomas 12.8-20), ranging from 3.4 to 44.7 hours for brain of any type) and radiation-induced malignancy. death and 4.7 to 46.6 hours for circulatory death donor kidneys. At > 12 hours of CIT, an increased risk Radiation therapy is frequently used as part of the of graft failure in kidneys donated after circulatory multimodal therapies used for the treatment of death versus after brain death was observed. This risk childhood genitourinary malignancies, e.g. Wilms rose significantly at > 22 hours of CIT (hazard ratio tumour, rhabdomyosarcoma, and germ cell tumours. (HR) 1.45; 95% CI 1.01-2.49; p < 0.044). Kidneys that The induction of breast and colon malignancies by came from 60-year-old circulatory death donors radiation therapy is of significant concern. Early demonstrated elevated hazard risk at 19 hours of CIT, detection of these tumours with strict follow-up a shorter timeline than that for kidneys that came protocols has shown to be extremely beneficial from brain death donors of the same age (HR 1.33; regarding risk of cancer-specific death. 95% CI 1.00-1.78; p < 0.046). The additional harmful effects of increased CIT in kidneys from circulatory The urologist who sees a patient with a history of death donors were also found for death censored childhood GU cancer plays a pivotal role in regraft failure but did not affect mortality rates in any establishing proper long-term follow-up protocols for significant way. the benefit of the high-risk patient. The findings support the hypothesis that prolonged cold ischemia is more harmful for circulatory death donor kidneys that have already been subjected to a permissible period of warm ischemia. Efforts should be made to reduce CIT, especially for older circulatory death donor kidneys

Source: Impact of cold ischemia time on outcomes of deceased donor kidney transplantation: An analysis of a national registry. Peters-Sengers H, Houtzager JHE, Idu MM, Heemskerk MBA, van Heurn ELW, Homan van der Heide JJ, Kers J, Berger SP, van Gulik TM, Bemelman FJ. Transplant Direct 2019, 25;5(5):e448. doi: 10.1097/ TXD.0000000000000888.

What a urologist needs to know about patients with a history of childhood genitourinary cancer Patients who received treatment for genitourinary cancer in childhood and survived into adulthood are still at various risk profiles for long-term complications and a subsequent malignant neoplasm (SMN). Approximately 10% of childhood cancers have a genitourinary origin and over 80% of these children are long-term survivors. They have often received intensive chemotherapy and/or radiotherapy treatments.

80% of children with GU malignancies are long-term survivors, but 20% of those develop a new malignancy ....

The authors concluded that patients undergoing deceased donor kidney transplantation with a mean arterial pressure > 80 mm Hg at the time of transplant reperfusion without requiring excessive fluid therapy in terms of colloids, albumin or crystalloids > 3,000 mL are less likely to develop delayed graft function. The intensity of treatment modalities employed at childhood is a potential cause of some complications Source: Modifiable risk factors for delayed graft in the form of cardiovascular disease, pulmonary function after deceased donor kidney dysfunction, endocrinopathies (primarily thyroid and transplantation. Kaufmann KB, Baar W, Silbach gonadal dysfunction) that may become manifest one K, Knörlein J, Jänigen B, Kalbhenn J, Heinrich S, or two decades later. SMNs are histologically distinct Pisarski P, Buerkle H, Göbel U. malignancies that develop in patients who survived Prog Transplant 2019, doi:10.1177/1526924819855357. their first cancer. They are the result of inherent or [Epub ahead of print] chemotherapy/radiation-induced genetic defects. Overall, approximately 20% of the long-term Key articles

June/July 2019

childhood cancer survivors will develop an SMN by the time they reach 40.

Source: Cancer screening in the pediatric cancer patient: a focus on genitourinary malignancies, and why does a urologist need to know about this? Husmann DA. J Pediatr Urol. 2019 Feb;15(1):5-11. doi: 10.1016/j. jpurol.2018.10.015. Epub 2018 Oct 24. Review. PubMed PMID: 30467017.

What have we learned from functional studies and evaluating congenital hydronephrosis in children? In the past, the majority of patients with congenital hydronephrosis (CH) presented with flank and abdominal pain, urinary tract infection, haematuria or abdominal mass while only a very small portion of them were incidentally diagnosed. The defining obstruction was mainly on clinical grounds and almost all children with such symptoms and marked hydronephrosis had to have an operation. Following the introduction of prenatal ultrasonography in the late 70s, many children with CH were diagnosed incidentally. Although initially urologists said they should all be operated, it did not take long for them to understand the concept that NOT every dilated system is obstructed or will eventually have functional loss. Many reports of long-term follow-up showed that: 1. m ost kidneys with CH have normal or near normal function; 2. r enal function usually remains stable without surgery; 3. r enal function often does not improve after corrective surgery despite improvement in CH; 4. s pontaneous improvement in CH may occur. Yet there was a group of patients presenting with already reduced renal function or deterioration in the follow-up because of obstruction and most of them still remained asymptomatic. It became essential to understand the dynamics of the upper urinary tract drainage and urine transport to define obstruction and properly select the patients who carry the risk of renal function loss in the follow-up. One logical and easy approach was close follow-up and surgery when deterioration was found.

Prof. Serdar Tekgül Section Editor Ankara (TR)

serdartekgul@ gmail.com

Of course, the ability to diagnose them early on, before any deterioration took place, was the preferred approach. This necessitated reliable diagnostic tools to understand upper tract dynamics. This led Bob Whitaker to develop a test to measure renal pelvic pressure at physiologic flow rates and prove that not all dilated systems are obstructed. Increased renal pelvic pressure is the cause of renal damage. The Whitaker test was actually an antegrade study to differentiate between the “obstructed” or merely “wide” ureter – which saved numerous children with dilated urinary tracts secondary to PUV, congenital mega-ureters, previous re-implantations or neuropathic bladders unnecessary surgery. The Whitaker test has been accepted as a very dynamic test to understand upper urinary tract dynamics; invasiveness was its main limitation. The test pre-dated and enabled a better interpretation of diuretic renography, which is the gold-standard today – but is still useful in cases of solitary dilated kidneys or where diuretic renography is inconclusive.

Our understanding of the dynamics of upper tract dilatation, with the use of the Whitaker test and diuretic renography, has saved numerous children from unnecessary surgery Diuresis renography (DR) is widely used in the evaluation of hydronephrosis and hydroureter in infants and children. The goal of this provocative nuclear imaging exam should be to detect the hydronephrotic kidneys at risk of loss of function and development of symptoms. The reliability of DR is dependent on the acquisition and processing of the data as well as interpretation and utilisation of the results. Test results can be affected by many anatomical, physiological and technical factors. While some patient-specific factors (namely renal function, and capacity and compliance of the dilated system) cannot be controlled, there are several elements of the DR technique that must be standardised properly to ensure an optimum study with interpretable results. Hydration, bladder fullness, timing of diuretic administration, gravity-assisted/post-void imaging, region of interest and background subtraction are some technical factors which all need to be standardised for reliable results. Inter-rater reliability in DR interpretation varies substantially, even across observers with experience in paediatric DR. Some key parameters (cortical clearance, cortical retention, differential renal function, postdiuresis drainage parameters - shape of drainage curve, T1/2 and clearance times) should be properly assessed in a standardised way for more reliable results. DR has proven to be a reliable diagnostic tool in various congenital and non-congenital hydronephrosis evaluations. Recently, the need for a joint guideline for a standardised DR technique has been recognised and developed by the Society of Nuclear Medicine and Molecular Imaging and the European Association of Nuclear Medicine. Hopefully, widespread adoption of this technique will lead to greater standardisation of diagnostic criteria and management protocols for obstructive and non-obstructive HN.

Source: The search for the definition, etiology, and effective diagnosis of upper urinary tract obstruction: the Whitaker test then and now. Farrugia MK, Whitaker RH. J Pediatr Urol 2019 Feb;15(1):18-26. doi: 10.1016/j. jpurol.2018.11.011. Epub 2018 Nov 22. Review. PubMed PMID: 30602417.

Diuresis renography in the evaluation and management of pediatric hydronephrosis: What have we learned? Bayne CE, Majd M, Rushton HG. J Pediatr Urol 2019 Apr;15(2):128-137. doi: 10.1016/j. jpurol.2019.01.011. Epub 2019 Jan 28. Review. PubMed PMID: 30799171.

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European Urology Today

HPV vaccination for males: Science and practice Time is ripe to seriously consider male vaccination against HPV Beyond condyloma At the time of writing, more than 200 HPV genotypes have been identified. Among these, two genotypes (6,11) are related to condyloma and about 4 to cancer (16, 18, 31, 33). Until now, we do not have data about the natural history of more than 150 HPV genotypes. Based on these facts, clinicians are recommended to consider HPV infection a systemic disease and not only condylomas.

Dr. Tommaso Cai Dept. of Urology Santa Chiara Regional Hospital Trento (IT)

tommaso.cai@ apss.tn.it

Moreover, a recent review performed by Silva and co-workers showed a prevalence in men, for different anatomical regions, in this order: penis, glans/corona, scrotum, perianal area, urethra and semen (Fig. 1)8.

Dr. Riccardo Bartoletti Dept. of Urology University of Pisa Pisa (IT)

Starting for this evidence, some authors suggested to use seminal plasma as a good diagnostic sample to use for HPV diagnosis in males2,9. Moreover, quantification of the viral DNA in the ejaculate is a useful indicator for monitoring viral infections10.

riccardo.bartoletti@ hotmail.com Human papillomavirus (HPV) infection is one of the most common sexually-transmitted infections in both genders1. HPV is the main cause of cervical carcinomas in women, and is responsible for anal, penile and oropharyngeal cancer in men1. Several authors stated that men play a key role in the transmission of HPV to women, but little is known about the natural history of HPV infections in men2. The prevalence of HPV in males ranges from 1.3 to 72.9%, but the majority of studies conducted so far have been performed on specific male populations, such as homosexuals, HIV-infected or infertile men3-4. The lack of knowledge of the natural history of HPV is mainly due to the limited information on HPV infection in men and on the appropriate diagnostic criteria that must be applied to detect with high specificity the presence of one or more HPV genotypes on the penis or in seminal fluids5.

Low prevalence of infection clearance in nonvaccinated males Recently, Cai and co-workers demonstrated in a large cohort of non-vaccinated males, that high risk-HPV showed a low prevalence of infection clearance11. This result strongly points to the need of considering the implementation of male vaccination programmes, especially against high risk-HPV. Moreover, the same authors stated that the good concordance between female partners and enrolled males in terms of HPV genotypes may be the key to extend the vaccination programmes to all men who are partners of women positive for high risk-HPV.

with chronic prostatitis-related symptoms. BJU Int. 2014 A 3-dose schedule is recommended for people who Feb;113(2):281-7. start the series on or after the 15th birthday and for people with certain immunocompromising conditions 3. Bartoletti R, Cai T, Meliani E, Mondaini N, Meacci F, Addonisio P, Albanese S, Nesi G, Mazzoli S. Human (such as cancer, HIV infection, or taking papillomavirus infection is not related with prostatitisimmunosuppressive drugs). The second dose should related symptoms: results from a case-control study. Int be given 1 to 2 months after the first dose and the Braz J Urol. 2014 Mar-Apr;40(2):247-56. third dose 6 months after the first dose. The minimum interval between the first and second doses of vaccine 4. Cai T, Di Vico T, Durante J, Tognarelli A, Bartoletti R. Human papilloma virus and genitourinary cancers: a is 4 weeks. The minimum interval between the narrative review. Minerva Urol Nefrol. 2018 second and third doses of vaccine is 12 weeks. The Dec;70(6):579-587. minimum interval between the first and third doses is 5 calendar months. If the vaccination series is 5. Bartoletti R, Zizzo G, Cai T, Mirone V. Genital interrupted, the series does not need to be restarted. condylomata are not the human papilloma virus male infection burden. Eur Urol. 2011;60(2):268–269.

The natural history of HPV infection in males is not 6. Association of Reproductive Health Professionals. deeply understood and the management is not yet Managing HPV: a new era in patient care. Clinical standardised. However, urologists should improve their Proceedings series. June 2009. http://www.arhp.org/ knowledge about HPV infection and should manage Publications-and-Resources/Clinical-Proceedings/ the patient without referring the patients to other Managing-HPV. Accessed September 1, 2009. specialists. Accurate informative programmes among 7. Lucia Giovannelli, Maria Colomba Migliore, Giuseppina urologists about HPV infection is urgently required. Capra, Maria Pia Caleca, Carmelina Bellavia, Antonio Final remarks • Consider HPV infection as a “systemic disease” • About 200 genotypes have been isolated • Condylomas are related to only a few HPV genotypes • Low clearance probability in high-risk genotypes in males • Discuss the possibility of HPV vaccine with your patients • Consider HPV vaccination in: • 11-12 years old boys • partners of HPV-positive woman • patients with recurrent HPV-related genital warts • high-risk HPV-related diseases group

The time is ripe for HPV vaccination in males References HPV infection is a systemic disease. To treat a systemic 1. Benevolo M, Mottolese M, Marandino F, et al. HPV disease we need systemic therapy. The vaccination prevalence among healthy Italian male sexual partners against HPV is the right road to follow. Randomized of women with cervical HPV infection. J Med Virol. control trials with the quadrivalent HPV vaccine 2008;80(7):1275-81. demonstrate robust antibody responses and high 2. Cai T, Wagenlehner FM, Mondaini N, D'Elia C, Meacci F, Standard HPV test efficacy against genital warts and anal precancers in Migno S, Malossini G, Mazzoli S, Bartoletti R. Effect of The first point to discuss is the lack of a standard HPV men. Gender-neutral vaccination has been human papillomavirus and Chlamydia trachomatis test in men. No agreement has been reached between recommended in the USA, Canada, Austria, and co-infection on sperm quality in young heterosexual men the authors on the standard HPV testing in the Australia. An HPV vaccine is most effective during following cases: childhood or adolescence, but adults can also benefit from the HPV vaccine. - Male partners of women with HPV lesions (condylomas, etc.) (There is no association The aim of HPV vaccination in males is: between the incidence of penile and cervical cancer, although both are linked to HPV). - to reduce the risk of HPV-related diseases in Dear EAUN members, - Males with genital warts males - Males at high risk of HPV infection - to reduce the risk of HPV sharing among females The growing evidence in urology nursing care is amazing! - to reduce the risk of HPV-related cancers in It is important to note, although 3 HPV DNA testing sexual partners kits are commercially available for use in women With this new column, the EAUN Bladder Cancer (Hybrid Capture II [Digene Corporation, Gaithersburg, The question is: who can benefit from HPV vaccine? SIG Group wants to put the spotlight on recent Maryland], Cervista HPV HR and Cervista HPV 16/18 Several authors suggest to vaccinate men in the publications in our field of interest. This month [Hologic Inc, Bedford, Massachusetts]), none are articles have been carefully chosen because of the following conditions: approved by the Food and Drug Administration for scientific value from PubMed and represent use in men. Also, there is a lack of agreement on the - HPV-naive patients (young) different methods and approaches in research and anatomical sites that should be sampled for HPV development in urological nursing care. We hope - Subject is a partner of an HPV-positive woman diagnosis in males. Several authors used penile and this new initiative will have your attention and - patients with recurrent HPV-related genital warts scrotal brushing, while others used seminal plasma7. - High-risk HPV-related diseases patients continuously provide information on "spot-on" From an andro-urological point of view, the HPV bladder cancer care. infection in males is not only related to genital warts The Advisory Committee on Immunization Practices but also to other relevant diseases, such as infertility, (ACIP) recommends a routine 2-dose HPV vaccine If you would like to inform us and your colleagues and penile and anal cancer. In this sense, we need to schedule. The two doses should be separated by 6 to about new initiatives or exiting developments in change our point of view and to start to realise that 12 months. The minimum interval between doses is Bladder Cancer Care you can contact us using the HPV is more than just condylomas! email address below. 5 calendar months.

Perino, Enza Viviano, Domenica Matranga, Pietro Ammatuna. Penile, Urethral, and Seminal Sampling for Diagnosis of Human Papillomavirus Infection in Men. J Clin Microbiol. 2007 Jan; 45(1): 248–251. 8. Silva R, León D, Brebi P, Ili C, Roa JC, Sánchez, R. Diagnóstico de la infección por virus papiloma humano en el hombre. Rev Chilena Infectol. 2013; 30 (2): 186–192. 9. La Vignera S, Condorelli RA, Cannarella R, Giacone F, Mongioi', Scalia G, Favilla V, Russo GI, Cimino S, Morgia G, Calogero AE. High rate of detection of ultrasound signs of prostatitis in patients with HPV-DNA persistence on semen: role of ultrasound in HPV-related male accessory gland infection. J Endocrinol Invest. 2019 Jun 4. doi: 10.1007/s40618-019-01069-8. 10. Evdokimov VV, Naumenko VA, Tulenev YA, Kurilo LF, Kovalyk VP, Sorokina TM, Lebedeva AL, Gomberg MA, Kushch AA. QUANTITATIVE DNA EVALUATION OF THE HIGH CARCINOGENIC RISK OF HUMAN PAPILLOMA VIRUSES AND HUMAN HERPES VIRUSES IN MALES WITH FERTILITY DISORDERS. Vopr Virusol. 2016;61(2):63-8. 11. Cai T, Perletti G, Meacci F, Magri V, Verze P, Palmieri A, Mazzoli S, Santi R, Nesi G, Mirone V, Bartoletti R. Natural history of human papillomavirus infection in nonvaccinated young males: low clearance probability in high-risk genotypes. Eur J Clin Microbiol Infect Dis. 2016 Mar;35(3):463-9.

Spot-on Bladder Cancer Care

Best regards

Penis

Bente Thoft Jensen, Chair, EAUN Special Interest Group - Bladder Cancer b.thoft@eaun.org

Selected from PubMed May 2019 1. Toward an Understanding of Patients' and Their Partners' Experiences of Bladder Cancer. Heyes SM, Prior KN, Whitehead D, Bond MJ. Cancer Nurs. 2019 Apr 25. doi: 10.1097/ NCC.0000000000000718. [Epub ahead of print] PMID: 31033514 https://www.ncbi.nlm.nih.gov/pubmed/31033514 2. Selecting candidates for early discharge after radical cystectomy for bladder cancer. Fonteyne V, Rammant E, Decaestecker K. Transl Androl Urol. 2018 Mar;7(Suppl 1):S86-S89. doi: 10.21037/ tau.2018.01.17. No abstract available. PMID: 29645003. https://www.ncbi.nlm.nih.gov/pubmed/29645003 3. Development and acceptability testing of a patient decision aid for urinary diversion with radical cystectomy. McAlpine K, Lavallée LT, Stacey D, Moodley P, Cagiannos I, Morash C, Black PC, Kulkarni GS, Shayegan B, Kassouf W, Siemens R, So A, Leveridge MJ, Boorjian SA, Daneshmand S, Smith AB, Power N, Izawa J, Drachenberg DE, Fairey A, Rendon RA, Breau RH. J Urol. 2019 May 17:101097JU0000000000000341. doi: 10.1097/JU.0000000000000341. [Epub ahead of print]. PMID: 31099720 https://www.ncbi.nlm.nih.gov/pubmed/31099720

Glans / corona

Perianal area

Urethra

Semen Figure 1: Pyramid showing the prevalence of HPV per location in men, lowest at the penis at the top of the pyramid and highest in the semen at the base of the pyramid8.

European Urology Today

www.eaun.uroweb.org June/July 2019

ICS hosts workshop for fistula repair in Sudan Trainees, residents learn latest techniques during regional workshop Prof. Sherif Mourad Secretary General ICS Cairo (EG)

msmourad@ tedata.net.eg From 12-14 December 2018, the International Continence Society (ICS) hosted the 7th Workshop for Surgical Repair of Vaginal Fistula and Urinary Incontinence. This was held at the Ministry of Health, Khartoum State in Sudan. The course received generous support from the Global Philanthropic Fund. Need for training in Sudan The ICS has a long and successful history of running surgical training courses to repair fistula with an emphasis on training doctors who work in developing countries. There was a clear need to organise a course in Sudan; this training would be particularly beneficial because of the lack of resources and limited availability of qualified surgeons in Sudan. The Masterclass allowed over 20 delegates to receive theoretical and practical hands-on surgical training on the repair of vaginal fistulas. The masterclass took 3 days: half a day was spent on education and 2 and half days on live surgery. The trainees acted as assistants of the trainers in all surgeries in order to acquire practical hands-on training and gain real-life experience in all steps, starting from the decision-making process of the treatment strategy to the approach and the techniques. Interpositional flaps were discussed and applied practically including martius flaps, peritoneal flaps and fibrin glue.

Complicated and recurrent cases The most important goal of the training programme is the evaluation and repair of complicated and recurrent cases, which represent a fundamental problem for both patients and surgeons. The scope of the training included the different techniques of urethral reconstruction and the treatment of associated urinary incontinence. The workshop was open to all international delegates with a focus on including trainees, residents and those working in developing and resource-constrained countries. Topics of the Masterclass A multi-disciplinary team taught various surgical techniques on local patients. ICS speakers covered the following topics: • Aspects of the problem • Anatomical consideration and surgical principles • Classification of vesicovaginal fistula (VVF) • Surgical repair of vesicovaginal fistula (VVF) • Complications of surgery and surgical tips • Fibrin glue • Postoperative care and patient follow-up.

Sherif Mourad demonstrates the surgical repair of a vaginal fistula

Positive evaluation The delegates provided very positive evaluation comments following the event, noting that the core aims and learning objectives of the event were achieved. There was unanimous agreement that the training would maintain and improve the standard of care for the delegates’ patients. In December 2019, ICS plans to host the 8th Workshop for Surgical Repair of Vaginal Fistula and Urinary Incontinence. This will be at the same venue in Sudan. Please check the ICS website for further updates. To view a video presentation and photo album from the course please visit: https://www.ics.org/ news/954 Delegates and faculty enjoyed a productive three days of education and training

Global Philanthropic Fund The Global Philanthropic Committee (GPC) consists of multi-national urology organisations including the American Urological Association (AUA), European Urology Association (EAU), International Continence Society (ICS) and the Société Internationale d’Urologie (SIU), with the goal of supporting proposals for worthy projects to improve urologic care throughout the world. The GPC allows organisations to pool their resources to fund larger scale philanthropic projects as a collaborative effort. Urology organisations can support a project through monetary funds and/or in-kind donations, including volunteer time. The GPC’s mission is to provide philanthropic support to improve urological education in the developing world. The GPC strives to provide funding mainly for education and generally will not provide funds for purchasing expensive equipment. The GPC will selectively provide funds for educators to travel for the purpose of providing training in various regions of the world, within the parameters of an approved funding request.

European Urological Scholarship Programme (EUSP) Do not forget to submit your online applications for Short Visit, Clinical Visit, Clinical and Lab Scholarship, and Visiting Professor Programme before 1 September. For more information and application, please contact the EUSP Office – eusp@uroweb.org or check our website www.uroweb.org/education/scholarship/

June/July 2019

European Urology Today

EAU Best Papers published in Urological Literature Awards

Apply now!

To be awarded at the 35th Annual EAU Congress in Amsterdam, 20-24 March 2020 The two EAU Prizes for Best Paper published in Urological Literature are tools through which the EAU encourages young and promising urological scientists to continue their work and to communicate their achievements to the European urological community. Two awards of € 5,000 each will be made available for the two Best Papers published in Urological Literature on Clinical and Fundamental Research. These papers have to be published or accepted for publication between 1 July 2018 and 30 June 2019. The awards will be handed out at the 35th Annual EAU Congress in Amsterdam, 20-24 March 2020. Rules and Eligibility • Eligible to apply for the EAU Best Paper published in Urological Literature are urologists, urologists-intraining or urology-related scientists. All applicants have to be a member of the EAU. • The submitting author must be either the first or the corresponding senior last author. • Each author is allowed to submit no more than one paper. • The paper must be written in English (or translated into English).

Apply now!

• The subject of the paper must be urological or urology related. • The deadline for submission is 1 November 2019. How to apply • Please send your paper by e-mail to m.smink@uroweb.org, indicating clearly the category in the subject line: “EAU Best Paper on Clinical Research” or “EAU Best Paper on Fundamental Research”. • Include a copy of your curriculum vitae. • Supply a list of all authors who have significantly contributed (if relevant). • Mention any financial support by companies, government or health organisations. • A publisher’s letter of acceptance has to be submitted along with your paper. A review committee consisting of members of the EAU Scientific Congress Office will review all submitted papers and select the winner of the two EAU awards for Best Paper published in Urological Literature.

EAU Prostate Cancer Research Award 2020 For the best paper published on clinical or experimental studies in prostate cancer With the goal to encourage innovative, high-quality research in prostate cancer, the EAU has launched the EAU Prostate Cancer Research Award. Supported by the Fritz H. Schröder Foundation, an expert jury will select the best paper dealing with clinical or experimental studies in prostate cancer. The award will be handed over at the 35th Annual EAU Congress in Amsterdam, 20-24 March 2020 during the Opening Ceremony.

• The paper must have been published or accepted for publication in a high-ranking international journal between 1 July 2018 and 30 June 2019, and submitted in English. • Applicants must be a member of the EAU. • The submitting author must be the first author of the paper or, by exception, the corresponding senior last author. • Applicants should only submit one paper. • Deadline for submission by e-mail is 1 November 2019.

Join this competitive search and help boost the quality of prostate cancer research in Europe!

A review committee will screen all entries and an independent jury will select the best paper based on quality and merits.

Rules and Eligibility • The topic of the paper should deal with clinical or experimental prostate cancer research.

How to apply Inquiries and correspondence should be addressed to the EAU Central Office, at m.smink@uroweb.org, with “EAU Prostate Cancer Research Award 2020” in the subject line of your e-mail.

The award is supported by a grant of €5,000 from the FRITZ H. SCHRÖDER FOUNDATION. www.fhsfoundation.eu

European Urology Today

June/July 2019

Call for EAU RF VENUS registry EAU RF sets up European registry for robotic female AUS implantation Dr. Benoit Peyronnet Dept. of Urology University of Rennes Rennes (FR)

Prof. Frank Van Der Aa UZ Leuven Dept. of Urology Leuven (BE)

peyronnetbenoit@ hotmail.fr

frank.vanderaa@ uz.kuleuven.ac.be

While AMS-800 artificial urinary sphincter (AUS) implantation is unanimously recognised as the gold-standard surgical treatment in male patients with severe stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD)1-2, its use in female patients remains very limited in most countries, where pubovaginal slings, Burch colposuspension or bulking agents are favoured in these patients3-4. Despite good functional outcomes, AUS has not been widely used in female patients due to the technical difficulty of its implantation via an open retropubic approach and the high inherent morbidity3,5. A laparoscopic approach has been described in the late 2000s with promising preliminary results in experienced hands 6-7. More recently, several reports have suggested that the robotic approach for female AUS implantation may combine minimally invasiveness with lower technical complexity and result in improved perioperative outcomes, especially lower rates of device erosion and infection8-10. While this robotic technique might expand the role of AUS implantation in female patients by decreasing the morbidity associated with its challenging implantation, the lack of high-level evidence studies keeps being pointed out as one of the main factors limiting the widespread adoption of female AUS11. The present study would be a significant step to confirm EAU Research Foundation

the promising findings of preliminary case series recently reported. It would also provide valuable materials to design future randomised controlled trials which ultimately should establish whether worldwide female AUS is what it was thought to be when Bradley Scott and Timm reported their initial experience with the first version of the AMS artificial urinary sphincter: the gold standard surgical treatment of SUI due to ISD in women12. Objectives The primary objective of the VENUS study is to assess the safety and efficacy of a standardised robotic AUS implantation technique in female patients with stress urinary incontinence due to intrinsic sphincter deficiency. Our secondary objectives are as follows: - To assess the urodynamic outcomes of robotassisted bladder neck AMS-800 AUS implantation in female patients with SUI due to ISD; - To assess the patient-reported outcomes and impact on quality of life of AMS-800 AUS implantation in female patients; - To assess the impact on sexual function of robot-assisted bladder neck AMS-800 AUS implantation in female patients with SUI due to ISD. Study design Following in the footsteps of the SATURN registry on male SUI surgery, the VENUS registry would be a prospective non-controlled cohort study evaluating

the outcomes of a standardised technique of robot-assisted artificial urinary sphincter (AUS) implantation in female patients. The aim is to include 150 female patients over 20 study sites throughout Europe. Patients would be followed up over a 5-year period after implantation. Participation in project We will send an open invitation to participate to all members of the Female & Functional Section of the EAU (ESFFU) along with other urologists undertaking robotic female artificial urinary sphincter implantation. This is a call from the European Association of Urology Research Foundation (EAU RF) to all European urologists to register for database entry. There will be no restriction on the number of patients enrolled as long as they are consecutive. A participating site must be able to complete the approvals process promptly. The aim is to have a long-term collection of data from as many European centres as possible. An initial assessment for the robustness of the data collection will be undertaken after one year by a nominated steering committee. Sponsor: European Association of Urology Research Foundation Study team: Principal Investigator Benoit Peyronnet Dept. of Urology University of Rennes France Protocol Writing -, and Steering Committee • Benoit Peyronnet, France • Frank Van Der Aa, Belgium • Wim Witjes, The Netherlands

Dr. Raymond Schipper Clinical Project Manager EAU Research Foundation Arnhem (NL) r.schipper@ uroweb.org

Dr. Wim Witjes Scientific and Clinical Research Director EAU Research Foundation Arnhem (NL) w.witjes@ uroweb.org References The references of this article are available from the EAU Research Foundation. Please send an e-mail to: researchfoundation@uroweb.org with reference to the article “Call for EAU RF VENUS registry” by Dr. Peyronnet, June/July issue 2019.

Interested to join the VENUS Registry? Please fill in the Feasibility Questionnaire at www.surveymonkey.com/r/5YZPG8W or send an email to researchfoundation@uroweb.org

EAU Research Foundation • Wim Witjes, Scientific and Clinical Research Director • Raymond Schipper, Clinical Project Manager • Christien Caris, Clinical Project Manager • Joke van Egmond, Clinical Data Manager

Break the silence Reach out to your community and start the conversation Urology Week is an excellent opportunity for a healthcare professional (HCP) such as yourself to talk to your patients and their families about the importance of urological care. This year, Urology Week will centre (but not solely) on benign prostatic hyperplasia. Here below are some of the ways for you to reach out and help increase awareness.

Hang these up We have designed some posters that you can hang in your clinic or event venue. You can find them in this issue European Urology Today and via www.urologyweek.org/healthcare-providers/ awareness-campaign/. Would you like to have the Urology Week posters in your language? Send us a request and the translated text via communications@uroweb.org. We will design the posters in your local language for free and send you a digital version so you can easily download, print and share them.

Squeezing is good for oranges, not your bladder!

Participate in or start a local event yourself during Urology Week. Brainstorm with your peers or national society on what you can do to inform patients about urological health. Organise or join a marathon; volunteer to help out in your community; set up an “Open Day” at your clinic and get your colleagues involved! Already have an event planned in September? Register your event at www.urologyweek.org/healthcare-providers/ get-involved/ to give it additional exposure.

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Tell us your story It is not always easy nor comfortable for patients and their loved ones to talk about urological diseases. How do you make your patients and their families feel at ease? Do you have a patient who is willing to share his/her inspiring story? Or have you dealt with a urological condition yourself? Please let us know. Sharing stories inspire others to share their own. Help break the silence. Read the stories that patients and other healthcare professionals are sharing at www.urologyweek.org/ stories/. Share your own experience, insights and tips to communications@uroweb.org.

Sharing is caring Show your support via social media and the press. Your tweet and/or retweet, a Facebook or Instagram post about Urology Week with hashtag #urologyweek will reach more people. Contacting your local/national press to raise awareness on urological health will give it an extra boost. Additionally, the EAU will conduct an international survery to gauge a country’s general urological knowledge. The results will be available for the press and for disseminating via social media as well.

Join us and together let us raise awareness on the importance of urological care. We can make a difference. Be a Urology Week ambassador!

For more information about Urology Week, please visit www.urologyweek.org June/July 2019

European Urology Today

EAU Crystal Matula Award 2020

Send your nominations today!

For a young promising European urologist The EAU Crystal Matula Award 2020 is the most prestigious prize given to a young promising European urologist aged 40 or under who has the potential to become one of the future leaders in academic European urology. The award will be presented at the Opening Ceremony of the upcoming 35th Annual EAU Congress in Amsterdam from 20-24 March 2020. The list of previous awardees includes many M. Albersen (2019), S. Silay (2018), C. Gratzke (2017), A. Briganti (2016), M. Rouprêt (2015), S. Shariat (2014), P. Boström (2013), P. Bastian (2012), S. Joniau (2011), J. Catto (2010), M. Ribal (2009), V. Ficarra (2008), M. Michel (2007), A. De La Taille (2006), M. Matikainen (2005), P. Mulders (2004), B. Malavaud (2003), M. Kuczyk (2002), B. Djavan (2001), A. Zlotta (2000), G. Thalmann (1999), F. Montorsi (1998), F. Hamdy (1996). Nomination Process National Societies can nominate a candidate by supplying the following documents: • Letter of endorsement • Motivation letter • Complete curriculum vitae

• List of publications in the below sequence: 1. Peer reviewed papers (including the impact factors of the journals) • Original articles • Reviews • Case reports 2. Book chapters or editor of books • Overview of grants received from (inter-)national institutions or from the industry • List of received Awards • The deadline for nomination is 1 November 2019. Please note that eligible candidates can also apply for this award by contacting their national urological society directly. The candidate is then expected to supply his/ her national society with a CV and the above mentioned documents, requesting a letter of endorsement. How to apply Please send your nominations to the EAU Central Office at m.smink@uroweb.org and mention “EAU Crystal Matula Award 2020” in the subject line of your e-mail.

The EAU Crystal Matula Award is supported by a grant of €10,000 from LABORIE.

EAU Hans Marberger Award 2020 For the best European paper published on Minimally Invasive Surgery in Urology The EAU Hans Marberger Award will be handed out for the best European paper published on Minimally Invasive Surgery in Urology. The award, annually given since 2004, is named after Prof. Hans Marberger to honour his pioneering achievements and contributions to endourology and the development of urologic minimally invasive surgical procedures. The award will be handed over at the 35th Annual EAU Congress in Amsterdam, 20-24 March 2020 during the Opening Ceremony. Rules and Eligibility • All urologists and scientists are invited to send in papers. • The topic of the paper should deal with Minimally Invasive Surgery in Urology. • The paper must have been published or accepted for publication in a European Journal between 1 July 2018 and 30 June 2019.

LABORIE

Apply now!

• All papers must be submitted in English. • All applicants have to be a member of the EAU. • The submitting author must be either the first or the corresponding senior last author. • Each author is allowed to submit no more than one paper. • Deadline for submission is 1 November 2019. A review committee, consisting of members of the EAU Scientific Congress Office, will select the winning paper. How to apply Please send your paper to the EAU Central Office at m.smink@uroweb.org and mention “EAU Hans Marberger Award 2020” in the subject line of your e-mail.

The EAU Hans Marberger Award is supported by a grant of €5,000 from KARL STORZ SE & CO.KG

European Urology Today

June/July 2019

Erectile dysfunction and cardiovascular disease Temporal relationship between ED and CVD discussed Dr. Athanasios Zachariou Board Member, EAU Section of Urologists in Office University Hospital of Ioannina Ioannina (GR) zahariou@otenet.gr

Prof. Nikolaos Sofikitis Chair, EAU Section of Andrological Urology University Hospital of Ioannina Ioannina (GR) v.sofikitis@ hotmail.com

Prof. Helmut Haas Chair, EAU Section of Urologists in Office Heppenheim (DE)

hf.haas-hp@ t-online.de

According to the Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease, ED should not be regarded only as a quality of life issue, but also as a potential warning sign of CVD. ED provides an opportunity for CVD risk reduction. ED not only shares risk factors with CVD but is also, in itself, an independent marker of increased risk for CVD, coronary artery disease, stroke and all-cause mortality5. Practical issues in ED medication for men with CVD PDE5 inhibitors (PDE5-I) are the mainstay therapy for ED. The Second Princeton Consensus Conference reviewed their appropriate use, and recent placebocontrolled and post-marketing surveillance studies have established their safety regarding cardiovascular events6. Chronic or on-demand use is well tolerated with a similar safety profile. The use of PDE5-I is contraindicated in patients: • who have suffered from a myocardial infarction, stroke, or life-threatening arrhythmia within the last six months, • with resting hypotension (blood pressure < 90/50 mmHg) or hypertension (blood pressure > 170/100 mmHg), • with unstable angina, angina with sexual intercourse or congestive heart failure categorised as New York Heart Association Class IV7.

The use of nitrate-containing medications in combination with a PDE5-I can cause a precipitous Erectile dysfunction (ED) is defined as the persistent drop in blood pressure. The duration of interaction inability to attain and maintain an erection sufficient between organic nitrates and PDE5-I depends on the to permit satisfactory sexual performance. ED is a PDE5-I and nitrate used. It is essential that patients highly prevalent and growing problem; it is estimated understand they cannot use their nitrates for at least that ED affects more than 150 million men worldwide 24 hours after the use of sildenafil or vardenafil and this number will reach approximately 322 million (half-life 4 hours), 12 hours if avanafil is used (half-life by 2025. 6-17 hours) and at least 48 hours if tadalafil is used (half-life 17.5 hours). Co-administration of PDE5-I with Despite many advances over the last few decades, antihypertensive medication showed approximately cardiovascular disease (CVD) remains the leading the same incidence of treatment-related side effects cause of death globally, with men afflicted at an when compared with patients taking PDE5-I without earlier age than women. antihypertensive agent. In general, the adverse event profile is not worsened even if patients use a The temporal relationship between ED and CVD multidrug antihypertensive regimen8. In 1985, Virag et al.1 published a paper in The Lancet, drawing attention to the distribution of “four main Interaction with α-blockers arterial risk factors”, including hypertension, All PDE5-I demonstrate some interaction with diabetes, smoking and hyperlipidaemia in men with α-blockers, which under some conditions may result ED. These findings formed the fundamentals for the in orthostatic hypotension. Therefore, patients should common risk factors approach to understanding the be haemodynamically stable on α-blocker therapy relationship between ED and CVD. before initiating sildenafil treatment and initiation of sildenafil at lower doses (25 mg) should be In the early 2000s, longitudinal studies on CVD and considered (to minimise the potential for developing ED began to reveal the two-way relationship: patients postural hypotension). with CVD are more likely to present ED and patients with ED are more likely to develop CVD in the future, The cardiovascular safety of testosterone replacement even when adjusted for shared risk factors2. It was therapy (TRT) remains a crucial issue in the presumed that there is an overlap in management of subjects with late-onset pathophysiological mechanisms including hypogonadism and ED. TRT is contraindicated in atherosclerosis, endothelial dysfunction, and patients with unstable cardiac disease. Available evidence indicates that low endogenous testosterone inflammation. represents a risk factor of acute myocardial infarction incidence and its related mortality. TRT in Artery-size hypothesis Montorsi et al. (2005)3 proposed the artery-size hypogonadal patients is able to improve angina symptoms in subjects with ischaemic heart diseases hypothesis, a pathophysiological mechanism to and exercise ability in patients with heart failure. explain this temporal relationship from a Also, when prescribed according to the recommended macrovascular perspective. It was based on the dosage, TRT does not increase the risk of heartassumption that atherosclerosis is a systemic related events9. disease and larger vessels can tolerate the same degree of atherosclerotic plaque deposition better than smaller vessels. Penile arteries have a smaller Practical issues in CVD medication in men with ED diameter (1-2 mm) compared to coronary (3-4 mm), Antihypertensive drugs exert different effects on ED: internal carotid (5-7 mm) or femoral arteries (6-8 thiazide diuretics and β-blockers, except nebivolol, mm)3. may promote ED. Nebivolol has a unique mechanism of action involving the release of nitric oxide, resulting Kaiser et al. investigated whether patients with ED in penile vasodilation, which may be beneficial in the and no apparent CVD had any structural and male patient with a history of hypertension and ED. functional abnormalities of their vasculature. The Limited short-term studies comparing nebivolol with study concluded that patients with ED had defects in other β-blockers indicate erectile function did not the endothelium-dependent and endotheliumworsen and may improve. Calcium channel blockers independent peripheral vasodilation, even in the and angiotensin-converting enzyme inhibitors may absence of any clinical CVD4. The presence of have a neutral effect; angiotensin receptor blockers endothelial dysfunction affects the production of nitric may even be beneficial10. oxide (NO) and leads to impaired relaxation and vasodilation of the arterioles. Since the attainment Hypoglycaemic drugs have been less evaluated in and maintenance of penile erection are significantly the ED setting, with metformin, pioglitazone, and dependent on the degree of vasodilation of cavernosal liraglutide presenting favourable results. Metformin supplies, a reduction in the provided flow occasioned may enhance endothelium-dependent vasodilatation through improved flow-mediated vasodilation as well as increased transcription of NO EAU Section for Urologists in Office (ESUO) synthase in erectile tissues. June/July 2019

References

by the impairment of NO-cGMP signalling pathway impairs penile erection (figure 1).

Figure 1: Risk factors associated with erectile dysfunction and cardiovascular diseases

Data on whether statins improve or worsen ED are conflicting. Some studies report a beneficial effect, particularly for ED, through statins' anti-inflammatory, antioxidant and cardiovascular protective properties. Others suggest that statins might be associated with sexual dysfunction through negative effects on hormone levels11. Conclusion Several population-based studies have confirmed a link between ED and CVD with similar pathophysiological sequelae of atherosclerosis and endothelial dysfunction. This connection between ED and CVD may authorise urologists to initiate lifestyle changes and risk factors modification before ED treatment or accompanying it. Treatment options must be tailored according to patient and partner satisfaction, quality of life as well as treatmentrelated safety and efficacy.

1. Virag R, Bouilly P, Frydman D. Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men. Lancet. 1985;1(8422):181-184. 2. Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996-3002. 3. Montorsi P, Ravagnani PM, Galli S, et al. The artery size hypothesis: A macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005;96(12):19-23. 4. Kaiser DR, Billups K, Mason C, et al. Impaired brachial artery endothelium-dependent and – independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol. 2004;43(2):179-184. 5. Nehra A, Jackson G, Miner M, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87(8):766-78. 6. Giuliano F, Jackson G, Montorsi F, et al. Safety of sildenafil citrate: a review of 67 double-blind placebo-controlled trials and the postmarketing safety database. Int J Clin Pract. 2010;64(2):240-55. 7. Giannetta E, Feola T, Gianfrilli D, et al. Is chronic inhibition of phosphodiesterase type 5 cardioprotective and safe? A meta-analysis of randomized controlled trials. BMC Med. 2014;12:185. 8. Pickering TG, Shepherd AM, Puddey I, et al. Sildenafil citrate for erectile dysfunction in men receiving multiple antihypertensive agents: a randomized controlled trial. Am J Hypertens. 2004;17(12):1135-42. 9. Corona G, Rastrelli G, Guaraldi F, et al. An update on heart disease risk associated with testosterone boosting medications. Expert Opin Drug Saf. 2019;18(4):321-332. 10. Viigimaa M, Vlachopoulos C, Lazaridis A, et al. Management of erectile dysfunction in hypertension: Tips and tricks. World J Cardiol. 2014;6(9):908-15. 11. Davis R, Reveles KR, Ali SK, et al. Statins and male sexual health: a retrospective cohort analysis. J Sex Med. 2015;12(1):158-67.

Fellowship Programme European Association of Urology Nurses

Visit a hospital abroad! 1 or 2 weeks - expenses paid Application deadline: 31 August 2019 • Only EAUN members can apply • Host hospitals in Belgium, Denmark, the Netherlands, Sweden, Switzerland and the United Kingdom • A great way of widening your horizon For Fellowship application forms, rules and regulations and information on which specialities the hosting hospitals can offer please visit the EAUN website. T +31 (0)26 389 0680 F +31 (0)26 389 0674 eaun@uroweb.org www.eaun.uroweb.org

European Association of Urology Nurses

European Urology Today

CEM19 features dynamic urology work in Central Europe Impressions and shared experiences from the meeting’s awardees By Erika De Groot The recently-concluded 19th edition of the Central European Meeting (CEM19) showcased young talent and innovative research within and beyond the region. Without breaking tradition, CEM19’s Scientific Programme delivered vital urological updates. In this article, recipients of prestigious CEM awards shared a first-hand view of what it was like at the meeting. Young, promising talent “The feeling on the podium was indescribable,” said Dr. Bernhard Grubmüller (AT), winner of the Young Urologist Competition. “I was very pleased to have the opportunity to present and defend my

work, and to represent my country after months of preparation. It energised me in an unimaginable way. I used to watch it for years as an audience member. Being on that podium at CEM19 was a moment of great pride.” Mr. Florian Janisch (DE), awardee of the BerlinChemie Best Poster recognition presented his review of the “Current disease management of Primary Urethral Cancer” at CEM19. He recalled the process of developing the research with his colleagues, “We assessed the treatment strategies of urethral cancer in a systematic literature search. We then compared the results to the currently available guidelines, and gave our expert opinion on possible therapy regimes for this rare malignancy.”

Recipient of the Karl Storz Best Poster award for the poster “Prospective comparison of 4-core targeted MRI-TRUS fusion versus systematic 12-core TRUS prostate biopsy for the diagnosis of prostate cancer”, Dr. Johannes Mischinger (AT) said, “The recognition encouraged me to further pursue scientific work in addition to daily urologic work.” He then shared how he and his colleagues procured data for the research. “We investigated our collected data on 4-core targeted magnetic resonance imaging (MRI) - transrectal ultrasound (TRUS) fusion versus systematic 12-core TRUS prostate biopsy for the diagnosis of prostate cancer. The precise and standardised pre-biopsy testing and perioperative documentation facilitated the data analysis. Although checking current literature was time-consuming, it was understandably mandatory for a holistic understanding and correct interpretation of our results.” Lasting impressions Dr. Grubmüller stated that for him, the CEM meetings are always the highlight among regional meetings. “The scientific updates, topics and the poster sessions were chosen wisely and fuelled great interest. The organisers did an excellent job.”

Pictured from left to right: Janisch, Grubmüller and Mischinger with the rest of the young awardees

CEM 19

9-10 May 2019 Vienna, Austria

scientific progress, a high standard for education, and improved international collaboration.” Mr. Janisch said, “While graced with a familiar welcoming atmosphere, the meeting also featured up-to-date topics and riveting debates. CEM19 provided a platform to encourage young urologists to take the first steps into the world of research; to give them an opportunity to present their data; and to receive valuable feedback.” The best of CEM19 Dr. Mischinger meeting highlights included the “How to become a good scientist” session wherein highly-regarded urologists gave important input on how to write a paper, give a good presentation and understand the statistics. He also mentioned the lecture given by Prof. Péter Nyirády (HU) on the latest developments on urachal adenocarcinomas, which “represent an oncologic entity that occurs very seldom and should be treated in a centre of excellence with a multidisciplinary approach.”

“While graced with a familiar welcoming atmosphere, the meeting also featured up-to-date topics and riveting debates...”

Mr. Janisch shared: “The CEM meeting provided an excellent opportunity for me and my young peers to present our data. I recommend this event to all fellow researchers and I would like to thank everyone involved for this valuable experience.”

To Dr. Mischinger, CEM19 incorporated all relevant features of what makes a scientific event valuable. He added, “I personally appreciate the collaboration among national societies such as the Austrian Society for Urology and the Bavarian Society of Urologists, with the European Association of Urology as the governing body. This teamwork guarantees rapid

“Firstly, I commend the well-organised courses where attendees improved their skills under the supervision of international experts,” stated Dr. Grubmüller. “Another highlight for me was the knowledge-exchange I’ve had with colleagues and friends from the other countries. Having the opportunity to meet and share knowledge is something I look forward to every year.”

International Academic Exchange Programme Japanese Urological Association (JUA) in collaboration with the European Association of Urology (EAU)

2020 Japanese Tour The JUA/EAU International Academic Exchange Programme will send both Japanese faculty to Europe and European faculty to Japan. The programme aims to promote international exchange of urological medical skills, expertise and knowledge. For 2020 the JUA/EAU International Exchange Programme will provide grants to enable two EAU members to travel to Japan. The tour should take place from 13-25 April 2020 starting with visits to urological facilities in Japan, culminating with participation in the 108th JUA Annual Meeting, which will be held in Kobe (23-25 April). Eligibility criteria • Less than 42 years of age • Minimum academic rank of assistant professor • Letter from the departmental chairman of the applicant’s commitment to academic medicine • Membership of the EAU • Availability to travel around two weeks at the earlier mentioned time

• • • •

Curriculum Vitae (C.V.) Personal statement (300 words or less) describing how participation in the Programme will benefit him/her both personally and professionally Statement of your primary and secondary area of academic and/or clinical interest Applications should include a letter of support from department chair (must be signed and on letterhead of the institute/department)

Information and application forms For all further information and programme application forms please visit http://uroweb.org/about-eau/our-partners/ and scroll down to Exchange Programmes and click on Japanese programme. Additionally you can contact Angela Terberg at the EAU Central Office, +31 26 389 0680, a.terberg@uroweb.org

Application deadline: 1 October 2019

Candidates must fill out an online application and submit electronic versions of the following documents:

European Urology Today

June/July 2019

Size reduction is healthy, also for your prostate! The bigger your prostate, the bigger your discomfort. This is a symptom of benign prostatic hyperplasia (BPH). Ask your urologist to know more.

#UROLOGYWEEK

urologyweek.org

June/July 2019

European Urology Today

June/July 2019

Having an enlarged prostate or benign prostatic hyperplasia (BPH) adds pressure on your bladder. Ease your discomfort. Consult your urologist to know more about BPH.

Squeezing is good for oranges, not your bladder!

urologyweek.org

#UROLOGYWEEK June/July 2019

European Urology Today

Brushing your teeth takes a lot longer. A prostate check only takes a few minutes and it can save your life. #UROLOGYWEEK

urologyweek.org

European Urology Today

June/July 2019

Report

Successful ESU Course on urothelial cancer in Kyiv An overview report with testimonials from the participants Learning in medicine is a continuous, dynamic process that reflects continuous changes in technologies, policies, systems as well as in the needs and expectations of patients, hospitals and society. Thanks to the European School of Urology (ESU), part of the European Association of Urology (EAU), up-to-date urological knowledge is brought to various parts of the world and Ukraine is no exception. The EAU Guidelines recommendations on bladder cancer, diagnosis, systemic therapies, surgery and organ-preserving approaches were the key points of the recently organised ESU Course in Kyiv. Unique opportunity The high-level Urothelial Cancer ESU Course offered the participants of the VIII National Congress of the Ukrainian Oncourological Society a unique opportunity for European urological education on-site on 12 April 2019. More than 300 congress participants had the chance to participate in the educational course of the ESU. Chairman Prof. Maurizio Brausi (IT) started the urological education course and covered guidelines recommendations on bladder cancer. He presented a hot topic on surgery versus organ-preserving therapeutic regimens for muscle invasive bladder cancer.

Prof. Brausi chairing the well-attended ESU course on Urothelial cancer

Dr. Rajesh Nair speaking on diagnosis and management of NMIBC

Language was not a barrier. Participants listened to interpreters via their headsets.

Dr. Rajesh Nair (GB) spoke about diagnosis and intravesical management for non-muscle invasive bladder cancer. His second talk covered chemotherapy and immunotherapy for advanced and metastatic bladder cancer.

feedback from participants and would like to share how they feel about the ESU course in Kyiv. Dr. Oleksandr Stakhovskyi (UA), a member of the EAU who recently returned from the 34th Annual EAU Congress in Barcelona, wrote a long post on his popular Facebook page @ ostakhovsky:

The participants, local oncourologists, were excited about the interesting, interactive case presented by Dr. Sophia Semko (UA) and discussed about treatment strategies with the ESU speakers. ESU brings international experts together Prof. Eduard Stakhovsky (UA): “We definitely use the international standards and the most effective approaches both in terms of health and economy. The ESU brings international experts together to help put the latest developments that are emerging in the world into practice. On behalf of the Ukrainian Oncourological Society and the National Cancer Institute, I would like to thank the ESU and the EAU for sharing their valuable knowledge and contributing to the professional growth of Ukrainian doctors. We hope this course will improve patient care and increase professional knowledge of our congress participants”. Social media posts We found several posts on social media with

“Professor Brausi is a real celebrity in Italian, European and world oncological urology. Honorary member of the EAU, author of hundreds of peer reviewed scientific articles that moulded the guidelines and treatment standards for major urological oncology malignancies. Since 2009, he has been working with the ESU and this brought him to Kyiv where he participated in the VIIIth International Congress of the Ukrainian Oncourological Society. Despite the numerous awards and nominations he received, Prof. Brausi remains very active in the OR, keeps on teaching residents and fellows and shares his experience with everybody who is interested. If there were more people like him we may be able to bring our fight with cancer to a good end. I am very happy to have such a contact and look forward to our future collaboration”.

Prof. Stakhovsky with the faculty members

Dr. Maksym Sabadash (UA) on his Instagram account: “Course organised by the ESU about bladder cancer, part of the VIIIth International Congress of the Ukrainian Oncourology Society. Speakers Profs. Maurizio Brausi from Italy and Rajesh Nair, M.D. from Great Britain”. Dr. Oleksandr Lychkovsky (UA) posted a photo on Facebook of himself, his colleague and the certificate of the ESU course. Dr. Maichuk Dmytro (UA): “Interesting reports, new knowledge, meeting colleagues”. Dr. Oleg Kushnir (UA): “An interesting and rich programme, a nice format, a meeting of leading urologists. Thanks to the organisers of the ESU (#ESU) we had the opportunity to listen to lectures of leading European oncology surgeons Profs. M. Brausi and R. Nair. And to experience how many Ukrainian doctors are committed to their cause. We will go forward and reach new heights!” By the Ukrainian Oncourological Society www.souu.org.ua, info@souu.org.ua @SOUUpage, @souu.oncouro.ukraine .

Report

BPO masterclass features minimally-invasive techniques Testimonials from delegates and programme overview By Erika De Groot Benign prostatic obstruction (BPO) requiring surgical intervention is one of the most prevalent urological diseases. The European School of Urology (ESU) together with the EAU Section of Uro-Technology (ESUT) organised the 4th ESU-ESUT Masterclass on Operative Management of BPO to offer updates on transurethral resection of the prostate (TURP) and several minimally-invasive alternatives. In this article, various perspectives from some of the delegates were collated to paint a picture on how the masterclass benefitted them, the skills they acquired, and their personal highlights. Reasons for applying “I'm a Romanian fellow working in France with residency accomplished in multiple centres in these two countries. This has enabled me to gain familiarity with various approaches and surgical techniques for BPO. I applied to the masterclass to stay up-to-date with the latest urological developments and its scientific programme perfectly matched my needs,” stated Dr. Vasile Buda (FR). He added, “The programme line-up included theoretical presentations with an EAU Guidelines review; and hands-on training to get insight on various techniques and/or to perfect one’s skills on simulators for transurethral resection, Holmium Laser Enucleation of the Prostate (HoLEP) and Greenlight laser vaporisation. The live and semi-live surgeries moderated and presented by some of the greatest names in the EAU. What more can I ask for? So I applied.” “The beauty of the masterclass is that within two days, all aspects of BPO management were covered. It was so comprehensive that it includes details from June/July 2019

live surgeries with all techniques; semi-live surgery with simultaneous comments from the experts; theoretical sessions; and hands-on-training on different models with mentorship. These were the reasons why I joined,” said Dr. Othman Al-Zaidy (IQ). “I decided to participate in this masterclass because I wanted to learn the novel approaches to the operative management of BPO: On what to do and how to do it. I wanted to boost what I know all in one place at one time under the guidance of leading experts in the field,” shared Dr. Bohdan Bidovanets (UA). Techniques learned and skills acquired Dr. Al-Zaidy said, “I’ve learned about the bipolar mechanical enucleation of the prostate. This procedure is cost-effective as no laser machine is needed. One can resect the prostate after enucleation without the need for a morcellator. I also learned about the UroLift procedure during the masterclass as well.”

which are feasible for patients not suited for general anaesthesia, there is prostatic artery embolisation which reports an improvement in International Index of Erectile Function (IIEF). The latter may offer good results but is a challenging intervention even for experienced radiologists.” Dr. Buda said during the masterclass, he discovered that aqua-ablation and Rezum (NxThera Inc) both show good results and the claim about their position in the armamentarium of BPO treatment is justified. Personal highlights and conclusions “For me, the most prominent highlights of the masterclass were the newest UroLift and iTIND techniques, and the operative management of BPO along with use of antiaggregants/anticoagulants,” stated Dr. Bidovanets. “In my opinion, this well-organised masterclass had multiple highlights. I was very interested in

its focus on prostate enucleation techniques. I also graduated from a formation programme on HoLEP and I intend to implement it in my clinical practice. The variety of enucleation techniques (e.g. en bloc, 3 lobs, done with holmium laser, Greenlight laser or with bipolar) caught and held my attention. There were a lot of possibilities demonstrated so that our patients can benefit from enucleation advantages. This really motivated me and highlighted a relevant point: HoLEP is becoming gold standard for surgical management of BPO,” stated Dr. Buda. “The masterclass was designed to provide optimal results and was elegantly executed; it resolved any confusion or questions one might have,” shared Dr. Al-Zaidy. The masterclass helped me further understand the possible complications and how to manage them efficiently. My special thanks to the ESU and to the team of local organisers.”

“I was interested in all the techniques featured during the masterclass,” disclosed Dr. Bidovanets. “However, what attracted me the most was the endoscopic enucleation. Coming back from this masterclass, I aim to implement this effective method in my clinical practice.” Dr. Buda stated that during the masterclass, he learned that laser vaporisation remains an attractive alternative to TURP especially for its low-bleeding risk on patients receiving antiplatelet and anticoagulant therapy. He added, “I’ve also learned about surgical treatments for BPO such as UroLift and the temporary implantable nitinol device (iTIND) which offer a considerably improved I-PSS (International Prostate Symptom Score). Aside from these two procedures

Dr. Bidovanets fine-tunes his skills

European Urology Today

www.esuerectile19.org

www.esukidneytransplant19.org

ESU-ESAU-ESGURS Masterclass on Erectile restoration and Peyronie’s disease

ESU-ESTU Masterclass on Kidney transplant 24-25 October 2019, Madrid, Spain An application has been made to the EACCME® for CME accreditation of this event

3-4 October 2019, Leuven, Belgium An application has been made to the EACCME® for CME accreditation of this event

www.esulasers19.org

www.esufocal19.org

ESU-ESUT Masterclass on Lasers in urology

ESU-ESUT-ESUI Masterclass on Focal therapy for localised prostate cancer

21-22 November 2019, Barcelona, Spain An application has been made to the EACCME® for CME accreditation of this event

28-29 November 2019, Paris, France An application has been made to the EACCME® for CME accreditation of this event

European Urology Today

June/July 2019

Test your knowledge on MIBC, NMIBC and PUC New ESU e-courses as current Guidelines refresher By Erika De Groot

(MIBC), non-muscle invasive bladder cancer (NMIBC), and primary urethral carcinoma (PUC).

Give your knowledge a boost through three new e-courses courtesy of the European School of Urology (ESU): EAU Guidelines on MuscleInvasive and Metastatic Bladder Cancer, EAU Guidelines on Non-muscle Invasive Bladder Cancer, and EAU Guidelines on Primary Urethral Carcinoma. Through e-courses such as these, the ESU provides vital up-to-date information to urologists and residents on a global scale. In line with the latest EAU Guidelines, these e-courses are developed by urologists from all over Europe and supported by the e-learning specialists of the EAU. The new e-courses will test your knowledge on muscle-invasive and metastatic bladder cancer

The e-courses are divided into multiple Learning Modules. Each module is made up of multiple-choice questions. To choose the right answer per question, you are encouraged to navigate to corresponding chapters in the EAU Guidelines. This way, you will review the most recent guidelines, learn about the essentials in patient treatment, and test your knowledge at the same time. The three e-courses are available in English. Completion of each e-course will take approximately 60 to 90 minutes to complete. It is mandatory that you answer the questions in the final assessment. A passing grade of 80% and above will guarantee you accreditation of one (1) European CME credits (ECMEC®) per e-course.

You can stop anytime during the course if needed. To pick up where you left off, simply log-in again to proceed with the remaining questions. Boost your expertise, take an e-course (or all three) now! Try other e-courses and gain more CME credits Interested in enriching your knowledge further and accumulate CME credits? The ESU offers other highly-informative e-courses with topics ranging from urolithiasis, men’s health, metastatic prostate cancer, renal cancer and more! Visit the ESU e-courses webpage https://uroweb.org/education/online-education/ e-courses/ for more information.

EAU Guidelines on Muscle-Invasive and Metastatic Bladder Cancer Publication date: June 2019 Learning Module 1: Etiology and imaging Learning Module 2: Treatment Duration: Approx. 60 – 90 minutes

EAU Guidelines on Non-muscle Invasive Bladder Cancer Publication date: March 2019 Learning Module 1: Clinical Aspects Learning Module 2: Diagnostic evaluation and prognosis Learning Module 3: Treatment Duration: Approx. 60 – 90 minutes

EAU Guidelines on Primary Urethral Carcinoma Publication date: January 2019 Learning Module 1: Epidemiology Learning Module 2: Diagnosis Learning Module 3: Management Duration: Approx. 60 – 90 minutes

Welcome page of PUC e-course’s first module

EAU Edu Platform

ESU Guidelines Course Group

The online learning platform for Lower Urinary Tract Symptoms

Thank you, Olivier!

This golden team develops e-courses for the ESU in cooperation with the E-course Manager, Nan Li, MSc.

For eight productive years, Prof. Olivier Traxer dedicated his expertise and served as a valued member of the ESU Board. He was active and committed in organising and offering ureteroscopy training.

For ideas and suggestions for future e-courses, please contact the ESU at educationonline@uroweb.org

Dr. Henk Van Der Poel, Chair Netherlands Cancer Institute, The Netherlands

Together with the ESU, he was integral in developing the UROBESTT programme where he will remain as one of its esteemed contributors. His tremendous contribution to the ESU will always be appreciated.

Dr. Nikolaos Grivas General Hospital of Ioannina G. Hatzikosta,Ioannina, Greece

Dr. Tom Marcelissen Maastricht UMC+, The Netherlands

uroluts.uroweb.org

Dr. Panagiotis Kallidonis University Hospital of Patras, Greece

Take your knowledge to the next level

June/July 2019

European Urology Today

ESU Event Calendar Date

Event name

15-17

ART in Flexible - Step 1

Location

JULY 2019 Berlin (DE)

SEPTEMBER 2019 6-11 17th European Urology Residents Education Programme (EUREP) 11-13 ESU-ERUS courses during the 17th Meeting of the EAU Robotic Urology Section (ERUS) 21 ESU course on Modern BPH surgery and Endourology (PCNL and RIRS) during the national congress of the Russian Society of Urology

Prague (CZ) Lisbon (PT) Rostov-on-Don (RU)

www.esunmibc20.org

ESU-ESOU Masterclass on Non-Muscle-Invasive Bladder Cancer 20-21 February 2020 Prague, Czech Republic

OCTOBER 2019

An application has been made to the EACCMEÂŽ for CME accreditation of this event

2 ESTs1 during the 5th Meeting of the EAU Section of Milan (IT) Urolithiasis (EULIS) 2-5 6th ConfederaciĂłn Americana de Urologia Residents Buenos Aires (AR) Education Programme (CAUREP) 3-4 ESU-ESAU-ESGURS Masterclass on Erectile restoration Leuven (BE) and Peyronie's disease 4 ESU course on The treatment of muscle-invasive bladder Tbilisi (GE) and metastatic bladder cancer during the Caucasus Central Asia meeting 10 ESU course on New challenges and unmet needs in Porto (PT) basic science and histopathology to address the clinical management of renal malignancies during the 26th Meeting of the EAU Section of Urological Research (ESUR) 11 ESU course on Update on prostate and bladder cancer Antalya (TR) during the national congress of the Turkish Urological Association 11-12 3rd EAU Update on Prostate cancer (PCa19) Prague (CZ) 10-11 ESTs2 during SET-UP Programme Bangkok (TH) 12 ESU course on Prostate cancer during the national Eger (HU) congress of the Hungarian Urologic Association 17 ESU course on Controversies on the treatment of Prague (CZ) urological tumours during the national congress of the Czech Urological Society 24-25 2nd ESU-ESTU Masterclass on Kidney transplant Madrid (ES) 31- 1/11 ESU-ESFFU Masterclass on Functional urology at the Prague (CZ) European Lower Urinary Tract Symptoms meeting (ELUTS19)

NOVEMBER 2019 11 ESU course on Prostate and bladder cancer; Insight into Tashkent (UZ) research and lecturing during the national congress of the Scientific Society of Urologists of Uzbekistan 14-17 ESU courses on Oligometastases in Genito urinary Vienna (AT) cancers and Immunotherapy for urological tumours during the 11th European Multidisciplinary Meeting in Urological Cancers (EMUC) 20 ESU course on Urolithiasis during the national congress Baghdad (IQ) of the Iraqi Urological Association 21-22 6th ESU-ESUT Masterclass on Lasers in urology Barcelona (ES) 23 ESU course on Prostate cancer imaging during the Vilnius (LT) national meeting of the Lithuanian Association of Urology 27-28 SEAREP Manila (PH) 27-30 E-BLUS during the Philippine Urological Association Manila (PH) (PUA) 60th Annual Convention 28-29 4th ESU-ESUT Masterclass on Focal therapy for Paris (FR) localised prostate cancer

www.urobestt.org

16-18 April 2020, Berlin, Germany

DECEMBER 2019 3-5 ART in Flexible - Step 2 Berlin (DE) 4 ESU course on Endourology during the national congress Cairo (EG) of the Egyptian Association of Urology 6 ESU course on Kidney cancer and the infertile couple Algiers (DZ) during the national congress of the Algerian Association of Urology

Application deadline: 1 February 2020

JANUARY 2020 17-19 ESU course during the occasion of the 16th meeting of the EAU Section of Oncological Urology (ESOU)

Dublin (IE)

FEBRUARY 2020 10-13 Hands-on training skills programme on Laparoscopy and Endourology 20-21 ESU-ESOU Masterclass on Non muscle invasive bladder cancer

Caceres (ES) Prague (CZ)

MARCH 2020 20-24

35th Annual EAU Congress

Amsterdam (NL)

APRIL 2020 16-18

URO Berlin Skills Teaching and Training (UROBESTT)

European Urology Today

Berlin (DE)

June/July 2019

Japanese Tour 2019 Academic Exchange Programme Programme improves knowledge and skills with an eye for culture Dr. Véronique Phé University Hospital La Pitié-Salpêtrière Dept. of Urology Paris (FR)

phe.veronique@ gmail.com

Dr. Marco Moschini Luzerner Kantonsspital Dept. of Urology Luzern (CH)

marco.moschini87@ gmail.com

From 7-20 April, we were given the opportunity to participate in the international exchange programme between the European Association of Urology (EAU) and the Japanese Urological Association (JUA). The exchange programme represents a unique opportunity to visit hospitals and urological departments in different Japanese cities but also to explore the Japanese culture and to make new friends and collaborations. The time we spent in Japan was an amazing experience and we enjoyed the legendary hospitality of our hosts. Visit to Niigata (7 - 10 April) I (Marco) started the first part of the trip alone since Véronique was planned to join me later in Tokyo. After a long flight with stops in Hong Kong and Tokyo, I finally arrived at Niigata airport at 19.00 where Dr. Masayuki Tasaki (Niigata University (JP)) picked me up and brought me to my hotel. At 19.45 I had the pleasure to meet Profs. Yoshihiko Tomita and Kazuhide Saito (Niigata University (JP)) with part of their team for an informal dinner. I had the opportunity to experience a traditional Japanese restaurant and to learn everything about sake (how to drink it, how to pour it, differences in taste or composition). The day after I participated in the morning conference by discussing a complex kidney tumour case with residents and medical students. Thereafter, I had the opportunity to visit the department and the outpatient clinic. Finally, I attended a robot-assisted radical prostatectomy perfectly performed by Prof. Tomita. It was great to share his interesting approach of using TRUS identification of the bladder neck during the procedure. I was also very surprised that a medical student was taking notes during the surgery in order to make a final report of any problems requiring further training in specific parts of the procedure. The day after, I did the morning round and I was impressed by the Japanese system. The normal

urological tasks do not only include the administration of chemotherapy/immunotherapy and management of patients who received a transplant, but also the delivery of a brachytherapy and sometimes even performing spinal anaesthesia when the anaesthesiologists are not available. Thereafter I had the opportunity to see the research activities of the department and to meet medical students to discuss about differences in work and life between Europe and Japan. A real exchange is not only about urology: I also enjoyed a guided tour in a sake factory in an old Japanese mansion. The visit ended with dinner in a traditional Japanese restaurant with the entire team. This was another great example of the warm hospitality of our Japanese friends. Visit to Tokyo (10 - 14 April) A bullet train (Shinkansen) took me from Niigata to Tokyo for the next part of my visit. Véronique was unfortunately blocked in Doha (Qatar) for 24 hours and missed the connecting flight. At 16.00 Dr. Soichiro Yoshida picked me up at the hotel and brought me to meet Prof. Yasuhisa Fujii (Tokyo Medical and Dental University Graduate School (JP)) in his office where I received a warm welcome and an illustrated book explaining the gasless 3D laparoscopy, the ‘speciality of the

The authors at the JUA welcome dinner

Some 3D printing models

and several best poster prizes. We were asked in return to present some work of our own. Marco presented the risk of harbouring secondary bladder cancer tumour after the treatment of primary prostate cancer and Véronique the artificial urinary sphincter robot-assisted approach. Over dinner we could exchange views on work and life in Japan and Europe with the entire team.

The final day During the final day at the hospital, we observed 2 robot-assisted radical prostatectomies performed by Dr. Kusaka and Dr. Takahara. In the evening, we attended dinner organised by Prof. Tomohiko Ichikawa, president of the 107th JUA Annual Meeting meeting. Véronique wore a beautiful kimono, a fundamental part of the cultural exchange.

During the weekend, we could enjoy the sakura (cheery flower blossom) and a training of Rikishis (sumo fighters).

“We started early in the morning by participating in the oncourological meeting with brilliant case presentations and active discussions.”

Visit to Nagoya (14 - 20 April) A bullet train took us to Nagoya, to the Marriot hotel, located at the top of the train station, with a bar on the 52th floor and a fantastic view over the city. Nagoya is the third largest Japanese city and is famous for the Toyota car factory. Dr. Naohiko

house’. Then we went to the operating room to observe a gasless laparoscopic partial cystectomy, part of their famous tetramodality approach for bladder cancer. The procedure was worth seeing thanks to the use of the 3D glasses, a futuristic and very useful instrument. The day ended with an informal dinner in a traditional restaurant with various chicken specialties and a visit of the local shrine with Prof. Fujii and part of his team. The day after Véronique finally arrived. We started early in the morning by participating in the oncourological meeting with brilliant case presentations and active discussions. Thereafter, we attended a partial nephrectomy performed with the gasless technique. Ongoing research projects The most important ongoing research projects by Prof. Fujii’s team were then presented with a highlight on several important articles published by our hosts. The local team is very active with about 10 presentations per year at EAU meetings

Meeting with Prof. Fujisawa, JUA President (front row, middle), our Japanese hosts and Profs. Gratzke and Alcaraz.

June/July 2019

We observed a gasless 3D partial nephrectomy through 3D glasses

We could attend the JUA annual meeting with many lectures from overseas during international sessions. We had the opportunity to meet Prof. Masato Fujisawa (JUA President), all our hosts and Prof. Antonio Alcaraz (University Hospital Clínic de Barcelona (ES)) and Prof. Christian Gratzke (Uniklinik Freiburg (DE)). In the ceremony we received our certificates. The JUA meeting was amazing, since it brought together 8,000 urologists. We were invited to give lectures during the congress. Marco did a presentation on the role of surgery in non-localised bladder cancer and Véronique on continent urinary diversion. In conclusion, this experience gave us the opportunity not only to visit a foreign country and active departments of urology in Japan but also to make new friend among Japanese colleagues.

We received a warm welcome in Tokyo from Prof. Fujii

Fukami picked us up at the hotel and drove us to Prof. Sasaki, one of the two female professors of urology in Japan at the Fujita Health University School of Medicine. She introduced us to Prof. Ryoichi Shiroki, chief of the department. Then we attended a RARP perfectly performed by Prof. Makoto Sumitomo, followed by a hospital tour with Dr. Kiyoshi Takahara (Fujita Health University School of Medicine (JP)). The day after, Prof. Mamoru Kusaka picked us up at the hotel and showed us the 3D printing technique for kidney tumours and transplants. We had the opportunity to meet the president of the university, Prof. Kiyotaka Hoshinaga, the former chief of the urological department and currently in charge of the management of the entire university of Nagoya. Subsequently, we attended a robotassisted retroperitoneal partial nephrectomy. At the end of the day we were invited to give a lecture to the team: Marco discussed the impact of bladder cancer on patients affected by other previous cancer diagnoses and Véronique robot-assisted supratrigonal cystectomy with augmentation cystoplasty. All this was accompanied by an excellent bento (lunch) box.

We thank everyone involved in the organisation of this event and especially the EAU for giving us this marvellous opportunity. We hope to see our friends again and to continue a fruitful collaboration with them.

The famous sakura blossom

European Urology Today

Where in the world.... A recap of the EAU's presence around the world The EAU membership is a gateway to more opportunities to boost one’s know-how and skills, and to connect urologists and healthcare professionals from around the world. To encourage knowledge-sharing, the EAU develops and maintains close relations with national urological societies throughout Europe.

In the past two months, the EAU was present with lectures, courses, and hands-on training in numerous events, and organised meetings and masterclasses all over Europe and beyond, as seen in the map below. To find out where our Membership Office will be present with a booth, check out www.uroweb.org/membership/meet/.

Reykjavic, Iceland

Glasgow, United Kingdom Rotterdam, Netherlands

Chicago, Illinois, USA

Talinn, Estonia

Astana, Kazakhstan

Arnhem, Netherlands

Prague, Czech Republic Heilbronn, Germany Vianna, Austria Salzburg, Austria Turin, Italy Bucharest, Romania Belgrade, Serbia Bilbao, Spain Sandanski, Bulgaria Patras, Greece Athens, Greece

Dutch Association for Urology (NVU) Spring Meeting 2019

Tehran, Iran Casablanca, Morocco

24. Kongres Udruženja Urologa Srbije

AUA 2019 Annual Meeting Bangkok, Thailand

LXXXIV Congreso Nacional de Urología. Photo by Dr. Luis Enrique Ortega Polledo (ES)

Due to space constraints the following meeting locations are only represented by a bullet: Bologna (IT), Chisinau (MD), Katowice (PL), Kyiv (UA), Martin (SK), Pristina (KS)

Newly-appointed Prof. Bernard Malavaud (FR), Co-Chairman of the EAU Membership Office, visits the EAU headquarters.

SYMPOSIUM

Maastricht, The Netherlands, 10 October 2019

POSIUM

Urologists with an interest in the past of their field, as well as a curiousity about the future can look forward to FutUrology, a day-long symposium that will be held in Maastricht (NL) this autumn.

Urology:

FutUrology is organised to coincide with Prof. Philip Van Kerrebroeck's retirement from the Maastricht University Medical Center. As Chairman of the EAU History Office, the invited international speakers at the symposium reflect his own career and his ongoing position on the EAU Board. The speakers will address a large variety of topics, including oncology, female urology and neuro-urology, each looking at that subject's past, present or future.

09.30 - 10.15

Session I: Oncological Urology and Urological Oncology Chair: Joep Van Roermund Speakers: Past: Roman Sosnowshi (Warsaw) Present: Manfred Wirth (Dresden) Future: Peter Mulders (Nijmegen)

Present, and Future of Urology

10.15 - 11.00 Session II: Female Urology and Uro-Gynaecology Chair: Gommert Van Koeveringe Speakers: Past: Jonathan Goddard (Leicester) Present: David Castro-Diaz (Tenerife) pt. of Urology Interested of the Maastricht UMC+ and via theMs. History Urology parties can register NancyOffice Logjesof the European Association Future: Helena Van Kerrebroeck (Genk) (n.logjes@mumc.nl) before 15 September. 150 seats are available and attendance is free of charge. 11.00 - 11.45 Session III: Male Urology and Uro-Andrology Chair: Tom Marcelissen Speakers: Scientific Programme Past: Dirk Schultheiss (Giessen) Present: Paul Abrams (Bristol) 09.00 - 09.15 Opening and opening remarks Future: Chris Chapple (Sheffield) by Gommert van Koeveringe, chairman dept. of Urology, Maastricht UMC+ 11.45 - 12.30 Session IV: Paediatric Urology and Uro-Paediatrics 09.15 - 09.30 Opening Lecture Chair: Piet Callewaert Prostate biopsies: to do or not to do? Speakers: That’s the question! Past: Jens-Peter Nørgaard by Peter Thompson, Hunter Professor of (Copenhagen) Urology, London. Present: Rien Nijman (Groningen) Future: Piet Hoebeke (Ghent)

12.30 - 13.30

Lunch

13.30 - 14.15 Session V: Neuro-Urology and Uro-Neurology Chair: Desirée Vrijens Speakers: Past: Sajjad Rahnama’i (Aken) Present: Emmanuel Chartier-Kastler (Paris) Future: Carlos D’Ancona (Sao Paulo) 14.15 - 15.00 Session VI: Endo-Urology and Benign Minimal Invasive Urology Chair: Elmer Francisca Speakers: Past: Rob Schipper (Den Bosch) Present: Jean De La Rosette (Istanbul) Future: Koen van Renterghem (Hasselt) 15.00 - 15.15

Closing Lecture FutUrology: past, present and future! by Frans Debruyne, past Secretary General European Association of Urology, Arnhem.

15.15 - 15.20

Closing remarks and closure by Gommert van Koeveringe, chairman Department of Urology, Maastricht UMC+

For information and registration please contact Ms. N. Logjes at n.logjes@mumc.nl. Limited places available!

Organised by the Department of Urology of the Maastricht UMC+ and the History Office of the European Association Urology

European Urology Today

June/July 2019

Turin hosts successful second edition of BCa Update Special live surgery session attracts international surgeons Prof. Paolo Gontero University of Turin Dept. of Urology, Surgery Turin (IT)

paolo.gontero@ unito.it On 17-18 May, Turin hosted a successful second edition of BCa19 in the Lingotto Congress Centre, a structure designed by Renzo Piano as a refashioning of an old FIAT factory. Two hundred and eighty delegates and faculty took part in two full days entirely devoted to bladder cancer. Lectures were designed to provide an update on key aspects of modern management of the disease, always keeping in mind a strong link to clinical practice. This task was also accomplished in arduous topics such as molecular staging (E. Comperat (FR)), genomic approaches (F. Liedberg (SE)), variant hystologies (P. Black (CA), S. Shariat (AT)) and urinary markers (L-M. Krabbe (DE)), admirably brought from bench to the bedside. Clinical case scenarios represented the core of the meeting, either in the more traditional format of a multidisciplinary panel case discussion (F. Soria (IT)) or as a guide for group discussions. In the latter case, hot and controversial topics such as techniques and new methodologies of visualisation for TURBT (M. Babjuk (CZ), A. Breda (ES), B. Malavaud (FR), J. Dominguez-Escrig (ES)), template of lymphadenectomy (M. Babjuk, F. Witjes (NL)), choice of urinary diversion (M. Ribal (ES), A. Stenzl (DE)) or techniques for cystectomy (open versus robotic – P. Gontero, J. Palou) were addressed as case discussions between the faculty and attendees divided into 3 subgroups in order to foster interactive discussion.

The outstanding lectures by A. Bossi (IT) on trimodal therapy, A. Necchi (IT) and T. Powles (GB) on the latest developments in oncological care and R. Faletti on MRI staging of bladder cancer superbly enriched the multidisciplinary intent of the meeting.

effort was made by the EAU that allowed an incredibly affordable total price of €200 for registration for the meeting including two nights’ stay at the congress hotel.

17-18 May 2019 Turin, Italy

Live surgery event A unique aspect of the meeting was the live surgery event that was organised by the Division of Urology, chaired by me at the Auditorioum of Molinette Hospital, an Academic Institution of the University of Studies of Turin. A wide range of surgical procedures specific to urothelial cancer were performed in three of the Urological theatres that were simultaneously connected with the Auditorium. In Theatre 1, M. Babjuk and F. Witjes presented 2 different ways to perform a TURBT for a papillary tumour (en-bloc resection) and a multifocal high-risk bladder cancer (TURBT with PDD) respectively, discussing the aims and principles of the 2 difference approaches. Subsequently, A. Breda presented the modern conservative management of a 2 cm primary pelvic papillary lesion using the Cellvizio and a combination of Thulium and Holmium laser to achieve a successful complete ablation. In Theatre 2 a nerve-sparing open radical cystectomy (A. Stenzl ) with an “N” neobladder (H. Van Poppel (BE)) took place while a robotic nerve sparing cystectomy (J. Palou) with an intracorporeal VIP neobladder (M. Gallucci (IT)) was ongoing in theatre 3. Notably, the urinary diversion part of both procedures took place at the same time, thus providing a unique show for the enthusiastic audience. The steering and the scientific committee have primarily designed BCa19 as a highly educational event for clinicians (urologists as well as nonurologists) that intend to update their clinical knowledge in the field of urothelial cancer. Two full days of intense work and no room for sponsored sessions. On top of that, a significant investment

Profs. Stenzl and Palou open proceedings on the first day

Close to 300 people came to Turin for the BCa update

Prof. Gontero leads the discussion in the room

Breakout sessions for case discussions are a hallmark of the EAU's oncology updates

Prof. Stenzl was also one of the surgeons on the separate live surgery event

Paul Van Cangh

Ambitious, talented urologist and family man 1943 - 2019 On 14 April 2019, Prof. Paul Van Cangh, an excellent urologist who was loved very much by his patients, passed away. He is survived by his wife Dominique, their children Christophe, Caroline and Sophie and seven grandchildren.

(which was held in English). He promoted uniformity through a European standard of urology and for some years, he was the Belgian representative in the European Board of Urology. But in the first place, Paul Van Cangh was a family man who loved his wife, children and grandchildren. Many of us know his wife Dominique since she joined him at most congresses. Around the year 2000, at the beginning of the digital information era, he showed a projection from his computer and said proudly: “I don’t know anything about these new techniques, but my daughter made the statistics and the pictures”.

Prof. Van Cangh was born in Brussels (BE) on 14 August 1943. He became a medical doctor at the Université Catholique de Louvain (BE) in 1967 where he started his specialisation in surgery which he continued at Harvard University in Boston (US). When he returned to Belgium he started as a resident in urology at the Université Libre de Bruxelles (Prof. Grégoir). Later he worked in Paris (FR) and at the University of California in Los Angeles (US). He was nominated consultant at the transplantation unit of the university clinic of the Université Catholique de Louvain. In 1982, he succeeded Prof. J. Brenez as head of the Urology Department at the Clinique Universitaire Saint Luc (part of the Université Catholique de Louvain). In 2001, he became Professor of urology at the UCL. When he was young, he had a small moustache and a pointed beard and with his lovely smile he resembled Professor Calculus from Tintin. He received multiple scientific distinctions and honorific awards, such as the EAU’s Willy Grégoir Medal of the EAU in 2009 and the Karl Storz Lifetime Achievement Award in Endourology from the World Society of Endourology. He was nominated titular member of the Royal Academy of Belgium in 2006 after having the honour of becoming a foreign member of the Académie Nationale de Chirurgie de Paris in 2005.

June/July 2019

Prof. Paul Van Cangh was an excellent speaker and (co-)author of multiple publications in the field of uro-oncology, urolithiasis and minimally-invasive endourology. He was also a very active member of the EORTC. From 1996 to 2004, he was member of the EAU Scientific Committee and contributed greatly to the quality and content of the Annual EAU Congress. He was also famous for the radical prostatectomy he performed, together with Patrick Walsh (Johns Hopkins, Baltimore (US)), on the Belgian King Baudouin on 23 August 1991. Paul Van Cangh was ambitious, since ambition is enthusiasm with a purpose. He was also a perfectionist, especially as a surgeon. He always felt there was room for improvement. A hard worker and

an example of discipline and honesty for his colleagues and residents. But on top of that, he was also an excellent teacher: a ‘vrai maître’ as they say in French. He liked to teach his residents everything he knew. When a famous foreign urological professor visited his department, all residents and staff were invited for an informal meeting in the attic of his house. Van Cangh was a man with a vision who organised many meetings and congresses. When he was president of the French-speaking Société d’Urologie in Belgium he united the association with the Dutch speaking Belgische Vereniging voor Urologie, which resulted in the yearly Belgian Urological Congress

Paul was a loyal friend. I had the pleasure of discovering some parts of the world with him and Dominique. In a canoe on the Zambezi river, he was attacked by a hippo. In Guatemala we went on an adventurous expedition by horse to discover some unexplored pre-Columbian temples and in Zanskar we visited Buddhist monks and herbalists at an altitude of 4,000 meters in the Himalayas. After he retired he planned to organise several missions to surgical and urological departments in developing countries to introduce minimallyinvasive surgery. But alas, it did not turn out the way he hoped. It started with a broken vertebra and he ended in a wheelchair. A very painful situation for such a brilliant man, but he never complained. He was a man with an open mind and a warm heart, an excellent teacher, a good doctor and a close friend to many. He will be greatly missed. Dr. Johan J. Mattelaer EAU History Office

European Urology Today

2019 EAU/JUA Resident Programme Report Japanese doctors' impressions of the 34th Annual EAU Congress Dr. Teruaki Sugino Nagoya University Graduate School of Medicine, Dept. of Nephrourology Nagoya (JP) suginot@med. nagoya-cu.ac.jp

As a part of the JUA / EAU (Japanese Urological Association/European Association of Urology) Resident Programme, I visited the Annual EAU Congress held in Barcelona, Spain, from 15 to 19 March 2019. It was the second time I participated in the EAU Congress and I entered the venue with high expectations and somewhat tense. I was overwhelmed by the scale, the excitement and the enormous amount of content and I realised how great it was to participate in this conference again. Resident programme As part of the Resident programme, the EAU and JUA assisted us with the registration fee and the cost of accommodation. We were given the opportunity to participate in the joint session with JUA, the opening ceremony and the resident’s dinner. In the joint session with JUA, active discussions

about the treatment strategy for kidney cancer and prostate cancer were held, from which I learned a lot. At the opening ceremony and resident dinner, I had the opportunity to interact with Dr. Hiroshi Shimura from Nagakubo Hospital (JP) and Dr. Juntaro Koyama from Tohoku University (JP), who participated in the same programme. We talked about clinical and basic research and were motivated by each other. Moreover, we had the chance to talk to doctors from overseas, which we enjoyed. I prepared two presentations for the conference; one about the basic research I am conducting (“β3 stimulant contributes to the prevention of renal crystal formation via differentiation of beige adducts”) and the other about clinical research, "Ureteroscopic assistance contributing to safer renal puncture during endoscopic combined intrarenal surgery". I was honoured to win the Best Poster Award for basic research, which greatly motivates me to continue my work.

spent his teenage years. I had the chance to visit the Picasso Museum in the Gothic quarter of Barcelona. His colourful and unique works touched my heart. The Spanish food is famous for small dishes (tapas) and paella served in Spanish style. Although their taste is probably a little bit strong for Japanese people, I found them to be delicious and they go great with beer. It was a life-changing experience for me to come into contact with Spanish culture as well as being able to join the international conference. I intend to make good use of this experience in daily clinical practice and research. Last but not least, I would like to thank Dr. Yoshihiko Tomita, International Chairperson of the Japan Urological Association, and the members of the European Urological Association who gave me this great opportunity, Prof. Takahiro Yasui of Nagoya City University Graduate School of Medical Sciences, who recommended me to apply for this programme, and all other people involved.

Works by Gaudí The many works designed by Antoni Gaudí are a great tourist attraction in Barcelona. I visited the Sagrada Familia, the Park Guell, Casa Mila and Casa Batllo buildings, all recognised as World Heritage Sites. I was really attracted by Gaudí's works, with their shapes inspired by the natural world and their use of vivid colours as well as unique motifs. Barcelona is also known as the place where painter Pablo Picasso

Dr. Juntaro Koyama Tohoku University Graduate School of Medicine Dept. of Urology Sendai (JP) juntarokoyama@ gmail.com I am thankful for the invitation to the 34th Annual EAU Congress as part of the JUA-EAU resident programme. It is very exciting to join this meeting for an early-career urologist like me. It was my first time to attend the Annual EAU Congress, which was held in Barcelona, Spain. I was surprised by the great variety of sessions and the abundance of tips which will help our daily practice.

The author with his award winning basic research poster at the 34th Annual EAU Congress in Barcelona

Dr. Sugino visiting the famous Sagrada Familia

Expert-guided poster tours A session type I found particularly interesting was a session called “Expert-Guided Poster

Dr. Koyama with a colleague at the EAU congress venue in Barcelona

Tours”. This session covered a wide range of subjects from LUTS to Trials in progress and the chairmen summarised the topics in these areas. Compared to other sessions, it was easy to ask questions to the presenters and I learned a lot. I was happy to be invited to the Resident’s Dinner on the 2nd day of the meeting. It was a great pleasure to meet such nice residents from all over Europe. I also went to various tourist spots during my stay. Barcelona is a beautiful city with many historical buildings, and good food. I was touched by the history of Europe and the kindness of the people. I am very grateful to the JUA and EAU international committee members for inviting me to the Annual EAU Congress 2019. I will surely return to the EAU congress as a presenter.

7th Female Urology and Voiding Dysfunction Workshop Prof. Heesakkers Visiting Professor at UroAlex in Alexandria (EG) Dr. John Heesakkers Radboud University Medical Centre Dept. of Urology Nijmegen (NL)

john.heesakkers@ radboudumc.nl The Urology Department of the Alexandria University is a very active department that is continuously focused on offering the highest standard of care and training in their department. Under guidance of the Head of Department, Prof. Ashraf Koraitim, a continuous training programme was started in the recent past that covers every part of urology. All subspecialties are dealt with and many international renowned colleagues have been invited to participate in one of the programmes that are being organised. The Head of the Female Urology and Voiding Dysfunction Unit is Prof. Mohamed Shafik. His unit was responsible for the 7th Female Urology and Functional Dysfunction Workshop. The organisation was taken care of by the Head of the Scientific Programme Uroclub 2018-2019, Prof. Wael Sameh, and his team. The coordinators of the course were Assistant Prof. Moustafa Elmessiry, Assistant Prof. Ahmed Abulfotooh and Dr. Wally Mahfouz. The content of the workshop consisted of theoretical education as well as live surgery. The morning started with various lectures on functional urology topics that were lively discussed by the participants. It is heart-warming to experience so much interest from staff members as well as residents. The international European Urological Scholarship Programme Office

European Urology Today

esteem of the department is very obvious when you witness the profound discussions and valuable contributions. Programme The theoretical programme was as follows: Day 1, Saturday, 6 April 2019 Moderators. Prof. AbdelAziz Sabry Fayed, Prof. Mohamed Hassouna 1. Introduction (5 min) (08.30 - 08.35) 2. Neuroanatomy and neurophysiology of the urinary tract (20 min) (Prof. John Heesakkers) (08.35 – 08.55) 3. SUI in neurogenic patients (20 min) (Prof. John Heesakkers) (08.55 - 09.15) 4. Coffee break (20 minutes) (09.15 - 09.35) 5. Management of post-sling obstruction (20 minutes) (Assistant Prof. Moustafa Elmessiry) (09.35 - 09.55) 6. Is the microbiota important with respect to LUTS disorders (20 minutes)? (Prof. John Heesakkers) (09.55 - 10.15) OAB session (Saturday 6 April 2019 from 08.30 10.00) Presenter: Dr. Wally Mahfouz, Moderator: Prof. John Heesakkers Speakers: Prof. John Heesakkers, Dr. Wally Mahfouz 1. OAB: Prevalence and Diagnosis (30 minutes) (Prof. John Heesakkers) 2. How to prescribe medical treatment for OAB? (30 minutes) (Dr. Wally Mahfouz) 3. Case scenario (30 minutes)

2. ProAct. Ins and Outs (20 minutes) (Prof. John Heesakkers) (08.50 - 09.10) 3. Coffee break (20 minutes) (09.10 – 09.30) 4. Age, polypharmacy and OAB (20 minutes) (Dr. Wally Mahfouz) (09.30 - 09.50) 5. New developments in neuromodulation for OAB (20 minutes) (Prof. John Heesakkers) (09.50 10.10) After the morning sessions the workshops continued with live surgery sessions, for which Dr. Wally Mahfouz had selected some difficult referral cases that could serve as good examples for every urological referral centre. Referral cases Two patients were suffering from fistulae that were not caused by obstetric trauma; one occurred after hysterectomy and the other was the result of a train accident leading to a pelvic fracture among other things. The poor woman was lucky to be alive but suffered from continuous urinary loss caused by two urethravaginal fistulae and one vesicovaginal fistula. Because the woman was young and the tissues healthy it was possible to close all fistulae with a vaginal approach. Of course it remains to be seen

Day 2, Sunday, 7 April 2019 Moderators: Prof. Salah Elsalmy, Prof. Aly AbdelKarim 1. Development of positioning, results and complications of the AMS 800 through the years Dinner with other workshop faculty in the harbour of (20 minutes) (Prof. John Heesakkers) (08.30 – Alexandria (EG) 08.50)

what the outcome with respect to voiding and continence will be. The second fistula operation was in a patient that underwent a hysterectomy previously and could also be closed vaginally without major issues. The operating team proved very skilled and used to complex surgery. They did not get nervous easily and can stand as an example for skilled urology surgical practice, and so can the whole department. The social programme was very well organised and included visits to the famous sites of Alexandria, such as the new Library, the Citadel and the former Royal Palace. It was a pleasure to be in Alexandria in a department with capable colleagues, a pleasant and professional atmosphere and a wonderful city very rich of history and culture.

Dr. Heesakkers with Dr. Wally Mahfouz at the workshop

June/July 2019

ERUS Section co-organises first ‘ERUS in Asia Pacific’ World-renowned experts inspire Taiwanese participants with live surgery, lectures and courses Prof. Alex Mottrie Chair EAU Robotic Urology Section (ERUS) Aalst (BE)

Invaluable insights Given the rapid developments in the robotic field, we also invited experts in nursing care to share best practices in the OR to ensure patient safety as well as better team collaboration. This will also help reduce the learning barrier with regard to handling delicate instruments, the TruSystem surgical bed and the prevention of pressure ulcer by means of on-site demonstrations. This conference has helped to advance learning opportunities to build better teams and enhance quality of care in all aspects.

with a focus on robotic surgical refinement for urology and gynaecology, oncological treatment and different aspects of nursing care. The meeting consisted of a wide range of activities, including live surgeries, presentations by world experts as well as panel discussions led by field experts from Taiwan and around the world.

Renowned doctors On the first day, a teleconference with Dr. Vipul R. Patel from the US was scheduled, the discussion covered surgical techniques and tricks for robotic The ”ERUS in Asia Pacific 2019” conference was held prostatectomy. Dr. Vipul Patel has completed more at Tungs’ Taichung MetroHarbour Hospital from 11-13 than 12,000 robotic prostatectomy surgeries, making April in Taiwan. This is the first time an ERUS meeting him one of the most experienced robotic surgeons was held in Asia Pacific and Tungs’ Hospital was in the world. Dr. Patel published textbooks detailing honoured to be the first organisation to host a robotic urology surgeries and he is also the teacher meeting of the EAU Robotic Urology Section in this of Dr. Yen Chuan Ou, who is the first urologist to region. The Taiwan Urology Association, Taiwan perform over 2,000 cases using robotic surgery in Association of Obstetrics and Gynaecology, Taiwan Asia. Association of Gynaecologic Oncologists, Taiwan PeriOperative Registered Nurses Association, the EAU We have also had the honour to have Dr. Ketan K. and the Tung Chuang-Sheng Cultural Educational Badani, Professor of urology at Icahn School of Foundation made the International “ERUS in Asia Medicine at Mount Sinai, (US) and Prof. Alexandre Pacific” Conference possible. Mottrie, Director of the Urology Department at OLV hospital (Aalst, BE) join the conference. Excellent platform for innovation and inspiration The high scientific level of the meeting was achieved ‘Meet the Expert’ sessions by inviting over 30 world-renowned experts from The morning session consisted of “Robotic assisted more than 9 countries including the US, Belgium, laparoscopic radical prostatectomy” performed by Australia, China, Japan, Korea, Thailand, Malaysia, Dr. Badani, as well as a ‘Meet the Expert’ session Singapore, Hong Kong and Taiwan. In total, the presented by world-renowned experts including meeting covered more than 113 topics presented by Dr. Ketan K. Badani, Dr.Chun-Te Wu, Dr. Raji Kooner, over 100 moderators and speakers and attracted Dr. Koon Ho Rha and Dr. Dong Wang. over 700 participants from Taiwan. Knowledge was also shared through a selection of 45 e-posters that was displayed. The Taiwan Urology Association also provided full support and shared the event on their e-school website, hoping to inspire more TUA members and residents to attend the conference and learn from the best. Through knowledge sharing and scientific discussion, the meeting acts as an excellent platform for innovation and inspiration. alex.mottrie@ olvz-aalst.be

The conference encompassed 3 areas of specialty including urology, gynaecology and nursing care, EAU Section of Robotic Urology

Dr. K. Badani (US) speaking on How to improve Sexual Function after RARP

Over the past few years, Tungs’ hospital has dedicated itself to the advancement of robotic surgery and this year it had the honour to host the ‘ERUS in Asia Pacific’ meeting. It has enabled colleagues in the field to gain access to the most advanced procedures in the world. The afternoon session began with “Robotic assisted laparoscopic partial nephrectomy” performed by Prof. In addition, this meeting allowed close interaction Mottrie. A live surgery demonstration offered viewers among participants to exchange ideas and provided a close observation of the surgery as well as real-time inspiration to young surgeons who wish to excel in the field of robotic care. We believe the invaluable insights interaction with the surgeons during surgery. The afternoon session of ‘Meet the Expert’ was presented provided by the speakers will promote better care in by Prof. Alex Mottrie, Dr. Hsiao-Jen Chung, Dr. Shiroki the robotic field to improve patient safety as well as Ryoichi, Dr. Shuo Wang, Dr. Chao-Yuan Huang and Dr. innovation in surgical approaches. Gang Zhu. The ‘ERUS in Asia Pacific’ is not only the first step toward closer collaboration between colleagues in the Day two consisted of a Young Urologist Section with region, it also serves as the platform for ongoing presentations by Dr. Chao-Yu Hsu, Dr. Yi-Sheng Lin, Dr.Chi-Ping Huang, Dr. Wei Chun Weng, Dr. Hung-Jen advancement in robotic care. Furthermore, it sheds light on the medical advancement in the robotic field Wang, Dr. Li Hua Huang, Dr. Marcelo Chen, Dr. Teng in Taiwan. We believe Taiwan could serve as the Aik Ong , Dr. Hsiang-Ying Lee, Dr. Wei-Tang Kao, Dr. Chih-Yin Yeh, Dr. Steven K. Huang and Dr. Anthony Chi platform for future collaboration and innovation, in order to achieve medical advancement. Fai Ng as well as an Education Course that included various urological topics presented by Dr. Bannakij More information and photos of this event can be Lojanapiwat, Dr. Shuji Isotani, Dr. Shaobo Jiang, Dr. found at: www.erusapc2019.org Jian-Ri Li and Dr. Tzu-Chun Wei.

Prof. Yen-Chuan Ou, Co-chair, with faculty members

The last meeting day The third day focused on Selected Article Review presented by Dr. Yuan-Hong Jiang, Dr. Sheng-Chun Hung, Dr. Chia-Yen Lin and Dr. Tzu-Ping Lin. The three Education Courses on this day were presented by Dr. See-Tong Pang, Dr. Gang Zhu, Dr. Kazunori Hattori, Dr. Edmund Chiong and Dr. Teng Aik Ong. And we invited Dr. Shing-Hwa Lu, Dr. Yen-Chuan Ou, Dr. ShaoChuanWang, Dr. Tzu-Hung Hsiao, Dr. Hung-Lin Chen, Dr. Eddie SY Chan, Dr. Cheng-Kuang Yang and Dr. Yu-Chieh Tsai to present on a wide selection of topics at another Meet the Expert session.

Faculty and participants of the first ‘ERUS in Asia Pacific’ meeting

Highlights of the ESUT live event Almost 1,800 delegates witnessed live and prerecorded surgery sessions Dr. Esteban Emiliani Fundació Puigvert Dept. of Urology Barcelona (ES)

emiliani@gmail.com Co-authors: Dr. Alberto Breda (ES), Prof. Evangelos Liatsikos (GR) This year, the live surgeries of the ESUT Live Event, in collaboration with the Urolithiasis (EULIS) and Robotics (ERUS) sections at the Annual EAU Congress 2019 in Barcelona (Spain), were held at Fundació Puigvert. Prof. Evangelos Liatsikos (Patras, GR) and Dr. Alberto Breda (Barcelona, ES) were event coordinators and Profs. Andreas Gross and Ali Serdar Gözen served as coordinators at the eURO auditorium. Broad spectrum of live surgery This event aimed at continuing the tradition of excellence achieved in previous meetings and therefore provided the opportunity to experience a broad spectrum of live surgery demonstrations by some of the leading urologists in Europe. During this event 29 surgeries were performed and presented in live and semi-live formats. The programme began with Prof. Alex Mottrie (Aalst, BE) and Prof. Antonio Alcaraz (Barcelona, ES) who performed robotic and laparoscopic complex partial nephrectomies. Later on Dr. Oriol Angerri Feu (Barcelona, ES) performed a supine mini-PCNL with laser lithotripsy and Dr. Jan Klein (Ulm, DE) a prone June/July 2019

prerecorded cases. In all prerecorded surgery sessions tips and tricks were given to optimise treatments and to manage surgical difficulties and complications.

standard PCNL with conjoint mechanical and pneumatic lithotripsy. Stone treatments In the second round, stone treatment was taken on by Dr. Esteban Emiliani (Barcelona, ES), by performing a RIRS with a single-use scope. He commented on what would be its proper use and was followed by Dr. Michael Straub (Munich, DE) with a second RIRS with a reusable scope. Later on Dr. Cesare Scoffone (Turin, IT) along with Dr. Antonio Celia (Bassano del Grappa, IT) performed a supine ECIRS with combined technologies for lithotripsy and Prof. Jens Stolzenburg (Leipzig, DE) performed a 4K laparoscopic radical prostatectomy, all of them showing brilliant skills. In the third round, Prof. Olivier Traxer (Paris, FR) commented on a RIRS along with Dr. Esteban Emiliani for the treatment of lower pole stones providing excellent tips and tricks. Prof. Thomas Knoll (Sindelfingen, DE) performed a prone L mini-PCNL and Prof. Evangelos Liatsikos and Dr. Leye Ajayi (London, GB) showed how to performed ECIRS in prone position. The oncology surgery in this round was performed by Dr. Alberto Breda who showed an en-block bipolar

This year, the meeting focussed on new technology improving video-assisted surgery, amongst others

Live surgery session showing delegates 6 operating views simultaneously

bladder tumour resection explaining the potential benefits. Live cases and prerecorded surgery For the last round of the day Dr. Bhaskar Somani (Southampton, GB) performed a RIRS with single-use scope. Dr. Thomas Tailly (Ghent, BE) performed a sheathless RIRS. Finally, the day ended with Dr. Daniel Perez-Fentes (Santiago de Compostella) who performed a supine miniPCNL showing ultrasoundguided puncture and Prof. Markus Graefen (Hamburg, DE) with a robot-assisted radical prostatectomy performing a smooth nerve sparing technique. In between the live cases prerecorded surgery sessions were shown in order to provide a realistic and complete spectrum of clinical scenarios. Surgeries for BPH - such as green light, bipolar and holmium and thulium laser enucleation - were shown as well as a prostate aqua-ablation and water vapour therapy, detailing each procedure step by step and comparing their benefits. Oncological surgery sessions such as vascular focal therapy with non-thermal light for unilateral low risk prostate cancer, NBI-assisted resection of bladder tumour, UTUC laser treatment and robot-assisted radical cystectomy were also shown in the form of live

Interactive discussions, detailed presentations This was one of the most prominent events at the congress and around 1,760 colleagues from all over the world were present in the auditorium. Thanks to the interactive discussions and detailed presentation of live surgeries, the participants were able to learn from several treatment options and different strategies for each surgical approach shown. As we like to say: technological development never ends! We would like to congratulate and acknowledge all the staff members of Fundació Puigvert, who made it possible to organise such an event in a single institution. Their organisation and timing were flawless and they took great care of the patients’ safety.

“We would like to congratulate and acknowledge all the staff members of Fundació Puigvert, who made it possible to organise such an event in a single institution.” This event would have not been possible without the collaboration of our sponsors: Boston Scientific, Coloplast, Cook, EMS, Grena, Intuitive, Karl Storz, Lumenis, Olympus, Procept, Pusen, Rocamed, Quanta, Steba and Wolf. We hope to see all readers at the ESUT20 Meeting in Leipzig, 23-24 January 2020 for more live and semi-live surgery. European Urology Today

Young Urologists/Residents Corner Nightmare case: Obstructive lithiasic pyelonephritis Atypical case associated with kidney stones, uncommon bacteria, bladder prolapse and amorphous matrix Dr. Gabriel Stoica Urologist CHIC Alençon Dept. of Urology Alençon (FR)

drgabrielstoica@ gmail.com Co-authors: M. Haydar (CHIC Alençon, Urology Dept.), C. Stoica (Paediatrician, Le Mans), J. Bizet (CHIC Alençon, Biology Dept.), J. Schlegel (CHU Caen, Urology Dept.), France This nightmare case started when a 57-year-old woman visited the Emergency Room for left flank pain. Past medical history included diabetes, hypertension, thyroidectomy.

The patient continued with the left ureteral stent and antibiotics (using an empirical concept, fosfomycin was prescribed once a week for 6 weeks in order to avoid an eventual bladder bacterial contamination). 4th hospitalisation: 9 February 2015 A flexible ureteroscopy was carried out in the left urinary tract with the purpose of the removal of the second renal calculus initially noticed on the CT scan. The urinalysis showed a negative result. Investigating the left kidney pelvis, the same aspect was discovered with large amorphous matrix occupying the whole pelvis of the left kidney. The procedure was again aborted. The patient continued with the left ureteral stent. After a multidisciplinary meeting, the urological team's decision was to proceed with laparoscopic pyelotomy.

1st hospitalisation: 9 November 2014 The patient was hospitalised for left flank pain, pyuria and sepsis. Additionally, on physical examination, she had a significant bladder prolapse. On the CT, two stones were visible in the left kidney (12 mm and 8 mm, respectively) with moderate dilatation of the left kidney pelvis. No abnormality could be detected in the right collective system. The urinalysis showed E. coli The histological exam reported an eosinophilic and Proteus Mirabilis, both highly sensitive to aspect, amorphous material and the presence of antibiotics. bacteria. After the matrix bacteriology test, Peptostreptococcus anaerobius and Gemella The medical staff decided to insert a ureteral stent in morbillorum were identified. the left urinary tract. Furthermore, the patient was prescribed antibiotics. The patient was put on antibiotics, initially on metronidazole and ofloxacin, and then on amoxicillin/ The nightmare starts slowly with a new clavulanic acid. No intra or postoperative hospitalisation, one month later. complications occurred.

urography. The US showed that the left kidney was stone-free and no abnormality could be detected.

quantity of matrix, either complete or incomplete, is doubtless a rare phenomenon (less than 1%) with a higher chance of encountering it after obstructive pyelonephritis with anaerobic germs.

Practice focus Obstructive pyelonephritis is treated in two steps in our department: with ureteral stent placement and antibiotics, followed by flexible or rigid ureteroscopy. The total duration between the 1st and 2nd step is about 4 - 6 weeks. More than 95% of non complicated urolithiasis is treated in an outpatient setting with good results and patient feedback. In my experience, only two cases of stone-like amorphous material (matrix) were encountered. The first one was an incomplete matrix around a calculus after an emphysematous pyelonephritis in which case the treatment of the calculus had been laborious but feasible. The second case is this complete matrix reported in the present manuscript. The coelioscopic approach or PNL are maybe the best two choices of treatment. The presence of a variable

2nd hospitalisation: 13 December 2014 The diagnostic work-up revealed a dislocated DJ stent. The urine culture showed Proteus Mirabilis, the same bacterial strain as one month ago.

Bacteriology focus Peptostreptococcus anaerobius: gram-positive, strictly anaerobic. Commensal in digestive tracts and ORL (dental tartar), vagina. Pathogenic in deep abscess (digestives, genitals, ORL, dentals). In children the bacteria are often found in polymicrobial infections (abscesses, ears, peritoneal fluid, lung infections, bone, sinuses) often favoured by predisposing conditions (surgery, immunodeficiency, diabetes, prematurity, corticoid treatment, sickle-cell anaemia). Gemella morbillorum: gram-positive or gramvariable. Aero-anaerobic. Commensal in oropharynx, upper respiratory tract, digestive tract. Pathogenic in deep abscess (digestives, endocarditis). In children the bacteria are rare, found in endocarditis and some acute respiratory fulminant infections with septic shock.

Top-notch research at EAU19

The migration of the DJ stent was favoured by a major bladder prolapse. It was decided to replace the stent into the left urinary tract and perform a flexible ureteroscopy a few weeks later. The antibiotic therapy was continued. The diagnosis was: obstructive pyelonephritis.

Meanwhile, a major soft matrix of amorphous nature was discovered in the left kidney pelvis. This discovery was suspicious and raised awareness. Minimal laser destruction was carried out but it was rapidly stopped since it proved to be inefficient. A sample of the amorphous material was collected with a nitinol basket, for histological examination. The histological result reported an eosinophilic aspect with no cells but some crystals. No fungus was detected. The procedure was aborted.

Fig. 4: All extracted pelvic matrix

It was the end of my nightmare case after 11 months. 5th hospitalisation: 12 May 2015 A laparoscopic pyelotomy was carried out. The dissection was very difficult due to the inflammation to the periureteral and peripelvic tissue. An impressive volume of magma (matrix) which occupied the entire pelvis and calyx, like a (cast) staghorn stone consisting of amorphous material, was extracted.

3rd hospitalisation: 29 December 2014 A left flexible ureteroscopy was carried out. The urinalysis was negative. The 8 mm stone was treated with laser fragmentation (270 µm-fiber, energy range 3 – 1300 W).

Fig. 3: Pyeloureterotomy and matrix

EAU Congress in Barcelona perfect place for residents Dr. Luis Enrique Ortega Polledo, 4th year resident, Madrid (ES)

Fig. 2: Ureter

Post-operative visit: 29 July 2015 The left ureteral stent removal was proposed but was rejected by the patient due to fear of pain. 6th hospitalisation: 5 August 2015 Left stent extraction under general anaesthesia was carried out. The urinalysis showed no bacteriuria. Post-ureteral stent removal: 1 October 2015 The patient refused to proceed with intravenous

The 34th Annual EAU Congress in Barcelona was my second opportunity to attend an EAU Congress, and I have got the impression that it gets (even) better every year. Barcelona, Spain´s second biggest city, is surrounded by the Mediterranean Sea and has superb weather: the perfect place to host this event. Immersed in new advances This Annual Congress is one of those meetings that you would not want to miss when you are a young urology trainee, because it gives you the opportunity to become immersed in the new advances that this wonderful specialty has to offer. After noticing that in 2019 the Annual EAU Congress would take place in Barcelona, I definitely gave priority to attend this event.

on virtually any single topic. World-class urologists enlightened us about Oncology (especially urothelial, renal and prostate cancer), Stone disease and lasers, and Imaging in Urology, among other brilliant speeches. Live surgery sessions proved that Barcelona´s urology practice is still a reference. Another resident-orientated session that I found extremely helpful was the YUORDay19, where you could encounter lots of different viewpoints from other countries, learn some tips & tricks and challenge your knowledge at the Guidelines Cup.

Networking events Apart from the scientific events, Barcelona offered us an extraordinary weekend hosting several networking events where junior urology doctors from all over the world could blend together. I would like to highlight the French-Spanish Connection that took place on 15 March near the beach, with some drinks and relaxing music that matched our mood in a perfect way. The The venue was in Fira Barcelona, not so far away from ESRU party was hosted in a beautiful brewery called the neuralgic centre of the city. The pavilion was well Fábrica Moritz on 16 March. divided, with areas marked by colour, which made it easy to find any room you desire in an intuitive way. All good things come to an end, and the Annual EAU The exhibition hall was spacious and the ideal place Congress is no exception. I believe this event is a to find the latest technological advances in any area of unique experience for any urologist, but especially for our specialty, such as Endourology, Imaging, Robotics young residents and consultants, since it is inspiring and Laparoscopy. It was easy to find lots of colleagues and stimulating for anybody looking forward to and friends walking along those long corridors, become a better urologist. creating a unique atmosphere to exchange ideas and knowledge. ESU courses The ESU courses offered a wide range of possibilities to get a comprehensive view on various subspecialties, and this is one of the strongest points of this meeting for a resident. This chance to get updated in any area you are interested in by well-recognised urologists from all over the world is a true gem.

Fig. 1: Initial CT scan

European Urology Today

Regarding the congress sessions, I was thrilled that we could choose from a wide range of great lectures

Fun and excitement during the Guidelines Cup 2019 at the YUORDay

June/July 2019

ERUS19: Weighing the cost of innovation Maes: “Promise of innovation, but emerging systems have to prove themselves” Registration is currently open for ERUS19! The EAU Robotic Urology Section’s annual meeting is coming to Lisbon, Portugal on 11-13 September, 2019. The regular scientific programme starts on September 12th, but delegates are encouraged to take part in the Technology Forum on the 11th. Other activities on the 11th include the Junior ERUS – YAU meeting for young urologists. Courses by the European School of Urology are –for the first time– integrated into the regular scientific programme. We spoke to Dr. Kris Maes (Lisbon, PT), ERUS member, Chairman of the Urology Department at Hospital da Luz in Lisbon, and Chairman of the ERUS19 Local Organising Committee about the upcoming meeting. Diversification and future of robotics “The Technology Forum at ERUS19 will reveal various aspects of the evolution of medical technology. We are all anxious to see how new systems will enter the market, what the price settings will be, and what innovations they will offer us. The new systems will have to prove themselves, irrespective of their cost, as the Da Vinci systems have proven themselves over the years.” “Another important aspect will be the advancements in imaging and image implementation and the role we will be giving to Artificial Intelligence as a tool to improve the performance and teaching of robotic surgery. The Technology forum will be extremely interesting.” Dr. Maes sees the potential of some of the technology that is due to be released in the near future: “For the moment it is unclear what is going to be the role of nanotechnology and Artificial intelligence in the field of Robotic surgery, what is sure is that it will have a role. Image detection and recognition could be helpful not only in training and surgical skill evaluation, but could also be helpful as aid in performance surgery. This together with image integration (MRI, CT etc…) in the robotic

console, 3D reconstruction and various fluorescence linked applications should assist the surgeon in every way.” “The introduction of 5G networks could reopen the remote surgery path for several applications. We are also seeing new robots will entering the market, probably evolving to a more specific robot for specific fields. Finally, let’s not forget the single trocar SP, already in use in the USA, entering Europe within months.”

Register now for the late fee! Deadline: 2 September 2019 An experienced audience ERUS Chairman Prof. Alex Mottrie (Aalst, BE) has previously commented on the changing nature of the ERUS meeting as robotic surgery matures and widens in scope. Keeping delegates coming means that the ERUS meeting’s scientific programme needs to accommodate a range of topics for beginners and experts alike. Maes: “It is indeed a challenge for the organizing committee to keep the ERUS interesting for all delegates. As the years have passed, the experts have become more experienced but lots of delegates also are, and they are more demanding. The courses are becoming more important and extended and will this year be integrated into the meeting. We will have specific courses on nerve-sparing prostatectomy, radical cystectomy, and partial nephrectomy but also on reconstructive surgery.” “The live cases will all be performed by highlyskilled volume surgeons working only on the newest da Vinci X systems, showing the latest evolution of their technique. The SP single trocar system will make its entrance in this meeting and the scientific lectures are upgraded to reflect the latest level of knowledge. We hope to please every level of participants.”

Live surgery Live cases will be coming from Hospital da Luz in Lisbon, where Dr. Maes is based. “My centre was a pioneer in robotic surgery and is still the leading hospital in robotic surgery in the country. It makes perfect sense for all procedures to take place here. During ERUS19 we have will have three robotic ORs at our disposal, each equipped with an Xi system.” “We will try to show well-performed standard cases and a couple more challenging ones, as well as some rare cases, with the intention that everyone, whatever level, can pick something up from the experts.”

For the complete Scientific Programme visit www.erus19.org “The evolution of the ERUS meeting has been tremendous, it started in France in 2004 where 20 physicians got together to discuss the newly emerging field of robotic-assisted urology. In 2011, ERUS joined the EAU as one of its sections. Over the last couple of years, the ERUS meeting has become the biggest robotic urology event in the world.”

Since the last ERUS meeting, in Marseille in September 2018, Dr. Maes and the scientific committee have been preparing the hospital for the event. “We are having weekly meetings with various teams, coordinated by myself and my colleagues from the local organizing committee in order to prepare a smoothly-run and excellent meeting. Dr. Jochen Walz, local organizer for ERUS18, has been a great inspiration and help to guide us in this.”

ERUS19 16th Meeting of the EAU Robotic Urology Section Creating consensus in robotic urology

11-13 September 2019, Lisbon, Portugal

A veteran ERUS member Dr. Maes is an experienced robotic surgeon and longstanding ERUS member, having attended nearly every meeting since its inception in 2004.

Robotic Live Surgery

“I guess I missed only two ERUS meetings since the beginning. Initially as delegate, and later on getting more involved as faculty in the meetings, then as part of the educational committee and recently as Associated Board member and live case surgeon.” “I started in robotic surgery in Belgium in 2005. In 2011, I started at Hospital da Luz. It is now the reference of robotic surgery in Portugal. Since last year, our centre has been recognised as an ERUS Host center. Hosting an ERUS meeting in Lisbon, is an honour for myself and my team and I hope it will give a boost to robotic surgery in the country.”

International Academic Exchange Programme Canadian Urological Association (CUA) in collaboration with the European Association of Urology (EAU)

2020 Canadian Tour The European Association of Urology (EAU) and the Canadian Urological Association (CUA) are pleased to announce the 2020 Canadian tour! The CUA/EAU International Exchange Programme will send Canadian faculty to Europe and European faculty to Canada. The programme aims to promote international exchange of urological medical skills, expertise and knowledge.

Information and application forms For all further information and programme application forms please visit uroweb.org/canadaexchange or contact Angela Terberg at the EAU Central Office, +31 (0)26 389 0680, a.terberg@uroweb.org. Application deadline: 1 October 2019

For 2020 the CUA/EAU International Exchange Programme will provide grants to enable three Junior EAU Members to participate in the Canadian Tour. The tour should take place from 13-29 June 2020 starting with visits to different urological centres in Canada, culminating with participation at the CUA Annual Meeting in Victoria, BC, from 27-29 June 2020. Eligibility criteria • Less than 42 years of age • Minimum academic rank of assistant professor • Letter from the departmental chairman of the applicant’s commitment to academic medicine • Membership of the EAU • Availability to travel around 2.5 to 3 weeks at the earlier mentioned time

June/July 2019

Canadian Urological Association (CUA)

European Urology Today

EULIS19 leaves no stone unturned Extensive coverage with expert insights, live surgeries and relevant updates Clinicians involved in the study and treatment of urinary stones face numerous challenges. The disease is frequently associated with other non-communicable chronic diseases such as arterial hypertension, metabolic syndrome and osteoporosis; and its prevalence increases due to lifestyle modifications and global warming. For these reasons, strengthening primary prevention and implementation of measures against recurrences are vital. On the other hand, further development of minimally invasive treatment is also needed to reduce morbidity and to guarantee the quality of life e.g. refinement of technologies for fragmentation and stone removal. Delegates of the upcoming 5th Meeting of the EAU Section of Urolithiasis (EULIS19) in Milan, Italy can expect comprehensive coverage on these topics excellently executed through live surgeries to be performed by brilliant surgeons, a masterclass by a prominent scientist, joint-sessions with various societies, to name a few. The EULIS19 meeting will kickstart on 3 October and will conclude on 5 October. Prior to the meeting, a full day will be dedicated to the hands-on training course EST s1 (Endoscopic Stone Treatment step 1) on 2 October. Due to the course's popularity, availability is limited and will be granted on a first-come, firstserved basis.

Prof. Peter Alken (DE), a pioneer of percutaneous surgery for renal stone treatment, will deliver a lectio magistralis to mark the commencement of EULIS19. The meeting will comprise of presentations by esteemed experts such as previous EULIS Chairman Prof. Palle Osther (DK) on the evolution of the technology for ureteroscopy; Prof. Dr. Bernhard Hess (CH) on the efficacy of the medical management of stones; Dr. Jan Halbritter (DE) on the genetic background of renal stone disease; and Dr. Giovanni Battista Fogazzi (IT) on urinary sediment of renal stone formers.

Register now for the late fee! Deadline: 25 September 2019 Live surgeries The EULIS19 programme will include two live surgery sessions which will demonstrate the actual modalities of treatment for renal and ureteral stones. Procedures will include super mini-percutaneous nephrolithotomy (PNL), RIRS (retrograde intrarenal surgery) by using new disposable instruments, and standard PNL in prone and supine. Paediatric stone management A thematic session will centre on the management of paediatric stones wherein paediatricians and nephrologists will discuss the current epidemiology and etiology of nephrolithiasis and nephrocalcinosis in children. Presenters will feature stone procedures with miniaturised endoscopic instruments and robot-assisted laparoscopy used in the treatment of malformations associated to renal stones. Delegates can also look forward to lectures on the clinical and metabolic evaluation of stone-forming patients, focusing on genetic and environmental causes of the disease.

Prof. Emanuele Montanari Milan (IT)

Dr. Alberto Trinchieri, Milan (IT)

Technologies and armamentarium The EULIS19 Scientific Programme is packed with highly-educational presentations on technologies and

ERUS19 16th Meeting of the EAU Robotic Urology Section

Robotic Live Surgery

Creating consensus in robotic urology

Collaborative sessions Members of scientific societies will share and exchange valuable insights through joint sessions at EULIS19. Together with CLU (Club Litiasi Urinaria), aspects related to metabolic study of patients and prevention of recurrences; and optimisation of endourological treatments will be discussed.

Designed for residents and nurses A session with nurses in mind will cover essential topics such as characteristics of diverse urological instruments (reusable or disposable); disinfection of endoscopic instruments; patient positioning for endourological procedures; and management of nephrostomy after surgery. The lectures will be in Italian. Another notable session is the Resident corner: Petra Group which will be dedicated to residents. The session will discuss the importance of visits to other European centres, and networking to promote and stimulate research activities. Join us in Milan Receive expert insights, relevant updates, emerging technologies and top methodologies in stone management at EULIS19. Feel free to explore the official website www.eulis.org to see what is in store for you.

Another joint session organised in collaboration with the European nephrologists of ERA-EDTA (European Renal Association – European Dialysis and Transplant Association) will centre on stones secondary to enteric diseases or bariatric surgery with attention to the potential use of new probiotic drugs or enzymes. The urologists of SEGUR (South Eastern Group for Urological Research) will share their experience and expertise in the medical and surgical treatment of urolithiasis.

EULIS19 5th Meeting of the EAU Section of Urolithiasis 3-5 October 2019 Milan, Italy

Members of the IAU (International Alliance of Urolithiasis) will examine the current state of basic research on the pathogenesis of nephrolithiasis, as well as, the various aspects of extracorporeal and endourological treatment of urinary stones.

In conjunction with: Junior ERUS-YAU Meeting European School of Urology (ESU) Courses ESU/ERUS Hands-on Training in Robotic Surgery

· · ·

GUA-CCA19 1st Georgian Urological Association Caucasus Central Asia Meeting 4-5 October 2019, Tbilisi, Georgia

11-13 September 2019, Lisbon, Portugal

European Urology Today

Other EULIS19 lectures will focus on the prevention and treatment of infectious complications and encrusted stents; radiation protection for both patient and surgeon against excessive x-ray exposure; advances in ureteroscopy and PNL; metabolic evaluation and medical management.

For the complete Scientific Programme visit www.eulis19.org

www.gua-cca19.org

www.erus19.org

armamentarium such as new miniaturised instruments for percutaneous surgery; new flexible ureteroscopes; improvements in lithotripsy with Holmium lasers and new lasers for the future. Most modern devices used in improving evacuation of fragments and preventing stone retropulsion will be showcased at the meeting, together with the use of virtual reality for training endourologists, telementoring, and facilitation of challenging procedures.

An application has been made to the EACCME® for CME accreditation of this event

In conjunction with the European Association of Urology (EAU)

June/July 2019

ELUTS19 delivers frontline section meetings and an ESU-ESFFU masterclass Vital updates from EAU Sections and the ESU

For the complete

Although generally dedicated to lower urinary tract symptoms (LUTS), the Scientific Programme of the ELUTS19 meeting is packed with updates from varied urological subspecialties. To give participants well-rounded treatment approaches, a number of EAU Sections and the European School of Urology (ESU) organised three meetings and a masterclass. These will take place on the 31st of October and some will continue until the 1st of November.

scientific programme, visit

31 October - 1 November 2019 Prague, Czech Republic

31 October 2019 Prague, Czech Republic

ESAU meeting to bring advancements in andrology

ESUO meeting to enhance practice and unify office urologists

The EAU Section of Andrological Urology (ESAU) continually pursues advancement Prof. Nikolaos Sofikitis in the field of Chairman ESAU andrology and bolsters that knowledge through diligent investigation. At ELUTS19, the ESAU meeting will deliver updates on male infertility, erectile dysfunction, and male endocrinology.

LUTS include storage symptoms such as nocturia and incontinence; voiding Prof. Dr. Helmut Haas symptoms such as weak stream, and Chairman ESUO terminal dribble; and post-micturition symptoms such as incomplete emptying. These have a significant negative effect on patients’ quality of life with both psychological and physical health consequences. Following the general practitioner, the office urologist is usually the first specialist physician these patients are referred to.

The meeting will commence with “Andrology debates in office urology Joint Session of ESAU and ESUO”. The session will include a keynote lecture and a case presentation on varicocele and azoospermia. Experts in the field will deliberate on several common andrological conditions such as varicocele in azoospermic males i.e. Is varicocelectomy or testicular sperm extraction (TESE) as primary treatment? Which therapeutic strategy will bring a couple to the desired pregnancy faster? The session will also examine the effects of selective serotonin reuptake inhibitors (SSRIs) on male reproductive potential; the genetic aspects of male infertility; and the current management of priapism. Other sessions in the Scientific Programme will investigate male infertility is an index for men’s health, quality of life, and life expectancy; and the link to inflammation among testosterone deficiency, cardiovascular and metabolic disease.

“The ESAU meeting will deliver updates on male infertility, erectile dysfunction, and male endocrinology.” Studies in animal and human subjects with varicocele have demonstrated that the Leydig cellular secretory function is diminished. It is a highly controversial issue to perform varicocelectomy or alternatively, recommend testosterone treatment to improve the late onset hypogonadism symptoms in men with varicoceles. The ESAU meeting will examine this issue further. Nowadays a certain degree of concern has been raised concerning the effects of various pharmaceutical agents on sperm fertilizing capacity. The meeting will discuss the effects of pharmaceutical agents administered for the treatment of erectile dysfunction, anabolic steroids, micronutrients, supplements, antioxidants, antibiotics, and anti-inflammatory medicines. The ESAU meeting will also tackle gender development in transgender pre-school children, surgical interventions, and fertility preservation in the adolescent transgender child. Explore the rest of the ESAU meeting lectures and activities via www.eluts19.org/scientificprogramme/esau-section-meeting/

June/July 2019

31 October 2019 Prague, Czech Republic

European office urologists work on a broad spectrum of urological conditions with roles varying per country. The EAU Section of Urologists in Office (ESUO) has organised a meeting to bring together these urologists, encourage scientific discussions, bridge differences, and ultimately enhance their clinical practice. This meeting aims to guide participants through the current EAU Guidelines on LUTS diagnostics and conservative/drug treatment. Expert speakers will address stressful urological conditions such as interstitial cystitis and "painful voiding" in female. They will examine new combination drug treatments in non-neurogenic LUTS, and patient adherence to LUTS pharmacological therapy.

“The ESUO has organised a meeting to bring together urologists, encourage scientific discussions, bridge differences, and ultimately enhance their clinical practice.”

www.eluts19.org

31 October - 1 November 2019 Prague, Czech Republic

ESGURS meeting to provide updates, address controversies The EAU Section of GenitoUrinary Reconstructive Surgeons (ESGURS) meeting will focus on developments Prof. David Ralph in reconstructive surgery. Chairman ESGURS Its programme will be interspersed with surgical case discussions, semi-live video surgery sessions and other activities. Participants can look forward to a comprehensive coverage on urethral surgery, penile surgery, and surgery for erectile dysfunction and incontinence. The meeting will also investigate the effect of radiotherapy and the role of robotics in genital reconstruction. Ureteric reconstruction including paediatrics is another vital topic of the programme. What are the pros and cons of collagenase use? Which method is optimal for pyeloplasty? What is the best way to treat incontinence in the male patient? These are questions that the ESGURS meeting will also address and expound upon. The meeting will examine major challenges such as lack of funding for basic research of oncology, as a collective central funding from national societies is crucial to advance the field. Another challenge is motivating young promising talent to specialise in this field, as majority want to pursue robotics. The ESGURS meeting will also address the need to for more centres of excellence that will provide certification for competence in all of the areas of genital reconstruction. The meeting’s expansive programme will also comprise of state-of-the-art lectures by the Young Academic Urologists (YAU), videos and lively debates designed to boost the overall learning experience. Check out the full ESGURS meeting via www.eluts19.org/scientific-programme/ esgurs-section-meeting/

Prof. Francisco Cruz Chairman ESFFU

Dr. John Heesakkers Course Director ESU Masterclass

Masterclass to enrich know-how in female and functional urology Organised by the ESU and EAU Section of Female and Functional Urology (ESFFU), the ESU-ESFFU Masterclass on Functional Urology has earned its reputation as an exceptional and reliable programme throughout the years, and continues to do so. At the upcoming ELUTS19 meeting, the masterclass will offer a comprehensive programme centred on the male and female anatomy; neuroanatomy and physiology; and bladder pain syndrome/interstitial cystitis. The masterclass will also cover vesicovaginal fistula, complications after stress urinary incontinence surgery, and urinary diversion in functional urology. The programme will include examination of patient cases submitted by the participant themselves and followed by deliberations for the best approach for each case. Like all ESU masterclasses, this masterclass is developed to provide high-level training for improved patient care and clinical practice. The atmosphere of ESU masterclasses is always cordial and conducive to learning and brainstorming. For more information about the masterclass, check www.esu-masterclasses.org/ masterclass/esu-esffu-masterclass-onfunctional-urology/

The meeting will also underline the hazards of fluoroquinolones due to their widespread use for urinary tract infections, and the increased microbe resistance existing in some European countries. Participants can look forward to a broader framework for assessing LUTS pathophysiology and management aimed to be developed and integrated into clinical practice or research. The meeting will present new emerging technologies including the Low Intensity Shock Wave as a potential new office-based treatment for LUTS; and will briefly discuss LUTS’ association with erectile dysfunction. In addition, a presentation on the unmet needs of office urologists will explain the reasons why patients abandon drug therapy for overactive bladder. View the full ESUO meeting programme via www.eluts19.org/scientific-programme/ esuo-section-meeting/

ELUTS19 European Lower Urinary Tract Symptoms meeting 31 October - 2 November 2019 Prague, Czech Republic By

www.eluts19.org

In collaboration with

European Urology Today

Exploring innovative options in prostate cancer treatment PCa19: Third Update comes to Prague “PCa 19 will provide an in-depth and critical assessment of standard, innovative and prospective PCa therapies,” says Prof. Jeroen van Moorselaar (Amsterdam, NL). “To Prof. Jeroen Van achieve this, we’ve Moorselaar pooled the expertise of (Amsterdam, NL) prostate cancer Chairman PCa19 specialists from various Scientific Committee European countries and faculty members of the European School of Urology (ESU) and organised a two-day programme which covers a whole array of topics in PCa management.” Prof. Van Moorselaar sits on the PCa19 Scientific Committee, and has been involved in making the scientific programme since PCa18. Speakers and tutors are coming from every PCa-related experise: “The whole field of prostate cancer treatment is covered. We are very happy that so many experts in the field will come to Prague.”

Register now for the late fee! Deadline: 13 July – 2 October 2019 Over the past few years, the EAU has introduced a series of meetings beyond the traditional Section Meetings, which follow subspecialties of urology (Onco-urology, Robtotic Urology, Urolithiasis, etc). The new Oncology Update series started in 2017 with the first PCa Update in Vienna, leading to more topic-based, educational updates that involve speakers from several backgrounds and EAU Sections. In its wake, BCa and RCC Updates followed. Critical assessment In presenting this critical assessment and updating the audience, PCa19 offers an

interactive and educationally-oriented scientific programme. Van Moorselaar: “A large part of the programme will be the case discussions, which will stimulate discussions among the participants.” “Through this we understand how to implement the guidelines in daily practice and appreciate differences among the countries in Europe.”

EAU Update on Prostate Cancer

For the complete Scientific Programme visit www.pca19.org Van Moorselaar sees the most important topics at PCa19 as the new imaging possibilities that are available to specialists, such as MRI and PSMA-PET scanning. “New treatment options are available for metastatic hormone sensitive prostate cancer, but also for non-metastatic castration resistant prostate cancer. Furthermore very interesting is the field of treatment of oligometastatic disease.”

11-12 October 2019 Prague, Czech Republic

EAU onco-urology series

www.pca19.org

Prof. Van Moorselaar is also taking part in the scientific programme: “I will be chairing a session on focal therapy. Although the EAU Guidelines state that focal therapy is still experimental, many new data with longer follow-up show interesting results. An important part of the discussion should be about the comparison to active surveillance.” Urologists should familiarise themselves with new developments in PCa treatment, as they are essential in the multidisciplinary future. Van Moorselaar: “As the programme shows, the treatment of prostate cancer is typically a case for a multidisciplinary team of urologists, radiation oncologists, nuclear medicine specialists, pathologists and medical oncologists. The urologist has the initial contact with the patient and makes the diagnosis. In a large team you need a leader or chairman and this is the urologist.”

ESUR19: When urological research helps fuel innovation Investigations on new diagnostic and therapeutic strategies Urological research helps fuel innovation. It is the pursuit for new and better diagnostic and therapeutic strategies for patients. Urological research is driven by the need for solid understanding of urological tumours with the aim to improve treatment and management. It also addresses urogenital disorders on various levels: epidemiological, genetic, molecular, cellular, physiological and pharmacological. American theoretical physicist and Harvard professor, Prof. Lisa Randall, once said “Scientific research involves going beyond the well-trodden and well-tested ideas and theories that form the core of scientific knowledge. During the time scientists are working things out, some results will be right, and others will be wrong. Over time, the right results will emerge.” The yearly meeting of the EAU Section of Urological Research (ESUR) is where results of experimental (basic and translational) and clinical research in urology and related fields are amassed and showcased. Since its inception, the meeting has been the platform for urological researchers, and the upcoming 26th edition, ESUR19, will be no different. ESUR19 is organised in collaboration with the American organisation SBUR (Society for Basic

Urologic Research), and the ESUP (EAU Section of Uropathology) to bolster interdisciplinary discussions. Internationally-known and esteemed experts will present new and exciting results of investigations on translational neurology, bladder dysfunction; local therapy in metastatic prostate cancer; microenvironment, metabolism and epigenetic reprogramming. Point-counterpoint sessions have always been a part of ESUR meeting programme wherein experts with clinical and research points of view convene to deliberate and eventually boost present findings. The meeting aims to further probe into the growing knowledge on different cancer biology aspects, including the metabolic shift along with epigenetic reprogramming which suggests that there might be novel cancer therapeutic targets that need to be explored. Moreover, new molecules targeting the epigenome have been tested in urological tumours in both pre-clinical and clinical settings.

Register now for the early fee! Deadline: 15 August 2019 ESUR19 will also examine epidrugs (from basics to clinical trials), and molecular subtypes and therapeutics. Although immuno-oncology is not an entirely new topic on urological research, relevant updates such as pre-clinical and clinical trials will still be shared at ESUR19. In line with the European Union’s concerns on individual data protection and ethical issues related to patients, updated information on this topic will be also approached and discussed by experimental researchers and medical doctors at the meeting.

Prof. Carmen Jeronimo (PT) Meeting Chair

Prof. Kerstin Junker (DE) ESUR Chair

European Urology Today

In addition to invited speakers, young researchers will have the opportunity to discuss

For the complete Scientific Programme visit www.esur19.org their innovative work with colleagues and potential mentors. Their oral presentations on selected abstracts and extensive poster sessions are designed to maximise interaction and dissemination. In order to enable young researchers to attend the meeting, travel awards are provided for the best abstract submissions. ESUR19 delegates will also have the opportunity to partake in the course “New challenges and unmet needs in basic science and histopathology to address the clinical management of renal malignancies”, which is organised by the renowned European School of Urology (ESU). The ESU course aims to offer vital information on current indications for the treatment of renal malignancies, and to provide an update on the histopathological features and molecular patterns of kidney cancer. The course will also focus on the opportunities for the introduction of genetic and molecular profiling in the daily clinical practice of patients with renal cell carcinoma.

Learn more about ESUR19 by exploring www.esur.uroweb.org. Interested in presenting your original research at this meeting? Submit your abstract(s) before the deadline of 8 July 2019 through www.esur.org/scientificprogramme/abstracts/. Register before 15 August 2019 to take advantage of the early bird rate through www.esur.org/register/. We look forward to welcoming you in Porto, Portugal!

ESUR19 26th Meeting of the EAU Section of Urological Research 10-12 October 2019, Porto, Portugal In collaboration with the Society for Basic Urologic Research (SBUR) and the EAU Section of Uropathology (ESUP)

From the very beginning, the ESUR meeting is determined to establish connections and knowledge-sharing between basic, translational and clinical researchers. Thus, we expect to have tripartite discussions that may propel procurement of solid knowledge and understanding of the most relevant aspects currently investigated in urological tumours. This year through ESUR19, we aim to find innovations that will benefit patients’ treatment and management in the short and in the long term, and we will continue to do so in the years to come. June/July 2019

EMUC19 to come to Vienna this autumn Keeping the programme relevant for young onco-urology specialists A multidisciplinary approach to the treatment of urological cancers may have become more commonplace over the past decade, but young professionals still benefit from having a voice when the scientific programme for EMUC19 is made. The 11th European Multidisciplinary Congress on Urological Cancers (EMUC19) is coming to Vienna on November 14-17. The meeting is co-organised by the European Association of Urology (EAU), the European Society for Medical Oncology (ESMO) and European SocieTy for Radiotherapy & Oncology (ESTRO). Also on November 14th, the EAU Section of Urological Imaging is holding its 8th meeting, ESUI19. Early registration for EMUC19 is available until August 14th.

invited to participate in the EMUC19 scientific programme committee as ESMO Young Oncologists Committee (YOC) representative to establish involvement and address interests of young Medical Oncology professionals in the upcoming EMUC conferences. As such, the YOC contributes to scientific abstract reviewing with 5 supporters and I have been invited to actively participate in the programme including a case presentation on testicular cancer and a discussion on localised prostate cancer.”

Important Topics Asked about which topics are of particular interest to young onco-urology professionals, Xylinas (YAU) points to state-of-the-art lectures. “We like these for giving an overview of the current evidence on a topic. The organizing parties have appointed representatives Sessions that address the current guidelines are from their ‘young professionals’ wings to sit on the popular, as are clinical cases discussion by key EMUC19 scientific committee to ensure that the opinion leaders.” scientific programme reflects their interests and professional requirements. We spoke to each Bibault (ESTRO YC) considers the topics that will representative about their role and their views on the define the standard of care and best practice for important topics. young professionals in radiation oncology in prostate cancer and bladder cancer the most important. “When should you consider radiotherapy, what Register now for the early fee! volumes, what dosage? How does radiation therapy Deadline: 14 August 2019 can be combined and coordinated with surgery and systemic treatments?” These and more will be part of A voice for young professionals the three-day scientific programme. Dr. Evanguelos Xylinas (Paris, FR) represents the EAU’s Young Academic Urologists (YAU) on the “Both well-structured introductions to current EMUC19 scientific committee. Dr. Xylinas describes his standards and discussion of areas with lacking role as proposing speakers and topics to be covered evidence or practice-changing, up-to-date on behalf of YAU. developments are highly relevant for young professionals to increase their knowledge and Jean-Emmanuel Bibault (Stanford, CA, USA) is confidence in GU cancer care,” says Oing (ESMO involved in EMUC19 as a member of ESTRO’s Young YOC). Committee. “I help design the programme of the annual meeting, particularly on the sessions where “Rare cancers, i.e. testicular and penile cancer, are radiation oncology is relevant.” also important to address, as individual experience with such cancers may be scarce. In addition, case Dr. Christoph Oing (Hamburg, DE) is on the EMUC19 discussions are of particular importance to provide Scientific Committee as a member of the ESMO’s practical advice and illustrate the beneficial impact of Young Oncologist Committee (YOC). “I have been multidisciplinary GU cancer care.”

For the complete Scientific Programme visit www.emuc19.org Multidisciplinary reality Oing also sees a tendency in genitourinary oncology: “It is rapidly evolving irrespective of the subspecialty involved in GU cancer care. The multidisciplinary approach of EMUC, with its multifaceted expert scientific committee and conference structure is outstanding and a key to success in sharing knowledge on current standards and future developments for both the attendees and faculty.” Bibault concurs: “Multidisciplinarity is essential in uro-oncology if we want to give the best possible treatment to our patients. We absolutely need to work, discuss each case with our friends and colleagues from surgery and medical oncology. Comprehensive cancer centers are essential in that setting.” Xylinas: “I think oncology and onco-urology in particular equals multidisciplinarity. The aim is to provide, all together, the best care for our patients.” EMUC19 has a comprehensive scientific programme featuring expert speakers from all onco-urology-

related fields. The ESUI meeting, as well as ESU courses and the ESUP Symposium are all optional elements of the programme on November 14th. Discounted registration fees are available for EAU, ESMO and ESTRO members, as well as residents. Dr. Evanguelos Xylinas (Paris, FR) is Associate Professor of Urology at Bichat Claude Bernard Hospital. Jean-Emmanuel Bibault (Stanford, CA, USA) is a radiation oncology Associate Professor from Paris currently doing a postdoctoral research fellowship in the Laboratory of Artificial Intelligence for Medicine and Biomedical Physics, at Stanford University School of Medicine. Dr. Christoph Oing (Hamburg, DE) is specialised in Internal Medicine, Haematology and Medical Oncology. He is a clinical fellow at the Dept of Oncology, Haematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf (DE), among several other affiliations.

14-17 November 2019, Vienna, Austria

Implementing multidisciplinary strategies in genito-urinary cancers 11th European Multidisciplinary Congress on Urological Cancers In conjunction with the • 8th Meeting of the EAU Section of Urological Imaging (ESUI) • European School of Urology (ESU) • EMUC Symposium on Genitourinary Pathology and Molecular Diagnostics (ESUP)

www.emuc19.org

www.esui19.org

www.esou20.org

ESUI19

ESOU20

8th Meeting of the EAU Section of Urological Imaging

17th Meeting of the EAU Section of Oncological Urology

14 November 2019 Vienna, Austria

17-19 January 2020, Dublin, Ireland

In conjunction with the 11th European Multidisciplinary Congress on Urological Cancers

An application has been made to the EACCME® for CME accreditation of this event

Less is more: What’s really needed in imaging

June/July 2019

European Urology Today

ESUT20: Top-level live surgery in a full two-day event Leipzig to be the centre of uro-technology meeting coming January Organized in conjunction with the German working groups of Endourology, Laparoscopy and Robotics, Leipzig will host more than 700 uro-technology experts from 23-24 January 2020. The biannual ESUT Meeting is a growing event, focussing on live surgeries including broadcasts from across the globe and on pre-recorded cases; so-called semi-live surgeries. The great advantage of this meeting is that variations of surgical techniques are shown simultaneously on three screens highlighting the surgeons’ tips and tricks of each specific procedure. Two screens will cover the live transmission from Leipzig University Hospital, and the third screen will show a transglobal transmission. Since modern transmission technology allows to broadcast surgeries from far away, ORs from all over the world have the opportunity to join the meeting. The scientific programme is continuously evolving and the surgeries shown will include live transmissions from several continents. The full list will be announced in the coming months.

Abstract submission now open! Deadline: 22 September 2019 Building on experience Already the 7th Meeting of the EAU Section of Uro-Technology, the meeting builds on long-term experience in organizing live surgery events like the traditional full live surgery day at the Annual EAU congress. This experience is on display in a programme that demonstrates up-to-date surgery at its best. Two full days of surgery, from morning to evening, are scheduled to guarantee enough time to display every detail of the technique shown. The main goal of the meeting is to show variations of a specific surgical procedure so that the participants can later choose which technique is to be used and in which patient this achieves the best

existence of a growing interest in acquiring surgical techniques via live surgery.

Delegates can expect parallel live surgery sessions, some local and some (very) remote

At ESUT18, headsets let the audience switch between moderation of each procedure

possible result. Having moderated live surgery is traditionally seen as hugely educational for the audience.

new achievements and technical gadgets that make urological surgery so extraordinary. Since the past two meetings were well accepted by the attendants and the surgeons, we can establish the

The ESUT group as well as the German working groups will work hard to support this meeting to the highest level live surgery event in Europe and across the globe. Don’t miss it.

Dr. Jan Klein, ESUT Board Member

For the complete Scientific Programme visit www.esut20.org

Newest technologies and trends in endoscopic, laparoscopic and robotic surgery will be the main focus of the programme as is traditionally the case during every ESUT Event. New: collaborative meeting The cooperation between the ESUT and the German working groups reflects another long tradition: fruitful collaboration. Leipzig is hosting this event for the first time. ESUT Chairman Prof. Evangelos Liatsikos and Prof. Jens-Uwe Stolzenburg, Chairman of the Urology Department of the Leipzig University Clinic are the main actors in this great event. Together with the working groups, these two well-known surgical experts will be composing a programme of superlatives including the new rising generation of robot machines.

ESUT20

Incl. Live Surgery

7th Meeting of the EAU Section of Uro-Technology in conjunction with the German Working Groups of Endourology, Laparoscopy and Robotic Assisted Surgery 23-24 January 2020, Leipzig, Germany

The aim of this meeting is to supply all urologists with the newest surgical kits around and to show the younger generations of urologists what are

„New technology drives medicine“

Arbeitskreis Endourologie

SMIT meets in Heilbronn In collaboration with ESUT and ESOU The 31st International Congress of the Society for Medical Innovation and Technology (SMIT) will take place in Heilbronn (GE) from Thursday, 10 October to, 11 October 2019. The theme of the congress will be “Technology drives medicine”. The idea of the society meeting, founded in 1989 by John Wickham, is to bring engineers, industry and physicians together.

Call for abstracts October 10-11, 2019, SMIT 2019 Konzert- und Kongresszentrum Harmonie

Further information: www.smit2019.com

The meeting is organised in collaboration with two important sections of the EAU (ESUT and ESOU). It will focus on minimally invasive surgery, including flexible surgery and robotics. Other interesting topics are interventional (uro-) radiology, focal therapy, computer-assisted medicine, smart technologies, future OR & logistics, vision of the future, particularly with respect to artificial intelligence. Additionally, three sessions will especially focus on minimally invasive management of urogenital tumours including new forms of medical treatment.

"...bringing engineers, industry and physicians together." In the long tradition of this innovative meeting, interdisciplinary exchange of ideas as well as direct contact with our partners from the industry are often the main goals. This is again true for SMIT 2019. Therefore, this year a platform for start-up companies and ideas was added to the programme. We would like to invite all interested urologists to attend this exciting meeting in the beautiful city of Heilbronn (www.smit2019.com).

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European

Urology

Today

Notification:

Promoting your meetings The EAU executive is pleased to help promote any scientific meetings. However, due to the large number of requests we are receiving, we have been forced to set up some rules and regulations related to the circulation of promotional material. All EAU related meetings (Section Offices either full members or partners) and national societies meetings with which we have a special alliance, may be promoted by e-mail (e-mail newsletter or separate e-mail communication), in addition to the other available channels. All other urological meetings may be included in our Uroweb online calendar. Please feel free to contact us (EUT@uroweb. org) in case there are any queries or remarks related to this notice.

In cooperation with ESUT and ESOU

European Urology Today

June/July 2019

A decade of educational collaboration EAUN celebrates 10th anniversary of co-operation with Asia Lawrence DrudgeCoates Urological Oncology CNS Chair, EAUN Special Interest Group Prostate Cancer London (UK) ldrudge-coates@nhs.net UrologyWard visit - The 2nd Affiliated Hospital, Tianjin

Multi-professional approaches to urological care are fundamental in ensuring positive outcomes in urological care, in which nurses are central and play a pivotal part. Furthering this approach, our visit to China celebrated the 10th anniversary of the collaboration between the Chinese (CUAN), Hong Kong (UNAHK) and European urology nursing communities. It symbolises a decade of continued friendship and strong educational links in the development of urological nursing both now and for the future. Practical workshops and lectures The collaborative educational programme delivered both practical workshops and lectures covering

clinical aspects in prostate cancer in conjunction with our physician colleagues. Broader aspects of care approaches including that of evidence based guideline development and concepts regarding specialist nursing were discussed and delivered in English, Cantonese and Mandarin Chinese. Unfortunately, illness prevented Paula Allchorne (EAUN Chair Elect) from attending the meetings with myself. I am delighted to say, however, she is now well and back on her feet. So on behalf of the EAUN I set upon delivering over 20 lectures and educational workshops over 10 days, across China from Guangzhou in the south, to Hefei, Tianjin and Beijing in the north. As always, a somewhat intensive schedule which required a degree of sleep deprivation, caffeine and amnesia regarding the task ahead, but thoroughly rewarding. These visits also afforded us the chance to see urological nursing first-hand and there was great interest in our visits to the wards from both patients and staff alike. In addition, many high-level healthcare and hospital leaders were present at the meetings in support of these conferences for nurses.

EAUN SIG Chair Lawrence Drudge-Coates and Ms. Lani (Head of Urological Nursing) at The First Affiliated Hospital, Sun Yat Sen University Hospital, Guangzhou (CH)

Essential podcasts The EAUN lectures in China (Guangzhou, Hefei, Beijing, Tianjin) were attended by over 1,000 delegates. Thanks to supporting technology, nurses

Members of the Urology Department of the Peking University Hospital

were able to follow both the lectures and workshops online by accessing podcasts. This is an essential element in China when considering education approaches due to the sheer size of the country and the ability of nurses to travel to these meetings. In my opening speeches, on behalf of the EAUN, I once again reiterated the importance of such collaboration and from its infancy recounted the developments and significant achievements that had already occurred. I stressed that “while being divided by culture and language, there was a strong unity in the need to provide optimal patient care for urology patients, and as such collaboration provided the vehicle by which to achieve this goal” and that we had a lot to learn from each other.

with great interest, and allowed all parties to consider both the positive and negative aspects, while identifying commonalities in the rationale for these approaches to be developed. Once again this visit proved to be a highly interactive educational event, with a real sense of the mutual need to develop urology nursing excellence and therefore all credit goes to our colleagues from Hong Kong & China. Without their continued support such an event would not be possible.

Nurse specialisation This year also saw a growing interest in the concept of nurse specialisation in urology with the development of programmes in urological nursing as the first nursing discipline in China to address this issue and begin to formulate key aspects of this approach. Peking University Hospital, Urology Department – workshop on Experiences from the UK and elsewhere were viewed rectal examination

EAUN19 Poster Sessions: Food for thought How to transfer new information from session to daily practice Jason Alcorn, FHEA, DN, MSc, BSc, Dip Urol Carer, RN Adult EAUN Board Member Wakefield (UK)

j.alcorn@eaun.org Hello colleagues, I hope you enjoyed the Annual EAUN Congress as much as we did. The sessions were well attended, informative and gave much food for thought. Apart from the sessions, the posters were of a high standard and gave the adjudicators a headache trying to select the top two in each category. In total there were 44 poster and 3 video abstracts submitted with 25 selected for your review. The poster abstracts were then roughly split evenly into ‘practice development’ and ‘scientific’. The abstracts were submitted by colleagues from Europe as well as from Australia, Pakistan, Israel, Hong Kong, Qatar, Singapore, Taiwan and China. Just to show you how well-known our conference is around the globe. Entire patient pathway The posters came from a wide variety of settings: from outpatient departments to clinical settings in hospitals and from the entire patient pathway, from pre-diagnostic tests to post-treatment follow-up. The subjects of the posters were good examples of how nurses can improve their clinical or personal practice, as well as their work settings for other nurses to follow in the future. Unfortunately, our colleagues from Pakistan were unable to attend the conference in person. Therefore they gave their presentation via skype, a first I am led to believe. This worked well, it seemed they June/July 2019

were in the room with us. A first for the EAUN conference and one, I am sure, that may well be used again. Abstract scores The abstracts submitted by hopeful participants were initially scored by the Scientific Committee and the submitters of the top-scoring posters invited to bring and present their poster in Barcelona. These top-scoring posters were displayed on the poster boards for your review. The adjudicators viewed each poster and listened to the participants presenting their research/work during the session. Each participant’s poster was scored against predetermined criteria. It should be noted that the final total number of points given to the projects were exceptionally close for the winning posters in each category. This means that they were of a high standard and promoted urology nursing. I would like to present a brief synopsis of the winner of each category’s poster.

stewardship and use of resources. McConkey concluded that appropriately trained nurses can deliver safe and high-quality patient centred services. Something with which we all agree I think. Ostomy self-care study In the scientific section, the winner was poster 13: ‘Self-care in ostomy patients and their caregivers’, presented by M. Boarin (IT). This was a descriptive study focussed on self-care levels in ostomy patients and their caregivers by using two new tools. They noted that ostomy patients face great challenges in the physical, psychological, emotional and social aspects of their lives. They sampled 105 patients and 75 caregivers. The conclusion of this study showed that the tools were important in supporting nurses in their practice, as they gave an objective assessment of ostomy patients and caregivers levels of self-care. Boarin hypothesised

that these tools may contribute to significant reduction in readmissions and ostomy complications. Improve healthcare In concluding this short piece, I don’t think I have done the winners and their work enough justice, so I wholeheartedly invite you to look at these pieces of work by following this link https://resourcecentre.uroweb.org/resource-centre/prize-winners/ eaun19. Please feel free to take a look at other works presented as well, digest them and look at how they can be used to inform your daily practice. These examples can be spread all over Europe by presenting them in a congress such as ours, as well as in your own workplace. This way, best practice and knowledge can be used in other hospitals and improve healthcare for all our patients.

“...the posters were good examples of how nurses can improve their clinical or personal practice...” Winner practice development section The winner of the practice development section was poster 3: ‘Development of an advanced nurse practitioner-led bladder cancer surveillance service in Ireland: Preliminary audit results’, presented by R. McConkey (IE). This practice development was building on the advanced nurse practitioner role used in other countries where the role of a nurse cystoscopist has evolved. The poster showed the reader how the role was conceived, planned, implemented and then evaluated. It was this evaluation that McConkey presented to the conference. It took into account some of the issues that we contend with every day in clinical practice, such as effective care and support, antimicrobial

EAUN Board Chair Chair Elect Board member Board member Board member Board member Board member Board member

Susanne Vahr (DK) Paula Allchorne (UK) Jason Alcorn (UK) Jerome Marley (GB) Tiago Santos (PT) Corinne Tillier (NL) Jeannette Verkerk (NL) Giulia Villa (IT)

www.eaun.uroweb.org Poster viewing by jury and delegates before the poster presentations start

European Urology Today

Self-care in ostomy patients and their caregivers Measuring self-care levels in ostomy patients and caregivers using two new validated indexes Mattia Boarin, RN, MSN Staff Nurse & Lecturer Dept. of Urology San Raffaele Hospital Milan (IT) boarin.mattia@hsr.it

At the 20th International EAUN Meeting in Barcelona, we presented a poster describing a study conducted in our hospital in Milan, aimed at investigating the self-care levels in ostomy patients and caregivers using two new indexes, validated in Italian. Introduction Patients with an ostomy have to face great challenges on physical, emotional, psychological and social level. We, as health-care professionals, play a key part because we support adaptation, we encourage patients to be involved in stoma care directly and we create the best conditions to promote effective self-management. There are over 72.000 people in Italy currently living with an ostomy. Aim of the study The aim of our study is to describe the levels of self-care in ostomy patients and their caregivers using two new validated tools: the Ostomy Self-Care Index (OSCI) and the Caregiver Contribution to Self-Care in Ostomy Patient Index (CC-OSCI). The OSCI is composed of four scales: assessing self-care maintenance (daily behaviours implemented as a routine), self-care monitoring (ostomy and peristomal skin monitoring), self-care management (identification of complications and the response to it), and self-care confidence (confidence in personal abilities, in order to be involved in the self-care process). The CC-OSCI is composed of the first three scales of OSCI. There are 33 items for the OSCI and 23 for the CC-OSCI, with

their proper indicators (self-completed instrument rated on Likert scale 1-5); for the two indexes, the increase in score is directly proportional to the adopted self-care level. Materials & Methods We conducted a descriptive study on a sample of adult ostomy patients and their caregivers in our Department of Urology. The questionnaire subjected to patients was composed of a sociodemographicclinical data form, to collect information about demographics, living, family and work conditions, clinical information about ostomy, the OSCI, and the Stoma Care Quality of Life scale (Stoma-QoL), a specific instrument commonly used to assess quality of life in ostomy patients and validated in the Italian context. The Stoma-QoL consists of 20 items based on four domains: sleep, sexual activity, relations with family and close friends, and social relations outside family and close friends; every item uses a 4-point Likert scale ranging from “always” to “not at all.” The caregiver questionnaire was composed of a sociodemographic-clinical data form, and the CC-OSCI. Results Out of 107 questionnaires, 105 were returned and analysed (98.13%). The sample considered was composed of 105 patients and 75 caregivers, for a total of 180 people. Patients were 68 years old on average and mostly male. The majority was married (56.19%), with an average of two children each. In almost 82% of the cases, patients did not live alone, and most of the patients were retired (80.95%). Regarding clinical data, 49 people (46.67%) had a colostomy. The predominant reason why the patients needed a stoma was oncological (95, 90.48%). The period the patients had a stoma was about 22.35 months (range 1-60) on average. Almost half of the patients declared they were autonomous in stoma management (48.57%). Out of 105 patients, 33 (31.43%) had one or more complications and 27 (25.71%) had readmissions. In order to assess whether the scales could detect the difference in

incidence rates of complications or readmissions References 1. Ang S. G., Chen H.C., Siah R. J., He H.G., Klainin-Yobas P. according to self-care behaviour, we examined the (2013). Stressors relating to patient psychological health differences in self-care scores between patients following stoma surgery: an integrated literature review. experiencing complications or readmissions and those Oncology Nursing Forum. 40(6), 587- 594. who had no adverse events. All scales showed 2. Canova C, Giorato E, Roveron G, Turrini P, Zanotti R. statistically significant differences in the presence or Validation of a stoma-specific quality of life absence of complications or readmissions (p < 0.0001 questionnaire in a sample of patients with colostomy or in all scales). Caregiving The average age of caregivers was about 59 years (range 45-73). The sample consisted of 76% women; the recruited caregivers were mainly husbands/ wives/partners (65.33%), and in 73.33% of the cases, they lived with the patient. Finally, the average time spent on caregiving was about 19 hours per week. After analysing the scores achieved by our sample by using the two indexes, the median of the patients’ answers turned out to be mostly 4 or 5, indicating that data values are positioned around those scores. This shows a good level of self-care. For quality of life, the mean of the Stoma-QoL score was 57.30 ± 17.72. Such values indicate an average level of quality of life, because the score has a theoretical range between 20 (worst possible quality of life) and 80 (optimal quality of life). Conclusions We can conclude that the characteristics of our population sample appear not to be significantly different from ostomy patients described in literature. Each scale that we used showed a similar average score with regard to patients; the scores indicated a good level of self-care and an average level of quality of life. The OSCI and the CC-OSCI represent two important tools to support us in our clinical practice. The objective assessment of self-care levels in ostomy patients and their caregivers is an important first step in clinical management, in order to guarantee evidence-based educational support. This might contribute to a significant reduction of readmissions and complications.

ileostomy. Color Dis. 2013;15(11):692-698. 3. Villa G, Vellone E, Sciara S, et al. Two new tools for self-care in ostomy patients and their informal caregivers: Psychosocial, clinical, and operative aspects. Int J Urol Nurs. 2019;13:23–30. 4. Hu A., Pan Y., Zhang M., Zhang J., Zheng M., Huang M., Wu, X. (2014). Factors influencing adjustment to a colostomy in chinese patients a cross-sectional study. Ostomy Care. 41(5), 455-459. 5. Jensen B. T., Blok W. D., Kiesbye B., Kristensen A. S. (2013). Validation of the urostomy education scale: the european experience. Urologic Nursing. 33(5), 219- 229. 6. Lim S. H., Chan S. W., He H.G. (2015). Patients’ experiences of performing self-care of stomas in the initial postoperative period. Cancer Nursing. 38(3), 185-193. Complete references of this article are available from the EUT Editorial Office. Please send an e-mail to: EUT@uroweb.org with reference to the article “Self-care in ostomy patients” by M. Boarin, June/July issue 2019. Self-care in ostomy patients and their caregivers

4/1/2019

Self-care in ostomy patients and their caregivers

EAUN19 P13

logo

Mannarini M.1, Della Giovanna G.1, Boarin M.2, Villa G.2, Marzo E.3, Manara D.F.4

1RN, School of Nursing, Vita-Salute San Raffaele University, Milan (Italy); 2RN, MSN, Dept. of Urology, San Raffaele Hospital, Milan (Italy);

Mannarini M.1, Della Giovanna G.2, Boarin M.3, Villa G.4, Marzo E.5, Manara D.F.6

3RN, MSN, PhD - 4RN, MSN, Associate Professor, School of Nursing, Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan (Italy)

EAUN19 P13

1RN, Dept. of

Cognitive and functional abilities

Social support

Confidence in Abilities

Self-care

Possibility to care access

XXXXX, XXXXXX, Milan (Italy); 2RN, Dept. of XXXXX, XXXXXX, Milan (Italy); 3,4RN, MSN, Dept. of Urology, San Raffaele Hospital, Milan (Italy);

Introduction: 5RN, MSN, PhD - 6RN, MSN, Associate Professor, School of Nursing, Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan (Italy) 12

Habits

Cultural beliefs and values

Motivation Experience and Ability

Riegel et al. (2012)

Patients with an ostomy have to face great challenges, notOSCI: only Ostomy just on physical, butIndex also on emotional, psychological, and social level. Health Self-Care professionals have a key role, supporting adaptation, encouraging patients to be involved in stoma care directly, and creating the best Introduction: conditions to promote an effective Measuring people ostomy but also on emotional, Patients with an ostomy have self-management. to face great challenges, notself-care only in just onwith physical, Abitudini Abilità 32 items Fiducia cognitive psychological, and social level. Health professionals have a key role, supporting adaptation, encouraging patients nelle e Better quality Likert scale (1-5) Aim: abilità to be involved in stoma care directly, and creating the best conditions to promote an effective self-management. Adjustment funzionali of life To describe the self-care’s (SC) levels in ostomy patients and their caregivers using two new tools:

Aim:

Ostomy Self-Care(SC) Index CC-OSCI: Caregiver Contribution to Self-Care in tools: the Ostomy Empowerment ToOSCI: describe the self-care’s levels in ostomy patients and their caregivers using two new SelfOstomy PatientPatient Index Index (CC-OSCI). Care Index (OSCI), and Caregiver Contribution to Self-Care in Ostomy Measuring self-care in people with ostomy

items MaterialsLikert &32scale Methods: (1-5)

Measuring caregiver contribution to self-care in people with ostomy

Villa et al., accepted

Results:

Out of 107 questionnaires, 105 were returned and analyzed (98.13%). The considered sample was composed of 105 patients (average age: 68 y/o; mostly male) and 75 caregivers (180 subjects). In almost Out of 107 questionnaires, 105 were returned and analyzed (98.13%). The considered sample was composed of 105 patients (average age: 68 y/o; the 82% of cases, patients did not live alone; the 46.67% had a colostomy. The predominant causes of mostly male) and 75 caregivers (180 subjects). In almost the 82% of cases, patients did not live alone; the 46.67% had a colostomy. The predominant stoma creation were oncological (90.48%). The average time of stoma creation was 22.35 months (range causes of stoma creation were oncological (90.48%). The average time of stoma creation was 22.35 months (range 1-60). Almost half of the 1-60). Almost half of the sample declared to be autonomous in stoma management (48.57%). Regarding sample declared to be autonomous in stoma management (48.57%). Regarding the caregivers, the 76% was composed by women (average age: 59 the caregivers, the 76% was composed by women (average age: 59 y/o), mainly husbands/wives/partners y/o), mainly husbands/wives/partners (65.33%), the 73.33% living with the patient. The average time spent on caregiving was about 19 hours/week. (65.33%), the 73.33% living with the patient. The average time spent on caregiving was about 19 hours/ The 31.43% of patients’ sample had one or more complications and the 25.71% had readmissions. week. The 31.43% of patients’ sample had one or more complications and the 25.71% had readmissions.

Conclusions:

Selfcare

Self-care person Possibilità with di accesso ostomy alle cure

22 items

Likert scale (1-5) A descriptive study was conducted on a sample of adult ostomy patients and caregivers in the Dept. of Urology (San Raﬀaele Hospital, Milan), from Jan. to Sept. 2018. The patient questionnaire was Materials & Methods: composed of a sociodemographic-clinical data form, to collect information about demographics, living, CC-OSCI:onCaregiver to Self-Care A descriptive study was conducted a sampleContribution of adult ostomy patientsin and caregivers in the Dept. of Urology (San Raﬀaele Hospital, Milan), family andPatient work conditions, clinical information about ostomy, the OSCI, and the Stoma Care Quality of Ostomy Index from Jan. to Sept. 2018. The patient questionnaire was composed of a sociodemographic-clinical data form, to collect information about Life scale (SQoL). The caregiver questionnaire was composed of a sociodemographic-clinical data form, demographics, living, family and work conditions, clinical information about ostomy, the OSCI, and the Stoma Care Quality of Life scale (SQoL). Measuring caregiver to self-care in about people with ostomy to contribution collect information demographics, living, family and work conditions, and the CC-OSCI. The caregiver questionnaire was composed of a 22sociodemographic-clinical data form, to collect information about demographics, living, family items and work conditions, and the CC-OSCI. Likert scale (1-5)

Results:

Supporto sociale

Villa et al., accepted

BARCELON 16-18 Ma rch 2019

Credenze culturali e

Reduction of valori Complications Motivazione

Esperienza ed abilità

ﬁle:///Users/Mattia/Desktop/logo.svg

1/1

Riegel et al. (2012)

Results of SC levels in patients/caregivers SCALE

MEAN (SD)

MEDIAN

MAX

MIN

OSCI A

34.76 (11.47)

30.45 (9.42)

OSCI C

16.99 (3.69)

OSCI D

36.40 (10.29)

CC-OSCI A

32.44 (13.32)

CC-OSCI B

22.89 (13.75)

CC-OSCI C

12.69 (6.96)

SQoL

57.30 (17.72)

OSCI B

A: self-care maintenance B: self-care monitoring

9 8

C: self-care management D: self-care conﬁdence

Conclusions:

The characteristics of our sample appear similar to ostomy patients described in literature. Each scale reaches a similar average score towards patients; the scores indicated a good level of SC and an The characteristics of our sample appear similar to ostomy patients described in literature. Each scale reaches a similar average score towards patients; the average level of quality of life. The OSCI and CC-OSCI are two important tools for support nurses in their practice. An objective assessment of ostomy patients’ and caregiver’s SC levels is an essential scores indicated a good level of SC and an average level of quality of life. The OSCI and CC-OSCI are two important tools for support nurses in their practice. An starting point willing to guarantee an evidence-based educational support. This might contribute a significant reduction of readmissions and ostomy complications. objective assessment of ostomy patients’ and caregiver’s SC levels is an essential starting point willing to guarantee an evidence-based educational support. This might contribute a significant reduction of readmissions and ostomy complications. Reference: Riegel B., Jaarsma T. & Stromberg A. (2012). A Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science. 35(3), 194-204.

Contacts: boarin.mattia@hsr.it villa.giulia@hsr.it

The presented poster on our “self-care in ostomy” project that won me and my co-authors the First Prize for the Best Scientific Poster Presentation

EAUN20 delegates: An exciting programme awaits you With expansive coverage on many current topics in urological nursing Imagine an event so comprehensive that it covers core principles and current topics and debates inof urological nursing. Not only will joining that event benefit you, but also the patients who are under your care. An event such as described does exist. Every year, the European Association of Urology Nurses (EAUN) organises its congresses to focus on the professional needs of urological nurses and other healthcare professions (HCPs). The upcoming 21st edition, EAUN20, in March 2020 will offer you current relevant scientific and practical updates.

Abstract submission now open! Deadline: 1 December 2019 What to look forward to For a sneak peek at EAUN20, topic coverage will include doctor-nurse cooperation in daily practice from both points of view; nurse-led management of LUTS (lower urinary tract symptoms); strategies for improving the quality of urology care, and plenty more. Complementing the Scientific Programme, EAUN20’s Thematic Sessions will include new sessions of SIGs (Special Interest Groups) concentrating on endourology (i.e. coverage on stone disease, benign prostatic hyperplasia, and technologies such as robotics) and addressing skeletal issues in metastatic prostate cancer (PCa). And as you know, enuresis is prevalent among children and nocturia in middle-aged and older adults; and both conditions have a profound impact on the patients’ quality of life. At EAUN20, your know-how on the predictive factors, as well as, medical and non-medical management will increase. Additionally, you can further enrich your skills through workshops on antimicrobial resistance; sexual function; uro-oncology; palliative end of life urology care; continence care; the role of 40

European Urology Today

shared decision making; and patient education initiatives. Nurses whose dedication is a source of inspiration, and whose contribution help boost the quality of nursing care will share their expertise in the Special Session “Best of urological nursing practice in Europe”. Their efforts have been recognised and will be awarded during the session as well. Developments and controversies The Plenary Session “Educational Framework for Urological Nursing (EFUN) (Curriculum) and the role of ANP” will centre on the development of the ANP role, which has advanced in a variety of ways across Europe. Experiences with the ANP role and the link to the current Guidelines will be shared with the audience, as well as, the progress with the development of an Educational Framework for Urological Nursing (Curriculum). EAUN20 will also examine controversial topics such as the emerging role of genomic screening in treatment decision-making for PCa and bladder cancer.

For the complete Scientific Programme visit www.eaun20.org balancing it with the nurses’ ability to interpret current research, best practices, and the Guidelines. Be part of this impressive lineup EAUN20 is designed to stimulate discussions with the latest evidence and practice updates in urological nursing. The congress will bring together an exceptional group of nurses and HCPs,

and we would be very pleased to have you present your original research and valuable insights at EAUN20. Submit your poster and/or video abstracts, research project plans, and difficult cases before the deadline of 1 December 2019. You will find submission details at www.EAUN20.org/ Scientific-Programme. We look forward to welcoming you in Amsterdam, the Netherlands! Save the dates: 21 to 23 March 2020.

21st International EAUN Meeting

Join us in Amsterdam! 21-23 March 2020, Amsterdam

Meeting current challenges The influence of AMR (Antimicrobial Resistance) on urological healthcare, and the long-term side effects of BCG (Bacillus Calmette-Guerin) are some of the challenges that EAUN20 will address. The congress will also investigate how to overcome difficulties in non-muscle invasive bladder cancer care. In addition, EAUN20 will examine the ability of nurses to easily interpret the evidence-based findings that support current practice. The main challenge here is to meet the needs of patients who have high expectations of healthcare, whilst in conjunction with

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