A highly successful meeting amidst a pandemic

Prof. Nikolaos Sofikitis Dept. of Urology Ioannina University (GR)

v.sofikitis@ hotmail.com

I would like to thank the Executive Committee of the European Association of Urology (EAU) and its Secretary General Prof. Christopher Chapple (Sheffield, GB) very much for giving me the unique opportunity to participate in the 108th Annual Meeting of the Japanese Urological Association (JUA 2020) and give three invited lectures here. The meeting took place in Kobe (JP) from 22 to 24 December 2020. It was one of the few physical meetings in 2020.

Japan is closed for foreigners during the Covid-19 pandemic. I was able to visit Japan because I have a permanent resident status here. I had undergone my first SARS-CoV-2 PCR test in Greece prior to my departure. Immediately after my arrival in Tokyo, I underwent a rapid SARS -COVID 2 test. After that, I could not travel to the venue of the meeting; according to the rules of the Japanese government, I had to isolate myself in a hotel for two weeks. At the end of the isolation period, I travelled to Kobe. In this city, I immediately saw that Japanese citizens protected themselves from the coronavirus by carefully adopting the suggestions of their government. In the venue, the body temperature of each participant was measured. Sweets and liquids were offered in specific places of the venue. Although JUA 2020 was held amidst a pandemic, I consider its organisation highly successful. A high-level scientific programme was offered to the participants, and additionally the highly developed sense of kindness and responsibility inherent in the nature of the Japanese people coupled with the unique Japanese hospitality offered a uniquely friendly atmosphere.

“The highly developed sense of kindness and responsibility inherent in the nature of the Japanese people offered a uniquely friendly atmosphere.”

A significant number of urologists participated in JUA 2020. All Japanese medical universities (more than 100) had asked their urologists to be physically present at the meeting. As a result, many young urologists were there; in contrast, most urologists from public hospitals and private practice urologists attended virtually. Several invited lectures were given by professors in person, mainly from Japanese medical universities, whereas some invited lectures were presented online; most of which were delivered by international speakers. The scientific atmosphere was exciting and the scientific messages that were offered to the participants were significant and remarkable.

Testicular descent in mammals and humans I gave three invited lectures. One of them, named "Philosophical, financial, and physiological consequences of testicular descent in mammals and in the human", attempted to answer many unanswered questions, such as "what is the benefit for the male to have its testicles descended within a scrotum?”, “why did nature decide that thousands of calories should be consumed during testicular descent?", “is it correct to state that during the evolution of species, testicular descent remains an important feature for the maintenance of the testes in a low-temperature environment?", and "if this last hypothesis is correct, how can we explain the presence of adequate testicular spermatogenesis in species with intraabdominal testes such as the Asiatic elephant and the turkey?"

The take-home messages of this lecture supported the thesis that the testicular descent does offer benefits to males, since males with scrotal sacs: b) demonstrate larger quantitative and qualitative sperm motility c) have a better epididymal sperm reservoir function d) show more optimal intratesticular testosterone concentration e) are characterised by a smaller percentage of genetic alterations in haploid cells

Males with testicles located within a large, colourful, wrinkled scrotum are prone to polygamy. Males without scrotal sacs are prone to monogamy. Thus, testicular descent in the male influences the male sexual behaviour. A colourful, wrinkled scrotum is always attractive for the females.

“These observations may make young urologists realise that basic research in urology is exciting and can provide interesting explanations.”

In addition, my lecture provided evidence that female sexual behaviour, too, influences male sexual behaviour. For example, species in which females commonly have multiple male partners, such as the chimpanzees and bonobos, tend to have higher rates of sperm competition within the female reproductive tract. Thus, female infidelity increases the competition between spermatozoa ejaculated by different males that try to fertilise the oocyte of a given female animal. The overall result is the need for the male to develop larger testicles in order to produce a larger number of spermatozoa, aiming to win in the sperm competition race. However, large testicles are accompanied by the need for a large, well-developed scrotum that will host these large testicles. This will, in turn, attract many females. Thus, female infidelity leads to male infidelity.

Finally, the lecture described physiological mechanisms explaining the mystery why species with scrotal sacs (i.e. humans) have larger quantitative and qualitative sperm motility but lower sperm counts compared with ascrotal species. Testicular descent is accompanied with a longer course of testicular artery compared with ascrotal species, which offers the opportunity for incomplete testicular torsions in the species with scrotal sacs. This may lead to the development of episodes of testicular ischemia. The spermatozoa in scrotal species are thus trained in anaerobic glycolysis, in addition to their ability to utilize the metabolic pathway of aerobic glycolysis. The overall result is a larger potential for motility of the spermatozoa of scrotal species. Thus, spermatozoa of scrotal species are better and more efficiently ‘trained’ for their future endeavour in the rigorous female environment.

To sum up, scrotal species:

a) develop metabolic advantages in the sperm physiology compared with ascrotal species and thus b) demonstrate a larger quantitative and qualitative sperm motility

Male elephants and turkeys with intraabdominal testicles have internal mechanisms to lower testicular temperature, thereby securing optimal sperm production and maintenance of sperm reproductive potential.

The above observations may make young urologists realise that basic research in urology is exciting and can provide interesting explanations about the development of species during evolution and about several features in the physiology of the genital tract that provide certain advantages to the reproduction and the survival of some species.

International Journal of Urology I also had the honour to participate in two sessions of the editorial board of the International Journal of Urology. I also had the great honour to be invited to become a member of this editorial board. The International Journal of Urology has a significant impact factor and attracts many manuscripts from all over the world for consideration for publication. The journal contributes to the promotion of research and education in urology worldwide. We agreed that EAU Section of Andrological Urology (ESAU) board members are going to submit articles on various topics in andrology to the International Journal of Urology Review Studies for consideration for publication. Furthermore, we have developed a schedule for publishing a debate on an andrology topic between a member of the ESAU board and an andrology expert from JUA in European Urology Today (EUT) one or two times per year. This plan has been accepted by the Secretary General of EAU and the Executive Committee of EAU. With the support from the leaders of JUA, we anticipate exciting debates in the topics erectile dysfunction, penile surgery, male infertility, and male endocrinology.

My participation in the two sessions has given me the possibility to reconfirm the wish of JUA to collaborate with EAU in several types of educational activities. My personal feeling is that a close collaboration between JUA and EAU will promote education of urologists for the great benefit of urologists of both organisations.

Personal exchange of knowledge Overall, I feel that a physical meeting amidst a pandemic is more attractive to participants – provided that the rules for the safety and health of those participants are strictly followed. I enjoyed the direct interactions and thus meaningful discussions I had with participants after each lecture. If the period for discussion during a session wasn’t sufficient to allow for all the questions to be answered, personal exchange of scientific information, knowledge, and experience was possible. The obvious cons of a physical meeting are the risks to the health of the participants. I was only able to visit Japan because I have a permanent resident status, and traveling during a pandemic is not easy. In the long run, I would prefer a physical meeting – and let’s hope this will be possible for all delegates again soon.

Prof. Nikolaos Sofikitis (bottom row, second from the left) together with the other participants in the International Journal of Urology editorial board meeting

“We developed a schedule for publishing a debate on an andrology topic between a member of the ESAU board and an andrology expert from JUA in EUT one or two times per year.”