ESU section: An overview of ESU masterclasses in 2021

Vital key messages, diverse topic coverage, and testimonials

By Erika De Groot

Not even the advent of the COVID-19 pandemic impeded the quest for knowledge of young and experienced urologists. This year, the European School of Urology (ESU), together with key opinion leaders in urology in Europe, forged ahead and even redesigned some of the masterclasses into virtual events to cater to the increasing demand for educational activities.

This report is a compilation of key messages from the faculty and impressions from the participants of the following five ESU masterclasses that took place later this year: • ESU-Weill Cornell Masterclass in General urology 2021 • Virtual ESU-ESAU-ESGURS Masterclass on Erectile restoration and Peyronie's disease 2021 • ESU-ESTU Masterclass on Kidney transplant 2021 • Virtual ESU-ESFFU Masterclass on Functional

Urology 2021 • ESU-ESUT Masterclass on Lasers in Urology 2021

On general urology From 12 to 16 July 2021, the ESU-Weill Cornell Masterclass in General urology 2021 covered a myriad of topics such as nephrectomy, upper urinary tract urothelial carcinoma (UTUC), diagnosis of testis cancer, and muscle-invasive bladder cancer (MIBC) staging, to name a few. ESU faculty member and former ESU Chair, Prof. Joan Palou (ES), provided the following important key points of the masterclass: 1. With regard to small renal masses – from surveillance or minimally-invasive treatment, to partial nephrectomy – the factors to be considered are age, comorbidities, location and size of the tumour. 2. Opting for partial nephrectomy or enucleation is still debatable. However, there is enough indirect evidence showing similar results related to recurrence. 3. TURB a very important step in the management of bladder cancer; always go for more external and deeper than you initially think!

Participant Dr. Aurore Mattlet (BE) shared, “The masterclass was a great opportunity for me. The planning for everything – from the lectures, accommodation, travels, to meals – was perfect. There is no comment about that except thank you. I enjoyed and learned a lot during all the lectures on MIBC and renal mass. However, I found one lecture difficult to follow and needing more clarity, and the paediatrics presentations were at a basic level. Overall, I want to express my appreciation for this opportunity and for the participation of experts in urology.”

On erectile restoration and Peyronie's disease Participants from 31 countries from around the world attended the Virtual ESU-ESAU-ESGURS Masterclass on Erectile restoration and Peyronie's disease 2021, which took place from 6 to 7 October 2021. The collaborative efforts of the ESU, EAU Sections of Andrological Urology (ESAU) and Genitourinary Reconstructive Surgeons (ESGURS) paid off when the evaluation report showed that majority of the participants felt that the masterclass increased their professional knowledge and could benefit their patient care.

ESU faculty member, Dr. Maarten Albersen (BE), offered the following take-home messages of the masterclass: 1. If pharmacotherapy does not work, there are various options in terms of erectile prosthesis to allow penetrative intercourse. Advantages and disadvantages of the two commonly used types of implants (malleable and three-piece inflatable) should be thoroughly discussed with the patient

Learning by doing, laparoscopy training during ESU-Weill Cornell Masterclass

and the partner. 2. Always measure penile length in a standardised fashion and with the patient awake before embarking on penile curvature correction: subjective penile shortening is one of the most prevalent complaints after this type of surgery and an important determinant of patient satisfaction. 3. Modesty is important when combined surgery is employed for complex penile curvatures: do not use large grafts on top of penile implants and do not overstretch the corpora after dissection of the urethra and the neurovascular bundle.

Participant Dr. Fadi Dalati (BE) stated, “The presentation on non-surgical options by Dr. Albersen made the most impact. The slides were very informative and was presented in an orderly fashion. All statements were combined with reliable references, as well as, with the personal experience of the user, which has an important added value. It’s a shame the meeting was not face-to-face as we would have much benefited from rich discussions during and after the presentation.”

On kidney transplant The ESU and the EAU Section of Transplantation Urology (ESTU) organised the ESU-ESTU Masterclass on Kidney transplant 2021 which was held from 28 to 29 October 2021 in Madrid, Spain. The masterclass delivered updates on kidney donors and rejection consequences during the pandemic; kidney preservation practices and strategies, and more together with hands-on trainings on hypothermic renal perfusion.

ESU faculty members Prof. Dr. Enrique Lledó García (ES) and Prof. Francisco Javier Burgos Revilla (ES) encapsulated the key messages of the masterclass: 1. Transplantation is an essential part of urology.

Organ procurement techniques, bench surgery and complex vascular surgery associated with kidney transplant activity increase the skills of the urologists to face major oncological surgeries. 2. Donor profile is changing with a higher number of expanded criteria and non-beating heart donors.

Normothermic reperfusion in the donor and pulsatile hypothermic perfusion of the graft are important to prevent delayed graft function. 3. Robotic kidney transplant is an innovative technique feasible in living donor kidney transplant. At present, recipients with iliac atheromatosis is a limitation for this approach. According to participant Dr. David Andrés Castañeda Millán (CO), the insights he gained from the two lectures of Dr. Vital Hevia Palacios which were entitled “Evaluation of oncological disease in the donor” and “Incidence and treatment of urological tumors in KT recipients” will benefit his daily practice. He added, “The oncological issues surrounding the kidney transplant (donor and recipients) covered by the masterclass were useful and changed some paradigms related to the acceptance and use of kidney grafts with small renal masses for transplantation. These presentations gave the participants important and relevant clinical knowledge in management in terms of the urooncological aspects after kidney transplantation.”

On functional urology From 3 to 4 November 2021, experts of the ESU and EAU Section of Female and Functional Urology (ESFFU) comprised the faculty of the Virtual ESUESFFU Masterclass on Functional Urology 2021. They provided vital insights on neuroanatomy and physiology, bladder pain syndrome, interstitial cystitis, and urinary diversion, to name a few. The lectures were interspersed with step-by-step videos, commonly-encountered and unique patient cases.

Participant Dr. Florine Schlatmann (NL) shared, “The topic that will have the biggest impact on my daily clinical practice was the coverage on complications after tape surgery. As a resident in the last phase of her training, not being able to prevent or causing a complication is obviously a big fear. Learning how to deal with possible complications is of great added value. The good visuals, interactive discussions with the faculty and colleagues, and time for questions made this masterclass very informative!” Please go to page 20 for the expanded report of fellow participant, Dr. Martina Beverini (IT).

On lasers From 18 to 19 November, the ESU-ESUT Masterclass on Lasers in Urology 2021 kicked off in Barcelona, Spain. Faculty members, who are experts from the ESU and the EAU Section of Uro-Technology (ESUT), delivered laser fundamentals and developments which included videos on lasers for UTUC, stones, and benign prostatic hyperplasia. One remarked that the masterclass was of high calibre and “the best in the world” in terms of scientific content. In the evaluation report, participants stated that it was “a high-level masterclass that was relaxed which made it an excellent forum for engagement” and “a must-attend for endourologists.”

ESU faculty member, Dr. Alberto Breda (ES), shared the following key points of the masterclass: 1. Thulium fibre lasers are more and more used in the field of stone fragmentation and dusting. 2. The combination of Holmium and Thulium-YAG lasers is possibly the best treatment for upper tract tumour ablation. 3. No matter what laser is used, prostate enucleation is the standard of care for BPH treatment.

On-site during the masterclass on lasers

Hypothermic renal perfusion demonstration

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Access the scientific content

Explore and (re)view the scientific content of the masterclasses that took place this year via UROsource, the EAU learning library for urologists. Simply go to www.uroweb.org/ masterclass-content-on-urosource or scan the QR code with your smartphone.