Highlights from the Irish Society of Urology Annual Meeting 2018

October 3, 2018/by Clare O Connell

Dr Kent T. Perry Jr. delivers a lecture on minimally invasive kidney surgery

The Irish Society of Urology annual meeting has a strong tradition of attracting world class guest speakers, and this year was no different. We were joined by Dr Kent T. Perry Jr. (Co-Director of the Minimally Invasive Surgery Program & Associated Professor at Northwestern University Chicago), Professor Hendrik Van Poppel (Adj. Secretary General of EAU for Education), Mr Jeremy Ockrim (Honorary Lecturer and Consultant Urologist at University College London), Mr Kieran O’Flynn (Immediate BAUS past president and Consultant Urologist at Salford Royal Foundation), and Dr Matthias Hofer (Assistant Professor at Dept. Urology, Northwestern University Chicago). The excellent programme of guest speakers started on Friday afternoon with Dr Matthias Hofer’s talk on urethral reconstruction-a ‘no frills’ overview of a complex topic which surely inspired several trainees in the room to consider a career in Reconstructive Urology.

The historic Strokestown House, Co. Roscommon

The Saturday formal dinner was held in the historic Strokestown House in Roscommon-the former home of the Packenham Mahon family, built on the site of a 16^th Century castle, which was home to the O’Conor-Roe Gaelic Chieftains. It is now the site of the National Famine Museum. We were treated to a fascinating tour of the house on arrival, before enjoying a wonderful dinner, and some fantastic harp-playing. The presidential chain was conferred to the incoming president, Mr Paul Sweeney of The Mercy University Hospital in Cork, and the society are already looking ahead to exciting things during his tenure as president.

About the authors:

Dr Clare O’Connell is a first year Urology SpR in the Department of Urology & Transplant in Beaumont Hospital, Dublin (@oconnellclare).

Dr Sorcha O’Meara is a second year Urology SHO in the Department of Urology in The Mater Misericordiae University Hospital, Dublin (@sorchaOm).

Guideline of guidelines: primary monotherapies for localised or locally advanced prostate cancer

October 1, 2018/by Admin

Abstract:

Decisions regarding the primary treatment of prostate cancer depend on several patient‐ and disease‐specific factors. Several international guidelines regarding the primary treatment of prostate cancer exist; however, they have not been formally compared. As guidelines often contradict each other, we aimed to systematically compare recommendations regarding the different primary treatment modalities of prostate cancer between guidelines. We searched Medline, the National Guidelines Clearinghouse, the library of the Guidelines International Network, and the websites of major urological associations for prostate cancer treatment guidelines. In total, 14 guidelines from 12 organisations were included in the present article. One of the main discrepancies concerned the definition of ‘localised’ prostate cancer. Localised prostate cancer was defined as cT1–cT3 in most guidelines; however, this disease stage was defined in other guidelines as cT1–cT2, or as any T‐stage as long as there is no lymph node involvement (N0) or metastases (M0). In addition, the risk stratification of localised cancer differed considerably between guidelines. Recommendations regarding radical prostatectomy and hormonal therapy were largely consistent between the guidelines. However, recommendations regarding active surveillance, brachytherapy, and external beam radiotherapy varied, mainly as a result of the inconsistencies in the risk stratification. The differences in year of publication and the methodology (i.e. consensus‐based or evidence‐based) for developing the guidelines might partly explain the differences in recommendations. It can be assumed that the observed variation in international clinical practice regarding the primary treatment of prostate cancer might be partly due to the inconsistent recommendations in different guidelines.

Michelle Lancee, Kari A.O. Tikkinen, Theo M. de Reijke, Vesa V. Kataja, Katja K.H. Aben and Robin W.M. Vernooij

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From necessity to defining new standards: the new ORSI Academy Campus aims to advance training standards and opportunities for surgical trainees #OrsiNewCampus

October 1, 2018/8 Comments/by Justin Collins

The sun comes out for the official opening of the new Orsi Academy training campus

Orsi Academy (www.orsi-online.com) is a Belgian centre of surgical innovation and expertise where industry, clinical practitioners and academic partners work together on the improvement of best practices in minimally invasive surgery via training, academic research and technological R&D. Orsi Academy continually strives to form inclusive partnerships to further surgical training and improve patient outcomes.

With expert clinicians from around the world, Orsi Academy has a strong history of pioneering peer-to-peer training driven by collaboration with key opinion leaders in the different medical fields. The trainings are validated through academic research and accredited by different scientific bodies (EAU, NASCE, Ugent, KU Leuven). ORSI Academy continually reports and publishes on validated surgical training and the impact on patient outcomes and published the first validated robotic curriculum.

Within the organisation of Orsi Academy there is a rich history of developing and utilising novel training technologies and developing simulation models for dry and wet-lab training. Our aim is to define optimised surgical techniques and to develop models that reflect these defined objective metrics. Examples of this work include 3D printed models, the Venezolan chicken model for Vesico-urethral anastomosis, the dog cadaver for RARP and VR simulation. An example of a successful product launch in VR simulation is the robotic prostatectomy model on the Simbionix ® system that was developed under the guidance of Orsi Academy training staff. At ORSI Academy the first robotic Curriculum was validated on robotic prostatectomy and is now certified by the European Scientific Society EAU (CC-ERUS). Continuous innovation has helped Orsi Academy maintain a leading market position and the evolved curriculums designed by Orsi Academy are being replicated in training centres of excellence around the world.

Since Orsi Academy’s inception in 2012 it has continued to build on its reputation for training surgeons in new technologies and to continually advance the boundaries of excellence in surgical healthcare. With growing numbers of trainees and courses, capacity became a growing issue and in 2015 ambitious plans were formulated to build a new Orsi campus. The initial plans to rebuild quickly built momentum and planned capacity was further expanded as talks progressed and interest from our supporting partners grew.

The new Orsi Academy, planned for September 2018

In 2016 the design of the new building was finalised. The new Orsi Academy facility would contain four 350m² clusters, each housing four to six fully equipped training labs. Two clusters will be equipped for robotic surgery training, the others will be setup for training in other minimally invasive techniques and would include state-of-the-art imaging technologies. The cutting-edge facility would also include an auditorium with the latest audio-visual technologies, where up to 120 people will be able to attend lectures, watch livestreams of surgeries from around the globe, and contribute to discussions and debates in real-time. Additionally, there would be multiple fully equipped meeting rooms and a modern open office set-up would allow all stakeholders to work efficiently, either alone or in small groups. A new inhouse restaurant was planned that would provide meals with soup bar, salad bar, cold dishes and hot meals available.

In February 2017 work commenced and in August 2018 the dream of creating this training centre of excellence was finally realised.

On the 18^th September Orsi Academy had their official opening of the new campus facilities. The opening ceremony was attended by invited guests, including politicians, representatives of Leuven and Ghent University, surgeons from all over the world and our facilitator for the ceremony a previous Miss Belgium and presenter from Belgian news TV.

Alex Mottrie (CEO), Geert Vandenbrouke (Chairman) and Luc Veramme (COO) present at a press conference from the new 120-seat auditorium

Press look around the new facilities

Some of the guests try out one of the six Da Vinci robots already installed

Describing the benefits of simulation training to the press, to introduce new technologies without compromising patient safety

Industry presents on why they have supported this project

The guests for the opening ceremony begin to arrive and receive their name tags

Mingling in the main entrance hall

Admiring some of the newly installed artwork

Artwork has generously been loaned for both inside and outside the new building

Time to chat with the guests

The celebration party starts

The Orsi Academy training centre has been expanded and upgraded with the support of the European Fund for Regional Development (EFRD), the Flemish Agency of Innovation and Entrepreneurship (VLAIO) and the province of East-Flanders. Additional private funding was provided by the universities of Ghent and Leuven and the medical technology companies Medtronic and Intuitive. Orsi would like to thank industry, the Universities, EU and Flanders funding agencies and all the board for their ongoing support of this educational project. Together we aim to continuously improve standards of training in Europe.

Have you trained at Orsi Academy? If so please post a comment and tell us about your experience and how your career has progressed #OrsiNewCampus

Justin Collins, Medical Director Orsi Academy

October 2018 – about the cover

September 27, 2018/by Admin

This issue’s Article of the Month is The effect of timing of an immediate instillation of mitomycin C after transurethral resection in 941 patients with non‐muscle‐invasive bladder cancer, carried out by a team from Amsterdam, The Netherlands.

The cover shows the skyline of Amsterdam, the capital of the Netherlands, although it is not the seat of government, which is The Hague. Amsterdam is well-known for its canals, its Art (particularly Rembrandt and Van Gogh) and its infamous coffee shops. In 2013 there were more bicycles than people in Amsterdam.

©istock.com/fotolupa

Residents’ podcast: Urinary continence recovery after radical prostatectomy

September 26, 2018/by Maria Uloko & Giulia Lane

Maria Uloko is a Urology Resident at the University of Minnesota Hospital and Giulia Lane is a Female Pelvic Medicine and Reconstructive Surgery Fellow at the University of Michigan.

In this podcast they discuss the BJUI Article of the Week ‘Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence‘.

Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence

Yoshifumi Kadono*, Takahiro Nohara*, Shohei Kawaguchi*, Renato Naito*, Satoko Urata*, Kazufumi Nakashima*, Masashi Iijima*, Kazuyoshi Shigehara*, Kouji Izumi*, Toshifumi Gabata† and Atsushi Mizokami*

*Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan; †Department of Radiology, Kanazawa University School of Medicine, 13‐1 Takara‐machi, Kanazawa, Ishikawa 920‐8640, Japan

Read the full article

Abstract

Objective

To assess the chronological changes in urinary incontinence and urethral function before and after radical prostatectomy (RP), and to compare the findings of pelvic magnetic resonance imaging (MRI) before and after RP to evaluate the anatomical changes.

Patients and Methods

In total, 185 patients were evaluated with regard to the position of the distal end of the membranous urethra (DMU) on a mid‐sagittal MRI slice and urethral sphincter function using the urethral pressure profilometry. The patients also underwent an abdominal leak point pressure test before RP and at 10 days and 12 months after RP. The results were then compared with the chronological changes in urinary incontinence.

Fig. 1 Intraoperative view of the apex of the prostate transection line between the urethra and prostate at the normal (straight line) and long urethral stump (dashed line) positions.

Results

The MRI results showed that the DMU shifted proximally to an average distance of 4 mm at 10 days after RP and returned to the preoperative position at 12 months after RP. Urethral sphincter function also worsened 10 days after RP, with recovery after 12 months. The residual length of the urethral stump and urinary incontinence were significantly associated with the migration length of the DMU at 10 days after RP. The residual length of the urethral stump was a significant predictor of urinary incontinence after RP.

Conclusion

This is the first study to elucidate that the slight vertical repositioning of the membranous urethra after RP causes chronological changes in urinary incontinence. A long urethral residual stump reduces urinary incontinence after RP.

ERUS 2018 – Marseille

September 21, 2018/1 Comment/by Simon van Rij

Robotic Heaven

The EAU Robotic Urology Section (ERUS) is unabashedly a Robotic surgery conference. We have all drunk the Kool-Aid and we have all come for the robot. There is no need to rush between rooms deciding which session to attend. 3D Glasses are donned, we sit back and the education comes at you on the Cinemax style screen, three live surgeries at a time. This year, the 15^th Annual Meeting of ERUS took place in Marseille from 5-7^th September 2018 and was convened by Dr Jochen Walz, Director of GU Oncology at the Institut-Paoli Calmettes Cancer Centre. Over 650 delegates from all over the world attended what is the world’s leading robotic surgery conference in urology.

Three reasons you should have been there

The Rise of the new Robots

In a world exclusive we saw the first cadaveric prostatectomy using the Versius from CMR surgical (aka the Cambridge Robot)

In a candid presentation Prof Dasgupta gave his personal feedback on his experience. This helped grow the enthusiasm for this robotic platform that has been gaining widespread media exposure in recent times.

https://www.bbc.com/news/health-45370642

Invariably the talk of new robots spilled over into social media with a wish list and critique of the current landscape of robotic surgery.

ERAS at ERUS

If we are doing surgery minimally invasive then we should maximise recovery for our patients. A multi-disciplinary team of speakers highlighted the pathways for our patients. We should all be adopting these programs in our own centres. Rather then re-inventing the wheel in each centre we should utilise the great resources already available.

erus18.uroweb.org/wp-content/uploads/ERAS-Protocol-070718.pdf

Live Surgery

Surgeons like surgery and to watch ones craft is undoubtedly a form of education.

All of the 16 live surgery cases were performed by experts to an elite standard and were extremely informative. As per the EAU guidelines we were given updates from both the previous years patients and also the follow up of those performed during the conference.

But live surgery does walk a tightrope of ethics for surgeons and again we must be mindful of the sanctity of the surgeon – patient relationship and above all else patient safety comes first.

#Ilooklikearoboticsurgeon

Hopefully the ERUS committee have a long-term diversity plan to ensure more (any) female surgeons are in the live surgery and on the podium. It is very much not for lack of high quality world class female surgeons, many who I have had the privilege to train or work with.

Make Friends not Robots

For all the robotic contact we got, we all crave that human touch and herein lies the key reason to consider ERUS2019 in sunny Portugal.

Prof Dasgupta editor of the BJUI tweeted it best and I wholeheartedly agree. The friends through out the world that I got to catch up with make all that travel worthwhile.

The 16^th ERUS takes place in Lisbon from 11-13^th September 2019 and will be convened by Dr Kris Maes. Check out Kris’ promo video here

Simon van Rij (@sivanrij) is a Urologist based in Auckland, New Zealand.

September 2018 – about the cover

September 12, 2018/by Admin

This issue’s Article of the Month is Retzius‐sparing robot‐assisted radical prostatectomy using the Revo‐i robotic surgical system, carried out by a team from Seoul, Korea.

The cover shows one of the buildings of Yonsei University, the oldest university in Korea, founded in 1885 and named after the two colleges of which it is formed: Yonhi College and Severance Union Medical College. It offers graduate, postgraduate and doctorate courses in Korean or English.

Urofair 2018

August 29, 2018/by Admin

Urofair Congress Highlights – Singapore 2018

From 12-14 July, the Singapore Urological Association (SUA) welcomed 450 delegates from across Asia and further afield to sunny Singapore for Urofair 2018.

The theme was Integrating Scientific Knowledge, Technology and Clinical Urology, and the excellent scientific program crafted by the organizing chairman John Yuen and scientific chairmen Joe Lee and Terence Lim, certainly reflected this.

Continuing a fine tradition, the BJUI once again has supported this meeting with all accepted abstracts to be published in a special supplements issue.

Learn about healthy supplements at Amazon.com.

Pre-Urofair activities

Preceding the Urofair, was the Urology Residents Course (URC) and the European Basic Laparoscopic Urological Skills (E-BLUS). The revision of key concepts at URC followed by grounding of basic laparoscopic skills by great minimally invasive surgeons Christian Schwenter and Evanguelos Xylinas was truly beneficial for the residents, and primed them well for the latest updates they received at Urofair.

Urology Residents Course Class of 2018

Simulation and tutoring – Evanguelos Xylinas supervising a trainee on laparoscopic trainer at E-BLUS

Urofair 2018 started with a bang, with the ever popular live and semi-live surgery sessions at Tan Tock Seng Hospital. One of the highlights of the session was the masterful demonstration of retroperitoneal robotic assisted partial nephrectomy by James Porter (@JamesPorterMD). One of the attractions of live surgery is the anticipation of intraoperative problems and the thrill of watching experts manage them. This session was no exception, as Allen Sim of Singapore General Hospital showed calmness under pressure, as he showed how to deal with an inadvertent breach of the peritoneum and control of bleeding during a difficult retroperitoneal nephroureterectomy. The semilive demonstrations were no less educational, with Christopher Evans showing how he manages unusual anatomic variants during robotic radical prostatectomy.

One of the main highlights of this year’s Urofair was the launch of the inaugural KT Foo Lecture by the Father of Singapore Urology, Professor Foo, Keong Tatt who presented his life-long research work on the management of BPH. At the end of this tour de force, he was presented with the well-deserved SUA Life-time Achievement Award.

Lim Kok Bin (left), President of the SUA presenting the SUA Lifetime Achievement Award to Prof KT Foo (right)

One of the goals of the SUA is to serve as a bridge between regional and international urological associations. Urofair 2018 reflected this goal with multiple joint sessions with our friends from the Malaysian Urological Association (MUA), European Urological Association (EAU), Urological Associations of Asia (UAA), Federation of Asean Urological Associations (FAUA) and Hannam Urological Association. Dr Tan Hui Meng delivered the MUA lecture on testosterone replacement therapy (TRT). He refuted some of the controversies regarding TRT, and cited the supporting data to defend its use. On a practical note, he shared his checklist for counselling and consent-taking before starting TRT in clinical practice. We were deeply honoured that the Secretary General of the EAU Professor Christopher Chapple(@ProfCRChapple) himself, delivered the EAU plenary on Substitution Urethroplasty. The management of urethral strictures is challenging due to the vast variability between patients, stricture aetiology, location and available tissue reconstruction. One key tip was that urethroscopy was useful to identify early stricture recurrence, which otherwise can be missed on uroflowmetry.

Hong Seok Shin from the Hannam Urological Association presented his unique presentation on Plastic surgery in collaboration with phẫu thuật gọt hàm, highlighting the importance of patient selection and counselling. The FAUA session was held concurrently with attendance of key office-holders of the various ASEAN urological associations. The theme of the session was on the development of MIS in Urology in the ASEAN countries discussion on “Cross-boundary Disease Management” with interesting clinical cases presented from different countries was lively. Koon Ho Rha delivered the UAA lecture on “The Role of Cytoreductive Prostatectomy in Advanced Prostate Cancer”, and showed in his series, that well selected patients with locally advanced disease, benefited from prostatectomy, which can be safely done robotically.

Multiple masterclasses ran concurrently on a range of subjects, including MRI-TRUS Fusion biopsies, Renal Transplantion, Andrology and Reconstructive Urology. The Robotic Surgery Masterclass chaired by Png Keng Siang was attended by a full house! The five expert robotic surgeons (Chris Evans, Koon Ho Rha, James Porter, Declan Murphy and Steve Chang) spoke on a range of topics from retroperitoneoscopic RAPN, to nerve-sparing techniques and complications of RARP to the use of different versions of robots (Si vs Xi) in robotic nephroureterectomy. The session ended with lively discussions between the panel and the audience in an interactive video session on trouble shooting challenging surgical aspects of RAPN and RARP.

The closing plenary was a “Glimpse into the Future”, covering topics from Precision Oncology and the role of Clinical Genetics for Urologic cancers, to the “The New Robots on the Block”.

Koon Ho Rha gave us a tour of the development of the ubiquitous Da Vinci, followed by the up and coming competitors, including one which has licensed and commercially available in Korea. Competition in this field can only make robotics in urology better and hopefully more cost effective.

Declan Murphy(@declanmurphy), Social Media Director of the BJUI shared his insights on the role of Social Media in Urology Practice. He highlighted the shift in the publishing paradigm, with videos and blogs of new findings peer reviewed on social media, before “traditional publication” by a journal, followed by amplification of the publication on social media.

Nurses are an integral part of the urological care, and they were certainly active at Urofair. The 180 strong audience at the Nursing Symposium were rapt with attention as Ms Helen Crowe shared her vast experience as Australia’s first Urology Nurse Practitioner on Prostate Cancer Nursing as well as expanding the role of Urology Nurses.

The Nursing Masterclass on the management of urinary incontinence was fully subscribed, and the practical hands on nature of the class was a big hit with the participants.

Physiotherapists conducting pelvic floor exercises with the Urology Nurses

Our GP partners were not forgotten, and the 120 GPs who attended were treated to a great program. In this era of fake news, the standout lecture must have been “Google is not your friend”, where Lee Fang Jern shared the perils of medical fake news, and how medical practitioners can guide our patients to navigate the internet in search of reliable medical information.

The Gala Dinner was a fitting end to a fruitful Urofair, where everyone had a chance to strengthen and renew friendships over good food and wine.

Organising Chairman John Yuen is all smiles after the successful conclusion of Urofair

The highlight of the Gala, was the rarely seen Bian Lian (变脸) performance. Bian Lian is an ancient Chinese dramatic art, where performers wear brightly colored costumes and vividly colored masks, typically depicting well known characters from the opera, which they change from one face to another almost instantaneously with the swipe of a fan, a movement of the head, or wave of the hand.

Bian Lian (变脸) performer

On a personal note, Urofair was a great opportunity to reconnect with Declan Murphy, who was my supervisor during my fellowship at the Royal Melbourne Hospital. I was honoured to have him and his son @cianblakemurphy (who is probably the youngest person to drive the Da Vinci) visit the National University Hospital where I work. Declan shared to a multispecialty group of robotic surgeons, his journey of expanding the adoption of robotics across multiple surgical disciplines at the Peter MacCallum Cancer Centre, and that the Da Vinci’s role in education, research and talent retention was key in surmounting concerns regarding cost.

On behalf of the SUA, we would like to thank all our international and local faculty for their efforts, and the delegates from near and far, for making Urofair 2018 a resounding success.

Finally, we are excited to announce Urofair 2019 will be held on 4-6 April 2019. Please save the date, and we look forward to welcoming you to Singapore.

Lincoln Tan

Consultant Urologist and Director of Urologic Oncology, National University Hospital, Singapore

Twitter: @LincolnRoboDoc

Breaking Taboos in Urology Awareness Month

August 21, 2018/1 Comment/by admin Z.9

This September marks the fifth annual Urology Awareness Month, an opportunity for urologists, researchers, GPs, patients, and urology advocates to raise awareness of and speak openly about urology disease. In doing so, they can help to break the taboos that so often blight urology patients.

Set up by The Urology Foundation (TUF) in 2014, Urology Awareness Month (UAM) aims to encourage the public to actively take care of their urology health by raising awareness of the signs and symptoms of urology disease, breaking down stigmas and raising money for the fight against urology disease.

Getting involved

There are multiple ways to support this campaign. Firstly, you can get in touch with us for leaflets and posters for your clinics. If you have a patient with an experience of urology disease that you think others would benefit from hearing, you can get in touch with TUF and we can help to get that message out.

We are also calling on people to take part in the Big 5 Challenge. If just 120 people commit to raising £500 each, that would allow TUF to fund one extra research project in 2019. So often our research projects go on to provide big breakthroughs in urology through new treatments and diagnostic tools. We are funded entirely by our supporters across the country, so the more people that get involved, the more research that can be funded. You can find out more about the Big 5 Challenge on our website.

Make sure you can share your support for the breaking down of taboos or the importance of knowing the signs of urology disease by using the hashtag #urologyawareness. You could also encourage the hospital you work at to use the same hashtag.

In 2017, TUF reached millions of people throughout UAM. TUF radio interviews were heard by an estimated 6 million people, a urology-themed pull out was distributed to nearly 1 million Guardian readers, and TUF featured on TV through London Live and Sky’s Chrissy B Show. This year is set to be even better and we thank you for your support.

A month for all of urology

Urology Awareness Month is about breaking taboos and raising awareness of all urology diseases, not just cancers. So, whatever your area of expertise is, UAM is an opportunity to speak up and encourage the nation to actively take care of their urology health.

Louise de Winter, CEO of TUF

August 2018 – About the Cover

August 8, 2018/by admin Z.9

This issue’s Article of the Month is the UK-ROPE study, a multicentre study with several authors from Southampton. The cover shows Southampton’s Calshot Castle, an artillery fort constructed by Henry VIII.

The development of Calshot castle as well as Cowes, Hurst and Netley castles along Southampton Water and the Solent, by Henry VIII in about 1540, meant that Southampton was no longer so dependent upon its fortifications.