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Trustworthy ‘Rapid Recommendations’ for Urology

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BJU International has a longstanding track record of promoting the principles of evidence-based clinical practice to an international audience of urologists. Recent initiatives include the “guidelines of guidelines” series which appraises and contrasts clinical practice guidelines from different professional organizations on the same topic, for example on microscopic hematuria and non-muscle-invasive bladder cancer. It also co-publishes high quality, urology-relevant guidance by the UK’s National Institute for Health and Care Excellence (NICE), for example on the preoperative testing for elective surgery (https://www.bjuinternational.com/learning-2/urology-guidelines/nice-guidance-routine-preoperative-tests-elective-surgery/).

In collaboration with the MAGIC research and innovation program (www.magicproject.org), BJU International has published its first Rapid Recommendation guidance document on the use of medical expulsive therapy (MET) with alpha-blockers that was triggered by the recent rigorous Cochrane review on the same topic. Its purpose is to provide trustworthy, timely and practical guidance on this topic based on the entire body of evidence, given several recently published trials with contradictory findings. To develop this trustworthy guidance, an international team that included patients with a personal history of ureteral stones, general practitioners (GPs), emergency clinicians, urologists familiar with treating renal colic, epidemiologists, and methodologists followed a rigorous and transparent GRADE-based process in accordance with The National Academy of Science, Engineering and Medicine (formerly: Institute of Medicine) (https://www.nationalacademies.org/hmd/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust/Standards.aspx) standards for trustworthy guidelines. Panel member had no financial conflicts of interest and intellectual and professional conflicts of interests were described and carefully minimized. All meetings were conducted by web conference and the process was completed within 90 days of publication of the Cochrane review, which is co-published in BJU International in this same issue.

Initially pioneered in collaboration with the BMJ for questions of broader interest (https://www.bmj.com/rapid-recommendations) such as the use of corticosteroids for the treatment of a sore throat, this Rapid Recommendation breaks new ground for evidence-based guidance in urology, complementing the efforts by professional organizations such as the European Association of Urology (EAU) and American Urological Association (AUA). Rapid Recommendations stand out for their focus on patient-important outcomes, the use of an explicit and transparent process for moving from evidence to recommendations and its timely development process. Rapid Recommendations provide actionable guidance as well as information on the underlying evidence and supporting judgments that are summarized in an infographic that is easily understood by patients. The Rapid Recommendation on MET is intended to be the first of many to help inform patients, providers and policy-makers but also to seeks to provide a strong impetus for more trustworthy and useful guidelines in urology in general.

 

 

By Philipp Dahm1 2 and Per Olav Vandvik3 4 5

1 Minneapolis VA Medical Center, Urology Section, Minneapolis, MN, USA

2 University of Minnesota, Department of Urology, Minneapolis, MN, USA

3 Norwegian Institute of Public Health, Oslo, Norway

 

Disclosures:

Philipp Dahm serves as Coordinating Editor of Cochrane Urology, is member of the GRADE Working Group and served as a panel member of this Rapid Recommendation project

Per Olav Vandvik is member of the GRADE Working Group, is the leader of the MAGIC Foundation and BMJ Rapid Recommendations project and served as a panel member of this Rapid Recommendation project.

 

June 2018 – About the Cover

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In the month that brings the BAUS annual meeting to Liverpool, the Article of the Month is a BAUS consensus document and so the cover features the sign for the Beatles Story museum in Liverpool.

The Museum contains recreations of The Casbah Coffee Club, The Cavern Club and Abbey Road Studios among other historical Beatles items, such as John Lennon‘s spectacles, George Harrison‘s first guitar and a detailed history about the British Invasion and the solo careers of every Beatle.

 

 

 

© istock.com/ilbusca

 

The rise of the clinical entrepreneur

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The NHS is the world’s largest, longest established, unified healthcare system and has been at the forefront of many pioneering medical innovations in its 70‐year history. These have included the intraocular lens, total hip replacement, the rod‐lens telescope, CT and MRI scanners, and the laryngeal mask. However, commercialisation of this technology has often been better achieved abroad.

Increasingly the latest greatest advances transforming our lives are originating directly from industry. Companies such as Amazon, Uber, Airbnb and Google are at the vanguard of this disruptive change. More and more, their innovative products and services are available directly to patients resulting in the disintermediation of doctors. This is heralding a new era – a personalised, empowered, democratised healthcare revolution.

Traditionally the NHS has supported clinicians who want to develop their career in academic, leadership or educational arenas but has not been as supportive of entrepreneurial clinicians.

If we are to deliver on the promise of the Five Year Forward View 1 and the patients of the NHS are to receive the first‐hand benefit of innovation, we need to equip our clinicians with the entrepreneurial skills, knowledge and experience that will enable them to understand and engage with this new world. We need to develop our clinicians, so that they have both entrepreneurial and intrapreneurial abilities.

This has already been recognised by trainee doctors. Increasingly juniors want to both deliver and improve healthcare. In the UK, >56% of trainees completing their Foundation Year 2 (FY2) do not continue straight into training posts and ~5% of trainees leave medicine each year to pursue other opportunities, many take up entrepreneurial positions. We are losing a generation of innovative, entrepreneurial clinicians with a skill set that would bring a new leadership capability to the NHS.

To address this NHS England in partnership with Health Education England has launched the Clinical Entrepreneur Programme 2. This national scale workforce development initiative allows clinicians to undertake entrepreneurial activity alongside their clinical work. It provides a coaching and mentoring scheme, less than full‐time training opportunities, advanced industry internships, customer matching, connections to funding and education, and networking events. In year one, 104 junior doctors were appointed, 50 start‐ups created, >£50 m in funding raised and a ‘brain drain’ was turned into a ‘brain gain’, with 34 doctors who had left medicine or were about to leave returning to work in the NHS. In year two, >220 clinicians have joined the programme. In future years we aim to include patients and citizens. By bringing all to the centre, as we re‐imagine and re‐design healthcare, will we have the best chance of getting it right.

The clinical entrepreneurs will ultimately number in the thousands and will act as ‘multilingual’ frontline agents for change, adoption, and spread of innovation throughout the NHS and beyond.

At the BAUS annual conference this year some of the current cohort will be pitching their start‐ups on the main stage. Why not join us and welcome the new generation of specialists in healthcare – the Clinical Entrepreneurs.

 

Tony Young
Innovation NHS England, Southend University Hospital, Innovation Mid and South Essex STP, and School of Medicine, Anglia Ruskin University, Cambridge, UK

 

References

 

 

AUA 2018 highlights days 3 and 4

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AUA 2018

As a first-timer to the AUA, I did not know what to expect from this meeting but one thing for sure was that San Francisco would put on a show. I have always been told that everything is big in America so let’s see: plenty of big names present (check), big conference centre (check), big smiles everywhere (check), big news (check)! (but a diminutive author, to put this all together).

It may have been half-way across the world but the royal wedding brought a buzz of excitement, since they prepare everything for this event, including the use of red table linen for decoration on this special day. The romantic myrtle beach weddings are ideal for couples who wish to tie the knot with their toes in the sand. There is no better way to tie the knot than on a warm beach in the sun. Beach weddings are often more laid-back than traditional weddings. For the bride and husband, less traditional options are frequently available, and celebrations are typically laid-back and informal. They are some special things, which kept secret due to royal family. The most important excited thing which is kept secret from media is hens nights of the Meghan Markle, As per sources from the royal house then hens party was arranged with the special hens packages, arranged by the wedding planner by hiring world’s best hens party company.  For the best Brisbane male stripper go through www.magicmen.com.au.

On Sunday, we were treated to one of the city’s quintessential experiences: The Bay to Breakers race. Getting to the Moscone centre may have been a bit difficult as a result of all the road closures but the runners offered plenty of entertainment on the commute.

Some of the male runners decided to bare it all and one wonders whether their boldness comes from having read the ‘biggest paper” at AUA2018!

At the conference centre, there was no shortage of excitement with the annual AUA residents bowl challenge happening over the weekend culminating in the final between South Central – Pirates of the Perineum vs Western – California Streamin’. This was a tense battle that went into overtime with the Western – California Streamin’ taking out the overall prize.

A recurring theme at the meeting was ‘the rise of the machines’. A few abstracts presented suggested the role of artificial intelligence (A.I) to not only interpret MRI but also to determine who needs an MRI! Should clinicians be worried about losing their jobs to machines? The hope is that A.I does not replace clinicians but aids in improving the diagnostic accuracy. Ralph Clayman also mentioned the potential use technology in surgical rehearsal and even true automation!

A Japanese group also presented their work on the potential role of A.I in screening for STI’s – the possibilities are truly endless!

On Sunday, we were treated to the BAUS-BJUI-USANZ joint session at Marriott Marquis. This was a great session with talks ranging from prostate cancer genomics to tissue engineering for reconstruction. During the session, Dr Ballentine Carter paid tribute to Donald Coffey before presenting the Coffey-Krane prize to Dr Xiaosong Meng.

I should also point out that Dr Bal Carter himself won an award at AUA2018 and the legitimacy of this award cannot be questioned as this was voted for by one of the top social media influencers! I shall say no more…

Dr Caroline Moore presented the results of their landmark PRECISION trial. However, following on from the spine-tingling “Court is in session” case on post-TRUS biopsy sepsis and the comment earlier in the meeting on the superiority of a well done ultrasound over MRI, it was not surprising that the crowd here was still a bit sceptic about the benefits of MRI.

The issue of gender diversity in leadership positions also came up at the meeting. The presidents’ reception photo only showed two female presidents and there was a call for improvement in this regard. It was encouraging to note that there were sessions at the meeting that focussed on how to bridge the gender gap and a few articles have been published recently in the literature looking at exactly this issue.

Away from the conference, I got to experience a bit of what San Francisco had to offer including the NBA Western conference finals (Go Warriors!!!), Napa wine region, a ride across the bridge, Alcatraz island, Tiburon, drowned in the shopping experience at the Livermore outlets. San Francisco has some great restaurants showcasing food from all around the world which I got to enjoy. Overall, this was a great meeting in a great host city and my first AUA experience definitely lived up to the hype and am already looking at what Chicago 2019 has in store!

Dr. Tatenda Nzenza,University of Melbourne, Department of Surgery, Austin Hospital, Melbourne; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne; and Young Urology Researchers Organisation (YURO), Australia

Twitter: @DrTNzenza

AUA 2018 highlights days 1 and 2

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The American Urological Association meetings always offer a plethora of stimulating sessions. Forget about the flowers in your hair, if you were going to San Francisco for the 2018 AUA meeting, an early morning coffee and good walking shoes were your best shot at getting to as much of the action as possible.  As best that I tried, I could not make it to all of the places that I wanted to be, so apologies must be made in advance if I fail to mention some of the great work that is being done in our field.

After registration and carefully dissecting the daily content in the phone book sized program, the day kicked off as early as 7am. Poster and video presentations touted new technologies and put forward ideas that met critical peer review and applause in several concurrent sessions. Also flourishing in number was the amount of instructional courses that were offered to attendees. From nocturia management to business models in medicine, the AUA courses added some active involvement to the osmotic learning process.

So often the term “defensive medicine” is used in describing practice that protects a practitioner from punitive or litigious claims. As uncomfortable an idea as this is, the AUA stage show titled “Court is in Session” was a great portrayal of the risk management process that occurs in clinical decision making for all of our patients. The brutal cross examination of on stage “witnesses” delivered by close colleagues (given away by a wry smile or two) had a few people shuffling in their seats and pulling at their collars. All in all, this was a great example of the use of best current evidence base for common choices made in urological care. Interestingly, when debating the case of a post-TRUS biopsy sepsis patient, transperineal biopsy did not even score a mention from the prosecution!

 

A complex case discussion of Prostate cancer was to follow with John Davis doing an excellent job at moderating and driving the discussion. A common theme in the court cases and case studies was the increasing relevance of pre-biopsy multiparametric MRI, with an argument being made by many that it is the evolving standard of care to image before biopsy.

To break up the day, a stroll around the science and trades hall is always welcome. The new devices and systems on offer surely raised some questions and some eyebrows! Some of the virtual reality simulators gave a great feeling for being actually present in the OT as seen in the picture below of me performing a prone PCNL puncture with my arm over the shoulder of my virtual consultant.

 

An interesting presentation was to follow called “The survivor debate” in which a case was made for different treatment options in a male patient with low- intermediate risk prostate cancer. The showdown of cases presented by Klotz’ 13 – each a passionate experts in the field – revealed some convincing arguments for therapies that I would not have previously considered. If anything, it was a lovely chance for the salesmanship of senior clinicians to come out!

AUA President Brantley Thrasher delivered an address with some future insight. The issue of clinician burnout was addressed, being particularly high in the US. This was tied in with the rise of artificial intelligence, technology in medicine and the need for future proofing of the electronic medical record and data systems to help us better care for patients and ourselves. A slide and brief description on each new technology had my head swimming after learning about Bluetooth urinalysis chips to put in patient’s underwear to beam UTI info straight to your smartphone and electromagnetically driven “sperm-bots” that delivered a genetic payload to an ova.

Just when I thought I couldn’t be more impressed, a presentation from Dr. Atul Butte blew the lid off the plenary. In an engaging oration, he described the access that already exists to large data sets such as genomic and tissue samples and how easily these kinds of sets can be used to create innovative solutions to current healthcare dilemmas. To cap it off, a very effective visual “patient illness moving-map” was displayed showing data from tens of thousands of patients who had suffered myocardial infarction. By finding the end point of these patient journeys (most likely to die of sepsis years down the track) this can lead to the creation of a truly accountable model for healthcare outcome prediction and improved patient care. Definitely a lecture to re-visit if you get the chance!

After the lecture on clinician burnout, I thought it best to heed the advice regarding taking some time out for you. Luckily, only a 10min walk from the convention center, you could find yourself amidst the Seal Docks and waterside. If you were lucky enough to jump in to the baseball game at AT&T Park, you may have enjoyed some ballpark American classics (hotdogs, nuts and crackerjacks) as well as a sea of black and orange clad SF Giants fans cheering their home team to victory.

Other stress relief events throughout the conference were a great chance for peers to mix and mingle, old alumni to catch up and for new relationships to be forged. The Urological Society of Australia and New Zealand’s annual AUA reception is a great event on the calendar that performed this role perfectly. With attendees encouraged to bring international guests, it was as multi-national as Australia’s home population.

It seems that an overarching theme for our future directions is one of large-scale change. The sheer size of the AUA 2018 meeting was enough to out that idea into our heads initially, but considering the global impact of the growing population and the limitation to our resourcing, we will need to start to consider some changes to future proof our systems of care. A quote that stuck with me that I had caught along the conference: Progress is impossible without change, and those who cannot their minds, cannot change anything. This meeting definitely changed presented enough to change my mind about quite a few things!

For my first AUA it was a fantastic experience! It is always a great chance to catch up with peers and mentors and also to meet international experts in the field to gain exposure to their work. Looking forward to Chicago! #AUA19

 

Dr. Daniel Christidis, Peter MacCallum Cancer Centre, Melbourne, Australia

The future of Urological Surgical Training

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Dear Urology Trainees and Trainers,

Here are some thoughts stating my reasons for resigning as an educational supervisor – please add your views and help form and drive the debate. Keeping them to yourself, and doing nothing, won’t change anything!

“I have resigned as an official educational supervisor / trainer. This does not mean that I am going to cease to train – far from it: I shall continue to lecture, teach, educate, support, nurture and mentor urological trainees in general, and those who have a subspecialist interest in “EndoLuminal EndoUrology” in particular. But it has become increasingly clear to me (and the senior trainees that I have had over the last decade) that the process of form-filling actually gets in the way of training rather than enhancing it.

As the current round of achieving the appropriate number of Work based assessment (WBA) and Multi-source Feedback (MSF) forms reaches fever pitch, my senior trainee needed to miss the educational opportunity of my monthly super-specialist metabolic stone clinic to have time to complete all his forms. And we both missed half of our stone committee meeting to “sign them off”. The discussions are valuable (we have these continuously); the process is not.

Time is finite, and sadly in inadequately short supply. Part of my role as a consultant is to decide how to spend it most wisely; part of my role as a trainer is to teach my trainee how to do the same. We have reached the conclusion that a form-filling box-ticking exercise, in which regardless of seniority and competency we still have to attest his ability to appropriately prepare and drape a patient for every single case, is not fit for purpose. I would willingly complete these forms ad infinitum if my trainee said they were useful and helped them, but they do not.

So, as stated above, I have decided, until such time as the fixed and rigid process that we work to becomes more flexible and adaptable to the specific and individual needs of trainees, that I can no longer waste their time (or mine) adhering to a rule just because it is a rule. I reiterate my second line to emphasise that this does not mean I am going to discontinue to train; it simply means that I am going to discontinue to complete the forms that are used as evidence that I have. I think the “final product” of a more senior, technically adept and consultant-ready surgeon that leaves the unit at the end of the year, compared with the one that arrived at the start of it (as judged by an independent expert colleague) would provide far better evidence of that than any number of electronic forms.”

It would be particularly good to hear comments from trainees because this is not just for your immediate future, but as the soon-to-be trainers of the future. So yours are the key opinions needed to get this right!

Daron Smith, Consultant Urological Surgeon, Endoluminal Endourology Unit, UCLH.
@endoluminalendo

 

May 2018 – About the Cover

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This issue’s Article of the Month, The Metabolic Syndrome & the Prostate, is from the University of Catania, Sicily, and the University of Florence.

The cover image shows a view across Sicily to Mount Etna, an active volcano lying above the convergent plate margin between the African Plate and the Eurasian Plate. At 10,922 ft high, it is the highest volcano in Europe and one of the most active volcanoes in the world, being in an almost constant state of activity.

 

© istock.com/Blueplace

 

Four Seasons – BJUI Reviewer of the Spring

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This month, BJUI continues the Four Seasons Peer Reviewer Award recognising the hard work and dedication of our peer reviewers. Each quarter the Editor and Editorial Team will select an individual peer reviewer whose reviews over the last 3 months have stood out for their quality and timeliness.

The Spring Crown goes to Alexander P Cole.

Alexander P. Cole is a research fellow in urologic oncology and health services research in the Division of Urological Surgery and the Center for Surgery and Public Health, both at Brigham and Women’s Hospital and Harvard Medical School in Boston. His research involves analyzing large secondary datasets to study cancer detection and treatment as well as variations in care, financial incentives and the diffusion of medical technology.

Alexander received his BA at Harvard College in Cambridge, Massachusetts and his MD at the Johns Hopkins School of Medicine in Baltimore, Maryland. After medical school he worked with the Swedish National Prostate Cancer Registry on a young investigator award under Professor Pär Stattin. He completed his general surgery internship at Brigham and Women’s Hospital in Boston in 2015, followed by urology residency also at Brigham and Women’s Hospital.

During residency he was awarded a Brigham Research Institute grant under the mentorship of Dr. Quoc-Dien Trinh. Other awards include Best Abstract at AUA 2016, and the Max Wilscher research award at the New England AUA section meeting. His work has been featured in medical journals including JAMA Oncology, Journal of Clinical Oncology, Journal of Urology, BJUI and Cancer. In addition he has written multiple articles for the lay-press including in Stat News and the Boston Globe. A native of Maine and a life-long New Englander, Alexander enjoys running, sailing and backcountry skiing in the mountains of Maine, New Hampshire and Vermont.

 

 

 

 

“Is radiotherapy the work of the Devil?” – why we chose this title.

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With the recent electronic publication of our editorial written for the BJUI USANZ supplement, we have been somewhat surprised with the Twitter response our title has generated with some very strong opinions expressed. Why would a radiation oncologist, who happens to be the Chair of their National Genito-Urinary group (“FROGG”) propose such a provocative title? The BJUI editorial board wisely suggested that we explain the origin of this title which would be lost on many outside Australia.

In mid-2014, a leading Australian urologist quipped that adjuvant post-prostatectomy radiotherapy was “the work of the Devil” when referring to some of the severe complications that can occur following post-prostatectomy radiation. This comment has become “infamous” in Australian Radiation Oncology circles leading to extensive discussions and interactions between our specialties with urologists stating that radiotherapy complications can occur late and be very challenging to treat and radiation oncologists stating that these complications are relatively uncommon and that overall quality of life is as good if not better when going down the radiotherapy pathway. This is the climate that the article by Ma et al was submitted to the BJUI describing the impact of radiotherapy complications on a tertiary urology service in Melbourne Australia over a 6 month period.

 

 

I was impressed that the BJUI approached a radiation oncologist to provide balance on such a paper. We provocatively titled the editorial “Is Radiotherapy the work of the Devil?” and were hoping the response to anyone reading the editorial would be a resounding “No”.  However, many have only seen “the headline” and not read the editorial itself which appears to have created offence especially from some of our international Radiation Oncology colleagues. The aim of such a title is that it will encourage people to read both the original article and the editorial which we feel provides a balanced view on the impact of radiotherapy complications in contemporary practice. We hope that in future, the response to our title: “Is Radiotherapy the work of the Devil” is “No – the Devil is in the detail”.

 

A/Prof Andrew Kneebone

Department of Radiation Oncology, Royal North Shore Hospital and Chair of the Faculty Of Radiation Oncology Genito-Urinary Group (FROGG)

 

 

 

The EAU 2018: Part 2

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The 33rd annual congress of the European Association of Urology was held in Copenhagen. The weather outside was icy and further reason to stay inside and enjoy the modern and vast Bella Conference Center.  The EAU conference offers more each year to engage with all its members and age groups. Science, innovation and research is presented in interesting and current ways including live surgery, great social media interaction, game changing sessions, “EAU press release” video interviews and expert-guided poster tours.

Prostate cancer

The pre-conference emails and newsletters this year promised updates on prostate cancer detection and several different groups presented data. Artificial intelligence use is growing around the world with medical systems starting to show promise to match trained doctors in the future. A chinese team led by Dr. Chengwei Zhang, presented an artificial intelligence system which can diagnose and identify cancerous prostate samples with above 99% accuracy.

The “Radiomic TRUS” system, uses an artificial intelligence system to target transrectal ultrasound biopsies, allowing only 6 cores to be taken. The artificial intelligence imaging system is calibrated from radical prostatectomy specimens and can detect lesions from US not visible to the human eye. Their recent randomised controlled trial also showed better detection rate compared to TRUS guided 12 core to systematic biopsies and mpMRI assisted 12 core systematic biopsy in their study. However systematic biopsies may soon be obsolete according to the “Game Changing” plenary session and one of the conference highlights, came from the “PRECISION” trial from UCL, presented by Veeru Kasivisvanathan.

The results showed 71 (28%) of the 252 men in the MRI arm of the study avoided the need for a subsequent biopsy. Of those who needed a biopsy, the researchers detected clinically significant cancer in 95 (38%) of the 252 men, compared with 64 (26%) of the 248 men who received only the TRUS biopsy. This shows the benefit of using a mpMRI for ALL men with suspicion of prostate cancer. Men with a normal MRI (and no red flags) can avoid a biopsy. Men with a suspicious lesion on mpMRI can have targeted biopsies only (not systematic). Therefore using this protocol avoids unnecessary biopsies and when biopsies are taken, fewer cores are required.

(Read more in the PRECISION BJUI blog by Declan Murphy:-

PRECISION delivers on the PROMIS of mpMRI in early detection of prostate cancer

Upper Tract Urothelial Cancer (UTUC)

The winner of the first prize for oncology was for the results of the POUT trial, a phase III randomised trial of peri-operative chemotherapy versus surveillance in upper tract urothelial cancer (UTUC), by Birtle A.J et al. They compared surveillance and adjuvant chemotherapy with gemcitabine-cisplatin,

post nephro-ureterectomy giving histologically confirmed pT2-T4 N0-3 M0 UTUC.

The chemotherapy arm showed improved metastasis-free survival in UTUC. Recruitment to the POUT trial was terminated early because of efficacy favouring the chemotherapy arm; follow up for overall survival continues. POUT is the largest randomised trial in UTUC and its results support the use of adjuvant chemotherapy as a new standard of care.

Transgender

The first accurate data to confirm that male to female transgender surgery can lead to a better life. The study shows that 80% of male-to-female patients perceived themselves as women post-surgery. However, the quality of life of transgender individuals is still significantly lower than the general population. Dr. Jochen Hess and his team from Germany, followed 156 patients for a median of more than 6 years after surgery. They developed and validated the new Essen Transgender Quality of Life Inventory, which is the first methodology to specifically consider transgender QoL. They found that there was a high overall level of satisfaction with the outcomes of surgery.

Stones

Since the SUSPEND trial showed no benefit to stone passage with medical expulsive therapy (MET) many centres have ceased tamsulosin for ureteric stone passage. However this has not been as widely adopted as might be expected, with opinion especially from USA feeling that larger stones may benefit from MET. A Chinese multicenter, randomised, double-blind, placebo-controlled has now shown benefit to ureteric stone passage greater than 5 mm. With the MIMIC study (a multicenter, International ureteric stone study) showing no benefit in MET for stone passage, the debate is set to continue! However for now the latest EAU guidelines recommends MET may be used to aid spontaneous passage for ureteric stones greater than 5 mm.

Renal Cell Carcinoma

Diagnostic renal biopsy for presumed renal cancer may increase in the future, with data from the Royal Free Hospital, London, showing benign results in 21.5% of biopsies, of which 98% avoided surgical intervention.

Social media

Twitter use overall seems to be slightly less than the last two years, with fewer Tweets and tweets/participants, but there were more active Tweeps and more impressions.

The 6th annual BJUI social media awards was held at the Crowne Plaza Hotel, close to the conference center. This fun and lighthearted event celebrated tech leaders, with two awards going to the EAU communications department for best conference and innovation. Stephen Fry was also acknowledged for raising awareness by tweeting on his personal prostate cancer journey.

(Read more https://www.bjuinternational.com/bjui-blog/6th-bjui-social-media-awards-2018/)

EAU guidelines are finding effective dissemination though social media.

 

Finally the top conference tweet went to BJUI editor Prokar Dasgupta for his thought provoking talk on robotic surgery in the developing world.

(read more https://eau18.uroweb.org/robotic-surgery-is-unnecessary-in-the-developing-world/?utm_source=EAU+News&utm_campaign=3d6dc39e7c-EAU_Newsletter_September9_14_2017&utm_medium=email&utm_term=0_019a710c04-3d6dc39e7c-106500857&ct=t(EAU_Newsletter_September9_14_2017)&goal=0_019a710c04-3d6dc39e7c-106500857)

This was a fantastically well organised conference with some great practice changing presentations, up next is EAU Barcelona in 2019. #EAU19 #Barcelona #SoMe

 

Nishant Bedi

Urology Registrar North London

@nishbedi

 

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