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Video: T1 renal tumours: Partial versus Radical Nephrectomy

January 20, 2016/by admin Z.9

Partial versus Radical Nephrectomy for T1 renal tumours: An analysis from the British Association of Urological Surgeons Nephrectomy Audit

Marios Hadjipavlou, Fahd Khan, Sarah Fowler*, Adrian Joyce†, Francis X. Keeley‡, Seshadri Sriprasad and on behalf of BAUS Sections of Endourology and Oncology

Department of Urology, Darent Valley Hospital, Dartford Kent, *British Association of Urological Surgeons, London, †Department of Urology, St James’s University Hospital, Leeds, and ‡Bristol Urological Institute, Southmead Hospital, Bristol, UK

Read the full article

OBJECTIVES

To analyse and compare data from the British Association of Urological Surgeons Nephrectomy Audit for perioperative outcomes of partial (PN) and radical nephrectomy (RN) for T1 renal tumours.

PATIENTS AND METHODS

UK consultants were invited to submit data on all patients undergoing nephrectomy between 1 January and 31 December 2012 to a nationally established database using a standard pro forma. Analysis was made on patient demographics, operative technique, and perioperative data/outcome between PN and RN for T1 tumours.

RESULTS

Overall, data from 6 042 nephrectomies were reported of which 1 768 were performed for T1 renal tumours. Of these, 1 082 (61.2%) were RNs and 686 (38.8%) were PNs. The mean age of patients undergoing PN was lower (PN 59 years vs RN 64 years; P < 0.001) and so was the WHO performance score (PN 0.4 vs RN 0.7; P < 0.001). PN for the treatment of T1a tumours (≤4 cm) accounted for 55.6% of procedures, of which 43.9% were performed using a minimally invasive technique. For T1b tumours (4–7 cm), 18.9% of patients underwent PN, in 33.3% of which a minimally invasive technique was adopted. The vast majority of RNs for T1 tumours were performed using a minimally invasive technique (90.3%). Of the laparoscopic PNs, 30.5% were robot-assisted. There was no significant difference in overall intraoperative complications between the RN and PN groups (4% vs 4.3%; P = 0.79). However, PN accounted for a higher overall postoperative complications rate (RN 11.3% vs PN 17.6%; P < 0.001). RN was associated with a markedly reduced risk of severe surgical complications (Clavien Dindo classification grade ≥3) compared with PN even after adjusting for technique (odds ratio 0.30; P = 0.002). Operation time between RN and PN was comparable (141 vs 145 min; P = 0.25). Blood loss was less in the RN group (mean for RN 165 vs PN 323 mL; P < 0.001); however, transfusion rates were similar (3.2% vs 2.6%; P = 0.47). RN was associated with a shorter length of stay (median 4 vs 5 days; P < 0.001). A direct comparison between robot-assisted and laparoscopic PN showed no significant differences in operation time, blood loss, warm ischaemia time, and intraoperative and postoperative complications.

CONCLUSIONS

PN was the method of choice for treatment of T1a tumours whereas RN was preferred for T1b tumours. Minimally invasive techniques have been widely adopted for RN but not for PN. Despite the advances in surgical technique, a substantial risk of postoperative complications remains with PN.

The second joint academic meeting of the Sri Lankan and British Associations of Urological Surgery (SLAUS & BAUS)

November 17, 2015/by Mark Speakman

The inaugural international joint meeting of BAUS and SLAUS was held two years ago. The second joint meeting has just finished in Colombo, bringing together British and Sri Lankan urologists. We were also joined by excellent Chinese and Indian colleagues.

The meeting commenced on Monday 2^nd November with a series of urological workshops. These started with an excellent laparoscopic workshop at Colombo South Teaching Hospital, led by Gordon Kooiman (King’s, UK), Wei Wang, Zhu Gang (Bejing) and Srinath Chandrasekera (Sri Lanka).

The College of Surgeons of Sri Lanka was the chosen venue for the second day of the pre-congressional sessions. This kicked off with a trans-world MDT, with John Kelleher (UK), Gordon Kooiman (UK), Mark Speakman (President of BAUS), Archana Fernando (Guy’s and St Thomas’ Hospitals, London), Sanchia Goonewardene (University of Warwick), Ranga Wickramarachi (National Hospital of Sri Lanka) and Niroshen Seneviratne, (Sri Jayawardenapura, Sri Lanka). Fifteen complex cancer cases were presented, ranging from prostate and bladder cancer to complex renal cases. The intellectual sparks flew as each side vigorously debated their management of each patient, with input from Chinese Professors Zhu Gang and Wei Wang. The MDT was wonderfully organised by Dr Ranga Wickramarachi, who brought together both faculties, with solid science and learning on both sides.

The afternoon was led by Mr Julian Shah (University College London), who presented on medico-legal issues and communication skills, with input from Sri Lankan doctors. There are an ever increasing number of medico-legal situations clinicians may find themselves in, and this workshop provided the tools for how to manage them. Also noteworthy were the acting skills of Dr Manjula Herath (Kandy Hospital, Sri Lanka) and his colleagues, who deserved an Oscar for the excellent case scenarios they enacted as a background for a critique of their communication skills. On a more serious note, these clearly highlighted issues that are becoming more and more significant in today’s practice.

The third day of the pre-congressional sessions was a trip to Galle in the south of the island for a joint meeting with the Galle Medical Association. A 6am start was complemented by teaching on the neuropathic bladder by Ms Jean Macdonald and Mr Julian Shah, as well as a workshop on penile diseases from Mr Suks Minas at the Jetwing Lighthouse hotel. There was also teaching from Galle medical personnel, notably Kareen Hareen on haematuria. Additionally, there was a lecture on LUTS/BOO from Mr Speakman, and wise lessons to all trainees present on the validity of BPH treatment. A wonderful lunch was served, with chances to interact with Sri Lankan trainees and to clearly see differences in training in both countries – although we are not that dissimilar. A relaxed afternoon beckoned, including a wonderful tour of the ancient Portuguese Galle fort and its scenery. This was followed by afternoon tea at the Closernberg Hotel, Galle.

The next day brought live surgery at Lanka Hospital, conducted by Julian Shah, and Suks Minhas (University College London), with a focus on female and functional urology. A complicated ureteric strictures managed by pyeloplasty and a complex female urethral stricture were demonstrated with live surgery. Additionally, there were video operative lectures by EAU Secretary General Professor Chris Chapple (Royal Hallamshire Hospital, Sheffield), on urethroplasty; valuable lessons for all trainees.

There was also a visit to Sri Jayawardenapura hospital from the Faculty. It was brilliant to see Sri Lankan medicine in practice, with lessons to be learnt by all BAUS faculty members. Afterwards a workshop on trauma occurred at the Faculty of Medicine, University of Sri Jayardenapura, composed of all Faculty members. The best lesson learnt was how to manage renal trauma. This was followed by a hands-on skills for ureteric reconstruction. The course, run by Peter Thompson, had been started 20 years before by Prof. Harold Ellis at RCS England. This was run by Mr Thompson, Ms Goonewardene and Prof. Wang (China). It was considered a fantastic opportunity for all trainees, with hands-on experience of anastomoses of the pig urinary system. Its success was justified the next day when, in practice, a trainee was called upon to manage a ureteric injury.

A beautiful inauguration ceremony in front of 200 people was conducted that evening at Kings Court, Cinnamon Lakeside Hotel, with traditional Kandian dancing and lighting of the oil lamp. This was followed by inauguration speeches, given by Prof. Satish Goonesinghe (Colombo), Prof. Chris Chapple (EAU), and Mr Mark Speakman (BAUS). The evening ended with entertainment from Kandian dancers, and singing from Prof. J. Shah, Prof. S. Fonseka and Mr J. Kelleher– the rock band was aptly named ‘The Professors.’

The next day, the full congress kicked off, with a presentation from Mr Thompson on the history of British urology. The audience learned about great legends, including Malcolm Coptcoat, pioneer of laparoscopic surgery at King’s College London. The next section was on urolithiasis, started by Ms S. Goonewardene on metabolic stone analysis, Ms J. Macdonald (North Middlesex Hospital) on PCNL, and finally from Dr Ranga Wickramararchi on open stone surgery. The learning outcomes demonstrated to trainees the importance of being a well-trained general urologist prior to sub speciality training.

The next section was brightened by Mark Speakman, President of BAUS, talking on surgeons’ outcome data — a really valid subject as this can greatly impact surgical practice. Training issues as part of this were also highlighted. At the end of the day, this can also be used as a continuous assessment tool to improve practice. This was followed by Prof. C. Chapple talking on OAB, a complex subject to manage. There was great interaction between trainees and Faculty, a wonderful learning experience.

Mark Speakman, Chris Chapple, Satish Goonesinghe and Majula Herath at the Inuguration ceremony

This was followed, after a lovely tea, by Julian Shah speaking on female voiding difficulties. This was very important to all present, as it clearly highlighted other factors that can affect bladder function. After that, Prof. Chapple spoke on advances in pharmacotherapeutic management of LUTS; valuable lessons for all present. Also presented were the potential complications or failures of TURP prostatectomy, highlighting the importance of good case selection. To complete this section, the sensitive bladder was reviewed by Dr Sanjay Pandey, (India).

After lunch there were registrar presentations, varying from renal cell carcinoma to paediatric urethral valves. The afternoon was completed by a detailed uro-oncology session, with presentations from Gordon Kooiman, Mark Speakman, Suks Minhas and John Kelleher, covering a range of oncological subjects.

Each speaker was presented with a beautiful silver plaque for their involvement. The ceremony concluded with an evening dinner aboard an arc in the Colombo wetlands. The meeting closed, and was clearly one of the most successful there had ever been, with the promise of returning in years to come with further joint BAUS/SLAUS meetings.

–Mark Speakman and Sanchia Goonewardene

Mark J Speakman

Consultant Urologist, Taunton & Somerset FNHST and President BAUS
Twitter: @Parabolics

Here comes the sun

July 29, 2015/by Ben Challacombe

Sun, sea, sand and stones: BJUI on the beach.

Welcome to this month’s BJUI and whether you are relaxing on a sun-drenched beach or villa somewhere having a hard-earned break, or back at your hospital covering for everyone else having their time off, we hope you will enjoy another fantastic issue. After an action packed BAUS meeting with important trial results, innovation, social media and the BJUI fully to the fore, this is a great moment to update yourself on what is hot in urology. This is probably the time of year when most urologists have a little extra time to take the BJUI out of its cover or open up the iPad and dig a little deeper into the articles, and we do not think you will be disappointed with this issue, which certainly has something for everyone.

In the ‘Article of the Month’, we feature an important paper from Egypt [1] examining factors associated with effective delayed primary repair of pelvic fractures that are associated with a urethral injury. Do be careful whilst you are travelling around the world, as most of the injuries in this paper were due to road traffic accidents. They reported 76/86 successful outcomes over a 7-year period. When a range of preoperative variables was assessed, four had particular significance for successful treatment outcomes. The paper really highlights that in the current urological world of robotics, laparoscopy and endourology, in some conditions traditional open surgery with delicate and precise tissue handling and real attention to surgical detail are the key components of a successful outcome.

Whilst you are eating and drinking more than usual over the summer, we have some food for thought on surgery and metabolic syndrome with one of our ‘Articles of the Week’. This paper contains an important message for all those performing bladder outflow surgery. This paper by Gacci et al. [2] from an international group of consecutive patients clearly shows that men with a waist circumference of >102 cm had a far higher risk of persistent symptoms after TURP or open prostatectomy. This was particularly true for storage symptoms in this group of men and should influence the consenting practice of all urologists carrying out this common surgery.

Make sure you drink plenty of Drink HRW to stay well hydrated on your beach this August, as the summer months often lead to increased numbers of patients presenting to emergency departments with acute ureteric colic, so it seems timely to focus on this area.To this end I would like to highlight one of our important ‘Guideline of Guidelines’ series featuring kidney stones [3] to add to the earlier ones on prostate cancer screening [4]and prostate cancer imaging [5]. This series serve to assimilate all of the major national and international guidelines into one easily digestible format with specific reference to the strength of evidence for each recommendation. Specifically, we look at the initial evaluation, diagnostic imaging selection, symptomatic management, surgical treatment, medical therapy, and prevention of recurrence for both ureteric and renal stones. Quite how the recent surprising results of the SUSPEND (Spontaneous Urinary Stone Passage ENabled by Drugs) trial will impact on the use of medical expulsive therapy remains to be seen [6].

So whether you are sitting watching the sunset with a drink in your hand or quietly working in your home at night, please dig a little deeper into this month’s BJUI on paper, online or on tablet. It will not disappoint and might just change your future practice.

References

1 Koraitim MM, Kamel MI. Perineal repair of pelvic fracture urethral injury: in pursuit of a successful outcome. BJU Int 2015; 116: 265–70

2 Gacci M, Sebastianelli A, Salvi M et al. Central obesity is predictive of persistent storage lower urinary tract symptoms (LUTS) after surgery for benign prostatic enlargement: results of a multicentre prospective study. BJU Int 2015;116:271–7

3 Ziemba JB, Matlaga BR. Guideline of guidelines: kidney stones. BJU Int 2015; 116: 184–9

4 Loeb S. Guideline of guidelines: prostate cancer screening. BJU Int 2014; 114: 323–5

5 Wollin DA, Makarov DV. Guideline of guidelines: prostate cancer imaging. BJU Int 2015; [Epub ahead of print]. DOI: 10.1111/bju.13104

6 McClinton S, Starr K, Thomas R et al. Use of drug therapy in the management of symptomatic ureteric stones in hospitalized adults (SUSPEND), a multicentre, placebo controlled, randomized trial of a calcium-channel blocker (nifedipine) and an a-blocker (tamsulosin): study protocol for a randomized controlled trial. Trials 2014; 15: 238

Ben Challacombe
Associate Editor, BJUI

Highlights from #BAUS15

June 24, 2015/by Rebecca Tregunna

#BAUS15 started to gain momentum from as early as the 26^th June 2014 and by the time we entered the Manchester Central Convention Complex well over 100 tweets had been made. Of course it wasn’t just Twitter that started early with a group of keen urologists cycling 210 miles to conference in order to raise money for The Urology Foundation.

Monday 15^th June 2015

By the time the cyclists arrived conference was well under way with the andrology, FNUU and academic section meetings taking place on Monday morning:

The BJU International Prize for the Best Academic Paper was awarded to Richard Bryant from the University of Oxford for his work on epithelial-to-mesenchymal transition changes found within the extraprostatic extension component of locally invasive prostate cancers.
Donna Daly from the University of Sheffield received the BJUI John Blandy prize for her work on Botox, demonstrating reductions in afferent bladder signaling and urothelial ATP release.

Professor Reisman’s talk on ‘Porn, Paint and Piercing’ as expected drew in the crowds and due to a staggering 44% complication rate with genital piercings it is important for us to try to manage these without necessarily removing the offending article as this will only serve to prevent those in need from seeking medical attention.
With the worsening worldwide catastrophe of antibiotic resistance, the cycling of antibiotics for prevention of recurrent UTIs is no longer recommended. Instead, Tharani Nitkunan provided convincing evidence for the use of probiotics and D-Mannose.

The afternoon was dominated by the joint oncology and academic session with Professor Noel Clarke presenting the current data from the STAMPEDE trial. Zolendronic acid conferred no survival benefit over hormones alone and consequently has been removed from the trial (stampede 1). However, Docetaxal plus hormones has shown benefit, demonstrated significantly in M1 patients with disease-free survival of 65 months vs. 43 months on hormones alone (Hazard ratio 0.73) (stampede 2). This means that the control arm of M1 patients who are fit for chemotherapy will now need to be started on this treatment as the trial continues to recruit in enzalutamide, abiraterone and metformin arms.

The evening was rounded off with the annual BAUS football tournament won this year by team Manchester (obviously a rigged competition!), whilst some donned the

lycra and set out for a competition at the National Cycle Centre. For those of us not quite so energetic, it was fantastic to catch up with old friends at the welcome drinks reception.

Tuesday 16^th June 2015

Tuesday kicked off bright and early with Professor John Kelly presenting results from the BOXIT clinical trial, which has shown some benefit over standard treatment of non-muscle invasive bladder cancer, but with significant cardiovascular toxicity.

The new NICE bladder cancer guidelines were presented with concerns voiced by Professor Marek Babjuk over discharging low-risk bladder cancer at 12 months given a quoted 30-50% five-year recurrence risk. Accurate risk stratification, it would seem, is going to be key.

The President’s address followed along with the presentation of the St. Peter’s medal for notable contribution to the advancement of urology, which was presented to Pat Malone from Southampton General Hospital. Other medal winners included Adrian Joyce who received the BAUS Gold Medal, and the St. Paul’s medal went to Mark Soloway.

A plethora of other sessions ensued but with the help of the new ‘native’ BAUS app my programme was already conveniently arranged in advance:

‘Heartsink Conditions’ included pelvic and testicular pain and a fascinating talk by Dr Gareth Greenslade highlighted the importance of early and motivational referral to pain management services once no cause has been established and our treatments have been exhausted. The patient’s recovery will only start once we have said no to further tests: ‘Fix the thinking’

Poster sessions are now presented as ‘e-posters’, abolishing the need to fiddle with those little pieces of Velcro and allowing for an interactive review of the posters.

Pravisha Ravindra from Nottingham demonstrated that compliance with periodic imaging of patients with asymptomatic small renal calculi (n=147) in primary care is poor, and indeed, these patients may be better managed with symptomatic imaging and re-referral as no patients required intervention based on radiograph changes alone.

Archana Fernando from Guy’s presented a prospective study demonstrating the value of CTPET in the diagnosis of malignancy in patients with retroperitoneal fibrosis (n=35), as well as demonstrating that those with positive PET are twice as likely to respond to steroids.

Wednesday 17^th June 2015

Another new addition to the programme this year was the Section of Endourology ‘as live surgery’ sessions. This was extremely well received and allowed delegates to benefit from observing operating sessions from experts in the field whilst removing the stressful environment and potential for risk to patient associated with live surgery. This also meant that the surgeon was present in the room to answer questions and talk through various steps of the operation allowing for a truly interactive session.
Wednesday saw multiple international speakers dominating the Exchange Auditorium:

The BJU International guest lecture was given by Professor Hendrik Van Poppel: a heartfelt presentation describing what he believes to be the superiority of surgery over radiotherapy for high-risk localised prostate cancer.
The Urology Foundation presented the Research Scholar Medal to Ashwin Sachdeva from Freeman Hospital, Newcastle for his work on the ‘Role of mitochondrial DNA mutations in prostate carcinogenesis’. This was followed by an inspiring guest lecture by Inderbir Gill on ‘Robotic Urologic Oncology: the best is yet to come’ with the tag line ‘the only thing that should be open in 2015 is our minds’
Robotic Surgery in UK Urology: Clinical & Commissioning Priorities was a real highlight in the programme with talks from Jim Adshead and Professor Jens-Uwe Stolzenburg focussing on the fact that only 40% of T1a tumours in the UK were treated with partial (as opposed to radical) nephrectomy, and that the robot really is the ‘game-changer’ for this procedure. Inderbir Gill again took to the stage to stress that all current randomised trials into open vs. robotic cystectomy have used extracorporeal reconstruction and so do not reflect the true benefits of the robotic procedure as the dominant driver of complications is in the open reconstruction.

These lectures were heard by James Palmer, Clinical Director of Specialised Commissioning for NHS England who then discussed difficulties in making decisions to provide new technologies, controlling roll out and removing them if they show no benefit. Clinical commissioning policies are currently being drafted for robotic surgery in kidney and bladder cancer. This led to a lively debate with Professor Alan McNeill having the last word as he pointed out that what urologists spend on the robot to potentially cure cancer is a drop in the ocean compared with what the oncologists spend to palliate!

Thursday 18^th June 2015

The BJU International session on evidence-based urology highlighted the need for high-quality evidence, especially in convincing commissioners to spend in a cash-strapped NHS. Professor Philipp Dahm presented a recent review in the Journal of Urology indicated that the quality of systematic reviews in four major urological journals was sub-standard. Assistant Professor Alessandro Volpe then reviewed the current evidence behind partial nephrectomy and different approaches to this procedure.

Another fantastic technology, which BAUS adopted this year, was the BOD-POD which allowed delegates to catch-up on sessions in the two main auditoria that they may have missed due to perhaps being in one of the 21 well designed teaching courses that were available this year. Many of these will soon be live on the BAUS website for members to view.

The IBUS and BAUS joint session included a lecture from Manoj Monga from The Cleveland Clinic, which led to the question being posed on Twitter: ‘Are you a duster or a basketer?’The audience was also advised to always stent a patient after using an access sheath unless the patient was pre-stented.

The updates session is always valuable especially for those studying for the FRCS (Urol) exam with far too many headlines to completely cover:

Endourology: The SUSPEND trial published earlier this year was a large multi-centre RCT that showed no difference in terms of rates of spontaneous passage of ureteric stone, time to stone passage or analgesic use between placebo, tamsulosin and nifedipine. There was a hot debate on this: should we be waiting for the meta-analysis or should a trial of this size and design be enough to change practice?
Oncology-Prostate: The Klotz et al., paper showed active surveillance can avoid over treatment, with 98% prostate cancer survival at 10 years.
Oncology-Kidney: Ellimah Mensah’s team from Imperial College London (presented at BAUS earlier in the week) demonstrated that over a 14-year period there were a higher number of cardiovascular-related admissions to hospital in patients who have had T1 renal tumours resected than the general population, but no difference between those who have had partial or radical nephrectomy.
Oncology-Bladder: Arends’s team presented at EAU in March on the favourable results of hyperthermic mitomycin C vs. BCG in the treatment of intermediate- and high-risk bladder cancer.
Female and BPH: The BESIDE study has demonstrated increased efficacy with combination solifenacin and mirabegron.
Andrology: Currently recruiting in the UK is the MASTER RCT to evaluate synthetic sling vs. artificial sphincter in men with post-prostatectomy urinary incontinence.

Overall BAUS yet again put on a varied and enjoyable meeting. The atmosphere was fantastic and the organisers should be proud of the new additions in terms of allowing delegates to engage with new technologies, making for a memorable week. See you all in Liverpool!

Rebecca Tregunna, Urological Trainee, West Midlands Deanery @rebeccatregunna

Dominic Hodgson, Consultant Urologist, Portsmouth @hodgson_dominic

The Inaugural Annual Academic Sessions Joint Meeting of BAUS and SLAUS

November 7, 2013/4 Comments/by Sanchia Goonewardene

BAUS / SLAUS 2013 Conference Report: 4th – 7th November, Colombo, Sri Lanka

Day 1

Greetings from Colombo, Sri Lanka. Home of the Inaugural Meeting of BAUS / SLAUS. The gathering, held in cool Colombo was off to a great start at Asiri Surgical Hospital. It was inundated with delegates from all over Sri Lanka and the UK, who had come to learn and exchange opinions. The conference started with a focus on LUTS. Mr. Mark Speakman (Taunton, UK) emphasizing importance and correct terminology used in treatment of this condition. This was followed by Mr. Pallavoor Anandaram (Wrexham, UK) and Mr. Ian Pearce (Manchester, UK) talking on medical management the pros and cons, with great debate and participation from delegates. This was followed by Mr. Peter Acher (Southend, UK) covering surgical management of LUTS.

Lunch was held on the rooftop terrace, with gourmet Sri Lankan cuisine. The afternon was filled with laparoscopic talks led by Mr. Christian Brown (London, UK) with Mr. Sanjeev Madaan (Dartford, UK) reflecting on use of cryotherapy importance, technique and complications.

In addition there was also a live surgical link up with Mr. Ranjan Thilagarajah (Chelmsford, UK) conducting live robotic surgery at Kings College. This was streamed to Australia, USA, Sri Lanka and the UK.

In true Sri Lankan fashion, the day concluded with a welcome dinner, and exchange of gifts for the Faculty. All in readiness for a new day!!!

Day 3

The day kicked off to a bright start discussing complex MDT cases, with a combined panel from the UK and Sri Lanka. Involved in discussions were Dr. Serozsha AS Goonewardena (Colombo, Sri Lanka), Prof. Raj Persad, Mr. Sanjeev Madaan, Miss Sanchia Goonewardene (London, UK). There were a variety of cases covered including prostate, bladder and renal cancer and a variety of management strategies discussed.

As before, local gourmet cooking was served for lunch, with the afternoon moving onto a series of lectures. Firstly was Mr. Ian Pearce (Manchester, UK) on how to get a paper published. Secondly, Miss Sanchia Goonewardene on UK training, followed by Mr. Sohan Perera (Colombo, Sri Lanka) on Sri Lanka training. Mr. David Tolley (Edinburgh, UK) then covered aspects of educational involvement from the college, and the afternoon ended with Mr. David Jones (Gloucester, UK) explaining the process of internal review. A welcome address was conducted by Mr. Anura Wijewardane (Colombo, Sri Lanka), then Chief Guest Mr. Mark Speakman spoke, before an address by the Guest of Honour, Dr. Athula Kahandaliyanage (Colombo, Sri Lanka).

Both Mr. Mark Speakman and Mr. David Tolley were awarded Honurary Fellowships by SLAUS, before a vote of thanks was conducted by Dr. Ajith Malalasekera (Secretary, SLAUS).

The evening concluded with a cultural show and reception, just what all needed.

Day 4

The day kicked off with Mr. Vincent Gnanapragasam (Oxford, UK), lecturing on risk stratification on prostate cancer. Mr. Gurpreet Singh then spoke on surgical management of LUTS, including objective assessment of obstruction. An audience vote was taken for surgical treatment, with the vote almost unanimously being in favour of bipolar. Then Mr. Peter Acher spoke on HoLEP, giving the pros and cons of the system. Mr. Christian Brown spoke on greenlight laser, therapy and protocol involved. This revealed a ground breaking moment as he presented new data on green light vs. TURP (unpublished).

Overactive bladder symptoms and treatment were then discussed by Ms. Tharani Nitkunan (Surrey, UK), including at times a mixed response to treatment. Mr. Roger Walker (Epsom, UK) then spoke on stress inconvenience and use of mid urethral tape. Complications of tapes were then covered by Mr. Simon Fulford. Mr. Pravin Menezes (Sunderland, UK) then discussed non communicable disease and types of stone.

Mr. Mark Stott (Exeter, UK) then spoke on urosepsis and mortality, highlighting the importance of preventing urosepsis and early antibiotic therapy. Dr. Anuruddha M Abeygunasekara (Colombo, Sri Lanka), then spoke on GU TB. This was especially interesting to the UK delegates, like that we do not see.

Mr. Mark Speakman then gave the SLAUS lecture on prostate cancer incidence and trials involved.

After lunch, uro-oncology was covered by both Mr. Thiru Gunendran (Manchester, UK) and Prof. Raj Persad. Also during the afternoon was the trainees forum ranging from stone disease to uro-oncology to new techniques for urethral pull-through for management of membrano prostatic disease.

After tea came management of spinal cord injury by Mr. Simon Fulford and Mr. Julian Shah, before facilitation of UK fellowships by Mr. Ranjan Thilagarajah and management of vesico-vaginal fistulae by Mr. Julian Shah.

The evening ended with a closing ceremony and banquet.

Sanchia Goonewardene and Raj Persad*
Homerton University Hospital, London and *Bristol Urological Institute, Southmead

[caption id=”attachment_10517″ align=”alignleft” width=”800′ label=’ Faculty member, Miss Sanchia Goonewardene and President Elect of BAUS, Mr. Mark Speakman at the Faculty Dinner, Pegasus Reef Hotel, Sri Lanka.

Urologists up in arms? ….Diclofenac no longer indicated in high risk groups

July 17, 2013/3 Comments/by Jonathan Makanjuola

This blog is an update form the originally published comment article in BJU International, 110: 607–608.
DOI: 10.1111/j.1464-410X.2012.11330.x

On the 23^rd June 2013 the MHRA (The Medicines and Healthcare products Regulatory Agency) issued a press release stating that ‘patients with serious underlying heart conditions, such as heart failure, heart disease, circulatory problems or a previous heart attack or stroke should no longer use diclofenac’. The MHRA is responsible for regulating all medicines and medical devices in the United Kingdom (UK) by ensuring they work and are acceptably safe.

The new guidelines in the UK state:

Diclofenac is now contraindicated in patients with established:
– ischaemic heart disease
– peripheral arterial disease
– cerebrovascular disease
– congestive heart failure (New York Heart Association [NYHA] classification II–IV)

Patients with these conditions should be switched to an alternative treatment at their next routine appointment

Diclofenac treatment should only be initiated after careful consideration for patients with significant risk factors for cardiovascular events (e.g., hypertension, hyperlipidaemia, diabetes mellitus, smoking).

Now for urologists in the UK this has wider implications. What else are we to use for acute renal colic, chronic pelvic pain, prostatitis, urethritis and any other type of..-itis?

We are treating an ever aging population and the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, will increase. NSAIDs have been the cornerstone of pain relief in patients with first presentation of renal and ureteric lithiasis. The British Association of Urological Surgeons (BAUS) and the European Association of Urology (EAU) guidelines for the acute management of renal and ureteric lithiasis state the first line analgesia is an NSAID e.g. diclofenac [1][2]. There have been a number of clinical trials which have clearly shown that NSAIDs provide effective relief in patients who have acute stone colic [3][4][5].

Controversies of NSAID use

Rofecoxib (trade name Vioxx ®), was approved by the Food and Drug Administration (FDA) in May 1999. The drug was heavily promoted by the global pharmaceutical and chemical company Merck as safer than older generation NSAIDs. The increased risk of stroke was highlighted in a large study, the Vioxx gastrointestinal outcomes research (VIGOR) study, published in the New England Journal of Medicine in 2000. Merck voluntarily took rofecoxib off of the market on 30 September 2004 after research showed that it almost doubled the risk of myocardial infarction and stroke when taken for 18 months or longer. In 2007 Merck paid $4.85bn to settle about 26 000 lawsuits in the United States relating to the drug in state and federal courts.

What are the alternatives suggested?

Naproxen and low-dose ibuprofen are considered to have the most favourable thrombotic cardiovascular safety profiles of all non-selective NSAIDs. There is limited evidence for the use of naproxen and low-dose ibuprofen in the management of acute renal colic. We do not know if the efficacy is equivalent to diclofenac. There are a lot of unanswered questions since the press release, but the key questions remain: Is this guidance applicable to us as urologists? And will this change my practice?

This topic is an important area for urologists to be aware of as NSAIDs are prescribed daily in urological practise to a wide range of patients. There is some caution that has to be exercised when reviewing the published data. In a recently published meta-analysis by the Coxib and traditional NSAID Trialists’ (CNT) Collaboration group their data provides further evidence that the vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs.

The majority of trials evaluating the cardiovascular risk of NSAIDs have looked at a group of patients with predominately arthritis or Alzheimer’s disease; not a typical urological cohort of patients. None of the studies in the meta-analysis looked at the short term use of NSAIDs, in particular diclofenac. Some may argue that absolute rates of events were low and clinically irrelevant as the event rates in the included trials are considerably lower than in routine clinical settings.

The options for the treatment of acute urological pain have not changed in the past 15 years. COX-2 selective inhibitors and diclofenac are associated with an increased risk of thrombotic events. Naproxen is associated with a lower thrombotic risk and low doses of ibuprofen (1.2 g daily or less) have not been associated with an increased risk of myocardial infarction. The lowest effective dose of NSAIDs should be prescribed for the shortest period of time to control the symptoms and the need for long term treatment should be reviewed periodically. As we treat an ever aging population with increasing medical co-morbidities the widespread use of NSAIDs has to be evaluated and urologists need to keep up to date with current prescribing guidelines and long term cardiovascular risk factors.

Jonathan Makanjuola is a Urology Trainee, Innovator and techie based at King’s College Hospital, London, United Kingdom. @jonmakUrology

References

EAU guidelines on urolithasis. European Association of Urology; 2011. https://www.uroweb.org/gls/pdf/18_Urolithiasis.pdf. Accessed 12 December 2011.
Guidelines for acute management of first presentation of renal/ ureteric lithiasis (excluding pregnancy). British Association of Urological Surgeons; 2008. https://www.baus.org.uk/AboutBAUS/publications/stones-guidelines. Accessed 12 December 2011.
Phillips E, Kieley S, Johnson EB, et al. Emergency room management of ureteral calculi: current practices. J Endourol 2009; 23: 1021–1024.
Micali S, Grande M, Sighinolfi MC, et al. Medical therapy of urolithiasis. J Endourol 2006; 20: 841–847.
Engeler DS, Schmid S, Schmid HP. The ideal analgesic treatment for acute renal colic–theory and practice. Scand J Urol Nephrol 2008; 42: 137–142.

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Uro-oncology Highlights from #BAUS13

June 24, 2013/by Ben Jackson

The BAUS annual meeting in Manchester proved hugely enjoyable and notable for the high level of educational content and the quality of the speakers involved. There was a clear emphasis on the increasing role of the web and social media in urological education in the UK, and it was exciting to hear @prokarurol lay out his vision for the BJUI in this regard.

All subspecialties were well represented at BAUS, but I would like to focus particularly on urologic oncology, which was the subject of a number of excellent sessions.

Before that, I would like to show you some the Symplur data on social media traffic at #baus13:

This figure shows that 88 people people engaged with the #baus13 hashtag, many of many of whom were not in Manchester or even in the UK. Using the complex algoritim on their website, they calculate that the 556 tweets sent led to over 340,000 impressions in social media and other digital spaces.

The traffic each day was impressive and the largest spike happened during the BJUI Social Media Course. Well done to all who tweeted from the meeting.

Professor Ben Lee from Tulane University, New Orleans gave two fascinating talks on Tuesday and Thursday morning regarding novel imaging techniques to facilitate uro-oncologic diagnosis and treatment. He quoted work from Dr. Peter Pinto from @theNCI demonstrating the utility of MRI-TRUS fusion targeted biopsies which detected cancer in 37% of patients with a negative initial TRUS, 11% of whom had high-grade disease. He also discussed novel imaging techniques that may enter uro-oncology practice in the future, including diffuse reflectance imaging and confocal microscopy with fluorescein staining. These techniques may allow intraoperative assessment of oncologic margins at the histological level, and there has been some success with this in the field of breast lumpectomy. One final innovation is the development of a patient-specific simulator for minimally invasive renal surgery. This allows a patient’s CT imaging to be reconstructed into a virtual 3d model, allowing the surgeon to practice that individual patient’s procedure prior to putting knife to skin for real.

Wednesday morning’s session, chaired by Tim O’Brien, aimed to address a variety of contemporary issues across urological oncology. Mr. Ed Rowe and Dr. Stephen Tolchard from Bristol presented their experience of CPEX testing prior to radical cystectomy. Their series demonstrated that CPEX testing was highly predictive of the risk of post-op complications, whereas ASA grade performed poorly. The ability to assess risk pre-operatively is clearly going to be vital to the publication of properly risk-adjusted individual surgeon outcomes, and CPEX testing may be a useful way to do this.

Professor Tom Treasure from UCL was asked to make sense of pulmonary metastasectomy. He pointed to the difficulty of selection bias towards fitter patients with low volume disease who are likely to survive for longer regardless of the effect of the surgery. Prospective randomised trials are needed, but lacking.

Professor Markus Graefen won widespread acclaim for his presentation of the merits of the very high volume radical prostatectomy practice at the Martini clinic in Hamburg. Particularly impressive was the use of continuous statistical monitoring of results, so that incremental technical improvements could be identified and disseminated between surgeons.

The morning session concluded with Dr. Arthur Grollman giving an intriguing account of how Aristolochia herb ingestion was finally established as the underlying cause for Balkan endemic nephropathy.

Wednesday saw another session organised by the Section of Oncology, this time chaired by Mr. Simon Brewster and focussing on active surveillance (AS) for prostate cancer. The session format made use of short, punchy presentations from a variety of speakers addressing controversies in patient selection and protocols for active surveillance.

Professor Graefen returned to discuss surgical and pathological outcomes following delayed RP after active surveillance. He quoted work led by Ruth Etzioni that used a simulation model derived from large active surveillance and radical prostatectomy cohorts to predict comparative outcomes for immediate and deferred treatment. Only very modest reductions in cancer-specific survival with deferred treatment were predicted, with treatment able to be deferred for a median of 6.4 years.

Those data relate to men with low-risk prostate cancer, but what about active surveillance for intermediate-risk disease? Dr. Parker argued the case for, pointing to only 2 of 88 men in the Royal Marsden series developing PSA failure, and one death. @declangmurphy argued for caution however, pointing to the fact that 12 of 92 men in this category from the Göteborg screening study had progressed to require androgen deprivation therapy at a median follow-up of 6 years, which has to be regarded as a poor outcome from surveillance. There was general agreement however that intermediate-risk cancers are a heterogeneous group and that more sophisticated risk stratification is required. Biomarkers may be part of the answer, and Professor Martin Gleave gave an eloquent update including the new multiple gene expression panels that are becoming commercially available in the US.

Further presentations addressed the topic of how to evaluate men entering active surveillance. Mr. Brewster stressed the pitfalls in relying on PSA kinetics alone, given that they perform poorly as a predictor of adverse pathology or recurrence following radical prostatectomy for progression on biopsy-based criteria. Mr. Declan Cahill strongly advocated transperineal template biopsies as routine prior to enrolment and for repeat biopsies, pointing to an upgrading rate of 1/3 at Guy’s where all patients entering AS are offered transperineal biopsies. Professor Freddy Hamdy made the case for avoiding routine repeat transrectal biopsies, given that changes in grade/volume may be an artefact of inadequate sampling, and therefore unhelpful. Finally, Professor Mark Emberton discussed the current role of imaging, making the case for pre-biopsy multiparametric MRI which can exclude tumour foci down to a size of 0.2cc with 95% accuracy and allows targeted biopsies as mentioned earlier. Whether a man with a raised PSA and a negative MRI can safely avoid a biopsy however, remains an open question. MRI may also prove to be a safe, non-invasive way to monitor tumours for progression on AS, reducing the need for repeat biopsy.

Professor Gleave then switched the focus to castrate-resistant disease in the Prostate Cancer UK Guest lecture. Along with a masterful overview of androgen receptor pathways and novel endocrine therapies, he urged us as urologists to get involved in the administration of these agents. Whilst presently utilised post-chemotherapy, they are likely to move into the pre-chemo setting and possibly even replace LHRH analogues for hormone-naïve patients.

Thursday saw an oncologically-orientated @BJUI sub-plenary session chaired by @prokarurol. @jdhdavis provided some great insights into the utility and technique of robotic extended pelvic lymph node dissection in prostate cancer. @qdtrinh gave a fascinating insight into the complexities of health services research, as well as outlining some recent data regarding complications of robotic vs. open radical prostatectomy. Finally, Professor Rob Pickard discussed the recent health technology assessment addressing the relative cost-effectiveness of robotic and laparoscopic radical prostatectomy. Whilst the model requires a number of assumptions, it seems clear that centralisation of robotic surgery into high-volume centres is much more likely to result in acceptable cost-effectiveness, not to mention improved outcomes for patients.

In summary this has been a fantastic BAUS meeting for uro-oncological topics in particular and one I have thoroughly enjoyed attending. It seems the future uro-oncologist will need to be able to interpret and integrate advanced imaging techniques into their practice, make sophisticated decisions about when and how to defer treatment for prostate cancer, utilise a broad range of non-surgical treatments, and provide the very best surgical outcomes in a new era of transparency. I’m looking forward to the challenges ahead.

Ben Jackson
ST7 in Urological Surgery, Royal Derby Hospital
@Ben_L_jackson

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BAUS 2013 Conference Report – Day 1-2

June 20, 2013/1 Comment/by Nishant Bedi

This year’s BAUS Annual Meeting was held in Manchester’s International Convention Centre and attended by almost 1200 delegates from all over the world. There has been a lot of anticipation this year following great attendance and atmosphere at the USANZ13, EAU13 and AUA13; much of the success and excitement coming from those conferences was echoed by the delegates on Twitter.

This was my first BAUS conference and I was particularly excited about my place on a urology skills course using fresh frozen cadavers, along with teaching sessions on Paediatric Urology and Urogenital emergencies and a “Walk with Experts” session around the academic posters.

The conference started with 3 parallel sessions on Monday morning:

Andrology and Genito-Urethral surgery key updates were discussed with a joint academic session in the afternoon to include the latest basic science research into Peyronie’s pathophysiology, artificial sperm, post-prostatectomy ED and genital tissue Bioengineering.
The BAUS Female, neurological and Urodynamic Urology Section focused mainly on the latest updates for urological fistulae, with other Keynote addresses over the following day covering mesh erosions and recurrent stress incontinence.
The Academic Session consisted of presentations from the six best abstracts submitted to BAUS this year. As our chairman Professor Dasgupta pointed out, all these presentations were based on clinical research rather than basic science. Is this a bias towards the clinical or is the standard of clinical work higher? The session finished with the awarding of the prestigious BJUI John Blandy Prize, received by the best and most cited BJUI article over the last two years. This year Dr Jérémie Haffner from France won the prize and £5000, for his work titled [the] “Role of MRI for Prostate Cancer Screening”, which he presented in fluent English.

In the afternoon the Exhibition arena provides the opportunity to see some of the latest innovations from the pharmaceutical and equipment industry representatives, and even have a play with 3D laparoscopy. However most trainees are understandably drawn to the Da Vinci stand where a robotic console is the main attraction. Delegates got the chance to use the robot to test their basic skills.

My walk with the experts was really informative; each group consisted of approximately six trainees and two consultants. It was comfortable to ask questions and really maximised how much you can learn from the posters.

Day two started with a great update on laparoscopy, followed by the BAUS President, Mr Adrian Joyce, who gave his official address and awards as follows;

St. Peter’s Medal was awarded to Mr Malcolm Lucas, Swansea, UK.
St. Paul’s Medal was awarded to Professor Glenn Preminger, Durham, USA.
The BAUS Gold Medal was awarded to Mr Justin Vale, London, UK.

Social media is increasingly present in professional conferences allowing worldwide coverage and dissemination of all the conference content. Recent success was publicised from other Urology conferences, see other BJUI blogs.

BAUS has embraced this emerging technology and the “uro-twitterati” by establishing a twitter hashtag #BAUS13 and having updates throughout the conference. Furthermore a sold-out teaching course on Social Media run by Associate Professor Declan Murphy (@declangmurphy) and Professor Dasgupta (@prokarurol), was held at BAUS this year, which must surely be one of the first at any surgical conference? The session aimed to raise awareness of social media and advise delegates on the safe and best uses of social media in light of the recently drawn GMC guidance on the issue. Members were also helped by the unveiling of a set of BJUI guidelines on social media.

A range of experience was shown by the group, with about 50% using Twitter and other social media professionally at the present time.

Teaching new things in new ways

The BJUI supports BAUS regarding social media and demonstrated their rapid uptake of social media by posting the highest “influence” of any urology journal with a Klout score of 56.

During the conference BAUS president Mr Adrian Joyce, blogged his response to a newspaper article demonstrating that BAUS are developing an interest in social media and are using the expertise of their friends at BJUI to help them get their message out. It is an exciting time for all and I think we will see much more activity in social media in urology.

Other changes for the future were raised at the BURST session, where simulation in Urology training was discussed. Simulation will be used more in training and may not just include surgical skills but extend to non-technical skills including leadership, and working with distraction and disruptions.

The conference has a great educational element, produced by Miss Tamsin Greenwell, with numerous small skills and teaching sessions running on every day of the conference. This allows every delegate to tailor their experience to their interests and needs. In particular the skills session gave us the rare chance for realistic surgical simulation using fresh frozen cadavers, with significant sponsorship at a fraction of the cost. These courses ranged from PCNL access and TURP to basic cystoscopy, ureteric stenting and supra-pubic insertion.

The BAUS social programme is rightly famous, with great events planned every night. The main event from Day 1 was the regional football competition, which was again competitive and well attended with congratulations to the Newcastle Trainees for winning the Cup.

With so much to do and see I am sure that many had a completely different experience to me and I am already looking forward to next year.

Dr Nishant Bedi is a Core Surgical (Urology) Trainee in the West Midlands Deanery, UK.
@nishbedi

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The Best of British

June 13, 2013/by Prokar Dasgupta

We live in a world that is getting smaller mainly because of global friendship, the Internet and the ease of travel. The British contribution to this should be a matter of pride for every UK urologist. Many friends and colleagues say that the BJUI has gone global, a decision that was made during the editorship of Hugh Whitfield and promoted under John Fitzpatrick. It was the correct move and has allowed British urology to maintain its prominent position in the rapidly changing world of academic publishing.

During BAUS 2013 we wanted our readers to know that the B in BJUI remains vital to the journal. We continue to publish and promote the best papers from UK for the benefit our local and international audience.

So here is the “Best of British” virtual issue, a selection of the most cited papers from UK in the BJUI in 2012-13. There are articles from every part of the British Isles proving that geography is not a barrier to quality.

It came as a surprise to me that Functional urology is the most cited section of the BJUI. We have highlighted a controversial but real life follow-up of patients having Botulinum toxin A injections for overactive bladder (OAB), a multicentre trial of a mini-sling and the natural history of urinary symptoms amongst ketamine users.

This is complemented by a Translational Science paper on the inhibition of stretching-evoked ATP release from bladder mucosa by anticholinergic agents. High-quality basic research with rapid translation is becoming real, thanks to the growth of Biomedical Research Centres in UK and overseas. We want to publish the best science papers and make them relevant to surgeons through Science Made Simple, a section that explains why our readers should care about science in a “dummies” fashion. The term “autophagy” is set to become as important as apoptosis.

Urological oncology is the largest section of the BJUI. There is considerable interest in prostate biopsies through the transrectal and transperineal routes and attempts at better imaging through MRI and perhaps Histoscanning. The role of surgery in high-risk prostate cancer is of particular relevance to British urologists within multidisciplinary teams as a number of our patients have aggressive, palpable and locally advanced disease. It is becoming clear that robotics can achieve oncological outcomes as robust as open surgery even in these patients. The Robotics and laparoscopy section of the BJUI has some of our most cited papers. We have given it prominence by featuring beautiful illustrations of these common and evolving procedures in a Step by Step fashion on the front cover of our paper journal. Finally, a randomised controlled study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy, has an important message.

While a number of new modalities of resection such as blue light and narrow band imaging are emerging, good quality white light resection by experienced endoscopists must not be ignored. It is not just about resection, however; adjuvant intravesical gemciabine found its way into a systematic review in patients with non-muscle invasive disease.

The Upper urinary tract often suffers at the hands of the bladder and prostate but is equally important. We have highlighted systematic reviews of ureteroscopic and percutaneous management of upper tract urothelial carcinoma, its surgical management by other modalities and the changing trends in stone disease that will be of interest to our endourological colleagues.

We have introduced a new Surgical Education section and bring to your attention the first results from the BAUS SIMULATE project, which combines technical and non-technical skills. This will be of great importance to every British trainee and indeed we are the international standard bearers in this field, thanks to your active participation.

We thoroughly enjoyed selecting this issue for your reading pleasure. A number of these articles have already been free downloads on www.bjui.org as articles of the week, and are now free to everyone as part of this virtual issue. They are further promoted internationally through our social media network and we are hoping to see a number of you at the BJUI SoMe course during BAUS.

Enjoy the highest quality, most cited articles from Britain. And be very proud, you deserve it!

The Best of British

Prof. Prokar Dasgupta, Editor in Chief, BJUI, Guy’s Hospital, King’s College London. @prokarurol

Scott Millar, Managing Editor, BJUI. @BJUIjournal

The BJUI and BAUS join forces at AUA in San Diego

May 14, 2013/1 Comment/by Declan Murphy

For the first time, the BJUI and our friends at the British Association of Urological Surgeons (BAUS), joined forces at the Annual Meeting of the American Urological Association to stage a satellite session focusing on some interesting areas of urology. While both BAUS and BJUI have long had strong relations and have worked together on many occasions, this was the first time we had an opportunity to present a full afternoon of plenary content at the AUA.

This year’s AUA took place in beautiful San Diego, a very popular destination for delegates, even those travelling all the way from the UK. The convention centre is very conveniently located and is state-of-the-art. The adjoining Marriott hotel hosts many of the satellite events and it was here on Sunday 5^th May 2013 that the joint BAUS/BJUI session took place. We attracted over 200 delegates in the face of tremendous competition from parallel sessions and had a wonderful atmosphere all afternoon.

Prokar Dasgupta excited about this session at AUA Annual Meeting 2013

Part one was chaired by BAUS President Adrian Joyce and featured state-of-the-art lectures from Prof Tony Mundy, Dr Tamsin Greenwell, Dr Craig Rogers, Mr Ben Challacombe, Mr Simon Brewster , Dr Philippa Cheetham and Prof Mark Emberton.

The second session was opened by BJUI Chairman Dr David Quinlan who gave a great introduction before handing over to BJUI Editor-in-Chief Prokar Dasgupta who Chaired the session. This was a fascinating session which combined state-of-the-art addresses from well known BJUI editors/contributors Dr John Davis, Dr Peter Gilling and Dr David Ralph, along with an exciting overview of social media and digital publishing by Prokar Dasgupta, Casey Ng and myself. The future of publishing is certainly not in paper and attendees at this session were given a wonderful preview of how urology publishing might look in the future.

The joint session finished with the presentation of the BJUI Coffey–Krane Prize, which was accepted by Dr Christian Pavlovich on behalf of his team for their paper Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. The Prize was presented by the great Dr Coffey who gave a humorous overview after his warm introduction by Dr Quinlan.

Dr Christian Pavlovich receives the Coffey–Krane Prize 2013 from Dr Donald Coffey,
Prof Prokar Dasgupta and Mr David Quinlan

Attendees enjoyed socializing over drinks following the session and toasted the strong relationship between BAUS, the BJUI and the AUA.

We look forward to similar conjoined events in the future and are particularly looking forward to the BJUI supporting the forthcoming BAUS Annual Meeting in Manchester from 17–20^th June 2013.

Declan Murphy BJUI Associate Editor

Follow Declan on Twitter @declangmurphy

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