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Editorial: The importance of citrate in patients with calcium stones and loss of bone mineral density

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Stone disease and osteopaenia are both common conditions, and reduced bone mineral density (BMD) is an increasingly recognized complication in stone formers; indeed, in a previous paper in BJUI, Arrabal-Polo et al. reported that patients with recurrent stones have lower BMD compared with controls or patients with just a single episode of urolithiasis.

Although the exact pathogenesis of bone loss in stone disease is yet to be determined, the conceptually obvious relationship with hypercalciuria is well documented. In the present study, Arrabal-Polo et al. emphasise that hypocitraturia is also associated with reduced BMD. Furthermore, they found a higher calcium : citrate ratio in patients with a cumulative maximum stone diameter > 20 mm, or in those with frequent recurrences than in controls, and found that this correlated with higher levels of β-crosslaps, consistent with increased bone resorption in these patients.

We commented in our previous editorial that metabolic abnormalities should be sought in recurrent stone formers, and managed in a multi-disciplinary setting. In addition to dietary advice, options for treatment include bisphosphonates (which inhibit bone resorption, and are commonly used in osteoporosis), thiazide diuretics (which reduce calcium excretion and can increase BMD) and potassium citrate (which acts as an alkalinizing agent mitigating the bone restorative effect of acidosis). This approach is supported by recent data in medullary sponge kidneys, in which hypercalciuria and hypocitraturia were commonly detected in association with reduced BMD. Patients who were treated with potassium citrate were found to have increased urinary pH citrate levels, and an improvement in their BMD.

In the present article, Arrabal-Polo et al. suggest using a calcium : citrate ratio of 0.25 for predicting the risk of future recurrent stone formation, but this value could equally be used to predict the risk of patients having reduced BMD and the complications that may follow. Either way, their findings strengthen the argument for metabolic screening of recurrent stone formers, and for an assessment of these patients’ BMD. Patients can then be appropriately treated with a thiazide diuretic, potassium citrate, or a bisphosphonate, either singly or in combination, according to the abnormalities detected and their progress on treatment.

Daron Smith
Stone and Endourology Unit, University College Hospital, London, UK

Chris Laing
UCL Centre for Nephrology, Royal Free Hospital London, London, UK

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Tiger Testes

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Although I enjoyed reading Jim Duthie’s Blog Post ‘Surgery Isn’t Normal’, I would argue that no profession, particularly those constituting a high degree of specialization, are normal. Let me set the scene from a research scientist’s perspective…

It was late on a Tuesday night three years ago, and being a poor PhD student at the time (PhD scholarships pay below poverty level), I was completing my part-time work in the histology department to help make the rent. My research laboratory specialises in diseases of the prostate; however, the laboratory next to ours – for which I was currently performing histology work – specialises in germ cell development and male fertility. Most of their work is focused on the human species, however, one of their projects was looking into the fertility of rare or endangered species to help prevent their extinction. As such, they had an ethics agreement with the Melbourne Zoo which gave them access to the reproductive organs of any endangered species that passed away. So there I was on my microtome sectioning the testes of a recently deceased Bengal tiger.

For anyone who works in pathology, the temperature and hydration of tissue to be sectioned must stay within a tight range in order to obtain perfect 5-µM thick sections that can then be stained for analysis. Too hot and your tissue will crumple, too cold and the sections will curl over on themselves, whilst over-hydrated tissues will swell out of the paraffin wax, and under-hydrated tissues break when they meet the microtome’s blade. These tiger testes were getting a little too warm for my liking, so I placed them on ice and left the room to grab myself a beverage from the hospital cafe – cutting testes is thirsty work!

To my dismay when I arrived back at the hospital laboratory my access card would not let me in the room. It was late, no one was around in the histology department, and I was now getting worried about the time these testes had been sitting in water on ice, so I headed for the hospital security. As I stood there explaining to a ICORP Security guard that I urgently needed to get into the histology department on level 3 as my tiger testes were getting too cold and may over hydrate, I too had the realisation of how abnormal this must seem. And yet, the very things that may make my job seem abnormal to an outsider are the very things I love most about my role. Every day is different, and I get exposed to new and exciting research projects that really make a difference to the world and people in it.

This particular job has also come in handy in some unexpected situations. When I caught a man trying to steal the hubcaps off my tyres I was able to tell him, “I may look harmless, but I cut testes for a living,” and so my hubcaps remain…

Dr Sarah Wilkinson is a post-doctoral research fellow at Monash University, Melbourne. She is interested in how the prostate tumour microenvironment can be targeted as a therapeutic treatment for prostate cancer.

Twitter: @wilko3040

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A Tale of Four Prostates

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There was a time when doctors were reluctant to tell patients the truth about a diagnosis of cancer, and even more unwilling to discuss any illness from which they themselves suffered.  John Anderson broke the mould last year when he made a public announcement about his newly diagnosed liver metastases, which subsequently turned out to be the result of secondary spread of adenocarcinoma of the prostate.

John was President Elect of the British Association of Urological Surgeons (BAUS) at the time, so sadly had to resign his presidency (the best president we never had!) and subsequently his trusteeship of the Prostate Cancer UK charity. John’s energy and drive are legendary, he is a true surgeon’s surgeon. The stoicism and determination that he has displayed throughout a year in which he has received hormonal treatment, followed by chemotherapy, is awe-inspiring.

My admiration for John, in addition to my own recent diagnosis of localised prostate cancer, requiring robot-assisted radical prostatectomy (https://moreintelligentlife.co.uk/content/ideas/simon-garfield/prof-roger-kirby) led me to approach Sean Vesey and Damian Hanbury, whom I knew were similarly afflicted by a disease that carries a 1 in 9 lifetime risk. It occurred to me that there was a great deal to be gained from frank disclosure and discussion, as opposed to treating this problem as some dark, furtive secret. Women suffering from breast cancer are generally much more open about their problem and consequently receive much more support from friends, relatives and others who have been touched by the disease. This empowers them to make the difficult but smarter choices about their health by opting in to breast cancer treatment. Men need this kind of social encouragement and support so that we can be within reach to them as well.

The result was a publication entitled “a Tale of Four Prostates” in the upcoming issue of Trends in Urology and Men’s Health (www.trendsinurology.com) and a short accompanying video.

In this John, Damian and myself discuss the impact of our respective diagnoses and treatment. We sincerely hope that, by being frank, honest and transparent about our own situation, we can help other patients to help themselves by seeking advice and treatment earlier, and by sharing information about their diagnosis with others in order to mobilize support from their family and friends.

 

Sadly, John Anderson has since died. You can read an obituary by Roger Kirby here. 

 

 

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In Memoriam of Bill Hendry

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I have the fondest memories of Bill Hendry, who sadly died, aged 73, last autumn. I first met him, and his wife Chirsty, on a urology section of the Royal Society of Medicine (RSM) ski trip, when I immediately fell for his infectious enthusiasm and energy. I remember hearing him delivering a brilliant lecture on the outcomes of radical cystectomy, an operation of which he was consummate performer.

I joined Bill and Hugh Whitfield as a consultant at St Bartholomew’s Hospital in 1986, where I saw first hand his skill as a surgeon and his unerring caring compassion towards his patients. I used to do Friday afternoon clinics with him at Bart’s: he focussed on infertility, while I ran an erectile dysfunction clinic. Bill used to joke that we should have a signpost: Penises this way, testicles the other!

I was honorary secretary when Bill was President of the RSM urology section. With typical energy he decided to depart from the ski meeting formula and instead led the group to Zimbabwe, an excellent meeting that finished memorably with a dinner in the Victoria Falls Hotel. A fabulous evening was had, significantly enhanced by the generous provision of specially imported South African Meerlust (sea breeze) wine.

I also had the privilege of being honorary secretary when Bill was president of the British Association of Urological Surgeons (BAUS). We had so much fun together, planning and running the annual meetings, and we can claim the honour of founding the very successful BAUS Section of Oncology. I remember discussing the idea with Bill on a ski lift in Grindelwalt. He had the vision and drive to get it established.

Bill took rather early retirement and went to live on the Isle of Lewes, where took up breeding highland cattle and won a number of prizes. Unfortunately Chirsty died and only a few months later Bill suffered a heart attack and passed away. He will be remembered as a brilliant surgeon, teacher and communicator. I do hope some of those who trained under him will add their own special memories to this blog.

 

Roger Kirby
BJUI Associate Editor

 

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EAU Annual Meeting 2013 – Final thoughts

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The BJUI team was most impressed with this year’s EAU Annual Congress which has just concluded in Milan. The scientific content was excellent – topical plenary sessions from key opinion leaders; lively poster sessions; superb video sessions and very high-quality courses run by the European School of Urology. The EAU are to be congratulated on consistently raising the bar with the quality of this meeting which is reflected in the huge delegate numbers again this year.

The last two days had a number of highlights, some of which we summarise here:

  • The Plenary on lower urinary tract symptoms – management of side-effects included a wide variety of presentations including an specific talks on new potential drug treatments which certainly wouldn’t be considered main-stream at the moment. It will be interesting to monitor how trials with beta-3 agonists, botulinum toxin and PDE5 inhibitors go over the next few years for this potentially huge market. Professor Marberger finished the session discussing if TURP remains the gold standard for BPO. The answer may be that it is not, although it remains the ‘reference’ to which all other treatments must match. It is interesting to see how delegates reacted to this on Twitter such as Dr GomezSancha who tweeted to his 251 followers:

 

We are not sure if all would agree but we do enjoy seeing the debate bouncing around the Twittersphere!

  • Prevention of infections – chaired by T.E. Bjerklund Johansen, this plenary updated us on resistance to antibiotics which is increasingly a problem and has led the lay press to describe this as an Apocalypse and more recently as big a risk as terrorism. Dr Kahlmeter then discusses the implications for urology in this video interview with the EAU. This is a highly topical area and we are pleased to see key urology meetings showing leadership here to address these broad concerns.
  • Urological Surgery in Renal Transplant Patients – this session was very emlightening for urologists who work alongside bust renal transplantation services. The transplant population have many challenging urological issues and Dr Jon Olsburgh from Guy’s & St Thomas’ in London provided an excellent overview of some of these. He outlined very nice strategies for stones in patients who have received an allograft and also for those considering kidney donation. A summary can be found in the EUT Newsletter from Day 3.
  • There were many poster sessions throughout each day – too many to be honest for us to keep track of.  Fear not though – keep an eye on the BJUI blogs for the Best of the Best Posters coming soon. We would also direct you to Twitter where you will find some excellent commentary from the many active Tweeters who attended various poster sessions. Just search under the #eau13 hashtag. Watch out in particular for tweets from the Montreal/Detroit group who presented much work and were particularly active on Twitter (@qdtrinh, @peepeedoctor, @jdsammon, @maxinesun and others).
  • Souvenir Session and EAU Guidelines on Live Surgery: The last day featured an excellent souvenir session which overviewed some of the key messages for the meeting. European Urology Editor-in-Chief Elect , Jim Catto, reviewed Urothelial cancers and observed that PET scanning has most value for evaluating distant disease rather than pelvic lymphadenopathy when compared to CT scanning. The management of small renal masses, a dominant topic this year, also . The highly-anticipated EAU Guidelines on Live Surgery were presented very nicely by Section Chairman Keith Parsons and were very well received. There are sometimes competing goals here and these guidelines will ensure that the best interests of patients are maintained while maximising the educational value of these very popular sessions.
  • Breaking News: this final session had a number of headlines, one of which was data from Peter Wiklund’s group in Sweden which suggested that long-term cancer outcomes for localised prostate cancer patients are better for those who underwent surgery rather than radiotherapy. Also data from Bertrand Tombal showing a greater than 50% reduction in cardiovascular morbidity for patients on the GnRH antagonist degarelix when compared with those on GnRH analogues. Further detail of this are awaited.

Lastly, we would again like to congratulate EAU and all the active Tweeters who contributed so much to the social media side of this year’s meeting. The final data from Symplur show huge activity which greatly expanded the reach and engagement of this meeting:

We are also very pleased that the BJUI team dominated the metrics for key influencers of #eau13 which reflects well on the strong social media strategy which we have put in place since January 2013. We were delighted to visit the busy EAU Communications back-office on the last day of the meeting to congratulate Communication Manager Evgenia “Zhenya” Starkova and her talented team who did a fantastic job running the Congress and EAU websites, twitter, facebook, video interviews etc and who we enjoyed interacting with through the week. Zhenya’s team kept tweeters engaged by awarding a “Tweet of the Day”:

EAU Official Tweets of the Day for the conference:

Friday –  “Small renal masses, debate continues: surveillance vs biopsy vs partial vs radical neph. Individualised care is key.” @HamidAbboudi

Saturday – “#eau13 this is not just the European meeting now. It is the world meeting! What an event.”
@benchallacombe

Sunday – “It’s going to be a tough act for Stockholm to follow! Great congress so far! #eau13”@SJGore

Monday – “I suspect #eau13 will be remembered as 1st major urology meeting to do social media seriously. It’s been great fun!”@MattBultitude

So we look forward to EAU Annual Congress 2014 which takes place in Stockholm from 11-15th April 2014. We wish Scientific Chair Arnulf Stenzl and the team at EAU Central Office all the best with planning for next year’s meeting!

We will be back with more conference coverage from the Urological Society of Australia and New Zealand Annual Scientific Meeting that takes place in Melbourne next month (#usanz13).

 

Declan Murphy & Matt Bultitude
BJUI Associate Editors

 

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Editorial: What is the optimal length of time for SNM testing?

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The authors are to be commended for their unique investigation of an extended stage 1 SNM test period. To our knowledge, no other series has included a minimum 4-week duration and microbiologic testing. Optimal duration for the test phase has not been elucidated and initial responses are likely compounded by a short-term placebo effect that may dissipate after time. Knowledge of when maximal improvement occurs would define a population of true responders and reduce implant failure rates. This series shows the feasibility of an extended test phase in a small cohort, but does not identify the optimal length of time for testing.

One must question how many responders are in the 2- to -4 week interval and if such patients would do as well with earlier implantation. Current testing with permanent leads and externalized hardware is cumbersome and not always convenient for activities of daily living, especially showering. Furthermore, knowing the sampling interval used by the authors to assess response and the time at which the majority of patients reached the established implant criteria could clarify the time needed for maximal response. In this small cohort, however, the difference would fail to show significance.

As the authors note, a low stage 2 failure rate is important in an era with rising concern over health care expenditure, but it generates questions on what to do for responders
who have symptomatic improvement >50% but <70%. Do we risk not helping an individual who has 50% improvement in order to reduce stage 2 failures, and how do we justify making this quality-of-life decision? The low stage 2 failure rate in this study may have resulted from the strict criteria for stage 1 success, specifically a 70% or greater response, and not necessarily the prolonged test phase.

Notably, there were no infections in this series despite an extended stage 1 test phase. This is considerably lower than the 5–7% infection rate reported in the literature (Urology, Eur Urol). Perhaps the degree of hygiene and antibiotic regimen contributed to the lack of infectious complications, but concern remains that such results are not generalizable. Infectious events not captured in this series may become evident with a larger sample size and surely the rate will be greater than zero. Granted, the results of this study add to our knowledge of SNM, it is not conclusive that the outcomes can be applied to the population at large, and further evidence from randomized trials are needed to identify the balance between benefits and risks associated with an extended test phase.

Brian K. Marks and Sandip P. Vasavada
Center for Female Urology and Reconstructive Pelvic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

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Day 3 at EAU Annual Meeting

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Day 3, St Patrick’s Day, saw the Irish trying to lift their spirits having been beaten by Italy in the Six Nations rugby tournament the evening before. Cathy Pierce from European Urology donned a shamrock for the day but declined Declan’s suggestion to serve Guinness instead of champagne for the Platinum Journal’s cocktail hour.

Our day started with the BJUI Editorial Board Meeting hosted by new Editor-in-Chief, Prokar Dasgupta. There was much enthusiasm for the new-look of the Journal and for the return to a once-monthly print edition. The new web interface is receiving huge traffic and the close integration with our social media platforms has proved very popular to date. It is clear that the future for urology journals will require a much broader vision than the production of a print journal and we are excited by the suggestions made by our learned editorial board members for how we might achieve that.

The main plenary on day 3 addressed contentious issues involving the upper urinary tract. Prof Pilar Laguna opened the packed session by overviewing challenges in diagnosis of upper tract tumours and the role of new technologies in improving diagnostic strategies here. Tim O’Brien moderated a debate on surgical approaches for upper tract TCC, which featured some stunning video from Dr Traxer. Key messages from this session (summarized very nicely by EUT Congress News) included:

  • Dr Shariat: “Treatment is more and more based primarily on the risk of the tumour and efficacy of therapy rather than practical limitations; role of LND during segmental ureterectomy remains to be evaluated.”
  • Dr Brausi: “Lymphadenectomy (LND) improves disease staging and helps in selecting patients who can benefit from chemotherapy; several retrospective studies suggest the potential therapeutic role of LND during nephronureterectomy for transitional cell carcinoma of the upper urinary tract.”
  • Dr Traxer: “Regarding endoscopic treatment, flexible URS (ureterorenoscopy) for diagnosis is recommended, and new tools for better detection are needed such as narrow band imaging (NBI).

One other highlight from the plenary was provided by Dr Shahrokh Shariat who presented evidence to support the use of partial ureterectomy instead of nephroureterectomy for patients with upper tract TCC. In a large, retrospective, multi-institutional study, using matched-pair analysis, they reported that segmental ureterectomy provided similar oncological and renal functional outcomes when compared to nephro-ureterectomy.

Three back-to-back poster sessions on stone disease covered the topics from basic science to ESWL, ureteroscopy and PCNL. Olivier Traxer’s group presented their comprehensive series of classifying complications in flexible uretero-renoscopy using the modified clavien grading system. They reported on over 1000 patients and this data will provide a contemporary benchmark for us to advise our patients on the expected incidence of these complications. Dr András Hoznek reported a new online programme (also available from the Apple AppStore) for the metabolic work-up of stone disease.

This is an area that traditionally urologists have done poorly and it is hoped that innovations such as this will ensure a standardisation of investigations and it is hoped that future developments will allow patients to analyse their diet and fluid intake to make individual recommendations (personal communication O.Traxer). There was much debate about the use of simulators for PCNL and Mahesh Desai chairing the session commented that this is surely where the future lies in training young urologists. Finally, Lucarelli et al. reported on functional renal loss after iatrogenic injury causing obstruction to the upper urinary tract. They confirmed 1970s animal experiments that there was a clear benefit to dis-obstruction within 2 weeks compared with delayed treatment using both eCrCl and MAG-3 renograms.

Continuing a recurrent theme for this year’s EAU Annual Meeting, Dr Inderbir Gill and Dr Mike Jewitt debated the role of surveillance versus surgery for the management of small renal masses. Clearly there is a role for surveillance here, especially in older patients, but until there is more certainty about the precise nature of these masses based on better imaging and biopsy strategies, then partial nephrectomy will remain the standard here. This image of Dr Gill tweeted out by @hendrikborgmann shows him somewhat impressed about the idea of not doing surgery!

Watch out for more contention today as Dr Gill debates Dr Alex Mottrie over laparoscopic versus robotic-assisted partial nephrectomy. We have already seen much minimally-invasive partial nephrectomies at this year’s meeting thanks to the various video and live surgery sessions. Ben Challacombe was not happy with the blood loss during conventional laparoscopy on show yesterday and clearly thinks the robot is the answer!

Social media continues to grow significantly at #eau13 with significant growth in Twitter traffic:

(Statistics courtesy of www.symplur.com)

After resolution of some teething issues with the complimentary wifi that EAU provide at the meeting, delegates and those watching from further afield really got the conversation going throughout the day and there was a constant stream of commentary and humour streaming out using the #eau13 hashtag. Organisers of major urology meetings should take note of the fact that social media will be increasingly embraced and having good wifi access (complimentary please) throughout the venue will be considered essential by smart-device-wielding delegates.

More from the team tomorrow!

Matt Bultitude – BJUI Associate Editor (Web)
Declan Murphy – BJUI Associate Editor (Social Media)

 

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The Daily Blog from EAU 2013: Day 1 and 2

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Saluti di Milano! This week the BJUI team are bringing you live updates from the European Association of Urology Annual Meeting in one of Europe’s most beautiful destinations – Milan. Our team has been Tweeting, Facebooking and now blogging from Europe’s premier urology gathering. In fact, we are the leading influencers in social media at this year’s meeting as shown by the metrics updated at Symplur where we registered the official hashtag #eau13.

 

 

Social media has really taken off at this meeting with the EAU Media team having formalized a strategy to promote social media. By just following #eau13 on your smart device you will receive a constant stream of interesting news and gossip from our team, from the excellent EAU Twitter-feed, and from the increasing number of others who are getting active in social media. One of the features we really like is the live twitter feed running on all the LCD screens detailing sessions around the venue:

 

This is something we first used at the Australasian Prostate Cancer Conference in Melbourne in 2012 and we are presenting outcomes from our social media initiatives at that meeting at the forthcoming BAUS meeting in Manchester.

But back to Milan. You have got to admit that one of the attractions of the EAU Annual Meeting is that it usually takes place in Europe’s favourite cities. – Paris, Milan, Stockholm. In the past ten years the EAU meeting has grown from a relatively modest meeting with variable scientific content, to a truly world-class event with very high-quality plenary sessions, poster presentations, video sessions, courses and satellite events. As of close of business on day two today, there were over 10,000 urologists and health professionals registered (and @benchallacombe was awarded Tweet of the Day by the EAU for letting the world know!), with another couple of thousand industry representatives. This is a big meeting! Over 14,000 delegates are expected before the close of the meeting.

The meeting actually started on Friday with a special all-day International Consensus meeting looking at chemoprevention of prostate cancer and five satellite symposiums. Dr Schroder re-iterated his stand that “PSA screening significantly reduces mortality. Harms are identified and quantified; they do not exceed the benefits”. The panel of experts from around the world intend producing a consensus statement on early detection, prognostic markers to predict high-grade disease, and the most appropriate clinical preventions strategies. There were also the “Urology Beyond Europe” meetings which allow urological associations from 11 other regions to run sessions at EAU. This certainly reflects the fact that the EAU meeting is a truly global event, maybe moreso than the AUA meeting. This year there are delegates from over 100 countries . This year’s meeting kicked off in spectacular style two days ago with a lavish opening ceremony featuring an operatic performance from La Scala in the main auditorium:

As I arrived in Milan at 0700 on Friday, I spent most of the day in a groggy mess trying to shake off the jet lag having spent 24 hours on a plane. I did make it in to hear Dr Urs Studer issue a call to young urologists at the opening session to “widen your interests, be aware of urology’s many aspects and don’t be a keyhole specialist”.

Saturday morning kicked off in the spectacular style we have got used to with the festival of live surgery that is the European Section of Urological Technology (ESUT) Section meeting. The ESUT has consistently been the most-highly attended Section meeting at the EAU for a number of years and this year was convened in conjunction with the new EAU Robotic Urology Section (ERUS) and the Urolithiasis Section. The main eUro auditorium was packed for most of the day as many thousands of delegates watched the live feed from the operating theatres at San Raffaele Hospital.

 

Over the day, there were 20 cases of which ten were live and the remainder pre-recorded the previous day. The technical quality was outstanding with all broadcasts in high-definition and some robotic procedures in 3D. The ESUT along with EAU and ERUS will be announcing the new EAU Guidelines on Live Surgery on the closing day of the meeting which will address concerns about the governance and ethical considerations of live surgery. I have blogged about this previously and we all welcome the leadership that EAU/ESUT and ERUS have demonstrated in this area.

Competing with ESUT for numbers on Saturday were six other section meetings, 22 poster sessions, two video sessions, 12 courses and seven sponsored satellite sessions. Myself and other editorial board members and contributors to the BJUI have been tweeting highlights and photos from these various sessions. Here are a few of the headlines:

  •        PSA screening in men aged 55-69 reduces prostate cancer-specific mortality by 31%. Dr Monique Roobol presented the latest findings from the ERSPC study and also showed no benefit to PSA screening for men aged 70-74 in the world’s largest PSA screening study. In another poster, Dr Roobol also showed the addition of the Prostate Health Index (PHI) to the ERSPC Risk Calculator added a net benefit increasing the area under the curve from 0.56 to 0.73.
  •        MRI guided prostate biopsies: a lively session saw the role of multiparametric MRI being debated by a number of experts. Should we only biopsy patients who have a lesion demonstrable on MRI?? A step too far for now but mpMRI and fusion biopsies will be a hot topic for the next couple of years.
  •        Innovation & Infection: this most-aptly named session addressed the highly-topical area of urological infections which has attracted much media attention in recent times with increasing warnings of antibiotic resistance. This is reaching crisis proportions in some regions and commonly performed procedures such as prostate biopsy are of particular interest.
  •        BPH surgery complications are under-estimated: a large French study has shown that complication rates following TURP and open prostatectomy in real clinical practice compared to clinical trials. A review of over 260,000 patients undergoing BPH surgery revealed a re-operation rate of 4.7%, clot retention in 3.4% of TURPs and urethral stricture in 2.7% of patients. 420 men (0.18%) underwent surgery for urinary incontinence.
  •        Robotic partial nephrectomy – there is clearly increasing adoption of robotic partial nephrectomy with a number of posters and videos featuring already. A key message is that larger, more complex tumours can successfully be managed with this approach in experienced centres. The role of fluoresce-guided robotic surgery is evolving.
  •        From young to old: An interesting theme at this year’s meeting has been an overview of the urologist’s role of managing the ageing urinary tract. A plenary session yesterday was dedicated to this and a particular message was the rising role of surveillance for small renal masses in older patients. More harm can be done from intervention than surveillance in this group
  •        Stone prevention – a packed auditorium at the EULIS section meeting heard that stone prevention strategies instead of treatment modalities should be explored for recurrent stone formers with rapid screening of diet including internet-based approaches. Dr Knoll presented a staggering analysis of 200,000 stones from Germany(!) showing an increase in calcium oxalate composition and surprisingly stable levels of uric acid (considering the rising obesity levels). Newer imaging modalities such as dual-energy CT may help to identify stone composition which may help tailor treatment.

Of course, a lot of other activity goes on around the periphery of meetings like this. Yesterday I attended the Consulting Editors meeting of European Urology where outgoing Editor-in-Chief Francesco Montorsi welcomed newly appointed successor, Jim Catto from Sheffield in the UK. Jim takes over the reins in January 2014 and we look forward to the new ideas he will bring to the Platinum Journal. Today we have the BJUI Editorial Board meeting which is a great opportunity to meet with our friends and colleagues from round the world who are doing a fantastic job under new Editor-in-Chief Prokar Dasgupta.

 These meetings are also a great opportunity to catch up with colleagues from around the world. We are posting pictures on our Facebook site this week and you will see photos on Twitter also.

Pictured at the Duomo – Ben Challacombe (London), Stacy Loeb (New York), Declan Murphy (Melbourne)

Stay following #eau13 and join the conversation!

 

Declan Murphy

T: @declangmurphy

Associate Editor (Social Media) BJUI

Uro-Oncologist, Melbourne

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