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Highlights from BAUS 2016

July 5, 2016/3 Comments/by Nishant Bedi

In the week following Britain’s exit from Europe after the BREXIT referendum, BAUS 2016 got underway in Liverpool’s BT convention Centre. This was the 72^nd meeting of the British Association of Urological Surgeons and it was well attended with 1120 delegates (50% Consultant Member Urologists, 30% Trainees, 10% Non member Urologists/Other, 10% Nurses, HCP’S, Scientists).

Monday saw a cautionary session on medicolegal aspects in Andrology, focusing on lawsuits over the last year. Mr Mark Speakman presented on the management issue of testicular torsion. This sparked further discussion on emergency cover for paediatrics with particular uncertainty noted at 4 and 5 year olds and great variation in approach dependent on local trust policy. Mr Julian Shah noted the most litigious areas of andrology, with focus on cosmesis following circumcisions. Therefore serving a reminder on the importance of good consent to manage patients’ expectations.

In the Dragons’ Den, like the TV show, junior urologists pitched their ideas for collaborative research projects, to an expert panel. This year’s panel was made up of – Mark Emberton, Ian Pearce, and Graeme MacLennan. The session was chaired by Veeru Kasivisvanathan, Chair of the BURST Research Collaborative.

Eventual winner Ben Lamb, a trainee from London, presented “Just add water”. The pitch was for an RCT to investigate the efficacy of water irrigation following TURBT against MMC in reducing tumour recurrence. Ben proposed that water, with its experimental tumouricidal properties, might provide a low risk, low cost alternative as an adjuvant agent following TURBT. Judges liked the scientific basis for this study and the initial planning for an RCT. The panel discussed the merits of non-inferiority vs. superiority methodology, and whether the team might compare MMC to MMC with the addition of water, or water instead of MMC. They Dragons’ suggested that an initial focus group to investigate patients’ views on chemotherapy might help to focus the investigation and give credence to the final research question, important when making the next pitch- to a funding body, or ethics committee.

Other proposals were from Ryad Chebbout, working with Marcus Cumberbatch, an academic trainee from Sheffield. Proposing to address the current controversy over the optimal surgical technique for orchidopexy following testicular torsion. His idea involved conducting a systematic review, a national survey of current practice followed by a Delphi consensus meeting to produce evidence based statement of best practice. The final presentation was from Sophia Cashman, East of England Trainee for an RCT to assess the optimal timing for a TWOC after urinary retention. The panel liked the idea of finally nailing down an answer to this age-old question.

Waking up on Tuesday with England out of the European football cup as well as Europe the conference got underway with an update from the PROMIS trial (use of MRI to detect prostate cancer). Early data shows that multi-parametric MRI may be accurate enough to help avoid some prostate biopsies.

The SURG meeting provided useful information for trainees, with advice on progressing through training and Consultant interviews. A debate was held over run through training, which may well be returning in the future. The Silver cystoscope was awarded to Professor Rob Pickard voted for by the trainees in his deanery, for his devotion to their training.
Wednesday continued the debate on medical expulsion therapy (MET) for ureteric stones following the SUSPEND trial. Most UK Urologists seem to follow the results of the trial and have stopped prescribing alpha blockers to try and aid stone passage and symptoms. However the AUA are yet to adopt this stance and feel that a sub analysis shows some benefit for stones >5mm, although this is not significant and pragmatic outcomes. Assistant Professor John Hollingsworth (USA) argued for MET, with Professor Sam McClinton (UK) against. A live poll at the end of the session showed 62.9% of the audience persuaded to follow the SUSPEND trial evidence and stop prescribing MET.

In the debate of digital versus fibreoptic scopes for flexible ureteroscopy digital triumphed, but with a narrow margin.

In other updates and breaking news it appears that BCG is back! However during the shortage EMDA has shown itself to be a promising alternative in the treatment of high grade superficial bladder cancer.
The latest BAUS nephrectomy data shows that 90% are performed by consultant, with 16 on average per consultant per year. This raises some issues for registrar training, however with BAUS guidelines likely to suggest 20 as indicative numbers this is looking to be an achievable target for most consultants. Robotic advocates will be encouraged, as robotic partial nephrectomy numbers have overtaken open this year. The data shows 36% of kidney tumours in the under 40 years old are benign. Will we have to consider biopsying more often? However data suggests we should be offering more cytoreductive nephrectomies, with only roughly 1/10 in the UK performed compared to 3/10 in the USA.

The andrology section called for more recruitment to The MASTER trial (Male slings vs artificial urinary sphincters), whereas the OPEN trial has recruited(open urethroplasty vs optical urethotomy). In the treatment of Peyronie’s disease collagenase has been approved by NICE but not yet within the NHS.

Endoluminal endourology presentation showed big increases in operative numbers with ureteroscopy up by 50% and flexible ureteroscopy up by 100%. Stents on strings were advocated to avoid troubling stent symptoms experienced by most patients. New evidence may help provide a consensus on defining “stone free” post operation. Any residual stones post-operatively less than 2mm were shown to pass spontaneously and therefore perhaps may be classed as “stone free”.

Big changes seem likely in the treatment of benign prostatic hyperplasia, with a race to replace the old favorite TURP. Trials have of TURP (mono and bipolar) vs greenlight laser are already showing similar 2 year outcomes with the added benefit of shorter hospital stays and less blood loss. UROLIFT is an ever more popular alternative with data showing superiority to TURP in lifestyle measures, likely because it preserves sexual function, and we are told it can be performed as a 15 minute day case operation. The latest new therapy is apparently “Aquabeam Aquablation”, using high pressured water to remove the prostate. Non surgical treatments are also advancing with ever more accurate super selective embolisation of the prostatic blood supply.

This year all accepted abstracts were presented in moderated EPoster sessions. The format was extremely successful removing the need for paper at future conferences? A total of 538 abstracts were submitted and 168 EPosters displayed. The winner of best EPoster was P5-5 Altaf Mangera: Bladder Cancer in the Neuropathic Bladder.

The best Academic Paper winner was Mark Salji of the CRUK Beatson institute, titled “A Urinary Peptide Biomarker Panel to Identify Significant Prostate Cancer”. Using capillary electrophoresis coupled to mass spectrometry (CE-MS) they analysed 313 urine samples from significant prostate cancer patients (Gleason 8-10 or T3/4 disease) and low grade control disease. They identified 94 peptide urine biomarkers which may provide a useful adjunct in identifying significant prostate cancer from insignificant disease.

The Office of Education offered 20 courses. Popular off-site courses were ultrasound for the Urologist, at Broadgreen Hospital, a slightly painful 30 min drive from the conference centre. However well worth the trip, delivered by Radiology consultants this included the chance to scan patients volunteers under guidance, with separate stations for kidneys, bladder and testicles and learning the “knobology” of the machines.

Organised by Tamsin Greenwell with other consultant experts in female, andrology and retroperitoneal cancer, a human cadaveric anatomy course was held at Liverpool university. The anatomy teaching was delivered by both Urology consultants and anatomists allowing for an excellent combination of theory and functional anatomy.

BAUS social events are renowned and with multiple events planned most evenings were pretty lively. The official drinks reception was held at the beautiful Royal Liver Building. The venue was stunning with great views over the waterfront and the sun finally shining. Several awards were presented including the Gold cystoscope to Mr John McGrath for significant contribution to Urology within 10 years appointment as consultant. The Keith Yeates medal was awarded to Mr Raj Pal, the most outstanding candidate in the first sitting of the intercollegiate specilaity examination, with a score of over 80%.

During the conference other BAUS awards presented include the St Peter’s medal was awarded to Margeret Knowles, Head of section of molecular oncology, Leeds Institute of Cancer and Pathology, St James University hospital Leeds. The St Paul’s medal awarded to Professor Joseph A. Smith, Vanderbilt University, Nashville, USA. The Gold medal went to Mr. Tim Terry, Leicester General Hospital.

An excellent industry exhibition was on display, with 75 Exhibiting Companies present. My personal fun highlight was a flexible cystoscope with integrated stent remover, which sparked Top Gear style competiveness when the manufacturer set up a time-trial leaderboard. Obviously this best demonstrated the speed of stent removal with some interesting results…

Social media review shows good contribution daily.

Thanks BAUS a great conference, very well organised and delivered with a great educational and social content, looking forward to Glasgow 2017! #BAUS2017 #Glasgow #BAUSurology

Nishant Bedi

Specialist Training Registrar North West London

Twitter: @nishbedi

West Coast Urology: Highlights from the AUA 2016 in San Diego… Part 2

May 12, 2016/1 Comment/by Jonathan Makanjuola

By Ben Challacombe (@benchallacombe) and Jonathan Makanjuola (@jonmakurology)

The AUA meeting was starting to hot up with the anticipation of the Crossfire sessions, PSA screening and the MET debate that appeared to rumble on. We attended the MUSIC (Michigan Urological Surgery Improvement Collaborative) session. It is a fantastic physician led program including >200 urologists, which aims to improve the quality of care for men with urological diseases. It is a forum for urologists across Michigan, USA to come together to collect clinical data, share best practices and implement evidence based quality improvement activities. One of their projects is crowd reviewing of RALP by international experts for quality of the nerve spare in order to improve surgical outcomes.

The MET debate continues to cause controversy. In the UK there has been almost uniform abandonment of the use of tamsulosin for ureteric stones following The Lancet SUSPEND RCT.

The MET crossfire debate was eagerly awaited. The debate was led by James N’Dow (@NDowJames) arguing against and Philipp Dahm (@EBMUrology) in favour of MET. Many have criticised the SUSPEND paper for lack of CT confirmation of stone passage. Dr Matlaga (@BrianMatlaga) stated that comparing previous studies of MET to SUSPEND is like comparing apples to oranges due to different outcome measures. He recommended urologists continue MET until more data is published. More conflicting statements were made suggesting that MET is effective in all patients especially for large stones in the ureter. The AUA guidelines update was released and stated that MET can be offered for distal ureteric stones less than 10mm.

In a packed Endourology video session there were many high quality video presentations. One such video was a demonstration of the robotic management for a missed JJ ureteric stent. Khurshid Ghani (@peepeeDoctor) presented a video demonstrating the pop-corning and pop-dusting technique with a 100w laser machine.

One of the highlights of the Sunday was the panel discussion plenary session, Screening for Prostate Cancer: Past, Present and Future. In a packed auditorium Stacy Loeb (@LoebStacy), gave an excellent overview of PSA screening with present techniques including phi, 4K and targeted biopsies. Freddie Hamdy looked into the crystal ball and gave a talk on future directions of PSA testing and three important research questions that still needed to be answered. Dr. Catalona presented the data on PSA screening and the impact of the PLCO trial. He argued that due to inaccurate reporting, national organisations should restore PSA screening as he felt it saved lives.

There was a twitter competition for residents and fellows requiring participants to tweet an answer to a previously tweeted question including the hashtag #scopesmart and #aua16. The prize was Apple Watch. Some of the questions asked included; who performed the 1st fURS? And what is the depth of penetration of the Holmium laser?

UK trainees picked up the prizes on the first two days.

The British Association of Urological Surgeons (BAUS) / BJU International (BJUI) / Urological Society of Australia and New Zealand (USANZ) session was a real highlight of day three of the AUA meeting. There were high quality talks from opinion leaders in their sub specialities. Freddie Hamdy from Oxford University outlined early thoughts from the protecT study and the likely direction of travel for management of clinically localised prostate cancer. Prof Emberton (@EmbertonMark) summarised the current evidence for the role of MRI in prostate cancer diagnosis including his thoughts on the on going PROMIS trial. Hashim Ahmed was asked if HIFU was ready for the primetime and bought us up to speed with the latest evidence.

The eagerly awaited RCT comparing open prostatectomy vs RALP by the Brisbane group was summarised with regards to study design and inclusion criteria. It is due for publication on the 18th May 2016 so there was a restriction of presenting results. Dr Coughlin left the audience wanting more despite Prof. Dasgupta’s best effort to get a sneak preview of the results! We learnt from BAUS president Mark Speakman (@Parabolics) about the UK effort to improve the quality of national outcomes database for a number of index urological procedures.

Oliver Wiseman (@OJWiseman) gave us a flavour of outcomes from the BAUS national PCNL database and how they are trying drive up standards to improve patient care. A paediatric surgery update was given by Dr Gundeti. The outcomes of another trial comparing open vs laparoscopic vs RALP was presented. There was no difference in outcomes between the treatment modalities but Prof. Fydenburg summarised by saying that the surgeon was more important determinant of outcome than the tool. Stacy Loeb closed the meeting with an excellent overview of the use of twitter in Urology, followed by a drinks reception.

It was not all about stones and robots. The results of the Refractory Overactive Bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment (ROSETTA) trial results were presented. Botox came out on top against neuromodulation in urgency urinary incontinence episodes over 6 months, as well as other lower urinary tract symptoms.

The late breaking abstract session presented by Stacy Loeb highlighted a paper suggesting a 56% reduction in high-grade prostate cancer for men on long term testosterone. This was a controversial abstract and generated a lot of discussion on social media.

It has been an excellent meeting in San Diego and we caught up with old and met new friends. It was nice to meet urologists from across the globe with differing priorities and pressures. There was a good British, Irish and Australian contingent flying the flag for their respective countries. It was another record-breaking year for the #AUA16 on twitter. It surpassed the stats for #AUA15 with over 30M impressions, 16,659 tweets 2,377 participants. See you all in Boston for AUA 2017.

West Coast Urology : Highlights from the AUA 2016 in San Diego… Part 1

May 10, 2016/3 Comments/by Ben Challacombe

By Ben Challacombe (@benchallacombe) and Jonathan Makanjuola (@jonmakurology)

The 2016 AUA returned to the beautiful city of San Diego set on the shores of the Pacific in an excellent conference centre located in the centre of the town adjacent to the Gaslamp district. For a change the wifi was excellent and allowed enhanced levels of social media interaction and urological discussion. Opening these interactions were 2 key sessions which provoked much debate. Firstly the announcement that after over 10 years of trying the FDA has approved HIFU treatment although it seemed to get there through a slightly “de novo” pathway. Apparently the FDA approved it as an ablation tools but not for prostate cancer.

Although not directly approved for use in prostate cancer, that is exactly what it is going to be used for. A packed house saw a debate with evidence from both sides. Dr Nathan Lawrentschuk promoted the 4 Ds of HIFU. His key point was that 56/101 had a post treatment biopsy of which 51 where biopsy positive!

The second big session focussed on the AUA/SAR consensus statement document on prostate cancer diagnostics. This recommended a “High Quality” MRI should be strongly considered if patient has a rising PSA with a previous negative biopsy, has persistent clinical suspicion for prostate cancer or is undergoing a repeat biopsy. There was no mention of MRI for all at the pre-biopsy stage which many had hoped for and only 2 lines on trans-perineal biopsy as an option. This is of course related to health resources and the outpatient office-based nature of most USA urologists.

A welcome innovation was the Crossfire Sessions which pitted 2 well known advocates of one treatment against 2 with the opposite views. It was hardly debating of the Oxbridge variety but none the less did provoke some useful discussions. Topics included radical prostatectomy vs radiotherapy, endoscopic vs nephro-ureterectomy management of upper tract TCC, and enucleation at partial nephrectomy vs formal resection. Standing room only at the back of the halls but no real audience interaction or voting which was a shame.

The session which really woke everyone up was Rene Sotalo’s wonderful complication horror show. Bleeding, bleeding and more bleeding in a variety of ways. How would you handle this he asked? Pray I thought! But this and similar sessions clearly show the benefits of recording all cases and reviewing these DVDs if something goes wrong. The cause of some complications were only identified by review of the intra-operative tapes. Some clinical titbits learn’t included using only a horizontal incision for the camera port at RARP to reduce hernias and turning off pneumocompression stockings if there is a major venous injury to prevent excessive venous bleeding.

From a SoME perspective there was both good and bad. One poster showed that 40% of graduating US residents had publicly accessible unprofessional content on social media. Food for thought at the consultant interview no doubt, but on the other side SoMe ranks third in the acquisition of urological knowledge (and climbing…). One hack produced this tweeting guideline for all to reflect on.

Prof Prokar Dasgupta had the honour of presenting the widely anticipated session on emerging robotic technology . At last there appears to be some real competition to Intuitive’s dominance on the way. There are at least 3 credible robotic systems on the way. He finished with an intriguing slide on Dr Google being the most powerful doctor in the world!

Despite Europe and Asia moving towards the use of PMSA PET , the USA is not moving in this direction due to reimbursement issues if the PMSA molecule.

There was a lot of interest in a packed auditorium to see live surgery for a single use disposable fURS “Lithovue” with some reporting superior vision , optics and deflection.

There were some sceptics amongst the stone community with the environmental impact and cost effectiveness a concern.

With the popular Gaslamp district a stones throw away many delegates went after the conference for a meal and drinks. The local baseball team San Diego Padres was a popular destination with may watching baseball for the 1st time whist others had gone for a run along the harbour and even caught a sighting of some seals!

Bringing Out the Best: 69th USANZ ASM Highlights

April 26, 2016/1 Comment/by Amanda Chung

The 69^th Annual Scientific Meeting (ASM) of the Urological Society of Australia and New Zealand (USANZ) took place at a venue, well-known for its sun and surf – Gold Coast, Queensland. With some of Australia’s best beaches and coast line, the theme of the meeting was fitting: “Bringing out the Best”. Prem Rashid (@premrashid) and Peter Chin (@docpete888) convened a meeting boasting an impressive international and local faculty. Attendees were provided with a healthy balance of scientific update and social interaction to truly ‘bring out the best’ in each of us.

The meeting got off to a flying start with Dr. Mukesh Haikerwal AO (@DrMukeshH) delivering the Harry Harris Oration. His words were a timely reminder that the healthcare team has only one purpose: to care for the patient in need. The inspiring narrative of his time as a patient following a violent assault was told with humour and humility. The vastly underestimated issue of mental health was also brought to the fore. Despite a few technical malfunctions (Apple and Android!), the tone of the meeting was well and truly set. Attendees were then led out of the auditorium by a vibrant, rhythmic ensemble – a USANZ ASM first! Delegates at the welcome reception were joined by the SandMan, who created an artistic sand sculpture of the conference surfboard logo whilst delegates greeted one another over drinks and canapés.

A drumming ensemble lead delegates to the Welcome Reception

The plenary sessions were varied and engaging. Mornings were filled with world-class presentations by local and international faculty. Michael Cookson (@uromc) discussed management of advanced prostate cancer, Margit Fisch discussed urinary diversion options, and Armando Lorenzo discussed issues in transitional care, an area very dear to his heart. James N’Dow (@NDowJames) was especially engaging. He spoke on the importance of the EAU Guidelines and the recent ratification of the same by USANZ. The cross-continental collaborative spirit was further demonstrated by an announcement from Christopher Chapple that USANZ had been accepted as a member of the EAU. On a softer note, James N’Dow captured listeners’ hearts with tales of his philanthropic work in Sub-Saharan Africa and Scotland. His starkly honest account challenged all present to consider engaging in charitable works for those in need both local and abroad.

James N’Dow was particularly engaging, telling of his philanthropic work

Australia’s own Jeremy Grummet (@JGrummet) presented latest data on transperineal biopsy for the detection of prostate cancer. It was hard to argue with such impressive statistics: zero incidence of sepsis after more than 1000 biopsies and counting. He also reported early experiences with the Biobot Mona Lisa – a robotic technology for obtaining transperineal biopsies. Jeremy is to be congratulated for being recently appointed as an associate to the EAU Guidelines Committee.

Prokar Dasgupta @prokarurol presented the BJUI Global Prize to @maheshatw and Sean Huang.

The @BJUIjournal global prize winners, @maheshatw and Sean Huang! #usanz16 pic.twitter.com/61K272Eaki

— USANZ (@USANZUrology) April 18, 2016

Live debates provided robust discussion regarding hot topics. Kathleen Kobashi (@KKseattle) (described by the conference convenor as “the definition of intellectual elegance”!) and Kurt McCammon (@mccammonka) provided very topical debate regarding the merits and outcomes of native tissue versus synthetic slings. Focal therapy for prostate cancer was debated between our local expert Phil Stricker and international guest Jonathan Epstein, both of whom had very compelling arguments.

All this was conducted by the plenary session chairs, who looked particularly dapper behind the surf board faculty table! Only in Australia.

@DrRLC: “Only in Australia would a urological discussion around a surfboard be considered quite normal…”

Concurrent sessions were well attended throughout the meeting. Highlights include Thomas Knoll’s (@rockknoll) update on stone disease including his approach to difficult stones. He managed to enlighten and entertain even with topics such as “Metabolic Evaluation of Stones”! Mini-PCNL was in the spotlight with David Webb deserving of special mention. Run Wang discussed a practical approach to management of Peyronie’s disease, and Christian Gratzke (@cgratzke) discussed management of male LUTS and presented outcomes of prostatic urethral lift.

The program included non-scientific sessions titled “Getting My Message Across” (Henry Woo [@DrHWoo] & Declan Murphy [@declangmurphy]) and a fantastic education session (Stuart Philip & Melvyn Kuan [@MelvynKuan]). Trainees and consultants were updated on controlling their online presence in the internet age, publishing tips and pitfalls to avoid, and professionalism. Claus Roehrborn (@clausroehrborn) was especially illuminating on how to read a journal article. Equally, David Hillis (@dhillis1957) and Stephen Tobin (@deansurg) shared thoughts on professionalism that all surgeons would do well to heed. Speakers at the global health session inspired many to consider making an impact abroad.

The customary trainee breakfast grilling session was chaired by Nathan Lawrentschuk (@lawrentschuk) and his partner in crime, Louis Kovoussi (@DrKavoussi). Trainees were interrogated on all topics and benefited immensely from Louis’ expertise. Kurt McCammon (@mccammonka) taught the trainees on posterior urethral reconstruction, but also inspired their minds with career and life advice – a charge to be happy, do what you love, and prioritise family. His parting words “Don’t leave any potential on the table”, certainly urged trainees to, Bring out the Best from within.

Socially, the meeting was an absolute delight. Faculty dinners, industry dinners, dinners between friends and colleagues, were dotted around various restaurants all over the Gold Coast. The social highlight of the Meeting was the annual Gala Dinner, held at Australia’s Movie World, hosted by Batman and Marilyn Monroe! Alfresco style, the night was fresh and lively, with food, chatter, singing and dancing. The convenors @premrashid and @docpete888 were congratulated for a successful meeting. Prize winners were announced and congratulated: Ahmed Saeed Goolam (@asgoolam) for the BAUS Trophy, Matthew Winter (@matthewwinter01) for the Keith Kirkland prize, David Wetherell (@DrDRW) for the Villis Marshall prize, and Ailsa Wilson (@Willyedwards) for the inaugural Low-Arnold Prize in Female and Functional Urology.

Guests siphoning into Australia’s Movie World for the Gala Dinner

The Gala Dinner – the social highlight of the USANZ ASM

The Meeting flew by at phenomenal pace and soon it was time to pack our bags and say goodbye (or go for another surf!). Time sure flies when you’re having fun, and learning constantly! The 69^th USANZ ASM surely brought out the best.

We’d like to extend our gratitude to the international and local experts who attended the meeting and generously shared of their expertise and collegiality. International guests include: Christopher Chapple, Michael Cookson, Jonathan Epstein, Prokar Dasgupta @prokarurol, Shin Egawa, Margit Fisch, Pat Fulgham (@patfulgham), Mantu Gupta, Christian Gratzke (@cgratzke), Louis Kavoussi, Thomas Knoll, Kathleen Kobashi (@kkseattle), Daniel Lin (@DanLinMD), Armando Lorenzo, Kurt McCammon, James N’Dow, Claus Roehrborn, Mark Speakman (@Parabolics), Anil Varshney and Run Wang. On behalf of ANZ Urologists and Trainees (@USANZurology), we thank you for your time, expertise, and friendship. We hope you are either enjoying some much deserved recreational time Down Under, or else have arrived safely home.

We would also like to thank the Meeting’s sponsors, in particular, platinum sponsor Abbvie for supporting the Meeting.

We are also grateful to everyone who participated in #usanz16 on social media, making #usanz16 the most active USANZ ASM on Twitter ever! With over 5 million impressions, the conference fun and science was more far-reaching than we could ever know. Thank you for helping to Bring out the Best.

A special mention for Ruth Collins (@DrRLC) for her witty tweets and Photoshop talent throughout the meeting.

@DrRLC: “Henry Woo & David Winkle ponder the risks of hanging out on a surf board all morning #usanz16”

We look forward to the 70^th USANZ ASM which will be held in Canberra, the nation’s capital (24-27^th February 2017). Although the 69^th USANZ ASM will be a hard act to follow, no doubt, convenors Nathan Lawrentschuk @lawrentschuk and Shomik Sengupta @shomik_s, will have some great tricks up their sleeves and we look forward to the program they have compiled. Till next time!

Somebody had to do it.#usanz16 pic.twitter.com/xZ7bDTrb3K

— Henry Woo (@DrHWoo) April 18, 2016

Amanda Chung is a Urological Surgeon and PhD candidate in Sydney, NSW and Isaac Thangasamy @USANZUrology trainee in Queensland, Australia

EAU 2016 Congress Day 3

March 18, 2016/1 Comment/by Kari Tikkinen

Das bringt mich weiter! While the sun was shining in Munich, the 3^rd day of the 31^st EAU Annual Congress continued with very well attended plenary and poster sessions. And that is no wonder because the EAU Scientific Committee had created such an attractive program, including amazing plenary sessions during the morning and a plethora of informative poster sessions in the afternoon.

Professor Hendrik Borgmann (@HendrikBorgmann) has already covered highlights of the opening days 1 and 2 of this year’s Congress in his BJUI blog. We will give you some highlights of Day 3 and highly recommend you to take a look on EAU congress website, Day 3, which has archived a huge amount of material to allow you to catch up on sessions you may have missed. Indeed, lots of webcasts are available!

We focused on non-oncology plenary morning sessions and oncology poster sessions afternoon. Here are some of our highlights:

SURGERY IN THE ELDERLY – As our urological patients become older and older, surgery for octogenarians, or even nonagenarians, is increasingly common. The morning session covered various aspects on diagnosis and treatment of benign prostatic hyperplasia and other urological conditions in the ageing patient.

Professor Cosimo De Nunzio began the morning with “Highlights” on lower urinary tract symptoms and prostatic disease presented during this year’s EAU congress. Also this year, as many as every third abstract was on either prostate cancer or prostatic hyperplasia.

Indeed, the plenary session on Day 3 also covered prostatic disease.

Professor Alexander Bachmann talked about surgery for BPO in the elderly. He pointed out that in elderly (high-risk) patients we do not need a complete anatomical tissue removal, we do not need a (very) long-term follow-up and that we do not need tissue for prostate cancer diagnosis. Instead, we need a safe and efficient operation with individual adaptation of the technique and preferably feasibility in an ambulatory setting or local anaesthesia.

Professor Bachmann further emphasized that it would be preferable if surgery for the elderly would be performed by experienced surgeons, and that age per se is not a reason to not operate. There are several new minimally invasive operations available, and especially for elderly less is often more.

HOW AND WHEN TO STOP ANTICOAGULATION – Managing perioperative thromboprophylaxis for patients who already receive anticoagulants remains a challenge. Associate professor Daniel Eberli and Professor Per Morten Sandset covered many of these aspects in their helpful presentations.

Dr. Eberli told us that bridging therapy (options for stopping or not stopping anticoagulation in the above figure) is eminence-based, as no papers exist showing benefits. He also presented data from the recent NEJM trial (BRIDGE study; see Table below), which showed that stopping anticoagulation without bridging was non-inferior to perioperative bridging for the prevention of arterial thromboembolism and decreased the risk of major bleeding.

Dr. Eberli gave us all a take home message to discuss and question our local bridging guidelines as new evidence is very likely not supporting them (concluding slide below).

Professor Sandset recommended that during the perioperative period only use aspirin in high-risk patients, that is, those with recent thrombotic event or extensive coronary heart disease. He also informed us that stopping antiplatelet therapy 5 days before surgery (figure below) is often the way to go, and agreed with Dr. Eberli regarding bridging therapy statements.

Professor Sandset also gave helpful information regarding use of direct oral anticoagulants (DOACs) in urological surgery:

There were numerous poster sessions available on Day 3, as usual, many of them on prostate cancer. We have selected some of the highlight abstracts presented.

PROSTATE CANCER – On Day 3, prostate cancer presentations dominated once again in a number of poster, abstract and thematic sessions but also kidney, bladder, testicular and penile cancer sessions, which provided new interesting data.

Molecular markers, genomic profiling and individualized risk and treatment assessments were presented and discussed in poster session 58, and summarized by Stacy Loeb (@LoebStacy). Further advances in prostate cancer biomarkers in prostate cancer were presented in poster session 84. These new tools are moving from bench to bedside and urologists can hopefully incorporate these new tools to cancer care sooner rather than later.

In sessions on prostate cancer diagnostics, more advanced risk profiling tools were highlighted. For instance, STHLM3 test combines history of the patient, clinical parameters, biochemical markers and genetic markers. It was presented earlier in the congress and on Day 3 further health, economic and clinical evaluations were presented in Thematic session 12. It is one example of the tests showing promising results to potentially decrease the number of prostate biopsies needed. Other similar risk profiling tools were also presented during the congress. In addition to PSA only, evaluation of the smart use of already available clinical and biochemical parameters and the combination of genetic markers may bring individualized risk assessment of prostate cancer to the next level.

In poster session 62 on Day 3, diagnostic proceedings in prostate cancer with co-morbidity evaluation, biopsy strategies and MRI imaging were presented. A combination of molecular markers and imaging may be the way to proceed in future. These aspects were covered nicely in Thematic session 12.

MRIs have been heavily integrated in prostate cancer diagnostics during recent years. Image guidance in prostate biopsies seem to be making a breakthrough in prostate cancer diagnostics. Targeted biopsies with cognitive or MRI-TRUS fusion imaging were shown to be the way to enhance the results and reliability of biopsies and cut down the number of biopsies. However, as biopsies are still needed in prostate cancer diagnostics, use of the pre-biopsy MRI protocols were suggested to be done only in clinical trial setting. Many aspects of MRI diagnostics of prostate cancer were elegantly summarized in Thematic session 11.

New sophisticated imaging technologies in addition to MRI were present in several sessions during the meeting. Diagnostic enhancement has been seen also in metastatic prostate cancer. PSMA-PET seems to be replacing choline-PET-TT in evaluation of relapsing and metastatic prostate cancer (e.g. Thematic session 10). More reliable diagnostics and imaging of prostate cancer are also enhancing the treatment decision and treatment choice of patients with local prostate cancer. Finding the right patients for the active surveillance protocols is also being helped with advanced diagnostics. Indeed, finding only patients who need treatment for prostate cancer should be the ultimate goal for enhanced diagnostics as discussed in poster sessions 66 and 75 on Day 3. There are also high expectations on focal therapy (e.g. poster session 66), which at the moment is still experimental but will likely be a real option for patients with low volume prostate cancer verified by imaging.

The role of quality of life evaluations and patient reported outcomes measured were heavily discussed during the congress in all treatment modalities of both local and advanced prostate cancer. Survivorship issues are an increasingly important issue when more effective treatments both in local and advanced prostate cancer are available.

In metastatic disease, the use of early chemotherapy in combination with hormonal treatment has been implemented very rapidly to clinical use after the results of the CHAARTED and STAMPEED studies. Further evaluation of early chemo in metastatic disease is still needed and the patient selection needs still clarification. Hormonal therapy still has a very marked role in metastatic prostate cancer and new advances can also be found in new strategies of using castration therapy as presented in poster session 67. Urologists should actively follow the changing landscape of the medical treatment of metastatic prostate cancer and be active in treatment planning and treatment of these patients. At the same time with poster session 62 novel drugs and new forms of isotope radiation therapy in castration resistant prostate cancer were discussed in poster session 61. These open new possibilities for potential treatments.

The clinical and scientific content of the program of the Day 3 was of a very high standard, and reflective of the breadth of contemporary research in many areas within urology. Besides this session, it was our pleasure to meet old and new urological friends worldwide. The annual EAU meeting remains a highly effective method of knowledge translation and provides the opportunity for collaboration between surgeon scientists and other researchers in the field. As always in big congresses, there are so many interesting sessions going on at the same time, that it is hard to pick up and follow everything you would like to. We hope that this report provides some memories and take home messages of the Day 3 to the readers of the BJUI and BJUI blogs.

We look forward to future BJUI and EAU happenings!

Kari Tikkinen

Urology resident, adjunct professor of clinical epidemiology

Helsinki University Hospital, Helsinki, Finland

@KariTikkinen

Mika Matikainen

Chief of urology, adjunct professor of urology

Helsinki University Hospital, Helsinki, Finland

EAU 2016 Congress Days 1 & 2

March 15, 2016/1 Comment/by Hendrik Borgmann

Willkommen in München! I’m happy to give you some flavours of this year’s return of the EAU meeting to my home country after nine years of absence. Let’s start of with the first little episode that many of us might have encountered: Arriving at the congress centre, it took me only 1 minute to recognize that the EAU is always racing ahead: They placed the famous red London telephone box right in the centre of the entry hall. What a start! It created the scenery of joyful anticipation of EAU 2017 in England. Congress attendees were invited to take funny pictures. Great idea to do that on the first day of the congress rather than after many days of work and party. Not surprisingly the BJUI Board jumped in and seized this opportunity.

Ben Challacombe and Matthew Bultitude
posing for EAU 17 in London.

But let’s get back to the present and to Munich’s highlights on Friday. The congress kicked off with the joint meetings of the EAU and various urological societies from around the globe. The EAU has started to reach out to urologists from all countries over the couple of years – one factor on their way to being currently recognized as the world’s leading association in our specialty. The joint sessions covered a colourful range of topics from urological oncology over men’s health to functional and reconstructive urology. Highlight of the day though was of course the opening ceremony on Friday night. I gave my best shot for BJUI’s best #selfie award when asking three beautiful violin artists to smile for the camera. I wasn’t successful, but it was fun anyhow.

🙂 You’ll find out the best #selfie winner later.

@HendrikBorgmann at Opening Ceremony with Violin Artists

Still, the selfie experience made the girls feel so confident that they gave the audience a virtuoso, charmful atmospheric violin performance. EAU Secretary General Prof. Chapple gave out 13 awards for great achievements by pioneers in our field. Prof. Artibani received the Willy Gregoir Medal, Prof. Teillac the Frans Debruyne Life Time Achievement Award and Prof. Briganti the EAU Crystal Matula Award. Yet, the greatest honour was given to an absolute luminary in urology: When Michael Marberger received the EAU Honorary Member Award, standing ovations from the audience and an open-hearted applause created a goose bump atmosphere. There’s nothing more to say.

Michael Marberger receiving the EAU Honorary Member Award

Waking up on Saturday after Friday nights activities – paying for it, as usual – drove me into the first plenary session: Evidence-based medicine vs. common practice / challenging the evidence. EAU Guidelines office chair James N’Dow and European School of Urology chair Joan Palou led the discussion, which used clinical cases to stimulate the debate between two opposing camps: pro vs. con for medical-expulsive therapy and personal experience vs. EAU guidelines for male incontinence after radical prostatectomy. The first plenary was rounded up by the AUA lecture by Abraham Morgentaler on a 40 years perspective on testosterone therapy.

Lively discussions on the current state of evidence for medical expulsive therapy during the first plenary session

Munich’s conference centre made me cover some distance and burn some calories when rushing to the poster sessions. Funnily or annoyingly, depending on the point of view, a lot of poster presenters were fighting with rigid poster walls and poor needles. On top of that, scientific exchange was limited during the 20 minutes of poster viewing preceding the talks – shall we dedicate more time to talks instead?

Poster presenters struggling to pin their research on stiff walls.

The EAU congress wasn’t all about the latest research though. Of course, education played a major role, which was reflected by over 70 hands-on training courses. You want to improve your surgical skills on adrenalectomy? No problem. Try out Green Light Laser Vaporisation and get advice from experts? Go ahead. Looking for advanced training on urethral stricture surgery? Sure! There were hands-on-training sessions for everybody.

Practice, practice, practice. Trainers and trainees enjoying surgical simulation during hands-on-training course.

The congress wouldn’t have been the same without it’s indispensable elixir of life: LIVE SURGERY. The Urotechnology, Robotic Urology and Urolithiasis Sections shined with their latest advancements: 3D-HD laparoscopy, fluorescence partial nephrectomy, SPIES-assisted and NBI-assisted ureterorenoscopy for upper tract urothelial cancer – the spectacle went on and on. Interestingly, a working group from Italy took on the hot topic of ethics in live surgery for an important study: In their work “Live surgery: Harmful or helpful? Experience of the ‘Challenge in Laparoscopy and Robotics’ meeting” the authors retrospectively reviewed 197 live surgery cases. The authors found an acceptable overall complication rate of 11.6% according to Clavien Dindo classification. Over the course of time, the interest in live surgery seemed to remain alive, as shown by the high number of 539 participants per event. I think the study is very original and we can anticipate an interesting paper on this very soon.

Sunday morning was all about the Plenary Session on prostate cancer in the eURO Auditorium. Results of the TOOKAD® Phase III trial were highly anticipated. High noon was at 8AM when Marc Emberton presented the results of their study “TOOKAD Soluble ® versus active surveillance in men with low risk prostate cancer – a randomized phase 3 clinical trial”. 413 patients were randomized 1:1 to vascular-targeted photodynamic (VTP) therapy vs. active surveillance. Progression free survival rates were higher for VTP (28% of patients progressed) when compared to active surveillance (58% progressed; hazard ratio: 0.34; 95% confidence interval: 0.24-0.46; p<0.001). Also, fewer VTP treated men underwent radical therapy within 24-months: 6% vs. 29%, RR=0.20 [0.11-0.36].

Results from the TOOKAD study

Discussant Declan Murphy congratulated the group for the well-designed study and asked 3 questions:

1.) Does this type of very low-risk prostate cancer need intervention?

2.) What is going on in the control arm?

3.) What is the impact of TOOKAD on future intervention?

The population from the PRIAS study was comparable to the presented study population. PRIAS showed that active surveillance can be pursued safely in very low-risk prostate cancer patients. Moreover, the control arm of the TOOKAD study had much worse outcomes for histological progression, negative biopsy and need for radical intervention when compared to the PRIAS population. Finally, salvage radical prostatectomy post-TOOKAD had notable morbidity and disappointing oncological outcomes in a small study of 19 patients, which differs from outcomes observed for radical prostatectomy after active surveillance.

Take home messages from discussant Declan Murphy

After this strong opening, the prostate cancer fireworks continued with debates on the role for pre-biopsy MRI, timing of radiotherapy after radical prostatectomy and indications for chemotherapy in hormone-naïve prostate cancer.

On Sunday afternoon magic happened: the #EAU16 Twitter feed took the 10,000-tweet-hurdle for the first time in #EAU Twitter history: Congratulations and thanks to all contributors. More numbers needed? Up to 15 million impressions, 1,400 users and 115 tweets/hour show that the Twitter fan community is constantly growing. No one of us knows when the boom will slow down.

Urologic Twitterati contributing to the #EAU16 Twitter feed.

Which content went viral though? See for yourself in the wordle I pulled from Tweetarchivist and the Retweet analysis from Twitonomy.

Wordle showing the top words used in the #EAU16 Twitter feed.

Most retweeted tweets during #EAU16.

Despite that, the social media highlight was yet to come: the famous BJUI SoMe awards! The urologic Twitterati gathered in the beautiful roof-top lounge in Munich city centre for the “cult awards” as Prokar Dasgupta (@prokarurol), BJUI Editor-in-chief, justifiably stated. We warmed up with wine or beer and felt the suspense increasing when everybody was waiting for Declan’s last-minute slide editing to the start the show. Prokar honoured the Twitter community for their huge engagement. While everybody was enjoying the show, we were coming closer to the most awaited prize: the @BJUIjournal best selfie award! Morgan Roupret (@MRoupret) and Angelika Cebulla (@AngelikaCebulla) were fighting hard for it, but it the end Maria Ribal (MariaJRibal) raced ahead and won the coveted award. But the show wasn’t over and the best was still to come in the final round: the @BJUIjournal Social Media Award 2016. Stacy Loeb (@LoebStacy) made a great proof-of-principle when initiating the #ILookLikeAUrologist campaign, which reached close to 1,000 tweets and was the well deserved award winner.

Stacy Loeb receiving the prestigious BJUI Social Media Award 2016 from Prokar Dasgupta and Declan Murphy

For more details of the Award winners look out for Declan’s forthcoming blog, coming to this site soon.

Congratulations to all social media entrepreneurs! Stay tuned for EAU congress days 3 and 4! Peace, love and #urology!

Hendrik Borgmann, Urologist, Mainz/Vancouver
@HendrikBorgmann

EAU 2015 Review Days 3 and 4

March 26, 2015/by Declan Murphy

Persistent rain throughout this year’s 30th EAU Annual Congress failed to dampen the spirits of over 12,000 delegates who have enjoyed another fantastic congress here in Madrid. The EAU Scientific Committee, led by Arnulf Stenzl, deserve tremendous credit for the work they have done to construct an extremely comprehensive and stimulating programme once again this year. I do recall my last EAU Congress in Madrid 12 years ago and there is no doubt but that the standard of this meeting has risen exponentially during this time. It is not just be Annual Congress of course which has developed in this time; the EAU has seen enormous growth in its global influence through the meteoric rise of European Urology, the activities of the European School of Urology (even beyond Europe), the pre-eminence of the EAU Guidelines, and the introduction of new initiatives such as UroSource. The Annual Congress is the nidus for much of this activity and it has become an unmissable event for many of us (even when based in Australia as I am!).

Rebecca Tregunna and Matthew Bultitude have already covered some of the highlights of the opening days of this year’s Congress in their BJUI blog . I will give you some further highlights and point you towards the excellent congress website which has archived a huge amount of material to allow you to catch up on sessions you may have missed.

Big highlights for me on day 3 and 4 include the following (please forgive my oncology focus):

PSMA PET scanning – there was considerable interest in the early data on PSMA PET scanning for recurrent prostate cancer at last year’s EAU Congress, and this year has seen some very positive data being presented from Munich and Heidelberg and further enthusiasm for this imaging modality. Tobias Maurer (Munich) presented a number of papers showing the high sensitivity in particular for PSMA PET in detecting recurrent prostate cancer at low levels of biochemical recurrence using either PET CT or PET MRI (poster 928).

Many other plenary speakers also highlighted the positive data surrounding PSMA PET and also the possible theragnostic potential of this in the future (poster 675 and Dr Haberkorn plenary lecture). However in the scientific souvenir session which closed the meeting, Dr Peter Albers burst the bubble somewhat by warning that we need much better data (tissue validation in particular), before we all rush towards PSMA. He has a point of course, although I have been extremely impressed with our initial experience using PSMA PET in Melbourne over the past six months and I do expect it to live up to the hype.

CHAARTED data looking good – Nine months after he made world-wide headlines when he presented the overall survival data of the CHAARTED study at ASCO, Dr Chris Sweeney crossed the Atlantic to again present this data to a packed eUro auditorium. This randomised study of 790 men with metastatic prostate cancer, has demonstrated that men who receive six cycles of docetaxel chemotherapy upfront at the time of starting androgen deprivation therapy, have a considerable survival benefit compared to those who receive ADT on its own (the current standard of care). This was especially so for men with high volume metastases who had a 17 month survival benefit (HR 0.61).

Although the French GETUG study has not shown the same benefit, Sweeney and others have proposed rational explanations for why this might be so. While the final paper has not yet been published (will be submitted this week), very many of us have already embraced the CHAARTED as the new standard of care for men presenting with high-volume metastatic prostate cancer. A proper landmark study.

Metastatic castrate-resistant prostate cancer (mCRPC) – still more questions than answers. What an amazing few years for this disease area! Five years ago, urology trainees only had a handful of “essential reading” papers in the world’s top journal, the NEJM, that we could cite to support evidence-based practice. It is now difficult to keep up with all the landmark trials in NEJM and other top journals reporting overall survival advantage for a variety of agents targeting mCRPC. Enzalutamide has already joined the ranks of these blockbuster drugs and this year’s EAU saw more data illustrating the powerful activity of enzalutamide in the pre-chemo mCRPC space. In the Breaking News session on the final day, Dr Bertrand Tombal presented the final analysis of the PREVAIL study which confirmed the overall survival advantage of patients receiving enza pre-chemo when compared with placebo. The HR of 0.77 was strongly significant (p=0.0002) and the therapy was well tolerated.

However as pointed out by discussant Dr Maria de Santis, we have still a way to go to figure out which patient will benefit from which therapy and when. The sequence and combination of therapies is still being worked out, and while the potential of predictive biomarkers such as AR7 is certainly exciting, we are still bereft of data and tools (and funding), to figure out the best pathways.

Robot vs open surgery – cystectomy is the new battleground. As Alberto Brignati pointed out in his outstanding souvenir session on localised prostate cancer, it appears that the old debate of robotic vs open prostatectomy is no longer of interest. Despite the lack of prospective randomised data, there appears to be little doubt that robotic prostatectomy is the standard of care in many regions. A large number of posters and plenaries demonstrated convincing data of excellent outcomes in robotic prostatectomy series, including data from a multicenter randomised study (REACTT, poster 622) led by Dr Stolzenberg which demonstrated improved potency outcomes for robotic prostatectomy (not the primary endpoint).

The same cannot yet be said of robotic cystectomy. Despite my own enthusiasm for and publications on robotic cystectomy, it is hard to get away from some of the cautionary language being expressed about the role of robotic cystectomy at the moment. An excellent plenary featuring giants in the field of bladder cancer (Dr’s Bochner, Wiklund, Studer, Palou), debated the issue in the main eUro auditorium and the following day’s newsletter summed it up nicely:

This provoked much discussion on Twitter with some prominent names chiming in from the US. Dr Khurshid Guru got involved to reassure us that the International Robotic Radical Cystectomy Consortium which he leads will provide the answer.

Well said @khurshidguru!

On a non-cancer note, it is clear that some of the most popular session and courses at EAU15 were focused on uro-lithiaisis. Stone surgeons are also very active on Twitter and although I did not attend any stone sessions, I was pleased to see that standardization of terminology is also important to the “pebble-ologists”:

Finally, #EAU15 was truly a social experience, not just in the wonderful bars and restaurants of Madrid, but also through Twitter and other social media channels, strongly supported by the excellent communications team at EAU. We recently published a paper in the BJUI documenting the growth of social media at major urology conferences and at EAU in particular. Between 2012 and 2014, the number of Twitter participants increased almost ten-fold, leading to an increase in the number of tweets from 347 to almost 6,000 At #EAU14, digital impressions reached 7.35 million with 5,903 tweets sent by 797 participants.

(From Wilkinson et al BJUI 2015)

As might be expected, #EAU15 has continued this trajectory with almost 8000 tweets sent by 1220 participants.

One of the only criticisms I have of EAU15 is that the scientific program is now so large that it is impossible to get to all the sessions I am interested in. There did seem to be a lot of prostate cancer running simultaneously but I am not sure how much the Scientific Committee can do to avoid such clashes. Thankfully, the EAU meeting website www.eaumadrid2015.org contains a huge amount of material including webcasts, interviews, posters etc which allows delegates and EAU members to catch up on some of the outstanding content.

Another big attraction of the EAU Annual Congress is of course that it takes place in Europe’s most wonderful cities. EAU16 heads to Munich – put the date in your diary 11-15 March 2016.

Declan Murphy, Urologist, Melbourne
Associate Editor – Social Media, BJUI
@declangmurphy

Click here for Declan Murphy’s disclosures

EAU 2015 Review Days 1 and 2

March 23, 2015/1 Comment/by Rebecca Tregunna

The 30^th anniversary EAU congress is currently taking place in the beautiful but rainy city of Madrid with over 12,000 delegates attending. The opening Friday proved a monumental day with the start of the congress as well as personally as I gave into the pressure of social media, and joined Twitter. This is being heavily promoted by the EAU this year and with multiple engaging sessions going on at the same time this seemed to be the best way to have my cake and eat it and enjoy highlights from different parts of the meeting.

The second ESO prostate cancer observatory was well attended and led to interesting debates about PSA screening and informed consent due to risks of over-detection and subsequent overtreatment of indolent disease. Indeed Andrew Vickers also highlighted that the results of the much anticipated ProtecT trial should be interpreted with caution given the high number of Gleason 6 patients that have been randomised.

In the evening the opening ceremony took place with an emotional final introduction to the congress by Per Anders Abrahamsson as he steps down and hands over to Chris Chapple as EAU Secretary General (photo courtesy @uroweb).

The EAU also gave out a number of awards including the Crystal Matula award for promising young urologist which was given to Morgan Roupret.

The scientific programme on Saturday started with the main plenary session on controversies in bladder and kidney cancer. It is difficult to draw conclusions regarding lymphadenectomy in upper tract tumours due to a lack of randomised data but certainly based on retrospective data a benefit is seen both in terms of staging and cancer specific survival. A hot topic lecture on molecular profiling in bladder cancer gave a thrilling insight into how agents will be able to target pathways based on specific mutations and Professor Studer, in his last ever plenary session, led to an interesting debate on robotic vs. open radical cystectomy. This has caused much controversy recently with the Bochner randomised controlled trial and this debate will surely run and run. Maybe most importantly, as Studer concluded “The surgeon makes the difference not the instrument”. This was highlighted on the front cover of the congress news with a more downbeat headline on robotic cystectomy.

Next came an intriguingly titled talk “What would Charles Darwin make of renal cell carcinoma?” with discussion about the heterogeneity of renal tumours making it difficult to identify specific targeted treatments based on renal biopsy alone.
Multiple section meetings then ensued. From the EAU section of urolithiasis (EULIS) meeting it seems that PCNLs are increasingly being miniaturised with development to mini, ultra-mini and micro procedures. The issues behind “diabesity” and stones were discussed with Professor Reis Santos predicting an epidemic of stones either due to uric acid stone formation from obesity or calcium oxalate formation from malabsorbative bariatric procedures. There was also a recurring theme with poster and podium sessions on “ESWL – is there still a role?” While the argument is made for ESWL there is no doubt that worldwide treatment rates for ESWL are falling.
As the EAU Section of Female and Functional Urology there was an excellent series of talks on mesh and mesh complications. There was a fantastic review of dealing with these complications through a variety of approaches and techniques and whether all these should all be dealt with in high volume centres. Unfortunately, no one knows what high volume means for this. Interestingly the terminology is changing, moving away from ‘erosion’ to ‘exposure’ and ‘perforation’. Removing the mesh only relieves associated pain in 50% of cases and these dedicated centres need to offer multimodality treatments to deal with pain and ongoing continence issues.
In the parallel EAU section meeting of Genito-urinary Reconstructive Surgeons, Professor Mundy gave a personal 30 year series of 169 patients treated with both clam cystoplasty and artificial sphincter. The majority of complications were related to the sphincter. The largest subgroup was patients with Spina Bifida but were the patients with the best outcomes.
David Ralph in the EAU Section of Andrology stated that shunts were ineffective after 48 hours after priapism and that a prosthesis instead should be inserted to prevent corporal fibrosis.
The EAU section of Oncological Urology also heard that 68Ga-S+PSMA-PET improves detection of metastatic lymph nodes in prostate cancer and can be used intra-operatively in radioguided surgery for targeted lymph node dissection.
Overall the organisers have done a fantastic job with a well organised meeting and a great venue despite the disappointing weather. There were sessions that people could not get in to as the rooms were full.

However, with live TV screens outside those rooms and transmission to an adjacent overflow room this didn’t seem to matter too much. Much to look forward to for the rest of the conference #EAU15.

Rebecca Tregunna, Speciality Trainee, Burton Hospitals NHS Foundation Trust, West Midlands Deanery. @RebeccaTregunna

Matthew Bultitude, Consultant Urologist, Guy’s and St. Thomas’ Foundation Trust; Web Editor BJU International. @MattBultitude

Social media makes global urology meetings truly global

February 5, 2015/1 Comment/by Stacy Loeb

The use of social media continues to expand in urology and the BJUI is proud to be at the forefront of these efforts. All of the global urology meetings now have their own twitter feed, which is indexed using a ‘hashtag’ (e.g. #EAU14, #AUA14). Analogous to a Medical Subject Heading (MeSH) in PubMed, hashtags are used to categorise related tweets together in one place, providing a convenient way to follow conference proceedings.

Surrounding the 2014 European Association of Urology (EAU) Congress (9–16 April 2014), there were a record 5749 tweets from 761 unique contributors. The BJUI and its editorial team represented four of the top 10 social media influencers based on the number of times that they were mentioned in the #EAU14 conference twitter feed.

Social media engagement continued to grow to new heights at the 2014 AUA meeting. From 14–23 May 2014, there were a total of 10 364 tweets from 1199 unique contributors in the #AUA14 conference twitter feed. The BJUI and its editorial team represented six of the top 10 influencers based on the total number of mentions.

In addition to urology conferences, the BJUI continues to actively participate in social media throughout the year. We provide a variety of specialised content such as videos, picture quizzes, and polls, as well as free access to the ‘Article of the Week’. This provides a great way to stay up-to-date on the latest research in a dynamic, interactive setting.

Finally, I would like to call your attention to two ‘Articles of the Week’ featured in this issue of BJUI, both of which will be freely available and open to discussion on twitter. The first by Kates et al. [1] deals with the interesting question of the optimal follow-up protocol during active surveillance. Using yearly biopsy results from the Johns Hopkins active surveillance programme, they report what proportion of reclassification events would have been detected had the Prostate Cancer Research International Active Surveillance (PRIAS) protocol been used instead (including less frequent biopsies and PSA kinetics).

Another feature ‘Article of the Week’ by Eisenberg et al. [2] addresses the controversial link between testosterone therapy and prostate cancer risk. Among men undergoing hormonal testing at their institution, they used data from the Texas Cancer Registry to compare the rates of malignancy between those who were and were not using testosterone supplementation. We hope that these articles will stimulate an interesting discussion and encourage you to join us on twitter.

Dr. Stacy Loeb is an Assistant Professor of Urology and Population Health at New York University and is a Consulting Editor for BJUI. Follow her on Twitter @LoebStacy

Highlights from the Irish Society of Urology 2014

September 29, 2014/2 Comments/by Greg Nason

Failte go Cill Airne (Welcome to Killarney, Co Kerry).
The urology community of Ireland descended on the picturesque town of Killarney in the south west of Ireland for its annual scientific meeting.

Mr David Quinlan (@daithiquinlan), President of the ISU, commenced proceedings with a tribute to the late Professor John Fitzpatrick and Mr Dermot O’Flynn. It is the first ISU following the sad passing of Professor Fitzpatrick in May of this year. Professor Fitzpatrick led a distinguished career and was a respected figure in world urology. The recent BJUI blog following his death demonstrated how highly regarded he was across the globe, with many sharing personal memories of him. Outside of his undoubted ability in the operating room, he was entertaining, had a special way with words and was a great story teller. He will be missed both here and afar.

Dermot O’Flynn, past President of the RCSI, also passed away this year aged 93. Mr O’Flynn was an established urologist in the Meath Hospital. He played a significant role in the formalisation of urological training in Great Britain and Ireland not only to the training programme but also the specialist exit examination.

Academic Program

The academic program commenced on Thursday morning with front line basic science presentations. Kieran Breen (@kjkibbles – who won the ISU Registrar’s Prize winner) from the Conway Institute (scientific laboratory set up by Professor Fitzpatrick) reported tissue microarrays following radical prostatectomy regarding immunohistochemistry staining for insulin receptors, IGF-1 receptor and PTEN as markers of predicting biochemical recurrence. Early data suggest these markers could identify potential patients at risk of biochemical recurrence. Tuzova et al. presented a multi-centre study led by the St James’ group that suggested urinary profiling of DNA hypermethylation can selectively detect high-risk prostate cancers with improved specificity over the traditional PSA test.
The afternoon podium session focused on prostate cancer and resulted in an expected heated debate – Daniel Good (@willbgood1) from Edinburgh, reported the use of a novel device in prostate cancer detection. The E-finger, is a probe that fits on the tip of a finger and attempts to differentiate significant from insignificant findings based upon prostate elasticity. The debate continued regarding the use of pre biopsy MRI as well as the role of transperineal biopsies as a standard. Rick Popert advocated the use of systematic transperineal biopsy based on an anatomical map of the prostate as opposed to the traditional ‘lucky dip’ that is the transrectal ultrasound biopsy.
Friday morning focused on urological training in Ireland – Elaine Redmond outlined the lack of urological exposure among primary care physicians and suggested a urological or men’s health module be incorporated in their curriculum. Matthew Burke, highlighted the need for dedicated paediatric urological training to meet the needs of the health service going forward – this echoed the thoughts of BAUS President Mark Speakman who highlighted the impending void in paediatric urology.
Other highlights included the suggestion of a national network for the management of penile cancer in Ireland, similar to this week’s BJUI article of the week. In a country with such low volumes, a supra-regional network may improve long-term morbidity and survival.
Finally, O’Kelly et al. (@fardodokelly), demonstrated the merits and quality of national urological meetings from the smaller European countries with a favourable final publication rate of 46%. The quality of presentations, in particular basic science demonstrated this will continue.

Guest Speakers

The ISU has continued to attract significant guest speakers from the world of urology and this year we were joined by Craig Peters (‘THE’ American Paediatric Urologist), Mike Leonard (Vice-President of the Canadian Urological Association), Mark Speakman (President of BAUS) and Prokar Dasgupta (@prokarurol – Editor of the BJUI).

Guest Speakers – Mr John Thornhill (incoming ISU President), Mr Roger Plail (President of the Section on Urology, Royal Society of Medicine), Mr David Quinlan (outgoing ISU President), Professor Prokar Dasgupta (BJUI Editor), Professor Craig Peters (University of Virginia), Mr Mark Speakman (President of BAUS), Professor Mike Leonard (Vice-President Canadian Urological Association)

Professor Peters lecture on Robotic Surgery in Paediatric Urology ‘Reflections on emerging technologies’ was an eye opener in to what can be achieved if we push the boundaries. His strive for excellence and improved patient outcomes in the face of ‘robot-scepticism’ have led to advances in paediatric robotics. Outside of the robotic pyeloplasty – they have pioneered and tested the use of robotics in hypospadiology due to the undoubted improved optics as well the management of congenital abnormalities.
In one of the highlights of the meeting, Professor Peters was pitted against Professor Mike Leonard (Vice-President of the Canadian Urological Association) in a debate ‘Robotics are alien in paediatric urology’ panelled by Professor Dasgupta and Mark Speakman. ‘Robocop’ versus the sensible Canadian approach duelled in a fascinating debate – detailing clinical efficacy, cost effectiveness, quality control. Professor Peters offered Professor Leonard his card for redo pyeloplasty ‘in which the robot works quite well’.
Professor Dasgupta, (the man who still carries a diary) engaged the audience in a tour de force regarding immunotherapy in prostate cancer as well as detailing his future vision for the BJUI. This was the first year the abstracts were published in the BJUI, the Official Journal of the ISU. This is a most welcome addition and adds to the standing of our annual meeting.

Professor Prokar Dasgupta – the Editor of the ‘journal that never sleeps’ – with his pocket diary.

Mark Speakman, gave an impressive demonstration in the art of oratory at the gala dinner regarding delivering a service and the impending need to publish surgeon-specific outcomes. He continued to speak to trainees and the need to add a ‘second string to your bow’ highlighting the areas which will require urologists in the future – paediatrics, andrology and female urology – warning that we cannot all be robotic pelvic oncological urologists.

Social Media Presence

The #ISU14 hashtag gathered momentum in the past few days. Again an inaugural addition to our meeting and something we will endeavour to promote in years to come. Any attendee at the EAU, AUA, BAUS will attest to the quality of social media presence and this is something we can learn from. By the end of the meeting we had followers across the globe, in the United States and Australia.

ISU Social Media Team ( Mr Rustom Manecksha – @dr_rpm, Mr David Bouchier-Hayes – @dbh44, Mr Garrett Durkan – @gcd67, Professor Prokar Dasgupta – @prokarurol, Mr Greg Nason – @nason_greg, Mr David Quinlan – @daithiquinlan,
Mr Fardod O’Kelly – @fardodokelly)

The now standard selfie – Mr John Thornhill, Mr Roger Plail, Mr David Quinlan, Professor Prokar Dasgupta, Professor Craig Peters, Mr Mark Speakman, Professor Mike Leonard)

Symplur #ISU14 analytics

Moving forward

The annual meeting also ended Mr David Quinlan’s tenure as the President of the Irish Society of Urology. The ISU has moved from strength to strength under his watchful eye, incoming President John Thornhill applauded Mr Quinlan as ‘a rock who sailed a steady ship’. We look forward to welcoming all to next year in Limerick for hopefully a bigger annual conference with a wider global audience.

Mr David Quinlan (outgoing President of ISU), Professor Prokar Dasgupta (BJUI Editor), Mr John Thornhill (incoming ISU President)

Greg Nason is a Specialist Registrar in Urology in Ireland.
ISU Social Media Team (David Quinlan, Rustom Manecksha, David Bouchier-Hayes, Fardod O’Kelly, Greg Nason)