Nishant Bedi

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The EAU 2018: Part 2

April 11, 2018/by Nishant Bedi

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

Prostate cancer

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

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

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

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

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

Upper Tract Urothelial Cancer (UTUC)

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

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

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

Transgender

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

Stones

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

Renal Cell Carcinoma

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

Social media

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

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

EAU guidelines are finding effective dissemination though social media.

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

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

Nishant Bedi

Urology Registrar North London

@nishbedi

Royal Society of Medicine: Key issues in Endourology

October 30, 2017/by admin Z.9

The RSM section of Urology #RSMUrology hosted a day on the Key issues in Endourology on 20^th October. This was the first meeting of the academic year under President Roland Morley. Sri Sriprisad put together a complete endourology day with key subject areas of “PCNL and stones”, “upper tract TCC” and “BPH and retention”. Speakers from India, America and Spain provided expert opinions from around the globe.

The day started with the evolution of stone and urological laparoscopic surgery. Showing an insight into the challenges with the initial introduction of laparoscopic urological surgery. In order to allow surgeons the chance to discuss their experiences and troubleshoot and develop surgical techniques the SLUG forum (southern laparoscopic urology group) was created, which is still running today in the annual AUA meeting.

PCNL techniques were the subject for several debate lectures. Access for PCNL tracts was debated by Dr Janak Desai, visiting from Samved Urology hospital in India, arguing for fluoroscopic puncture with over 10,000 cases to date! Jonathan Glass, from Guy’s and St. Thomas’ Hospital, spoke for the prone position for the majority of PCNL, but selecting the supine position in 5-10% of cases depending on the anatomy and stone position. Dr Desai also spoke on ultra-mini PCNL, which he advocates using to treat solitary kidney stones under 2 cm in preference to flexible ureteroscopy.

The future of ESWL was debated and the audience voted that it is still “alive and clicking” by a narrow margin. However, although up to 80% clearance rates are quoted for upper pole stones less than 2 cm, the problem is that results of treatment are varied and unpredictable, and real-life success rates are far inferior. The variation in results may in part be due to the fact that there are no formal training courses for specialist radiographers nor SAC requirements for specialist registrars. Professor Sam McClinton presented on clinical research in stone disease with results from the TISU trial on primary ESWL vs. ureteroscopy for ureteric stones due out next year. The results will be fascinating and may help to decide if ESWL has a future in the UK.

Professor Margaret Pearle, visiting from the University of Texas Southwestern Medical Centre, explained the importance of treating residual fragments. With data showing that 20 – 36% of >2 mm residual stones after ureteroscopy required repeat surgery within 1 year. In a thought provoking lecture, she presented data showing that ureteroscopy may not be as good as we think and when critically examined, true stone-free rates maybe no better than ESWL. Maybe miniaturised PCNL is the way forward after all?

The follow up of small kidney stones is an uncertain area with very little written in either the EAU or AUA guidelines. Data from a meta-analysis by Ghani et al. shows that for every year of follow up on small kidney stones 7% may pass, 14% grow and 7% will require intervention. However, it is not possible in most health systems to follow everyone up forever and Mr Bultitude advocated increasing discharge rates from stone clinics to primary care after an agreed time of stability, allowing more on the complex and metabolic stone formers.Figure 1- Stone follow up algorithm

The expert stone panel then debated several challenging cases including “the encrusted stent”, stones in a pelvic kidney or calyceal diverticulum. These cases certainly are a challenge and require an individualized approach usually with multi-modality treatments.

Figure 2 – Stone expert panel

Upper tract urological biopsies are notoriously inaccurate, with only 15% of standard biopsies quantifiable histologically. Low grade tumours, are potentially suitable for endoscopic management with laser ablation. Dr Alberto Breda, from the urology department of Fundacio Puigvert Hospital in Spain, presented a novel solution for the future. This promising new technology uses confocal endomicroscopy to grade upper tract urological cancer. Initial results show 90% accuracy in diagnosing low grade tumours, which could then be safely managed endoscopically avoiding nephron-ureterectomy for some patients.

Figure 3 – Confocal endomicroscopy for upper tract malignancy

In the final session, a debate on BPH treatment, the audience preferred the bipolar resection technique for treating “the 60 year old with retention, with a 90 gram prostate and on rivaroxaban”, although HOLEP came a close second, with that talk giving the quote of the day “I spend more time with the morcellator than the wife.”

Figure 4 – Bipolar TURP wins the day

Nishant Bedi

ST4 Specialist urology registrar

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

Digital Doctor Conference 2013

January 28, 2014/1 Comment/by Nishant Bedi

Digital consumerism is progressing relentlessly and whilst the advantages of new technology are evident in our personal lives, there is a palpable air of concern amongst the medical profession. “The Digital Doctor” team are positively embracing the benefits of moving healthcare into a new era and hope to direct the use of new technology in a constructive manner that will benefit both healthcare professionals and patients. To achieve these aims the “Digital Doctor Conference 2013”, was held for its second year last November, again kindly sponsored by the British Computer Society and held at their excellent headquarters in Covent Garden, London. The conference was attended by IT professionals, doctors, medical students and patients; thus group sessions contained some perspective on every aspect of healthcare technology. The organisers are also an eclectic mix of doctors and IT professionals, united by their interest in improving Health IT.

The conference included plenary talks, interactive group sessions and workshops. Eminent plenary speakers included Martin Murphy, Clinical Director at NHS Wales Information Service.

Martin challenged us to redefine our relationship with our patients in a new era where clinical information will be in control of patients and access to healthcare professionals can be as easy as a click away. Currently, services like those at rocketdoctor.ca are now properly stablished and operating everyday. Adapting to this change works the same way as medicine has always done. Implementing new technologies to improve medicine is and always has been a top priority, looking only to more effectively save or better lives.

Software mediated care – implications for our patients and ourselves from Digital Doctor on Vimeo.

Popular teaching sessions at the conference were daily life IT tools, including the “Inbox Zero” philosophy, how to collaborate online, keeping up to date with RSS readers and Stevan Wing gave an introduction to the open-source “R project” for statistics. Other sessions focused on how to develop IT systems. This insight is useful both to allow healthcare professionals to construct their own IT solutions but also to help translate ideas to IT professionals. One such example being Sarah Amani, who used her experience as a mental health nurse to develop a mental health app for young people, called “My Journey”. In her inspiring plenary, co-presented with Annabelle Davis who developed the Mind of my Own app, she makes the point that the vast majority of young people rely on email, social media and online services therefore this is the best place to reach them. A session giving the methods and practicalities of developing IT systems was given by Rob Dyke, Product Development Manager of Tactix4. To help delegates get their ideas to reality Ed Wallitt, one of the organisers and the founder of Podmedics, built on earlier sessions about how to code, how a website works and information design, explaining how to use wireframes and prototypes, to achieve professional design of websites and apps.

Existing NHS IT systems were explained using the example of an emergency patient admission. Tracking the patient journey from home to hospital, via A+E, then transfer to ward, rehab back home, with GP clinic the final destination. At each stage a different IT system is employed such as the emergency 999 network and the N3 private network. Concepts such as the NHS spine were introduced and explained. A complex web of systems were shown to be in use, with numerous safety mechanisms; providing some explanation as to the difficulties faced by employees in the NHS.

Delegates were able to implement this teaching in the “App factory”, to solve problems they face in daily life or work. Three app ideas were created and presented by separate teams. These were a teaching log for doctors to record teaching sessions and simultaneously get feedback from students, a productivity app to provide useful information for new doctors to know about any hospital, however the winning idea was a patient facing app for use in hospital, to track updates in ongoing care.

In another session Matthew Bultitude, an Associate Editor of BJUI, was invited by Nishant Bedi (another organiser) for his vision of the future of medical journals. Journals are key in shaping the way medical practice is conducted and the dissemination of information is as important as ever in the digital age. Paperless journals may be the future however traditional business models rely on paper journals for revenue and many journals have yet to feel confident in moving all of their content exclusively online. Yet there are signs of change with European Urology adopting a paperless format for members from Jan 2014, now surely others will follow?

Under new leadership, the BJUI has recently focused on revolutionising its online presence, starting with a complete website overhaul. Amongst many changes to its design, the website now hosts an article of week, user poll, blogs and picture quiz. Numerous metrics for the website now show significant improvement in website visitors, duration of visit (1 to 3 min) and “bounce” rate. The increasing importance of social media for health professionals is demonstrated by the fact that more than ¼ of website traffic now arrives from Twitter and Facebook, having previously been dominated by search engines. Matthew finished by discussing alternatives to impact factor, such as the journal’s “Klout” score or “individual article” metrics, which are likely to be increasingly important as medical journals develop more web and social media presence. Extremely accurate individual “article level metrics” are calculated by checking number of views, tweets and re-tweets, and mentions in review sites (such as F1000 Prime). It is clear to see how powerful this could be, for example when discussing viewing numbers and duration of reading, Matthew can inform us that currently BJUI Blog articles are each read for a total of 5 min, with even the 15th most popular article receiving almost 500 views.

This talk was paired with one from the futuristic journal “F1000 Prime”. This journal provides an extra layer of expert peer review, using scientific articles that are already published in other journals. Thus articles selected by F1000 Prime direct users to the most significant developments in their chosen field, the expert reviews of the articles include an article rating, relevance to practice and whether there are any new findings. Research has shown that selection of an article by F1000 Prime, is an accurate indicator of future impact factor. Users may also receive email alerts of recommended relevant papers and they are able to nominate articles, follow the recommendations of an expert reviewer. Also refreshingly, any submissions to the journal, receive a completely transparent peer review process, openly available to any user.

Conference attendees were given the patients’ perspective of Health IT, by a panel chaired by Anne-Marie Cunningham (another organiser). These real life stories, gave insight into the mindset of people suffering from demanding chronic disease, both at home and in the hospital. Importance is given to people taking ownership of their health; both rare and common diseases were mentioned including Addison’s disease, asthma and mental health issues, where 24 hour support is an unfulfilled requirement and there is a need for a more integrated approach. Positive examples were given with one patient gaining reassurance by regular home peak-flow monitoring that can be reviewed remotely by her respiratory consultant. This helps to determine optimal timing for clinic review, with other similar examples seen in home blood pressure or blood sugar monitoring. Importantly social media and support groups can provide 24 hour advice and connect patients with expert doctors or similar sufferers all over the world. It was clear that the lack of hospital WiFi disconnects some patients from their online support networks, when they are actually most vulnerable. Other complaints centred around the underuse of email appointments and text alerts, which could empower patients to chase their own appointments or scans.

Delegate feedback suggests this conference is unique and covers a rapidly expanding area of Medicine. We look forward to the next conference in 2014. The Digital Doctor 2013 conference program and highlights are available from the website or directly on our vimeo chanel. For updates and upcoming events follow us on Twitter @thedigidoc and the podcast is available from iTunes or our website.

Mr. Nishant Bedi
Core Surgical Trainee (Urology), West Midlands Deanery

Dr Stevan Wing
Academic Neurology Registrar, East of England and The University of Cambridge

Annabelle Davis

BAUS 2013 Conference Report – Day 1-2

June 20, 2013/1 Comment/by Nishant Bedi

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

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

The conference started with 3 parallel sessions on Monday morning:

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

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

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

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

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

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

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

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

Teaching new things in new ways

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

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

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

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

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

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

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

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