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Highlights from BAUS 2016

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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 72nd 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).

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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.

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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.

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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.

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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.

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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.

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

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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.

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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.

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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.

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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%.

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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…

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Social media review shows good contribution daily.

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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

 

April #UROJC: The Surgeon Scorecard – Merits of Publicly Reported Surgical Outcomes

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The April 2016 International Urology Journal Club on Twitter (#urojc) hosted a discussion on our paper, “Comparing Publicly Reported Surgical Outcomes with Quality Measures from a Statewide Improvement Collaborative”. Published in JAMA Surgery on March 16, 2016, the paper was authored by Gregory Auffenberg MD, David Miller MD, Khurshid Ghani, Zaojun Ye, Apoorv Dhir, Yoquing Gao. I contributed as a member of MUSIC.

It was an honor to have the paper selected for a #urojc discussion, and the authors would like to thank JAMA Surgery for providing open access during the discussion period. This post serves as an overview, and the entire #urojc transcript is available for reading courtesy of Symplur

For those not familiar, the #urojc Twitter chat is a 48-hour asynchronous conversation amongst urologists around the world on Twitter on a selected journal paper, taking place on the first Sunday/Monday of every month.

 

The ProPublica Surgeon Scorecard

The subject of our research centered on the online U.S. surgeon ratings compiled for ProPublica’s Surgeon Scorecard. ProPublica is an investigative journalism organization that was given exclusive access to U.S. Medicare data for the years 2009 to 2013.

“Reporters Olga Pierce and Marshall Allen studied almost 75 million hospital visits billed to Medicare looking for eight common, elective surgeries. They then looked to see whether the same person returned to the hospital for what appeared to be complications from the surgery. Their full methodology is spelled out here.”

 

The Michigan Urological Surgery Improvement Collective

Specifically, our research paper looked at ProPublica’s ratings for only one procedure – results on radical prostatectomy (RP) for prostate cancer – and correlation to reporting by MUSIC, the Michigan Urological Surgery Improvement Collaborative. MUSIC is a state-specific quality initiative in the U.S. in which I am a participating surgeon. Participation in MUSIC is voluntary, over 85 percent of urologists in the State of Michigan participate in the collaborative.

 

 

April #UROJC

As our paper states, the recent release of the Surgeon Scorecard accelerated debate around the merits of publicly reporting surgical outcomes. Surgical outcomes assessment is not a new concept, even dating back to 1860 as this tweet by @mattbultitude surfaced.


What does our community of urologists think about public reporting? Does greater transparency correlate with better outcomes? What are the benefits of a collaborative method like MUSIC? What methods are used in other parts of the world?

 

The #urojc discussion found that many urologists outside the U.S. were not familiar with the ProPublica ratings or debate. Some were not surprised that we did not find a correlation between our MUSIC outcomes data and the ProPublica data, thereby validating the need for quality outcomes data.

 

 

If the Surgeon Scorecard is flawed, what needs to be done to create an acceptable public reporting system?

 

Is public reporting of surgical outcomes taking place in Australia, UK, Canada & elsewhere?

 

 

How are ‘outliers’ identified by this study handled by MUSIC?

 

Do ratings lead to cherry-picking of patients?

 

According to New York cardiologist, Sandeep Jauhar, MD via Medscape, 63 percent of cardiac surgeons acknowledged accepting only relatively healthy patients for heart bypass surgery owing to report cards in New York State.

 

Moving Surgical Outcomes Forward 

On behalf of the authors of the paper and the entire MUSIC collaborative, I would like to thank our #urojc colleagues around the world for their thoughts, insights, criticisms and questions about the paper.

The ProPublica Surgeon Scorecard has generated significant and serious discussion in the U.S. about the challenges and merits of the public reporting of surgical outcomes. In an increasingly connected world, it’s difficult to imagine how this can remain simply an American debate.

Urologists by their very nature are leaders. Personally, I see this debate as yet another opportunity for us to develop and implement systems and strategies that reassure the public and advance patient care.

MUSIC JAMA Paper

 

The 4th BJUI Social Media Awards

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As you may know, we alternate the occasion of the BJUI Social Media Awards between the annual congresses of the American Urological Association (AUA) and of the European Association of Urology (EAU). Our first awards ceremony took place at the AUA in San Diego in 2013, followed by the EAU in Stockholm, and a really fun evening at AUA in New Orleans last year. This year, we descended on Munich, Germany to join the 13,000 or so other delegates attending the EAU Annual Meeting and to enjoy all the wonderful Bavarian hospitality on offer. More about that in our blog posts from #eau16.

1.1On therefore to the Awards. These took place on Sunday 13th March 2016 in the roof garden bar of the beautiful Bayerischer Hof hotel. Over 70 of the most prominent uro-twitterati from all over the world turned up to enjoy the hospitality of the BJUI and to hear who would be recognised in the 2016 BJUI Social Media Awards. Individuals and organisations were recognised across 46 categories including the top gong, The BJUI Social Media Award 2016; awarded to an individual, organization, innovation or initiative that has made an outstanding contribution to social media in urology in the preceding year. The 2013 Award was won by the outstanding Urology Match portal, followed in 2014 by Dr Stacy Loeb for her exceptional individual contributions, and in 2015 by the #UroJC twitter-based journal club. This year our Awards Committee consisted of members of the BJUI Editorial Board – Declan Murphy, Prokar Dasgupta, Matt Bultitude, Stacy Loeb, Mike Leveridge, and Henry Woo, as well as BJUI Managing Editor Scott Millar whose team in London drive the content across our social platforms. The Committee reviewed a huge range of materials and activity before reaching their final conclusions. As befits the fast-moving nature of social media, we decided to omit a couple of previous categories and add two new ones.

One of these was the “Best #EAU16 Selfie” competition which we launched on the eve of this year’s EAU Annual Meeting to encourage some fun among congress attendees.

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We had dozens of enthusiastic entries which betrayed the social side of urology conferences today – see examples on our Awards Prezi.

 

The full list of awardees, along with some examples of “best practice” in the urology social media sphere can be found in the Prezi. The winners are also listed here:

  • Most Read Blog@BJUI – “The drugs don’t work”. Dr Matt Bultitude
  • Most Commented Blog@BJUI – “The Urology Foundation Cycle India” – 87 comments. Accepted by Dr Ben Challacombe, on behalf of Prof Roger Kirby, London, UK
  • Most Social Paper (new category) – “Twitter response to the USPSTF recommendations against screening with PSA”. Published in BJUI 2015. Accepted by Stacy Loeb on behalf of Dan Makarov and other co-workers.
  • Best BJUI Tube Video – “Extended PLND – creating the spaces”. Accepted by Declan Murphy on behalf of John Davis, MD Anderson, USA.
  • Best Urology Conference for Social Media – #AUA15 – The American Urological Association Annual Meeting 2015. Accepted by Dr Stacy Loeb on behalf of the AUA.
  • Best Urology App – The “British Association of Urological Surgeons Emergency Urology App”. Accepted by BAUS President Mark Speakman on behalf of BAUS and Dr Nick Rukin
  • Innovation Award 2016 – “Urology Ontology Tag Project”. Accepted by Dr Jim Catto and Dr Henry Woo (Dr Alex Kutikov not present)
  • #UroJC Award – Dr Rustom Manecksha, Dublin, Ireland
  • Most Social Trainee (new category) – Kari Tikkinen
  • Best Selfie – Khurshid “Macgyver” Guru
  • Best Urology Journal for Social Media –Journal of Sexual Medicine. Accepted by Associate Editor for Social Media, Mikkel Fode
  • Best Urology Organisation – European Association of Urology. Accepted on behalf of EAU by European Urology Editor-in-Chief, Jim Catto.
  • Best #EAU16 Selfie (new category) – Maria Ribal with special mentions to Morgan Roupret and Inge van Oort
  • The BJUI Social Media Award 2016 – #ilookllikeaurologist. Accepted on behalf of female urologists all over the world by Dr Stacy Loeb, New York, USA

Most of the Award winners were present to collect their awards themselves, including Dr Stacy Loeb who received our top gong for her work in driving the #ilooklikeaurologist campaign. The Awards Committee had identified this wonderful social media campaign from early on as a stand-out example of how social media (Twitter in particular), can be deployed to drive a really important social message. The #ilooklikeasurgeon campaign had already caught the imagination of all of us who identified with the message that female surgeons were undervalued in our specialty, and the #ilooklikeaurologist campaign really brought a welcome focus on our female urology specialists and trainees. The tweet that first used the hashtag was sent by Stacy in August 2015 in reply to a tweet from Rustom Manecksha:

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Since that time, over 1000 tweets have been sent using this hashtag, most featuring great pictures of our female urologists at work or at play. See plenty of examples on our Prezi or just search the hashtag #ilooklikeaurologist.

A special thanks to our outstanding BJUI team at the Editorial Office in London, Scott Millar and Max Cobb, who manage our social media and website activity as well as the day-to-day running of our busy journal.

See you all in Boston for #AUA17 where we will present the 5th BJUI Social Media Awards ceremony!

Declan Murphy, Peter MacCallum Cancer Centre, Melbourne, Australia

Associate Editor – Social Media, BJUI

@declangmurphy

 

 

 

 

March #urojc: Radiotherapy for Prostate Cancer – Is it a gift that keeps on giving?

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The International Urology Journal Club on Twitter is now well into its 4th year.  The subject for the March 2016 discussion was a paper published in the BMJ entitled “Second Malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis”.

Lead and senior authors, Chris Wallis and Rob Nam were kind enough to  make themselves available to participate in this discussion.  Rob Nam made use of the  #urojc guest twitter account.

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The literature was searched using Medline and Embase and the method of review was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational studies in Epidemiology (MOOSE) guidelines for reporting of this systematic review and meta-analysis.

Chris Wallis provided an excellent TL:DR summary with the following tweet.

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It is well recognized that secondary malignancies following radiation exposure could take many years to become apparent.

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The responses were fairly predictable but nevertheless an important point to explore.

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Early in the discussion, there was also relevant reminder of the issue of differences in odds ratios and absolute risk.  That said, consideration needs to be given to the ‘big ticket’ nature of secondary malignancy where even a small absolute risk drives a great deal of interest in this subject matter.

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An interesting finding from the study was that the risk of secondary malignancy was less with brachytherapy compared with external beam radiation.

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Further to this, is it possible that there could be a difference between HDR and seed brachytherapy?  An interesting thought although not specifically covered in the paper.

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A more controversial aspect to the discussion was whether the risk of secondary malignancy would justify screening or surveillance. The following exchange was worthy of note.

Whilst there is nothing in the way of documented guidelines or actual evidence to demonstrate a benefit of surveillance, it seems something worthy of consideration for future practice guidelines –  in other words, recommendations one way or the other.

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Rob Nam refers to a third paper on radiation outcomes in the context of previous surgery.  This BJC paper, the Lancet Oncology paper (previous discussed at a #urojc in 2014) and now the current paper could cheekily be called the Nam Trilogy – make note that you heard this term here for the first time.

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To what extent should we be counseling our patients on the risk of secondary malignancy if they are to undergo radiation for prostate cancer?  Is this just another factor to encourage surgery over radiotherapy?  Will there be no change in practice, particularly in the US where many lucrative radiation oncology services are actually owned by urological surgeon private practice groups?

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The state of radiation oncology practice is different outside the US and my own personal thoughts on the matter are that the Nam Trilogy of papers will create a series of well cited ‘evidence’ that will further shift the weight of opinion towards surgery over radiotherapy as a primary treatment for localized prostate cancer.

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Anybody who followed the March installment of the #urojc would have been impressed by the high level of interaction by the authors Chris Wallis and Rob Nam.  A particular mention should be given to Sabin Motwani who as a radiation oncologist, provided valuable input to the discussion.

Please do join us for the April installment of the #urojc and I encourage you all to email, tweet or DM your suggestions for papers to be discussed.  Please also, feel free to volunteer to write up a monthly summary for publication on the BJUI blogs.  I would also like to acknowledge the contributions of Rustom Manecksha who was the winner of the 2016 BJUI SoMe Award for #urojc – a reflection to the quality of his participation and support for this online educational activity.

 

Henry Woo is an Associate Professor of Surgery at the Sydney Adventist Hospital Clinical School of the University of Sydney.  He is the coordinator of the International Urology Journal Club on Twitter.

The Urology Tag Ontology Project

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This blog was first posted at https://www.symplur.com/blog/the-urology-tag-ontology-project/

 

Urology-Tag-Ontology-Project-970x300

Urologists have been on the forefront of harnessing Social Media for professional use. Urological Organizations and Journals have used Social Media to lower barriers for information dissemination [1,2] [3] [4]. Meanwhile, Social Media engagement at Urological meetings has been used to augment the experience of attendees and allow remote “attendance” for those not able to physically be present at the meetings [5,6] [7]. Academic exchange through a formal Twitter-based Journal Club on the #urojc hashtag has enjoyed international participation [8]. Social Media has also been employed to assess the Media’s and the Public’s responses to news events in the Urologic clinical space [9], and guidelines for responsible and effective Social Media use now have been developed [10] [11]. Moreover, an extremely active patient advocacy voice has been growing louder on a number of the Social Media channels.

The Urology Tag Ontology Project aims to align hashtag use for this burgeoning Urological Social Media community. Utilizing this standardized list of Social Media communication descriptors, the project hopes to facilitate communication and promote collaboration in the healthcare provider and patient communities.

In creating the list, we crowd-sourced the Urologic Social Media community at large and were fortunate to receive buy-in from key stakeholders (Table 1).

Effective and standardized hashtag use remains an organic process that clearly cannot be dictated by a simple creation of a list. Indeed, the current list attempts to strike a balance between existing hashtags that enjoy heavy use and those descriptors that key opinion leaders in a particular urologic sub-specialty would like to see gain traction. As such, we hope for the Urology Tag Ontology Project to remain a “living document,” which is reassessed and updated on a regular basis.

 

Alexander Kutikov, MD, FACS @uretericbud
Associate Professor of Urologic Oncology
Fox Chase Cancer Center, Philadelphia, USA @FoxChaseCancer
Associate Editor for Digital Media
European Urology @EUPlatinum

Henry Woo, MD @DrHWoo
Associate Professor of Surgery
University of Sydney, Sydney, Australia
Founder and Manager
International Urology Journal Club #urojc @iurojc

James Catto MB, ChB, PhD, FRCS @JimCatto
Professor in Urological Surgery
University of Sheffield
Editor-in-Chief
European Urology @EUPlatinum

 

Table 1: Urological Social Media Stakeholders Supporting Urology Tag Ontology Project
 Organization  Hashtag / Twitter Handle
 European Association of Urology (EAU)  @UroWeb
 American Urological Association  @AmerUrological
 EAU Guidelines Committee  #EAUGuidelines
 AUA Social Media Committee  N/A
 Society of Urologic Oncology / Young Urologic Oncology Committee  @SUO_YUO
 Urological Society of Australia and New Zealand  @USANZurology
 British Association of Urological Surgeons  @BAUSurology
 Endourological Society  @EndourolSoc
 European Urology Journal  @EUPlatinum
 Journal of Urology  @JUrology
 BJUI   @BJUIjournal
 Urology Gold Journal  @UroGoldJournal
 Nature Reviews in Urology Journal   @NatRevUrol
 Prostate Cancer and Prostatic Diseases Journal  @PCAN_Journal
 Journal of Sexual Medicine  @JSexMed
 Bladder Cancer Journal  @BladderCaJrnl
 Journal of Clinical Urology  @JCUrology

 

 References

[1]         Loeb S, Catto J, Kutikov A. Social media offers unprecedented opportunities for vibrant exchange of professional ideas across continents. European Urology 2014;66:118–9. doi:10.1016/j.eururo.2014.02.048.

[2]         Cress PE. Using Altmetrics and Social Media to Supplement Impact Factor: Maximizing Your Article’s Academic and Societal Impact. Aesthetic Surgery Journal 2014;34:1123–6. doi:10.1177/1090820X14542973.

[3]         Nason GJ, O’Kelly F, Kelly ME, Phelan N, Manecksha RP, Lawrentschuk N, et al. The emerging use of Twitter by urological journals. BJU Int 2014:n/a–n/a. doi:10.1111/bju.12840.

[4]         Loeb S, Bayne CE, Frey C, Davies BJ, Averch TD, Woo HH, et al. Use of social media in urology: data from the American Urological Association (AUA). BJU Int 2014;113:993–8. doi:10.1111/bju.12586.

[5]         Matta R, Doiron C, Leveridge MJ. The dramatic increase in social media in urology. The Journal of Urology 2014;192:494–8. doi:10.1016/j.juro.2014.02.043.

[6]         Canvasser NE, Ramo C, Morgan TM, Zheng K, Hollenbeck BK, Ghani KR. The Use Of Social Media in Endourology: An Analysis of the 2013 World Congress of Endourology Meeting. J Endourol 2014:140715142757008. doi:10.1089/end.2014.0329.

[7]         Wilkinson SE, Basto MY, Perovic G, Lawrentschuk N, Murphy DG. The social media revolution is changing the conference experience: analytics and trends from eight international meetings. BJU Int 2015;115:839–46. doi:10.1111/bju.12910.

[8]         Thangasamy IA, Leveridge M, Davies BJ, Finelli A, Stork B, Woo HH. International Urology Journal Club via Twitter: 12-Month Experience. European Urology 2014;66:112–7. doi:10.1016/j.eururo.2014.01.034.

[9]         Prabhu V, Lee T, Loeb S, Holmes JH, Gold HT, Lepor H, et al. Twitter Response to the United States Preventive Services Task Force Recommendations against Screening with Prostate Specific Antigen. BJU Int 2014;116:65–71. doi:10.1111/bju.12748.

[10]       Rouprêt M, Morgan TM, Bostrom PJ, Cooperberg MR, Kutikov A, Linton KD, et al. European Association of Urology (@Uroweb) recommendations on the appropriate use of social media. European Urology 2014;66:628–32. doi:10.1016/j.eururo.2014.06.046.

[11]       Murphy DG, Loeb S, Basto MY, Challacombe B, Trinh Q-D, Leveridge M, et al. Engaging responsibly with social media: the BJUI guidelines. BJU Int 2014;114:9–11. doi:10.1111/bju.12788.

 

 

 

 

#pass4prostate gears up for Rugby World Cup

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Declan_theatre2Here is a fun campaign which should appeal to anyone interested in rugby or prostate cancer for that matter. The 2015 Rugby World Cup kicks off in England and Wales next month and as part of their warm up schedule, Australia are playing USA Rugby in a friendly match at Soldier Field in Chicago on the 5th of September. As part of their sponsorship of this fixture, Astellas are supporting a social media campaign called #pass4prostate which will directly raise funds for prostate cancer research in both the USA and Australia.

As part of their support, Astellas will donate $5 to prostate cancer research and advocacy organizations for every qualifying #pass4prostate submission posted to Twitter, Facebook, or Instagram, up to a maximum contribution of $125,000 in the USA and a further $40,000 in Australia. At socialboost you will get the best review of the instagram traffic boosting tools.  Therefore to make sure we maximize this commitment, we need to drive lots of traffic using the #pass4prostate hashtag! You can see examples of Australian and US rugby players supporting the campaign below by throwing around special blue rugby balls, but the campaign is encouraging people to make videos supporting the campaign and throwing anything blue around (in a rugby style of course!).

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The campaign will run up to the match on 5th September, and there be lots of activity at the 2nd Prostate Cancer World Congress which takes place in sunny Far North Queensland, Australia, from 17-21st August 2015. Follow #pcwc15 or #pass4prostate to get involved!


For full details, please visit the pass4prostate website.

 

Declan Murphy

Melbourne, Australia

@declangmurphy

 

Highlights from #BAUS15

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

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Monday 15th June 2015

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

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

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

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

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

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

 

Tuesday 16th June 2015

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

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

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

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

  •     ‘Heartsink Conditions’ included pelvic and testicular pain and a fascinating talk by Dr Gareth Greenslade highlighted the importance of early and motivational referral to pain management services once no cause has been established and our treatments have been exhausted. The patient’s recovery will only start once we have said no to further tests: ‘Fix the thinking’
  • Poster sessions are now presented as ‘e-posters’, abolishing the need to fiddle with those little pieces of Velcro and allowing for an interactive review of the posters.

 

Photo 22-06-2015 22 36 07Pravisha Ravindra from Nottingham demonstrated that compliance with periodic imaging of patients with asymptomatic small renal calculi (n=147) in primary care is poor, and indeed, these patients may be better managed with symptomatic imaging and re-referral as no patients required intervention based on radiograph changes alone.

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

 

Wednesday 17th June 2015

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

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

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

 

Thursday 18th June 2015

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

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

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

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

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

 

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

 

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Rebecca Tregunna, Urological Trainee, West Midlands Deanery @rebeccatregunna

 

Dominic Hodgson, Consultant Urologist, Portsmouth @hodgson_dominic

 

The Social Media Revolution in Chinese Urology

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12It is well known that Twitter, Facebook and YouTube, the most popular social media platforms available in the West, are not easily accessible in China. It is also clear that urologists in the West have embraced these social media platforms (Twitter in particular), not just for personal interaction, but also for professional engagement, and journals such as BJUI have enthusiastically encouraged the use of social media for urologists through their use of Twitter, blogging, YouTube etc.

So what then of Chinese urology? Are we missing out on all this? Not at all! In fact, as a recent BMJ blog observed, China is among the most heavily connected populations on earth, and the smartphone revolution has seen this connectivity grow very rapidly in recent years, more than in many Western countries. The lack of access to Western websites has just meant that a host of home-grown websites have cropped up to allow the insatiable appetite for connectivity to be met. Therefore sites such as RenRen (like Facebook), Sina Weibo (like Twitter), and Youku (like YouTube). The BMJ have blogged about this and have highlighted the huge volume of activity on Chinese social media sites.

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Figure from “Your quick guide to social media strategy in China”

At present, the most popular platform among Chinese urologists is WeChat. WeChat, (similar to WhatsApp), is connecting more than a half billion Chinese people now. Apart from free chat, video and voice call, group chat is perfect for professional online discussion. There are several major urological discussion groups. Each group has many hundreds of participants. It is estimated that more 3000 urologists (1/4) in China have been involved in one or more online discussion group. Earlier this month, Prof. Declan Murphy’s lecture slides were uploaded to our urology major discussion group after his presentation at the Asia Urology Prostate Cancer Forum in Shanghai.

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More than 2000 Chinese urologists (1/6) watched his slides on smartphones that weekend and shared feedback using the app. Prof Murphy, one of the world’s foremost leaders in social media, even joined WeChat and engaged in dialogue with the discussion group.

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At present, the top two most famous discussion groups are called scope art and Hippocrates group. A talented young urologist, Dr. QIan Zhang, set up scope art two years ago. More than 500 urologists from across the country were invited to join the group.  New knowledge, case discussion and meeting information can be arranged in the group. Recently, the Top 10 WeChat urologists has been selected thorough WeChat vote platform system. More than 20,000 WeChat users voted for their favorite social medial stars. Several discussion groups were built based on the different specialties (stone disease, andrology etc.). Several leading uro-oncologists, urologists, pathologists, radiologists and related experts also built an MDT discussion group to discuss interesting uro-oncology cases to help select the best options for patients.

We are now also seeing these online discussions develop a physical presence. Recently, a WeChat integrated Hippocrates urological meeting was held in Jiaxing. When each speaker starts to talk, the slides were uploaded to the WeChat discussion group, allowing the entire membership of the discussion group to attach their comments and questions during the presentation. All the questions and comments are projected to the separate screen in the meeting hall. The speaker can discuss with all the members, wherever they are.

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WeChat meeting in action in Jiaxing

As these examples demonstrate, social media significantly helps Chinese urologists communicate more effectively, especially in such a large country with a huge population. We are very keen to embrace these new communication platforms and to engage more with our colleagues in the West!

Dr. Wei Wang 

Consultant Urologist, Beijing Tongren Hospital, Capital Medical University, China

WeChat ID: medtrip

 

Give the pill, or not give the pill. SUSPEND tries to end the debate

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Christopher BayneJune 2015 #UROJC Summary

News of a landmark paper on medical expulsive therapy (MET) for ureteric colic swirled through the convention halls on the last day of the American Urological Association’s Annual Meeting in New Orleans, Louisiana. I watched the Twitter feeds evolve from my desk at home: the first tweets just mentioned the title, then the conclusion, followed by snippets about the abstract. As time passed and people had time to read the manuscript, discussion escalated. Without data to prove it, there seemed to be more Twitter chatter about the SUSPEND trial, even among conference attendees, than the actual AUA sessions.

Robert Pickard and Samuel McClinton’s group utilized a “real-world” study design to publish what many urologists consider to be the “best data” on MET. The study (SUSPEND) randomized 1167 participants with a single 1-10 mm calculi in the proximal, mid, or distal ureter across 24 UK hospitals to 1:1:1 MET with daily tamsulosin 0.4 mg, nifedipine 30 mg, or placebo. The study’s primary outcome was the need for intervention at 4 weeks after randomization. Secondary outcomes assessed via follow-up surveys were analgesic use, pain, and time to stone passage. Though the outcomes were evaluated at 4 weeks after randomization, patients were followed out to 12 weeks.

Some of the study design minutiae are worth specific mention before discussing the results and #urojc chat:

  • Treatment allotment was robustly blinded. Participants were handed 28 days of unmarked over-encapsulated medication by sources uninvolved in the remaining portions of the study
  • Medication compliance was not verified
  • The study protocol didn’t mandate additional imaging or tests at any point
  • Participants weren’t asked to strain their urine
  • Secondary outcomes assessed by follow-up surveys were incomplete: 62 and 49% of participants completed the 4- and 12-week questionnaires, respectively

The groups were well balanced, and the results were nullifying. A similar percentage of tamsulosin- , nifedipine-, and placebo-group patients did not require intervention (81%, 80%, and 80%, respectively). A similar percentage of tamsulosin-, nifedipine-, and placebo-group participants had interventions planned at 12 weeks (7%, 6%, and 8%). There were no differences in secondary outcomes, including stone passage. There was a trend toward significance for MET, specifically with tamsulosin, in women, calculi >5 mm, and calculi located in the lower ureter (see image taken from Figure 2).

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The authors concluded their paper was iron-clad with results that don’t need replication.

“Our judgment is that the results of our trial provide conclusive evidence that the effect of both tamsulosin and nifedipine in increasing the likelihood of stone passage as measured by the need for intervention is close to zero. Our trial results suggest that these drugs, with a 30-day cost of about US$20 (£13; €18), should not be offered to patients with ureteric colic managed expectantly, giving providers of health care an opportunity to reallocate resources elsewhere. The precision of our result, ruling out any clinically meaningful benefit, suggests that further trials involving these agents for increasing spontaneous stone passage rates will be futile. Additionally, subgroup analyses did not suggest any patient or stone characteristics predictive of benefit from MET.”

Much of the early discussion focused on the trend toward benefit for MET in cases of calculi >5 mm in the distal ureter:

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Journal Club participants raised eyebrows to the use of nifedipine and placebo medication in the trial:

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A few hours in, discussion shifted toward the study design, particularly the primary endpoint of absence of intervention at 4 weeks rather than stone passage or radiographic endpoints. The overall consensus was that that this study was a microcosm of “real world” patient care with direct implications for emergency physicians, primary physicians, and urologists.

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The $20 question (cost of 4 weeks of tamsulosin according to SUSPEND) is whether or not the trial will change urologists’ practice patterns. Perhaps not surprisingly, opinions differed between American and European urologists.

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We owe SUSPEND authors Robert Pickard and Sam McClinton special thanks for their availability during the discussion. In the end, the #urojc banter for June 2015 was the largest and most-interactive monthly installment of International Urology Journal Club to date.

June urojc 26Christopher Bayne is a PGY-4 urology resident at The George Washington University Hospital in Washington, DC and tweets @chrbayne.

 

The 3rd BJUI Social Media Awards – #AUA15 in New Orleans

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Murphy-2015-BJU_InternationalWhat a fun destination we had for the 3rd Annual BJUI Awards! As you may know, we alternate the occasion of these awards between the annual congresses of the American Urological Association (AUA) and of the European Association of Urology (EAU). Our first awards ceremony took place at the AUA in San Diego in 2013, followed last year in Stockholm at the EAU. This year, we descended on New Orleans, Louisiana to join the 16,000 or so other delegates attending the AUA Annual Meeting and to enjoy all that the “Big Easy” had to offer. What a fun city; a true melting pot of food, music and culture all borne out of the eclectic French, American and African cultures on show. I think I met more key opinion leaders in the clubs on Frenchman Street than I did in some of the prostate cancer poster sessions!

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You can read more about all that in our #AUA15 Conference Highlights blog, so on now to the Awards. The AUA Annual Meeting plays host to intense social media activity and it is fitting that the BJUI Social Media Awards gets to acknowledge the rapidly growing number of Uro-Twitterati in attendance. Over 100 of the most prominent tweeters turned up to the Ritz-Carlton to enjoy the hospitality of the BJUI and to hear who would be recognised in the 2015 BJUI Social Media Awards. Individuals and organisations were recognised across 16 categories including the top gong, The BJUI Social Media Award 2015, awarded to an individual, organization or innovation who has made an outstanding contribution to social media in urology in the preceding year. The 2013 Award was won by the outstanding Urology Match portal, followed in 2014 by Dr Stacy Loeb for her outstanding contributions.  This year our Awards Committee consisted of members of the BJUI Editorial Board (Declan Murphy, Prokar Dasgupta, Matt Bultitude as well as BJUI Managing Editor Scott Millar whose team in London drive the content across our social platforms).

 

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The full list of awardees, along with some examples of “best practice” in the urology social media sphere can be found on this Prezi. The winners are also listed here:

 

  • Most Read Blog@BJUI – “Are you ready to go to prison on a manslaughter charge?”. Accepted by Dr Ben Challacombe, on behalf of Prof Roger Kirby, London, UK
  • Most Commented Blog@BJUI – “Prof John Fitzpatrick – Life in the Fast Lane”. Accepted by Dr Ben Challacombe, on behalf of Prof Roger Kirby, London, UK
  • Best Blog Comment – Dr Brian Stork, Michigan, USA
  • Best BJUI Tube Video – Hospital volume and conditional 90 day post-cystectomy mortality. – accepted by Dr Angie Smith on behalf of Dr Matt Neilsen, North Carolina, USA.
  • Best Urology Conference for Social Media – SIU Annual Congress, Glasgow 2014. Accepted by Dr Sanjay Kulkarni on behalf of the SIU
  • Best Social Media Campaign – Dr Ben Davies, Pittsburgh, USA, for highlighting industry issues around BCG shortage
  • “Did You Really Tweet That” Award – Ben Davies, Pittsburgh, USA (three years running!)
  • Best Urology App – The Rotterdam Prostate Cancer Risk Calculator. Accepted by Dr Stacy Loeb on behalf of Dr Monique Roobol, ERSPC, Rotterdam, The Netherlands
  • Innovation Award 2015 – #eauguidelines. Accepted by EAU Guidelines panellists Dr Stacy Loeb and Dr Morgan Roupret, on behalf of Dr James N’Dow, Dr Maria Ribal, and the EAU Guidelines Committee.
  • #UroJC Award – David Canes, Boston, USA
  • Best Selfie – Morgan Rouprêt, Paris, France
  • Best Urology Facebook Site – European Association of Urology. Accepted by Dr Alex Kutikov, Digital Media Editor, European Urology
  • Best Urology Journal for Social Media – Nature Reviews Urology. Accepted by Editor-in-Chief, Annette Fenner
  • Best Urology Organisation – American Urological Association. Accepted by Taylor Titus, AUA Communications Office
  • The BJUI Social Media Award 2015 – International Urology Journal Club #urojc. Accepted by Dr Henry Woo, Sydney, Australia.

 

Most of the Award winners were present to collect their awards themselves, including the omnipresent Dr Henry Woo who received our top gong for his work on the very successful International Urology Journal Club #urojc. The #urojc now has over 3000 followers and its monthly, asynchronous 48hr global journal club has become a huge event. Many other specialties and #FOAMed resources have recognised #urojc and BJUI are delighted to publish a blog summarising each month’s discussions. Well done to Henry, Mike Leveridge and others in setting and maintaining this outstanding example of social media adding real value.

A special thanks to our outstanding BJUI team at BJUI in London, Scott Millar and Max Cobb, who manage our social media and website activity as well as the day-to-day running of our busy journal.

See you all in Munich for #EAU16 where we will present the 4th BJUI Social Media Awards ceremony!

Declan Murphy

Associate Editor for Social Media at BJUI. Urologist in Melbourne, Australia

Follow Declan on Twitter @declangmurphy and BJUI @BJUIjournal

 

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