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Bringing Out the Best: 69th USANZ ASM Highlights

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

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

drummingensemble_smA drumming ensemble lead delegates to the Welcome Reception

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

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

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

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


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

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

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

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

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

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

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

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

galadinner2_smThe Gala Dinner – the social highlight of the USANZ ASM

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

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

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

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

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

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

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

 

 

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

 

 

The professional benefits of USANZ trainee week 2015

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sanchia photoI landed on a bright sunny Brisbane morning for the Urological Society of Australia and New Zealand (USANZ) Trainee Week 2015 – an annual, 5 day, comprehensive, bi-national conference specifically for trainees.  I have much to be grateful for including sponsorship from BAUS, TUF, USANZ and SURG. All these organisations had realised international organisation inter-working is required to foster a higher level of teaching for trainees.

Later that day, I had opportunities to meet trainees from all over Australia and New Zealand (ANZ). The quality of training given is truly remarkable. When looked at in detail, the ANZ system focuses on general surgery training initially, prior to moving to urology as a separate speciality. The result of this are that they are superb open surgeons. This is often a dying art and difficult to gain.

Our first day started with a chance to observe mock FRACS stations. The standard of the candidates was incredibly high, despite it being a mock exam. As part of this, an overview of the FRACS exam was given by one of the FRACS senior examiners, Mr. Neil Smith. The day concluded with meetings of trainees for each region within ANZ – again another fantastic way to support the trainees. I have never seen anything quite like this. This also ensures trainees are receiving adequate training as concerns and issues are relayed directly to the training board chair. The evening concluded with a Welcome reception and barbeque at Brisbane Surf club.

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The next day started with a series of lectures on bladder cancer, led by Mr Shomik Sengupta (Melbourne) and Mr. Roger Watson (Brisbane). There were many learning points for trainees to take away, including case based management discussions, role of cystoprostatectomy and role of bladder preservation (Dr Tanya Holt, Brisbane).

Also covered were the roles of neoadjuvant vs adjuvant chemotherapy, (Dr. Niara Oliveira, Brisbane), the pros and cons of urinary diversion (Dr. Sarah Azer), and LND (Dr. Jonathan Chambers, Brisbane).  After lunch the most amazing teaching was given on uro radiology, with a focus on nuclear medicine and also on pathology. The FRACS exam is very different from any other end of training exam, as there will be both radiology and pathology stations.

The next day dawned bright and early, with a whole morning of paediatric urology.  I can think of many registrars, who would love a whole morning of teaching on this subject- it is not often easy to get access to paediatric urology.  Testicular embryology and maldescent were very nicely covered by Mr. Peter Borzi, (Brisbane). Both normal and abnormal conditions were discussed including reasons for orchidopexy with maldescent. Former USANZ President, David Winkle then spoke on translation care. Mr Pete McTaggart, then covered Adolescent voiding dysfunction, a profoundly difficult subject to manage, given the age of the patient and the disease involved.

The next focus was on the adrenal including functions of the adrenal, management of the adrenal mass and investigations and phaeochromocytoma. This again, is another area, which is not often covered or encountered in clinical practice.

The morning concluded with a Board of Urology update addressed by Mr Richard Grills, Board Chair, covering the training programme for urologists. Also covered were training policies and involvement of RACS in governing this. Most impressively, USANZ has negotiated membership for all of its’ trainees with EAU, SIU and AUA. A good step forward regarding international working and fellowship.

The next day started with a breakfast meeting, on how to pass the FRACS exam. This session was chaired by Dr. Matt Winter. Big congratulations also went out to Dr. Tim Smith, who had had a baby the day before and still attended to teach. Topics covered were perspectives of preparing emotionally, physically, and psychologically. This recognised how difficult it can be to prepare. All tips and tricks were given by former trainees, who had passed the exam. Further mock practice also occurred, being taken through a pathology exam.

A whole session was dedicated to renal cancer covering topics such as active surveillance, partial and radical nephrectomy, RFA and cryotherapy. A really fantastic lecture was given by Mr. Simon Wood on management of RCC and cyotreductive nephrectomy, followed by oncological management of metastatic RCC. This is an area, which unless you are in a renal fellowship, may not see.

The next session involved teaching on upper tract and transplant. This was absolutely brilliant at covering donor assessment, management of transplant ureter and assessment of renal function and prognosis. Unless a transplant job were done, this knowledge would not be gained.  All of this contributes to making a far better surgeon.

The afternoon focused on mastering difficult interactions with colleagues. Lastly, the day ended, with case based discussions, focused on FRACS viva practice. After having gone through that, I have a greater respect for all candidates going through post graduate exams. The evening was completed by a lovely boat ride through Brisbane and farewell dinner.

2The next day, started with a bang, with Prof Samaratunga (Brisbane) talking on prostate grading. It is wonderful to have a lady professor. It shows the forward thinking of the Australia medical field, clearly ahead of others. Next, very valuable teaching was received from Dr. Peter Swindle (Brisbane). This was followed by teaching on PSA screening by Dr John Yaxley (Brisbane).  PSMA PET was then covered by Dr. Rob Clarke (Brisbane), and its role in detection of prostate cancer. A fantastic presentation on management of elevated PSA was covered via a balloon debate- much loved by all and a different way of learning.

The conference ended with a quiz- Masters of the Uroverse. Teams from different regions of Australia battled it out for the title. It ended the conference is a very fun and unusual way. After having been to this meeting, my knowledge base has grown.

Our thanks go to Ms. Deborah Klein, the star organiser who is Education and Training Manager of USANZ, the Convener Mr. Stuart Philip and Mr. Richard Grills Chair, Board of Urology for hosting a thoroughly enjoyable event. Also to all the trainees and consultants who made us incredibly welcome.

 

Sanchia Goonewardene, University of Warwick, UK. @survivorshipuk

 

Future Proofing Urology – Conference Highlights from the USANZ ASM 2014

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Dr Marnique Basto (@DrMarniqueB) 

 

 

Delegates of #USANZ14 received a sunny welcome at this year’s 67th annual scientific meeting in Brisbane, affectionately coined by Aussies as ‘Bris-vegas’ attributed to a love of Elvis and the city’s growing live music scene. The reins were passed from Professor Damien Bolton and A/Professor Nathan Lawrentschuk (@lawrentschuk) who convened last year’s ASM in Melbourne to Greg Malone (@DrGregJMal) and Eric Chung. @BJUIjournal Editor-in-chief Prokar Dasgupta (@prokarurol) praised the USANZ organising committee for their tremendous hospitality.

A star studded international faculty made the long-haul down under including Shahrokh Shariat, Alan Partin, Gerry Andriole, James Eastham, Rainy Umbas, Per-Anders Abrahamsson, Monique Roobol, Hein Van Poppel, Jean de la Rosette, Gerald Brock, Brad Leibovich, Gary Lemack, Tom Lue, Jonathan Coleman, Michael Jewett, Oliver Traxer, Eric Small, Adrian Joyce, Roger Kirby, Gopal Badlani, Sunil Shroff, Eila Skinner, Jaspreet Sandhu, Matthew Rettig, Pilar Laguna, Jaime Landman, Irwin Goldstein, Todd Morgan and Gregor Goldner.

The hype around #USANZ14, however, had kicked off well before conference doors opened with @USANZUrology mounting the largest pre-conference social media (SoMe) campaign of any Urology conference internationally to date. Over 200 tweets were generated in the five-day lead-up from the @Urologymeeting account, doubling last year’s efforts of the social media team at the Prostate Cancer World Congress in Melbourne. It’s fair to say Australia is setting a blazing pace in the use of SoMe to amplify the Urology conference experience and generate international engagement and global reach.

“Future proofing urology” was the conference theme this year to promote and foster multidisciplinary collegiality and evidenced urological practice. The theme was entwined throughout the four-day conference with the final day showcasing a multidisciplinary forum with international experts discussing complex cases. Additionally the Australian and New Zealand Urological Trials (@ANZUPtrials) session highlighted the interplay between urology, radiation and medical oncology and the current trials underway. 

USANZ president David Winkle officially opened conference proceedings and we had the honour of Scottish-born Australian Scientist Professor Ian Frazer AC, the mastermind behind the Human Papilloma Virus vaccine and the fight against cervical cancer, deliver the Harry Harris oration. Professor Frazer’s ongoing dedication to implementing vaccination programs in low GDP countries such as Vanuatu and Butan was truly inspirational. Harry Harris was the first full time Urology specialist in Australia, and suitably the award of the seven newest fellows of the USANZ collegiate followed. Congratulations to all.

A lively point-counterpoint debate on the viability of prostate cancer prevention then ensued between Shahrokh Shariat (@DrShariat) on the negative and Gerald Andriole (@uropro) on the affirmative. Interestingly both parties used the same sets of data to reach opposite conclusions. The ability to use the opposition’s prior publications against them became the clincher in several of the debates throughout the conference; however, it was the ‘no show’ of hands from the audience when asked “who currently uses chemoprevention?” that reinforced the inevitable conclusion.

The BJUI session was then underway and A/Prof Nathan Lawrentschuk, Associate Editor of the BJUI USANZ supplement, outlined his vision for the journal going forward. The winner of the BJUI Global Prize awarded to a trainee who significantly contributed to the best international article went to Dr. Ghalip Lidawi for his paper titled ‘High detection rate of significant prostate tumours in anterior zones using transperineal template saturation biopsy’. In an Oscar-style award ceremony Dr Lidawi was broadcast from Tel Aviv. Professor Alan Partin (@alan_partin) went on to deliver a brilliant and balanced rationale behind why Gleason 6 IS prostate cancer and potentially coined the alternative name PENIS (‘Prostatic epithelial neoplasm of indeterminate significance’).  News of ‘PENIS of the prostate’ hit social media channels instantly with Urologists chiming in from the US to give their opinion within minutes and before Dr Partin had even stepped down from the podium.

Dr. Ghalip Lidawi accepting his BJUI Global Prize via video message (photo courtesy of Imogen Patterson).

After the opening plenary each morning, the 950 delegates were treated to a range of concurrent sessions from the faculty, which included localised prostate cancer, endourology, andrology/prostheses, high risk prostate cancer, LUTS/BPH, prostate cancer multidisciplinary forum, urology general, bladder cancer, kidney cancer and abstract poster presentations. There was a concurrent nursing program also running during the USANZ schedule that proves year after year to be a huge success.

A stand out session of the meeting was on high-risk prostate cancer section on Monday afternoon. Professor James Eastham (who is rumoured to have just joined twitter!) discussed the role of pelvic lymph node dissection (PLND) for diagnostic and therapeutic purposes with reference to the Memorial Sloan Kettering (MSK) experience and the role of salvage PLND after radical prostatectomy for choline PET detected retroperitoneal or pelvic node recurrence. Professor Hein van Poppel went on to support the role of surgery in high-risk disease in this session, while Drs Shariat and Per Anders Abrahamsson discussed the latest in hormonal adjuvant therapy. 

What makes USANZ special?

The abstract submissions this meeting far superseded last year in volume and quality requiring two concurrent poster presentation sessions running most of the conference. The use of transperineal template biopsy was a prominent theme again in the abstract series, as was active surveillance for low risk prostate cancer. Pleasingly we saw the development of large international collaborations involving Australia such as the Vattikuti Global Quality Initiative on Robotic Urologic Surgery where Mr Daniel Moon has collaborated with nine hospitals throughout Europe, North America and India on their growing robotic partial nephrectomy series. 

Each year a select group of our young talented trainees compete for the prestigious Keith Kirkland (KK) clinical and Villis Marshall (VM) basic science prizes. This year Dr Kenny Rao (@DrKennyRao) was awarded the VM prize from a field of five candidates for his work titled ‘Zinc preconditioning protects the rat kidney against ischaemic injury’. Dr Helen Nicholson (@DrHLN) took out the KK prize over 10 other candidates for her work; ‘Does the timing of intraoperative non-steroidal anti-inflammatory analgesia affect pain outcomes in ureteroscopy? A prospective, single-blinded, randomised controlled trial’. These were awarded at the gala ball located at the Brisbane townhall, a venue soon to be filled by some of the most prominent in the world for the G20 summit. Other awards on the night included the Alban Gee for best poster to Shomik Sengupta (@shomik_s), the BAUS trophy (@BAUSUrology) to Michael Holmes and the Abbvie Platinum award to Niall Corcoran.

Unlike any other Urology meetings worldwide, the USANZ ASM is compulsory for all trainees from their third year on and is encouraged in the first two years. Trainees were treated to a breakfast meeting with Dr Shahrokh Shariat who imparted 14 career tips and then assisted @lawrentschuk in grilling trainees on difficult case studies in preparation for their fellowship exams. A brilliant learning opportunity! Trainees also got to meet one-on-one with international faculty members of their choice to facilitate potential future fellowships in somewhat of a staged ‘speed-dating’ affair – 10 minutes chat, then move on. To top off the trainee program, the @BJUIjournal delivered an extremely practical and useful workshop focussed on getting published in the digital and social media era where blogs are encouraged, tweets are citable and your CV now contains a social media section.

A SoMe session attracted a lot of attention from international delegates and twitter activity on the #USANZ14 hashtag skyrocketed as we were joined by Stacy Loeb (@LoebStacy) in Moscow, Alexander Kutikov (@uretericbud) in the US and Rajiv Singal (@DrRKSingal) in Canada. Declan Murphy (@declangmurphy), Henry Woo (@DrHWoo) and Todd Morgan (@wandering_gu) put on a masterful (and non-nauseating) prezi display with the audience taken on an e-health journey of novel gadgets and devices including one that measured tumescence and sends the file automatically to the physician records. The possibilities are endless! Twitter boards were back in force; a sign of a quality and successful conference according to @declangmurphy. The wifi at the conference venue could not be faulted!

Controversial areas of SoMe were also broached including the APRAH Advertising Guidelines that came into effect this week, Monday March 17. Australian Plastic surgeon Jill Tomlinson (@jilltomlinson) has actively opposed the guidelines that will see physicians responsible for all testimonials associated with them on the internet. The policy mandates this information be removed otherwise a fine of up to $5000 is possible, many feel this places an unreasonable burden on health practitioners to be responsible for content that they may potentially be unaware of. Read Jill Tomlinson’s letter to APRAH here.

The @BJUIJournal and its editors @prokarurol, @lawrentschuk, @declangmurphy and @alan_partin (left to right below) and off screen @drHwoo were prominent SoMe influencers of the meeting two years running. We were also delighted to have Mike Leveridge (@_theurologist) from Canada attending, one of the pioneering uro-twitterati. A mention goes out to fellow countryman @drrksingal who was again mistaken for being at the conference due to his strong SoMe presence from afar. The twitter activity for the conference period March 16 (00:00) to March 19 (23:59) generated nearly 1.4 million impressions and 2,326 tweets or approximately 344K impressions and 581 tweets per day. Based on the study conducted by our team examining metrics of all eight major urological conferences of 2013, #USANZ14 would comparatively rate second only to the AUA in the international engagement and global reach attained. Congratulations to @USANZUrology and @Urologymeeting for enhancing our conference experience and sending our message out to almost 1.4 million potential viewers in just a 4-day period. 

The BJUI Workshop featured Editor-in-Chief Prokar Dasgupta and Associate Editors Nathan Lawrentschuk, Declan Murphy and Alan Partin.

In 2015 we take a trip to Adelaide for the 68th Annual Scientific Meeting of USANZ with experts already confirmed including Steven Kaplan, Martin Koyle, Morgan Rupert, Matthew Cooperberg and Glenn Preminger. See you all there!

 

Dr Marnique Basto (@DrMarniqueB) is a USANZ trainee from Victoria who has recently completed a Masters of Surgery in the health economics of robotic surgery and has an interest in SoMe in Urology.

Check out the new BJUI Instagram feed for more photos from #usanz14 www.instagram.com/bjui_journal

 

 

USANZ 2014 Video Abstracts

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67th USANZ Annual Scientific Meeting, Brisbane, 16-19 March 2014

[accordion]

LUTS / BPH

[acc_item title=”Robot-assisted simple prostatectomy – initial clinical experience‘ label=’
S. LESLIE*, N. AHMADI*, K. HART*, N.N. JEFFERY*, P. SVED*, A. VASILARAS*, J. WONG*, D.R. EISINGER*, J. BOULAS* and M. ARON†
*Royal Prince Alfred Hospital, Department of Urology, Sydney, Australia; †University of Southern California, Institute of Urology, USA

[/acc_item]

Oncology

[acc_item title=”Submucosal contrast injection to facilitate image-guided delivery of external beam radiotherapy post-prostatectomy – a pilot study‘ label=’
S. SENGUPTA*,†, D.L. JOON‡, N. LAWRENTSCHUK*,† and D. BOLTON*,†
*Department of Urology, Austin health, Heidelberg, Australia ; †Austin Department of Surgery, University of Melbourne, Australia; ‡Department of Radiation oncology, Austin health, Heidelberg, Australia

)[/acc_item]

Other

[acc_item title=”LESS left simple nephrectomy‘ label=’
G. MIRMILSTEIN, A. RUTLEDGE and A. TIU
Department of Urology, Royal Newcastle Centre, Newcastle, Australia

[/acc_item]

[acc_item title=”LESS right upper pole moiety nephrectomy‘ label=’
A. RUTLEDGE, G. MIRMILSTEIN and A. TIU
Department of Urology, Royal Newcastle Centre, Newcastle, Australia

[/acc_item]

[acc_item title=”Transperineal biopsy streamlined‘ label=’
J. GRUMMET*,† , S. MANN† , H. GRUMMET† and D. MURPHY*
*Epworth Healthcare, Melbourne; †Australian Urology Associates, Melbourne

[/acc_item]

Prosthesis Urology

[acc_item title=”‘How I do it’ – the Minimally Invasive No Touch (MINT) penile implant‘ label=’
C. LOVE*,† and D. KATZ*
*Men’s Health Melbourne, Melbourne, Australia; †Bayside Urology, Melbourne, Australia

[/acc_item]

Reconstructive Urology/Transplant

[acc_item title=”Endoscopic Young-Dees incision for recurrent bladder neck stenosis after radical prostatectomy‘ label=’
V. TSE* and J. WONG†
*Concord Hospital, University of Sydney, Sydney, Australia; †Royal Prince Alfred Hospital, Sydney, Australia

[/acc_item]

Uro-oncology

[acc_item title=”Laparoscopic left partial nephrectomy in morbid obesity‘ label=’
A. RUTLEDGE , G. MIRMILSTEIN and A. TIU
Department of Urology, Royal Newcastle Centre, Newcastle, Australia

[/acc_item]

[/accordion]

 

Radiation within urology: challenges and triumphs

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As gatekeepers urologists remain at the frontline of urological oncology in a position of trust that they have held since Charles Huggins, Nobel Laureate in Urology, pioneered the use of hormone manipulation to treat prostate cancer. However, radiation within urology is an important adjunctive, palliative and even primary treatment method for many urological malignancies. However, within many spheres, particularly internationally regarding prostate cancer, tensions appear to have been simmering between urologists and radiation oncologists. Fortunately, this does not appear to be the case in Australia and New Zealand but it is an important time to reflect on such issues as we move ever forward in the multimodality era.

In the USA the use of self-referral by urologists of men for adjuvant radiotherapy (RT) has come under scrutiny. Some urology groups have integrated intensity modulated RT (IMRT), a RT treatment carrying a high reimbursement rate, into their practice. This was highlighted in a recent New England Journal of Medicine article where the rate of IMRT use by urologists working at National Comprehensive Cancer Network centres remained stable at 8% but increased by 33% among matched self-referring urology groups [1]. This study has been criticised for bias but nonetheless captured political and academic attention. Certainly this situation has not arisen in our hemisphere but it remains important we think critically of what treatments we offer our patients and ensure patient’s best interests are maintained.

Clearly more research is required as to who should be receiving adjuvant RT and at what stage. In the latest issue of the BJUI USANZ supplement we highlight the Radiotherapy – Adjuvant vs Early Salvage (RAVES) trial for prostate cancer biochemical failure and high-risk disease [2]. There is no doubt this is an important trial because to date we have been unable to establish exactly which patients should receive adjuvant RT and when. Recruitment has been challenging as patients doing well after surgery often do not want additional treatment and a very small subset who are still recovering want to be enrolled but due to timing missing eligibility. Enthusiastic patients also may demand treatment rather than be randomised. Critics would also argue that the trial can never really answer the question because many men not requiring adjuvant RT will receive it [3]. Ongoing support of all parties should achieve accrual and in time, robust data. Excitingly imaging with MRI and other modalities will ensure further trials to assist in identifying disease in the salvage setting making choices easier based on more objective data [4].

 

Read the USANZ Supplement

Consumerism has driven robotic surgery [5] and is doing the same for RT but descriptions of treatment would be better placed to remain generic. The use of the term ‘radiosurgery’ has highlighted the shift away from the term ‘radical radiotherapy’. Of course the term ‘robot’ has become synonymous with radical prostatectomy but the ‘radical’ contribution remains and interestingly the term ‘robot’ has been trialled by radiotherapists: ‘image-guided robotic radiosurgery’ or its other more commonly used term Cyberknife® (Accuracy Incorporated, Sunnyvale, CA, USA). Certainly this would be more accurately known as stereotactic body RT (SBRT). It is these terminology changes and continual shifts in treatment regimens that rankles many, with the old argument that RT treatment was done with inferior technology so results should be ignored receives disproportionate use at conferences. All groups need to acknowledge treatments have improved rather than disowning data from older treatment regimes. On the counter side one example from brachytherapy [6] concluded that despite the hype of improving dosimetry and reducing complications, the preoperative condition regarding erectile function and LUTS are the most important factors regarding postoperative outcome. This is almost certainly true for surgery as well. Comparison of side-effects appears unfair with grading of radiation toxicities more lenient than Clavien listed complications – an even playing field for comparison of complications is warranted.

Multimodality treatment for high-risk disease is becoming the standard of care. Urologists are beginning to embrace this regime of planned surgery with likely RT and ultimately systemic therapies. However, radiation oncologists often prefer to use radiation and hormonal manipulation and consider this ‘modified monotherapy’. Some men receive different modes of RT with concerns this leads to significantly more complications and in combination with androgen deprivation comes with all of the secondary effects of such therapy. An ideal study for such high-risk patients would randomise men to RT and androgen deprivation vs a graded multimodality treatment starting with surgery and then progressing to RT and systemic therapies when required (as some men will have T2 or T3a disease with clear margins that can be observed for a PSA rise necessitating treatment).

Complications do develop after any therapy and urologists are expertly placed to deal with them. Yet, there is a belief that RT and its long-term effects are real and these are often underplayed. This is contributed by a paucity of follow-up data beyond 5 years with primary RT. Major problems from surgery are generally able to be repatriated. However, the same may not be stated for RT complications: cystitis, stricture disease, permanent catheter drainage and chronic pain syndromes although uncommon, are not rare events and not easily remedied due to the altered tissues. Urologists are able to assist with these conditions but some feel that their efforts are unrecognised and that they share too much of the burden from somewhat surprised patients when situations are not able to be satisfactorily resolved. This reinforces the involvement by enthusiastic urologists with the patient selection and follow-up of brachytherapy and even other RT treatments being the cornerstone for ideal patient management and success.

Other areas worthy of engagement are with patients who develop a recurrence after RT treatment where the available data are sparse, making a decision even more difficult [3]. The perceived reluctance to refer RT failures to urologists in a timely fashion meaning many men are not offered salvage surgery or other options [7]. Occasionally urologists do the same with surgical failures but with multi-disciplinary teams, this is a rare event.

Communication remains a key to a multidisciplinary approach. Against the successes and strains, there are newer developments that will conspire to bring teams closer together, such as newer systemic therapies and the consideration of RT in men with oligometastatic disease. Also, based on Surveillance, Epidemiology and End Results (SEER) data, it appears that patients with limited metastatic disease may benefit from having treatment of the primary disease with a significant decrease in mortality (slightly more pronounced with surgery than radiation) [8]. This will ensure further debate on how far we stretch our primary treatment boundaries for the betterment of patients. Finally, use of fiducial markers and spacers will hopefully minimise morbidity and these are discussed in this supplement [9].

Just like any long-term relationship, the balance will shift at times and there has to be give and take on both sides. Many of the points in this editorial could be switched the other way with urologists at fault, so we must always be careful to be global, and not focal in our approaches. With everyone working together we have improved outcomes and survival of many with many urological malignancies. Overall, there is still harmony but room for even greater communication and collaboration as we strive towards better outcomes in future decades.

Nathan Lawrentschuk
University of Melbourne, Department of Surgery and Ludwig Institute for Cancer Research, Austin Hospital and Peter MacCallum Cancer Centre, Department of Surgical Oncology, Melbourne, VIC, Australia

Read the USANZ Supplement

References

  1. Mitchell JM. Urologists’ use of intensity-modulated radiation therapy for prostate cancer. N Engl J Med 2013; 369: 1629–1637
  2. Pearse M, Fraser-Browne C, Davis ID et al. A Phase III trial to investigate the timing of radiotherapy for prostate cancer with high-risk features: background and rationale of the Radiotherapy – adjuvant versus Early Salvage (RAVES) trial. BJU Int 2014; 113: 7–12
  3. Chen RC. Making individualized decisions in the midst of uncertainties: the case of prostate cancer and biochemical recurrence. Eur Urol 2013; 64: 916–919
  4. Thompson J, Lawrentschuk N, Frydenberg M, Thompson L, Stricker P. The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int 2013; 112 (Suppl. 2): 6–20
  5. Alkhateeb S, Lawrentschuk N. Consumerism and its impact on robotic-assisted radical prostatectomy. BJU Int 2011; 108:1874–1878
  6. Meyer A, Wassermann J, Warszawski-Baumann A et al. Segmental dosimetry, toxicity and long-term outcome in patients with prostate cancer treated with permanent seed implants. BJU Int 2013; 111: 897–904
  7. de Castro Abreu AL, Bahn D, Leslie S et al. Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy. BJU Int 2013; 112: 298–307
  8. Cheng J. Would you really do a radical prostatectomy on a man with known metastatic prostate cancer? BJU Int BLOG posted 09 December 2013. Available at: https://www.bjuinternational.com/bjui-blog/would-you-really-do-a-radical-prostatectomy-on-a-man-with-known-metastatic-prostate-cancer/. Accessed January 2014
  9. Ng M, Brown E, Williams A, Chao M, Lawrentschuk N, Chee R. Fiducial markers and spacers in prostate radiotherapy: current applications. BJU Int 2014; 113: 13–20
 

Blog report from USANZ ASM, Melbourne

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Dr Marni Basto & Dr Sarah Wilkinson

G’day from the Annual Scientific Meeting of the Urological Society of Australia & New Zealand, easily identified globally this week using its hashtag, #USANZ13. This year’s meeting has taken place in Melbourne – the city of lane-way lattes, sport, lifestyle and culinary delights!  It has certainly been a jam-packed four days of academic content led by a stellar International Faculty – 23 key opinion leaders from every corner of the globe covering every aspect of urology. Almost 1000 delegates were registered and were joined by an additional 250 delegates from the Asia Pacific Prostate Society who convened their 3rd Annual Scientific Meeting as a conjoined event. There were a lot of urologists in Melbourne!

This year’s Annual Scientific Meeting convened by Professor Damien Bolton and Associate Professor Nathan Lawrentschuk (@Lawrentschuk) kicked off with an emotional Oration by Moira Kelley discussing her inspiring work with Mother Teresa and flying sick children to Western countries to undergo lifesaving medical treatment.  Tears were soon dried however as USANZ acknowledged Professor Anthony Mundy with an honorary membership for his profound achievements and long association with USANZ. The welcome reception provided a great opportunity for delegates to mingle and try the rich assortment of wines Australia has to offer.

Visiting American Professor James Eastham was full of praise for the manner in which approximately 1 in 6 men in Australia and New Zealand are managed by active surveillance compared to around 10% of eligible patients in the US.  Professor Eastham from Memorial Sloan Kettering Cancer Centre in New York went to press saying “Australia and New Zealand are among the best places in the world to be diagnosed with prostate cancer”.

Certainly active surveillance, focal therapy and the use of MRI in prostate cancer were hot topics of debate throughout the meet.  Prof Eastham’s was not alone in his reservations for focal therapy stating his view that “it should be considered experimental”.  Others on the International faculty such as Professor Mark Emberton argued in its defence in the appropriate setting. Dr Emberton also delivered the BJUI Lecture on “Best practice in prostate cancer imaging”. Other BJUI highlights included Editor-in-Chief Prof Prokar Dasgupta who delivered a wonderful overview of the “Scientific Advances in Robotic Surgery” as well as delivering some excellent tips for how to get published during the Surgical Authorship session. This very well attended session also featured Dr Annette Fenner, Editor-in-Chief of Nature Reviews Urology (and a prolific tweeter), who gave a masterful overview of how to write a review paper. BJUI Chairman Dr David Quinlan, challenged our assumptions by asking “Are men pursuing sexual function following radical prostatectomy”. Professor Dasgupta also announced the inaugural BJUI Global Prize Winner, accepted by Dr Yen-Chuan Ou.

The @BJUIJournal and its editors @prokarurol, @declangmurphy & @drhwoo were once again leading influencers throughout this year’s meeting showing form consistent with #EAU13 depicted by the metrics supplied by Symplur (@healthhashtags).  Around 135 participants got involved in the #USANZ13 discussion including many from around the world who joined the conversation.

A special mention to Toronto’s Dr Rajiv Singal (@drrksingal) who even made the list of top 10 influencers! And to our many other Twitter-mates who joined the conversation from all over the world.

It is safe to say social media, or what the Urology twitterati refer to as ‘SoMe’, has now cemented a definitive and purposeful place in engaging and reaching out to the International Urology community.  @Urologymeeting was the official handle with tweets also coming from the primary @USANZUrology official account.  The #USANZ13 hashtag was an obvious option and it appears despite last year’s AUA meeting hashtag controversy with the use of #Uro12 instead of #AUA12, we have now firmly set the hashtags for Urology meets around the world; #EAU13, #USANZ13, #AUA13, #BAUS13, #ERUS13, #ACU13 etc.

A select group of our young talented research and clinical registrars were challenged at the podium battling for the prestigious Keith Kirkland and Villis Marshall prizes.  These were awarded to Dr Isaac Thyer and Dr Sandra Elmer respectively at the Gala evening.  Located at the elegant Grand Ball Room at the Regent Theatre, the Gala evening was certainly an event to behold.  Professor Stephen Ruthven, current President of USANZ handed over the reins to Dr David Winkle who will hold the post for the next two years.

For the first time a dedicated “Social Media & Education” session was chaired by @declangmurphy and @drhwoo with presentations from some of the well known Aussie Uro-twitterati; @isaacthagasamy, and @wilko3040. The SoMe session saw our session chairs with their heads deep in their computers, ipads and iphones creating traffic Internationally with the USA, Canada, the UK and mainland Europe, while monitoring the Tweetchat stream. This traffic generated the largest peak of the conference as seen in the tweet activity graph with close to 400 tweets in the hour.

BJUI Associate Editor Declan Murphy wowed the crowd by abandoning Powerpoint in favour of Prezi to showcase the social media landscape. By way of emphasis, he demonstrated the utility of social media by Tweeting a link to his Prezi which at the time of writing had been viewed by well over 200 people (most from outside Australia). Social media revolution!

We are already looking forward to USANZ 2014 which will take place in Brisbane from 16-19th March 2014. Put the date in your diary – fun to follow on social media but much better in real life!

 

Marni Basto is  a Uro-Oncology Research Fellow at Peter MacCallum Cancer Centre, Melbourne, Australia

Twitter: @Dr MarniqueB

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

Twitter: @wilko3040

 

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