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European Urology Today

Official newsletter of the European Association of Urology Volume 20 - No. 4 August/September 2008
Do multivitamins promote PCa? The Swiss experience Predictive modelling in PCa
Findings of increased incidence in PCa elicit First in a series on the day-to-day practice of Venice meeting discusses current trends in

8 further study
Dr. Cyrill Rentsch 17 private practice urologists
Prof. Hans-Peter Schmid 37 predictive modelling research
Dr. Riccardo Valdagni

Europe remains in EAU’s core mission and strategy


Nurturing a European role is crucial amidst ‘global’ tendencies
By Joel Vega nurses and residents associations; relations between Relevance of regional meetings Jacqmin also noted in his concluding remarks that
urologists and the industry; the scope or coverage of Another point of discussion was the relevance of regional meetings serve as an effective venue for the
Nurturing a European role must remain in the core the upcoming Urology Week; and identifying an regional meetings. Although the views on regional EAU to identify promising young urologists and
mission of the European Association of Urology (EAU) effective strategy concerning patient support groups. meetings were mixed, there was a general agreement potential opinion leaders, but added that the EAU
in the face of a gradual shift to a more outward- that Eastern European countries have a greater need needs to further refine the current set of rules to
looking stance within the organisation. This was one Regarding the pursuit of a global role for the EAU, the for regional meetings compared with Northern and
of the general sentiments expressed by participants consensus among the various societies showed that Western Europe. Continued on page 2
during the two-day annual EAU meeting with reaching out to countries outside Europe is not only
national urological societies held last June in inevitable but also beneficial for the EAU to achieve
Barcelona. their goals and plans that fulfil the group’s
international ambitions. However, the participants
Led by Prof. Didier Jacqmin, Chair of the EAU’s also pointed out that the “advantages and benefits of
International Relations Office, representatives from 24 new (inter-national) collaborations should be mutual”
national urological societies met with the EAU’s and should not distract the EAU from strengthening
Executive Committee composed of Professors collaborations with its European partners.
Per-Anders Abrahamsson, Walter Artibani, Chris
Chapple and Manfred Wirth. Also present in the “The EAU should continue to mainly focus on
meeting were Helmut Madersbacher of the EU-ACME Europe,” concluded one of the discussion groups even
Office, Keith Parsons of the Guidelines Office, Luis as other participants say that a global role for the EAU
Martinez-Pineiro of the Section Office and Tarik Esen would bring in benefits and make the EAU more
of the Residents Office. Rien Nijman represented the relevant in the international arena.
European Board of Urology (EBU).
Other views include strengthening the EAU’s core
With the participants split in four discussion groups mission on education with emphasis on expanding its
led by Jacqmin, Abrahamsson, Artibani and Parsons, ties with international professional groups from other
the meeting’s agenda tackled seven discussion points, medical disciplines such as what has recently been
namely: the EAU’s role as a global organisation; achieved in a multi-disciplinary meeting (1st
presidency of the EAU Annual Congresses; establishing European Multidisciplinary Meeting on Urological
links with the office urologist; cultivating ties with Cancers in Barcelona in November 2007). Participants to the 2008 EAU Annual National Societies Meeting held in Barcelona, Spain.

GP´s best placed to provide initial urological care


Symptom Incidence Prevalence Men Women The value of processes of continuous learning and the
Prof. Jean-Jacques
Painful accreditation obligation has not been well studied so
Wyndaele 2.3 1.2 3.3
voiding far. The period between research data and application
EAU Strategy
Committee Member 3 1.6 4.3 in GP practice still seems to remain quite long. An
Frequency 2.2 1.9 2.4 exception may be through industry representatives
3.1 2.8 3.4 who explain and propagate their new products when
Urinary brought on the market. From the side of the physician
2.3 1 8
incontinence critical evaluation of this information is needed but
Jean-Jacques. 6 2.7 27.8 often difficult to achieve for many reasons.
Wyndaele@uza.be Voiding
1.1 1.6 0.8
problem The information given to general practitioners, faced
1.8 2.3 1.2 with a well-informed population of patients, appears
Diseases of the organs responsible for the transport Hematuria 1.1 1.6 9.7 to be overall insufficiently clear. Guidelines would be
of urine and for male sexual function are not rare. 1.7 2.3 1.1 interesting but to prepare proper guidelines is
Some of the symptoms and conditions related to difficult. Health care is not an exact science and an
urology are amongst the most bothersome and Disease Incidence Prevalence Men Women evidence base is often missing. Moreover such
dangerous a human being can experience. One can Acute guidelines should be clear, concise and overall
0.7 0.5 1.7
quote: prostate diseases, urinary infection, LUTS, pyelonefritis practical.
erectile problems, incontinence, etc. Due to the high 1 0.5 1.8
prevalence the general practitioners (GP) would be Cystitis 33.3 8.3 66 GPs need to be informed about a wide range of health
best placed to manage a large part of these 38.5 9.2 70 problems. Urology is one of these and special skills
problems. Malignant and knowledge are needed. Most will agree that a GP
0.2 0.2 0.2
tumour preferably needs to know about diagnostics better
This would permit the patient to enter the care 0.5 0.7 0.4 than staging and management information, and
without too much difficulty in an environment close Kidney Stone 1.4 2.5 1 urological infectious topics better than urological
by, and where management can be provided, 2.4 4.1 2.1 cancers. 24th Annual EAU Congress
integrated in a good knowledge of the general health
history, the family situation, the economic and Disease Incidence Prevalence Abstract deadline
psychological condition. This is the best of theory.
For primary care different databases exist in Europe
It is no surprise that the GP will deal with quite a
number of the problems related to urinary organs.
BPH
Acute prostatitis
3.9
0.9
15.4
0.9
1 November 2008
where information on clinical practice is gathered. Urologists and the EAU should provide primary health www.eaustockholm2009.org
Epididymitis 1.2 1.2
The following data from selected databases give an care with optimal guidelines, updates on evolution in
Phimosis 2.3 2.3
indication of incidence and prevalence of urological urological knowledge and explanation of what will more info see page 7
symptoms and pathology seen by GPs in two North happen to the patient after referral. Urologists and Hydrocoele 1 1.6
European countries. Incidence and prevalence are EAU should also provide guidelines for post-treatment
given per 1,000 patient years. follow up, screening and prevention. The listing as given above may help guide the effort.
A GP needs to know alarm signs which necessitate
It is a fact that despite the increasing energy put into early referral. They need to be proficient in physical
education at the universities and medical schools, the examination, urinanalysis interpretation and catheter
knowledge to be acquired increases so fast that insertion. Undergraduate medical education should
obtaining a solid experience with all aspects of health reflect these needs. A GP often has only limited
care has become almost impossible. The duality is knowledge of specialist diagnosis and treatment. The
that at one side information is more easily available communication between specialist and GP is therefore
for physicians but on the other side time to learn is not always easy for both parties. In this respect the
often lacking. EAU can also offer valuable help.

August/September 2008 European Urology Today 1


Cooperation with other EAU bodies is the key
ESFFU board aims at passing the message to a broad public
By Franz-Günter Runkel FGR: Is the relation between urologists and
gynaecologists changing?
FGR: Why did the European Society of Neuro-Urology
(ESNU) and the European Society of Female Urology Heesakkers: We should cooperate in those areas where
merge and form the new ESFFU? mutual interest, knowledge and skills exist and benefit
from the conjoint effort. However, I think that so far the
Heesakkers: The feeling was with most board urologists are more complete. If you are a functional
members of the ESNU and of the ESFU, that the topics urologist you see both neurogenic patients and
discussed every EAU annual congress during the ESNU non-neurogenic patients, female patients as well as
and the ESFU section meetings had lots of overlap. A male patients. The bladder problems are more
lot of presenters and people in the audience joined approached from a basic science point of view by

Photo by: Runkel


both the ESNU and ESFU meetings during the annual urologists than from a practical point of view which is
congress… This made it more logical to merge the two mostly the gynaecological level of knowledge. There is
societies and make a bigger one, where people not a strong relationship. There are some areas with
European Urology Today had to choose between two, more or less equal similar topics such as stress incontinence, in some
programmes. The ESNU, the neuro-urology section, countries prolapse, urge incontinence and all kinds of Dr. John Heesakkers, chairman of the new European Society of
focuses of course mostly on neurogenic patients. But bladder complaints. But in total the urological part is Female and Functional Urology (ESFFU)
Editor-in-Chief the pathophysiological mechanisms and the physiology broader…Of course there is also a bit of competition.
Prof. M. Wirth, Dresden (DE) of micturition are similar, and the diagnosis and Those specialties that see most patients are best skilled For some years we have botulinum toxin injections in
treatments that are done in neurogenic patients, are in doing some kind of treatment. For gynaecologists neuro-urology and functional urology. In female
Section Editors quite often also done in the functional urology field in that would be stress incontinence and prolapse repair. urology new treatments of stress incontinence are still
Dr. A. Cestari, Milan (IT) non-neurogenic patients. There is a big overlap On the other hand, apart from some competition a hot item, because the treatments tend to become
Mr. Ph. Cornford, Liverpool (GB) between the way of reasoning but also the topics and apects, there is some mutual interest to work together more and more minimal invasive. Overactive bladder
Prof. O. Hakenberg, Dresden (DE) the treatments are often similar. So it was logic to e.g. when the pathophysiological mechanisms complaints and urge incontinence are additional
Prof. P. Meria, Paris (FR) merge the two societies. ... There will be a very underlying those disorders are not known. There cornerstones of the activities of the ESFFU... There are
Prof. Dr. med. J. Rassweiler, Heilbronn (DE) important integrative move in many urological should be a cooperation to see how a joint effort can new treatments like neuro-stimulation, neuro-
PD Dr. med. O. Reich, Munich (DE) specialties in the years to come. This process will help to find solutions for problems not solved yet. modulation, drug treatments, conservative
Dr. Th. Roumeguère, Brussels (BE) definitively not be limited to female and functional treatments…There is much development ongoing in
Mr. D. Summerton, Leicester (GB) urology. FGR: Which are the major ESFFU targets in the coming every functional urological field… An important focus
Dr. T. Zóber, Budapest (HU) years? will be male incontinence. There are very interesting
FGR: Is it correct that neuro-urology is completely treatments for iatrogenic sphincteric incontinence that
Special Guest Editor integrated in female and functional urology? Heesakkers: The ESFFU board would like to have we caused ourselves e.g. by doing radical
Prof. F. Montorsi, Milan (IT) some stand-alone meeting focussing on crucial prostatectomies. And then we try to explore areas that
Heesakkers: The functional urology comprises as well clinical topics. What we would like to express is that are not exactly our field of working such as faecal
Advisory Board neurogenic as non-neurogenic diseases. That means the functional urologists in Europe are busy and are incontinence or the positioning of pelvic organ
Prof. C. Abbou, Paris (FR) that the neuro-urology part will be covered by the doing a good job…Also, up to date there is no prolapse and its repair.
Prof. P. Abrams, Bristol (GB) adjective “functional”. We could even call it the separate functional urological training in Europe. We
Prof. W. Artibani, Verona (IT) European Society of Functional Urology, because we would like to have some sort of in-depth course FGR: What about sling procedures such as TVT or TOT?
Prof. T. Bjerklund-Johansen, Porsgrunn (NO) expanded not only from neurologic to female but also which gives you a certified expression that you are a
Prof. T. Esen, Istanbul (TR) to male disorders…However there is still some functional urologist. We are cooperating with the Heesakkers: There is continuous development in
Prof. F. Hamdy, Sheffield (GB) discussion about the proper terminology and titles. European Board of Urology (EBU) and the European slings. The tendency is to be as minimal invasive as
Prof. D. Jacqmin, Strasbourg (FR) School of Urology (ESU), bodies within the EAU that possible, but that should not jeopardize the efficacy of
Prof. H. Madersbacher, Innsbruck (AT) FGR: Did you intend to stress the female part of urology deal with certification and education…Furthermore the treatment. So we should try to find a balance to
Prof. M. Marberger, Vienna (AT) choosing the new name? we have to find out in what way we can organise a achieve a satisfying efficacy in minimal invasive
Prof. L. Martínez-Piñeiro, Madrid (ES) programme which gives you some kind of a procedures. There is also a tendency to use mini-
Prof. V. Mirone, Naples (IT) Heesakkers: There is a difference in interpretation in super-specialty accreditation…A nice masterclass is slings and mini-tapes right now. However the
Prof. F. Montorsi, Milan (IT) several European countries and therefore the word organised by the ESU in the second part of the year in problem is that there are so many tapes on the
Prof. P.F.A. Mulders, Nijmegen (NL) “female” is stressed. In the UK there is a specialty Nice about female urology. The ESFFU is taking part in market that it is really difficult to have solid data on
Prof. J.M. Nijman, Groningen (NL) called “uro-gynaecology”. It consists of urogynaeco- that programme. That will be the kick off to offer ... the real value of every separate tape.
Mr. K.F. Parsons, Liverpool (GB) logists’ focus on functional female problems. The training in functional urology… There will also be
Prof. H. Van Poppel, Leuven (BE) urological counterpart is “female urology”. In the some activities to define centres of excellence in FGR: Which ideas and projects will dominate your
Dr. H. Van Der Poel, Amsterdam (NL) Netherlands for instance we do not have this severe Europe being accredited as trainee clinics for chairmanship?
Prof. J. Rassweiler, Heilbronn (DE) distinction. We do not have urogynaecologists. We functional and female urology.
Prof. I. Romics, Budapest (HU) know gynaecologists who treat functional disorders, Heesakkers: We should start communicating with our
Prof. J. De la Rosette, Amsterdam (NL) but that is not a sub-specialty of its own. Therefore the FGR: Which areas of female and functional urology will patients and also with governments…I think we
Prof. J. Schalken, Nijmegen (NL) need to counterbalance that gynaecology part is not be highlighted in future ESFFU activities? should try to find out what patients and governments
Prof. C. Schulman, Brussels (BE) present in every European country…So on one hand really want from us. And we should start from there
Dr. D. Schultheiss, Gießen (DE) the ESFFU wants to stress the focus on female urology Heesakkers: In neuro-urology more bladder to probably redefine the way we are working…It is
Prof. I. Sinescu, Bucharest (RO) items but on the other hand our society’s new name innervation pathways will be explored where also important that we try to level up all European
Prof. C. Stief, Munich (DE) does not exclusively focus on female urology, but also increasing knowledge is gathered: basic bladder countries. The ways of training should be comparable.
Prof. A. Tubaro, Rome (IT) on functional urology. That means that male functional innervation knowledge from bladder up to the brain. Everybody should work according to the state of the
urological problems also can come in. There will be a lot of focus on different treatments. art defined by the European Association of Urology.
Founding Editor
Prof. F. Debruyne, Nijmegen (NL)
EAU’s core mission general public would be to employ popular mass the EAU guidelines although the on-line and electro-
Head of Communication Continued from page 1 media channels such as newspapers and the Internet. nic versions are attracting steady numbers in terms of
F-G. Runkel, Arnhem (NL) web users and page hits. He also mentioned that the
avoid duplication of activities and programme The services and achievements of the EU-ACME, recent successful collaboration between the EAU and
Editorial Team content. The issue of establishing a strong link with Guidelines Office, Section Office, Residents Office and the AUA in producing a guideline for the treat- ment
L. Brouwer, Arnhem (NL) the office urologist also found common agreement the EBU were also highlighted with individual of ureteric calculi is not to going to be repeated for
H. Lurvink, Arnhem (NL) with most of the participants saying that continuing presentations from the respective heads and officers. other urological conditions, at least in the short term.
K. Plass, Arnhem (NL) education, particularly in subspecialties, is crucial in The national societies were further invited and
J. Vega, Arnhem (NL) maintaining the influence of urology. encouraged to complement their activities for their Martinez-Pineiro, meanwhile, reported on the aim of
members, particularly in education, by availing or the Section Office to avoid an overlap of activities from
EUT Editorial Office On the issue of cultivating stronger ties with allied participating in the continuing professional the sections and those from the EAU. He said one of
PO Box 30016 medical professions like urological nursing, the development programmes offered by these offices. the ways to achieve this is by integrating the expertise
6803 AA Arnhem unanimous opinion is to further develop links with from the sections or carefully coordinating their ac-
The Netherlands nursing groups across Europe and that integrating In particular, the EBU and EU-ACME are increasingly tivities with those from parallel offices such as the
T +31 (0)26 389 0680 urological nurses associations with the EAU would being relied upon to support or provide educational Guidelines group or the European School of Urology
F +31 (0)26 389 0674 redound to everyone’s benefit. It was recommended opportunities or at least assist in developing activities (ESU).
EUT@uroweb.org that the EAU initiate further activities or actively meant to upgrade the skills and training of urologists.
reinforce its links with these professional groups. Esen also noted the achievements and goals of the
Disclaimer For instance, the EU-ACME reported the substantial EAU Resident Office saying that in both the Berlin and
No part of European Urology Today (EUT) may be Collaborating with patient groups
Colofon

growth in the annual total number of EU-ACME Milan congresses residents made a strong showing,
reproduced without written permission from the
Communication Office of the European Meanwhile, the consensus on patient support groups members who actively collect credit points during particularly in the former when five abstracts prizes
Association of Urology (EAU). The comments of is for the EAU to closely cooperate or effectively meetings or via its website. Numbers have risen from were won by residents who were listed as first
the reviewers are their own and not necessarily
dialogue with these groups as they can be relied upon 2,710 out of 8,330 (32% of the members) in 2006 to authors. He also mentioned the goal to improve the
endorsed by the EAU or the Editorial Board. The
EAU does not accept liability for the consequences as allies within or even beyond the national level. 4,804 of 10,156 (47% of members) in 2007. interaction between the Residents Office, the EBU,
of inaccurate statements or data. Despite of Identifying mutually beneficial goals with various ESU and the European Society of Residents in Urology
utmost care the EAU and their Communication
Office cannot accept responsibility for errors or
patient support groups would be a key element in the Growing interest (ESRU).
omissions. attempts to work or collaborate with them. Meanwhile, Nijman said the EBU’s Board examination
Other items in the agenda were the changing has seen a growing interest in the FEBU exam, with In their closing remarks both Abrahamsson and
dynamics in the relationship between industry and countries such as Poland and Hungary making the Jacqmin thanked all participants for their input and
medical practitioners and the scope of activities or FEBU exam obligatory to urologists. said that the opinions that were put forward will help
coverage for the forthcoming Urology Week project. the EAU map out its long-term strategies. The next
The participants say the scope or focus would depend From the Guidelines Office, Parsons noted most meeting with the national societies will be held on 12
on each country and the best means to reach the residents have a preference for the printed versions of to 13 June in Florence, Italy.

August/September 2008 European Urology Today 2


Continuous-flow ureterorenoscopy
Increased visibility reduces retrograde stone mobilisation

Table of Contents
Prof. Dr. Maurice 5.5F working channel The
Stephan Michel ex-vivo model consisted
University Hospital of complete urinary tracts
Mannheim of domestic pigs obtained
Mannheim (DE) freshly from the
slaughterhouse.

maurice-stephan. Both instruments were


michel@uro.ma. used in five urinary
uni-heidelberg.de tracts, and six
ureterorenoscopies were
performed in each
urinary tract. To measure
the pressure in the RP, a
Advances in technology have generated 6F cystometry catheter
ureterorenoscopes (URSs) with increasingly smaller (Porgès S. A., France) Europe remains in EAU’s core mission
diameters. The price for reduction in diameter in was introduced into the and strategy. . . . . . . . . . . . . . . . . . . . . . . . . . 1
most URSs is one common channel for irrigation and RP, fixed with a suture, GP´s best placed to provide initial urological
the passage of instruments, resulting in decreased Fig. 2. Conventional ureterorenoscope. and sealed watertight care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
irrigation. Good irrigation is vital for dilation of the with cryanoacrylate glue.
ureter and collecting system, for enhancing Material and methods Pressure measurement was performed using a Cooperation with other EAU bodies is the key. 2
instrument passage and for vision. Ureterorenoscopies were performed with the newly urodynamic measuring system (Dantec Duet Multi). Continuous-flow ureterorenoscopy. . . . . . . . . 3
developed continuous-flow URS with separate inflow The urinary tract was held in place by
When using common URSs with combined inflow and and outflow channel (Fig. 1) and a conventional URS micromanipulators. Height of the irrigation solution Resident section:
The season changes and it’s back to
outflow channel, problems concerning good sight, on with a combined inflow and outflow channel (Fig. 2) above renal level and flow capacity in mL/min was
business. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
the one hand, and high pressure in the ureter or renal also documented. Swedish urologists favour specialist
pelvis (RP) in combination with retrograde stone and EBU exams . . . . . . . . . . . . . . . . . . . . . . . 4
manipulation, on the other hand, can occur. Various Prof. Dr. med. Jens Results Junior Swedish urologists hold successful
techniques have been tried to improve irrigation, Rassweiler meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
including gravity drainage, pressurized irrigant bags Section editor Conventional URS Valuable training at Leuven’s Catholic
and handheld or foot-activated syringe-based Heilbronn (DE) The intrapelvic pressure correlated with the height of University (BE). . . . . . . . . . . . . . . . . . . . . . . . 5
systems.1 All these solutions will lead to an increased the irrigation solution above renal level. The European residents get expert update on
intrapelvic pressure as well as an increased risk of maximum flow capacity at a solution level of 20 cm incontinence. . . . . . . . . . . . . . . . . . . . . . . . . . 5
retrograde stone manipulation. was 0.2 mL/min, rising to a flow capacity of 0.5 mL/ Do multivitamin supplements promote
min at a solution level of 40 cm above renal level (Fig. prostate cancer?. . . . . . . . . . . . . . . . . . . . . . . 7
The newly developed continuous flow URS (Fig. 1) jens.rassweiler@ 3). The intrapelvic pressure also correlated with the
(Karl Storz, Tuttlingen, Germany) has a separate slk-kliniken.de height of the irrigation solution, rising from 20 _ 3.7 Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 9
inflow and outflow channel that enables the user to cm H2O at a solution level of 20 cm to 39 _ 2.5 cm Testosterone deficiency is a challenge
maintain continuous irrigation. The aim of this study H2O at a level of 40 cm. At a level of 50 cm, a plateau for urologists . . . . . . . . . . . . . . . . . . . . . . . . 10
was the evaluation of pressure and flow relation pressure of 40 _ 3.3 cm H2O was reached, and a
using a common URS in comparison with a newly (Karl Storz, Tuttlingen, Germany). Both URSs had a distinct pyelolymphatic and pyelovenous backflow Interview with Morgan Rouprêt. . . . . . . . . . . 11
developed continuous-flow URS using an ex-vivo total sheath diameter of 10.5F. The continuous-flow was observed (Fig. 4). WHO Conference on Bladder Cancer
urinary tract model. URS has a 5F working channel and a 3.8F irrigation resounding success. . . . . . . . . . . . . . . . . 12-13
channel, whereas the conventional URS has only one Continuous-flow URS
Djavan shares skills with Belgian
The maximum flow capacity for the continuous-flow
residents in Leuven. . . . . . . . . . . . . . . . . . . . 15
URS was about 100 times higher than the
conventional URS. At a solution level of 20 cm, the www.reviews. . . . . . . . . . . . . . . . . . . . . . . . 15
maximum flow capacity was 20 mL/min, rising to a Book reviews. . . . . . . . . . . . . . . . . . . . . . . . 16
flow capacity of 70 mL/min at a solution level of 40
cm above renal level (Fig. 3). The intrapelvic pressure Still going strong . . . . . . . . . . . . . . . . . . . . . 17
was 15 _ 2.1 cm H2O at a solution level of 20 cm and EAU launches new Urology Week website . . 18
15 _ 1.5 cm H2O at a level of 40 cm (Fig. 4). In
contrast to the conventional URS, the intrapelvic EUT Congress News – 3rd Barcelona Masterclass:
pressure did not exceed the physiologic renal Harmonized level of knowledge. . . . . . . . . . 19
pressure of 20 cm H2O. Even if the irrigation solution Open minds for new therapies. . . . . . . . . . . 19
was at a height of 100 cm Advanced testicular cancer –
chemotherapy and surgery. . . . . . . . . . . . . . 20
The roadmap to cure cancer?. . . . . . . . . . . . 20
Higher flow capacity “We need good quality trials” . . . . . . . . . . . 20
The newly developed continuous-flow URS provides a Improved prognosis for patients. . . . . . . . . . 21
100 times higher flow capacity compared with the Targeted local hormonal therapy . . . . . . . . . 21
conventional URS. Simultaneously, the preservation of Two EBU exams in future. . . . . . . . . . . . . . . 21
a physiologic pressure in the renal pelvis is preserved ESU Masterclass “must attend”. . . . . . . . . . 22
even at high irrigation pressure levels. It can be
assumed that these characteristics will improve ESU section:
ESU courses get high approval at
visibility and reduce retrograde stone manipulation,
Slovak annual congress . . . . . . . . . . . . . . . . 22
operative time, and complications under clinical ESU, CUA collaborate for 1st CUREP in
conditions. The results of this ex-vivo study have to be Shanghai . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
confirmed under in-vivo conditions.
Urinary Incontinence Special:
FIG. 1. Continuous-flow ureterorenoscope (URS). 1 _ continuous-flow URS; 2 _ tip of the continuous-flow URS showing the Patients´ perspective on LUTS. . . . . . . . . . . . 24
separate inflow and outflow channel; 3 _ tip of a conventional URS showing the combined inflow and outflow channel.
Uro-Technology Global postural re-education and
pelvic floor training . . . . . . . . . . . . . . . . . . . 24
Tension free vaginal tape versus TOT . . . . . . 25
Surgical treatment of SUI: looking for
a common ground . . . . . . . . . . . . . . . . . . . . 25
Translational research in renal cryosurgery
technologies. . . . . . . . . . . . . . . . . . . . . . . . . 26
Key-articles . . . . . . . . . . . . . . . . . . . . . . . . . 28
More userfriendly levels of decision. . . . . . . 29
Effective neuro-urology fellowship at
University of Innsbruck, Austria . . . . . . . . . . 30
EBU section:
Interest in FEBU exams remains high. . . . . . 31
Five years of CME-CPD system in Poland. . . . 33
EBU certificate for Pomerian Medical
University . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Predictive modelling in prostate cancer . . . . 37
People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Congress calendar . . . . . . . . . . . . . . . . . . . . 38
EAUN section:
Sacral Nerve Neuromodulation
(InterStim®) Part II . . . . . . . . . . . . . . . . . . . . 39
Ensuring continence in difficult cases. . . . . . 40
Fig. 3. Flow capacity relative to height of flow solution. Fig. 4. Renal pelvic pressure relative to height of flow solution.

August/September 2008 European Urology Today 3


E.S.R.U.
The season changes and it’s back to business…
Dr. Tamás Zóber It is my hope that in this forthcoming ESRU meeting spent a month in Leuven, Belgium and gave us a Finally, you will find the next chapter of our history
Residents section we will have NCOs (national communication officers, glimpse on the daily routine of the urological column series and you can test yourself with our
editor e.g. national delegates) from most of the European department. regular line-up of quizzes. Enjoy and have fun!
Chairman-elect of countries. Having good representation will enable
ESRU us not only to become effective, but also to
Budapest (HU) thoroughly discuss the important issues affecting
urological residents from as many viewpoints as
possible, and all under the auspices and guidance of
the ESRU.

This summer there was another important gathering


where many residents also actively participated. ESRU
By the time you are reading this column, many of us Chairman Andreas Petrolekas gives us a report and
might be already experiencing the first splendours of commentary about the 4th International Consultation
autumn. With the seasonal changes, I hope you just on Incontinence held in Paris. Many countries in
had a great summer vacation and has summoned the Europe also integrate the European Board of Urology
needed energy and high spirits to carry through past (EBU) exam into their national specialist exams. This
the rainy months ahead. issue is discussed in depth by former ESRU
chairperson Stina Erikson who conducted an initial
In the beginning of September many residents will research about the importance of the specialist and
meet in Prague. Last year, nearly 275 residents EBU exams to Swedish urologists.
participated in the much-awaited European Urology

Photo by Dóra Molnár


Residents Programme (EUREP) wherein every Another Swedish contribution in this issue is an
participant got an update of their urological update about the Swedish Junior Urologist Meeting
knowledge. As has been the custom every year, the held in Örebro written by Edvard Lekas. Lekas gave a
European Society of Residents in Urology (ESRU) will brief but interesting report on the meeting.
concurrently hold its semi-annual meeting during
EUREP. Meanwhile, Maksudhon Rashidov from Uzbekistan The river Tisza, a popular vacation destination in Hungary

Swedish urologists favour specialist and EBU exams


Dr. Stina Erikson I wanted to find out what the general opinion is today department and that an exam would probably raise haven’t had to decide on the issue of fee
Former ESRU in Sweden regarding a specialist exam and, more the general quality among urologists since it would reimbursement.
chairman specifically, the EBU exam. To accomplish this I sent update and strengthen knowledge and personal
Norrköping (SE) two separate questionnaires: to the heads of security. From both groups, some respondents, A salary raise after the exam?
departments and professors (38 in total) and another however, said they do not think an exam should be Here the answers differed. Fifteen percent (3/20) of
questionnaire to 60 residents. The questions were compulsory. the R’s confirm a higher salary after the EBU exam,
identical except for an extra query for the residents 30% (6/20) said they don’t get any raise and 55%
regarding whether they know about the EUREP Would you prefer the EBU exam or a national exam? (11/20) didn’t know. Forty-one percent (7/17) of the
course. I received 20 answers from the residents (R’s) Eighty percent (16/20) of the R’s prefer the EBU exam H’s answered they offer a higher salary for those who
Stina.Erikson@lio.se and 17 from the department heads (H’s). The answers (this includes the 10% who didn’t think an exam passed the EBU exam (normally corresponding to
to each question are shown below: important), 10% (2/20) would prefer a Swedish exam. €50-100 extra per month), 12% (2/17) count the EBU
One respondent wanted both and another gave a exam together with other merits for the level of salary
Is a specialist exam important? vague answer. Eighty-two percent (14/17) of the H’s and 23,5% (4/17) do not offer a raise and 23,5% (4/17)
Ninety percent (18/20) of the R’s and 100% of the H’s prefer the EBU exam whereas the rest either prefer a commented that the issue has not been considered in
We don’t have any national specialist exam in answered yes. The R’s commented that an exam is a Swedish exam or think it is not very important their departments.
urology in Sweden. The reason is basically that there good motivation for them to keep up with theoretical whether the exam is Swedish or European. One of the
are so few of us qualifying each year that the cost for studies and a way to show competency as well as a H’s commented that he didn’t think the residents A scholarship from the Swedish Urological Society
an exam would not be reasonable. Some have means of ‘ensuring safety’ for both patients and would be motivated to study subjects like Eighty-five percent (17/20) of the R’s and 24% (4/17) of
suggested that we make the EBU exam compulsory, urologists. Some explained that good tutorship and transplantation and paediatric urology (which we the H’s didn’t know that the Swedish Urological
but this was not accepted. Our system in Sweden is practical tips during residency reduces the need for don’t work with as urologists in Sweden) for the EBU Society provides a scholarship of 5000 SEK (around
very much based on continuous control with help an exam. The H’s saw an exam as a means to find out exam, whereas I didn’t get any such comment from €530) to those who have successfully passed the EBU
from the tutors of the residents. the level of competence outside of the local the R’s. Both some R’s and H’s thought that the EBU exam.
exam is important for Swedish residents in order to
strengthen Swedish urologists within the European Positive response

Test your knowledge! community.

Do the heads of departments encourage the residents to


The majority of residents and heads of departments in
Sweden are positive over a specialist exam and are
also in favour of using the EBU exam, even though
The EBU offers three MCQs to test your knowledge. Challenge your memory by answering the following take the EBU exam? this exam covers some subjects that are not
questions: Ninety-four percent (16/17) of the H’s said they traditionally part of urological practise in Sweden.
encourage their residents to take the EBU exam,
1. Which answer is correct? whereas 80% (16/20) of the R’s said they felt they The heads of departments encourage their residents
Reagent strips (dipsticks) in the diagnosis of microhematuria: received some encouragement. to take the EBU exam and will pay for travel as well
a. Make a microscopic analysis superfluous. as the examination fee. However, there is uncertainty
b. Are equivalent to microscopic analysis in sensitivity and specificity. EUREP and In-Service Assessment over a raise in salary after having passed the exam.
c. Are able to differentiate between glomerular and non-glomerular erythrocytes. Seventy-five percent of the R’s knew about the EUREP. There is also a need to promote the EUREP and the
d. Have a lower specificity than microscopic analysis. Unfortunately I forgot to ask the H’s about this. In-Service Assessment as well as information about
Around 25% of the R’s as well as the H’s didn’t have the scholarship from our national society to those
2. A 45-year old woman complains of urge incontinence 9 months following a retropubic any knowledge about the IN-Service Assessment, who have successfully passed the EBU exam.
urethropexy. A video-urodynamic study shows normal bladder compliance, no detrusor 59% of the H’s say that they encourage their residents
overactivity and a poor urinary flow, cystoscopic evaluation demonstrates a high fixed to do it but only 20% of the R’s feel encouraged. I It might have helped that an article similar to this one
retropubic position of the urethra. have to point out that it is not necessarily residents has been published in Swedish in “SUF-Nytt” – a
The next step is: and heads from the same departments who have web-based newsletter for the Swedish Urological
a. Urethral hyperdilatation. answered the questionnaires, which is why this does Society, which can be found on www.urologi.org
b. Transvaginal urethrolysis. not have to be contradictory.
c. Urethrolysis and needle suspension. Finally, I find it of interest if these opinions from the
d. Anticholinergic agent administration and intermittent catheterisation. Travel expenses and examination fee paid by the Swedes are shared by their colleagues throughout
departments Europe.
3. Which step should be taken in a 60-year old patient with maximal androgen blockade for Eighty-eight percent of
metastatic prostate cancer and neurological symptoms due to spinal cord compression? the H’s confirmed that
a. Stop antiandrogen and give Strontium 89. they are ready to pay the
b. Stop antiandrogen and perform bilateral orchidectomy. expenses related to the
c. High dose of intravenous glucocorticoids and radiotherapy. EBU exam. In a few
d. Start chemotherapy and perform surgical spinal cord decompression. departments it would be
frowned upon if the
residents didn’t take the
EBU exam. The remaining
12% of the H’s
To check out the correct answers, visit: commented that nobody
www.ebu.com/Examinations/Study Material took the exam yet in their
department, so they

August/September 2008 European Urology Today 4


E.S.R.U.
Junior Swedish urologists hold successful meeting
Dr. Edvard Lekas The organising team from the host city of Örebro had screaming maniacs when you put a laser gun into
Växjö (SE) put together a pleasant day at a conference center
located in the city water tower, 56 meters high with
their hands! After this bonding experience we sat
down for a cool beer in the pleasant surroundings
European Society of
nine million liters of water and hopefully without any and ended the evening with a get-together party at Residents in Urology
outlet obstruction! Several challenging case reports the impressive 16th century Castle of Örebro. The
were put forward by some of the residents with following two days were spent mostly in the scientific
‘mentometers’ (voting system) for the audience and spring meeting of the Swedish Urological Society.
expert opinions by a team of some of the leading
edvard.lekas@ urologists at the Örebro University Hospital.
ltkronoberg.se Ann-Charlotte Kinn, who is the second female
urologist in Sweden and now also professor of
urology gave two very interesting lectures, one on
aphrodisiacs and the other an account of her own
way through career and research as a woman
In conjunction with the annual spring meeting of the urologist. After this we all left the beautiful sunshine
Swedish Association of Urology, the junior doctors and warm weather and scuffled into a cellar for a
had a day of their own, for a great chance to get laser game.
together and make new friends and catch up with old It’s amazing to see how twenty or so healthy and
ones. otherwise normal grown-up doctors transform into
Chairman Andreas Petrolekas
Chairman Elect Tamás Zóber
Past Chairman Stina Erikson
Valuable training at Leuven’s Catholic University (BE) Secretary
Treasurer
Francesco Sanguedolce
Toine van der Heijden
Database Manager Michael Pesl
Project manager Ivar Bleumer
Dr. Maksudhon The Urology Department, headed by Prof. Hein Van and pelvic floor pathologies. I was impressed with the Internet Officer Swen Werner
Rashidov Poppel, is located in Gasthuisberg, a huge modern delicate work of Prof. G. Bogaert, a unique specialist EBU Delegates Andreas Petrolekas
Senior Resident hospital at the limits of the city. There, I had a chance in paediatric urology. Tamás Zóber
State Specialized to spend a very interesting and stimulating training EUSP Delegate Theodoros Kalogeropoulos
Centre of Urology period in a wonderful setting, characterised by high I also met a number of professional surgeons such as EUT Editor Tamás Zóber
Tashkent (UZ) quality medical achievements. Leuven’s Urology Dr. S. Joniau, a specialist in oncological and
Department is well known not only in Belgium but all reconstructive surgery, who all shared their
over Europe as a leading centre of uro-oncology. knowledge. Furthermore, I had the unique www.esru.net
maksutrashidov@ opportunity to attend, for the first time, operations
yahoo.com During my visit, I participated in daily morning assisted by a Da Vinci robot, performed by Dr. B. Van
conferences where all cases were digitally presented Cleynenbreugel and Dr. S Klaver.
and discussed in English. It was very useful and
interesting for me to be introduced in up-to-date According to Prof. Van Poppel I was the youngest
diagnostic and treatment management in uro- among his fellows. I had the chance not only to assist TURKUROLAP led by Prof. Dr. Y. Ozgok, I was also
oncology. him several times on operations but was also invited by Prof. Dr. J. Rassweiler to the 49th Annual
From March 24 to April 28 of this year, I had the fortunate to receive very valuable tips and learned Conference of the South West German Society of
excellent opportunity to visit the Urology Department Moreover, I attended and assisted in many different updated techniques under his supervision, making Urology held from April 30 to May 3 in Heilbronn,
of the Katholieke Universiteit Leuven in Belgium. procedures in the operation theatre. We had an my short term visit to Belgium very useful and Germany.
intensive daily schedule: operations began at 8 a.m. productive:
The city of Leuven is composed of five communities, and lasted until around 4 to 5 p.m. and covered all I would like to express my gratitude to Prof. Van
namely: Leuven, Heverlee, Kessel-Lo, Wilsele, advanced fields of current urology, particularly My visit to Belgium also coincided with the 23rd Poppel and his friendly staff as well as to the EAU and
Wijgmall. It has more than 90,000 inhabitants, uro-oncology. I particularly enjoyed learning Prof. Van Annual Congress of the European Association of EUSP boards for the wonderful opportunities that
including 35,000 students, an impressive number. So Poppel’s special techniques in cystprostatectomy and Urology in Milan, Italy. This gave me the chance to allowed me to benefit from such a unique and
once in Leuven do not be surprised to find the streets partial nephrectomy. participate at the ESRU meeting as an official productive fellowship. My special thanks also to Petra
full of young faces, and with city life distinctly representative from Uzbekistan, which has recently Van Aalten, the ESRU board and to all colleagues
marching to the students’ rhythm: hectic rush during I also had the chance to attend the operations of Prof. joined ESRU as a new member. without whom my visits to these European countries
weekdays and relative calm on weekends. D. De Ridder, a renowned master in uro-gynecology At the end of my fellowship, and as a member of would not be so fruitful.

European residents get expert update on incontinence


Dr. Andreas Speaking on behalf of ESRU, it was a great honour for
Petrolekas me to welcome all these residents who came from
ESRU Chairman various countries in Paris. It is one of ESRU’s major
Athens (GR) goals to participate in international events that bring
residents and young urologists together.

I would like to thank the A.F.U.F, especially its


president Baptiste Albouy as well as the French NCOs,
T. Bessede and Pierre-Nicolas Gosseine, for
agpetol@otenet.gr organising this marvellous Parisian evening. I would
like also to thank Prof. Khoury for making possible
the participation of these residents and his generous
contribution to the social evening.
Dear Friends,
We looking forward to meet you all in the upcoming
One-hundred and forty European residents had the EUREP course in Prague in September , but most of
opportunity to participate in the 4th International all in the upcoming ESRU day during the next EAU
Consultation on Incontinence that took place from 5 to Congress to be held in Stockholm in March 2009. Until
8 July in Paris. Despite previous visits to this city, with then please fill up our questionnaires and make ESRU
good summer weather that bathed the French capital stronger.
in radiant sunshine, the French capital looked more
beautiful than ever.

Aside from the Europe-based residents, 20 other


residents came from outside Europe coming from as
far as the Brazil, Costa Rica, Pakistan, Canada, the US distinguished speakers. During the coffee breaks the on a warm Saturday evening in a cozy Parisian bar
and Algeria. The residents participated in this participating residents also have the chance to meet restaurant, located near the Champs Elysees. The
international event upon the invitation of the French their professors and exchange ideas with the experts welcome a dinner was followed by a party until early
Association of Urology( A.F.U.F), the ESRU and Prof. S. in the field of incontinence. Furthermore, the in the morning( Photos 1).
Khoury, secretary of the International Consultation. residents built relationships with other residents from
all over the world as they exchange information about The next following day a welcome reception took
For three full days, the rooms of venue Palais de training and education issues. place (Photo 2). All participants also filled up and
Congress was crowded with young urologists taking returned the questionnaires distributed by ESRU
notes, presenting posters but most of all acquiring The hosts, A.F.U.F and E.S.R.U with a generous regarding training centres, the ambitious project that
experience and knowledge offered generously by the financial aid of Prof Khoury, welcomed 70 residents ESRU currently runs in every country across Europe.

August/September 2008 European Urology Today 5


E.S.R.U.

Quiz answers
1b, 2d, 3c, 4d, 5b.
Quiz are:
Did you know that...?
The correct answers of this issue’s Guidelines
Blind lithotripsy Irrigation irrigation and evacuation of fragments and
- The first published lithotripsy was performed by - Civiale used the tube of his first lithotripter (Fig.3) making possible the lithotripsy of greater stones.
E u ro the Hellenic lithotomist( !) Ammonios (born for irrigation by allowing the irrigation water to
pean
Urolo 276B.C) after perineal cystotomy. flow from the bladder (1824).
Officia
l new
sletter
of the

gy To
4 Europe
an Ass
ocia
‘Con
day
tion
of Uro
solid 7 log
ate ou y

- At the time of Aristoteles diamond splinters - Thompson invented the first hollow two-armed
Abraha
msson
wins r gain 16
Volume
unanim
ous vot s, im 19 - No.
e as Sec plem 2 Apr
il 200
reta ent ke 7
ry-G
eneral y stra 17
tegies

Abraham
you reall sson: “If
I
tell me y have to don’t deliv

were attached to metal probes in order to lithotriptor with two channels allowing the
destroy bladder stones. irrigating water to flow through.
what’s step er,
wron forward
g...” and

Teilla
c:
we all “I believe
have that with
plan to done, wha
and
be prou do, European what we t

- Ambroise Paré (1510-1590) cited a bullet forceps


d of their urolo still
associatio gists can
n.”

22nd
Annu
al EAU
Congress

(tire des balles) which became a model for later


lithotriptors.
2nd
ESU
on Me Maste
for Urodical On
29 June
Barc
rclass
logists cology

elon 1 July 200
- Franz von Gruithausen (1774-1852), a Bavarian Fig. 5: Stonepunch according to Mauermayer-Hartung
doctor, introduced his steinbohrer, the first
a, Spa 7
in

Notification: lithotriptor of the following generation.


- Charles Louis Stanislas Heurteloup (1793-1864, Types of energy
Promoting your London) first introduced the term lithotripsy. He - George Robinson of Newcastle described
also invented the « percuteur courbé à marteau electro-lithotrity in 1855 using repeated discharges
meetings (Fig.1). of a Leyden jar.
- Electrohydraulic lithotripsy was introduced in
1959.
The EAU executive is pleased to help promote Fig. 3:Civiale’s “lithotripteur”
any scientific meetings. However, due to the
large number of requests we are receiving, we
have been forced to set up some rules and Endoscopic lithotripsy
regulations related to the circulation of - The first cystoscopic instrument for lithotripsy was
promotional material. introduced by Max Nitze of Berlin in 1891.
- Fenwick ordered a trocar cystoscope from Leiter of
All EAU related meetings (Section Offices either Vienna for suprapubic bladder lithotripsy (Fig.4).
fully of affiliated sections) and national societies - Leopold Casper of Berlin improved the Nitze
meetings with which we have a special alliance, lithotriptor in 1895 with more efficient jaws for
may be promoted by e-mail (e-mail newsletter grasping.
or separate e-mail communciation), in addition - G.Walker improved the lithotriptor by providing a
to the other available channels. better supervision of the lithotripsy procedure.
Fig. 1: Percuteur courbé à marteau - H.H.Young constructed a powerful lithotriptor with
All other urological meetings may be included a second channel used for suction of stone
in our Uroweb and Urosource congress particles using a suction balloon.
calendar as well as in the European Urology - Blind lithotripsy reached a high point in 1876 - Wolfgang Mauermayer and R.Hartung of Munich
Today congress calendar. when litholapaxy under narcosis was developed introduced the punch lithotriptor in 1967, the
by Henry Bigelow (1818-1890) of Boston who longitudinal movement of which made it more
Please feel free to contact us (EUT@uroweb. invented the lithotriptor that was named after resistant to breakage (Fig.5). Furthermore the
org) in case there are any queries or remarks him (Fig.2) irrigation channel was bigger, improving
related to this notice.

Extract from: Matthias A.Reuter ( 2000): Endoscopic


lithotripsy of urinary bladder calculi
In: Dr. J.J. Mattelaer and Dr. D. Schultheiss (ed.) De Historia
Urologiae Europeae (vol.7). EAU, Arnhem, pp.

Fig. 2: Bigelow- Lithotriptor in action, vision with


trocarcystoscope Fig. 4: Trocar-cystoscopy

Guidelines Quiz
1. The intended aim of using age-specific reference ranges for PSA is to: 5. Under normoxic conditions, HIF is expressed at low levels and undergoes
a) Minimise the number of prostate biopsies per biopsy. hydroxylation at the alpha subunit. VHL gene regulates HIF expression.
b) Improve sensitivity in younger men (< 60years). a) Following the hydroxylation of HIF, the b domain of the VHL complex
c) Improve sensitivity in older men (> 60 years). binds to HIFb. Under hypoxic conditions, HIF undergoes hydroxylation
d) Improve specificity in younger men (< 60 years). and initiates the transcription of hypoxia-inducible genes.
b) VHL gene mutation results in the expression of mRNA encoding
2. What is the most frequent complication of chronic prostatitis/chronic hypoxia-inducible genes such as vascular endothelial growth factor
pelvic pain syndrome: (VEGF), platelet-derived growth factor (PDGF), transforming growth
a) Recurrent urinary tract infections. factor-a (TGF-a), erythropoietin (EPO), glucose transporter 1(GLUT-1), and
b) Fibrosis and obstruction of the bladder neck. carbonic anhydrase IX (CAIX).
Apart from quiz c) Development of prostate cancer. c) Biosynthesis of HIF-1a is not regulated by growth factors through the
d) Anxiety and depression. phosphatidylinositol 3-kinase-AKT, mTOR, IGF, EGF and PTEN.

photos, the EUT 3. The treatment with alphablockers in Chronic Prostatitis Syndrome:
d) RCC overexpresses growth factors,
which sustain tumor cell proliferation
a) Brings about a symptomatic improvement in all NIH categories of patients and angiogenesis. So far no European

residents corner is b)
c)
Is useful only in improving urinary flow
May reduce intraprostatic reflux
correlation with the likelihood of
tumor metastases, pathological stage
Association
of Urology
d) Stimulates apoptosis of renal cancer and survival was
Guidelines
once again calling for 4. Metastatic clear cell renal cell carcinoma is characterised by a variety of
seen.
2008 edition
molecular changes. Some of them are of therapeutic consequence. Please
your comments, select correct statement(s):
a) Ki67 is an important risk indicator and can be suppressed by targeted

articles and opinions.


therapies.
b) Expression of Carboanhydrase IX is elevated in IL-2 responding patients.
c) VEGFR and PDGF are important regulators of angiogenesis and can be The correct answers of this Guidelines
blocked by specific drugs in various ways. Quiz can be found elsewhere on this
Tamás Zóber d) B + C. page.

6 European Urology Today August/September 2008


17-21 March 2009

24th Annual EAU Congress


www.eaustockholm2009.org

Scientific Programme General Information


EAU Section Meetings
Tuesday, 17 March, Urology beyond Europe The following EAU Sections will hold their meeting on
International joint sessions involving opinion leaders from the EAU and major Wednesday, 18 March:
worldwide urological societies
European Society of Uro-Technology (ESUT)
European Society of Female and Functional Urology
(ESFFU)
Wednesday, 18 March European Society of Transplantation Urology (ESTU)
- EAU Section Meetings European Society for Urological Research (ESUR)
- 16th Meeting of the European Society of Residents in Urology (ESRU) European Organisation for Research and Treatment of
- Scientific abstract sessions Cancer Genito-Urinary Group (EORTC-GU)
- Sub-plenary sessions on Testis and penis and Infections European Society for Oncological Urology (ESOU)
European Society of Andrological Urology (ESAU)
- Joint session of the European Society for Therapeutic Radiology and
European Society for Urological Imaging (ESUI)
Oncology (ESTRO) and the EAU European Society of Genito-Urinary Reconstructive
- Sponsored symposia Surgeons (ESGURS)
- Congress Opening Ceremony & Welcome Cocktail eUrolithiasis Society (eULIS)
European Society for Uro-Pathology (ESUP)
European Society for Infection in Urology (ESIU)
Urological Research Society (URS)
Thursday, 19 March
- Plenary sessions on New technologies and treatments in urological practice Congress Venue
- Sub-plenary sessions on Paediatrics, Stones and Female urology The 24th Annual EAU Congress will be held at the
- Update from the EAU Guidelines Office Stockholm International Fairs in Stockholm, Sweden.
- Scientific abstract sessions Stockholmsmässan Stockholm International Fairs
- Sponsored symposia and workshops Mässvägen 1
12580 Stockholm, Sweden
- ESU courses
T +46 (0)8 749 41 00
- ESU hands-on training courses F +46 (0)8 749 63 72
A joint exhibition will be held on 18-20 March.

Friday, 20 March Abstract Submission


- Plenary sessions on Prostate cancer More than 1,200 abstracts are usually accepted for
presentation during poster, oral and video sessions
- Sub-plenary sessions on Andrology, Basic science oncology and
during the Annual EAU Congresses. You can submit
Reconstruction your abstract(s) online through
- Joint session of the European Society for Medical Oncology (ESMO) and the www.eaustockholm2009.org. The deadline for
EAU abstract submission is 1 November 2008 23:59:59 CET
- Scientific abstract sessions (Central European Time).
- Sponsored symposia and workshops Abstract Deadline
- ESU courses Contact Information 1 November 2008
- ESU hands-on training courses EAU Congress Office
Congress Consultants B.V.
PO Box 30016
Saturday, 21 March 6803 AA ARNHEM
The Netherlands
- Plenary sessions on Bladder cancer
T +31 (0)26 389 17 51
- Souvenir session F +31 (0)26 389 17 52
- EAU General Assembly info@congressconsultants.com

For the detailed up-to-date scientific programme, please visit


Do not forget to bring your
www.eaustockholm2009.org EAU ID Card to Stockholm!
P-A. Abr
ahamsso Sweden

n
EAU Mem
ber ID 10
6985

August/September 2008 European Urology Today 7


Do multivitamin supplements promote prostate cancer?
regular dietary supplements can be scientifically
increased incidence of advanced and fatal prostate
Cyrill A. Rentsch,
MD-PhD proven in a relatively healthy target population. But
cancers, especially if they had a family history of
Dept. of Urology also individuals diagnosed with a serious disease or
prostate cancer (7). The second study prospectively
with a family history of serious illness like cancer
investigated the effects of carotenoids (lycopene,
University of Berne
Berne (CH) often resort to dietary supplements. Forty-eight
alpha-carotene, beta-carotene, beta-cryptoxanthin,
percent of 350 cancer patients reported they began to
lutein, and zeaxanthin) on prostate cancer risk in
take dietary supplements after diagnosis (3), while
more than 600 men (8). High serum beta-carotene
73% of 280 persons with a family history of prostate
concentrations were found to be associated with
urology-berne@ cancer stated they believed diet can influence prostate
aggressive prostate cancer whereas the other
insel.ch cancer risk, and 39% described at least one change in
carotenoids had no effect on prostate cancer
their diet or lifestyle behaviour (4).
incidence. In the third study, a nested case-control
study of the Prostate, Lung, Colorectal, and Ovarian The global multivitamin-multimineral (MVMM) market is a
Co-authors: Ramesh Thurairaja, MD; Urs E. Studer, But do MVMMs deliver as promised by their (PLCO) Cancer Screening Trial, high circulating levels rapidly growing multibillion euro industry that thrives on the
MD, Chair. Dept. of Urology, University of Berne (CH) manufacturers and hoped for by their consumers? A of Vitamin D (25-hydroxyvitamin D) were discovered relentless marketing of health food fads.”
recently published meta-analysis of the Cochrane to be significantly associated with increased risk of
More than a third of adults in industrialised countries Database of Systematic Reviews incorporating data on aggressive prostate cancer (9). with cancer. J Am Diet Assoc 2003;103(3):323-328.
are estimated to consume multivitamin supplements more than 230,000 men and women found no benefit 4. Cowan R, Meiser B, Giles GG, Lindeman GJ, Gaff CL. The
hoping to receive the health benefits promised by in overall survival among supplemental antioxidant To sum up, MVMMs may both increase the risk of beliefs, and reported and intended behaviors of
their manufacturers. Those benefits, however, are not users (5). This analysis, in fact, showed a significant developing prostate cancer and of advanced and unaffected men in response to their family history of
supported by scientific evidence. Some vitamins, in increase in mortality associated with beta-carotene, aggressive forms of the disease, especially MVMMs prostate cancer. Genet Med 2008.
fact, may even have harmful side effects such as the Vitamin A, and Vitamin E intake, whereas Vitamin C containing beta-carotene and Vitamin D. Moreover, 5. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud
initiation and promotion of cancer cell growth in and selenium had no influence on survival. Vitamin E, beta-carotene and Vitamin A may shorten C. Antioxidant supplements for prevention of mortality in
general, and prostate cancer cell growth in particular. overall life expectancy in men with prostate cancer. healthy participants and patients with various diseases.
It is incumbent upon urologists, therefore, that they The urologist must consider findings such as these Cochrane Database Syst Rev 2008(2):CD007176.
encourage their well-nourished patients to stop “Randomised double blind studies when counselling patients on diet and multivitamin 6. Klein EA, Thompson IM, Lippman SM, Goodman PJ,
multivitamin use or urge them to join clinical trials use. Looking forward, randomised double blind
scientifically assessing the benefits and side-effects
are needed to further examine studies are needed to further examine the effects of
Albanes D, Taylor PR, Coltman C. SELECT: the selenium
and vitamin E cancer prevention trial. Urol Oncol
of vitamin intake. the effects of MVMMs before MVMMs before vitamin supplementation can be 2003;21(1):59-65.
recommended to cancer patients, especially prostate
The global multivitamin-multimineral (MVMM)
vitamin supplementation can be cancer patients. Until the results of such studies are
7. Lawson KA, Wright ME, Subar A, Mouw T, Hollenbeck A,
Schatzkin A, Leitzmann MF. Multivitamin use and risk of
market is a rapidly growing multibillion euro industry recommended to cancer patients.” available, the operative principle must be: “more is prostate cancer in the National Institutes of Health-AARP
that thrives on the relentless marketing of health food not necessarily better”. Diet and Health Study. J Natl Cancer Inst 2007;99(10):754-
fads and sports nutrition to all sectors of the Moreover, no differences in survival were noted 764.
population, young and old, healthy and ill. The between healthy and diseased individuals, which is of References 8. Peters U, Leitzmann MF, Chatterjee N, Wang Y, Albanes D,
public’s confidence in the benefits of MVMM use is particular interest to urologists in view of 1. Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C, Gelmann EP, Friesen MD, Riboli E, Hayes RB. Serum
well documented. In a 2004 survey up to 50% of experimental evidence of anti-tumoural effects and Picciano MF. Dietary supplement use by US adults: data lycopene, other carotenoids, and prostate cancer risk: a
healthy adults reported taking a dietary supplement significantly decreased prostate cancer rates in from the National Health and Nutrition Examination nested case-control study in the prostate, lung,
in the month before the survey and more than a third individuals participating in phase III studies on both Survey, 1999-2000. Am J Epidemiol 2004;160(4):339-349. colorectal, and ovarian cancer screening trial. Cancer
reported regular use of an MVMM product (1). MVMM selenium and Vitamin E intake (6). The findings of 2. Yu SM, Kogan MD, Gergen P. Vitamin–Mineral Epidemiol Biomarkers Prev 2007;16(5):962-968.
intake was associated with a higher level of three further studies shed more light on MVMM use Supplement Use Among Preschool Children in the United 9. Ahn J, Peters U, Albanes D, Purdue MP, Abnet CC,
education, lower body mass index, and a higher level and prostate cancer. The first assessed the risk of States. Pediatrics 1997;100(5):1-6. Chatterjee N, Horst RL, Hollis BW, Huang WY, Shikany JM,
of physical activity in the study population. Up to 50% prostate cancer associated with MVMM intake in more 3. Patterson RE, Neuhouser ML, Hedderson MM, Schwartz Hayes RB. Serum vitamin D concentration and prostate
of adolescents may regularly consume MVMMs (2) than 290,000 men. Those with excessive MVMM use SM, Standish LJ, Bowen DJ. Changes in diet, physical cancer risk: a nested case-control study. J Natl Cancer Inst
which raises the question of whether a benefit from (more than 7 times per week) showed a significantly activity, and supplement use among adults diagnosed 2008;100(11):796-804.
© 2008 - Photos courtesy of Corporación de promoción turística de Chile

EAU 2nd Eastern


Mediterranean
Meeting (EMM)
23-24 January 2009, Cairo, Egypt

November 19-22, 2008 | Santiago, Chile

INCORPORATING
The ICUD Consultation on Penile Cancer
The XXXI Annual Meeting of the Sociedad Chilena de Urología
The Society of Genitourinary Reconstructive Surgeons
Uro-Oncology Update for Pediatric Surgeons

www.siucongress.org
Call for Abstracts
deadline 1 October 2008

European
Association
SIU CONGRESS OFFICE of Urology
1155 University, Suite 1155, Montréal (QC) Canada H3B 3A7
Tel: +1 514 875-5665 Fax: +1 514 875-0205

8 European Urology Today August/September 2008


Client: SIU 2008 Docket number: 28-1047 File Size: 100 %
Description: SANTIAGO Trim Size: 133,4 mm X 194,3 mm 1:0
Clinical challenge
Prof. Oliver Case study No. 8:
Hakenberg The Clinical challenge section presents interesting or difficult clinical problems
Section editor
which in a subsequent issue of EUT will be discussed by experts from
Abdominal discomfort
Rostock (DE)
different European countries as to how they would manage the problem. 24 years after
complete cystectomy
Readers are encouraged to provide interesting and challenging cases for
Oliver.Hakenberg@ discussion at h.lurvink@uroweb.org
med.uni-rostock.de A 26-year old man with a MAINZ III pouch presented
with a three months history of vague abdominal and
flank discomfort. As a child aged two he had
undergone first partial and later complete cystectomy
for a rhabdmyosarcoma, followed by radio- and
Case study No. 7: Large tumour in 22-year old woman chemotherapy. The patient had been recurrence-free
ever since. Management of his pouch had been
uneventful with clean intermittent self-catherisation
A 22-year old woman with a prior history of through the appendiceal access with a 10F catheter.
recurrent vague left abdominal pain presented in Recently, however, he had developed problems
the second month of her first pregnancy with an emptying the pouch with increased mucus production
episode of severe and acute left abdominal pain and clouded urine. On examination his general
with a self-noticed palpable left abdominal mass. condition was normal. Ultrasound showed bilateral
hydronephrosis, serum creatinine was elevated with
On examination her general condition was normal, 120 mmol/l (< 105). Catheterised urine microscopically
with normal vital signs and temperature. There were showed mucus, leucocytes and few bacteria. The
large and fixed masses palpable in the abdomen/ plain abdominal x-ray is shown. Bilateral
retroperitoneum bilaterally. Ultrasound showed percutaneous nephrostomies were inserted and
several hepatic hemangiomas and very large antibiotic treatment was started. Within three days
bilateral retroperitoneal masses with apparently serum creatinine had normalised. An isotope
liquid content. Renal parenchyma on both sides was nephrogram showed reduced renal function with a
visualised as normal without calyceal dilatation. clearance of 210 ml/min (normal > 250 ml/min)
Blood chemistry was hemoglobin 10.5 g/L, white Figure 1: IVP Figure 2: MRI Figure 3: Right renal angiography distributed equally to both kidneys.
blood cell count 5.6 x 10-9/L, ESR 15 mm/h, serum
creatinine 0.12 mmol/L, serum bilirubine 18 μmol/L.
Urinalysis showed 5-6 leucocytes and 1-2 red blood Urology Department for further work-up and
cells/HPR and no bacteria. treatment.

Percutaneous biopsy of the tumour showed fatty Discussion points


and connective tissue and fragments of large blood 1. What is the working diagnosis?
vessels. Aspiration cytology of the liquid component 2. What is the natural course of the suspected
of the right-sided tumour showed lysed red blood disease?
cells with few leucocytes, no sign of malignancy and 3. What treatment can be offered?
microbiology was negative.
Case provided by Dr. Roman Sheremeta and Dr. Bohdan
Due to increasing pain and apparent tumour volume Borys, Department of Urology, Lviv Regional Clinical
the pregnancy was terminated during the fourth Hospital, Lviv, Ukraine, bborys@mail.lviv.ua
month. After that, the patient was referred to the
Figure 4: Left renal angiography

Using CT to diagnose large retroperitoneal tumours


Comments by The possible diagnosis can be represented by the associated with a palpable mass and a reduced
Prof. Paolo Fornara, Wunderlich-Syndrome. Spontaneous retroperitoneal haemoglobin concentration, as in this case.
Halle/Saale (DE) hemorrhage from the kidney was first described in The radiologic diagnosis is based on intravenous Figure 1: Plain abdominal x-ray
1700 by Bonet. Wunderlich gave his name to this pyelography, renal angiography, computerized
syndrome in 1856. Up to now, 250 cases are reported tomography and magnetic resonance imaging. CT
in literature. This syndrome is a rare but nevertheless is the best imaging method to establish the Discussion points
life-threatening complication in cases of benign or diagnosis and in some cases the aetiology of 1. What is the diagnosis?
malignant space-occupying lesions in the kidneys. A Wunderlich’s syndrome, with a sensivity of 71%. 2. What management is appropriate?
precise preoperative differentiation often turns out to The treatment that can be offered for this 3. What long term measures might be helpful?
This is an uncommon case of large abdominal and be difficult because of the formation of a hematoma. pathology is represented by a surgical exploration
retroperitoneal tumours in a 22-year old pregnant This disease entity is associated with an underlying of the kidney, above all if there are bilateral
woman. Ultrasound showed several hepatic pathology, which may be a benign tumor such as an suspicious masses larger than 4 cm. If the bleeding
hemangiomas and very large bilateral angiomyolipoma or a malignant tumor such as a is caused by a malignant tumour, extrafascial
retroperitoneal masses with apparently liquid renal cell carcinoma with bleeding through a nephrectomy is the treatment of choice. For those Case provided by Oliver Hakenberg, Rostock (DE)
content. A percutaneous biopsy of the tumour spontaneous rupture in the retroperitoneum. The risk with benign tumours, renal arteriography with
showed fatty and connective tissue and fragments of this rupture is higher during pregnancy. Usually all embolization is an important therapeutic method Readers are encouraged to provide interesting and
of large blood vessels. the patients present with flank pain, often severe and to control the bleeding and to avoid surgery. challenging cases for discussion.

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August/September 2008 European Urology Today 9


Testosterone deficiency is a challenge for urologists
EAU Forum on men´s health will take place in Venice this November

Prof. Claude in a decrease of testosterone. The metabolic Although testosterone levels decrease in men with
Schulman syndrome, which is an association of hypertension, age, the incidence of prostate cancer increases
University Clinics of hyperlipidemia increased insulin resistance (glucose significantly. In prostate cancer, men with more
Brussels - Hôpital intolerance – diabetes type II) is interlinked with aggressive disease (Gleason score of 8 or greater)
Erasme - Belgium obesity and TDS. Also obesity, and its associated actually have lower levels of serum testosterone.
Brussels (B) decrease in testosterone, is associated with an These perspectives do not support a scientific basis
for the belief that T causes CaP to develop.

Claude.Schulman@
ulb.ac.be
“Benefits of testosterone therapy
outweigh risks”
The incidence of prostate cancer increases with age while
It is my pleasure to invite you to the EAU forum on testosterone levels decrease.
men´s health, hormones and prostate disease which Most of the available preparations of testosterone,
will take place at Hotel Monaco & Grand Canal in intramuscular, transdermal, oral and buccal
Venice, Italy from 7-8 November 2008. Though often preparations are safe and effective, if used correctly. The benefits of TRT in men presenting with TDS far
cited in quality of life issues, testosterone deficiency However, short-acting (transdermal, oral, buccal) outweigh the safety risks that can be largely avoided
may affect morbidity and, ultimately increase preparations should be preferred over long-acting. by following the most appropriate recommendations
cardiovascular and all cancer mortality. Urologists The preparations avoiding supraphysiological 2,6
. Larger-scale and long-term studies are needed on
are in the best position to see patients with concentrations and releasing steady testosterone the effects of testosterone treatment in men regarding
testosterone deficiency and monitor the efficacy and increased risk of more aggressive prostate cancer. levels should be preferred. their benefit and risks. Although there is a need for
especially prostate safety of testosterone treatment. Men with total testosterone levels below 200 ng/dl more evidence, testosterone therapy has many
(6.9 nmol/l) have a two-fold higher risk of death, a Before initiation of TRT, prostate health has to be benefits and few risks.
Testosterone Deficiency Syndrome (TDS) is a clinical three-fold higher risk of cancer-related death and a checked, by the determination of serum prostate-
and biochemical syndrome which results in significant two-fold higher risk of cardiovascular-related death specific antigen (PSA) associated to digital rectal References
detriment in the quality of life and adversely affects over 17 years than men with testosterone levels of 410 examination (DRE). Transrectal ultrasound- guided 1. Morales A., Schulman C., Tostain J., Wu F: Testosterone
the function of multiple organ systems 1. to 509 ng/dl (14.2–17.7 nmol/l)3. biopsies of the prostate are indicated only if the DRE Deficiency Syndrome (TDS) Needs to be Named
or the serum PSA levels are abnormal as in usual Appropriately – The Importance of Accurate Terminology,
TDS is characterised by a decrease in testosterone and Fears on safety are unfounded Good Clinical Practice (GCP) 2,6. Eur. Urol. 2006; 50: 407
other hormones and is associated with changes in Huggins and Hodges reported in 1941 that marked 2. Nieschlag E., Swerdloff R., Behre HM. et al. Investigation,
body mass index, obesity, osteoporosis, sleep and reductions in testosterone (T) by castration or Men on testosterone therapy should be monitored at Treatment and Monitoring of Late-Onset Hypogonadism
mood disorders 2. Obesity appears to be a driving estrogen treatment caused metastatic prostate cancer three-month intervals during the first year of use and in Males. ISA, ISSAM, and EAU Recommendations. Eur.
factor since adiposite cells secrete leptin which results (CaP) to regress, and administration of exogenous T thereafter at one-year intervals 2,6. Urol. 2005 ;48: 1
caused CaP to grow. Remarkably, this latter 3. Araujo AB. et al. Total testosterone as a predictor of
conclusion was based on results from only one mortality in men: results from the Massachusetts Male
patient who showed elevated but fluctuating acid Aging Study. In: The Endocrine Society Annual Meeting.
phosphatase levels after testosterone injection. 2005. San Diego, California, USA.
4. Shores MM., Matsumoto AM., Sloan KL. et al. Low serum
Multiple subsequent reports revealed no CaP testosterone and mortality in male veterans. Arch Intern
progression with T administration, and some men Med. 2006; 166: 1660
even experienced subjective improvement, such as 5. Morgentaler A. Testosterone and Prostate Cancer: An
resolution of bone pain. More recent data have shown Historical Perspective on a Modern Myth. Eur. Urol. 2006;
no apparent increase in CaP rates in clinical trials of 50: 935
T supplementation in normal men or men, neither 6. Rhoden E., Morgentaler A. Risk of testosterone-
even in men at increased risk for CaP with high grade replacement therapy and recommendations for
The influence of testosterone on different target organs PIN or following radical prostatectomy6. monitoring. NEJM 2004; 350: 482

EAU Forum
Men’s health, hormones and prostate diseases

EAU Forum Dear colleagues,

It is our pleasure to invite you to the EAU forum on Men’s health, hormones and prostate diseases
which will take place in Venice, Italy from 7–8 November 2008.
With prolonged life expectancy, men and women can expect to live one-third of their lives with some
Congress Consultans B.V.
PO Box 30016
6803 AA Arnhem
form of hormone deficiency. Men have the added problem of developing specific urological diseases, T +31 (0)26 389 1751

Men’s health, hormones such as benign prostatic hyperplasia, prostate cancer, continence disorders and erectile dysfunction.
Testosterone is not just important in medicine for sexual activity, but for many conditions in men, like
cardiovascular diseases and also metabolic conditions. The potential benefits and risks of testosterone
treatment must be carefully assessed. Special focus should be put on testosterone and the prostate.
F +31 (0)26 389 1752
eauforumvenice2008@
congressconsultants.com
www.uroweb.org

and prostate diseases Though often cited in quality of life issues, testosterone deficiency may affect morbidity and, ultimately
increase cardiovascular and all cancer mortality.
Urologists are in the best position to see patients with testosterone deficiency and monitor the efficacy
and especially prostate safety of testosterone treatment.

We are looking forward to seeing you in Venice.

7-8 November 2008, Venice, Italy


Chairmen:

W. Artibani, Padua (IT) V. Mirone, Naples (IT) C.C. Schulman,


Chairman Chairman Brussels (BE)
Chairman

Scientific Programme Topics


Testosterone
Testosterone deficiency
Metabolic syndrome
Testosterone supplementation: Benefits and risks

Erectile dysfunction
Erectile dysfunction: An endothelial dysfunction
Erectile dysfunction and cardiovascular diseases
Contemporary management of sexual dysfunction

Testosterone and prostate cancer


The importance of the androgen receptor in the prostate
Why does prostate cancer become more hormone-resistant?
Testosterone and prostate cancer risk: Evidence or historical myth?
Risk of androgen deprivation treatment (ADT) in prostate cancer:
The other side of the coin

Faculty
W. Artibani, Padua (IT)
C.R. Chapple, Sheffield (GB)
N. Clarke, Manchester (GB)
F. Debruyne, Arnhem (NL)
I. Eardley, Leeds (GB)
S. Meryn, Vienna (AT)
Online registration now open at V. Mirone, Naples (IT)
F. Montorsi, Milan (IT)
P. Montorsi, Milan (IT)
registrations.uroweb.org C.C. Schulman, Brussels (BE)
W. Weidner, Giessen (DE)
E. Wespes, Brussels (BE)

European
This meeting is organised in collaboration with the European Society
of Andrological Urology, a full member of the EAU Section Office
European
Association Association
of Urology of Urology

10 European Urology Today August/September 2008


INTERVIEW
By Joel Vega

Photography by
Rens Plaschek

A young urologist

Morgan
can bring new ideas and
a new way to look at the
specialty. Young doctors are
in a position to ask questions The only way

Rouprêt
that were never asked before for us urologists to maintain
and go beyond the limits. We and hold our influence is to
are always looking ahead consider ourselves not only
although we don’t have the a physician of an organ but
knowledge of our senior to look at our speciality as
colleagues. a whole and wide-ranging
field.
Bagging the prize for the Best Paper
published on Clinical Research in 2007 Our mentors
during the 23rd Annual EAU Congress in and senior urologists have the In my country
Milan last March, Morgan Rouprêt has responsibility to give or teach France, there are 62 million
added another accolade to his growing to the young generation not inhabitants and only 1,000 My greatest fear
stash of honours. only the necessary surgical urologists. It is difficult to is not being able to operate
knowledge and skills but struggle and to battle for anymore, one day.
The 33-year-old Rouprêt is Chef de also pass on or help develop every field in urology and
Clinique of the Urology Department at the in young doctors critical keep them in our hands
Hôpital Pitié-Salpétrière, Faculté de A committed researcher and writer with a thinking. as we are limited in terms To relax
Médecine Pierre et Marie Curie, University string of publications in international, of numbers. We will be I go to the cinema (for a
Paris 6. In 1999, he received his first peer-reviewed journals, Rouprêt focuses stronger if we stay connected ‘popcorn’ movie!), read
recognition from the Paris School of and writes on urological cancers with urologists from other books and enjoy sports like
Urology would be stronger European countries.
Medicine and the urology prize in 2004 particularly upper urinary tract tumours if urologists are in a position skiing.
from the French National Academy of and prostate cancer. He earned a PhD in to keep or maintain their
Medicine. The following year, he received the field of onco-urology and genetic hold on their turf because
the gold medal AP-HP Prize and the Le markers. His award-winning paper, which for each pathology there I have strong admiration I have a hidden talent
Dentu-Renon Prize bestowed by the impressed the EAU jurors with its are medical and surgical for people in politics and to convince people to go the
French National Academy of Surgery. In innovative and well-designed treatments. If we depend on to see how much time they way they have not chosen in
2006, Rouprêt collected the Prize Auquier, methodology, examined molecular other specialists for a key invest into their work and the beginning, and for them
followed in 2007 by another citation from detection of localised prostate cancer decision on treatment then their readiness to sacrifice to follow different ideas
the EAU’s European Urological using quantitative methylation-specific we are not fully part of the the personal for a very public and the common sense of a
Scholarship Programme (EUSP). PCR. decision. life. group.

The EAU Crystal Matula Award 2009 is the most prestigious prize given to a young
The EAU Crystal Matula Award promising European urologist under the age of 40 who has the potential to become one of
the future leaders in academic European urology. The award also includes a honorarium

2009 of Euro 10,000 and will be presented at the upcoming Annual EAU Congress in Stockholm.

The list of previous awardees includes many well-known names:

1996 Paris F.C. Hamdy, Sheffield, United Kingdom


1998 Barcelona F. Montorsi, Milan, Italy
1999 Stockholm G. Thalmann, Berne, Switzerland
2000 Brussels A. Zlotta, Brussels, Belgium
2001 Geneva B. Djavan, Vienna, Austria
2002 Birmingham M. Kuczyk, Hanover, Germany
2003 Madrid B. Malavaud, Toulouse, France
2004 Vienna P.F.A. Mulders, Nijmegen, The Netherlands
2005 Istanbul M.P. Matikainen, Nokia, Finland
2006 Paris A. De La Taille, Creteil, France
2007 Berlin M.S. Michel, Mannheim, Germany
2008 Milan V. Ficarra, Padua, Italy

Nomination process
National Societies can nominate a candidate by supplying a letter of endorsement, a
motivation letter and a complete curriculum vitae of the proposed candidate.

p ly
Ap ow!
However, please note that eligible candidates can also apply for this award by contacting
their national urological societies directly. The candidate is then expected to supply their
national society with a CV and motivation letter, requesting a letter of endorsement.
n How to apply
All correspondence can be sent to: a.venhorst@uroweb.org

Deadline for submission is: 1 November 2008

This initiative is made possible through an unrestricted


educational grant provided by Laborie Medical Technologies LABORIE

Send in your nominations today!

August/September 2008 European Urology Today 11


WHO Conference on Bladder
International Consultation organised by the World Health Organization in cooperation
Prof.Dr. Lennart smoking also entail an increased risk. Importantly, certain benign conditions; a risk that increases with a Although first degree relatives of bladder cancer
Andersson smoking cessation has been shown to reduce the higher cumulative dose. According to Prof. Sten patients have a two-fold increased risk of bladder
Chairman likelihood of bladder cancer. Nilsson phosphoramide mustard represents the cancer, high-risk bladder cancer families are
Stockholm (SE)   primary mutagenic metabolite here. Considering the extremely rare according to Prof. Bart Kiemeney (NL)
Dr. Göran Boëthius, co-founder and chair of “Doctors effects of other chemotherapeutic agents, it appears when discussing hereditary aspects of bladder cancer.
against Tobacco, Sweden” discussed what society and that melphalan and thiotepa may elevate the risk of There is no clear Mendelian inheritance pattern that
various organizations are doing to prevent cigarette bladder cancer when given in combination with pelvic can explain the increased familial risk making
smoking. Inasmuch as smoking does not seem to be radiotherapy. classical linkage studies for the mapping of
lennart.andersson@ on the increase in Western countries, it is particularly   susceptibility genes impossible. The disease may be
ki.se worrisome to see that the tobacco industry is now Chronic infection with Schistosoma hematobium in caused by the combination of exposure to exogenous
showing greater interest in promoting smoking in the endemic areas is an important factor for the carcinogens and the existence of a large number of
Third World. development of bladder cancer according to Prof. Hassan susceptibility genes with modest effects. Genome-
Prof.Dr. Michael   Abol-Eneim. Government-sponsored projects are being wide association studies currently underway may be 
Droller Several specific chemical agents have been conducted in the affected countries with the aim of better suited to identify these genes.
Co-chairman significantly associated with the risk of developing diminishing infestation with this parasite. By  
New York (USA) bladder cancer. Exposure to selected chemical comparison, the possible connection between bladder Professor Margaret A. Knowles (UK) highlighted the
carcinogens, occupations, or industries was the topic cancer and chronic bacterial or viral infections is unclear. bladder cancer subtypes defined by genomic alterations.
of Prof. Seth Lerner’s contribution. He stated that Many of these affect the function of tumour suppressor
carcinogens with the greatest impact are certain Pathogenesis genes (TSGs), leading to partial or complete loss of
aromatic amines; 20–27% of bladder cancer cases Under the chairmanship of professors Rodolfo protein expression or function with varied phenotypic
michael.droller@ may be caused by exposure to these substances as Montironi (I) and Per-Uno Malmström (SE) a panel of consequences. Some of the genes implicated (such as
mountsinai.org may be the case with industrial exposure of blue collar experts reviewed the genetics, histopathological TP53 and RB1), are important in other tumour types.
workers in the workplace (but not necessarily with the characteristics, biochemical and molecular profiles, Others, particularly some on chromosome 9, show
general population). However, individual susceptibility hereditary factors and biostatistical concerns related bladder-specific involvement. The recent identification
Introduction to these cancers may also play an important role. to the interpretation of genetic and molecular aspects of mutations of FGF receptor 3 (FGFR3) in most
Last April 24th-25th Stockholm provided a fitting Although regulatory controls in industrialized nations of the various forms of bladder cancer. non-invasive bladder tumours and overexpression of
location for the 2008 International Consultation this receptor in both superficial tumours and many
“Bladder Cancer – from Pathogenesis to Prevention”, invasive bladder cancers has generated optimism that
a conference organized by the World Health therapies targeting this receptor for tyrosine kinase may
Organization (WHO) in collaboration with the have major application in  treatment.
European Association of Urology (EAU).  
  As a multifactorial disease, both environmental and
Professor Lennart Andersson, Chairman of the WHO genetic factors are involved in the development and
Collaborating Center for Urologic Tumors and the progression of bladder cancer. Prof Núria Malats (ES)
Sweden-based organizing committee, had invited reviewed the genetic epidemiology of bladder cancer.
laboratory and clinical scientists from all over the This neoplasm is a paradigm for the participation of
world to discuss the progress in understanding of the low penetrance genetic variants (GSTM1-null and
various aspects of the fundamental biology, NAT2-slow) in contributing to the susceptibility of a
epidemiology, genetics and biochemical particular individual to the carcinogenic activity of
characteristics of bladder cancer. This information is environmental exposure. Genetic variants in
crucial in defining and characterizing the various nucleotide excision and double strand break DNA
cancer forms and their global impact. The discussions repair pathways have provided further evidence for
also covered screening for early diagnosis, this with ERCC2-XPD rs238406 being a notable
alternatives in treatment and prevention, and the example both  by itself and by interacting with
financial burden placed on society by the incidence tobacco. Variants in other pathways such as cell cycle
and prevalence of bladder cancer. control, 1-C metabolism, and inflammation, have also
  been studied though results are not consistent.
The following provides an overview of the Expert panel on Pathogenesis. From left to right: Richard Sylvester, Brussels, Belgium, Carlos Cordon-Cardo, New York, USA,  
presentations. Full manuscripts will be published in Per-Uno Malmström, Uppsala, Sweden, Rodolfo Montironi, Ancona, Italy, Antonio Lopez-Beltran, Cordoba, Spain, Angela van Tissue microarray studies have provided a valuable
The Scandinavian Journal of Urology and Nephrology. Tilborg, Rotterdam, the Netherlands, Ellen Zwarthoff, Rotterdam, the Netherlands, Theo van der Kwast, Toronto, Canada, tool for high-throughput genomic and proteomic
The WHO Collaborating Center for Urologic Tumors Margaret Knowles, Leeds, United Kingdom, Arndt Hartmann, Regensburg, Germany analyses and offered reliable information on the
and the Organizing Committee for this conference are relation of molecular markers and clinical outcomes.
grateful to Professor Manfred Wirth, M.D., Editor-in- As discussed by Arndt Hartmann (D) this technique
Chief of European Urology Today, and Professor have resulted in decreased exposure to many bladder  Presentations in this session focused on the concept has also been used to evaluate immunohistochemical
Per-Anders Abrahamsson, M.D., Secretary General of carcinogens, this unfortunately is not the case in many that bladder neoplasms can be subdivided into two candidate markers for prognosis and to reveal the
the EAU, for permitting publication of this review. developing countries. groups: those that recur but  remain non-invasive, amplification frequency of candidate oncogenes in
  and those that become invasive and progress. regions with copy number alterations detected by
Epidemiology and Etiology Various nutritional factors that might be of Traditionally the evaluation of  bladder neoplasms comparative genomic hybridization and array-based
Global demographic and environmental factors importance in the aetiology of bladder cancer were and their natural history has been based on the methods.  Multimarker expression studies of several
associated with bladder cancer were discussed by the described by Prof. Maurice Zeegers (UK). These morphological analysis of tissue and urine samples.  specific biological functions (e.g. apoptosis or cell
“Epidemiology and Etiology” committee led by include salted and barbecued meat, pork, total fat, The classification introduced by the WHO in 2004 cycle proteins) and of signal transduction pathways
professors Ziya Kirkali (TR), Wiking Mansson (SE), Jan pickled vegetables, salt, soy products, spices, and subdivides lesions into flat and papillary, further have also been performed.
Adolfsson (SE) and Paolo Boffetta (FR). artificial sweeteners. In contrast, fruit and yellow- subdividing each on the basis of the degree of cellular  
  orange vegetables (particularly carrots) may be and architectural changes. The value of several biomarkers in voided urine in
Bladder Cancer is the ninth most common cancer associated with a moderately reduced risk of bladder   detecting recurrent bladder cancer was the topic
worldwide. The epidemiology of bladder cancer cancer. Citrus fruits and cruciferous vegetables may In recent years, molecular studies to further explain presented by Dr. Ellen C. Zwarthoff (NL). In general,
presents a rather stable situation in the Western also have a protective effect, whereas no clear these distinctions have been made possible through sensitivities are much lower when only patients under
world, as shown in a review by Prof. Donald Parkin association has been determined for beef, eggs, the refinement of various analytic techniques - surveillance are taken into account than when patient
(UK). However, there are concerns over a mixed processed meats, or total fluid intake. including tissue microarrays, identification of markers cohorts include those with primary disease or  with
development in Asia due to the increasing rates of   at the genetic and epigenetic levels, genotyping, gene high-grade tumours. The markers with sensitivity and
cigarette smoking. Indeed, it is estimated that as Coffee drinkers have a moderately higher relative risk epidemiology, risk adapted gene signatures, and specificity  >70% are Lewis X, NMP22, microsatellite
many as one-third to one-half of all cases worldwide of developing bladder cancer as compared to those characterization of molecular alterations in initiation analysis (MA), CYFRA 21.1, cytokeratin 20 (CK20) and
are associated with cigarette smoking. Unfortunately, who do not drink coffee, but this may be the result of and progression. Although these new techniques the UroVysion fluorescence in situ hybridization test
true incidence estimates are difficult to assess due to confounding by smoking or dietary factors according have not yet replaced morphological evaluation of (FISH). In general, lesions that are missed are pTa and
changes in cancer registration, multiplicity of the to Prof. Carlo La Vecchia (I). Indeed, the absence of bladder neoplasms, they are increasingly being low grade. Recent developments in  the use of FGFR3
tumours, and reporting procedures and protocols. risk relationships with dose and duration has been combined with morphological findings to provide mutation analysis and methylation detection were
  suggested to contradict the existence of a causal more accurate information on the clinical behaviour of included in the discussion.
In Russia, for example, an increase in incidence of association. The same issue appears to be the case various types of bladder cancer in individual patients
bladder cancer is being seen, which may well be with regard to alcohol. and assist in identifying those at risk (hereditary and The concept of molecular alterations affecting
associated with a high rate of smoking.  Prof. Dmitry   non-hereditary factors). “genetic pathways” was the theme of Prof. Carlos
Pushkar (RU) cautions that the true potential risk may Convincing evidence of a relationship existing   Cordon-Cardo’s (USA) presentation. He pointed out
actually be underestimated because  the current mean between an increased risk of bladder cancer and The (histo)pathological and clinical presentation of that alterations of p53 and PTEN/Akt are significantly
life expectancy of Russian males is only 60 years. exposure to ionizing radiation was presented by Prof. patients presenting with bladder urothelial carcinoma associated with bladder cancer progression and
  Per Hall (SE). Initially based on data from atomic were examined by Prof. Antonio Lopez-Beltran (ES). disease specific mortality. In view of the key role
According to the report from Prof. Paolo Boffetta (FR), bomb survivors, similar findings have been obtained The most recent WHO classification (2004),  includes exerted by the PTEN protein in tumour suppression,
over one-third to one-half of bladder cancer cases in in studies of cancer patients (e.g. prostate or cervical urothelial flat lesions (flat hyperplasia, dysplasia and its further elucidation in bladder cancer  is of high
men are linked to smoking; both the intensity and carcinoma) treated with high-dose radiotherapy. In carcinoma in situ) and papillary lesions  (broadly potential significance. The challenge is to evaluate
duration of smoking have an impact on the risk of contrast, no carcinogenic effects on the bladder have subdivided into benign papilloma and inverted such targets for therapeutic development, as well as
developing this disease. Also, black tobacco is been found with lower doses of radiation papilloma, papillary urothelial neoplasia of low to translate progression and outcome biomarkers into
associated with a higher risk compared to blond (occupational exposure) or from protracted low dose malignant potential (PUNLMP) and non-invasive low improved clinical management.
tobacco cigarettes (reflecting the higher content of exposure (radioiodine). or high grade papillary carcinoma). The most
aromatic amines in black tobacco). Cigar and pipe   controversial proposal of the WHO 2004, that PUNLMP Torben Ørntoft of Aarhus (DK) reviewed gene
The significant risk of developing secondary bladder has lower malignant behaviour when compared with signatures for risk adapted treatment of bladder
cancer has been identified after cyclophosphamide low grade papillary carcinoma, is supported by recent cancer. A major challenge for molecular diagnosis of
Effects and Actions: International Meeting Reports
treatment for other types of malignancies or for molecular studies. bladder cancer is the subdivision of tumours beyond

12 European Urology Today August/September 2008


Cancer resounding success
with the EAU in Stockholm, Sweden
Natural History, discussed the criticisms that have been levelled single drugs and removing patients from study when
Screening, Prevention regarding their performance.  clinical recurrence has occurred. Most studies have
and Economic Impact of   not achieved their primary endpoint of decreasing the
Bladder Cancer Professor Peter Albertsen (USA) then reviewed the rate of bladder cancer recurrence.
A third committee grouped history of the use of PSA testing in the diagnosis of
under the header “Natural prostate cancer and the pitfalls that have emerged in The most commonly used strategy to investigate
History, Screening, Preven- attempts to use this biomarker as an indication for chemoprevention in bladder cancer has been to apply
tion, and Economic Impact” performing biopsies, diagnosing disease, and an intervention in patients with a history of this
was chaired by professors applying various therapies, presumably earlier in the disease to decrease the rate of tumour recurrence.
Bernhard Tribukait (SE), course of the different forms of prostate cancer (both Although most trials have failed to demonstrate
Michael J. Droller (USA) low risk or “clinically insignificant” forms of disease efficacy, they have indicated that: (1) the interventions
and H. Barton Grossman and high risk or “clinically significant” forms of should have low toxicity to be acceptable; (2) trials of
(USA). This panel discus- disease). These were placed in the context of single drugs may not be the optimal chemopreventive
sed the treated and outcomes that have been achieved in applying PSA strategy; and (3) alternative study designs such as
untreated natural history screening for earlier detection to presumably reduce continuing therapy after the first tumour recurrence
of the various forms of the potential morbidity and mortality of the disease should be tested.
bladder cancer; the role itself and of the treatment utilized to treat and  
of screening in potentially possibly cure the various forms of disease. In this, Although complementary approaches are widely
Professors Lennart Andersson, Per-Anders Abrahamsson, Ziya Kirkali and Tadao Kakizoe reducing morbidities and numerous pitfalls in screening were identified and it used, there is little data documenting the efficacy of
mortality; new directions seemed apparent that much remained to be done in alternative medicinal and dietary approaches in
in possibly suppressing, selecting  populations at risk for having high risk bladder cancer as Dr. Mark Moyad (USA) pointed out
histological classifications into clinically relevant preventing, or reversing each diathesis either medically disease and applying screening tests to these in his review. Because of results in animal studies and
molecular subgroups. The evolution of molecular or with complementary approaches, and the overall judiciously. tantalizing observations in humans, however, there is
high-throughput techniques for assessing a large budgetary impact each diathesis might have.   a compelling need for rigorous research on the effects
number of molecular features at the same time has   Chemoprevention – the use of chemical agents to of alternative medicine in bladder cancer. Effective
made comprehensive investigation of these subgroups Professors Tadao Kakizoe (JP) and Michael J. Droller prevent or slow the development of bladder cancer strategies should be designed to  lower the incidence
possible. Molecular signatures for disease stage, reviewed the natural course of untreated were subdivided by Prof. H. Barton Grossman (USA) and/or recurrence rates of bladder cancer without
grade, progression, carcinoma in situ, presence of (preclinical) versus treated (clinical) course of the in “primary” prevention as a means to seek increasing morbidity or mortality of other diseases.
metastases, and treatment response have been different forms of bladder cancer as based upon the prevention of the occurrence of disease in a healthy  
reported. Some of these molecular signatures are concept that different developmental pathways population, “secondary” prevention as endeavouring Bladder cancer is the most expensive neoplasm both
now being tested in multicentre studies with the could be used to envision the different courses of to prevent the development of clinical cancer in in costs per patient and lifetime costs. Prof. Arnulf
purpose of introducing these into the clinic,  planning these tumour diatheses as these represented low individuals with well-defined “pre-malignant” Stenzl (DE) explained in his presentation that
of follow-up and selection of treatment . risk versus high risk disease. In the case of the conditions, and “tertiary” prevention as an attempt to non-muscle invasive disease accounts for most of
  former, risk was taken to imply the likelihood of prevent recurrences in patients with a history of these costs, with the largest proportion resulting from
An overview of  recent molecular-genetic findings,  recurrence without the likelihood of progression. In cancer who were currently clinically free of disease. the treatment of recurrent disease. Cessation of
critically appraising  their relationship with each of the case of the latter, risk was intended to signify the   cigarette smoking could help reduce these costs by
the WHO 2004 disease categories was provided by risk of progression and of potential mortality. The Since primary prevention decreases the fundamental decreasing the incidence of bladder cancer, this being
Prof. Theodor van der Kwast (CA). Most of these have histologic diagnosis and characteristics of a bladder incidence of disease and cigarette smoking is the potentially most effective in the adolescent
been successfully distinguished by means of genome cancer at its initial presentation can be considered most common cause of bladder cancer, he suggested population. Other strategies to decrease the rate of
profiling and identifying distinct genetic alterations. as  providing a “snapshot” of a particular that efforts to decrease smoking are likely to be the tumour recurrence, e.g. transurethral resection with
Molecular-genetic data  suggest that papillomas may developmental pathway and of a specific tumour most highly cost-effective method for achieving fluorescence cystoscopy to more fully eradicate all
not represent a precursor lesion for bladder cancer diathesis. The concept of screening to provide earlier primary prevention. However, because of the long visible disease, could also be cost-effective. For
but rather a benign neoplasm sharing mutations in “snapshots” could theoretically be useful in lagtime between exposure and the development of patients requiring cystectomy, cost savings could be
the FGFR 3 gene. In contrast, genetic alterations in allowing earlier interventions to reduce the risk of clinical disease and the low incidence of bladder achieved by treatment in high volume centers by high
papillary urothelial neoplasia of low malignant recurrence or progression and reduce the extent and cancer, a study that might critically investigate this volume surgeons.
potential are identical to those found in non-invasive complexity of the treatments required if the disease strategy would likely be both expensive and time-
low grade papillary urothelial carcinoma (PUNLMP), were diagnosed earlier in the course of its consuming. The supplement of the Scandinavian Journal of
implying that they are within a spectrum of the same preclinical natural history.  Urology and Nephrology with the proceedings
neoplasm. Expression profiling data corroborate the   Secondary prevention has not been explored because from the meeting can be ordered free of charge at
view that (secondary) carcinoma in situ may not only of the lack of a consensus on well-defined pre- the WHO Collaborating Center for Urologic
act as a precursor lesion for invasive non-papillary `....if the disease were diagnosed malignant conditions in bladder cancer. Tertiary Tumors, Karolinska University Hospital,
urothelial carcinoma, but also as a precursor for prevention has been studied in several prospective Stockholm, Sweden, e-mail diana.eriksson@ki.se
non-muscle invasive papillary urothelial carcinoma.
earlier in the course of its preclinical randomized trials usually involving investigation of
  natural history, the extent and
Biostatistical considerations in the use of molecular
markers and gene expression profiling to improve the
complexity of the treatments
predictive accuracy of current prognostic indices were required could be reduced.`
presented by Prof.  Richard Sylvester (B) who pointed to
the many statistical pitfalls in establishing the benefit of
a multi-gene expression classifier during its The theoretical and practical considerations of
development. First are issues related to the screening as these could provide a framework in
identification of individual genes and their false considering the value of screening for the different
discovery rate, instability of the genes identified, and forms of bladder cancer were discussed by Prof.
their combination into a classifier. Second, the classifier Lorelei Mucci (USA). Since the prevalence of disease
needs to be validated (preferably on an independent is a critical factor in assessing the positive or negative
data set) in order to show its reproducibility. Third, it is predictive values of any particular test used to screen
necessary to show that adding the classifier to an for bladder cancer, it is highly important in screening
existing model, as based on the most important clinical to be able to select a population at risk in order to
and pathological factors, improves the predictive make these predictive values more clinically relevant
accuracy of the model. This cannot be determined as and powerful as well as more cost effective.
based on the classifier’s hazard ratio or p value in a  
multivariate model. Rather, it needs to  be assessed In the context of these considerations, Professor
based on the Area Under the Curve and the Droller discussed practical issues of screening for the
Concordance Index. Finally, nomograms appear to be various forms of bladder cancer.  He reviewed how
superior to stage and risk group classifications for testing for haematuria, use of various approved
predicting outcome, but the model predicting outcome biomarkers (BTA stat and trak, NMP22) and urinary
must be well calibrated. It is important for investigators cytology together with fluorescent labelled adjuncts
to be aware of these pitfalls in order to develop (FISH assay for abnormal chromosomes – Urovysion -
statistically valid classifiers that will truly improve our and markers for tumour surface antigens –
ability to predict a patient’s risk of progression. Immunocyt) have been used in screening and

August/September 2008 European Urology Today 13


Rules and Regulations
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t5IFUPQJDPGUIFQBQFSTIPVMEEFBMXJUI.JOJNBMMZ*OWBTJWF4VSHFSZJO
VSPMPHZ
t5IFQBQFSNVTUIBWFCFFOBDDFQUFEGPSQVCMJDBUJPOJOB
&VSPQFBO+PVSOBMJOPS
t"MMQBQFSTNVTUCFTVCNJUUFEJOUIF&OHMJTIMBOHVBHF PSJHJOBM
&OHMJTIQBQFSTPSUSBOTMBUJPOTJOUPUIF&OHMJTIMBOHVBHF

t"MMBQQMJDBOUTIBWFUPCFBNFNCFSPGUIF&"6
t5IFTVCNJUUJOHBVUIPSNVTUCFFJUIFSUIFmSTUPSUIFDPSSFTQPOEJOH
TFOJPSMBTUBVUIPS
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t%FBEMJOFGPSTVCNJTTJPOJT/PWFNCFS
t5IFBXBSEXJMMCFIBOEFEPWFSBUUIFUI"OOVBM&"6$POHSFTTJO
4UPDLIPMN .BSDIEVSJOHBTQFDJBMTFTTJPO

"SFWJFXDPNNJUUFF DPOTJTUJOHPGNFNCFSTGSPNUIF&"64DJFOUJmD
$POHSFTT0GmDF XJMMTFMFDUUIFXJOOJOHQBQFS

How to apply
1MFBTFTFOEZPVSQBQFSUPUIF&"6$FOUSBM0GmDFBUFBV!VSPXFCPSH
BOENFOUJPOi&"6)BOT.BSCFSHFS"XBSEwJOUIFTVCKFDUMJOFPG
ZPVSFNBJM
Win the EAU Hans
Marberger Award
This initiative is made possible through an unrestricted educational
grant by Karl Storz Endoscope, Germany
2009
Submit your paper on Minimally Invasive
Surgery and you might be awarded the
EAU Hans Marberger Award 2009 of € 5,000!

Important The two EAU Prizes for Best Paper


Published in Urological Literature are tools
How to apply
t Please send your paper to the following
through which the EAU encourages young e-mail address: eau@uroweb.org.
announcement and promising urological scientists to
continue their work and to communicate
t Include a copy of your curriculum vitae.
t Supply a list of all authors who have
their achievements to the European significantly contributed (if relevant).
urological community. t Indicate clearly for which category the

EAU Best Papers Two prizes of € 5,000 each will be made


paper is intended (clinical or fundamental
research).
available for the two Best Papers Published t Mention any financial support by
Published in in Urological Literature on Clinical or
Fundamental Research. These papers have
companies, government or health
organisations.

Urological Literature to be prepared, published or accepted


for publication between 1 January and 31
t A publisher’s letter of acceptance has to
be submitted along with your paper.
December 2008.
A review committee consisting of members
Rules and Regulations of the EAU Scientific Congress Office will
To be awarded at the t Eligible to apply for the EAU Best Paper review all submitted papers and nominate
Published in Urological Literature are the recipients of the two EAU prizes for Best
24th Annual EAU Congress in Stockholm, urologists, urologists-in-training or Paper Published in Urological Literature.
urology-related scientists. All applicants
17-21 March 2009 have to be a member of the EAU.
t The submitting author must be either
the first or the corresponding senior last

p ly author.

Ap ow!
t Each author is allowed to submit no more
than one paper.

n
t The paper must be written in the English
language (or translated into the English
language).
t The subject of the paper must be
urological or urology related. All correspondence is to be sent to the EAU
t The deadline for submission is 17 Central Office, at eau@uroweb.org, clearly
November 2008. indicating the relevant prize in the subject
t The awards will be handed out at the 24th line: “EAU Best Paper on Clinical Research”
Annual EAU Congress in Stockholm, 17-21 or “EAU Best Paper on Fundamental
March 2009 during a special session. Research”.

14 European Urology Today August/September 2008


Djavan shares skills with Belgian residents in Leuven
Dr. Frank Van Der Aa When we met Prof. Djavan at the Brussels airport, the history, current medical problems, indications for
Chief resident first thing he asked was to drive past his apartment. surgery, alternative treatments and the radiological
University Hospitals In the beginning we thought he liked jokes about examinations of the patients were reviewed and
Leuven German highways and fast cars (a drive to Vienna discussed. We found (luckily) great similarities in our
UZ Gasthuisberg would almost take 12 hours in an everyday resident approach to patients.
Leuven (BE) car). Later we learned that the foreign professor we supervision, his technique. This case was followed by
invited had become a close neighbour since his In the evening, we organised a seminar entitled another partial nephrectomy. In the late afternoon,
appointment as chief of the Department of Urology in “Adult reconstructive urology: state of the art we had a 90-minute session of case discussions on
frank.vanderaa@ the Erasme Hospital in Brussels. We found out that he lectures.” Prof. De Ridder, Dr. Van Der Aa and Dr. routine and less-frequent oncological cases.
uz.kuleuven.ac.be spoke fluent French and that even his Dutch language Fransis from our department presented several
skill is getting somewhere. lectures. Prof. Djavan presented the Rocco-Djavan For the last evening with Prof. Djavan in Leuven, we
technique for optimal bladder reconstruction and the organised a formal dinner with all the residents and
The official visit started on Monday with a tour around continence outcome during radical prostatectomy. The staff members of the University Hospital Gasthuisberg.
When we asked Professor Bob Djavan to visit our the department. We showed Prof. Djavan the way we day ended with an informal late evening dinner in a We thanked Prof. Djavan for his enthusiastic
department on a cold winter day in December 2007 at work in Gasthuisberg Leuven. We visited the wards, local Italian restaurant and a first visit to our “night participation in the visiting professor programme and
the BAU congress in Kortrijk, he immediately agreed. the outpatient clinic, the operating rooms and the day office,” a local pub were we often chatted about for his teaching activities. Professor Hein Van Poppel
We were pleased to have invited an international clinic. We demonstrated the computer system we urological and world problems. and Djavan and also some of the residents also gave
expert on various (oncological) topics. We knew he used and shared experiences about the modus short testimonials. We gifted Prof. Djavan Leuven’s
was Austrian, that he fluently spoke several On Tuesday, a full- day of surgery was planned. We iconic “Fonske,” symbol of student life in our city.
languages and that he was an excellent lecturer. We started early in the morning by performing a radical Again, the evening ended in our ‘night office.’
were sure we could learn a lot from him. prostatectomy, with Prof. Djavan demonstrating the
Rocco-Djavan technique which he presented the day Prof. Djavan left Leuven early the following morning.
Several months later, in spring 2008, the three last before. The second case was another radical Although some of the residents and staff suffered
year residents of our department invited Prof. Djavan prostatectomy. Prof. Djavan explained how he headaches from all the ‘late-night’ teaching activities,
to be the visiting professor at our hospital from 26 to performs the essential steps in the procedure and we all had a very good impression of the ‘visiting
29 May with generous sponsorship from the EAU’s again demonstrated the Rocco-Djavan technique. The professorship’ of our new neighbour. Indeed, we are
European Urological Scholarship Programme (EUSP). third case was a partial nephrectomy. In between glad that he will be working at Erasme in Brussels
surgeries, we found time to visit the wards and check and we wish him good luck. Finally, we are grateful
the patients that were operated on a day earlier. to the EUSP for its generous sponsorship of this
wonderful programme.
After surgery, Prof. Djavan presented his views on
several oncological topics. We discussed “Open vs.
laparoscopic vs. robotic radical prostatectomy,” and
Prof. Djavan (3rd from left) in theatre with senior residents (from “The standards of prostate biopsies in 2008.” We also
left) Frank Van Der Aa, Marc Claessens and Karen Fransis discussed “Radical prostatectomy vs. radiation in cT3
disease: results at 10 years follow up”. The sessions
operandi in a hospital. We don’t know how big the were all lively and we had an interactive discussion.
difference is between Austrian and Flemish hospitals In the evening, we visited the centre of Leuven. A
or between Flemish and Walloon hospitals. We did dinner was planned in a typical Belgian restaurant.
appreciate not only the punctual “Austrian school” Afterwards we visited the old market place to taste a
rules, but also the interest of Prof. Djavan to create a typical Leuven Stella. Everybody who visited Leuven
home for the residents in the hospitals. We did not knows that the next Stella always tastes better then
ask him whether this means that they also have to live the previous one…
Prof. Djavan with his “Fonske”. 24 hours a day in the hospital…
On Wednesday, two cases were operated, with the
After the tour, we discussed the patients that were first a case of radical prostatectomy. Prof. Djavan Prof. Djavan (middle) with the staff and residents of the urology
European Urological Scholarship Programme
planned for surgery in the coming days. Medical allowed the senior residents to perform, under his department in Leuven

www.reviews Embracing Excellence


Dr. Andrea Cestari Education and Training (SET) programme. This new in Prostate, Bladder
Section Editor programme started this year and involves a re-think
and a restructure of surgical training, moving away
and Kidney Cancer
Milan (IT)
from the old apprenticeship model where surgery is
taught as a craft, to one which involves an adult
learning model where learning is self-directed,
experiential and reflective. In the ‘Position’ section, 27-29 November 2009
interesting fellowships programmes are listed and
described. Barcelona, Spain
a_cestari@yahoo.it

www.hindawi.com/journals.au/
www.usanz.org.au
www.urosoc.org.au Advances in Urology is a peer-reviewed, open access
journal that publishes state-of-the-art reviews and
This is the official web site of the Urological Society of original research papers of wide interest in all fields
Australia and New Zealand (USANZ). In case you want of urology. The journal is both dedicated to basic and
to change your way of living and decide to start a new clinical urologic research. The journal also strives to
life on the other side of the world, it might be helpful provide the publication of important manuscripts to
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www.emucbarcelona2009.org

2nd European Multidisciplinary Meeting on Urological Cancers organised by:

August/September 2008 European Urology Today 15


Book reviews Recent advances demonstrated that erectile
dysfunction (ED) could be related to endothelial
dysfunction and predictive of forthcoming vascular
disease. The authors included all new concepts in this
book which contains 22 chapters.
Prof.Dr. Paul Meria Prostate Cancer: biology,
After general considerations a specific chapter focuses
Section Editor genetics and new on cardiac issues related to ED and the authors
Paris (FR)
therapeutics emphasise the role of ED as a primarily vascular
disorder in many cases. The subsequent chapters
Seventy-five contributors produced this excellent consider various approaches of ED, including primary
textbook (Chung, et.al) which offers an overview in care management, hormonal and psychosocial
the wide field of prostate cancer. The first chapter is a evaluation. Various causes of ED are described,
paul.meria@sls. dedication to Donald Coffey whose research works including postoperative ED after pelvic surgery.
aphp.fr represented an outstanding contribution to our
knowledge about prostate cancer. The following three A separate chapter is dedicated to female problems
sections and 28 chapters are dedicated to genetics, which are currently best considered in clinical practise
biology and therapeutics. and represent an increasingly encountered problem.
Our summer reading this year covers a wide range of The treatment of ED is widely described, with many
topics ranging from a practical clinical guide on chapters dedicated to various aspects such as oral
female urology, new techniques in uroradiology to and intracavernosal therapies. Mechanical treatments
male sexual function. If one is looking for an including vacuum devices and penile implants are
overview on these subjects the following books offer also discussed. Two chapters focus on Peyronie’s
comprehensive information and insightful details. disease while another takes up priapism.
Two chapters are dedicated to the new aspects of Interestingly, the last chapter is dedicated to gene
urography, either by means of CT or MRI. Such therapy which, according to the authors, represents
Female Urology: a practical techniques are currently replacing the classical one of the emerging treatments for ED. The therapy’s
clinical guide intravenous urography in the management of most aim is to restore smooth muscle relaxation by means
urological diseases. The authors emphasise the role of gene transfer and the authors have noted the
Goldman and Vasavada, with the help of more than of helical CT scan in diagnosing urinary stones. They results of experimental studies which assess tissue
60 contributors have written this textbook dedicated demonstrate the accuracy of such a technique in remodelling through a molecular approach.
to female pelvic medicine. During the last 10 years detection and evaluation before treatment.
many aspects of female urology evolved either in the All practitioners of various disciplines involved in the
field of evaluation or in treatment even as minimally The use of imaging for kidney tumours is widely management of ED and other sexual diseases will
invasive procedures replaced most of open discussed. A chapter is dedicated to the diagnosis of find in this book a practical tool, which is useful for
techniques. Such evolution was associated with complex renal cysts while another chapter the assessment and treatment of most patients.
significant decrease of morbidity. demonstrates the role of imaging in planning for
nephron-sparing surgery. An important chapter is Editors : Mulcahy, John J.
also dedicated to various techniques currently ISBN : 978-1-58829-747-1
available for renal arteries imaging. Published by : Humana Press
Publication date : 2006
The role of MRI is described in the assessment of Pages : 504
parenchymal renal diseases including specific aspects Illustrations : 130 illus., 5 in colour
Molecular genetic aspects of prostate cancer are in children, while MRI’s utility in prostate imaging is Cost : 130 euro
presented in the first section. Various aspects, such as demonstrated in another chapter. Interventional Binding : Hard cover
hereditary cancer, genetic epidemiology, androgen techniques, such as percutaneous operations or Website : www.humanapress.com
receptor polymorphism or xenograft models are also image-guided ablation of renal tumours, are  www.springer.com/humana+press/
presented in detail. This section summarises recent described in two specific chapters. urology?SGWID=0-150710-0-0-0
developments and provides an excellent review of
current knowledge. Anticipated improvements and This textbook is richly illustrated and the quality of the
other advances in the field were also mentioned in images is quite excellent although colour figures are
this chapter. absent. Although the book is intended for radiologists,
most urologists and nephrologists will find useful
The nine chapters dedicated to cancer biology information for clinical practice.
described many aspects of basic science including
angiogenesis, molecular pathways and stroma- Editors : Morocs, Sameh; Cohan, Richard H.
epithelial interaction. The results from ongoing ISBN : 9780824728755
research in such a field represent a strong basis for Published by : Taylor & Francis Group
the development of new therapeutics. Publication date : April 2006
Pages : 416
The last part dedicated to therapeutics presents Cost : 158 euro
classical techniques such as radical prostatectomy and Binding : Hard cover
radiotherapy and also focuses on new developments Website : www.catalogue.informahealthcare.
The book is divided into three main parts. The first such as chemotherapy, antiprogression agents, com
part considers the anatomic basis of pelvic support vaccine or gene therapy. A special chapter is
and various evaluation such as urodynamics, taking dedicated to chemoprevention. Undoubtedly, the
account of clinical indications. The second part, future of prostate cancer management will associate
Male Sexual Function: a guide
dedicated to treatment, separates four sub-parts various therapeutics, which were presented in the to clinical management
including stress urinary incontinence, overactive aforementioned chapters. Researchers will find in this
bladder, prolapse and reconstruction. For each topic, textbook comprehensive information and clinicians Mulcahy and 43 contributors, all of them experts in
pharmacological and instrumental treatments are will obtain an excellent overview of the utility of the management of sexual diseases in men, have
presented. The two chapters dedicated to research that has bearing on the future of their written the second edition of this book which was first
reconstruction considered selectively female urethral practise. published in 2001. They aimed to provide the reader a
Book reviews
diverticula and vesico-vaginal fistula. comprehensive overview of male sexual dysfunction.
Editors : Chung, Leland W.K.; Isaacs,
The third part, certainly the most original, presents an William B.; Simons, Jonathan W.
overview of clinically encountered problems through ISBN : 978-1-58829-696-2
18 cases studies, each of them discussed by Edition : 2nd ed.
international experts. Complex female urology is also Published by : Humana Press
practically discussed including a presentation of two Publication date : 2007
cases studies dealing with post-prostatectomy Pages : 508
incontinence. Nevertheless such widening to male Illustrations : 94 Introducing a new category
incontinence is understandable since some new Cost : 140 euro
techniques of treatment are identical to those Binding : Hardcover of stone extractors.
proposed for female stress incontinence management. Website : www.humanapress.com
NGage Nitinol Stone Extractor is not a grasper
Physicians involved in the management of female www.springer.com/humana+press/ or stone basket, but an entirely new category in
urology and incontinence will appreciate this very urology?SGWID=0-150710-0-0-0 the evolution of stone extraction. The patented
practical textbook. design enables physicians to easily engage,
release or extract stones in the kidney or ureter.
Editors : Goldman, Howard B.; Vasavada,
New Techniques in
Sandip P. Uroradiology To learn more, contact your Cook Medical
representative or visit www.cookmedical.com.
ISBN : 978-1-58829-701-3
Published by : Humana Press The authors (Morkos, et. al) present an overview of
Publication date : 2007 various techniques of imaging in uroradiology


Pages : 438 including ultrasonography, tomography, MRI, and

Illustrations : 127 illus., 15 in colour radioisotopes. Nearly 30 authors from the USA, the
Cost : 140 euro UK, France and Italy wrote the 14 chapters including
Binding : Hardcover diagnosis techniques and interventional aspects of  
  
Website : www.humanapress.com uroradiology. General aspects of imaging techniques
www.springer.com/humana+press/ and their risks are presented before the authors
AO RT I C I N T E RV E N T I O N CA R D I O LO GY C R I T I CA L CA R E E N D O S CO PY P E R I P H E R A L I N T E RV E N T I O N S U R G E RY U R O LO GY WO M E N ’ S H E A LT H
urology?SGWID=0-150710-0-0-0 focused on various and specific aspects.

16 European Urology Today August/September 2008


Still going strong
Urologists in private practice: the Swiss experience
Hans-Peter Schmid, recent years there has not been a single-physician Euros, Figure 3). That Table 2: Number of surgical procedures performed per year
MD practice but rather the trend is for a private practice income has to be put
Professor and group consisting of two to four medical practitioners into relation to costs for Number of urologists
Chairman working together. The remaining 30% work at a living expenses Type of surgery performing this Median Range
Dept. of Urology public hospital as staff members. (housing, food, clothes particular procedure*
Gallen (CH) etc.) which are quite Kidney (open) 22 7 2 - 20
Today, Switzerland, which has a population of 7.6 high in Switzerland. Ureterorenoscopy 23 20 2 - 50
million people, has a total of 205 board-certified TUR bladder tumor 24 30 10 - 130
hans-peter.schmid@ urologists (10 women, 195 men). Their continuous Problems and Prostate biopsy 24 100 35 - 450
kssg.ch medical education (CME) is regularly checked by the challenges Radical prostatectomy 21 25 10 - 45
Swiss Society of Urology (SGU). CME credit points can The final question in TUR prostate 24 62 20 - 220
be earned through different means, among them the the survey revolved Vasectomy 24 55 25 - 146
At the 23rd Annual European Association of Urology annual three-day-congress and the annual one-day- around the views of the Circumcision 24 24 15 - 80
(EAU) Congress in Milan last March, Oliver course offered by the SGU. Since more than 80% of urologists regarding * 1 urologist did not deliver his statistics
Hakenberg, European Urology Today (EUT) editorial future prospects in
board member, brought up the idea of publishing a Fig. 2: Vacation time per year private practice. The
series of articles on the day-to-day clinical routine of question could be answered using trends such as the increasing use and reliance on
urologists working in private practice in different key words. Topping the list is the technology and stifling bureaucracy.
European countries. concern that the latest technology
(laser, laparoscopy, robotic devices) References
As the Swiss delegate for European Board of Urology is not available to them either due 1. Schmid H-P. Current developments in Urology in
(EBU) and with my deep interest in the demographic to the high costs of such equipment Switzerland. Urologe, in press.
and socio-economic aspects of European urology, I or the lack of training. A third of the 2. Leippold T et al. Prostate biopsy in Switzerland : a
immediately supported Oliver’s proposal. Since I work respondents expressed their worry representative survey on how Swiss urologists do it.
at a public hospital and in order to give this article a about increasing bureaucracy and Scand J Urol Nephrol 2008; 42: 18-23.
more scientific basis, a questionnaire was mailed to struggles with health insurance 3. Engeler DS et al. The ideal analgesic treatment for acute
colleagues who are in private practice. companies. The same number also renal colic – theory and practice. Scand J Urol Nephrol, in
expressed concern that the era of press.
Urological training single practice seems
After completing medical school, a resident has to to be over. Fig. 3: Annual income (1 Swiss franc = 0.61 Euro)
successfully conclude a training period of at least six
years to become a board certified urologist by the From my personal
Foederatio Medicorum Helveticorum (FMH). Residency 0-2 3-5 6-8 9+ Weeks clinician’s point of
includes two years of General Surgery, three years of view, Switzerland has
Urology and a year of Urology or Gynaecology. Every all Swiss urologists are EAU members, the annual insufficient numbers of young people
candidate has to spend at least three years in a EAU congress attracts many participants from willing to pursue an academic career.
category A institution and there are only six such Switzerland. Compared to countries with a similar
training programmes in Switzerland (Table 1). Another population like Austria and Sweden,
eight urological institutions are acknowledged as Daily private practice the scientific output of Switzerland is
one-year training centres. The survey was performed among private urologists modest. There is still an ongoing
in the German-speaking part of Switzerland which trend to prefer private practice over
At the end of the residency, every young urologist has covers 64% of the entire country. A questionnaire science.
to pass the official multiple choice examination of the with nine items was mailed to 58 board certified
EBU and a practical examination in his own hospital urologists. Since some of the questions were Going strong
where a committee will check his ability and somewhat private, they were answered anonymously Swiss urologists in private practice
knowledge in the operating room and at the bed side. and all data were treated with utmost confidentiality. are still going strong. The majority of
In addition, the majority of Swiss urologists will also The questions were: 1. Number of years in private them cover a wide and interesting
take part in European exams to become a Fellow of practice, 2. Memberships in urological societies, 3. field of surgical procedures. The
the EBU (FEBU). Furthermore, there is the possibility Total working hours per week, 4. Percentage of overall income is decent and there is In Swiss francs: c 300,000 – 400,000
to stay for another two years at a category A working time with direct patient contact, 5. Number enough time for vacation. a < 200,000 d 400,000 – 500,000
institution and obtain the additional title “Surgical of surgical procedures per year, 6. Use of laser and Nevertheless, concerns arise on b 200,000 – 300,000 e > 500,000
Urology.” laparoscopy, 7. Total time off (vacation) per year, 8.
Income per year before taxes, 9. Problems and
After completing six to eight training years and a challenges in the future.
successful board certification, approximately 70% of
all Swiss urologists go into private practice (1). In The questionnaire was filled out and returned by 25
of 58 urologists (43%). This rate is lower than the
Table 1: Urological training programmes in Switzerland 75% (133 of 178) we obtained in a recent survey on
prostatic biopsy in Switzerland (2) and the 58% (99 of
Category A (4 years are acknowledged) 170) in yet another survey on how to treat stone colic
Berna Prof. Dr. Urs Studer (3). However, in light of the personal nature of the
Geneva Prof. Dr. Christophe Iselin questions, a response rate of 43% is acceptable.
Lausanne Prof. Dr. Patrice Jichlinski
Liestal/Basel Prof. Dr. Thomas Gasser The respondents work a median of 11 years (range,
St. Gallena Prof. Dr. Hans-Peter Schmid 4-27) in private practice. As many as 22 out of the 25
Züricha Prof. Dr. Tullio Sulser respondents (88%) are EAU members which
Category B (1 year is acknowledged) demonstrates that Swiss urologists, despite
Aarau Prof. Dr. Franz Recker Switzerland not being an EU member, are interested
Baden Dr. Kurt Lehmann in European urology. Other memberships include the
Frauenfeld PD Dr. Jochen Binder “Deutsche Gesellschaft für Urologie (DGU)” (48%),
Lucerne Prof. Dr. Hansjörg Danuser the “Societé Internationale d’Urologie (SIU)” (36%)
Münsterlingen Dr. Guido Tenti and the American Urological Association (AUA) (12%).
Schlieren Dr. Hartmut Knönagel
Winterthur Prof. Dr. Peter Jaeger Most urologists work between 60 and 70 hours per
Zürich (Triemli) Dr. Stefan Suter week (Figure 1). The percentage of working time
a
European Board of Urology (EBU) certified training center spent directly with the patient is 40-60% for eight of
the respondents, 60-80% for 10 and more than 80%
for seven urologists. The number of surgical
Fig. 1: Working time per week procedures performed per year is shown in Table 2.
Note that 21 out of 24 urologists are
doing radical prostatectomies on a
regular basis. Regardless of the surgical The solution for extrinsic
procedure, 11 colleagues have access to
(any kind of) laser technology and four ureteral compression.
to laparoscopy. To learn more, contact your Cook Medical
representative or visit www.cookmedical.com.
The majority of the respondents will
spend six to eight weeks away from
their private practice (not including


holidays, Figure 2). Many of them own a ®
second house or a flat in the mountains
or in southern Switzerland (Canton
            
 
Ticino). The annual income – before
taxes – seems to follow a Gauss curve
and ranges from less than 200,000
AO RT I C I N T E RV E N T I O N CA R D I O LO GY C R I T I CA L CA R E E N D O S CO PY P E R I P H E R A L I N T E RV E N T I O N S U R G E RY U R O LO GY WO M E N ’ S H E A LT H
Swiss francs (122,000 Euros) to more
Life of a urologist in ....
than 500,000 Swiss francs (305,000

August/September 2008 European Urology Today 17


EAU launches new Urology Week website
www.urologyweek.org offers practical information
By Lindy Brouwer

The EAU recently launched a new website to promote national societies is considered of vital importance
the first European-wide Urology Week, which will be since they are better placed to reach a wider public.
held from 15 to 19 September. The new website, The EAU also aims to involve and collaborate with
www.urologyweek.org, is a general public-oriented urological nurses associations and patient groups.
site that aims to provide practical and concise Hospitals and medical institutions are invited as well
information about urological conditions and when to to participate and support the initiative.
seek help from a urologist.
The EAU has produced promotional material such as
The site currently includes information on three major a brochure, a flyer and a poster on each key subject.
pathologies - prostate conditions, urinary The promotional materials are available for
incontinence and erectile dysfunction - and offers downloads from the website and can be freely
patient and expert interviews, film footage, translated and distributed by those wishing to help
background articles and other materials. Information promote Urology Week initiative. Organisers are keen
on Urology Week activities coordinated by urological to receive feedbacks and comments on whether these
societies in their own countries will also be made materials and the website are effective and of value in
available and continuously updated. supporting patient groups across Europe.

Urology Week replaces Prostate Awareness Day, an We would appreciate it if you could add a link from
initiative launched a few years ago by former EAU the website of your hospital or institution to
Secretary-General Professor Pierre Teillac. Urology www.urologyweek.org, by placing, for example, a
Week was set up to make the general public more link on the patient information page. The more links
aware of urological conditions and the work of the placed on the website, the more people will access
urologist. To achieve this goal the EAU collaborates the information. This is, after all, is our ultimate goal:
with Europa UOMO, a European advocacy movement to provide Europeans with the best possible
working to educate the public on prostate cancer information about urological conditions and the
issues. crucial role of the urologist.

Several national urological societies in Europe have For further queries, contact Lindy Brouwer,
committed themselves to participate in Urology Week Communication Officer, at l.brouwer@uroweb.org or
by setting up a national programme. The support of visit www.urologyweek.org.

American
Urological
Association (AUA)

A chance to join the ...


International Academic Exchange Programme
American Urological Association (AUA) in collaboration with the
European Association of Urology (EAU)

2009 American Tour


To date six American and six European tours have been organised and each of those Deadline
proved extremely successful. Therefore the European Association of Urology (EAU) and All applications must be received at the EAU Central Office before
the American Urological Association are pleased to announce the 2009 American tour! December 1st, 2008

The AUA/EAU International Exchange Programme will send American faculty to Europe Information and application forms
and European faculty to the United States. The programme aims to promote For all further information and programme application forms please visit
international exchange of urological medical skills, expertise and knowledge. www.uroweb.org, and select International Relations, AUA-EAU International
Academic Exchange Programme or contact the EAU Central Office,
This upcoming 2009 American Tour will provide grants which will enable four EAU T +31 (0)26 389 0680, F +31 (0)26 389 0674, E: a.terberg@uroweb.org.
members (3 junior and 1 senior faculty member) to travel to and attend the AUA
congress in Chicago (April 25-30, 2009) and to participate in an extended two week
travel programme, taking them to several urology centres in the United States.

Eligibility criteria
• Less than 42 years of age
• Minimum academic rank of assistant professor
• Letter from the departmental chairman of the applicant’s commitment to academic
medicine EAU Central Office, Attn. Secretariat, P.O. Box 30016, 6803 AA Arnhem,
• Membership of the EAU The Netherlands

18 European Urology Today August/September 2008


European Urology Today

EUT Congress News


3rd ESU Masterclass on Medical Treatment for Urological Cancer No. 4 - Aug./Sept. 2008

Barcelona, 28-29 June 2008

Harmonized level of knowledge


Course director Prof. Hein Van Poppel stresses the value of organ-based medical oncology

Prof. Hein Van patient before eventually referring him to a colleague course. I am pretty sure that in future they will get
Photo by: Runkel

Poppel expert in medical oncology. certificates to prove that they have passed the
Course director of the examination and as a matter of fact are actually able
ESU masterclass, There is no debate that the treatment should be given to administer the therapy properly.
Leuven (BE) by someone who knows what he is doing. This can be
a medical uro-oncologist or a dedicated and educated The level of difficulty is a very complicated issue, since
oncologic urologist. It is for these experts that this for instance in Germany many urologists administer
Email: Hendrik. course has been designed. medical treatment and chemotherapy. In other
vanpoppel@ countries medical oncologists give cytotoxic
uzleuven.be In Belgium we are probably in the forefront of what chemotherapy. So the level in European countries is
will happen everywhere in Europe in the near future. quite different. German urologists who work in larger Barcelona hosted the 3rd ESU masterclass
The national health service will make prescription and training centres might feel the course to be basic, but
administration of these new drugs dependant on urologists from other European countries never had
We are very happy with the number of registrations. expertise. The targeted agents that are now training in medical oncology and find parts of the beginning and you have to know how to further treat
That´s actually the first time that we had more commercially available in my country are by law course too difficult. him. He wants you to advise and not to be sent to
applicants than tickets for the three modules. We do determined to be prescribed either by a medical another specialist without complete information on
not want to have the modules with more than 150 oncologist or by a urologist with a special title in For them it is completely new stuff and they actually what is going to happen.”
people in total. Fifty participants per module is the oncology. Indeed these new agents are very feel that the level of the masterclass is too high. It
maximum we can take in order to allow lively expensive. Therefore not every urologist is allowed to would be nice if this masterclass could contribute to Medical oncologists are responsible for the general
interaction. prescribe it. Any health insurance wants to limit this harmonize the European level of knowledge in medical treatment of cancer. They are not always
to a well-qualified number of specialists. The medical oncology. At the end all European urologists trained in hormonal and intravesical therapy. Many
The scientific level is pretty high. There is daily question then is “Who qualifies to be a urological interested in medical oncology should have the same medical oncologists treat breast cancer today, brain
practice in the programme such as lectures on oncologist?” Can we provide the proof that someone level of knowledge. This is why this masterclass is so tumours tomorrow and prostate cancer next week. I
intravesical or hormone treatment, which the is able to prescribe and administer these expensive important and will certainly attract more and more think this is not the right approach. In an ideal world
urologists are very keen on. And than there are more therapies? attendees in the coming years. we need medical uro-oncologists and radiation
sophisticated treatments which are the cytotoxic uro-oncologists to work with urologists specialised in
intravenous chemotherapy and the targeted agents. There will be very strict criteria. In this situation you “European prostate cancer patients come to us, to the oncology on a multidisciplinary basis.
When the targeted agents became available we felt need accreditation and credit points or certificates urologists, who see them from the early stages till the
that there was a need for urologists to expand their and this course is one of the tools to obtain this. advanced stages of the disease. You may send him to The urological cancer patient will be better off when
knowledge. They must be able to prescribe and another specialist at some stage of the disease but treatment is delivered by different organ based
administer these treatments themselves, or at least Today we have an examination, which is taken after even if you do so you are still his doctor. You need to specialists, be it surgeons, medical or radiation
have enough knowledge about the treatment the course. The participants today get a certificate that be aware of the different treatment options which are oncologists. We want to have organ-based medical
schedule and about the toxicity in order to inform his they have taken the exam after having done the to follow. You treat the patient right from the oncology and organ-based radiotherapy.

Open minds for new therapies


Over 150 participants joined this year´s ESU Masterclass on medical urological oncology

Prof. Ziya Kirkali There have been vast improvements during the last underway and a lot of them are also in the pipeline. radiologists for example treat oncologic diseases. And
Photo by: Runkel

ESU course director, decade in terms of our understanding of the But despite this seems to be the backbone of the the medical oncologists consider themselves to be the
Izmir (T) biological behaviour of certain urological cancers whole meeting, it is only a part of it. And it is primary doctors, but at least to my mind I would think
which led to develop many new therapeutic agents, interesting for me to see that the level of participants that the organ-based specialists knowing all the
the cytotoxics vaccines or targeted therapies. In is just at a stage at which they can learn a lot from functions should be the primary leaders in a
consideration of the advances in the minimal invasive this great faculty. multi-disciplinary team to treat the disease.
techniques and robotic surgery most of the urologists
are more inclined to get into these new surgical Usually we have an EBU exam after the course for Most of the upcoming drugs are much less toxic than
email: ziya.kirkali@ techniques rather than into learning and utilizing non those willing to take it. For 2009 we are planning sort the chemotherapy, which we had many years ago.
gmail.com surgical therapies of oncological diseases. of a multiple-choice exam before the course and a Most of our colleagues may not be using
second one after the course. We will have a better chemotherapy, but they may be inclined to use some
Actually the ESU masterclass is both basic education evaluation and it is important to have the level before of the new upcoming drugs. So the intent is to
It is actually the third year that we are having this and scientific update. With all these rapid changes it to see what we have achieved. I think for a majority of educate our colleagues. Attending this course we do
masterclass and I think we are quite satisfied with is almost impossible for anyone to catch up with all participants the level of the lectures is very not expect someone to be fully qualified in
what we have achieved so far. Obviously the reason these advances. What we thought of was sort of a appropriate. oncological urology. But, what we are claiming is that
why we started this project was because of the major course for the practicing urologist to update we can broaden their minds and give them the
changes in the field of urology and oncological himself on the non-surgical medical therapies. So this In fact the oncological urology is a field, which is stimulus to learn and educate themselves to get
urology in particular. masterclass is a compilation of all what we know heavily challenged by other disciplines. So the involved and use these new therapies.
about hormonal therapy, immunotherapy, targeted
In the third course we have more than 150 therapy, systemic cytotoxic chemotherapy and
participants and this is a big success. And we still see palliation.
a lot of applications we could not accept and had to
say: “Well, we are sorry, but it is all fully booked.” Oncology plays the major role in every urologist´s
Partly it is based on the interaction between the practice, so this course is focussing on the medical
attendees and the lecturers. If you have a larger therapies. And I think it has been a great success
audience this would be almost impossible. So this is because we were the first to do it in the world. We
why we had to limit it to 50 participants per module, have equal parts of participants from Europe and
which is the ideal figure. around the world. I am very much pleased that the
Americans are adapting this singular course and have
a similar event, which is a shortened version of the
ESU masterclass.

We have made a couple of changes in this year´s


programme such as palliative therapies. Every year at
the ASCO we are learning more and more about the
new targeted therapies. So a lot of new drugs are 150 urologists joined the 3rd ESU masterclass in Barcelona.

August/September 2008 European Urology Today 19


Advanced testicular cancer – chemotherapy and surgery
Better classification and risk-adapted treatment result in better outcome
Testis cancer in Europe has generally not indicated as a result of the US Intergroup than 90 percent of patients
an increasing incidence randomized trial (Motzer, JCO 2007). In general, patients will show necrotic residuals
(8-10/100.000) over the last with intermediate or poor prognosis should be referred as a result of a complete
decade. About 90 percent of to a specialized center in order to tailor treatment histological remission after
patients have stage I to II according to risk factors. Some patients may benefit standard chemotherapy,
disease and the number of from early intensified treatment in view of the US more or less independent on
patients with advanced Intergroup trial (e.g. unsatisfactory marker decline). residual size.
disease in industrialised The complication rate of
Prof. Peter Albers countries decreased over Based on a randomized trial from UK, all patients PC-RPLND / RTR has
time. The overall survival of with standard chemotherapy should receive an decreased over the last
patients with low stage disease is at the 98 to 100 antibiotic prophylaxis with levofloxacine to reduce the decades and in patients
percent level, however, patients with advanced number of febrile neutropenia episodes (Cullen, NEJM without co-morbidities less
disease and intermediate/poor prognosis criteria still 2005). Results from another randomized trial from than 10 percent of
face a risk of death of disease up to 50 percent. France in good prognosis patients (3 x BEP versus 4 x complications may be
EP) indicated that the rate of pulmonary toxicity by anticipated, mostly minor. A
Classification bleomycine is lower than expected, however, the rate future development of the
Most critical for a good outcome is the correct of peripheral neuropathy is higher than expected and surgical technique will be the
classification at diagnosis according to IGCCCG (see was more pronounced in the 3 x BEP arm with 16 selection of patients for so Correct classification at diagnosis according to IGCCCG
table). The basic parameters are the location of percent versus 5 percent (Culine, Ann Oncol, 2007). called „template“ resections.
metastases and the level of serum tumor markers after Not all patients benefit from
orchidectomy. Not only treatment is tailored according Residual tumor resection a full bilateral RTR with definitive loss of antegrade survival figures from ten years ago demonstrating the
to this classification, poor risk patients should be After major response to chemotherapy, RTR is ejaculation, especially if the initial primary tumor effect of centralization of treatment. In some of these
considered to be treated in centers with a lot of indicated in most patients with non-seminoma and metastasis was strictly located unilaterally. A patients, salvage surgery is indicated and a close
experience in chemotherapy and residual surgery. visible residual disease (usually > 1 cm). In patients combined series from Germany has shown a 85 interdisciplinary treatment strategy is recommended
In addition, patients with good prognosis parameters with radiologically complete remission, it is an percent of preservation of ejaculatory function at every stage of treatment.
should not be overtreated. They only need three individual decision of whether RTR will be without compromising the oncological outcome in Late toxicity issues get more and more important due
cycles of cytotoxic chemotherapy and residual tumor recommended or not (dependent on radiologic terms of retroperitoneal recurrences (Heidenreich, to detailled analysis of testis cancer survivors by
resection thereafter in cases of non-seminoma and appearance, primary histology, marker decline, Albers, GU-ASCO 2008). major European treatment centers. This should
visible disease. In contrast, patients with intermediate co-morbidities, location of residual disease). In remind everyone to reduce treatment in patients with
and poor prognosis will always need four cycles of patients with multiple metastatic sites, the site with Salvage treatment low stage disease and to tailor treatment to those
chemotherapy before residual tumor resection is the largest residuals will be the first to be resected. Salvage chemotherapy should be given by specialized who really benefit from dose-intensified strategies.
indicated. There are only very few patients with In general, all residual tumors should be resected. In centers after selection based on prognostic factors In summary, patients with advanced testis cancer face
seminoma and intermediate prognosis parameters patients with necrosis in the retroperitoneum and in (e.g. response to first line, location of metastases, a more favorable outcome compared to some years
(non-visceral metastasis). one side of the lungs, it might be considered to co-morbidities). Standard salvage chemotherapy ago mainly based on a better classification and
postpone the contralateral lung resection. consists of four cycles of chemotherapy, usually as risk-adapted treatment. Treatment mostly consists of a
Standard chemotherapy In patients with seminoma, the indication for residual different regimen compare to the initially given drugs. combination of chemotherapy and surgery and at
According to IGCCCG, three or four cycles of tumor resection is limited. Only patients with a In some patients, high-dose regimens may be least in intermediate and poor prognosis patients this
chemotherapy are standard initial care for patients with positive PET/CT scan or growing masses after benefitial and increase the overall survival to 40 to 50 treatment should be delivered in centers specialized
advanced testis cancer. High-dose chemotherapy is chemotherapy may be candidates for surgery. More percent. This is a major improvement compared to in the treatment of testis cancer.

The roadmap to cure cancer? “We need good quality trials”


Prof. Antonio Alcaraz describes the potential of Noel Clarke summarizes systemic chemotherapy
novel target therapy for RCC and prostate cancer for muscle-invasive bladder cancer
After knowing more about the molecular biology of the hormonal treatment. There are a number of schedules for treatment. The treatment, it is clear that
the tumour, especially for the clear-cell type of the There are side effects, but ones proven to be most effective are those involving there is going to be limited
renal cell carcinoma, it is clear that the mutation of they are manageable by the platinum based combination chemotherapy. Most information from adjuvant
the VHL gene produces a stimulation of the vascular urologist. If the patient groups have adopted Cisplatinum and Gemcitabine studies as these have
endothelial growth factor (VEGF). The reason for this develops the hormone as a popular standard. serially failed to recruit in
is the accumulation of a molecule called HIF refractory disease we do not adequate numbers. There is
producing the stimulation of the VEGF pathway. It is know much about the Systemic platinum based combination chemotherapy still a significant degree of
also very well known that not only VEGF stimulation changes of the tumour. is a standard of care for metastatic bladder cancer. uncertainty as to the true
but also the stimulation of other growth factors will Prof. Antonio Alcaraz There are only a few studies This is effective in a proportion of patients as a Mr. Noel W. Clarke benefit of this therapeutic
end in an up regulation of mTOR, which will finally on the molecular changes of palliative therapy and will continue to be used in this approach and the
increase the proliferation of the tumour cell. So VEGF the tumour. setting. However, it is not suitable for all patients, Urological Oncological
and mTOR are pathways to be targeted by the novel particularly those with poor performance status and community will have to be more innovative in
smart drugs…Today we have a wide range of drugs Because we do not know exactly what to target. patients with poor renal function. There is an urgent planning studies to answer questions about who
which can be used in the treatment of metastatic Regarding prostate cancer we do not know it with the requirement for new agents and trials of different should receive this therapy and what the best drug
disease. same accuracy as is the case with renal cell cancer. combinations to improve outcome and decrease regimens are.
We know only a little about the changes in the toxicity in this area of Urological Oncology. The use of
In the pre-antiangiogenetic therapy we were talking prostate cancer tumour after hormonal therapy. So peri-operative chemotherapy is interesting. In many Cytotoxic chemotherapy should be used with
about an average survival of 16 months in the first line investigators should focus on these changes of countries, despite the evidence for benefit, neo- circumspection in the high risk and elderly groups.
disease of metastatic renal cell carcinoma. Today the hormone refractory disease. What are the pathways? adjuvant chemotherapy is used only sparingly. The recent data from ASCO 2008 regarding EORTC
new data presented at the ASCO meeting have 30986 shows that the toxicity rate in this group of
recently shown an overall survival of 26 months. for In future we will be able to collect an important patients can be high, particularly if the renal function
those patients treated with sunitinib. This means that number of tissue samples from hormone refractory “There is an urgent requirement for is diminished significantly. We may need different
the survival of those patients has almost doubled. prostate cancer patients. We will define them approaches in this group.
molecularly to see the genetic profile of those
new agents and trials of different
I am not sure whether I would use the word “cure”, tumours. We will have to find the pathways activated combinations to improve outcome ...” The current agents are effective to a degree but there
but I think we will be able to make it chronic, so that and then develop the right drug for these prostate are significant problems. They are not curative in
the patient will die from another cause totally cancer patients. Why are we so successful in case of patients with advanced disease, they don’t work for
different from renal cell carcinoma. To some extent, in chronic myelocytic leukemia? Solid tumours use to This is because of the relatively limited overall everyone, there are toxicities and certain patients
a few cases this has been achieved in prostate cancer have thousand of changes in genetics. Only a few are improvement in survival and the perceived risks of cannot receive the existing drug combinations either
using hormonal therapy. really important as signal channels. In leukemia they toxicity and tumour progression whilst undergoing at all or at the optimum dose. We need good quality
could do it very easily. There is a single pathway and chemotherapy prior to surgery. Better information trials of new agents / combinations and we need a
The knowledge about the molecular changes in they know it very well. But this roadmap is still regarding which patients get the greatest benefit better understanding of the basic cancer biology of
prostate cancer is more difficult to understand. We unknown with respect to prostate cancer. We need to would help enormously in this area. Regarding this disease to enable us to develop more effective
have got a very attractive treatment for this disease, go back to basic science. adjuvant chemotherapy following definitive therapies in this area of cancer medicine.

20 European Urology Today August/September 2008


Improved prognosis for patients
Indications, results and toxicity of novel targeted therapy
In Europe approximately active across all Memorial Sloan-Kettering Cancer Center The AE profile of sorafenib is similar to other targeted In the first phase III trial, AEs leading to withdrawal
40,000 patients are (MSKCC) prognostic risk groups.5 therapies. Sorafenib has demonstrated a consistent occurred in more patients receiving bevacizumab plus
diagnosed with renal cell tolerability profile and most AEs are of grade 1/2 IFN-a than IFN-a alone (28 percent versus 12 percent,
carcinoma (RCC) annually. Sunitinib has also demonstrated activity in patients intensity. respectively). In the second trial, there was a
Of these, around one third with cytokine-refractory mRCC. In a phase II study, significantly higher incidence of grade 3/4 AEs with
have metastatic disease.1 median PFS in sunitinib-treated patients was 8.8 The mammalian target of rapamycin (mTOR) inhibitor, bevacizumab plus IFN-a versus IFN-a alone.
The introduction of novel, months and median OS was 23.9 months.6 In an temsirolimus, is licensed in Europe for first-line use in
targeted therapies has expanded-access study in more than 4,000 patients mRCC patients with poor prognosis.13 In a phase III Agents in development include the vascular
Prof. Joaquim Bellmunt dramatically improved with mRCC, sunitinib demonstrated activity in a broad study with treatment-naïve mRCC patients considered endothelial growth factor receptor inhibitor axitinib
prognosis for patients with range of patients, including those with brain at poor risk (modified MSKCC risk criteria), and everolimus. Everolimus – an mTOR inhibitor –
metastatic RCC (mRCC). This article reviews the latest metastases.7 Sunitinib is generally well tolerated and temsirolimus resulted in significantly longer median was evaluated in a phase III trial for the treatment of
information on targeted agents for mRCC. has demonstrated a consistent adverse event (AE) PFS and median OS compared with IFN-a (P=0.0069 patients with mRCC who have progressed on RTK
profile. The majority of AEs are of grade 1/2 intensity and P=0.0001, respectively).14 Temsirolimus is inhibitors (sunitinib and/or sorafenib). Everolimus-
Sunitinib is an oral, multitargeted receptor tyrosine and are manageable with medical intervention or generally well tolerated; in the phase III trial serious treated patients achieved significantly longer median
kinase (RTK) inhibitor, approved multinationally for the dose modification.8 AEs occurred less frequently in temsirolimus-treated PFS compared with those receiving placebo (4.0
first- and second-line treatment of mRCC. In a pivotal patients than IFN-a-treated patients.14 versus 1.9 months, respectively; P<0.0001).17 Incidence
phase III trial, sunitinib demonstrated superior efficacy Sorafenib is a multitargeted RTK inhibitor approved of AEs leading to withdrawal of treatment was higher
to interferon-alfa (IFN-a) for the first-line treatment of for second-line use in mRCC.9 In a phase III trial in Bevacizumab, a humanised monoclonal antibody for everolimus versus placebo (10 percent versus 4
mRCC.2 Median progression-free survival (PFS) with patients with cytokine-refractory mRCC, sorafenib had given in combination with IFN-a, is approved in percent, respectively).17
sunitinib (11 months) was more than double that seen significantly longer median PFS versus placebo (5.5 Europe for first-line use in mRCC. First-line treatment
with IFN-a (five months; P<0.000001).3 In the final versus 2.8 months, respectively; P<0.001).10 Patients of mRCC with bevacizumab in combination with IFN-a The targeted therapies have improved prognosis for
overall survival (OS) analysis, median OS was more than receiving placebo could crossover to sorafenib after compared with IFN-a plus placebo was assessed in patients with mRCC. As a result, they are
two years (26.4 months) with sunitinib compared with disease progression. After crossover, median OS with two phase III trials.15,16 In the first trial, adding recommended for the management of mRCC in
21.8 months in IFN-a treated patients (hazard ratio sorafenib was not significantly different from placebo bevacizumab to IFN-a significantly increased median treatment guidelines.1,18
0.821; P=0.0510). This is the first time OS of this duration (17.8 versus 15.2 months, respectively; P=0.146). In a PFS versus IFN-a alone (10.2 versus 5.4 months,
has been observed in first-line RCC treatment. Median pre-planned analysis censoring for crossover, median respectively; P<0.0001). In the second trial, median
OS in patients without any post-study treatments was OS was significantly improved with sorafenib PFS was 8.5 months for patients treated with The references belonging to this article can be
28.1 months with sunitinib versus 14.1 months with (P=0.0287).11 Sorafenib has also shown activity in an bevacizumab and IFN-a compared with 5.2 months obtained by sending an email to Ms. H. Lurvink at
IFN-a (hazard ratio 0.647; P=0.0033).4 Sunitinib was expanded-access study.12 for patients receiving IFN-a alone (P<0.0001).16 h.lurvink@uroweb.org

Targeted local hormonal therapy


Prof. Aus envisions hormonal therapy with less side effects and more local effects
By Franz-Günter Runkel FGR: There are various options within this hormonal really long acting depot formulation and the second work. It is very rare, but

Photo by: Runkel


therapy, anti-androgens are one of them. How would one has been that you have had histamine-like side sometimes it is worthwile to
FGR: What about the relation between orchidectomy you summarize their role in treatment? effects, even resulting in anaphylactic reactions… But keep an eye on serum
and hormonal therapy of prostate cancer? there are studies underway which might have better testosterone.
Aus: Today the role of anti-androgens is focused on results. This means there might be a coming market
Aus: Hormonal therapy is a wide scope. Orchidectomy patients with locally advanced disease without known for this kind of therapy. However the side effects are FGR: What’s in the future?
is one way of delivering a hormonal therapy where metastases. The reasons to use anti-androgens equal to those with surgical or chemical castration. It
you remove the serum testosterone. So surgical instead of LHRH analogue therapy are multi-focal. is just another way of delivering the chemical Aus: What I would like to
castration is a baseline hormonal therapy that works One of them is that you maintain your serum castration meaning that they are most probably hope and see is that we Prof. Gunnar Aus from
well but it is a surgical procedure. You will of course testosterone which means that you have a chance to restricted to patients with metastatic disease. have not stopped the Göteborg (SE)
have all the side effects of not having your maintain your sexual interest and maybe also the interest in hormonal
testosterone any more. There is a risk to loose your function. You will have no negative effects on the FGR: What is the best way to treat patients from your therapy. Why? Because given if you compare the side
bone mineral density; your skeletal strength can go bones but you have some other side effects. Especially point of view? effects of hormonal therapy to any other therapy, they
down. You will loose your libido and with that goes gynecomastia or breast pain… However, for most are quite low. For a cancer therapy it still has a very
also the potency. It is an irreversible therapy, but the patients, especially those sexually active, they have Aus: What we have learned during last year is that favorable side effect profile. I envision that we can
compliance is 100 percent. less side effects. To take care of the bones is especially hormonal therapy should not be given too early. Giving develop local hormonal therapy. This means that you
important for those who will stand on the therapy for it to a patient with a very low risk of progression the will develop a vehicle that makes it possible to deliver
Equal to that in terms of efficacy is the GnRH a long time. They have a lot of gain not to be castrated hormonal therapy will only cause side effects. The anti-androgens or other locally effective therapies
analogue therapy. When it comes to see the clinical early. I think that for patients who are in locally second important issue is that we have now shown directly to the tumour. Local hormonal therapy as
efficacy, it seems to be equal. But there are rare advanced disease and do not have metastases that the anti-androgen monotherapy seems to work. It targeted therapy… At the moment we are actually
cases where you will not have a full lowering of the anti-androgens are definitively a treatment option. offers a possibility for treatment of those who are not performing a phase I study, where we give local
serum testosterone. If you have a patient who does in a very bad shape with metastatic disease but have anti-androgen therapy, but it is very, very early… But
not respond as you expect from the medical therapy FGR: What about GnRH agonists? locally advanced disease. This still maintains some if we can find a depot formulation that works you can
you should test the serum testosterone to see that the quality of life. For patients with metastatic disease, it do an injection every third month for example. In this
lack of efficacy is not due to the lack of efficacy of Aus: They have been on the market for a long time. seems that you can choose either surgical or medical way it should be possible to minimize side effects and
your treatment instead of being that the tumour is not They have not really evolved to it. The main problem castration with equal efficacy, although you have to optimize the local anti-tumour effect. We want to
sensitive to hormonal manipulation. has been two-fold: One is that you do not have the remember that medical castration sometimes does not treat only the cancer and not the whole body.

Two EBU exams in future


Entrance test at the beginning and exit test are supposed to enhance the learning process
Accreditation is a major item at this moment and in and covering the topics that were dealt with during change the format of this evaluation in order to
order to have a meeting or course accredited by the the lectures. The MCQ’s were discussed beforehand in enhance the learning process of the participants, but
EBU in the future it will be necessary to evaluate the order to have valid questions. also of the teachers. There will be an entrance test
course by a test. and some of the MCQ’s asked during the entrance test
The participants in the examination (81 out of 150 will be repeated during the exit test. In this way the
During this year’s masterclass on medical treatment registered) will receive the results of the test a couple progress of the knowledge of the participants can be
for urological cancer in Barcelona, there was again a of weeks after the course and this will give the evaluated and while also the teacher can have an
multiple choice examination at the end of the course candidate an impression about his/her performance. idea about his performance. Did he or she succeed in
that could be taken on a voluntary basis. The test delivering the important message to the urologists?
contained 100 MCQ’s delivered by the course teachers For the future masterclasses, the intention is to 81 out of 150 registered passed the exam.

August/September 2008 European Urology Today 21


ESU courses get high approval at Slovak annual congress
Dr. Vladimir Balaz Dr. Nikoleta
Banska Bystrica (SK) Ledererova
F.D. Roosevelt Banska Bystrica (SK)
Hospital F.D. Roosevelt
Dept. of Urology Hospital

vbalaz@nspbb.sk lederer@gmail.com

other specialists are exerting efforts to improve their


The Slovak Society of Urology lauded the professional ties and cooperation with general
participation of the European School of Urology (ESU) practitioners in order to intervene and provide timely
during its annual congress held at Banska Bystrica treatment for patients who have early stage prostate
last June 26 to 28. More then 200 Slovak urologists cancer. Many patients, unaware of specialised
and 100 nurses specialised in urology attended the treatment, visit a urologist quite late, according to
annual event. Ledererova.

“We were very glad that in cooperation with the ESU The Slovak Society of Urology expressed its thanks to
a comprehensive course was also presented during Banska Bystrica, led by Vladimir Balaz, Dr. Nikoleta the course not only very timely and comprehensive the ESU for the unique opportunity of sponsoring and
the congress,” said Dr. Balaz Vladimir. Focusing on Ledererova and Dr. Marek Chudy, presented very but also a success in terms of attendance and quality. holding an ESU course. The society also said that it
urolithiasis and urinary tract infections, Professors interesting cases from their practice. hopes that more ESU courses will become a
Anup Patel and Tarik Esen chaired the ESU course The local organisers also appreciated the EAU guest traditional offer in their future national meetings.
which attracted a high number of participants. Esen “Urolithiasis is a disease that we see everyday in our lecture on prostate cancer
discussed epidemiology and etiology of urinary stones practice. This ESU course gave a global and detailed presented by Prof.
and the pro- and metaphylaxis and medical treatment view on disease from its etiology and diagnoses until Per-Anders
of urinary stones. the treatment,” said Ledererova. “It also gave us the Abrahamsson. “We
opportunity to have an interactive discussion during appreciate his presence
Patel gave an overview of the latest methods in the presentation. This was a chance for many of us to at our congress and the
urinary stones treatment and discussed some tips and compare our everyday work with European trends high quality of
tricks in percutaneous nephrolithotripsy. From the since not all of us get the chance to attend the presentation which
Slovak presenters, Ass. Prof. Jan Luptak (Martin) and European meetings.” Both the organisers and discussed the long term
his colleagues from the organising urology clinic in participants expressed appreciation and considered outcomes of watchful
waiting treatment, a
controversial and
well-discussed topic,”

ESU Masterclass a ‘must attend’ said Ledererova.

Ledererova added that in


Participants from Europe and worldwide Slovakia, urologists and

Dr. Wahjoe Djatisoesanto for Urological Cancer) has broadened my


from Indonesia took the understanding of the pathophysiology of certain
long journey to Spain just urological cancers and of how medications provide
for one reason: to take better and improved management modalities that
part in the ESU could, primarily or in conjunction with surgery,
masterclass. He is a enhance patient survival or quality of life. This
corresponding EAU Masterclass is a “must attend” for those interested in

European Urology
member and works in Uro-Oncology.”
Dr. Wahjoe Djatisoesanto the Dr. Soetomo Hospital
from Indonesia in Surabaya: “I am Italian urologist Dr. Valeria Tallis is a resident and
learning a lot about junior EAU member. She works in a hospital in
contemporary
chemotherapy and immunotherapy. Today there is no
high-grade bladder cancer in Indonesia without
Sienna: “The ESU masterclass provides valuable
information on
postoperative treatment
Forum 2009
cystectomy.” of our patients. Urologists

Dr. Juliano Z.K. Panganiban is a urologic surgeon at


are surgeons, but do not
follow up postoperatively. Challenge the experts
St. Lukes Medical Center in Quezon City and at the My intention is a
Chinese General Hospital in Manila and belongs to multi-disciplinary
the Philippine Board of Urology. Besides being a approach including 7-11 February 2009, Davos, Switzerland
urologist he also works as a Philippine diplomat: “As urologists,
a urologist accustomed to the surgical management Italian urologist Dr. Valeria radiotherapists and
of cancers, the Masterclass (on the Medical Treatment Tallis from Sienna oncologists.”
EAU Education Office
T +31 (0)26 389 0680
esu@uroweb.org
www.uroweb.org

European
Association
of Urology

The faculty of the 3rd ESU masterclass in Barcelona

22 European Urology Today August/September 2008


ESU Masterclass Information on the application procedure is available on www.uroweb.org or contact the ESU Office
T +31 (0)26 389 0680, F +31 (0)26 389 0684, esu@uroweb.org

on Female and functional reconstructive urology


10-12 October 2008, Nice, France www.uroweb.org
The ESU will organise the first masterclass on Saturday, 11 October 2008 16.15 – 16.45 Surgical management of stress Faculty
Female and functional reconstructive urology. The incontinence W. Artibani, Padua (IT)
management of women with functional disorders of 08.00 – 08.45 Bowel and anorectal physiology F.C. Burkhard, Berne (CH) F.C. Burkhard, Berne (CH)
the lower urinary tract, the pelvic floor and related K. Matzel, Erlangen (DE) 16.45 – 17.15 Discussion D. Castro Diaz, Santa Cruz De
pelvic organs, is a very important subject which will be Female endocrine physiology (incl Tenerife (ES)
addressed in detail during this masterclass. endometriosis) 17.15 – 17.45 Urinary fistulae C.R. Chapple, Sheffield (GB)
S. Hill, Blackburn (GB) C.R. Chapple, Sheffield (GB) D.J.M.K. De Ridder, Leuven (BE)
It is essential that appropriate training should be 17.45 – 18.15 Discussion J.P.F.A. Heesakkers, Nijmegen (NL)
08.45 – 09.15 Discussion
provided to the next generation of urologists, taking S. Hill, Blackburn (GB)
account of the likely future patterns of service delivery. K. Matzel, Erlangen (DE)
Clinical topics
This masterclass will provide an opportunity for in 09.15 – 10.00 Frequency-urgency syndrome Sunday, 12 October 2008
depth review of this subject. The intention is for this W. Artibani, Padua (IT)
to be combined with EAU funded scholarship visits Urinary incontinence Treatment options
to institutions across Europe and mentorship of F.C. Burkhard, Berne (CH) 08.00 – 08.45 Complications and re-operative
individuals who are selected to enter this programme. 10.00 – 10.30 Discussion surgery
W. Artibani, Padua (IT)
10.30 – 11.00 Coffee break F. Burkhard, Berne (CH)
C.R. Chapple, Sheffield (GB)
Programme 11.00 – 11.30 Pelvic pain syndrome 08.45 – 09.15 Discussion
D.J.M.K. De Ridder, Leuven (BE)
Friday, 10 October 2008 11.30 – 12.00 Discussion 09.15 – 10.00 Surgical management of detrusor
overactivity
13.00 – 13.45 Lunch break 12.00 – 12.30 Urinary retention in the female D.J.M.K. De Ridder, Leuven (BE)
C.R. Chapple, Sheffield (GB) 10.00 – 10.30 Neurogenic problems
13.45 – 14.30 Abdomino- pelvic anatomy Female sexual disorders D. Castro Diaz, Santa Cruz De Tenerife
J.P.F.A. Heesakkers, Nijmegen (NL) S. Hill, Blackburn (GB) (ES)
14.30 – 15.00 Discussion 12.30 – 13.00 Discussion 10.30 – 11.00 Discussion

15.00 – 15.45 Vesico-urethral physiology 13.00 – 13.45 Pelvic organ prolapse – diagnosis 11.00 – 11.15 Coffee break
C.R. Chapple, Sheffield (GB) W. Artibani, Padua (IT)
15.45 – 16.15 Discussion Pelvic organ prolapse – 11.15 – 12.00 Surgical management of prolapse
management W. Artibani, Padua (IT)
16.15 – 16.45 Break S. Hill, Blackburn (GB) S. Hill, Blackburn (GB)
12.00 – 12.45 Discussion
16.45 – 17.00 Patient evaluation (symptoms and 13.45– 14.15 Discussion
signs) 12.45 – 13.00 Summary and conclusions
J.P.F.A. Heesakkers, Nijmegen (NL) 14.15 – 15.15 Lunch break
17.00 – 17.30 Discussion
15.15 – 15.45 Anal incontinence/constipation
European K. Matzel, Erlangen (DE)
15.45 – 16.15 Discussion This meeting is EU-ACME accredited
Association
of Urology

ESU, CUA collaborate for 1st CUREP in Shanghai


As part of the ongoing collaboration between the from the European School of Urology (ESU) to set up a
European Association of Urology (EAU) and the similar programme in mainland China.
Chinese Urology Association (CUA), the first EAU-CUA
joint course, the Chinese Urological Resident CUREP will cover four topics and will enroll 120 young
Education Programme (CUREP), will be held from 21 Chinese urologists. The course will be presented in
to 23 November 2008 in Shanghai. English and the faculty for this year will include Prof.
Christopher Chapple (United Kingdom), Prof. Walter
With the EAU having established itself as an Artibani (Italy), Prof. Manfred Wirth (Germany) and
important international European-based association, Prof. Didier Jacqmin (France).
a number of collaborative links in education have
been established with various associations From the CUA side, eight professors of urology from
worldwide. China will join their European colleagues. They are Dr.
Liping Xie (Hangzhou), Dr. Yong Yang (Beijing), Dr.
Last year 12 enthusiastic young Chinese urologists After assessing the participants’ reports and receiving Dingwei Ye (Shanghai), Dr. Ningchen Li (Beijing), Dr. The joint CUREP programme represents some of the
participated in the annual European Urology a positive feedback, the CUA has been in contact with Kexing Xu (Beijing), Dr. Gang Zhu (Beijing), Kunjie important new initiatives to help boost urological
Residents Education Programme (EUREP) in Prague. the EAU Education Office and have asked for input Wang (Chengdu) and Dr. Jianguang Qiu (Guangzhou). education worldwide.

European School of Urology


Upcoming activities 2008/2009
September November
5-10 6th European Urology Residents Education Programme (EUREP) Prague (CZ) 3 ESU organised course on Genitourinary trauma and urethral reconstruction
at the time of the national congress of the Turkish Association of Urology Antalya (TR)
October 7 ESU organised course on Nephrolithiasis at the time of the national
2 ESU organised course on Laparoscopic radical prostatectomy and congress of the Austrian Society of Urology Linz (AT)
management of hypospadia and urethral strictures at the time of the 12 ESU organised course on Bladder cancer and aspects of paediatric urology
national congress of the Hellenic Urological Association Chalkidiki (GR) for adult urologists at the time of the national congress of the Egyptian
3 ESU organised course on Prostate cancer, bladder cancer and urolithiasis at Urological Association Hurgada (EG)
the time of the national congress of the Armenian Urological Society Yerevan (AM) 20 ESU organised course on Trauma in urology at the time of the national
9 ESU organised course on Prostate and renal cancer at the time of congress of the French Association of Urology Paris (FR)
the national congress of the Czech Urological Society Hradec Králové (CZ)
24 ESU organised course on Oncologic and reconstructive urology; February 2009
Update in stone management at the time of the national congress of the 7-11 European Urology Forum 2009 – Challenge the experts Davos (CH)
Georgian Urological Association Tbilisi (GE)
30 ESU organised course on Neurourology at the time of the national June 2009
congress of the Russian Urological Association St. Petersburg (RU) 27-28 4th ESU Masterclass on Medical treatment for urological cancer Barcelona (ES)
31 ESU organised course on Paediatric, reconstructive and female urology
at the time of the national congress of the Syrian Urological Society Damascus (SY)

ESU Office T +31 (0)26 389 0680 F +31 (0)26 389 0684 esu@uroweb.org www.uroweb.org ESU courses are accredited within EU-ACME programme by EBU with 1,5 credits per hour

August/September 2008 European Urology Today 23


Patients´ perspective on LUTS Urinary
Assessing experience of patients with artificial urinary sphincter

Incontinence
A biological urinary sphincter prevents urinary flow by a tertiary centre from 1984 to 2005. Of them 160 Table 2: Analysis of male respondents using pads
mucosal coaptation, compression, and pressure patients were eligible to receive the male or female most/all of the time (n = 35)
transmission. An artificial urinary sphincter (AUS) version of the ICIQ-LUTS long form questionnaires by
mimics the biological urinary sphincter by providing a post (139 men, 21 women, 30 patients deceased, 9 UUI (%) SUI (%) Unexplained
competent bladder outlet during urinary storage and an patients no contact details). UI (%)
open unobstructed outlet to permit voluntary voiding. Never 9 12 18
Occasional 50 29 53
An artificial urinary sphincter is the only device that Sometimes 18 24 18
closely simulates the function of a biological urinary Most of the time 15 21 6
sphincter. Recent advances in mechanical design,
“...patients of both sexes, have good All the time 9 15 6
applications of new technology, and lessons learned outcomes after AUS placement as
from clinical experience have inspired notable
improvements. At the 23rd Annual European
assessed by urinary symptoms.” For male respondents minimal storage and voiding
Association of Urology Congress held in Milan, Belal symptoms were reported after placement, as given in
and his colleagues presented their study (2008) that Table 1. Reported SUI was satisfactory for the majority
explored patient’s urinary symptoms using validated (75%), suggesting a good outcome after AUS. The
patient administered questionnaires, the International In total 84 patients returned their questionnaires (75 most troublesome symptom was wearing pads.
Consultation on Incontinence Questionnaires (ICIQs), men, 9 women), giving a response rate of 53%. The
after placement of artificial urinary sphincter (AUS). mean age of male respondents was 67 years (range Table 2 demonstrates that the main reason for wearing In conclusion, patients of both sexes, have good
21-86) and female respondents was 40 years (range pads was occasional urgency UI and unexplained outcomes after AUS placement as assessed by urinary
The study included 199 patients who received AUS 24-64). The mean implantation duration was 8 years incontinence. Furthermore, a minority of respondents symptoms. Complete continence is more likely in
(AMS 800 urinary sphincter) (178 male, 21 females) at (range <1 to 32 years). are wearing pads but not reporting incontinence. women than men receiving AUS.
Despite the small sample size for female respondents,
responses suggest that they have minimal urinary Source: Belal, M., Gardiner, N., Al-Hayek, S., Horsall, K.,
Table 1: ICIQ MLUTS response in male respondents (n=75) symptoms (Table 3). Most patients did not wear pads & Abrams, P. (2008). Lower urinary tract symptoms after
or suffered SUI. AUS placement at the bladder neck in artificial urinary sphincter placement - The patients’
Symptoms Never, Occasional, Most /All of the Mean bother SD women probably provides better continence. perspective. European Urology Supplements, 7(3), 90-90.
Sometimes (%) time (%) score
Urgency 94 6 2.3 2.6
Urgency UI 85 15 3.3 3.1 Table 3: ICIQ FLUTS response in female respondents (n=9)
Stress UI 75 25 3.3 3.2
Unexplained UI 91 9 2.7 3.0 Symptoms Never (%) Occasional (%) Sometime (%) Most/All of Mean bother
Pad use 50 50 3.9 3.4 the time (%) score SD
Frequency 95 5 1.7 2.6 Urgency 44 56 0.7 1.0
Nocturia 82 18 2.0 2.8 Urgency UI 67 33 1.6 2.4
Hesitancy 95 5 0.8 1.8 SUI 78 22 0.8 1.7
Nocturnal enuresis 90 10 1.7 2.9 Unexplained UI 100 1.3 2.8
Stream strength 86 14 1.4 2.4 Pad Use 78 22 1.4 2.9
Intermittency 92 8 1.2 2.5 Frequency 67 22 11 0.3 1.0
Bladder pain 96 4 0.8 2.0 Nocturia 33 56 11 1.2 2.5
Incomplete emptying 92 8 1.9 2.6 Hesitancy 57 33 10 1.1 1.5
Terminal dribbling 78 22 1.7 2.4 Stream strength 67 11 11 0.9 2.3
Post micturition dribble 90 10 2.9 2.9 Intermittency 68 16 16 1.2 2.9
Double micturition 90 10 1.3 2.4 Incomplete emptying 45 45 10 2.7 4.0

Global postural re-education and pelvic floor training


Brazilian study examines women group using GPR technique
The Global Postural Re-Education (GPR), created in The patients were evaluated before and after the improvement than Group 2
1981, is an original and revolutionary method of treatment and six months follow-up. Outcome (p < 0.001).
osteo-muscular rehabilitation based on simple measures were made using King’s Health
principles. In the first place, all static or dynamic Questionnaire, three days voiding diary, pad test and Efficient treatments
muscular activity is always concentric and entails a functional evaluation of pelvic floor. The patients’ In conclusion, GPR and PFMT
muscular shortening. satisfaction was evaluated using a subjective proved to be efficient
improvement classification. treatments for SUI, however
GPR is a technique based on the stretching of the adhesion to the GPR was
muscular groups and reestablishment of the skeleton higher than to the PFMT. The
axis. Normal pelvic floor function depends on the GPR had shown better
distribution of the forces over its fascia and ligaments “GPR and PFMT proved to be improvements when
and also on the levator ani muscles activity. At the efficient treatments for SUI, however compared to the PFMT,
23rd Annual European Association of Urology (EAU) considering specially
Congress, Fozzatti (University of Campinas - Unicamp, the adhesion to the GPR was higher subjective improvement
Department of Urology, Campinas, Brazil) and his than to the PFMT.” classification, leak episodes,
colleagues compared the results of female stress pad use and General
urinary incontinence (SUI) treatment using GPR Perception of Health.
technique and pelvic floor muscular training (PFMT).
Methods Effector organs making up the lower urinary tract (LUT). This is a representation of the female
In their study, 52 women with SUI were selected and The mean age was 50.8 (± 11.4) in GPR and 47.5 Source: Fozzatti, C., Herrmann, LUT. (Figure from the EAU Chronic Pelvic Pain Guidelines with permission of Mr. Vinal Kalsi).
divided in two groups of 26. The first group was (± 8.1) in PFMT. The body mass index was 26.2 kg/m2 V., Palma, P., & Riccetto, C.
treated with GPR, a session of 50 minutes weekly (± 4) and 29.3 (± 5), respectively. Twenty-five patients (2008). Prospective and
during the first three months and then a session every from GPR and 17 from PFMT were available for comparative study using global postural re-education incontinence. European Urology Supplements, 7(3),
other week for the following three months. The follow-up. In Group 1, at the end of treatment (T1) and pelvic floor muscle training for urinary stress 145-145.
second group underwent PFMT four times a week 16% of the patients were cured, 72% improved and
during three months, being once a week supervised 12% failures; at six-month follow-up (T2), 24% were
by a physiotherapist and the other three days at cured, 64% improved and 12% failures.
home.
In Group 2, at T1 68.8% of the patients improved and
31.2% failures; at T2, 18.8% were cured, 37.5%
improved, 31% failures and 12.5% worsened.
Urinary

Significant improvement in T1 (p < 0.001) and T2


(p < 0.001) were observed in both groups when
number of leak episodes, pad use and functional of the
pelvic floor muscle were evaluated, being the
improvements for leak episodes significantly higher in
Group 1 than in Group 2 (p = 0.048) and the pad use at
T1 and T2 significantly lower in Group1 than in Group 2
(p < 0.001).

Regarding the King’s Health Questionnaire,

Incontinence improvements in all domains were observed for


Group 1 and Group 2 and in General Perception of
Health Group 1 had a significantly higher

24 European Urology Today August/September 2008


Tension free vaginal tape versus TOT Urinary
Is there any difference in the mixed incontinence patients?

Incontinence
The tension-free vaginal tape (TVT) procedure has Multicentre randomised trial Results
become one of the most popular procedures Between May 2002 and April 2005, 116 consecutive
worldwide for the treatment of female stress urinary women with SUI were randomised to TVT (61) or to TOT TVT SUI
incontinence (SUI). Its high, long-term success rate TOT (55). Inclusion criteria included stress or mixed Mixed SUI Mixed - Dry
ranges from 84% to 95%. However, TVT procedure is urinary incontinence, urethral hypermobility. Patients - Improved
associated with concerns about operating safety in with grade II prolapse in any vaginal compartment - Not dry
terms of risk of injuries to the bowel and major blood were excluded. The Ulmsten and Delorne techniques 36 25 36 19
vessels, and of bladder and urethral perforation. were used. Mixed incontinence was present in 25 out 30 (83%) 17 (68%) 30 (83%) 8 (42%)
of 61 patients in the TVT group 19 out of 55 in the TOT 3 (8.3%) 8 (32%) 4 (13%) 7 (37%)
TVT is also associated with postoperative voiding group. 3 (8.3%) 0 2 (5.5%) 4 (32%)
difficulties such as transient urine retention and
urgency. To avoid the complications associated with The pre-operative work-up included a detailed case
the retropubic route, the transobturator route (TOT) history, the voiding diary, the urogenital distress The more frequent late complication is de novo
was developed. Insertion through the obturator inventory (UDI-6) and the impact incontinence quality urgency in both the procedures.
muscles reproduces the natural suspension fascia of life (IIQ-7) questionnaires, a clinical, neurological
of the urethra while preserving the retropubic space and urogynaecological, 1-h pad test, urodynamic Equally efficient mean follow-up of 31 months. Postoperative voiding
by avoiding intrapelvic and retropubic blind study. Subjective assessment (calculated by In summary the results of this prospective randomized symptoms are not different in the two groups. The
passages. questionnaire scores), The Mann-Whitney, Wilcoxon, study show no significant differences between TVT storage symptoms were lower in the TOT group of
Chi square and McNemar tests were used for the and TOT procedures. A special consideration has to be patients. Urgency remains a post-operative problem
Consequently, the TOT approach seems to limit the statistical analysis. done for the storage symptoms. While in the TVT especially in the TVT group. No statistical significant
risks of visceral and vesical lesions and, more group there were no statistical significant differences differences were observed in terms of cure rate in
importantly, of bowel and vascular injuries. In a SUI versus mixed incontinence. The preoperative of storage symptoms before and after the procedure, mixed urinary incontinence.
preliminary study, TOT was associated with a high parameters of the two groups doesn’t show statistical this became significantly lower in the patients treated
success rate, no bladder injury, and few perioperative differences. The perioperative and postoperative with TOT. In the TOT group the storage symptoms Source: Kocjancic, E., Costantini, E., Frea, B., Crivellaro,
complications in women with SUI. At the 23rd Annual complication rates are acceptable for both the were cured in a bigger proportion (31% in the TVT S., Degiorgi, G., Tosco, L., & Porena, M. (2008). Tension
European Association of Urology, Kocjancic and his procedures and not statistically different. The and 52% in the TOT). free vaginal tape vs. Trans obturator tape: Is there any
colleaguess (2008) compared TVT and TOT procedures subjective (questionnaire score) and objective (stress difference in the mixed incontinence patients ? Results
as a therapy for mixed urinary incontinence in a test) assessments of results show a good efficacy for In conclusion, TOT appears as efficient as TVT as a of a multicentre randomised trial. European Urology
prospective, multicentre, randomised study. both the procedure with no significant differences. therapy for female SUI, with minimal complications at Supplements, 7(3), 123-123.

Surgical treatment of SUI: looking for a common ground


Case series show positive results for TVT and some obturators
Female reconstructive urology he stressed that the TVT is completely new and Key messages
Professor Pushkar, who chaired the ESU course, said different. The same applies to obturators as practice Although it is not possible to provide thorough
female reconstructive urology, just like the entire field has showed that this procedure leads to specific answers to all these questions, Pushkar’s key
of urology and, indeed, medicine as a whole, has postoperative complications as of approach. messages were:
been influenced by the trend toward minimally Moreover, subjective and objective outcome of these 1. Vaginal urological surgery is an essential part of
invasive procedures. procedures are different. urological practice and should be implemented
accordingly.
SUI affects millions of women in Europe and the Aware of the differences between objective and 2. TVT and some obturators provide encouraging
United States. Nowadays dozens of surgical subjective outcomes, Munir et al. (2005) developed results in case series and randomly controlled
Prof. D. Pushkar procedures are available although with limited data their own questionnaire which was adapted from the trials. The longest follow- up data of 11 years are
used for treating SUI in female patients. Some Bristol Female Lower Urinary Tract Symptoms available now for conventional TVT procedure.
evidence-based medicine (EBM) data are available, Questionnaire since there were no suitable 3. Mini slings are new procedures with limited
At the course on vaginal surgery given by European but not widely applicable in all disciplines. Current questionnaires to help understand the patients’ clinical data, so patients should be informed of
School of Urology (ESU) during the 23rd Annual approaches and clinical guidelines are country perceptions that affect their satisfaction. the experimental status of these procedures and
Congress of the European Association Urology held dependent and in some places they consist of the the lack of long-term follow up.
last March in Milan, Italy, Professor Dmitry Pushkar Burch procedure as standard care and the With 54 patients completing follow-up with a 4. Synthetics are mostly used now – by both
(Department of Urology, Moscow State Medico- conventional trans-vaginal tape (TVT) that are response rate of 72%, Munir et al. reported that 59% urologists and gynaecologists.
Stomatological University, Russia) focused on the performed in more severe cases and in patients with of patients were completely dry or leaked less than 5. Type of mesh to be used is Macroporous Prolene.
surgical treatment of stress urinary incontinence (SUI). recurrence. once a week; 92% reported an improvement in their 6. Be prepared for reconstruction in case of serious
symptoms with 80% stating a greater than 75% complications after synthetic slings.
One of the goals of the course was to present clinical The TVT procedure was introduced in 1996 and was improvement. Ninety-four percent of patients were 7. There is a need for pelvic surgeons training
experience that describe and evaluate newly based on the so-called integral theory or, as some satisfied with their operation and 75% were very among European urologists.
developed techniques in current clinical practice. The authors claim, mid-urethral theory. It is misleading to satisfied. These rates were then compared to clinical 8. Vaginal prolapse surgery, using mesh, should
main theories of the development of SUI were consider the TVT procedure as a modification of notes where physicians have documented that 96% of be performed only by urologists who are
explored with the audience in an interactive manner. traditional pubovaginal sling since this is a totally patients reported improvement and 46% were specially trained in vaginal surgery and they
Special attention was given to new techniques that new and different procedure. completely dry. should have performed these procedures
use synthetic tapes in SUI surgery and the discussion regularly.
also covered the management of complications of Since the introduction of TVT, the procedure has Patients’ reports 9. Careful anatomical considerations should be
surgery for stress incontinence. become one of the most widely used surgical Not surprisingly, these rates did not differ much taken during patient’s examination in order to
treatments for SUI. Despite numerous short-term between the questionnaire and the information clarify indications.
Furthermore, the course also included a detailed reports of its efficacy, Deval et al. (2002) were the first reported by the patient to their physician. This 10. Urologists should spend more time with
coverage of pelvic anatomy for urologists to better to examine patients’ dissatisfaction with the TVT indicated that most patients are as likely to report patients before and after the procedure.
understand and apply modern surgical approaches to procedure. In their study, 90.4% patients were their urinary symptoms to their surgeon as they 11. Good results come only after a careful and
pelvic organ prolapse. Vaginal approach to prolapse objectively cured leaving too few patients to analyse if would in an anonymous manner. Instead of looking at detailed patient data analysis.
and the use of different meshes were presented in a any complications led to dissatisfaction. However, they urodynamic definitions of cure versus subjective 12. Strict criteria for cure/ improvement/ failure of
critical way and based upon personal experience. The noted a 70.6% subjective cure rate that was much assessment of cure, the Munir study analysed the incontinence should be defined based on
management of periurethral cysts, fistulas and other less than the objective cure rate. This was attributed quantity of leakage compared to the patients reports patient perception as well as on objective and
rare conditions were also shown during podium and to new onset urge symptoms. of improvement as well as satisfaction with the semi-objective tools such as validated
video presentations. Carefully prepared clinical cases procedure. questionnaires, diaries and pad tests. Subjective
and video demonstration of various surgical Synthetic sling patient’s analysis is the most important
techniques and tricks provided a clear understanding In 2001, Delorme (2001) described the use of a These rates demonstrate that patients may be instrument.
of the most common procedures to all participants. synthetic sling with passage through the obturator satisfied without being completely dry and some may
space called the transobturator tape (TOT). This be satisfied with less than a 75% improvement of Additional reading:
passage would theoretically reduce the risk of bowel, their symptoms, which again confirms how patient • Delorme, E. (2001). Transobturator urethral
bladder, and vascular injury during trocar passage. It satisfaction does not rely upon the attainment of cure. suspension: a minimally invasive procedure to
Urinary

may also lead to less urge symptoms postoperatively. Nevertheless, all efforts were made to minimise the treat female stress urinary incontinence. Progres
Today, there are still many urologists who prefer to procedures, and new procedures were developed En Urologie, 11(6), 1306-1313.
perform either conventional suburethral synthetic with the potential to reduce postoperative • Deval, B., Jeffry, L., Al Najjar, F., Soriano, D., &
tapes or obturators. complications and to improve continence results and Darai, E. (2002). Determinants of patient
overall patients’ satisfaction. dissatisfaction after a tension-free vaginal tape
During the course, Pushkar analysed the latest results procedure for urinary incontinence. Journal of
dealing with the efficacy of these procedures and Questions remain whether we should improve the Urology, 167(5), 2093-2097.
answered questions regarding novel approaches and existing techniques or we should, instead, implement • Munir, N., Bunce, C., Gelister, J., & Briggs, T.
minimal procedures. the newest procedures, or whether it is possible to (2005). Outcome following TVT sling procedure:
improve the existing techniques, as compared to A comparison of outcome recorded by surgeons

Incontinence Pushkar pointed out and reiterated that it is a


misleading to consider the TVT procedure as a
modification of the traditional pubovaginal sling, as
whether we are prepared to implement to the routine
practice with the newest procedures given the limited
clinical data we have now.
to that reported by their patients at a London
District General Hospital. European Urology,
47(5), 635-640.

August/September 2008 European Urology Today 25


Translational research in renal cryosurgery technologies
Dr. Jorge Rioja employment of termosensors in order to measure the influence the freezing rate (8). Inclusion criteria were
Urologist temperature at several locations, in and around the laparoscopic cryoablations (either transperitoneal or
AMC University tumour, is critically important. retroperitoneal approach) with at least one
Hospital In cryosurgery it is crucial that the performance of termosensor placed central into the tumour, while
Amsterdam (NL) cryoprobes is predictable and constant, as well as open cryoablations were excluded.
when comparing different set ups, such as single
versus multiple needles. To clarify this, the Other exclusion criteria were incomplete procedural
performance of the 17-gauge cryoprobe in vitro was
data and cases with additional cryoneedles
tested, analysing both intraneedle (between different
placement, or changes during
freeze cycles of one cryoprobe) and interneedle procedure. Between September
variations (between different cryoprobes) 2003 and August 2007, we
performed 70 cryoablations in 67
Prof.Dr. Jean De La To evaluate it, different set ups were used, employing patients, from these 54 met
Rosette eight single probes during six freeze cycles, four inclusion criteria and were
Urologist single probes during four freeze cycles, multiple further analysed. Upon the
AMC University configuration with four probes during two freeze findings of the intraoperative
Hospital cycles and multiple termosensors. For testing the tumour biopsy, two groups were
Amsterdam (NL) cryoprobes performance with regular thermo sensor, formed: Group 1, including those
cups with agar (3% LB Agar, Invitrogen) and documented Renal Cell Carcinoma
ultrasound gel (Conductivity gel, Ultra/Phoni, Codali) (RCC) or those cases with a non
J.J.Delarosette@amc. at room temperature were used as homogeneous diagnostic biopsy and Group 2
uva.nl medium for ice generation (4). including benign documented
The cryoprobe performance was defined previously as lesions (Oncocytomas or
the time it takes to lower the temperature from 0˚C to Angiomyolipomas)
Prof.Dr. Pilar Laguna -20˚C. To measure cryoprobe performance a
Urologist customised template was used. It consists of three The overall rate of the
AMC University Plexiglas round discs (1 cm thick), space 5 cm apart, temperature decrease in the
Hospital with drilled holes to exactly fit 17-gauge needles freezing phase of the first freezing Figure 3: Cryoprobe performance
Amsterdam (NL) (1.47cm) (Figure 1). cycle for both groups is shown in
Figure 4. Looking at the graph of
The results achieved were that the performance the RCC group, we see that the
differs on the medium used and that cryoprobes temperature decrease rate is
deliver reproducible freeze cycles. There is a variation larger until it reaches -40˚C
in between different cryoprobes during freezing, but (steeper slope of the curve), and
this variation is lesser within a multiple cryoprobe then the decrease continues in
configuration. (Figures 2-3) smaller rate. When comparing
both curves, the graph indicates
Cryosurgery is one of the minimally invasive Moving from the ‘bench’ to the ‘bedside,’ a that the rate of the temperature
techniques used to treat renal tumours < 4 cm. In prospective, multicentre study, which was run decrease for the RCC group, is
renal cryosurgery needle-shaped probes are inserted between September 2003 and August 2007, larger until it reaches -20˚C, but
into the tumour, and by using argon gas or liquid evaluating the peri-operative morbidity (30 days) was afterwards, it becomes larger for
nitrogen an ice ball is formed. This ice ball should conducted. 81% of the treated patients had some the benign group.
engulf the entire tumour, thereby ablating the co-morbidity associated, the ASA score was 2 (SD
cancerous tissue plus a safety margin of healthy 0.65), the Charlson Index was 2 (SD 1.47) and the Analysing which are the influence
tissue between 0.5-1 cm. age-adjusted Charlson index was 4 (SD: 2.08). Of the factors in the temperature
148 operations performed only three were done by an decrease for the RCC in the
The lethal effects of freezing arise from two major open approach, the mean time was 180 min and there univariate analysis, we found that
mechanisms. These are direct injury to cells caused by were three reconversion to open surgery, one because the age, gender, side of tumour,
ice crystal formation and the microcirculation failure of hypercapnia, one change into a nephrectomy and location of the tumour, size of the Figure 4: Temperature decline during the first freezing cycle with time (min) for the RCC
which occurs in the thawing period (1). These another into a partial nephrectomy. tumour, creatinine level prior group and the benign group.
mechanisms are related to several parameters: freeze surgery, ASA score monokidney,
rate, end temperature, duration of freezing, thaw rate, The presence of complications was correlated in the cardiomiopathy, diabetes mellitus, COPD, use of
and number of freeze cycles (1-3) univariate analysis with the ASA score (p = 0.04), the anticoagulants and hypertension. But of all these, Another interesting finding, despite previous
presence of cardiac problems (p = 0.010), the number preoperative creatinine levels above 120 IU, diabetes assumptions, is that the tumour size doesn’t influence
The rationale for performing cryosurgery are the of cryoneedles (p = 0.03) and the size of the tumour mellitus, ASA score 3 and location of the tumour in the freezing rate, which could be explained by the use
increasing diagnosis of small renal masses, the high (p = 0.000). In the multivariate analysis only the the lower pole are shown to increase the freezing rate of or the proper number of cryoneedles and their
percentage of benign (small) masses, their low presence of complications and the tumour size remain (with a significantly larger negative slope coefficient). correct placement. The strongest variable in the
biological potential, the incidence with elderly and ill significant entailing a higher risk of complication in multivariate analysis, which doubles the freezing rate,
patients, and that partial nephrectomy (open or the perioperative period. The only found factor that decreases significantly the is the presence of diabetes mellitus.
laparoscopic) is still a challenging procedure with a freezing rate is the presence of COPD, which we
high complication rate (18%). The patho-physiological mechanisms of cellular couldn’t find any patho-physiological explanation for Conclusion
destruction caused by cryotherapy in different time that fact. We may conclude that the freezing during cryotherapy
Therefore, nowadays the current indications for a phases have been and still are subjects of further However, it is shown in the multivariate analysis that is significantly influenced by various factors, including
renal cryosurgery are peripheral enhancing mass up study (5-6). Experimental series and most large the tumour location (lower pole) and the presence of technical ones, such as the number of needles, and
to 4 cm, central masses if visible by ultrasound, clinical series in humans show that destruction is diabetes mellitus are independent influence factors in by clinical factors like the presence of diabetes
elderly patients and the presence of co-morbidity, ensured by achieving cytotoxic freezing temperatures the temperature decrease rate, by accelerating the mellitus. More importantly though is that there are no
patient’s desire, congenital RCC syndromes and of -40˚C, with a double freeze-thaw cycle and 1 to 3.1 freezing process. short-term differences in the clinical outcome.
solitary kidney. cm ice-ball extension beyond the tumour margin (7) While the influence of diabetes seems logical, due to
the changes in the renal microvasculature inherent to References
The most extensively studied parameter is the lethal As there are factors that might influence the freezing illness, the reason why tumours of the lower pole 1. Gage A. A., Baust, J. Mechanism of tissue injury in
or critical temperature, resulting in complete loss of rate during cryotherapy which have not been have a faster freezing rate remains unclear. Although cryosurgery. Cryobiology. 37, 171-186 (1998)
cell viability. Unfortunately, there are limited tools investigated, we conducted a procedural analysis of polar arteries are more frequently encountered in the 2. Hoffman, N.E., Bischof, J.C., The cryobiology of
available to identify the three-dimensional location of all the cases performed at our institution, in order to upper pole, there is no evidence that differences exist cryosurgical injury. Urology. 60, 40-49 (2002)
the critical isotherm in cryosurgery. Nowadays, the identify clinical parametres or factors that might in the vascularisation of both renal poles. 3. Clarke, D.M., Robilotto, A.T., Rhee, E., Vanbuskirk, R.G.,
Baust, J.G., Gage, A.A., Baust, J.M. Measurements and
prediction of thermal behavior and acute assessment of
injury in a pig model of renal cryosurgery. J. Endourol.
15, 193-197 (2001)
4. Beemster, P.W., Lagerveld, B.W., Witte, L.P., de la Rosette
J.J., Laguna Pes, M.P., Wijkstra, H. The Performance of
17-gauge Cryoprobes in Vitro. Technol Cancer Res Treat.
Aug 7(4), 321-328 (2008)
5. Lin, C.H., Moinzadeh, A., Ramani, A.P., Gill, I.S.
Histholpathologic confirmation of complete cancer-cell
kill in excised specimens after renal cryotherapy. Urology
2004; 64:590
6. Baust, J.B., Gage, A.A. The molecular basis of
cryosurgery. BJU Int 2005;95: 1187-1191.
7. Johnson, D.B. and Nakada S.Y. Cryosurgery and needle
ablation of renal lesion. J Endourol 2001, 15:361-368
8. Tsakiris, P. Beemster, P., Wijkstra, H., de la Rosette, J.,
Laguna, M. In vivo factors influencing the freezing cycle
during cryoablations of small renal masses. J Endurol
2008 in press.

Figure 1: Photo of the customised template with one cryoprobe and 4 termosensor parallel to it Figure 2: Top view of the two templates employed and the temperature curves in agar and gel.
at 3 mm distance, and the development of the ice ball which engulfs the cryoprobe and the four
EAU Section of Uro-Technology
termosensors around it.

26 European Urology Today August/September 2008


For more information on registration please go to http://registrations.uroweb.org or

EAU 8 Central European Meeting


th contact the EAU Congress Organiser at CEM2008@congressconsultants.com

24-25 October 2008, Warsaw, Poland


www.uroweb.org

Preliminary 12.40 – 13.40 Lunch Saturday, 25 October 2008 Chairman EAU 8th CEM
M. Sosnowski, Lodz (PL)

Programme 13.40 – 14.40 State-of-the-art lectures


Is varicocelectomy outdated?
08.00 – 09.40 Renal Cell Cancer (RCC)
Improving the diagnosis of small renal Chairman EAU Regional Office
R. Kocvara, Prague (CZ) masses M. Marberger, Vienna (AT)
Thursday, 23 October 2008 Update on uro-pathology of prostate M. Hora, Plzen (CZ)
cancer Faculty
16.00 – 20.00 Registration Is active surveillance of small renal
K. Sikora, Warsaw (PL) P-A. Abrahamsson, Malmö (SE)
tumours a valid option? M. Babjuk, Prague (CZ)
Friday, 24 October 2008 Translational research in prostate J. Dobruch, Warsaw (PL) A.P. Borkowski, Warsaw (PL)
cancer: From the lab to the patient The limits of nephron sparing surgery for
07.00 – 09.00 Registration G. Böszörményi-Nagy, Budapest (HU)
P-A. Abrahamsson, Malmö (SE) RCC J. Breza, Bratislava (SK)
09.00 – 09.10 Introduction I.C. Sinescu, Bucharest (RO) P. Chlosta, Kielce (PL)
14.40 – 15.00 Coffee break
P-A. Abrahamsson, Malmö (SE) New aspects in systemic therapy of RCC Z.F. Dobrowolski, Cracow (PL)
C. Szczylik, Warsaw (PL) J. Dobruch, Warsaw (PL)
M. Sosnowski, Lodz (PL) 15.00 – 16.40 Poster session 4: External genitalia, R. Fiala, Olomouc (CZ)
Testis tumour 09.40 – 10.00 Coffee break P.A. Geavlete, Bucharest (RO)
09.10 – 10.40 Hot issues in prostate cancer
T. Hánuš, Prague (CZ)
Identifying curable and significant 15.00 – 16.40 Poster session 5: Bladder cancer M. Hora, Plzen (CZ)
10.00 – 11.40 Poster Session 7: Renal tumours
prostate cancer L. Jarolim, Prague (CZ)
L. Jarolim, Prague (CZ) 15.00 – 16.40 Poster session 6: Urinary diversion, 10.00 – 11.40 Poster Session 8: Urolithiasis, H.C. Klingler, Vienna (AT)
Reducing the morbidity of radical Renal transplantation R. Kocvara, Prague (CZ)
Laparoscopic surgery
prostatectomy A. Majoros, Budapest (HU)
P. Chlosta, Kielce (PL) 16.40 – 17.10 Pro-contra debate 10.00 – 11.40 Poster Session 9: Prostate cancer therapy M. Marberger, Vienna (AT)
Managing continence and erectile Primary therapy of ureteric stones is C. Oblak, Ljubljana (SI)
dysfunction SWL today 11.40 – 12.40 Female Urology P. Radziszewski, Warsaw (PL)
A. Majoros, Budapest (HU) Chair: I. Romics, Budapest (HU) Diagnostic work-up of the incontinent I. Romics, Budapest (HU)
The management of rising PSA after Pro: G. Böszörményi-Nagy, woman K. Sikora, Warsaw (PL)
curative therapy Budapest (HU) C. Oblak, Ljubljana (SI) I.C. Sinescu, Bucharest (RO)
N. Vodopija, Slovenj Gradec (SI) Contra: H.C. Klingler, Vienna (AT) M. Sosnowski, Lodz (PL)
Does the tape take care of everything?
Who should have chemotherapy, when C. Szczylik, Warsaw (PL)
T. Hánuš, Prague (CZ) N. Vodopija, Slovenj Gradec (SI)
and how long? 17.15 – 18.15 Symposium: Bladder cancer
P-A. Abrahamsson, Malmö (SE) The painful bladder
developments; expert panel review P. Radziszewski, Warsaw (PL)
Chairs: M. Sosnowski, Lodz (PL) Advisory Board
10.40 – 11.00 Coffee break P-A. Abrahamsson, Malmö (SE)
M. Marberger, Vienna (AT) 12.40 – 13.40 Panel discussion A.P. Borkowski, Warsaw (PL)
Update on classification, grading and Pandora’s box: T1 G3 bladder cancer
11.00 – 12.40 Poster session 1: Prostate cancer A. Borówka, Warsaw (PL)
staging of bladder cancer Chair: M. Marberger, Vienna (AT) J. Breza, Bratislava (SK)
diagnosis J. Breza, Bratislava (SK)
Panel: M. Babjuk, Prague (CZ) Z.F. Dobrowolski, Cracow (PL)
Improving the diagnosis of bladder J. Dvorácek, Prague (CZ)
11.00 – 12.40 Poster session 2: Urodynamics, Female A.P. Borkowski, Warsaw (PL)
cancer P.A. Geavlete, Bucharest (RO)
urology M. Marberger, Vienna (AT) J. Breza, Bratislava (SK)
Z.F. Dobrowolski, Cracow (PL) T. Hánuš, Prague (CZ)
Integrating Fluorescence cystoscopy/ G. Janetschek, Linz (AT)
11.00 – 12.40 Poster session 3: Andrology, BPH PDD to improve the management of R. Fiala, Olomouc (CZ)
J. Kliment, Martin (SK)
non-muscle invasive bladder cancer P.A. Geavlete, Bucharest (RO) O. Kraus, Zagreb (HR)
M. Babjuk, Prague (CZ) M. Sosnowski, Lodz (PL) C. Oblak, Ljubljana (SI)
European Sponsored by GE Healthcare I. Romics, Budapest (HU)
Association 13.40 Awards and closing remarks I.C. Sinescu, Bucharest (RO)
M. Sosnowski, Lodz (PL) M. Sosnowski, Lodz (PL)
of Urology This meeting is EU-ACME accredited M. Marberger, Vienna (AT) N. Vodopija, Slovenj Gradec (SI)

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August/September 2008 European Urology Today 27


Key-articles from international medical journals
Mr Philip Cornford men with lymph node metastases between the recurrence. Furthermore the authors outline the suggested that elevated CRP concentrations may also
Section editor groups, the analysis was repeated after excluding all importance of self-examination for local and regional predict shorter cancer-specific survival in men with
Liverpool (GB) men with positive lymph nodes. Again the results recurrence. The maximum follow up for all patients metastatic prostate cancer initiating androgen
were essentially unchanged (HR 0.34; [0.19-0.63]). should be 5 disease-free years. deprivation. Certainly elevated CRP has been
Analysis revealed that for salvage radiotherapy to be described to be predictive of survival in other
effective it needed to be initiated before the PSA A drawback of the study however is the fact that data advanced malignancies. However, it is not clear what
reached 2ng/ml and less than 2 years after recurrence were collected retrospectively and patients were is the biologically mechanism underlying this
was diagnosed. included over an extremely long period beginning correlation.
Philip.Cornford@ Those men whose PSA level became undetectable had back in 1956 when diagnosis and treatment of penile
rlbuht.nhs.uk the best outcomes and perhaps slightly surprisingly it cancer was certainly different from today’s modern
was the men with a PSA doubling time of <6 months imaging and surgical techniques. Source: C-reactive Protein as a prognostic
that experienced an improvement in prostate cancer marker for men with androgen-independent
specific survival with salvage radiotherapy. The other Source: Recurrence Patterns of Squamous Cell prostate cancer. Beer TM, Lalani AS, Lee S,
Salvage radiotherapy group with an improved outcome were those men Carcinoma of the Penis: Recommendations for Mori M, Eilers KM, et al.
with a PSA doubling time of >6 months but Gleason Follow-Up Based on a Two-Centre Analysis of Cancer 2008; 112:2377-83.
after radical prostatectomy 8-10 cancers and a positive surgical margin 700 Patients. Leijte J, Kirrander P, Antonini N,
gives long term cures Windahl T, Horenblas S.
This study challenges the common belief that local European Urology, Volume 54 , Issue 1 , p 161-169
recurrence is associated with relatively favourable
An increasing PSA level following radical prognostic features (e.g. Gleason score <8, and slow
Breast milk protein
prostatectomy is a cause of concern in both patients PSA velocity). Instead it suggests that local recurrence used to treat
and surgeon. Although surgery provides excellent with a potentially lethal phenotype but biologically
cancer control between 15% and 40% of men will responsive to radiation can occur and suggests that
Inflammatory marker predicts renal cancer
experience biochemical recurrence. In such cases is recurrent disease in the pelvis may be a more outcome for androgen-
difficult to distinguish between local recurrence and frequent contributor to biochemical recurrence than Despite new treatment modalities for metastatic renal
occult distant metastasis and although salvage previously thought.
independent prostate cancer cell carcinoma (RCC) it remains difficult to treat.
radiotherapy is frequently considered, there is no data Complete response to treatment is exceedingly rare
to show it confirms a survival benefit. This is not a randomized prospective trial and in a Although docetaxel chemotherapy has been shown to and the majority of patients die of their disease within
disease where the median time to death following prolong survival for men with metastatic androgen- 1 to 2 years. Talactoferrin is a recombinant form of
Recent studies have suggested adjuvant radiotherapy PSA recurrence after radical surgery is 13 years may independent prostate cancer (AIPC) there is significant human lactoferrin. Lactoferrin is an important
in patients with pT3 prostate cancer significantly be considered immature but it does provide the first variability both in the response to treatment and immunomodulatory protein found throughout the
improves biochemical relapse-free and clinical evidence that early salvage radiotherapy is associated overall survival. Improved stratification of patients by body but in the highest concentrations in breast milk.
recurrence free survival and therefore there is current with improved prostate cancer survival and the risk would inform patients, aid clinical decision- It plays an important role in helping establish the
on-going debate about whether patients should be magnitude of the survival benefit is similar to that making and potentially improve clinical trial design. immune system, including the gut-associated
offered immediate adjuvant treatment or delayed observed in adjuvant radiotherapy trials. lymphoid tissue (GALT) and is involved in cellular
salvage therapy. This study evaluates a cohort of men Beyond the standard clinically variables of age, growth and differentiation, antimicrobial defence,
with biochemical or local recurrence following radical Source: Prostate cancer-specific survival performance status; Gleason score; the presence of anti-inflammatory activity, immune modulation and
prostatectomy who received either no salvage therapy, following salvage radiotherapy vs observation visceral disease; PSA concentrations and kinetics cancer protection. Talactoferrin is produced in
salvage radiotherapy alone, or salvage radiotherapy in men with biochemical recurrence after interest has grown in the role of inflammation in the Aspergillus niger and is structurally identical to native
combined with hormonal therapy. radical prostatectomy. Trock BJ, Han M, development and progression of prostate cancer. human lactoferrin differing only in its glycosylation.
Freedland SJ, Humphreys EB, DeWeese TL, Certainly specific inflammatory cytokines as well as
Partin AW, Walsh PC. non-specific measures of systemic inflammation such
Recurrent disease JAMA 2008; 299(23): 2760-9. as C-reactive protein (CRP) and albumin have been
Oral talactoferrin
found to be strongly correlated with prognosis in
Between June 1982 and August 2004, 926 men had patients with a broad variety of common cancers. This After oral administration talactoferrin is transported
developed recurrent disease following radical study used samples and clinical outcomes data from into Peyer patches of the GALT, in which it recruits
prostatectomy and either did not receive salvage the ASCENT (AIPC study of Calcitriol enhancing immature circulating dendritic cells (DCs) bearing
therapy, received salvage radiotherapy alone, or
Squamous cell taxotere) to evaluate the role of a range of different tumour antigens and induces their maturation. This
received salvage therapy combined with hormone carcinoma cytokines, chemokines and inflammatory markers. induces a strong innate and adaptive immune
therapy. Men who received adjuvant hormonal or response resulting in the activation of lymphocytes in
radiation therapy or received salvage hormone of the penis 160 of 250 men enrolled in the ASCENT trial had tumour draining lymph nodes, cellular infiltration of
therapy alone were not included. Excluded from baseline plasma samples stored and were evaluated distant tumours and tumour-cell death. In phase 1
analysis were 7 men who declined to participate, 6 In this article Leijte et al retrospectively analyse the in this study. To be eligible men had to be studies oral talactoferrin was found to be well
men whose salvage treatment status could not be recurrence patterns of penile carcinoma. Their chemotherapy naive with metastatic AIPC. They tolerated with evidence of partial response in RCC. In
determined, 4 men for whom survival time could not experience is based on the analysis of one of the received 45μg of calcitrol or placebo by mouth on Day non-small cell lung cancer (NSCLC) talactoferrin
be determined, 60 men censored with no follow up largest published database (700 patients) of two 1 followed by docetaxel at a dose of 36 mg/m2 demonstrated an improvement in overall survival (OS)
data subsequent to prostate cancer recurrence and major referral centres in The Netherlands and intravenously on Day 2 along with dexamethasone with trends towards improvement in progression free
214 men lacking sufficient data to calculate PSA Sweden. Because penile cancer is a rare disease in (4mg 12 hours before, 1 hour before and 12 hours survival (PFS). As a consequence this phase 2 study in
doubling time following recurrence leaving 635 men the Western world most studies are hampered by the after docetaxel). This regimen was administered patients with advanced RCC was conducted
for analysis. Of these, 397 received no salvage small numbers of patients as well as limited weekly for 3 consecutive weeks of a 4-week cycle.
treatment 160 received salvage radiotherapy alone follow-up. 44 patients with histologically confirmed metastatic or
and 78 received radiotherapy combined with Samples were analysed by multiplex immunoassays unresectable RCC with predominantly clear cell
hormonal therapy. The authors published a follow-up over up to 358 using uniquely labelled flourescent microspheres histology and having failed at least 1 systemic therapy
months providing new insights for follow-up conjugated to anticytokine capture antibodies were included. The Karnofsky performance status had
Amongst those men receiving radiotherapy the recommendations for patients with penile carcinoma. measured IL-1α, IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, to be >70 and patients with brain metastasis, active
median time from recurrence to initiating salvage Recurrence rates were divided into local, regional and monocyte chemotactic peptide-1 (MCP-1), EGF, VEGF, ischaemic heart disease, symptomatic congestive
radiotherapy was 1 year and overall the median distant recurrences and correlated with organ plasminogen activator inhibitor-1 (PAI-1), matrix heart failure, serious active infection, autoimmune
follow-up from a diagnosis of recurrence was 6 years. preserving and amputational techniques. Patients metalloproteinase-9, (MMP-9), coluble E selectin disease, radiotherapy administered within 4 weeks,
undergoing organ preserving surgery had the highest (sE-Selectin), solubleintracellular adhesion molecule and other malignancies diagnosed within 5 years
The 3 groups differed significantly for all prognostic risk for a local recurrence (27.7%); there was little (sICAM-1), soluble vascular cell adhesion molecule were excluded. Patients received recombinant human
factors except surgical margin status. Notably, men impact on the survival, however. In the amputation (sVCAM-1) and CRP. All samples were tested in lactoferrin (rhLF) 1.5mg orally twice a day for 12 weeks
with no salvage therapy had a much higher group local recurrence was only 5.3%. duplicate and mean values were used for all analyses. followed by a 2 week break. A maximum of 2 addition
prevalence of positive lymph nodes (30% vs 3%-4%). Overall survival was defined as the time from cycles were permitted.
Men who received salvage radiotherapy and randomisation to death from any cause. PSA decline
hormonal therapy had significantly shorter time to
Distant recurrence was defined as a >50% reduction from baseline PSA The first CT scan was obtained at baseline followed by
recurrence, shorter PSA doubling time, and higher that was confirmed by a repeat measurement at least scans at weeks 8, 14, 21, 27, 34, 41, 48 and 55. Patients
PSA level at the time radiotherapy was initiated. All regional recurrences occurred within 50 months, 28 days later. were followed for OS for 12 months from the initiation
the prognosis was strongly associated with this type of the study treatment or until the medial OS for the
Univariate analysis demonstrated significant of recurrence. The resulting disease-specific survival study was determined
associations with prostate cancer-specific survival for was 92% after a local recurrence and 32.7% after a
Elevated CRP Twenty-nine patients (66%) completed cycle 1 of
the logarithm of PSA doubling time (HR 0.38; regional recurrence. The worst prognosis was in the therapy and 20 patients completed 2 cycles. 42
[0.31-0.46, p<0.001]), time from surgery to recurrence group of distant recurrence, all patients died within In a multivariate Cox proportional hazard model of patients reported at least 1 adverse event (AE) and 23
(HR 0.80; [0.73-0.88. p<0.001]), post-operative 22 months. Based on their data the authors the 16 markers measured only CRP was found to be (52%) reported at least 1 related AE, of which the
Gleason score of 8 or greater (HR 4.23; [2.21-8.09, recommend a modification to the only available independently associated with overall survival (HR most common was fatigue, flatulence, abdominal
p<0.001]), positive lymph nodes (HR 2.45: [1.10-5.46, international guidelines for penile cancer (EAU 1.41: CI 1.199-1.647 [p<0.0001]). When categorised as pain and diarrhoea, although none were >grade 2 in
p=0.03]) and salvage radiotherapy regardless of guidelines). The majority of recurrence occurs within normal (<8 mg/L) or elevated an elevated CRP was severity. The 14-week PFS was 59%. In a recent trial
whether given alone or with hormonal therapy (HR the first 2 years after diagnosis, therefore a 3 months determined to be a significant predictor of decreased of bevacizumab in second line patients the placebo
0.42; [0.22-0.71, p=0.001]). follow-up interval for patients undergoing penile- survival (HR 2.96; 1.52-5.77 [p=0.001]). Elevated CRP arm had a 4 month PFS rate of 20% and in the trial
preserving therapy and a 6 months interval for was also associated with a lower probability of PSA comparing sorafenib to placebo after 3-months the
In multivariable models after adjusting for these risk patients undergoing penile amputation is considered decline (odds ratio of 0.74 for each In(CRP) increase; placebo arm showed partial response or stable
factors salvage radiotherapy was associated with a to be sufficient. CI 0.60-0.92 [p=0.007]) disease in just 34% of patients so this was though to
significant reduction in the risk of death of more than be significant. The response rate was 4.5% with
65% (HR 0.32, [0.17-0.57, p<0.001]). Although To improve follow-up the authors recommend in CRP is readily measurable and proved more predictive 70.5% of patients demonstrating stable disease for at
pathological stage overall nor lymph node status were addition to physical examination of the inguinal than conventional prognostic factors in this group of least 8 weeks. The median PFS was 6.4 months,
statistically significant in the multivariate analysis, regions ultrasound and fine-needle aspiration men with metastatic AIPC who were initiating whilst the median OS was 21.1 months with 77% of
because of the large imbalance in the distribution of cytology on indication for early detection of regional docetaxel chemotherapy. A previous small study has patients surviving at least 1 year.

Key-articles EAU EU-ACME Office

28 European Urology Today August/September 2008


Prof. Oliver March 2003 to March 2006. Men who had elected treatment was associated with a distinct pattern of Prof. Oliver Reich
Hakenberg prostatectomy, brachytherapy, or external-beam change in quality-of-life domains related to urinary, Section editor
Section editor radiotherapy as primary treatment and their partners sexual, bowel, and hormonal function. These changes Munich (DE)
Rostock (DE) were eligible. Patient-reported measures, including on the other hand influenced satisfaction with
the Expanded Prostate Cancer Index Composite treatment outcomes among patients and their
(EPIC-26) and Service Satisfaction Scale for Cancer spouses or partners.
Care (SCA), were collected before treatment and at 2,
6, 12, and 24 months after the start of treatment. Source: Quality of Life and Satisfaction with
Oliver.Hakenberg@ Outcome among Prostate-Cancer Survivors Oliver.Reich@med.
med.uni-rostock.de Adjuvant hormone therapy was associated with worse Martin G. Sanda, M.D., Rodney L. Dunn, M.S., uni-muenchen.de
outcomes across multiple quality-of-life domains Jeff Michalski, M.D., Howard M. Sandler, M.D.,
among patients receiving brachytherapy or Laurel Northouse, R.N., Ph.D., Larry Hembroff,
radiotherapy. Patients in the brachytherapy group Ph.D., Xihong Lin, Ph.D., Thomas K. Greenfield,
reported having long-lasting urinary irritation, bowel Ph.D., Mark S. Litwin, M.D., M.P.H., Christopher successfully redirect these cells into working
This study shows a novel approach to and sexual symptoms, and transient problems with S. Saigal, M.D., M.P.H., Arul Mahadevan, M.D., endothelial cells and tissue, contractile cardiac tissue,
immunomodulation using a drug which is not vitality or hormonal function. Adverse effects of Eric Klein, M.D., Adam Kibel, M.D., Louis L. brain cells, and other cell types, illustrating the
absorbed and so has relatively lower toxicity. This may prostatectomy on sexual function were mitigated by Pisters, M.D., Deborah Kuban, M.D., Irving potential applications of such cells. The cells could
allow it to be used in combination with other nerve-sparing procedures. After prostatectomy, Kaplan, M.D., David Wood, M.D., Jay Ciezki, also be cultured into undifferentiated embryonic-like
treatment modalities. Certainly in NSCLC clinical data urinary incontinence was observed, but urinary M.D., Nikhil Shah, D.O., and John T. Wei, M.D. stem cells.
has suggested that talactoferrin can enhance the irritation and obstruction improved, particularly in NEJM, 358:1250-1261, March 20, 2008, Number 12
activity of chemotherapy and in preclinical studies the patients with large prostates. Thus, GPR125 represents a novel target for purifying
addition of talactoferrin to sunitinib has resulted in adult stem and progenitors from tissues, with the
enhanced activity Urinary incontinence was at its worst by 2 months goal of developing autologous multipotent cell lines,
after surgery and then improved in most patients. which can have the additional benefit of avoidance of
Source: Phase 2 trial of talactoferrin in Factors that were associated with worse incontinence
Spermatogonia: tissue transplant rejection.
previously treated patients with metastatic renal were an older age, black race, and a high PSA score true stem cells
cell carcinoma. Jonasch E, Stadler WM, at diagnosis. In contrast, mean scores on urinary
Bukowski RM, Hayes TG, Varadhachary A, irritation or obstruction improved after prostatectomy. Embryonic stem cells are a fascinating and highly
Use of testes biopsy
Malik R, Figlin RA, Srinivas S. Effects of radiotherapy on urinary symptoms had discussed area of science, because of their high
Cancer 2008; 113: 72-7. resolved at 12 months and improved over baseline at potential for treating a variety of diseases. The method to harvest stem cells from adult testes
24 months. Patients in the brachytherapy group Nevertheless, the use of them remains controversial and reprogram them into functional tissue is still
reported significant detriments in urinary irritation or due to ethical reasons. experimental and needs further studies. This
obstruction and incontinence as compared with approach may provide an easily accessible and
baseline (P<0.001). Research on stem cells is fastly expanding. A few plentiful alternative to controversial embryonic stem
Quality of life of prostate years ago stem cells in the testes of adult mice with cells. The key question is if the authors can replicate
cancer survivors QoL changes pluripotent properties have been described, which this with human cells. The end goal would be the use
may open a way to avoid the ethical resistance to of testes biopsy with expansion of these cells in
embryonic stem cells. However, the lack of specific culture redirecting them into any kind of tissue to
In their prospective evaluation, the authors sought to Incontinence after brachytherapy was reported by 4 to surface markers has hampered isolation of this treat a disease. There is a long way to go, but the first
identify determinants of health-related quality of life 6% of patients at 1 to 2 years after treatment. unrecognized subset of germ cells. important steps are made.
after primary treatment of stage T1 to T2 prostate Eighteen percent of patients in the brachytherapy, 11%
cancer and to measure the effects of such of those in the radiotherapy, and 7% of those in the Isolation of multipotent adult stem cells Source: Generation of functional multipotent
determinants on satisfaction with the outcome of prostatectomy group reported having moderate or In this study the authors discovered the novel orphan adult stem cells from GPR125+ germline
treatment in patients and their spouses or partners. worse distress from overall urinary symptoms at 1 G-protein coupled receptor (GPR125) that is restricted progenitors. Seandel M, Daylon J, Shmelkov SV,
year. Changes in quality of life were significantly to undifferentiated spermatogonia within the testis. Falciatori I, Kim J, Chavala S, Scherr DS, Zhang F,
To achieve this goal, Sanda et al prospectively associated with the degree of outcome satisfaction Using GPR125 they were able to isolate adult Torres R, Gale NW, Yancopoulos GD, Murphy A,
measured outcomes reported by 1201 patients and among patients and their spouses or partners. spermatogonial progenitor stem cells from testes in a Valenzuela DM, Hobbs RM, Pandolfi PP, Rafii S.
625 spouses or partners. Patients were enrolled from The authors conclude that each prostate-cancer mouse study and to expand them. They could Nature 2007; 449:346-350

Key-articles EAU EU-ACME Office

More userfriendly levels of decision


EAU to launch online update of the Prostate-Risk Indicator
By Franz-Günter Runkel and Joel Vega New risk indicators 3 to 6 year. Simultaneously a Dutch government grant and cost/benefit to public health are being evaluated.
recently financed an evaluation of risk indicators 3 Moreover the evaluation of pathology, marker biology
The Prostate-Risk Indicator, the first easy-to-use • Risk indicator 3 predicts the chance of a and 6 of four cooperating academic centres in the and quality control are given high priority. “By
online tool for doctors, has been thoroughly revised. positive sextant biopsy in a man who was Netherlands. including the most recent ERSPC findings,” Schröder
The second version of the oncological risk- never screened. The urologist adds digital summarized, “we can also identify with a high degree
assessment tool will be available as of 15 September. rectal examination and ultrasound study. The development of the risk indicator is based on the of certainty those cases that may not require
“The second version,” underlines Prof. Fritz Schröder, • Risk indicator 4 predicts the chance of a ERSPC study. Launched more than ten years ago, the immediate treatment.”
chairman of the Scientific Committee of the European positive sextant biopsy in a man who had a ERSPC-study the largest
Randomized Study of Screening for Prostate Cancer PSA < 4.0 ng/ml and no biopsy at a previous randomised study on
(ERSPC), “will offer two more levels of decision: men screen. prostate cancer screening
who have had a previous negative PSA screen and • Risk indicator 5 predicts the chance of a ever, has recruited more
men who had a previous negative biopsy.” The new positive sextant biopsy in a man who had a than 250,000 men from
version of the online tool will be more userfriendly, PSA ≤ 3.0ng/ml and had a prior negative eight participating
more practicable and will be available on biopsy at a previous screen. countries: Belgium,
uroweb.org and urosource.com soon. • Risk indicator 6 calculates the chance of Finland, France, Italy, the
having indolent prostate cancer which may not Netherlands, Spain,
New features in the task bar of the risk indicator will require immediate treatment. The man had a Sweden and Switzerland.
allow urologists direct access to every module prior positive biopsy at a previous screen. “At present we do not
required. The risk indicators 1 and 2 are targeted at know whether the
the man in the street. The text has been changed screening for prostate
according to the comments of many users. In order to make the indicator more userfriendly and cancer actually does
They are meant to inform and be accessible to men to further increase the number of men and doctors more harm than good. In
(aged 55 and older) who go for an initial risk taking access to the online tool, the language is easier this situation of
assessment. Using level 1 only requires information and more readable now. The website has been partly uncertainty it is important
that is readily available or known such as age, family re-designed and newly offers the doctors direct to provide balanced
health history and voiding complaints. access to the level required. Today a urologist for information on potential
instance has to go through levels 1 to 4, even if he is risks and benefits,”
only interested in level 5. Schröder underlined.
Decision: PSA determination or not.
As Schröder explains the risk indicator 6 has been Although the ERSPC is
validated in a study recently published in the Journal expected to publish the
At level 2, a PSA determination has been made and of Urology (F. Dong, F.H. Schröder, E.A. Klein, JUrol, final findings by 2011 at
the result is available with the man´s family doctor. If vol 180, 1: 150-154). This study with 296 patients who the latest, Schröder says
the PSA is elevated above 3.0 or 4.0 ng/ml the man is underwent prostate biopsy and radical prostatectomy the Dutch ERSPC team in
advised to see a urologist (risk of having cancer at validated the Kattan and Steyerberg nomograms. The Rotterdam took the
biopsy is 17 to 21 per cent). data showed that those nomograms “performed initiative to develop an
equally well for predicting indolent disease. These assessment tool
data further establish the role of validated nomo- introduced in its first
Decision: see a urologist or not. grams for clinical decision making for managing version in 2007: the The example given by the two screen shots of risk indicators 3 (previously unscreened) and 5
screening detected prostate cancer.” prostate-risk indicator. (previously screened negative biopsy) used data from the same men: TRUS abnormal (1), DRE
Within ERSPC not only normal (0), prostate volume (40 ml), PSA 6.0 ng/ml. The large difference in outcome between
The risk indicators 3 to 6 are made for doctors and Regarding the risk indicators 1 and 2 the validation in prostate cancer mortality 40% and 18% demonstrates the effect of a previous negative biopsy on the results of rescreening
offer special services: the Netherlands will be finished at the end of this but also quality of life and shows the usefulness of the addition of the new risk indicators to the 2007 version.

August/September 2008 European Urology Today 29


Effective neuro-urology fellowship
at University of Innsbruck, Austria
Dr. Athanassios
Oeconomou
University of Thessaly
Department of
Urology
Larissa (GR) bladder, incontinence and pelvic organ prolapse.
I particularly note the implantation of artificial in the
bladder neck and the replacement of artificial
sphincter.
30th Congress of the
I joined the daily morning conferences. On Monday
Société Internationale
The European Urological Scholarship Programme
mornings I actively participate in the Journal Club by
presenting articles from European Urology and other
journals. Tuesdays and Thursdays were the main
d’Urologie
(EUSP) provides young doctors in Europe not only a
superb opportunity to develop their urological skills
operation days when I can take part and perform
some operations. On Wednesdays and Fridays, I November 1-5, 2009
in the unique medical environment of another attended the Video-urodynamic department, where I Shanghai International Convention Center
country but also offers valuable contacts with some can perform a lot of video-urodynamic studies.
of the best urological experts. Thus, knowledge
becomes truly continental and a feeling of community I also attended daily the outpatient clinic, perform the
is established in a setting where leading centres of urodynamic studies and the non-invasive
our specialty effectively collaborate. neuromodulation procedures and join the ward
rounds. I had the opportunity to work as a regular
Through the EUSP I had the opportunity to visit the staff member in the outpatient clinic. On Thursday
10-bed Neuro-Urology Department of the University afternoons there was an x-ray conference with the www.siucongress.org
Hospital of lnnsbruck for three months, a highly radiologists where we discuss and interpret the
regarded centre of excellence in the field of neuro- findings from the video-urodynamic studies.
urology and incontinence. The University Hospital of
Innsbruck, a tertiary 1,500-bed hospital, is situated in In three months I gained a thorough knowledge in the
the centre of Innsbruck. Prof. Helmut Madersbacher, diagnosis of the most commonly encountered
one of the pioneers in the field of neuro-urology and conditions in neurogenic LUT dysfunction and
incontinence, is the department director aided by Drs. incontinence and improved my abilities by identifying
Peter Rehder, Gustav Kiss and Thomas Berger. The the indications, perform and interpret urodynamic
Neuro-Urology Department, equipped with a fully and video-urodynamic studies, and also learned to
developed outpatient unit complete with classify the steps of treatment management, amongst
urodynamics, video-urodynamics, physiotherapy, others.
non-invasive neuromodulation (IVES, TENS-P), etc.,
also provides urological training to a resident for 18 Moreover, the training enabled me to assess the value
months. of physiotherapy and neuromodulation in the
treatment of these diseases. Prof. Madersbacher and
My fellowship was aimed at obtaining a thorough his staff members were all ready to answer my
insight in neuro-urology, and my objectives were to questions. I participated in many operations such as
examine the evaluation, diagnosis, treatment botulinum toxin A intradetrusor and intraprostatic CMYK SIU CONGRESS OFFICE
1155 University, Suite 1155, Montréal (QC) Canada H3B 3A7
(conservative and invasive) and follow-up observation injections, operations for sacral neuromodulation,
Tel: +1 514 875-5665 Fax: +1 514 875-0205
of patients with neurogenic lower urinary tract bladder augmentations with continent self-
dysfunction and incontinence. Prof. Madersbacher is catheterized stoma, and many other operations. I feel 1026_SIU2009_EUT_ad_JUN.indd 1 5/15/08 10:10:09 AM
an excellent surgeon and an inspiring teacher, while that I can start my own practice with confidence. I
Dr Rehder is an expert on female urology and pelvic also did some scientific work and was responsible in Client: SIU 2009 Docket number: 28-1026 File Size: 100 %
reconstruction. Dr. Kiss is a neurologist with extensive a protocol for the pudendal nerve evaluation in Description: SHANGHAI Trim Size: 133,4 mm X 194,3 mm
PROOF #
1:0
experience in neuro-urology and neuromodulation. diabetic and non-diabetic females with stress Publication : European Urology Today Ad number : 28-1026-P Type Size: N/A
Dr Berger has an excellent knowledge of neuro- incontinence and also helped in some research Date: 2008/06 Bleed Size: N/A DATE: MAY 14, 2008
urology. protocols that were running. Operator: LAP Visible Size: N/A
Filename : 1026_SIU2009_EUT_ad_JUN.indd Lase Output @ 100%
A high number of patients are examined daily in the I had the privilege to write with Prof. Madersbacher a PLEASE NOTE: Colour lasers do not accuratly represant the colours in the finished product.
COLOUR S: C M Y K
outpatient department, with many of them monitored review on the use of botulinum toxin A in male This proof is strictly for layout purposes only
under close follow-up since the staff believes that a patients with LUTS due to BPE, which was accepted
regular and close follow-up minimise the risk of for publication in European Urology. We also
deterioration and side effects. Urodynamic and presented two abstracts in German urological
video-urodynamic studies are performed at least conferences and, hopefully, we will soon be ready to
twice in order to reproduce the findings. submit two other original papers.

A significant number of patients undergo daily My stay at the Neuro-Urology department was very
non-invasive neuromodulation (IVES, TENS-P) in the effective, and I fully realized all of my expectations
outpatient department. The physiotherapist is a from fellowship. It was an honor for me to attend the
valuable team member and plays an important role in fellowship and I thank the EUSP Board and the EAU
the evaluation and treatment (behavioural therapy, for the chance. My heartfelt thanks to Prof. Helmut
PFMT, biofeedback, magnetic chair, etc.) of the Madersbacher, Drs. P. Rehder, G. Kiss, T. Berger and
patients. the nursing staff of the department for their interest
in my training and for the hospitality they have all
In the operation room botulinum toxin A injections shown.
are performed usually under local anesthesia with the
use of a new smaller needle. Sacral neuromodulation I would definitely recommend to young urologists to
is performed with great success. Prof. Madersbacher apply for EUSP grants for them to have access to and
and Dr. Kiss use a different protocol with a prolonged receive high-quality urological training in excellent
(2 to 5 weeks) first stage. A relatively new procedure departments across Europe.
that I learned was
implanting a male
sling for stress
incontinence after
radical prostatectomy
or TUR-P. Developed
by Dr. Rehder, this
sling supports the
dorsal surface of the
sphincter complex by
proximal (cephalad)
repositioning of the
retro-urethral
structures. Both Prof.
Madersbacher and
Dr. Rehder perform
the whole range of
surgical procedures
for neurogenic

European Urological Scholarship Programme

30 European Urology Today August/September 2008


Interest in FEBU exams remains high
238 new FEBUs, 91% passing rate in 2008

The interest in the Fellow of the European Board of clinical cases, with the exam conducted by one Number of participants 2003-2008
Urology (FEBU) Examinations continues to increase examiner and a trustee.
and to accommodate the large number of candidates 2003 2004 2005 2006 2007 2008
in Athens, Greece, the oral examination held in June The FEBU written and oral examinations are an Total Oral Exam Candidates 108 144 176 197 196 261
this year was expanded and sessions were also integral part of the residents training in urology in
Pass 103 133 166 186 179 238
scheduled on Saturday and Sunday mornings. Poland since 1997 and in Hungary since 2006. The
EBU is the only board offering the oral examination in Pass rate 95% 92% 94% 94% 91% 92%
Out of the 261 oral exam candidates who took the 11 different languages, namely: Dutch, Danish, Paris/Athens 78 112 151 154 158 209
exams in three venues (Greece, Poland and Hungary), English, French, German, Greek, Italian, Portuguese,
Pass 77 105 145 144 145 193
238 passed the exams marking a 91% passing rate. Spanish, Polish and Hungarian.
Oral exam candidates are examined on three selected Poland 30 32 25 26 18 43
The next FEBU Oral Examination is scheduled on 6 and Pass 26 28 21 26 15 37
7 June 2009. Registration is open to candidates who Hungary - - - 17 20 9
passed the FEBU written examination between 2004
European Board of Urology (EBU) Pass - - - 16 19 8
and 2008. Registration will start in December 2008.

The following urologists were granted the FEBU title after passing the oral examinations in Greece, Poland and Hungary, June 2008

Athens, Greece Heinau, Marc Germany Ronchi, Piero Italy Stoeckelle, Eugen Austria
Heinrich, Tobias Peter Germany Ronkainen, Hanna-Leena Finland Straumann, Urs Switzerland
Abascal Junquera, Jose Maria Spain Hirschmann, Joachim Germany Ruggera, Lorenzo Italy Tahmatzopoulos, Anastasios Greece
Abduljawad, Farouk Saudi Arabia Horstmann, Jörg Germany Saad, Rodrigue France Tanidir, Yılören Turkey
Abdullah, Aosama United Arab Huwyler, Mirjam Switzerland Saeger, Ulf Germany Tavares dos Santos, Sérgio Portugal
Emirates Isaakidis, Isaak-Savvas Greece Saghir, Hamayun Naeem Ireland Thomay, Günther Austria
Akand Murat Turkey Islam, Jawad-Ul Ireland Sangalli, Mattia Nicola Italy Toutziaris, Chrysovalantis Greece
Alfhaidi, Fahad Saudi Arabia Izol, Volkan Turkey Sanguedolce, Francesco Italy Trilla Herrera, Enrique Spain
Al-Geizawi, Samer Jordan Jaeger, Tobias Germany Sanli, Mehmet Oner Turkey Trottmann, Matthias Germany
Allam, Khaled Saudi Arabia Jepsen, Jan V. Denmark Sauermann, Peter Switzerland Tuckus, Grazvydas Denmark
Al-Nahawi, Adnan Germany Joshi, Hrishikesh United Kingdom Sayed Ahmed, Taha Ismail Taha United Arab Türker, Polat Turkey
Al-Qadhi, Mohammed M Saudi Arabia Kaliská, Veronika Czech Republic Emirates Turi, Mubasher Saudi Arabia
Anantharamakrishnan, Krishnan United Kingdom Kalogeras, Nikolaos Greece Schauerte, Carsten Germany Van der Kolk, Marjan The Netherlands
Aragona, Maurizio Santi Italy Kalogeropoulos, Theodoros Greece Schlenker, Boris Germany Van Rhijn, Bas Canada
Arslan, Murat Turkey Karatas, Omer Faruk Turkey Schrey, Anton Austria Varadaraj, Haradikar Ireland
Assem, Akram Egypt Karpf, Rainer Austria Schwartz, Julien Switzerland Vis, Andre The Netherlands
Attar-Bashii, Ali. A.M. Iraq Kastner, Christof United Kingdom Sciberras, John Malta Vourekas, Stavros Greece
Babakerd, Maher Germany Katmawi-Sabbagh, Samer United Kingdom Seiler, Daniel Switzerland Waliszewski, Przemyslaw Germany
Bach, Thorsten Germany Kempkensteffen, Carsten Germany Shaat, Ahmed Qatar Yoong, How Fee Malaysia
Bamberg, Hendrik Sweden Kessler, Thomas Matthias Switzerland Simon, Pascal France Zahran, Ahmed Fahmy Ahmed Egypt
Bauer, Wilhelm Austria Klotz, Axel Germany Spounos, Marios Greece Zahwa, Firas France
Baumgartner, Martin Switzerland Konstantinopoulos, Angelis Greece Stanislaus, Peter Germany Z’Brun, Sebastian Switzerland
Bayraktar, Necmi Turkey Koritsiadis, Georgios Greece Stathoglou, Dimitris Greece Zetterquist, Henrik Sweden
Beatty, John United Kingdom Koumentakis, Michail Greece Stathouros, George Greece Zougkas, Konstantinos Greece
Bin Aggag, Abdulbari Saudi Arabia Kozyrakis, Diomidis Greece Stockhammer, Mathias Austria
Bingadhi, Abdul Raheem Omar Yemen Krasnitski, Maksim Belarus
Birkhäuser, Frederic Switzerland Lamche, Michael Austria
Birzele, Jan Switzerland Lazarov, Boyan Bulgaria Warsaw, Poland
Bogris, Sotirios United Kingdom Lenz, Matthias Austria Bochynek, Kamil

Congratulations!
Bosio, Andrea Italy Luginbuehl, Thomas Switzerland Bondarenko, Marianna
Bosl, Martin Germany Lumen, Nicolaas Belgium Brunowicz, Radosław
Bott, Simon United Kingdom Luzar, Oliver Germany Ch˛eciński, Marcin
Bretschneider-Ehrenberg, Patricia Germany Lynn, Naing Naing Kyaw United Kingdom Ciszewski, Sebastian
BunyaratavejvChanatee Thailand Madaan, Sanjeev United Kingdom Dobrowolska-Glazar, Barbara
Chmelik, Reinhard Austria Madani, Ahmed, H.S. Iraq Dobruch, Jakub
Chrysanthakopoulos, Georgios Greece Maffei, Nicola Italy Draczyński, Marek
Chun, Felix Germany Makris, Antonios United Kingdom Dworak, Jacek
Coltoiu, Virgil Constantin Cristian Romania Manu Ionita, Patricia Ingrid Romania El-Mohtar, Imad
Comploj, Evi Italy Markić, Dean Croatia Gradzikiewicz, Szczepan
Culty, Thibaut France Mauermann, Julian Austria Hrab, Michał
Damjanoski, Ilija Austria Mazzoccoli, Bruno Italy Jakubiak, Jarosław
Deirmentzoglou, Stavros Greece Mazzola, Brunello Switzerland Jaskulski, Jarosław
Derflinger, Ines Austria Mehta, Santbir Singh United Kingdom Kaliszczak, Agata
Dubosq, Francis France Mihalakis, Anastasios Greece Kalwas, Paweł
Eberli, Daniel Switzerland Mirzapour, Kiumars Germany K˛edzierski, Robert
Ebinger, Nicole Switzerland Moazin, Maher Saudi Arabia Kies, Grzegorz
Eddu, Subhakara Srinadh Oman Moazzam, Mohammed United Kingdom Klim, Marcin
Eisenhardt, Andreas Germany Mohammed, Gamal E. A. H. Saudi Arabia Krasnicki, Krzysztof
El Hajj Hassan, Rabih France Moraitis, Konstantinos Greece Kupajski, Maciej
Elgamal, Ahmed Saudi Arabia Muawad, Emad Sabet Egypt Kurant, Marcin Dr. Bunyaratavej from Thailand (right) receives his certificate from
Elizalde Benito, Angel Gabriel Spain Nader, Andreas Austria Kuskowski, Maciej Prof. Alivizatos.
Elmasry, Yasser United Kingdom Naderi, Nader The Netherlands Litarski, Adam
El-Musbahi, Abduel Salem United Kingdom Naoum Alsaigh, Naimet K. United Arab Łoś, Jacek
Elnagar, Mahmoud United Arab Emirates Olejnik, Rafał
Emirates Neyer, Michael Austria Pietraszun, Oskar
Emara, Amr Egypt Noor, M. Amjad Pakistan Potega,
˛ Jacek
Farikhullah Khan, Mohamad Afzal Malaysia Pace, Gianna Italy Przybyła, Jacek
Fleury, Nicolas Switzerland Papadopoulos, Alexandros Greece Ruciński, Artur
Frigo, Marta Italy Pape, Daniela Germany Sitko-Saucha, Aleksandra
Fuchs-Samitz, Alexandra Austria Pernkopf, Dominik Austria Syryło, Tomasz
Fuller, Florian Germany Peters, Robert Germany Szemplinski, Stanislaw
Galanakis, Ioannis Greece Pfleger, Gottfried Austria Trywiański, Tadeusz
Galvin, David Ireland Pietsch, Silke Germany Wenerski, Maciej
Gavis, Sotirios Greece Poněšický, Jiří Czech Republic Zagórski, Piotr
Georgalis, Athanasios Greece Preusser, Stefan Switzerland Ziółkowski, Tomasz
Gholais, Lutf Yemen Pushkar, Dmitry Russia
Gkougkousis, Evangelos United Kingdom Rahulan, Sunil India Budapest, Hungary
Gomha, Faaz Salah Qatar Ravisankar, Gopakumarapillai Bulgaria Ashaber, David
Gougousis, Anastasios Greece Rein, Patrick Austria Bagheri, Fariborz
Gözen, Ali Serdar Germany Remmele, Waltraud Germany Hencz, Lajos
Gregorin, Joel Patrick Switzerland Rentsch, Cyrill A. Switzerland Kerenyi, Gabor
Grell, Daniel Germany Ribaritsch, Ursula Austria Lacó, László
Hagemann, Jörn Germany Richter, Michael Germany Piróth, Csaba
Hajj, Pascal France Rith, Torsten Germany Pusztai, Csaba
Hassmann, Rene Germany Rogenhofer, Sebastian Germany Trautmann, Tibor Prof. Alivizatos congratulates Dr. Dmitry Pushkar (right).

August/September 2008 European Urology Today 31


For more information on registration please check http://registrations.uroweb.org or

EAU 4 South Eastern European Meeting


th contact the EAU Congress Organiser at SEEM2008@congressconsultants.com

17-18 October 2008, Tirana, Albania


www.uroweb.org

Preliminary 13.40 – 14.10 State-of-the-art lecture Surgical management of traumatic Chairman EAU 4th SEEM

Programme Translational research in prostate


cancer: From the lab to the patient
strictures
M.L. Djordjevic, Belgrade
F. Tartari, Tirana

P-A. Abrahamsson, Malmö Managing incontinence and ED after Chairman EAU Regional Office
Thursday, 16 October 2008 trauma M. Marberger, Vienna
14.10 – 14.30 Coffee break A. Ergen, Ankara
Faculty
16.00 – 19.00 Registration Urethral trauma in the female
P-A. Abrahamsson, Malmö
14.10 – 16.10 Poster sessions T. Tarcan, Istanbul N. Bojanic, Belgrade
Friday, 17 October 2008 14.10 – 14.30 Mounting, viewing of posters M.L. Djordjevic, Belgrade
14.30 – 16.10 Presentation and discussion 10.00 – 10.20 Coffee break A. Ergen, Ankara
07.00 – 09.00 Registration T. Esen, Istanbul
16.10 – 17.40 Urolithiasis 10.10 – 12.10 Poster sessions A. Grigorakis, Athens
09.00 – 09.10 Welcome and introduction Ureteric stones: Primary SWL or 10.10 – 10.30 Mounting, viewing of posters M. Hiros, Sarajevo
P-A. Abrahamsson, Malmö ureteroscopy 10.30 – 12.10 Presentation and discussion I. Ignjatovic, Nis
D. Kantzavelos, Neos Voutzas
S. Capeli, Tirana I. Varkarakis, Athens
L. Lekovski, Skopje
Lower pole calyceal stones 12.10 – 13.30 Panel discussion:
M. Marberger, Vienna
09.10 – 10.40 Renal cell cancer T. Esen, Istanbul High risk prostate cancer: The difficult S. Micic, Belgrade
Can we improve pretherapeutic The stone situation in Albania treatment decision D. Mladenov, Sofia
diagnosis F. Tartari, Tirana Chair: P-A. Abrahamsson, Malmö G. Moutzouris, Larissa
G. Moutzouris, Larissa The complex stone: Is open surgery Panel: T. Esen, Istanbul F. Özcan, Istanbul
Is watchful waiting an option? still needed A. Grigorakis, Athens V. Politis, Athens
N. Bojanic, Belgrade L. Lekovski, Skopje S. Micic, Belgrade T. Tarcan, Istanbul
Limits of nephron-sparing surgery Why do we have larger stones in South M. Tzvetkov, Sofia F. Tartari, Tirana
I. Varkarakis, Athens
F. Özcan, Istanbul Eastern Europe and what is to be done M. Xhani, Tirana
M. Xhani, Tirana
When is open nephrectomy still about it?
needed? M. Hiros, Sarajevo 13.30 Awards and closing remarks Advisory Board
D. Mladenov, Sofia F. Tartari, Tirana P-A. Abrahamsson, Malmö
Saturday, 18 October 2008 P-A. Abrahamsson, Malmö C. Alamanis, Athens
10.40 – 11.00 Coffee break M. Bazardzanovic, Tuzla
08.00 – 08.30 The concise refresher course: T. Esen, Istanbul
10.40 – 12.40 Poster sessions Evaluating the incontinent female A. Grigorakis, Athens
10.40 – 11.00 Mounting, viewing of posters I. Ignjatovic, Nis M. Hiros, Sarajevo
D. Kantzavelos, Neos Voutzas
11.00 – 12.40 Presentation and discussion
M. Marberger, Vienna
08.30 – 10.00 Urethral trauma
S. Micic, Belgrade
12.40 – 13.40 Lunch Immediate care and diagnosis D. Mladenov, Sofia
V. Politis, Athens This meeting is EU-ACME accredited F. Tartari, Tirana
A. Thanos, Athens
European
D. Tomic, Mostar
Association M. Tzvetkov, Sofia
of Urology M. Xhani, Tirana

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32 European Urology Today August/September 2008


Five years of CME-CPD system in Poland
By Mrs. Ela Ziolkowska, CME-CPD Project Manager, EBU- EAU initiative creating the programme called CME credits can be earned by participating in
Polish Urological Association, Warsaw (PL)

One of the important initiatives of the Polish Urological


Association was the implementation of the CME-CPD
European Urology – Accredited Continuing Medical
Education (EU-ACME). Administration of CME-CPD
activities moved from the EBU to the EU-ACME office.
accredited scientific events (congresses, conferences,
courses., workshops, etc… in Poland 97 accredited
events were held between 2002 and 2006).
The leaders
CME-CPD participants who collected over 1,300
system (Continuing Medical Education – Continuing All these changes showed that the system has evolved in CPD credits are granted for individual scientific credits during the last five years
Professional Development) created by Professor Alberto a positive way and that its managers are exerting efforts activities such as: lectures, presentations,
Matos-Ferreira. Introduced in Poland in January 2002, to look for better solutions. But one thing remained publications, participation in scientific boards, Prof. Andrzej Borówka
participation in the CME-CPD system by certified unchanged: the fact that the system can function organisational and scientific committees. The analysis Prof. Romuald Zdrojowy
urologists who are also PUA members is voluntary. smoothly only when there is effective cooperation among of the number of credits collected by CME-CPD Prof. Zbigniew Wolski
the organizers of accredited events, programme participants over five years showed that more CME Dr med. Piotr Chłosta, FEBU
The cost of participation by the Polish urologists is participants and the work of EU-ACME Office in Arnhem credits than CPD ones were collected. This is perhaps Dr med. Artur Antoniewicz, FEBU
covered by the PUA and since 2006 the fees of and the Warsaw-based CME-CPD Office. due to CME credits being granted automatically, Prof. Sławomir Dutkiewicz
PUA-EAU members have been covered by the EAU. whereas CPD activities have to be reported to the Prof. Andrzej Sikorski
EBU recommendations CME-CPD Office by the author/lecturer which often
Changes in CME-CPD The EBU recommendations concerning the number of entails time-consuming administrative work.
During the last five years there have been several credits that should be collected by the participants in
changes. The EBU headquarters moved from the CME-CPD system have changed several times 2002-2006 analysis The second largest group, 20.5%, received from 1 to
Rotterdam to Arnhem. In Poland the CME-CPD Office during the 5-year-period that was under evaluation. In 2002, the first year of the CME-CPD in Poland, 228 20 credits. The third largest group, 8.4%, are doctors
was relocated to the new PUA Office in Warsaw. Furthermore, the EBU has recommended since 2004 certified urologists registered with the CME-CPD who collected from 101 to 200 credits. The comparison
that participants should gain 300 credits over five system. Out of 228 urologists, 189 have remained with of recent results with the statistics from previous years
New CME-CPD cards were issued and a new website years: 250 CME credits (category 1 and 2) and 50 CPD the system up to this day. shows that this trend has been clearly visible
has been created. The most important change was the credits (category 3, 4, 5). throughout the last five years (chart 1).
The largest group of 80 people gained in 2002-2006
Chart 1: Number and percentage of active participants in each credit range in years 2002-2006 from 101 to 200 credits. Thirty urologists, gained from Congratulations go to the 13 ‘frontrunners’’ or leaders
Number of credits 2002 2003 2004 2005 2006 201 to 300 credits, while 48 doctors collected over 300 who collected over 200 credits in 2006 !
credits. There were some people who were excluded From 2002 to 2006, 48 CME-CPD (EU-ACME)
1-20 153 (25.5%) 160 (23.3%) 182 (28.1%) 165 (19.6%) 173 (20.5%)
from the system since they did not pay the PUA participants gained 300 (and more) credit points.
21-100 135 (64.9%) 154 (60%) 178 (61%) 229 (69.2%) 240 (67.4%) membership or did not collect any credits for two Among them, 30 met the EBU’s expectations or even
101-200 116 (7.7%) 133 (12.8%) 123 (7.9%) 127 (8.2%) 130 (8.4%) years. exceeded them. Those participants received not only
201-300 113 (1.4%) 116 (2.3%) 116 (2.1%) 117 (2.1%) 117 (1.9%) the PUA diploma but also special certificates
301-400 ------- 112 (0.8%) 111 (0.3%) 111 (0.3%) 112 (0.6%) All active participants receive each year a Credit emphasising their extraordinary activities during the
Registry Report prepared by the EU-ACME Office in five- year period.
401-500 111 (0.5%) 111 (0.4%) 111 (0.3%) 111 (0.3%) 111 (0.3%)
Arnhem. On the basis of the reports, the PUA’s
501-600 --------- ------- ------- ------- 111 (0.3%) CME-CPD diplomas are prepared. They state the Year 2007 was the sixth year of the CME-CPD
601-700 -------- 111 (0.4%) ------- 111 (0.3%) 111 (0.3%) number of credits received each year. (EU-ACME) system in Poland. For 54 participants, 2007
701-800 -------- ------- 111 (0.3%) -------- 111 (0.3%) In 2006, 356 out of 368 participants were active which marked their fifth year of being members. Like the 189
Total 208 257 292 331 356 means they collected credits and credits that were members in 2006, they also received special diplomas
registered at their individual EU-ACME accounts. The that showed the credits earned during the five years,
analysis of the yearly reports shows that most people divided into the CME and CPD category. The detailed
European Board of Urology (EBU)
– 67.4% - gained from 21 to 100 credits. analysis of their achievements will be prepared soon.

EBU certificate for Pomerian Medical University


Dr med. Marcin and have extensive medical experience. Many of them The idea of a current residency teaching programme admitted patients and those
Slojewski have attended both national and international was developed in 1997 when the EBU exam was qualified for surgery. They
Department of training courses in specialised departments. established as obligatory and equivalent with the are responsible for the proper
Urology Polish national exam in urology. We have noticed the paper work and electronic
Pomeranian Medical The department is mainly focused on developing need to update the course of training and adjust it to data collection. Residents are
University minimally invasive techniques. Currently there are the widely expanding European community criteria. also allowed to work on
Szczecin (PL) seven certified urologists-consultants who both The principal goal of training is to prepare fully duties as self-supported
provide general and specialised urological services. skilled, independent doctors, familiar with all surgical physicians with a consultant
martwist@sci.pam. Prof. Sikorski is specialised in uro-oncology with a and clinical aspects of modern urology. on call. Prof. Andrzej Sikorski
szczecin.pl high degree of expertise in this field. His research The academic development, personal and group Head of Department
work focuses on the detailed technique and results of research programmes, and familiarity with recent Surgery is one of the main
radical prostatectomy, female urology and the use of advances in urology are particularly emphasized. training elements and young residents usually start
laser energy in BPH. He is also a widely known expert with small supervised endoscopic procedures such as
Szczecin, located in north-western Poland, is only a on erectile dysfunction and problems of the ageing Residents are encouraged to perform clinical studies percutaneous nephrostomies, cystostomies or scrotal
few kilometres away from the German border, which male. under the supervision of the attending staff members, operations. Gradually, they move on to more
in contemporary Europe no longer divides the who also help them in preparing the manuscripts for complicated procedures like cytectomies and
neighbouring nations anymore. Formerly a German Prof. Sikorski’s deputy, Dr. Slojewski has developed an publication. Each resident is obliged to submit the laparoscopic nephrectomies. The training programme
city, Szczecin was annexed to Poland after World War outstanding expertise in laparoscopy which is used abstract for a presentation at the Scientific Congress also includes two years of general surgical practice
II. Much of the city’s urban and industrial structures every day in the department (about 50% of of the Polish Urological Association or in regional and several months of residency on vascular surgery,
were heavily destroyed during the war, with an procedures performed). In April 2004 he performed, conferences. The case discussions, pathology and gynaecology, renal transplantology and pediatric
estimated destruction ranging from around 60% to the first in Poland, a laparoscopic live-donor radiology meetings give them an opportunity to urology.
90%. nephrectomy. Dr. Slojewski is also responsible for improve their public-speaking skills.
educational and post-graduate programmes for Polish One of the basic goals is to prepare the resident to Residents also practise in sub-divisions like the stone
The damages were so severe that Szczecin was and foreign students, and has prepared courses in take independent decisions, adequate to their level of centre (ESWL, PCNL, URS), urodynamics and urinary
included amongst the 20 most ruined towns of advanced laparoscopy organised by the department training and with support from the supervisor. incontinence clinic and out-patient clinic. In general,
Germany at that time. Nowadays, the city has nearly for urologists and residents from other centres. the medical staff is relatively young and everyone
half a million inhabitants and is a major harbour and Currently there are four residents in the department contributes to make a team effort and create a good
shipyard centre in the Baltic Sea region. Szczecin is For many years, Prof. Sikorski and Dr. Slojewski have and a changing number of residents who attend teaching atmosphere. The relationships among
the capital of West Pomeranian Voivodeship with 1.7 participated in Polish FEBU exams as examiners or urological courses as part of their training doctors are not based on age or seniority but on
million inhabitants and an area of 23,000sq kms. observers. Dr. Gliniewicz has gained experience in programme in other specialisations such as respect, understanding and esteem.
endourology, open surgery for bladder cancer and gynaecology and general surgery.
Pomeranian Medical University (PAM) has been related pathologies. He cooperates with the Senior staff members are always available for help and
playing a leading role in the Pomeranian health care Department of Pathology and Genetics, carrying out Urology residents are involved in every-day diagnostic support. All the residents apply for an annual
system since its establishment in 1948. In 1955, a studies on the correlations between specific genes and therapeutic decisions such as taking care of In-Service EBU Assessment and the FEBU examination.
30-bed urological ward was opened, primarily as part mutations and the incidence of kidney and prostate patients, presenting the current patients’ status The residency programme meets the national standards
of PAM’s second surgical clinic. After only seven cancer. He is also responsible for the urodynamic during ward rounds, presenting the status of newly as defined by the Polish Urological Association.
years, the head doctor of the new ward, Dr. Alfons laboratory and for international contacts.
Wojewski, transformed the urological ward into an After having applied and met the criteria for
independent Department of Urology. Prof. Wojewski Dr. Gob, the youngest among them, has just finished certification, two members of the Urological Training
also organised the clinic right from the beginning, his urological training and passed the FEBU exam. He Programme Committee have visited our site. They
quickly raising it to the level of a modern research, has acquired wide experience in prostate biopsy. He confirmed the good educational atmosphere provided
teaching and service centre. also has developed and scientifically proved his own in our department. The staff is genuinely happy and
protocol of extended biopsy in early cancer detection proud to be among EBU-certified centres since this
Since 1986 Prof. Andrzej Sikorski has been the head of and its efficacy. He is well skilled in laparoscopy and encourages us to maintain the high standards of
the department. The ward has 62 beds and is a stone procedures. urological training. This accomplishment also helps
regional referral centre for the full range of create a very solid base for the future of our residents.
genitourinary problems with around 4,600 in-patients Dr. Agata Kaliszczak is the department’s youngest
treated in 2006. The medical staff is highly qualified certified urologist and passed the FEBU exam in May We would like to be involved in an exchange
2004 with distinction and the best result in Poland. Staff of the Department of Urology with EBU guests. Sitting programme among European institutes and
Two senior urologists work in two out-patient clinics, from left: Hans-Peter Schmid, Andrzej Sikorski and Sedat encourage residents from other countries to visit our
EBU Certified Centres
specialised in uro-oncology and general urology. Tellologlu centre to develop their scientific and surgical skills.

August/September 2008 European Urology Today 33


The Academy for Clinical Debates & Controversies in Medicine announces

The 2nd World Congress on


Controversies in Urology (CURy)

,)3"/.#/.'2%33#%.4%2s,)3"/. 0/245'!, &%"25!29  

Scientific Committee
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Controversies in Urology is accredited within the CME


programme by the Accreditation Committee

www.comtecmed.com/cury
cury@comtecmed.com
34 European Urology Today August/September 2008
For more information on registration please check http://registrations.uroweb.org or

EAU 2 nd
North Eastern European Meeting contact the EAU Congress Organiser at NEEM2008@congressconsultants.com

12-13 September 2008, Vilnius, Lithuania


www.uroweb.org

Preliminary 11.00 – 12.40 Presentation and discussion Saturday, 13 September 2008 Chairman EAU 2nd NEEM

Programme (Moderated poster sessions of


submitted presentations from the 08.00 – 09.30 Prostate cancer
D. Milonas, Kaunas (LT)

region on topics of high interest in Who needs curative treatment? Chairman EAU Regional Office
Thursday, 11 September 2008 urology today) P-A. Abrahamsson, Malmö (SE) M. Marberger, Vienna (AT)
Avoiding the detection of clinically
16.00 – 19.00 Registration 12.40 – 13.40 Lunch insignificant prostate cancer at biopsy Faculty
M. Marberger, Vienna (AT) P-A. Abrahamsson, Malmö (SE)
Friday, 12 September 2008 13.40 – 14.40 State-of-the-art lectures Update on systemic therapy for prostate Z.F. Dobrowolski, Cracow (PL)
Ageing bladder cancer J. Erenpreiss, Riga (LV)
07.00 – 09.00 Registration M. Tinzl, Malmö (SE) M. Jievaltas, Kaunas (LT) S. Fossa, Oslo (NO)
Has sting replaced anti reflux R. Hanecki, Warsaw (PL)
09.00 – 09.10 Welcome and introduction procedures? 09.30 – 10.00 Coffee break M. Jievaltas, Kaunas (LT)
D. Milonas, Kaunas (LT) R. Hanecki, Warsaw (PL) W. Månsson, Lund (SE)
R. Turcinskas, Lithuanian Minister of 09.30 – 11.30 Poster session 3 M. Marberger. Vienna (AT)
Health, Vilnius (LT) 14.40 – 15.00 Coffee break 09.30 – 10.00 Mounting, viewing of posters R. Mickevicius, Kaunas (LT)
10.00 – 11.30 Presentation and discussion D. Milonas, Kaunas (LT)
09.10 – 10.40 Bladder cancer 14.40 – 16.30 Poster session 2 (Moderated poster sessions of submitted J. Nordling, Herlev (DE)
Update on diagnosis, staging and 14.40 – 15.00 Mounting, viewing of posters presentations from the region on topics of M. Punab, Tartu (EE)
grading of bladder cancer 15.00 – 16.30 Presentation and discussion high interest in urology today) T. Tammela, Tampere (FI)
Z. Dobrowolski, Cracow (PL) (Moderated poster sessions of M. Tinzl, Malmo (SE)
High risk non muscle invasive bladder submitted presentations from the 11.30 – 12.30 Panel discussion D. Trumbeckas, Kaunas (LT)
cancer region on topics of high interest in Difficult situations in voiding dysfunction
W. Månsson, Lund (SE) urology today) Chair: J. Nordling, Herlev (DK) Advisory Board
Role of lymph nodes in invasive cancer Panel: T. Tammela, Tampere (FI) P-A. Abrahamsson, Malmö (SE)
W. Månsson, Lund (SE) 16.30 – 17.15 Andrology M. Tinzl, Malmö (SE) K. Krajka, Gdansk (PL)
Neo-/Adjuvant chemotherapy Association of erectile dysfunction D. Trumbeckas, Kaunas (LT) D. Milonas, Kaunas (LT)
S. Fossa, Oslo (NO) with cardiovascular disease J. Nordling, Herlev (DK)
T. Tammela, Tampere (FI) 12.30 Awards and closing remarks A. Pechersky, St. Petersburg (RU)
10.40 – 11.00 Coffee break Is variococelectomy still justified? D. Milonas, Kaunas (LT) A. Sikorski, Szczecin (PL)
R. Mickevicius, Kaunas (LT) M. Marberger, Vienna (AT) T. Tamm, Tallinn (EE)
10.40 – 12.40 Poster session 1 Testosterone deficiency in the ageing T. Tammela, Tampere (FI)
10.40 – 11.00 Mounting, viewing of posters male E. Vjaters, Riga (LV)
M. Punab, Tartu (EE)
Urological aspects of the testosterone
replacement therapy This meeting is EU-ACME accredited
J. Erenpreiss, Riga (LV)
European
Association
of Urology

18th Meeting of the European Society


For more information please check www.uroweb.org or
contact the EAU Congress Organiser at esur@congressconsultants.com
T: +31 26 389 1751, F: +31 26 389 1752

for Urological Research (ESUR)


16-18 October 2008, Barcelona, Spain www.uroweb.org

Programme 11.30 – 12.30 Oral session 1: Selected oral presentations


from submitted abstracts
09.30 – 10.00 Cell-selective knockouts of the androgen
receptor: A novel tool in the study of androgen
Meeting Chairs
N. Malats, Madrid (ES)
action J. Reventós, Barcelona (ES)
12.30 – 13.30 Poster guided tour G. Verhoeven, Leuven (BE)
Thursday, 16 October 2008 Chairs: M. Cecchini, Berne (CH) Faculty
L. Languino, Worcester (US) 10.00 – 10.30 Wnt and Wnt antagonist signalling in prostate M. Abal, Barcelona (ES)
16.00 –19.00 Registration N. Prevarskaya, Lille (FR) cancer A. Alcaraz, Barcelona (ES)
R. Kypta, Bilbao (ES) C. Bangma, Rotterdam (NL)
19.00 – 19.30 Opening and welcome 13.30 – 15.00 Lunch and poster session 1 A. Bjartell, Malmö (SE)
S. Giner, Barcelona (ES), IEC President 10.30 – 11.00 Refreshment break M. Cecchini, Berne (CH)
Z. Culig, Innsbruck (AT) 15.00 – 17.00 Genetic susceptibility and urological Z. Culig, Innsbruck (AT)
N. Maitland, York (GB) disorders 11.00 – 11.30 Advances in the management of castration J. De Bono, Sutton (GB)
N. Malats, Madrid (ES) Chairs: A. Bjartell, Malmö (SE) resistant prostate cancer C. Garmendia, Madrid (ES)
J. Reventós, Barcelona (ES) J. Palou Redorta, Barcelona (ES) J. De Bono, Sutton (GB) A. Gonzalez-Neira, Madrid (ES)
K. Hemminki, Heidelberg (DE)
19.30 – 20.00 Keynote lecture 15.00 – 15.30 Familiality of risk and survival in kidney 11.30 – 12.30 Oral session 3: Selected oral presentations from F. Jankevicius, Vilnius (LT)
The research value chain: Creating companies cancer submitted abstracts G. Jenster, Rotterdam (NL)
from academia to generate knowledge and K. Hemminki, Heidelberg (DE) R. Kypta, Bilbao (ES)
develop therapeutic and diagnostic tools 12.30 – 13.30 Poster guided tour L. Languino, Worcester (US)
C. Garmendia, Madrid (ES) 15.30 – 16.00 Genetic susceptibility to testicular cancer Chairs: J. De Bono, Sutton (GB) N. Maitland, York (GB)
The Spanish Minister of Science, Innovation E. Rajpert-De Meyts, Copenhagen (DK) J. Trapman, Rotterdam (NL) N. Malats, Madrid (ES)
and Technology G. Verhoeven, Leuven (BE) M. Mancini, Padua (IT)
16.00 – 16.30 Bladder cancer genetic susceptibility A. Mantovani, Milan (IT)
N. Rothman, Rockville (US) 13.30 – 15.00 Lunch and poster session 2 J. Palou Redorta, Barcelona (ES)
Friday, 17 October 2008 J-J. Patard, Rennes (FR)
16.30 – 17.00 Somatic genetic alterations in prostate 15.00 – 17.50 Scientific basis for clinical trials N. Prevarskaya, Lille (FR)
07.30 – 09.00 Registration cancer Chairs: A. Alcaraz, Barcelona (ES) E. Rajpert-De Meyts, Copenhagen (DK)
T. Visakorpi, Tampere (FI) M. Mancini, Padua (IT) F. Real, Madrid (ES)
07.30 – 09.00 Training course J. Reventos, Barcelona (ES)
Basic molecular biology for urologists 17.00 – 17.30 Refreshment break 15.00 – 15.30 Implementation of basic research in clinical N. Rothman, Rockville (US)
Coordinator: M. Abal, Barcelona (ES) trials for bladder and prostate cancer M. Sanchez-Carbayo Martin, Madrid (ES)
17.30 – 18.30 Oral session 2: Selected oral presentations C. Bangma, Rotterdam (NL) J. Schalken, Nijmegen (NL)
08.45 – 09.00 Welcome coffee from submitted abstracts B. Schmidt-Drager, Fürth (DE)
15.30 – 16.00 Predicting therapeutic response in bladder G. Thalmann, Berne (CH)
09.00 – 11.30 Survival and metastatis in urological 18.30 – 19.30 Special session cancer: Do we have biomarkers available? M. Thurnher, Innsbruck (AT)
cancers International networking in urological M. Sanchez-Carbayo Martin, Madrid (ES) J. Trapman, Rotterdam (NL)
Chairs: C. Bangma, Rotterdam (NL) research G. Verhoeven, Leuven (BE)
Z. Culig, Innsbruck (AT) Chairs: N. Malats, Madrid (ES) 16.00 – 16.30 Anti-angiogenic drugs in adjuvant and neo- T. Visakorpi, Tampere (FI)
G. Thalmann, Berne (CH) adjuvant settings in Renal Cell Carcinoma
09.00 – 09.30 Cell signaling in prostate cancer metastasis Panelists: N. Maitland, York (GB) J-J. Patard, Rennes (FR) ESUR Board
L. Languino, Worcester (US) J. Schalken, Nijmegen (NL) A. Bjartell, Malmö (SE)
B. Schmidt-Drager, Fürth (DE) 16.30 – 16.50 Refreshment break Z. Culig, Innsbruck (AT)
09.30 – 10.00 Mechanisms of progression in bladder T. Visakorpi, Tampere (FI) G. Thalmann, Berne (CH)
Photo: Montse Catalan, courtesy of IEC archive, Barcelona

cancer 16.50 – 17.20 Molecular pathways linking inflammation and F. Jankevicius, Vilnius, (LT)
F. Real, Madrid (ES) cancer G. Jenster, Rotterdam (NL)
Saturday, 18 October 2008 A. Mantovani, Milan (IT) N. Maitland, York (GB)
10.00 – 10.30 Calcium signatures of prostate cancer N. Malats, Madrid, (ES)
N. Prevarskaya, Lille (FR) 07.30 – 09.00 Training course 17.20 – 17.50 Dendritic cell biology: Basic observations and M. Mancini, Padua (IT)
Pharmacogenomics for urologists clinical application
10.30 – 11.00 Refreshment break Coordinator: A. Gonzalez-Neira, M. Thurnher, Innsbruck (AT)
Madrid (ES)
11.00 – 11.30 Mechanisms of osteoblast activation in 17.50 – 18.00 Refreshment break
prostate cancer bone metastasis 08.45 – 09.00 Welcome coffee
M. Cecchini, Berne (CH) 18.00 – 19.30 Special session
09.00 – 11.30 Hormones in urological disease Debate on translating urological research results
Chairs: G. Jenster, Rotterdam (NL) to the companies
European T. Visakorpi, Tampere (FI) Chairs: F. Jankevicius, Vilnius (LT)
J. Reventos, Barcelona (ES)
Association 09.00 – 09.30 The key role of the androgen receptor in
prostate cancer 19.30 – 20.30 ESUR General Assembly
of Urology J. Trapman, Rotterdam (NL)

August/September 2008 European Urology Today 35


20th Anniversary Congress of ESPU
6-9 MAY 2009 6th Meeting
Amsterdam of the European
Word of welcome Society of
Oncological
Dear colleagues and friends,

On behalf of the Board of the ESPU and the Dutch Paediatric Urologists, we would like to welcome
you for the 20th Anniversary Congress of the European Society for Paediatric Urology in Amsterdam,
May 6-9, 2009.

After the foundation in 1989, the first annual meeting of the ESPU was organized in Amsterdam in 1990.
Urology (ESOU)
In the same congress venue we will now organize for you the 20th Anniversary Annual Congress.
This meeting promises to be a very special one, not only for its high scientific content, but also for the
special social events we are planning to celebrate our 20th Anniversary. 16-18 January 2009, Istanbul, Turkey
The Congress Venue will be the Forum Complex at the RAI Congress Center in the southern part of ESOU is a full member of the EAU Section Office
Amsterdam. Amsterdam has one of the busiest airports of Europe, with numerous direct flight-connections
to the whole world. There is a direct 10 minutes train link from Schiphol Amsterdam Airport to the RAI Congress Consultants BV
T +31 (0)26 389 1751
Congress Center and the surrounding Hotels, in which a large number of hotel rooms has already been info@congressconsultants.com
www.uroweb.org
blocked for the meeting attendants.

The weather in Amsterdam in May is usually very pleasant, with very sunny conditions and temperatures of
over 20° Celcius in early May 2008! But please remember the green country side which might be
explained by some rain in may.

The historic City Center of Amsterdam is very close to the congress venue, and easily reached by a direct
RAI Forum Complex
tram-connection. It offers many famous museums like the van Gogh Museum, the Rijksmuseum and the
Anne Frank House and literally thousands of fine restaurants from very casual to Michelin Star rated ones.
Amsterdam
This time of year is also perfect to visit the Keukenhof, the famous outdoor exhibition of millions of
The Netherlands
blossoming flower-bulbs, which is in the close proximity of Amsterdam.
www.espu2009.com
20th AnniversaryOnline
Congress
registration of ESPU
On Friday 8 May the 20th ESPU Gala dinner will take place in the Winter Garden of one of the oldest and
finest hotels in Amsterdam, the Grand Hotel Krasnapolsky, offering you not only an enchanting
atmosphere, but also exquisite cuisine and swinging live music.
European
6-9 MAY 20092008 - 20 April 2009
1 September
We look forward to meeting you in Amsterdam! Association
of Urology

Amsterdam
Abstract Submission
Prof. dr. Rien Nijman, ESPU President
Prof. dr. Wouter Feitz, Congress Chairman
design: Resi Limbeek, www.colormehappy.nl

10 September - 10 November 2008


Dr. Robert de Gier, Congress Secretary
Dr. Tom de Jong, Local Scientific Committee Representative

European Society for Paediatric Urology

RAI Forum Complex


Amsterdam
The Netherlands
www.espu2009.com
Online registration
1 September 2008 - 20 April 2009
Abstract Submission
design: Resi Limbeek, www.colormehappy.nl

10 September - 10 November 2008

European Society for Paediatric Urology


36 European Urology Today August/September 2008
Predictive modelling in prostate cancer
Venice conference provides overview on predictive modelling People
Authors: score 6 biopsy specimens using a novel biopsy based Section Editor
Riccardo Valdagni, MD, PhD, Milan (IT), variable, cancer density, defined as percent positive Duncan Summerton
Louis Denis, MD, Antwerp (Belgium) and cores divided by prostate volume. Leicester (UK)
Peter T. Scardino, MD, New York (USA), Chairmen
Cancer density proved to be a better independent
The Inside Track Conference “Predictive Modelling in predictor of GS upgrading from biopsy to
Prostate Cancer” held in Venice on 17-19 April 2008 prostatectomy than total serum PSA. As a variable
was organised by the European School of Oncology based on biopsy data, cancer density adjusts for the
as the first ever event dedicated to the exciting topic prostate volume and gives a numerical estimate of Prof. Peter Alken
of prediction in prostate cancer. tumour volume in relation to prostate size and helps
evaluate the risk of having a more aggressive cancer AWARDED Prof. Peter Alken, director of the
Louis Denis, Peter Scardino and Riccardo Valdagni present at prostatectomy. Urology Department at the University Hospital
had the pleasure and honour of chairing this Mannheim, received the Gustav Simon Medal
conference and working with a faculty of Predictive models Ripamonti dealt with predictive models in palliative from the Southwest German Urological Society.
internationally acknowledged experts in their fields, Monique Roobol talked about predictive models in care, with reference to the prognostication of life Alken was cited for his major contributions in
namely: Chris Bangma and Monique Roobol diagnosing indolent cancer and the experience of the expectancy and the appropriate therapy for symptom developing and promoting German urology.
(Rotterdam, the Netherlands), Joaquim Bellmunt Rotterdam section of the European Randomised Study control. Amongst other positions, Prof. Alken is a faculty
Molins (Barcelona, Spain), Michael Donovan (New of Screening for Prostate Cancer who constructed an member of the EAU’s European School of Urology
York, USA), Phillip G. Febbo (Durham, USA), Claudio ad hoc predictive tool. Predictive models of toxicity (ESU) and also leads the EAU’s working group on
Fiorino (Milan, Italy), Michael Kattan (Cleveland, USA), After the clinical case discussion, Karim Touijer went urolithiasis.
Rodolfo Montironi (Ancona, Italy), Francesco Montorsi Karim Touijer presented the Memorial Sloan Kettering through predictive models of toxicity in surgery. In his
and Alberto Briganti (Milan, Italy), Carla Ripamonti experience with predictive models before surgery, presentation he pointed out that the goal of modern
(Milan, Italy), Mack Roach III (San Francisco, USA), started with the nomogram developed by Kattan et al prostatectomy is the complete removal of the prostate,
Ash Tewari (New York, USA), Karim Touijer (New York, in 1998 and predicting the risk of disease recurrence seminal vesicles, and pelvic lymph nodes, with
USA) and Nadia Zaffaroni (Milan, Italy). after radical prostatectomy for clinical localized minimal perioperative morbidity, no blood
prostate cancer, and after surgery, by extending transfusions, and early return to normal activities,
Prediction has always been considered a fascinating Kattan’s preoperative nomogram to postoperative with no positive surgical margins, and no long term
topic. Fortune tellers, magicians, prophets, sibyls, data in 1999, with inclusion of information available loss of continence or potency. He reported on the Prof.Dr. Peter Albers
oracles and Cassandras have been trying to anticipate postoperatively. He also made a survey on possible Memorial Sloan Kettering experience in the field of
the future. In oncology, the anatomic staging new nomograms being developed for prostate cancer recording and grading erectile dysfunction and APPOINTED Prof. Dr. Peter Albers has been
classification known as the UICC/AJCC TNM prostatectomy with the inclusion of image analyses urinary incontinence after prostatectomy and appointed head of the urology department of the
classification, has been the standard for decades. and molecular markers. A clinical case discussion on compared recovery from morbidity after laparoscopy Universitatsklinikum Düsseldorf , Germany,
Biological prognostic factors have complemented the the topics so far presented followed, thus stimulating and prostatectomy. replacing Prof. Dr. Rolf Ackermann. Born in
staging and stage grouping in most tumours. In the a proficient scientific debate. Nürnberg, Albers studied medicine in Mainz and
past 15 years sophisticated mathematical models have In the morning session of April 18, Mack Roach III Claudio Fiorino introduced the dosimetric issues of previously served in Montabaur Hospital,
been developed to analyze tumour variables and lectured on predictive models in external predictive models of toxicity in external radiotherapy, Hannover and Mainz. He also heads the EAU’s
response to treatments. Since the first attempts to radiotherapy, designed to allow physicians and analyzing predictive tools such as single/multiple EAU Working Group on Testis Cancer.
assess the risk of positive nodes before pelvic patients to understand what outcomes might be dose-volume constraints, Equivalent Uniform Dose or
irradiation, developed at Stanford University in 1987, expected for patients with specific pre-treatment Normal Tissue Complication Probability models. He APPOINTED The American Urological Association
and the clinical and pathological T&N characteristics clinical features, focusing on the prediction of analysed literature based knowledge as well as new (AUA) has appointed Priscilla Chatman, JD, as
before surgery, studied by Partin and colleagues in biochemical failure, the risk of metastasis and/or unpublished results about dosimetric predictors of Director of Government Relations and Advocacy
1993, more than 80 mathematical predictive models death as well as the importance of predicting toxicity for all the critical organs involved in prostate for the AUA’s greatly expanded government
have been so far formulated. pathological features (i.e. seminal vesicles, irradiation: rectum, bladder, bowel and regions relations program. Chatman, a health policy
extracapsular extension, lymph nodes involvement) to suspected to cause radio-induced erectile dysfunction. attorney, previously served as Vice President for
The conference has focused on the different aspects of Government for the Lupus Foundation of America,
predictive modelling in prostate cancer, including the Counsel and Director of Government Relations for
prediction of aggressive disease, positive biopsies, the National Committee to Preserve Social Security
response to different treatments (active surveillance, and Medicare was a former Special Assistant for
surgery, radiotherapy, brachytherapy, hormonal then US Senator Harris Wofford.
therapy, chemotherapy), survival, mortality and
treatment-related side effects. ELECTED The American Society of Clinical
Oncology (ASCO) has elected Dr. Douglas Blayney
Genomic technologies as president. Since joining ASCO in 1983, Dr.
After the welcome address by Riccardo Valdagni, the Blayney has demonstrated a comprehensive
morning session of April 17 was opened by Phillip record of service to ASCO and has served on the
Febbo, who presented the genomic approaches to Cancer Education Committee as Chair of the
outcome prediction and highlighted the role for Education Technology Assessment
genomic technologies in evaluating molecular
modifiers of prostate cancer risk and behaviour and
the construction of predictive models that anticipate
the development of prostate cancer, prostate cancer take clinical factors into account is need. The afternoon
progression, and response to therapy. session was ended by the clinical case discussion.

Nadia Zaffaroni lectured on biomolecular approaches Future of predictive models


to outcome prediction, stressing the need for novel On April 19 Alberto Briganti discussed predictive
molecular markers that are specifically associated models in andrology, showing nomograms estimating
with biologically aggressive disease for improved the risk of developing erectile dysfunction, and Ash
staging and prognostication, and also for providing Part of the faculty at the closing of the conference. From left: Dr. Michael Kattan, Dr. Riccardo Valdagni, Dr. Ash Tewari, Dr. Alberto Tewari lectured on predictive models of long term
mechanistic information to facilitate treatment Briganti, Prof. Mack Roach, Prof. Louis Denis, Dr. Karim Touijer. survival. After a clinical case discussion on these
selection. Rodolfo Montironi discussed the predictive issues, Michael Kattan, the “Grandmaster of
models in histopathology and the importance of a Nomograms,” forecasted the future of predictive
diagnostic decision support system, defined as a optimise selection of targets for radiation. An accurate knowledge of the dose-volume models and presented the take home messages.
methodology that provides guidance in situations relationships concerning the side effects of the organs
involving complex decision sequences and resulting Michael Kattan discussed predictive models in at risk is of paramount importance to drive the The purpose of this innovative meeting was to
in a systematic, ordered, and exhaustive evaluation of brachytherapy and the possibility of individualising optimisation of the treatment in minimizing the risk of describe the state of the art in predictive modelling of
evidence and weighting of individual items of the treatment proposal. He presented a nomogram complications. prostate cancer and to lay out future research trends
evidence as they are combined to form the basis for a predicting 5-years relapse-free survival, which is in the uro-oncologic community. Presentations and
final decision. based on pre-treatment PSA, Gleason sum, clinical Riccardo Valdagni presented the clinical issues of debates highlighted that prediction models, although
stage and presence of external beam radiotherapy modeling toxicity in external radiotherapy, showing imperfect, likely represent the most accurate
Presenting the systems pathology for building and a sub-sequent nomogram which takes into the first set of nomograms predicting the rectal prediction methods for estimating the probability of
predictive models, Michael Donavan talked about the account the quality of the brachytherapy implant. syndrome. Nomograms should increase the predictive having cancer, the outcome of a treatment or the
novel approaches with molecular diagnostics and accuracy of models based on dosimetric issues, probability of exhibiting treatment morbidity.
predictive testing for guiding therapy and overall Kattan’s conclusions underline that brachytherapy because they take important clinical factors (i.e.
patient management and discussed how a systems nomograms are rare and that heterogeneity across comorbidities, concomitant use of drugs, androgen Since prostate cancer is so heterogeneous and often
pathology programme, which includes image analysis centres plays an important role in this treatment deprivation, presence of previous abdominal surgery) occurs in older men with substantial co-morbid
and quantitative biomarker assessment with machine outcome. Predictive accuracy appears lower with into account. Careful prediction of treatment related conditions, treatment should be tailored to each
learning analytics, has transformed the clinical brachytherapy nomograms, but probably we can still morbidity is important because a high probability of individual patient and to the specific characteristics of
paradigm of personalized medicine. obtain a better prediction than not using a toxicity, could avoid the single patient unnecessary his cancer if we are to maximize cancer control and
nomogram. daily costs in terms of quality of life modification minimize morbidity. In the face of this complex
In the afternoon session, Ash Tewari lectured on during and after treatment, helping either patients in scenario the clinician needs a single, friendly,
predictive models in prostate cancer diagnosis. He Joaquim Bellmunt Molins discussed predictive models the decision making process or clinicians to better computer interface to all relevant prediction models
focused on a study aimed at predicting the incidence in medical oncology and pointed out the importance tailor the treatment to patient’s characteristics. for his patient. These topics are of growing interest
and risk of Gleason score upgrading between biopsy of capturing clinically relevant and measurable and need further work.
and final pathology after prostatectomy for Gleason variables for routine use to inform patients, improve Mack Roach III highlighted the use of predictive
palliation and treatment decisions, and create models of toxicity in brachytherapy. In this field a few A supplement of Cancer dedicated to the discussed
homogeneous prognostic strata for randomised dosimetric issue are known concerning rectal, urethra topics is being prepared and detailed information and
Effects and Actions: International Meeting Reports
comparative trials of therapeutic agents. Carla and bladder doses, development of new models that references will be available in our journal.

August/September 2008 European Urology Today 37


Congress calendar 2008/2009 Full, continually updated urological meeting calendar at
www.uroweb.org
September 2008 9-10: Minsk, Belarus 30: St. Petersburg, Russia 20: ESU organised course on Trauma in urology at
1st Annual Meeting of the Belarus Association of ESU organised course on Neurourology at the time the time of the national congress of the
5-10: Prague, Czech Republic Urology of the national congress of the Russian Urological French Association of Urology
6th European Urology Residents Education Contact: Minsk Regional Hospital, Lesnoy Dept. of Association
Programme (EUREP) Urology Contact: ESU 30 Nov.-4 Dec.: Shanghai, China
Contact: ESU Phone/Fax: +375 17 2652179 26th World Congress of Endourology
E-mail: urobel@mail.ru 30 Oct.-1 Nov.: Damascus, Syria Contact: WCE2008 Secretariat
12-13: Vilnius, Lithuania Website: www.urobel.uroweb.ru National Congress Syrian Urological Society Phone: +86 108 515 8150
EAU 2 North Eastern European Meeting (NEEM)
nd E-mail: dr.chams@net.sy Fax: +86 106 512 3754
Contact: Regional Office 9-11: Munich, Germany Website: www.sus-sy.org E-mail: wce2008@cma.org.cn
E-mail: NEEM2008@congressconsultants.com 35th Munich Urosurgical Symposium Endourology
31: ESU organised course on Paediatric, reconstructive
and Laser
Contact: Mrs. M. Tichy and female urology at the time of the national congress
December 2008
18-21: Kunming, China
CUA 2008 Annual Meeting Phone: +49 89 41402507 of the Syrian Urological Society
Fax: +49 89 41404843 Contact: ESU 7-11: Brussels, Belgium
Contact: CUA Joint Congress of the European Society for Sexual
E-mail: renyang@jlonline.com E-mail: monica.tichy@lrz.tum.de
Website: www.cua.cn Website: www.mriu.de November 2008 Medicine & International Society for Sexual Medicine
E-mail: office@issmessm2008.info
9-11: Dakar, Senegal 1-6: Antalya, Turkey Website: www.issmessm2008.info
19-21: Athens, Greece
9th Conference of the Pan-African Urological 20th National Congress of the Turkish Association of
8 Pan-Hellenic Andrology Congress & Postgraduate
th

Course of EAA
Surgeons’ Association (PAUSA) Urology January 2009
Contact: PAUSA DAKAR 2008 Phone: +90 212 232 4689
Contact: Erasmus Conferences
Phone: +221 338 694 061 Fax: +90 212 233 9804 16-18: Istanbul, Turkey
Phone: +30 210 7257693
Fax: +221 338 273 819 E-mail: uroturk@uroturk.org.tr 6th meeting of the European Society of Oncological
Fax: +30 210 7257532
E-mail: pausadakar2008@gmail.com Website: www.uroturk.org.tr Urology (ESOU)
E-mail: n.dargonakis@erasmus.gr
Contact: Congress Consultants
Website: www.andrologyGR2008.org
9-12: Palermo, Italy 3: ESU organised course on Genitourinary trauma E-mail: info@congressconsultants.com
Autumn Meeting of the EORTC Genito-Urinary Tract and urethral reconstruction at the time of the national
22-28: Rome, Italy
Congresso del Centenario SIU
Cooperative Group congress of the Turkish Association of Urology 21-23: Copenhagen, Denmark
Contact: Prof. Michele Pavone-Macaluso Contact: ESU The 15th Copenhagen Symposium on
Contact: Società Italiana di Urologia
Phone: +39 091 343120 Endoscopic Urological Surgery
Phone: +39 06 8620 26 37
Fax: +39 091 340330 5-7: London, United Kingdom Venue: Herlev Hospital
Fax: +39 06 3250 73
E-mail: info@edipocongressi.com Masterclass of Urethro-Genital Surgery Contact: Ms. S. Lenskjold
E-mail: educational@siu.it
Website: www.edipocongressi.com Contact: E.S. Hedley E-mail: suslen@seus2009.dk
Website: www.siu.it
Phone: +44 8701 236 221 Website: www.seus2009.dk
9-12: Istanbul, Turkey E-mail: ellen@ellensuehedley.wanadoo.co.uk
24-27: Stuttgart, Germany Hands on Live – Endoscopic BPH & Stone Treatment Website: www.instituteofurology.org
60th Annual Congress of the German Society of 23-24: Egypt, Cairo
Contact: Erasmus Conferences
Urology (DGU) EAU 2nd Eastern Mediterranean Meeting (EMM)
Phone: +30 210 7257693 7-11: Linz, Austria
Contact: DGU Contact: Regional Office
Fax: +30 210 7257532 National Congress of the Austrian Society of Urology
Phone: +49 211 51609 60 E-mail: emm2008@congressconsultants.com
E-mail: n.dargonakis@erasmus.gr Contact: Convention Group
Fax: +49 211 516096 60 Website: www.handsonlive2008.org Phone: +43/1/406 83 40
Website: www.urologenportal.de Fax: +43/1/406 83 43 February 2009
10-12: Nice, France E-mail: office@conventiongroup.at
October 2008 1st ESU Masterclass on Female and functional Website: www.uro.at 5-8: Lisbon, Portugal
reconstructive urology 2nd World Congress on Controversies in Urology
1-5: Chalkidiki, Greece Contact: ESU 7: ESU organised course on Nephrolithiasis at the Email: info@comtecmed.com
19th Panhellenic Urological Congress time of the national congress of the Austrian Society Website: www.comtecmed.com/cury/2009/
Contact: Hellenic Urological Association (HUA) 15-18: Mendoza City, Argentina of Urology
Phone: +30 210 7223 126 Annual Meeting Federación Argentina de Urologia Contact: ESU 7-11: Davos, Switzerland
Fax: +30 210 7245 959 Contact: Saint Germain Tours European Urology Forum 2009 - Challenge the
E-mail: hua@huanet.gr Phone: +54 261 405 0900 / 0903 7-8: Venice, Italy experts
Website: www.huanet.gr E-mail: producto@sgtours.com.ar EAU Forum - Men’s health, hormones and prostate Contact: ESU
Website: www.fau.org.ar diseases
2: ESU organised course on Laparoscopic radical Contact: Congress Consultants March 2009
prostatectomy and management of hypospadia 16-18: Barcelona, Spain E-mail: eauforumvenice2008@congressconsultants.com
and urethral strictures at the time of the national 18th Meeting of the European Society for Urological 7-10: Barcelona, Spain
congress of the Hellenic Urological Congress Research (ESUR) 7-9: Linthicum, Maryland (USA) 9th International Congress of Andrology
Contact: ESU Contact: Congress Consultants The 4th International Congress on the History of Urology Phone: +34 93 510 10 95
E-mail: esur@congressconsultants.com Website: www.urologichistory.museum/congress/ Fax: +34 93 510 10 09
2-5: New Dehli, India Website: esur.uroweb.org E-mail: tstevens@auanet.org E-mail: congresos.barcelona@viajesiberia.com
9th Asian Congress of Urology
Contact: Prof. Narmada P. Gupta Website: www.ica2009.com
16-19: Dbayeh, Lebanon 10-14: Hurgada, Egypt
Phone: +91 11 26594884, 26588174 National Congress of the Lebanese Association of National Congress Egyptian Urological Association
Fax: +91 11 26588641 Urology Contact: Egyptian Urological Association 11-13: Rome, Italy
E-mail: acu2008@gmail.com E-mail: aju@cyberia.net.lb Phone: +20 2 257 805 88 Sperm DNA Damage: From Research to Clinic.
Website: www.acu2008.com Fax: +20 12 219 07 57 ICA 2009 Satellite Symposium
17-18: Tirana, Albania E-mail: meissal@link.net Contact: CONGREDIOR - Organizzazione congressi
2-4: Yerevan, Armenia EAU 4th South Eastern European Meeting (SEEM) Website: www.uroegypt.org Phone: +39 71 2071411
10th Annual Congress Armenian Association of Contact: Regional Office Fax: +39 71 2075629
Urology E-mail: SEEM2008@congressconsultants.com 12: ESU organised course on Bladder cancer and E-mail: dna2009@congredior.it
Phone: +374 4 561 467 aspects of paediatric urology for adult urologists Website: www.spermdnasatellite.org
Fax: +374 1 28 44 50 17-18: Brussels, Belgium at the time of the national congress of the Egyptian
E-mail: aau@freenet.am 8th Annual Congress of the Belgian Association of Urological Association 17-21: Stockholm, Sweden
Urology Contact: ESU 24th Annual EAU Congress
3: ESU organised course on Prostate cancer, bladder Contact: Ismar Healthcare Contact: Congress Consultants
cancer and urolithiasis at the time of the national Phone: +32 3491 8270 12-17: City of Chihuahua, Mexico E-mail: info@congressconsultants.com
congress of the Armenian Urological Society Fax: +32 3491 8271 LIX National Congress of the Mexican Urological
Contact: ESU Website: www.eaustockholm2009.org
E-mail: info@bau2008.be Society
Website: www.bau2008.be Contact: Chihuahua International Convention Center
8-10: Hradec Králové, Czech Republic 18-21: ESU organised courses at the time of
Phone: +1 55 52 51 35 59 24
the 24th Annual EAU Congress
Annual Meeting Czech Urological Society 20-24: Nasr City, Cairo, Egypt E-mail: smu@wtcmexico.com.mx
Contact: Czech Urological Society 38th Annual Meeting of the International Continence Website: www.smu.org.mx
Phone: +420 224 967 862 Society (ICS)
Fax: +420 224 916 668 Phone: +44 117 944 4881 13-15: Terme Olimia, Slovenia
E-mail: cus.sekr@lf1.cuni.cz Fax: +44 117 944 4882 Annual Meeting Slovenian Urological Society For more elaborate information on all EAU
Website: www.cus.cz E-mail: info@icsoffice.org E-mail: ciril.oblak@kclj.si meetings please contact Congress
Website: www.icsoffice.org Consultants or consult the EAU website:
9: ESU organised course on Prostate and renal 19-22: Santiago, Chile Phone: +31 (0)26 389 1751
cancer at the time of the national congress of the 24-25: Warsaw, Poland SIU World Uro-Oncology Update Fax: +31 (0)26 389 1752
Czech Urological Society EAU 8th Central European Meeting (CEM) Phone: +1 514 875 5665 Website: www.uroweb.org
Contact: ESU Contact: Regional Office Fax: +1 514 875 0205
E-mail: CEM2008@congressconsultants.com E-mail: congress@siu-urology.org
8-11: Taormina, Italy Website: www.siucongress.org For more elaborate information on all ESU
XV Congresso Nazionale AURO.it 24: Tbilisi, Georgia courses please contact the European School
of Urology or consult the EAU website:
Contact: Sinthesis S.r.l. ESU organised course on Oncologic and 19-22: Paris, France
Phone: +31 (0)26 389 0680
Phone/Fax: +39 019 626485 reconstructive urology; Update in stone 102nd Annual Congress Association Française
Fax: +31 (0)26 389 0684
E-mail: sinthesis@uinet.it management at the time of the national congress of d’Urologie E-mail: esu@uroweb.org
Website: http://www.auro.it/index.php/xv- the Georgian Urological Association E-mail: am.merienne@colloquium.fr Website: www.uroweb.org
congresso-nazionale-auroit/ Contact: ESU Website: www.urofrance.org

38 European Urology Today August/September 2008


Sacral Nerve Neuromodulation (InterStim®) Part II:
Review of the InterStim® System
a negative and positive
While it is not critical for health care providers to know everything about the InterStim® (sacral nerve electrode is set, the amplitude
neuromodulation) equipment and programming, Part II of this series will increase the provider’s button is turned on, slowly
knowledge about InterStim therapy by describing the equipment, delineating patient education needs, increasing until the patient
and discussing the art of programming. This article will assist the provider in trouble shooting the describes the stimulation/
system and provide some insight into the patient’s therapy. sensation. The patient will
describe the stimulation/
Key Words: N’Vision programmer, external stimulator box, Interstim battery, patient programmer. sensation as a vibration,
flutter, or pulling between the
vagina/scrotum and rectum.
Helen Rittenmeyer, BSN, RN • Soft start/stop is a ramp-up system for patient
Nurse Manager, University of Iowa, comfort. When the programmer is turned on or if he Direct or phone
Department of Urology, Iowa City, IA (USA) or she is cycling, the sensation gently ramps up to communication with the
the set amplitude in 4 to 30 seconds. patient daily or every other
The success of any InterStim® Sacral Nerve • Impedance/battery life documents baseline day is essential; it is during
Neuromodulation program depends on the positioning impedance, the neurostimulator lifetime on the day these conversations that the
of the chronic tined lead and electrodes in the S3 of the implant, and yearly review of battery longevity technician and patient will
foramen and the sensation created when being and identification of broken leads. make changes if necessary Figure 6: Model 3058 and 3023 Battery Life
stimulated (Medtronic, 2006). A successful program and decide if the test is
has a physician who knows how to place a chronic These parameters are found on a special setting screen successful or unsuccessful.
lead in the best possible position as well as a of the N’Vision programmer (see Figure 1). The Success is determined by the diaries (objective) and
programming individual who knows how to set ultimate goal is to manipulate parameters to optimize how the patient feels about their symptoms
parameters to provide excellent, long-term therapy. the neurostimulator (battery) life. This is accomplished (subjective). At the end of the test, if the test is
This individual can be a nurse, medical assistant, or by using the cycling mode (20 seconds on, 8 seconds successful, the decision will be made to go on to the
designee who knows when it is necessary to off); keeping the amplitude, rate, and pulse width 2nd stage, when a neurostimulator (battery) is
reprogram to maximize therapy. values as low as effectively possible; avoiding unipolar implanted or the lead is removed. If there is minimal
(case positive) stimulation; and using the minimum symptom relief, changing the positive and negative
The programmer needs to program and/or reprogram number of electrodes for effective therapy. electrodes will increase the chances of a positive test. A
once the neurostimulator (battery) is implanted or successful test remains the best indicator for patient
whenever symptoms reappear, and when there is selection for implantation.
discomfort or a loss of stimulation. An N’Vision®
Clinician Programmer Model 8840 is required to begin Programming the Internal Neurostimulator
programming the neurostimulator. With the N’Vision in After a documented positive test, a neurostimulator
hand, the first programming occurs in the recovery (battery) is implanted; this is called the 2nd stage. The
room or in the office a few days later. internal neurostimulator (battery) is placed during
surgery in a small pocket created in the hip, and the
Programming concepts battery is then programmed using the N’ Vision
Programming requires an understanding of how to programmer. One way to begin programming is called
change the electrical impulse parameters by mapping; this is a systematic approach to
increasing, decreasing, or widening. The chronic tined programming the internal neurostimulator (battery). To
lead has 4 points (0, 1, 2, 3 electrodes) on the end, determine the optimal electrode combination, the
placed in the S3 foramen. These electrodes will create Figure 2: Component of External Stimulator Box programmer will elicit a patient response on each
the electrical impulse and stimulation. The electrode (0, 1, 2, 3). This is started by setting the
neurostimulator (battery) located in an internal pocket Programming external Neurostimulator/Patient neurostimulator case to positive and then, one by one,
created over the hip is also called the case, a fifth point education checking responses on the 0, 1, 2, and 3 electrodes as Figure 7: Example of N’Vison® Programmer
used to create a circuit causing a stimulation/ During both test phases, the patient has an external the negative. The amplitude is then increased by
sensation. The major stimulatory box attached to external wires. This increments of 0.1 (more sensitive 0.05) to elicit a enter multiple pre-set programs into the patient
parameters that can be set are amplitude, which is the external stimulator box looks similar to a TENS unit response and document; additional documentation programmer. For example, the first program would
intensity or strength of stimulation measured in volts, and is used to create the stimulation for the indicates where the patient feels the stimulation and have a positive case, negative 0, pulse width of 240,
and pulse width, which is the time or duration of the percutaneous test or the 1st stage of the staged what it feels like for each electrode. The same is done rate of 9.7, and no cycling (see Figure 7). The second
stimulation measured in microseconds. The rate is the procedure (see Figure 2). Patient education consists of by making the #3 electrode a positive, eliciting program is the same but with cycles, stimulation will
number of times per second a pulse is delivered. showing the patient how to use this box. It is helpful to responses with 0, 1, 2, as the negative, and again by be on for 20 seconds and off for 8 seconds, with a soft
Increasing the rate makes the stimulation feel more teach the patient about the external box prior to using the #2 electrode as the positive and 0, 1, 3 as start of 4 seconds. The last program is a positive 3,
like a flutter, while decreasing the rate feels more like surgery, and if that is not possible, the patient should negative. The end of the session occurs when the negative 1 with a pulse width of 180, rate of 16, and
a tapping. There are ranges associated with each of be taught on the day of the test. patient is comfortable with a pulsation or stimulation cycles. This ability to select different programs
these setting. that feels like a flutter or tapping and is not painful. improves the chance of optimal therapy. It also
The general rule is not to change the parameters for at decreases the number of times the patient will return
Other parameters associated with the InterStim® least 48 hours and only changing if there is no to the clinic for reprogramming.
include: symptom relief.
• Polarity is the current flowing between positive and The best response is a sensation described as a light There are two patient
negative electrodes. Unipolarity occurs when the flutter or tapping somewhere between the vagina/ handheld programmers
case is positive and there is one negative electrode scrotum and rectum. on the market – the
on one of 0, 1, 2, 3. Bipolarity occurs when the case Interstim Model 3031A
is off and there is a negative and positive charge on Figure 3: Neurostimulator – R for Equipment Neuro-stimulator (Battery) (see Figure 8) and the
0, 1, 2, 3 electrodes (for example, 0 is negative and 3 Resistance (Rate), A for Amplitude InterStim iCon patient
is positive) programmer Model 3037
• Cycling is when the stimulation turns on and off; a It is imperative that the patient understands how to use (see Figure 9). The
common setting would be 20 seconds on and 8 the external box before going home. Instructions InterStim 3031A is no
seconds off. include how to manipulate the amplitude (A) button, longer given to patients
which increases and decreases the sensation, and and will be eliminated in
information about the resistance (R) button that is set Figure 8: Patient Programmer the future, but some
and taped by the practitioner (see Figure 3). The back Model 3031A patients still use this
of the box is composed of two compartments: one is programmer. The 3031A
for a 9-volt battery and the second compartment has features a compartment for a 9-volt battery and buttons
an additional amplitude button, a pulse-width button, for increasing and decreasing amplitude as well as on
and electrode buttons. In the middle compartment is a and off buttons. The patient should be familiar with the
second amplitude button that can be set at 10 or lower Figure 5: Neurostimulator Model 3058 (A) and Model 3023 (B) four buttons on the front: increase, decrease, off, and
depending on how sensitive the patient is to the with extension on. There are lights on the back of the programmer;
stimulation. There are four small buttons that when a front button is pushed and no lights turn on,
correspond with the electrodes on the chronic tined In 2006, Medtronic introduced a smaller then the programmer needs a new battery.
lead that are set and changed if needed during the test neurostimulator battery, Model 3058 (see Figure 5). Other lights on the back panel address the functionality
(0, 1, 2, and 3) (see Figure 4). Patient education This smaller battery does not replace Model 3023, the of the neurostimulator. A green light indicates the
includes teaching the patient that one button is positive battery most commonly used until 2006. This smaller neurostimulator is on, and orange indicates it is off. If
and one is negative, and moving the buttons around to battery is used for patients who require lower there are no lights, the patient’s neurostimulator may
find the most comfortable sensation for the test. Once amplitudes and have smaller body mass. The size of be lifeless.
the battery is discussed with the patient prior to
surgery and implantation. Decisions should be based Along with the patient programmer, a patient is given
on how many programs are needed, whether the other a condensed fact sheet and a booklet that outline all
parameters together require more battery life, and if instructions and teaches the patient how to
high amplitudes are required. If these criteria are met, troubleshoot the programmer.
then the Model 023 should be used (see Figure 6).
The Interstim iCon patient programmer is a compact
Figure 1: Example of N’Vision® Programmer Patient Programmer piece of equipment compatible with both the InterStim
In 2006, Medtronic developed a new patient implantable neurostimulator (INS) and the InterStim II
Figure 4: 0, 1, 2, 3, 4 Correlates with programmer that increases programmable choices for
European Association of Urology Nurses
internal lead used for programming the patient. It allows the practitioner to create and Continued on page 40

August/September 2008 European Urology Today 39


Ensuring continence in difficult cases EAUN Board
Board member Tina Christiansen (DK)
Join our search for the best nursing solutions Board member Kate Fitzpatrick (IRE)
Board member Veronika Geng (DE)
Chair Bente Thoft Jensen (DK)
At the recent International EAUN Meeting in Milan of standard questions. The form should include a be granted a free registration for the 10th International Board member Ulla Lindström (SE)
some colleagues remarked that in our latest Good description of the problem, the nursing intervention EAUN Meeting in Stockholm and will be invited to Vice chair Ronny Pieters (BE)
Practice in Health Care series titled ‘The Male External provided, the material you have chosen to get the present their case in 3 minutes during a workshop on
Catheter’ (MEC) only ‘normal’ cases were described. patient continent and the final results. Thursday. The registrations are supported by an www.eaun.uroweb.org
Although it is common practice for a guideline to unrestricted educational grant from Hollister Europe
describe or focus on typical cases, the suggestion Together with the EAUN you will share and pass on Ltd. The EAUN holds the right to reproduce the
implies that there is a need for information on the use this knowledge to other nurses. The EAUN will place submitted photos and text material.
of MEC and other (in)continence devices in atypical the material on her website as a unique opportunity
cases such as retracted penis, anatomic to learn from each other. Carefully note the submission rules and criteria (check
abnormalities, allergic reactions, pressure sores. our website), particularly a written patient consent
The cases will be evaluated by a jury of nurses and a wherein approval is given for the photos and its (the Stockholm congress website) to download the
This is where we need your help. If you are among urologist. Those who submitted the 10 best cases will unrestricted use and the reproduction of the cases for form, disclaimer, example of written consent and the
those who encounter these problems in daily practice educational purposes. technical specifications for the photos.
and have found your own solutions, we would like to Call for Difficult Cases
invite you to take a few photos and write a standard If you are interested to take part in this project visit We are looking forward to your contributions at
protocol. We will provide you with a form with a list
Deadline 1 December 2008 www.eaustockholm2009.org/10th-eaun-meeting eaun@uroweb.org!

Continued from page 39 with ample time to spend with the patient. Do not This is the reprint of an article previously published in
hurry through the session. Discuss programming goals (February 2008) with permission of the
INS (see Figure 10). To with the patient before getting started. Actively listen publisher, the Society of Urologic Nurses and
begin programming, the to the patient and make sure he or she is listening. Associates, Inc. (SUNA). It is Part 2 in a series of 3
practitioner will bond Develop your own style so you are comfortable with articles. Part 1 was published in the June-July 2008
the iCon patient the patient programming and rely on your instincts as issue and Part 3 will be published in the October/
programmer using the to how well the patient has understood what he or she November issue of European Urology Today.
N’Vision programmer has been told.
and the implanted All illustrations reprinted with permission from Medtronic,
neurostimulator Conclusion Figure 10: Compatibility Chart Inc © 2007.
(battery). This is a new Clinicians of all levels are trained to work with patients
concept for the 2006 who are candidates for InterStim® therapy, and the

Figure 9: iCon Patient


patient programmer.
Programming begins
importance of programming and patient education has
been emphasized. It is essential that patients understand International Journal of Urological Nursing
Programmer Model 3037 with mapping, and once all the parameters and how to use their programmer.
Edited by Oliver Slevin, Jerome Marley and
completed, the provider Follow up is an important part of successful therapy; the
Rachel Busuttil Leaver
bonds the patient’s neurostimulator with the iCon patient’s recommended return to clinic is one month, six
programmer. The provider teaches the patient how to months, and yearly to check impedances and battery life. Blackwell Publishers is delighted to offer reduced
synchronize the iCon patient programmer when The ultimate programming goal is excellent patient rates for the International Journal of Urological
turning on the programmer and how to make changes, outcomes with a decrease in the patient’s urge Nursing, an international peer-reviewed Journal
such as increasing, decreasing, turning the incontinence, urinary frequency, or urinary retention. for all nurses, non-specialist and specialist. The
neurostimulator on or off, and changing to a different Journal is clinically focused and evidence based. European
Association
program. It is imperative that the patient understand References Check out the Journal online and register to receive of Urology
Nurses
how to use his or her programmer; there should be a Medtronic, Inc. (2006). Programming pointers: email alerts by visiting www.blackwellpublishing.
return demonstration at the end of each session. The N’Vision® Clinician Programmer. com/ijun.
patient must bring the programmer when returning
for follow-up care.
Minneapolis, MN: Medtronic, Inc. To subscribe as an EAUN member, please contact
the EAUN by email at eaun@uroweb.org to obtain
EAUN membership benefit
Note: The author disclosed that she is on the a subscription form. Print and online subscription for €60
Programming should be performed in a quiet room Consultant Presenter Bureau for Medtronic, Inc.

10 th International Meeting of the European For more information please check www.eaustockholm2009.org or
contact Congress Consultants at info@congressconsultants.com

Association of Urology Nurses (EAUN)


in conjunction with the 24th Annual EAU Congress
18-20 March 2009, Stockholm, Sweden www.eaustockholm2009.org

Preliminary 16.00 - 16.15 Good Practice in Health Care Friday, 20 March 2009 EAUN Board members
Urostoma T. Christiansen, Lund (SE)
Programme Introduction 08.30 - 10.15 EAUN Nursing Research Competition
Learning session
K. Fitzpatrick, Dublin (IE)
V. Geng, Lobbach (DE)
16.15 - 17.15 Symposium B.T. Jensen, Århus (DK)
Neurogenic bladder management 10.15 - 10.45 Break U. Lindström, Malmö (SE)
Wednesday, 18 March 2009 Sponsored by HOLLISTER EUROPE LTD R. Pieters, Ghent (BE)
10.45 - 11.30 State-of-the-art lecture
08.00 - 10.00 Workshop 17.15 - 18.15 Champagne Reception Suprapubic catheters
Superficial bladder cancer With 20 minutes hands-on mannequin
session
08.00 - 10.00 Workshop Thursday, 19 March 2009 E. Wallace, et al, Dublin (IE)
Sacral nerve stimulation
09.00 - 12.30 Hospital visit to the Karolinska University 11.30 - 11.45 Break
08.00 - 10.00 Workshop Hospital, Stockholm (SE)*
Assessing the urological patient 11.45 - 12.15 State-of-the-art lecture
(urodynamics) 08.30 - 09.30 ESU Course Evidence based practice in bladder Call for
10.00 - 10.30 Break
Urinary Tract Infection (UTI) Part 1 cancer nursing care
D.L. Berry, Boston (US) Abstracts and
10.30 - 12.30 Workshop
09.30 - 10.00 Break
12.15 - 13.15 Lunch Research Plans
Nocturia 10.00 - 11.00 ESU Course
Urinary Tract Infection (UTI) Part 2 13.15 - 14.00 State-of-the-art lecture
10.30 - 12.30 Workshop
Nephrostomy catheters 11.00 - 11.30 Break
Current research in the treatment of
incontinence in the elderly
Deadline:
12.00 - 15.00 Hospital visit to the Karolinska 11.30 - 12.30 Symposium
D. Newman, Philadelphia (US) 1 December,
University Hospital, Stockholm (SE)* Neurogenic bladder and sexuality 14.00 - 15.15 Oral Abstract Session 2008
Chairs: V. Geng, Lobbach (DE) and
12.00 - 13.00 Lunch 12.30 - 13.30 Lunch B.T. Jensen, Århus (DK)

13.00 - 15.00 Swedish National Society’s Scientific 13.30 - 14.00 Poster viewing 15.15 - 15.45 Break
session (in English)
14.00 - 15.15 Poster Abstract Session 15.45 - 16.00 Awards session
15.00 - 15.45 Break Chairs: R. Pieters, Ghent (BE) and Research Award supported by an
K. Fitzpatrick, Dublin (IE) unrestricted educational grant from * Optional visit to the urological
15.45 - 16.00 EAUN Opening FERRING PHARMACEUTICALS wards and outpatient clinic and
EAU Secr.-Gen.P-A. Abrahamsson, 15.15 - 16.00 State-of-the-art lecture ESWL unit
Malmö (SE) and Body-image and voiding problems 16.00 - 17.00 EAUN General Assembly Limited places are available and
EAUN Chair B.T. Jensen, Århus (DK) H. Forristal, Dublin (IE) Chair: B.T. Jensen, Århus (DK) registration will be on a first-
come, first-served basis. You
16.00 - 17.00 Workshop will be invited to inform us
Ensuring continence in difficult cases - of your interest to join one of
European solutions by nurses the hospital visits by e-mail in
Association January 2009.
of Urology
Nurses

40 European Urology Today August/September 2008