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

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

August/September 2008 European Urology Today 2

Continuous-flow ureterorenoscopy
Increased visibility reduces retrograde stone mobilisation
Prof. Dr. Maurice
Stephan Michel
University Hospital
Mannheim
Mannheim (DE)
maurice-stephan.
michel@uro.ma.
uni-heidelberg.de
Advances in technology have generated
ureterorenoscopes (URSs) with increasingly smaller
diameters. The price for reduction in diameter in
most URSs is one common channel for irrigation and
the passage of instruments, resulting in decreased
irrigation. Good irrigation is vital for dilation of the
ureter and collecting system, for enhancing
instrument passage and for vision.
When using common URSs with combined inflow and
outflow channel, problems concerning good sight, on
the one hand, and high pressure in the ureter or renal
pelvis (RP) in combination with retrograde stone
manipulation, on the other hand, can occur. Various
techniques have been tried to improve irrigation,
including gravity drainage, pressurized irrigant bags
and handheld or foot-activated syringe-based
systems.1 All these solutions will lead to an increased
intrapelvic pressure as well as an increased risk of
retrograde stone manipulation.
The newly developed continuous flow URS (Fig. 1)
(Karl Storz, Tuttlingen, Germany) has a separate
inflow and outflow channel that enables the user to
maintain continuous irrigation. The aim of this study
was the evaluation of pressure and flow relation
using a common URS in comparison with a newly
developed continuous-flow URS using an ex-vivo
urinary tract model.
FIG. 1. Continuous-flow ureterorenoscope (URS). 1 _ continuous-flow URS; 2 _ tip of the continuous-flow URS showing the
separate inflow and outflow channel; 3 _ tip of a conventional URS showing the combined inflow and outflow channel.
Fig. 3. Flow capacity relative to height of flow solution.
August/September 2008
Fig. 2. Conventional ureterorenoscope.
Material and methods
Ureterorenoscopies were performed with the newly
developed continuous-flow URS with separate inflow
and outflow channel (Fig. 1) and a conventional URS
with a combined inflow and outflow channel (Fig. 2)
Prof. Dr. med. Jens
Rassweiler
Section editor
Heilbronn (DE)
jens.rassweiler@
slk-kliniken.de
(Karl Storz, Tuttlingen, Germany). Both URSs had a
total sheath diameter of 10.5F. The continuous-flow
URS has a 5F working channel and a 3.8F irrigation
channel, whereas the conventional URS has only one
Fig. 4. Renal pelvic pressure relative to height of flow solution.
5.5F working channel The
ex-vivo model consisted
of complete urinary tracts
of domestic pigs obtained
freshly from the
slaughterhouse.
Both instruments were
used in five urinary
tracts, and six
ureterorenoscopies were
performed in each
urinary tract. To measure
the pressure in the RP, a
6F cystometry catheter
(Porgès S. A., France)
was introduced into the
RP, fixed with a suture,
and sealed watertight
with cryanoacrylate glue.
Pressure measurement was performed using a
urodynamic measuring system (Dantec Duet Multi).
The urinary tract was held in place by
micromanipulators. Height of the irrigation solution
above renal level and flow capacity in mL/min was
also documented.
Results
Conventional URS
The intrapelvic pressure correlated with the height of
the irrigation solution above renal level. The
maximum flow capacity at a solution level of 20 cm
was 0.2 mL/min, rising to a flow capacity of 0.5 mL/
min at a solution level of 40 cm above renal level (Fig.
3). The intrapelvic pressure also correlated with the
height of the irrigation solution, rising from 20 _ 3.7
cm H2O at a solution level of 20 cm to 39 _ 2.5 cm
H2O at a level of 40 cm. At a level of 50 cm, a plateau
pressure of 40 _ 3.3 cm H2O was reached, and a
distinct pyelolymphatic and pyelovenous backflow
was observed (Fig. 4).
Continuous-flow URS
The maximum flow capacity for the continuous-flow
URS was about 100 times higher than the
conventional URS. At a solution level of 20 cm, the
maximum flow capacity was 20 mL/min, rising to a
flow capacity of 70 mL/min at a solution level of 40
cm above renal level (Fig. 3). The intrapelvic pressure
was 15 _ 2.1 cm H2O at a solution level of 20 cm and
15 _ 1.5 cm H2O at a level of 40 cm (Fig. 4). In
contrast to the conventional URS, the intrapelvic
pressure did not exceed the physiologic renal
pressure of 20 cm H2O. Even if the irrigation solution
was at a height of 100 cm
Higher flow capacity
The newly developed continuous-flow URS provides a
100 times higher flow capacity compared with the
conventional URS. Simultaneously, the preservation of
a physiologic pressure in the renal pelvis is preserved
even at high irrigation pressure levels. It can be
assumed that these characteristics will improve
visibility and reduce retrograde stone manipulation,
operative time, and complications under clinical
conditions. The results of this ex-vivo study have to be
confirmed under in-vivo conditions.
Uro-Technology
Table of Contents
Europe remains in EAU’s core mission
and strategy. . . . . . . . . . . . . . . . . . . . . . . . . . 1
GP´s best placed to provide initial urological
care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Cooperation with other EAU bodies is the key. 2
Continuous-flow ureterorenoscopy. . . . . . . . . 3
Resident section:
The season changes and it’s back to
business. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Swedish urologists favour specialist
and EBU exams . . . . . . . . . . . . . . . . . . . . . . . 4
Junior Swedish urologists hold successful
meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Valuable training at Leuven’s Catholic
University (BE). . . . . . . . . . . . . . . . . . . . . . . . 5
European residents get expert update on
incontinence. . . . . . . . . . . . . . . . . . . . . . . . . . 5
Do multivitamin supplements promote
prostate cancer?. . . . . . . . . . . . . . . . . . . . . . . 7
Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 9
Testosterone deficiency is a challenge
for urologists . . . . . . . . . . . . . . . . . . . . . . . . 10
Interview with Morgan Rouprêt. . . . . . . . . . . 11
WHO Conference on Bladder Cancer
resounding success. . . . . . . . . . . . . . . . . 12-13
Djavan shares skills with Belgian
residents in Leuven. . . . . . . . . . . . . . . . . . . . 15
www.reviews. . . . . . . . . . . . . . . . . . . . . . . . 15
Book reviews. . . . . . . . . . . . . . . . . . . . . . . . 16
Still going strong . . . . . . . . . . . . . . . . . . . . . 17
EAU launches new Urology Week website . . 18
EUT Congress News – 3rd Barcelona Masterclass:
Harmonized level of knowledge. . . . . . . . . . 19
Open minds for new therapies. . . . . . . . . . . 19
Advanced testicular cancer –
chemotherapy and surgery. . . . . . . . . . . . . . 20
The roadmap to cure cancer?. . . . . . . . . . . . 20
“We need good quality trials” . . . . . . . . . . . 20
Improved prognosis for patients. . . . . . . . . . 21
Targeted local hormonal therapy . . . . . . . . . 21
Two EBU exams in future. . . . . . . . . . . . . . . 21
ESU Masterclass “must attend”. . . . . . . . . . 22
ESU section:
ESU courses get high approval at
Slovak annual congress . . . . . . . . . . . . . . . . 22
ESU, CUA collaborate for 1st CUREP in
Shanghai . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Urinary Incontinence Special:
Patients´ perspective on LUTS. . . . . . . . . . . . 24
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
European Urology Today 3

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
Residents section we will have NCOs (national communication officers, glimpse on the daily routine of the urological
editor e.g. national delegates) from most of the European department.
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
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
Swedish urologists favour specialist and EBU exams
Dr. Stina Erikson I wanted to find out what the general opinion is today
Former ESRU in Sweden regarding a specialist exam and, more
chairman specifically, the EBU exam. To accomplish this I sent
Norrköping (SE) two separate questionnaires: to the heads of
departments and professors (38 in total) and another
questionnaire to 60 residents. The questions were
identical except for an extra query for the residents
regarding whether they know about the EUREP
course. I received 20 answers from the residents (R’s)
Stina.Erikson@lio.se and 17 from the department heads (H’s). The answers
to each question are shown below:
Is a specialist exam important?
Ninety percent (18/20) of the R’s and 100% of the H’s
We don’t have any national specialist exam in answered yes. The R’s commented that an exam is a
urology in Sweden. The reason is basically that there good motivation for them to keep up with theoretical
are so few of us qualifying each year that the cost for studies and a way to show competency as well as a
an exam would not be reasonable. Some have means of ‘ensuring safety’ for both patients and
suggested that we make the EBU exam compulsory, urologists. Some explained that good tutorship and
but this was not accepted. Our system in Sweden is practical tips during residency reduces the need for
very much based on continuous control with help an exam. The H’s saw an exam as a means to find out
from the tutors of the residents. the level of competence outside of the local
Test your knowledge!
The EBU offers three MCQs to test your knowledge. Challenge your memory by answering the following
questions:
1. Which answer is correct?
Reagent strips (dipsticks) in the diagnosis of microhematuria:
a. Make a microscopic analysis superfluous.
b. Are equivalent to microscopic analysis in sensitivity and specificity.
c. Are able to differentiate between glomerular and non-glomerular erythrocytes.
d. Have a lower specificity than microscopic analysis.
2. A 45-year old woman complains of urge incontinence 9 months following a retropubic
urethropexy. A video-urodynamic study shows normal bladder compliance, no detrusor
overactivity and a poor urinary flow, cystoscopic evaluation demonstrates a high fixed
retropubic position of the urethra.
The next step is:
a. Urethral hyperdilatation.
b. Transvaginal urethrolysis.
c. Urethrolysis and needle suspension.
d. Anticholinergic agent administration and intermittent catheterisation.
3. Which step should be taken in a 60-year old patient with maximal androgen blockade for
metastatic prostate cancer and neurological symptoms due to spinal cord compression?
a. Stop antiandrogen and give Strontium 89.
b. Stop antiandrogen and perform bilateral orchidectomy.
c. High dose of intravenous glucocorticoids and radiotherapy.
d. Start chemotherapy and perform surgical spinal cord decompression.
To check out the correct answers, visit:
www.ebu.com/Examinations/Study Material
August/September 2008
The river Tisza, a popular vacation destination in Hungary
department and that an exam would probably raise
the general quality among urologists since it would
update and strengthen knowledge and personal
security. From both groups, some respondents,
however, said they do not think an exam should be
compulsory.
Would you prefer the EBU exam or a national exam?
Eighty percent (16/20) of the R’s prefer the EBU exam
(this includes the 10% who didn’t think an exam
important), 10% (2/20) would prefer a Swedish exam.
One respondent wanted both and another gave a
vague answer. Eighty-two percent (14/17) of the H’s
prefer the EBU exam whereas the rest either prefer a
Swedish exam or think it is not very important
whether the exam is Swedish or European. One of the
H’s commented that he didn’t think the residents
would be motivated to study subjects like
transplantation and paediatric urology (which we
don’t work with as urologists in Sweden) for the EBU
exam, whereas I didn’t get any such comment from
the R’s. Both some R’s and H’s thought that the EBU
exam is important for Swedish residents in order to
strengthen Swedish urologists within the European
community.
Do the heads of departments encourage the residents to
take the EBU exam?
Ninety-four percent (16/17) of the H’s said they
encourage their residents to take the EBU exam,
whereas 80% (16/20) of the R’s said they felt they
received some encouragement.
EUREP and In-Service Assessment
Seventy-five percent of the R’s knew about the EUREP.
Unfortunately I forgot to ask the H’s about this.
Around 25% of the R’s as well as the H’s didn’t have
any knowledge about the IN-Service Assessment,
59% of the H’s say that they encourage their residents
to do it but only 20% of the R’s feel encouraged. I
have to point out that it is not necessarily residents
and heads from the same departments who have
answered the questionnaires, which is why this does
not have to be contradictory.
Travel expenses and examination fee paid by the
departments
Eighty-eight percent of
the H’s confirmed that
they are ready to pay the
expenses related to the
EBU exam. In a few
departments it would be
frowned upon if the
residents didn’t take the
EBU exam. The remaining
12% of the H’s
commented that nobody
took the exam yet in their
department, so they
E.S.R.U.
Finally, you will find the next chapter of our history
column series and you can test yourself with our
regular line-up of quizzes. Enjoy and have fun!
Photo by Dóra Molnár
haven’t had to decide on the issue of fee
reimbursement.
A salary raise after the exam?
Here the answers differed. Fifteen percent (3/20) of
the R’s confirm a higher salary after the EBU exam,
30% (6/20) said they don’t get any raise and 55%
(11/20) didn’t know. Forty-one percent (7/17) of the
H’s answered they offer a higher salary for those who
passed the EBU exam (normally corresponding to
€50-100 extra per month), 12% (2/17) count the EBU
exam together with other merits for the level of salary
and 23,5% (4/17) do not offer a raise and 23,5% (4/17)
commented that the issue has not been considered in
their departments.
A scholarship from the Swedish Urological Society
Eighty-five percent (17/20) of the R’s and 24% (4/17) of
the H’s didn’t know that the Swedish Urological
Society provides a scholarship of 5000 SEK (around
€530) to those who have successfully passed the EBU
exam.
Positive response
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
this exam covers some subjects that are not
traditionally part of urological practise in Sweden.
The heads of departments encourage their residents
to take the EBU exam and will pay for travel as well
as the examination fee. However, there is uncertainty
over a raise in salary after having passed the exam.
There is also a need to promote the EUREP and the
In-Service Assessment as well as information about
the scholarship from our national society to those
who have successfully passed the EBU exam.
It might have helped that an article similar to this one
has been published in Swedish in “SUF-Nytt” – a
web-based newsletter for the Swedish Urological
Society, which can be found on www.urologi.org
Finally, I find it of interest if these opinions from the
Swedes are shared by their colleagues throughout
Europe.
European Urology Today 4

Junior Swedish urologists hold successful meeting
Dr. Edvard Lekas The organising team from the host city of Örebro had
Växjö (SE) put together a pleasant day at a conference center
located in the city water tower, 56 meters high with
nine million liters of water and hopefully without any
outlet obstruction! Several challenging case reports
were put forward by some of the residents with
‘mentometers’ (voting system) for the audience and
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
Valuable training at Leuven’s Catholic University (BE)
Dr. Maksudhon The Urology Department, headed by Prof. Hein Van
Rashidov Poppel, is located in Gasthuisberg, a huge modern
Senior Resident hospital at the limits of the city. There, I had a chance
State Specialized to spend a very interesting and stimulating training
Centre of Urology period in a wonderful setting, characterised by high
Tashkent (UZ) quality medical achievements. Leuven’s Urology
Department is well known not only in Belgium but all
over Europe as a leading centre of uro-oncology.
maksutrashidov@
yahoo.com During my visit, I participated in daily morning
conferences where all cases were digitally presented
and discussed in English. It was very useful and
interesting for me to be introduced in up-to-date
diagnostic and treatment management in uro-
oncology.
From March 24 to April 28 of this year, I had the
excellent opportunity to visit the Urology Department Moreover, I attended and assisted in many different
of the Katholieke Universiteit Leuven in Belgium. procedures in the operation theatre. We had an
intensive daily schedule: operations began at 8 a.m.
The city of Leuven is composed of five communities, and lasted until around 4 to 5 p.m. and covered all
namely: Leuven, Heverlee, Kessel-Lo, Wilsele, advanced fields of current urology, particularly
Wijgmall. It has more than 90,000 inhabitants, uro-oncology. I particularly enjoyed learning Prof. Van
including 35,000 students, an impressive number. So Poppel’s special techniques in cystprostatectomy and
once in Leuven do not be surprised to find the streets partial nephrectomy.
full of young faces, and with city life distinctly
marching to the students’ rhythm: hectic rush during I also had the chance to attend the operations of Prof.
weekdays and relative calm on weekends. D. De Ridder, a renowned master in uro-gynecology
European residents get expert update on incontinence
Dr. Andreas
Petrolekas
ESRU Chairman
Athens (GR)
agpetol@otenet.gr
Dear Friends,
One-hundred and forty European residents had the
opportunity to participate in the 4th International
Consultation on Incontinence that took place from 5 to
8 July in Paris. Despite previous visits to this city, with
good summer weather that bathed the French capital
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
and Algeria. The residents participated in this participating residents also have the chance to meet
international event upon the invitation of the French their professors and exchange ideas with the experts
Association of Urology( A.F.U.F), the ESRU and Prof. S. in the field of incontinence. Furthermore, the
Khoury, secretary of the International Consultation. residents built relationships with other residents from
all over the world as they exchange information about
For three full days, the rooms of venue Palais de training and education issues.
Congress was crowded with young urologists taking
notes, presenting posters but most of all acquiring The hosts, A.F.U.F and E.S.R.U with a generous
experience and knowledge offered generously by the financial aid of Prof Khoury, welcomed 70 residents
August/September 2008
screaming maniacs when you put a laser gun into
their hands! After this bonding experience we sat
down for a cool beer in the pleasant surroundings
and ended the evening with a get-together party at
the impressive 16th century Castle of Örebro. The
following two days were spent mostly in the scientific
spring meeting of the Swedish Urological Society.
and pelvic floor pathologies. I was impressed with the
delicate work of Prof. G. Bogaert, a unique specialist
in paediatric urology.
I also met a number of professional surgeons such as
Dr. S. Joniau, a specialist in oncological and
reconstructive surgery, who all shared their
knowledge. Furthermore, I had the unique
opportunity to attend, for the first time, operations
assisted by a Da Vinci robot, performed by Dr. B. Van
Cleynenbreugel and Dr. S Klaver.
According to Prof. Van Poppel I was the youngest
among his fellows. I had the chance not only to assist
him several times on operations but was also
fortunate to receive very valuable tips and learned
updated techniques under his supervision, making
my short term visit to Belgium very useful and
productive:
My visit to Belgium also coincided with the 23rd
Annual Congress of the European Association of
Urology in Milan, Italy. This gave me the chance to
participate at the ESRU meeting as an official
representative from Uzbekistan, which has recently
joined ESRU as a new member.
At the end of my fellowship, and as a member of
on a warm Saturday evening in a cozy Parisian bar
restaurant, located near the Champs Elysees. The
welcome a dinner was followed by a party until early
in the morning( Photos 1).
The next following day a welcome reception took
place (Photo 2). All participants also filled up and
returned the questionnaires distributed by ESRU
regarding training centres, the ambitious project that
ESRU currently runs in every country across Europe.
E.S.R.U.
European Society of
Residents in Urology
Chairman Andreas Petrolekas
Chairman Elect Tamás Zóber
Past Chairman Stina Erikson
Secretary
Treasurer
Francesco Sanguedolce
Toine van der Heijden
Database Manager Michael Pesl
Project manager Ivar Bleumer
Internet Officer Swen Werner
EBU Delegates Andreas Petrolekas
Tamás Zóber
EUSP Delegate Theodoros Kalogeropoulos
EUT Editor Tamás Zóber
www.esru.net
TURKUROLAP led by Prof. Dr. Y. Ozgok, I was also
invited by Prof. Dr. J. Rassweiler to the 49th Annual
Conference of the South West German Society of
Urology held from April 30 to May 3 in Heilbronn,
Germany.
I would like to express my gratitude to Prof. Van
Poppel and his friendly staff as well as to the EAU and
EUSP boards for the wonderful opportunities that
allowed me to benefit from such a unique and
productive fellowship. My special thanks also to Petra
Van Aalten, the ESRU board and to all colleagues
without whom my visits to these European countries
would not be so fruitful.
Speaking on behalf of ESRU, it was a great honour for
me to welcome all these residents who came from
various countries in Paris. It is one of ESRU’s major
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
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.
We looking forward to meet you all in the upcoming
EUREP course in Prague in September , but most of
all in the upcoming ESRU day during the next EAU
Congress to be held in Stockholm in March 2009. Until
then please fill up our questionnaires and make ESRU
stronger.
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

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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:
a) Minimise the number of prostate biopsies per biopsy.
b) Improve sensitivity in younger men (< 60years).
c) Improve sensitivity in older men (> 60 years).
d) Improve specificity in younger men (< 60 years).
2. What is the most frequent complication of chronic prostatitis/chronic
pelvic pain syndrome:
a) Recurrent urinary tract infections.
b) Fibrosis and obstruction of the bladder neck.
Apart from quiz c) Development of prostate cancer.
d) Anxiety and depression.
5. Under normoxic conditions, HIF is expressed at low levels and undergoes
hydroxylation at the alpha subunit. VHL gene regulates HIF expression.
a) Following the hydroxylation of HIF, the b domain of the VHL complex
binds to HIFb. Under hypoxic conditions, HIF undergoes hydroxylation
and initiates the transcription of hypoxia-inducible genes.
b) VHL gene mutation results in the expression of mRNA encoding
hypoxia-inducible genes such as vascular endothelial growth factor
(VEGF), platelet-derived growth factor (PDGF), transforming growth
factor-a (TGF-a), erythropoietin (EPO), glucose transporter 1(GLUT-1), and
carbonic anhydrase IX (CAIX).
c) Biosynthesis of HIF-1a is not regulated by growth factors through the
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
Hakenberg
Section editor
Rostock (DE)
Oliver.Hakenberg@
med.uni-rostock.de
Case study No. 7: Large tumour in 22-year old woman
A 22-year old woman with a prior history of
recurrent vague left abdominal pain presented in
the second month of her first pregnancy with an
episode of severe and acute left abdominal pain
with a self-noticed palpable left abdominal mass.
On examination her general condition was normal,
with normal vital signs and temperature. There were
large and fixed masses palpable in the abdomen/
retroperitoneum bilaterally. Ultrasound showed
several hepatic hemangiomas and very large
bilateral retroperitoneal masses with apparently
liquid content. Renal parenchyma on both sides was
visualised as normal without calyceal dilatation.
Blood chemistry was hemoglobin 10.5 g/L, white
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
cells/HPR and no bacteria.
Percutaneous biopsy of the tumour showed fatty
and connective tissue and fragments of large blood
vessels. Aspiration cytology of the liquid component
of the right-sided tumour showed lysed red blood
cells with few leucocytes, no sign of malignancy and
microbiology was negative.
Due to increasing pain and apparent tumour volume
the pregnancy was terminated during the fourth
month. After that, the patient was referred to the
Using CT to diagnose large retroperitoneal tumours
Comments by
Prof. Paolo Fornara,
Halle/Saale (DE)
This is an uncommon case of large abdominal and
retroperitoneal tumours in a 22-year old pregnant
woman. Ultrasound showed several hepatic
hemangiomas and very large bilateral
retroperitoneal masses with apparently liquid
content. A percutaneous biopsy of the tumour
showed fatty and connective tissue and fragments
of large blood vessels.
European Urology Today
European Urology Today, the EAU newsletter is
published six times each year. Its main role is to
function as the European Association of Urology’s
bulletin, as a platform for the EAU to present their
meetings, the various sections and offices, as well
as discuss general issues of interest to their
members. Another important objective is to have a
platform that allows for the inclusion of a range of
scientific papers which are considered of interest
to a large readership.
Editorial Policy
Manuscripts are submitted with the explicit
understanding that the decision to include material
will be made by the Editor-in-Chief in conjunction
with his Section Editors. All authors have read and
approved the manuscript subject to submission. It
is the author’s responsibility to obtain permission
to reproduce any parts of other publications (i.e.,
tables, figures). Precise reference to the original
August/September 2008
The Clinical challenge section presents interesting or difficult clinical problems
which in a subsequent issue of EUT will be discussed by experts from
different European countries as to how they would manage the problem.
Readers are encouraged to provide interesting and challenging cases for
discussion at h.lurvink@uroweb.org
Figure 1: IVP Figure 2: MRI
Urology Department for further work-up and
treatment.
Discussion points
1. What is the working diagnosis?
2. What is the natural course of the suspected
disease?
3. What treatment can be offered?
Case provided by Dr. Roman Sheremeta and Dr. Bohdan
Borys, Department of Urology, Lviv Regional Clinical
Hospital, Lviv, Ukraine, bborys@mail.lviv.ua
The possible diagnosis can be represented by the
Wunderlich-Syndrome. Spontaneous retroperitoneal
hemorrhage from the kidney was first described in
1700 by Bonet. Wunderlich gave his name to this
syndrome in 1856. Up to now, 250 cases are reported
in literature. This syndrome is a rare but nevertheless
life-threatening complication in cases of benign or
malignant space-occupying lesions in the kidneys. A
precise preoperative differentiation often turns out to
be difficult because of the formation of a hematoma.
This disease entity is associated with an underlying
pathology, which may be a benign tumor such as an
angiomyolipoma or a malignant tumor such as a
renal cell carcinoma with bleeding through a
spontaneous rupture in the retroperitoneum. The risk
of this rupture is higher during pregnancy. Usually all
the patients present with flank pain, often severe and
work must be given in the legends.
Statements in articles or opinions expressed by any
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the editors or the publisher.
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submission may be directed to:
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Submission platforms
All material is to be submitted in English, as
Figure 3: Right renal angiography
Figure 4: Left renal angiography
associated with a palpable mass and a reduced
haemoglobin concentration, as in this case.
The radiologic diagnosis is based on intravenous
pyelography, renal angiography, computerized
tomography and magnetic resonance imaging. CT
is the best imaging method to establish the
diagnosis and in some cases the aetiology of
Wunderlich’s syndrome, with a sensivity of 71%.
The treatment that can be offered for this
pathology is represented by a surgical exploration
of the kidney, above all if there are bilateral
suspicious masses larger than 4 cm. If the bleeding
is caused by a malignant tumour, extrafascial
nephrectomy is the treatment of choice. For those
with benign tumours, renal arteriography with
embolization is an important therapeutic method
to control the bleeding and to avoid surgery.
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describing the content of their article before
submission. Maximum word count for original articles
Case study No. 8:
Abdominal discomfort
24 years after
complete cystectomy
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
chemotherapy. The patient had been recurrence-free
ever since. Management of his pouch had been
uneventful with clean intermittent self-catherisation
through the appendiceal access with a 10F catheter.
Recently, however, he had developed problems
emptying the pouch with increased mucus production
and clouded urine. On examination his general
condition was normal. Ultrasound showed bilateral
hydronephrosis, serum creatinine was elevated with
120 mmol/l (< 105). Catheterised urine microscopically
showed mucus, leucocytes and few bacteria. The
plain abdominal x-ray is shown. Bilateral
percutaneous nephrostomies were inserted and
antibiotic treatment was started. Within three days
serum creatinine had normalised. An isotope
nephrogram showed reduced renal function with a
clearance of 210 ml/min (normal > 250 ml/min)
distributed equally to both kidneys.
Figure 1: Plain abdominal x-ray
Discussion points
1. What is the diagnosis?
2. What management is appropriate?
3. What long term measures might be helpful?
Case provided by Oliver Hakenberg, Rostock (DE)
Readers are encouraged to provide interesting and
challenging cases for discussion.
is approximately 2,000 words, exclusive of
references and illustrations.
In case authors provide large reference files, the
editor-in-chief may decide to either limit the total
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Certified Centres – etc)
General reports and papers on interesting
developments/urology departments/accreditation
etc. may be submitted for consideration to the
editor-in-chief. Illustrations are welcome. Word
count for reports are approximately 900/1,000
words.
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
It is my pleasure to invite you to the EAU forum on
men´s health, hormones and prostate disease which
will take place at Hotel Monaco & Grand Canal in
Venice, Italy from 7-8 November 2008. 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 increased risk of more aggressive prostate cancer.
especially prostate safety of testosterone treatment. Men with total testosterone levels below 200 ng/dl
(6.9 nmol/l) have a two-fold higher risk of death, a
Testosterone Deficiency Syndrome (TDS) is a clinical three-fold higher risk of cancer-related death and a
and biochemical syndrome which results in significant two-fold higher risk of cardiovascular-related death
detriment in the quality of life and adversely affects over 17 years than men with testosterone levels of 410
the function of multiple organ systems 1. to 509 ng/dl (14.2–17.7 nmol/l)3.
TDS is characterised by a decrease in testosterone and Fears on safety are unfounded
other hormones and is associated with changes in Huggins and Hodges reported in 1941 that marked
body mass index, obesity, osteoporosis, sleep and reductions in testosterone (T) by castration or
mood disorders 2. Obesity appears to be a driving estrogen treatment caused metastatic prostate cancer
factor since adiposite cells secrete leptin which results (CaP) to regress, and administration of exogenous T
caused CaP to grow. Remarkably, this latter
conclusion was based on results from only one
patient who showed elevated but fluctuating acid
phosphatase levels after testosterone injection.
Multiple subsequent reports revealed no CaP
progression with T administration, and some men
even experienced subjective improvement, such as
resolution of bone pain. More recent data have shown
no apparent increase in CaP rates in clinical trials of
T supplementation in normal men or men, neither
even in men at increased risk for CaP with high grade
The influence of testosterone on different target organs PIN or following radical prostatectomy6.
“Benefits of testosterone therapy
outweigh risks”
Most of the available preparations of testosterone,
intramuscular, transdermal, oral and buccal
preparations are safe and effective, if used correctly.
However, short-acting (transdermal, oral, buccal)
preparations should be preferred over long-acting.
The preparations avoiding supraphysiological
concentrations and releasing steady testosterone
levels should be preferred.
Before initiation of TRT, prostate health has to be
checked, by the determination of serum prostate-
specific antigen (PSA) associated to digital rectal
examination (DRE). Transrectal ultrasound- guided
biopsies of the prostate are indicated only if the DRE
or the serum PSA levels are abnormal as in usual
Good Clinical Practice (GCP) 2,6.
Men on testosterone therapy should be monitored at
three-month intervals during the first year of use and
thereafter at one-year intervals 2,6.
The incidence of prostate cancer increases with age while
testosterone levels decrease.
The benefits of TRT in men presenting with TDS far
outweigh the safety risks that can be largely avoided
by following the most appropriate recommendations
2,6
. Larger-scale and long-term studies are needed on
the effects of testosterone treatment in men regarding
their benefit and risks. Although there is a need for
more evidence, testosterone therapy has many
benefits and few risks.
References
1. Morales A., Schulman C., Tostain J., Wu F: Testosterone
Deficiency Syndrome (TDS) Needs to be Named
Appropriately – The Importance of Accurate Terminology,
Eur. Urol. 2006; 50: 407
2. Nieschlag E., Swerdloff R., Behre HM. et al. Investigation,
Treatment and Monitoring of Late-Onset Hypogonadism
in Males. ISA, ISSAM, and EAU Recommendations. Eur.
Urol. 2005 ;48: 1
3. Araujo AB. et al. Total testosterone as a predictor of
mortality in men: results from the Massachusetts Male
Aging Study. In: The Endocrine Society Annual Meeting.
2005. San Diego, California, USA.
4. Shores MM., Matsumoto AM., Sloan KL. et al. Low serum
testosterone and mortality in male veterans. Arch Intern
Med. 2006; 166: 1660
5. Morgentaler A. Testosterone and Prostate Cancer: An
Historical Perspective on a Modern Myth. Eur. Urol. 2006;
50: 935
6. Rhoden E., Morgentaler A. Risk of testosterone-
replacement therapy and recommendations for
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
Bagging the prize for the Best Paper
published on Clinical Research in 2007
during the 23rd Annual EAU Congress in
Milan last March, Morgan Rouprêt has
added another accolade to his growing
stash of honours.
The 33-year-old Rouprêt is Chef de
Clinique of the Urology Department at the
Hôpital Pitié-Salpétrière, Faculté de
Médecine Pierre et Marie Curie, University
Paris 6. In 1999, he received his first
recognition from the Paris School of
Medicine and the urology prize in 2004
from the French National Academy of
Medicine. The following year, he received
the gold medal AP-HP Prize and the Le
Dentu-Renon Prize bestowed by the
French National Academy of Surgery. In
2006, Rouprêt collected the Prize Auquier,
followed in 2007 by another citation from
the EAU’s European Urological
Scholarship Programme (EUSP).
that were never asked before
and go beyond the limits. We
are always looking ahead
although we don’t have the
knowledge of our senior
colleagues.
Our mentors
and senior urologists have the
responsibility to give or teach
to the young generation not
only the necessary surgical
knowledge and skills but
also pass on or help develop
in young doctors critical
A committed researcher and writer with a thinking.
string of publications in international,
peer-reviewed journals, Rouprêt focuses
and writes on urological cancers
Urology would be stronger
particularly upper urinary tract tumours if urologists are in a position
and prostate cancer. He earned a PhD in to keep or maintain their
the field of onco-urology and genetic hold on their turf because
markers. His award-winning paper, which for each pathology there
impressed the EAU jurors with its are medical and surgical
innovative and well-designed treatments. If we depend on
methodology, examined molecular other specialists for a key
detection of localised prostate cancer decision on treatment then
using quantitative methylation-specific we are not fully part of the
PCR. decision.
for us urologists to maintain
and hold our influence is to
consider ourselves not only
a physician of an organ but
to look at our speciality as
a whole and wide-ranging
field.
In my country
France, there are 62 million
inhabitants and only 1,000 My greatest fear
urologists. It is difficult to is not being able to operate
struggle and to battle for anymore, one day.
every field in urology and
keep them in our hands
as we are limited in terms To relax
of numbers. We will be I go to the cinema (for a
stronger if we stay connected ‘popcorn’ movie!), read
with urologists from other books and enjoy sports like
European countries.
skiing.
I have strong admiration I have a hidden talent
for people in politics and to convince people to go the
to see how much time they way they have not chosen in
invest into their work and the beginning, and for them
their readiness to sacrifice to follow different ideas
the personal for a very public and the common sense of a
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
Andersson
Chairman
Stockholm (SE)
lennart.andersson@
ki.se
Prof.Dr. Michael
Droller
Co-chairman
New York (USA)
michael.droller@
mountsinai.org
Introduction
Last April 24th-25th Stockholm provided a fitting
location for the 2008 International Consultation
“Bladder Cancer – from Pathogenesis to Prevention”,
a conference organized by the World Health
Organization (WHO) in collaboration with the
European Association of Urology (EAU).
 
Professor Lennart Andersson, Chairman of the WHO
Collaborating Center for Urologic Tumors and the
Sweden-based organizing committee, had invited
laboratory and clinical scientists from all over the
world to discuss the progress in understanding of the
various aspects of the fundamental biology,
epidemiology, genetics and biochemical
characteristics of bladder cancer. This information is
crucial in defining and characterizing the various
cancer forms and their global impact. The discussions
also covered screening for early diagnosis,
alternatives in treatment and prevention, and the
financial burden placed on society by the incidence
and prevalence of bladder cancer.
 
The following provides an overview of the
presentations. Full manuscripts will be published in
The Scandinavian Journal of Urology and Nephrology.
The WHO Collaborating Center for Urologic Tumors
and the Organizing Committee for this conference are
grateful to Professor Manfred Wirth, M.D., Editor-in-
Chief of European Urology Today, and Professor
Per-Anders Abrahamsson, M.D., Secretary General of
the EAU, for permitting publication of this review.
 
Epidemiology and Etiology
Global demographic and environmental factors
associated with bladder cancer were discussed by the
“Epidemiology and Etiology” committee led by
professors Ziya Kirkali (TR), Wiking Mansson (SE), Jan
Adolfsson (SE) and Paolo Boffetta (FR).
 
Bladder Cancer is the ninth most common cancer
worldwide. The epidemiology of bladder cancer
presents a rather stable situation in the Western
world, as shown in a review by Prof. Donald Parkin
(UK). However, there are concerns over a mixed
development in Asia due to the increasing rates of
cigarette smoking. Indeed, it is estimated that as
many as one-third to one-half of all cases worldwide
are associated with cigarette smoking. Unfortunately,
true incidence estimates are difficult to assess due to
changes in cancer registration, multiplicity of the
tumours, and reporting procedures and protocols.
 
In Russia, for example, an increase in incidence of
bladder cancer is being seen, which may well be
associated with a high rate of smoking.  Prof. Dmitry
Pushkar (RU) cautions that the true potential risk may
actually be underestimated because  the current mean
life expectancy of Russian males is only 60 years.
 
According to the report from Prof. Paolo Boffetta (FR),
over one-third to one-half of bladder cancer cases in
men are linked to smoking; both the intensity and
duration of smoking have an impact on the risk of
developing this disease. Also, black tobacco is
associated with a higher risk compared to blond
tobacco cigarettes (reflecting the higher content of
aromatic amines in black tobacco). Cigar and pipe
Effects and Actions: International Meeting Reports
12 European Urology Today
smoking also entail an increased risk. Importantly,
smoking cessation has been shown to reduce the
likelihood of bladder cancer.
 
Dr. Göran Boëthius, co-founder and chair of “Doctors
against Tobacco, Sweden” discussed what society and
various organizations are doing to prevent cigarette
smoking. Inasmuch as smoking does not seem to be
on the increase in Western countries, it is particularly
worrisome to see that the tobacco industry is now
showing greater interest in promoting smoking in the
Third World.
 
Several specific chemical agents have been
significantly associated with the risk of developing
bladder cancer. Exposure to selected chemical
carcinogens, occupations, or industries was the topic
of Prof. Seth Lerner’s contribution. He stated that
carcinogens with the greatest impact are certain
aromatic amines; 20–27% of bladder cancer cases
may be caused by exposure to these substances as
may be the case with industrial exposure of blue collar
workers in the workplace (but not necessarily with the
general population). However, individual susceptibility
to these cancers may also play an important role.
Although regulatory controls in industrialized nations
Expert panel on Pathogenesis. From left to right: Richard Sylvester, Brussels, Belgium, Carlos Cordon-Cardo, New York, USA,
Per-Uno Malmström, Uppsala, Sweden, Rodolfo Montironi, Ancona, Italy, Antonio Lopez-Beltran, Cordoba, Spain, Angela van
Tilborg, Rotterdam, the Netherlands, Ellen Zwarthoff, Rotterdam, the Netherlands, Theo van der Kwast, Toronto, Canada,
Margaret Knowles, Leeds, United Kingdom, Arndt Hartmann, Regensburg, Germany
have resulted in decreased exposure to many bladder
carcinogens, this unfortunately is not the case in many
developing countries.
Various nutritional factors that might be of
importance in the aetiology of bladder cancer were
described by Prof. Maurice Zeegers (UK). These
include salted and barbecued meat, pork, total fat,
pickled vegetables, salt, soy products, spices, and
artificial sweeteners. In contrast, fruit and yellow-
orange vegetables (particularly carrots) may be
associated with a moderately reduced risk of bladder
cancer. Citrus fruits and cruciferous vegetables may
also have a protective effect, whereas no clear
association has been determined for beef, eggs,
processed meats, or total fluid intake.
 
Coffee drinkers have a moderately higher relative risk
of developing bladder cancer as compared to those
who do not drink coffee, but this may be the result of
confounding by smoking or dietary factors according
to Prof. Carlo La Vecchia (I). Indeed, the absence of
risk relationships with dose and duration has been
suggested to contradict the existence of a causal
association. The same issue appears to be the case
with regard to alcohol.
 
Convincing evidence of a relationship existing
between an increased risk of bladder cancer and
exposure to ionizing radiation was presented by Prof.
Per Hall (SE). Initially based on data from atomic
bomb survivors, similar findings have been obtained
in studies of cancer patients (e.g. prostate or cervical
carcinoma) treated with high-dose radiotherapy. In
contrast, no carcinogenic effects on the bladder have
been found with lower doses of radiation
(occupational exposure) or from protracted low dose
exposure (radioiodine).
 
The significant risk of developing secondary bladder
cancer has been identified after cyclophosphamide
treatment for other types of malignancies or for
certain benign conditions; a risk that increases with a
higher cumulative dose. According to Prof. Sten
Nilsson phosphoramide mustard represents the
primary mutagenic metabolite here. Considering the
effects of other chemotherapeutic agents, it appears
that melphalan and thiotepa may elevate the risk of
bladder cancer when given in combination with pelvic
radiotherapy.
 
Chronic infection with Schistosoma hematobium in
endemic areas is an important factor for the
development of bladder cancer according to Prof. Hassan
Abol-Eneim. Government-sponsored projects are being
conducted in the affected countries with the aim of
diminishing infestation with this parasite. By
comparison, the possible connection between bladder
cancer and chronic bacterial or viral infections is unclear.
Pathogenesis
Under the chairmanship of professors Rodolfo
Montironi (I) and Per-Uno Malmström (SE) a panel of
experts reviewed the genetics, histopathological
characteristics, biochemical and molecular profiles,
hereditary factors and biostatistical concerns related
to the interpretation of genetic and molecular aspects
of the various forms of bladder cancer.
 Presentations in this session focused on the concept
that bladder neoplasms can be subdivided into two
groups: those that recur but  remain non-invasive,
and those that become invasive and progress.
Traditionally the evaluation of  bladder neoplasms
and their natural history has been based on the
morphological analysis of tissue and urine samples.  specific biological functions (e.g. apoptosis or cell
The classification introduced by the WHO in 2004
subdivides lesions into flat and papillary, further
subdividing each on the basis of the degree of cellular
and architectural changes.
 
In recent years, molecular studies to further explain
these distinctions have been made possible through
the refinement of various analytic techniques -
including tissue microarrays, identification of markers
at the genetic and epigenetic levels, genotyping, gene
epidemiology, risk adapted gene signatures, and
characterization of molecular alterations in initiation
and progression. Although these new techniques
have not yet replaced morphological evaluation of
bladder neoplasms, they are increasingly being
combined with morphological findings to provide
more accurate information on the clinical behaviour of
various types of bladder cancer in individual patients
and assist in identifying those at risk (hereditary and
non-hereditary factors).
 
The (histo)pathological and clinical presentation of
patients presenting with bladder urothelial carcinoma
were examined by Prof. Antonio Lopez-Beltran (ES).
The most recent WHO classification (2004),  includes
urothelial flat lesions (flat hyperplasia, dysplasia and
carcinoma in situ) and papillary lesions  (broadly
subdivided into benign papilloma and inverted
papilloma, papillary urothelial neoplasia of low
malignant potential (PUNLMP) and non-invasive low
or high grade papillary carcinoma). The most
controversial proposal of the WHO 2004, that PUNLMP
has lower malignant behaviour when compared with
low grade papillary carcinoma, is supported by recent
molecular studies.
Although first degree relatives of bladder cancer
patients have a two-fold increased risk of bladder
cancer, high-risk bladder cancer families are
extremely rare according to Prof. Bart Kiemeney (NL)
when discussing hereditary aspects of bladder cancer.
There is no clear Mendelian inheritance pattern that
can explain the increased familial risk making
classical linkage studies for the mapping of
susceptibility genes impossible. The disease may be
caused by the combination of exposure to exogenous
carcinogens and the existence of a large number of
susceptibility genes with modest effects. Genome-
wide association studies currently underway may be 
better suited to identify these genes.
 
Professor Margaret A. Knowles (UK) highlighted the
bladder cancer subtypes defined by genomic alterations.
Many of these affect the function of tumour suppressor
genes (TSGs), leading to partial or complete loss of
protein expression or function with varied phenotypic
consequences. Some of the genes implicated (such as
TP53 and RB1), are important in other tumour types.
Others, particularly some on chromosome 9, show
bladder-specific involvement. The recent identification
of mutations of FGF receptor 3 (FGFR3) in most
non-invasive bladder tumours and overexpression of
this receptor in both superficial tumours and many
invasive bladder cancers has generated optimism that
therapies targeting this receptor for tyrosine kinase may
have major application in  treatment.
As a multifactorial disease, both environmental and
genetic factors are involved in the development and
progression of bladder cancer. Prof Núria Malats (ES)
reviewed the genetic epidemiology of bladder cancer.
This neoplasm is a paradigm for the participation of
low penetrance genetic variants (GSTM1-null and
NAT2-slow) in contributing to the susceptibility of a
particular individual to the carcinogenic activity of
environmental exposure. Genetic variants in
nucleotide excision and double strand break DNA
repair pathways have provided further evidence for
this with ERCC2-XPD rs238406 being a notable
example both  by itself and by interacting with
tobacco. Variants in other pathways such as cell cycle
control, 1-C metabolism, and inflammation, have also
been studied though results are not consistent.
Tissue microarray studies have provided a valuable
tool for high-throughput genomic and proteomic
analyses and offered reliable information on the
relation of molecular markers and clinical outcomes.
As discussed by Arndt Hartmann (D) this technique
has also been used to evaluate immunohistochemical
candidate markers for prognosis and to reveal the
amplification frequency of candidate oncogenes in
regions with copy number alterations detected by
comparative genomic hybridization and array-based
methods.  Multimarker expression studies of several
cycle proteins) and of signal transduction pathways
have also been performed.
 
The value of several biomarkers in voided urine in
detecting recurrent bladder cancer was the topic
presented by Dr. Ellen C. Zwarthoff (NL). In general,
sensitivities are much lower when only patients under
surveillance are taken into account than when patient
cohorts include those with primary disease or  with
high-grade tumours. The markers with sensitivity and
specificity  >70% are Lewis X, NMP22, microsatellite
analysis (MA), CYFRA 21.1, cytokeratin 20 (CK20) and
the UroVysion fluorescence in situ hybridization test
(FISH). In general, lesions that are missed are pTa and
low grade. Recent developments in  the use of FGFR3
mutation analysis and methylation detection were
included in the discussion.
The concept of molecular alterations affecting
“genetic pathways” was the theme of Prof. Carlos
Cordon-Cardo’s (USA) presentation. He pointed out
that alterations of p53 and PTEN/Akt are significantly
associated with bladder cancer progression and
disease specific mortality. In view of the key role
exerted by the PTEN protein in tumour suppression,
its further elucidation in bladder cancer  is of high
potential significance. The challenge is to evaluate
such targets for therapeutic development, as well as
to translate progression and outcome biomarkers into
improved clinical management.
Torben Ørntoft of Aarhus (DK) reviewed gene
signatures for risk adapted treatment of bladder
cancer. A major challenge for molecular diagnosis of
bladder cancer is the subdivision of tumours beyond
August/September 2008
Cancer resounding success
with the EAU in Stockholm, Sweden
Natural History,
Screening, Prevention
and Economic Impact of
Bladder Cancer
A third committee grouped
under the header “Natural
History, Screening, Preven-
tion, and Economic Impact”
was chaired by professors
Bernhard Tribukait (SE),
Michael J. Droller (USA)
and H. Barton Grossman
(USA). This panel discus-
sed the treated and
untreated natural history
of the various forms of
bladder cancer; the role
of screening in potentially
Professors Lennart Andersson, Per-Anders Abrahamsson, Ziya Kirkali and Tadao Kakizoe reducing morbidities and
mortality; new directions
in possibly suppressing,
histological classifications into clinically relevant preventing, or reversing each diathesis either medically
molecular subgroups. The evolution of molecular or with complementary approaches, and the overall
high-throughput techniques for assessing a large budgetary impact each diathesis might have.
number of molecular features at the same time has  
made comprehensive investigation of these subgroups Professors Tadao Kakizoe (JP) and Michael J. Droller
possible. Molecular signatures for disease stage, reviewed the natural course of untreated
grade, progression, carcinoma in situ, presence of (preclinical) versus treated (clinical) course of the
metastases, and treatment response have been different forms of bladder cancer as based upon the
reported. Some of these molecular signatures are concept that different developmental pathways
now being tested in multicentre studies with the could be used to envision the different courses of
purpose of introducing these into the clinic,  planning these tumour diatheses as these represented low
of follow-up and selection of treatment . risk versus high risk disease. In the case of the
  former, risk was taken to imply the likelihood of
An overview of  recent molecular-genetic findings,  recurrence without the likelihood of progression. In
critically appraising  their relationship with each of the case of the latter, risk was intended to signify the
the WHO 2004 disease categories was provided by risk of progression and of potential mortality. The
Prof. Theodor van der Kwast (CA). Most of these have histologic diagnosis and characteristics of a bladder
been successfully distinguished by means of genome cancer at its initial presentation can be considered
profiling and identifying distinct genetic alterations. as  providing a “snapshot” of a particular
Molecular-genetic data  suggest that papillomas may developmental pathway and of a specific tumour
not represent a precursor lesion for bladder cancer diathesis. The concept of screening to provide earlier
but rather a benign neoplasm sharing mutations in “snapshots” could theoretically be useful in
the FGFR 3 gene. In contrast, genetic alterations in allowing earlier interventions to reduce the risk of
papillary urothelial neoplasia of low malignant recurrence or progression and reduce the extent and
potential are identical to those found in non-invasive complexity of the treatments required if the disease
low grade papillary urothelial carcinoma (PUNLMP), were diagnosed earlier in the course of its
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  
view that (secondary) carcinoma in situ may not only
act as a precursor lesion for invasive non-papillary `....if the disease were diagnosed
urothelial carcinoma, but also as a precursor for
non-muscle invasive papillary urothelial carcinoma.
earlier in the course of its preclinical
  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
discussed the criticisms that have been levelled
regarding their performance.  clinical recurrence has occurred. Most studies have
 
Professor Peter Albertsen (USA) then reviewed the
history of the use of PSA testing in the diagnosis of
prostate cancer and the pitfalls that have emerged in
attempts to use this biomarker as an indication for
performing biopsies, diagnosing disease, and
applying various therapies, presumably earlier in the
course of the different forms of prostate cancer (both
low risk or “clinically insignificant” forms of disease
and high risk or “clinically significant” forms of
disease). These were placed in the context of
outcomes that have been achieved in applying PSA
screening for earlier detection to presumably reduce
the potential morbidity and mortality of the disease
itself and of the treatment utilized to treat and
possibly cure the various forms of disease. In this,
numerous pitfalls in screening were identified and it
seemed apparent that much remained to be done in
selecting  populations at risk for having high risk
disease and applying screening tests to these
judiciously.
 
Chemoprevention – the use of chemical agents to
prevent or slow the development of bladder cancer
were subdivided by Prof. H. Barton Grossman (USA)
in “primary” prevention as a means to seek
prevention of the occurrence of disease in a healthy
population, “secondary” prevention as endeavouring
to prevent the development of clinical cancer in
individuals with well-defined “pre-malignant”
conditions, and “tertiary” prevention as an attempt to
prevent recurrences in patients with a history of
cancer who were currently clinically free of disease.
 
Since primary prevention decreases the fundamental
incidence of disease and cigarette smoking is the
most common cause of bladder cancer, he suggested
that efforts to decrease smoking are likely to be the
most highly cost-effective method for achieving
primary prevention. However, because of the long
lagtime between exposure and the development of
clinical disease and the low incidence of bladder
cancer, a study that might critically investigate this
strategy would likely be both expensive and time-
consuming.
Secondary prevention has not been explored because
of the lack of a consensus on well-defined pre-
malignant conditions in bladder cancer. Tertiary
prevention has been studied in several prospective
randomized trials usually involving investigation of
single drugs and removing patients from study when
not achieved their primary endpoint of decreasing the
rate of bladder cancer recurrence.
The most commonly used strategy to investigate
chemoprevention in bladder cancer has been to apply
an intervention in patients with a history of this
disease to decrease the rate of tumour recurrence.
Although most trials have failed to demonstrate
efficacy, they have indicated that: (1) the interventions
should have low toxicity to be acceptable; (2) trials of
single drugs may not be the optimal chemopreventive
strategy; and (3) alternative study designs such as
continuing therapy after the first tumour recurrence
should be tested.
 
Although complementary approaches are widely
used, there is little data documenting the efficacy of
alternative medicinal and dietary approaches in
bladder cancer as Dr. Mark Moyad (USA) pointed out
in his review. Because of results in animal studies and
tantalizing observations in humans, however, there is
a compelling need for rigorous research on the effects
of alternative medicine in bladder cancer. Effective
strategies should be designed to  lower the incidence
and/or recurrence rates of bladder cancer without
increasing morbidity or mortality of other diseases.
 
Bladder cancer is the most expensive neoplasm both
in costs per patient and lifetime costs. Prof. Arnulf
Stenzl (DE) explained in his presentation that
non-muscle invasive disease accounts for most of
these costs, with the largest proportion resulting from
the treatment of recurrent disease. Cessation of
cigarette smoking could help reduce these costs by
decreasing the incidence of bladder cancer, this being
potentially most effective in the adolescent
population. Other strategies to decrease the rate of
tumour recurrence, e.g. transurethral resection with
fluorescence cystoscopy to more fully eradicate all
visible disease, could also be cost-effective. For
patients requiring cystectomy, cost savings could be
achieved by treatment in high volume centers by high
volume surgeons.
The supplement of the Scandinavian Journal of
from the meeting can be ordered free of charge at
the WHO Collaborating Center for Urologic
Tumors, Karolinska University Hospital,
Stockholm, Sweden, e-mail diana.eriksson@ki.se
European Urology Today 13
 Rules and Regulations
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Win the EAU Hans
Marberger Award
This initiative is made possible through an unrestricted educational
grant by Karl Storz Endoscope, Germany
2009
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Surgery and you might be awarded the
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Important The two EAU Prizes for Best Paper

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announcement and promising urological scientists to
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their achievements to the European
urological community.
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n
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14 European Urology Today August/September 2008

Djavan shares skills with Belgian residents in Leuven
Dr. Frank Van Der Aa
Chief resident
University Hospitals
Leuven
UZ Gasthuisberg
Leuven (BE)
frank.vanderaa@
uz.kuleuven.ac.be
When we asked Professor Bob Djavan to visit our
department on a cold winter day in December 2007 at work in Gasthuisberg Leuven. We visited the wards,
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
We were pleased to have invited an international
expert on various (oncological) topics. We knew he
was Austrian, that he fluently spoke several
languages and that he was an excellent lecturer. We
were sure we could learn a lot from him.
Several months later, in spring 2008, the three last
year residents of our department invited Prof. Djavan
to be the visiting professor at our hospital from 26 to
29 May with generous sponsorship from the EAU’s
European Urological Scholarship Programme (EUSP).
Prof. Djavan with his “Fonske”.
European Urological Scholarship Programme
www.reviews
Dr. Andrea Cestari
Section Editor
Milan (IT)
a_cestari@yahoo.it
www.usanz.org.au
www.urosoc.org.au
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
for you to first visit and navigate through this
informative website.
The USANZ website is not only well designed but is
also user friendly with a handy tool bar on the left of
the screen to facilitate easy navigation. The two most website describes well-guided submission steps.
interesting sections of the site are the “Education and From the “Table of contents” button, readers and
training” and “Positions” The former section offers a
description of the USANZ’s innovative new Surgical
August/September 2008
When we met Prof. Djavan at the Brussels airport, the history, current medical problems, indications for
first thing he asked was to drive past his apartment. surgery, alternative treatments and the radiological
In the beginning we thought he liked jokes about examinations of the patients were reviewed and
German highways and fast cars (a drive to Vienna discussed. We found (luckily) great similarities in our
would almost take 12 hours in an everyday resident approach to patients.
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
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.
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.
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
local Italian restaurant and a first visit to our “night participation in the visiting professor programme and
for his teaching activities. Professor Hein Van Poppel
clinic. We demonstrated the computer system we urological and world problems. and Djavan and also some of the residents also gave
used and shared experiences about the modus short testimonials. We gifted Prof. Djavan Leuven’s
On Tuesday, a full- day of surgery was planned. We iconic “Fonske,” symbol of student life in our city.
started early in the morning by performing a radical Again, the evening ended in our ‘night office.’
prostatectomy, with Prof. Djavan demonstrating the
Rocco-Djavan technique which he presented the day Prof. Djavan left Leuven early the following morning.
before. The second case was another radical Although some of the residents and staff suffered
prostatectomy. Prof. Djavan explained how he headaches from all the ‘late-night’ teaching activities,
performs the essential steps in the procedure and we all had a very good impression of the ‘visiting
again demonstrated the Rocco-Djavan technique. The professorship’ of our new neighbour. Indeed, we are
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…
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
planned for surgery in the coming days. Medical allowed the senior residents to perform, under his department in Leuven
Embracing Excellence
Education and Training (SET) programme. This new in Prostate, Bladder
programme started this year and involves a re-think
and a restructure of surgical training, moving away
and Kidney Cancer
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
www.hindawi.com/journals.au/
Advances in Urology is a peer-reviewed, open access
journal that publishes state-of-the-art reviews and
the widest possible audience worldwide, and without
the constraints of expensive, hard-to-access,
traditional bound journals.
To submit a manuscript to this journal is easy, and the
website users can also have free access to all the
issues already published.
www.emucbarcelona2009.org
2nd European Multidisciplinary Meeting on Urological Cancers organised by:
European Urology Today 15
Book reviews
Prof.Dr. Paul Meria
Section Editor
Paris (FR)
paul.meria@sls.
aphp.fr
Our summer reading this year covers a wide range of
topics ranging from a practical clinical guide on
female urology, new techniques in uroradiology to
male sexual function. If one is looking for an
overview on these subjects the following books offer
comprehensive information and insightful details.
Female Urology: a practical
clinical guide
Goldman and Vasavada, with the help of more than
60 contributors have written this textbook dedicated
to female pelvic medicine. During the last 10 years
many aspects of female urology evolved either in the
field of evaluation or in treatment even as minimally
invasive procedures replaced most of open
techniques. Such evolution was associated with
significant decrease of morbidity.
The book is divided into three main parts. The first
part considers the anatomic basis of pelvic support
and various evaluation such as urodynamics, taking
account of clinical indications. The second part,
dedicated to treatment, separates four sub-parts
including stress urinary incontinence, overactive
bladder, prolapse and reconstruction. For each topic,
pharmacological and instrumental treatments are
presented. The two chapters dedicated to
reconstruction considered selectively female urethral
diverticula and vesico-vaginal fistula.
The third part, certainly the most original, presents an
overview of clinically encountered problems through
18 cases studies, each of them discussed by
international experts. Complex female urology is also
practically discussed including a presentation of two
cases studies dealing with post-prostatectomy
incontinence. Nevertheless such widening to male
incontinence is understandable since some new
techniques of treatment are identical to those
proposed for female stress incontinence management.
Physicians involved in the management of female
urology and incontinence will appreciate this very
practical textbook.
Editors : Goldman, Howard B.; Vasavada,
Sandip P.
ISBN : 978-1-58829-701-3
Published by : Humana Press
Publication date : 2007
Pages : 438
Illustrations : 127 illus., 15 in colour
Cost : 140 euro
Binding : Hardcover
Prostate Cancer: biology,
genetics and new
therapeutics
Seventy-five contributors produced this excellent
textbook (Chung, et.al) which offers an overview in
the wide field of prostate cancer. The first chapter is a
dedication to Donald Coffey whose research works
represented an outstanding contribution to our
knowledge about prostate cancer. The following three
sections and 28 chapters are dedicated to genetics,
biology and therapeutics.
Molecular genetic aspects of prostate cancer are
presented in the first section. Various aspects, such as
hereditary cancer, genetic epidemiology, androgen
receptor polymorphism or xenograft models are also
presented in detail. This section summarises recent
developments and provides an excellent review of
current knowledge. Anticipated improvements and
other advances in the field were also mentioned in
this chapter.
The nine chapters dedicated to cancer biology
described many aspects of basic science including
angiogenesis, molecular pathways and stroma-
epithelial interaction. The results from ongoing
research in such a field represent a strong basis for
the development of new therapeutics.
The last part dedicated to therapeutics presents
classical techniques such as radical prostatectomy and
radiotherapy and also focuses on new developments
such as chemotherapy, antiprogression agents,
vaccine or gene therapy. A special chapter is
dedicated to chemoprevention. Undoubtedly, the
future of prostate cancer management will associate
various therapeutics, which were presented in the
aforementioned chapters. Researchers will find in this
textbook comprehensive information and clinicians
will obtain an excellent overview of the utility of
research that has bearing on the future of their
practise.
Editors : Chung, Leland W.K.; Isaacs,
William B.; Simons, Jonathan W.
ISBN : 978-1-58829-696-2
Edition : 2nd ed.
Published by : Humana Press
Publication date : 2007
Pages : 508
Illustrations : 94
Cost : 140 euro
Binding : Hardcover
Website : www.humanapress.com
www.springer.com/humana+press/
urology?SGWID=0-150710-0-0-0
New Techniques in
Uroradiology
The authors (Morkos, et. al) present an overview of
various techniques of imaging in uroradiology
including ultrasonography, tomography, MRI, and
radioisotopes. Nearly 30 authors from the USA, the
UK, France and Italy wrote the 14 chapters including
diagnosis techniques and interventional aspects of
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.
After general considerations a specific chapter focuses
on cardiac issues related to ED and the authors
emphasise the role of ED as a primarily vascular
disorder in many cases. The subsequent chapters
consider various approaches of ED, including primary
care management, hormonal and psychosocial
evaluation. Various causes of ED are described,
including postoperative ED after pelvic surgery.
A separate chapter is dedicated to female problems
which are currently best considered in clinical practise
and represent an increasingly encountered problem.
The treatment of ED is widely described, with many
chapters dedicated to various aspects such as oral
and intracavernosal therapies. Mechanical treatments
including vacuum devices and penile implants are
also discussed. Two chapters focus on Peyronie’s
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
techniques are currently replacing the classical one of the emerging treatments for ED. The therapy’s
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
of helical CT scan in diagnosing urinary stones. They results of experimental studies which assess tissue
demonstrate the accuracy of such a technique in remodelling through a molecular approach.
detection and evaluation before treatment.
All practitioners of various disciplines involved in the
The use of imaging for kidney tumours is widely management of ED and other sexual diseases will
discussed. A chapter is dedicated to the diagnosis of find in this book a practical tool, which is useful for
complex renal cysts while another chapter the assessment and treatment of most patients.
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
in children, while MRI’s utility in prostate imaging is Cost : 130 euro
demonstrated in another chapter. Interventional Binding : Hard cover
techniques, such as percutaneous operations or Website : www.humanapress.com
image-guided ablation of renal tumours, are  www.springer.com/humana+press/
described in two specific chapters. urology?SGWID=0-150710-0-0-0
This textbook is richly illustrated and the quality of the
images is quite excellent although colour figures are
absent. Although the book is intended for radiologists,
most urologists and nephrologists will find useful
information for clinical practice.
Editors : Morocs, Sameh; Cohan, Richard H.
ISBN : 9780824728755
Published by : Taylor & Francis Group
Publication date : April 2006
Pages : 416
Cost : 158 euro
Binding : Hard cover
Website : www.catalogue.informahealthcare.
com
Male Sexual Function: a guide
to clinical management
Mulcahy and 43 contributors, all of them experts in
the management of sexual diseases in men, have
written the second edition of this book which was first
published in 2001. They aimed to provide the reader a
Book reviews
comprehensive overview of male sexual dysfunction.
Introducing a new category
of stone extractors.
NGage Nitinol Stone Extractor is not a grasper
or stone basket, but an entirely new category in
the evolution of stone extraction. The patented
design enables physicians to easily engage,
release or extract stones in the kidney or ureter.
To learn more, contact your Cook Medical
representative or visit www.cookmedical.com.


™



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


®
      
     

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

Urology Week replaces Prostate Awareness Day, an
initiative launched a few years ago by former EAU
Secretary-General Professor Pierre Teillac. Urology
Week was set up to make the general public more
aware of urological conditions and the work of the
urologist. To achieve this goal the EAU collaborates
with Europa UOMO, a European advocacy movement
working to educate the public on prostate cancer
issues.
We would appreciate it if you could add a link from
the website of your hospital or institution to
www.urologyweek.org, by placing, for example, a
link on the patient information page. The more links
placed on the website, the more people will access
the information. This is, after all, is our ultimate goal:
to provide Europeans with the best possible
information about urological conditions and the
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
and European faculty to the United States. The programme aims to promote
international exchange of urological medical skills, expertise and knowledge.
This upcoming 2009 American Tour will provide grants which will enable four EAU
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.
Information and application forms
For all further information and programme application forms please visit
www.uroweb.org, and select International Relations, AUA-EAU International
Academic Exchange Programme or contact the EAU Central Office,
T +31 (0)26 389 0680, F +31 (0)26 389 0674, E: a.terberg@uroweb.org.

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
Harmonized level of knowledge
Course director Prof. Hein Van Poppel stresses the value of organ-based medical oncology
Prof. Hein Van
Photo by: Runkel
Poppel
Course director of the
ESU masterclass,
Leuven (BE)
Email: Hendrik.
vanpoppel@
uzleuven.be
We are very happy with the number of registrations.
That´s actually the first time that we had more
applicants than tickets for the three modules. We do
not want to have the modules with more than 150
people in total. Fifty participants per module is the
maximum we can take in order to allow lively
interaction.
The scientific level is pretty high. There is daily
practice in the programme such as lectures on
intravesical or hormone treatment, which the
urologists are very keen on. And than there are more
sophisticated treatments which are the cytotoxic
intravenous chemotherapy and the targeted agents.
When the targeted agents became available we felt
that there was a need for urologists to expand their
knowledge. They must be able to prescribe and
administer these treatments themselves, or at least
have enough knowledge about the treatment
schedule and about the toxicity in order to inform his
Open minds for new therapies
Over 150 participants joined this year´s ESU Masterclass on medical urological oncology
Prof. Ziya Kirkali
Photo by: Runkel
ESU course director,
Izmir (T)
email: ziya.kirkali@
gmail.com
It is actually the third year that we are having this
masterclass and I think we are quite satisfied with
what we have achieved so far. Obviously the reason
why we started this project was because of the
changes in the field of urology and oncological
urology in particular.
In the third course we have more than 150
participants and this is a big success. And we still see
a lot of applications we could not accept and had to
say: “Well, we are sorry, but it is all fully booked.”
Partly it is based on the interaction between the
attendees and the lecturers. If you have a larger
audience this would be almost impossible. So this is
why we had to limit it to 50 participants per module,
which is the ideal figure.
August/September 2008
Barcelona, 28-29 June 2008
patient before eventually referring him to a colleague course. I am pretty sure that in future they will get
expert in medical oncology. certificates to prove that they have passed the
examination and as a matter of fact are actually able
There is no debate that the treatment should be given to administer the therapy properly.
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
course has been designed. medical treatment and chemotherapy. In other
countries medical oncologists give cytotoxic
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
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
commercially available in my country are by law course too difficult. him. He wants you to advise and not to be sent to
determined to be prescribed either by a medical another specialist without complete information on
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.”
oncology. Indeed these new agents are very feel that the level of the masterclass is too high. It
expensive. Therefore not every urologist is allowed to would be nice if this masterclass could contribute to Medical oncologists are responsible for the general
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
question then is “Who qualifies to be a urological interested in medical oncology should have the same medical oncologists treat breast cancer today, brain
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
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
therapies? attendees in the coming years. we need medical uro-oncologists and radiation
uro-oncologists to work with urologists specialised in
There will be very strict criteria. In this situation you “European prostate cancer patients come to us, to the oncology on a multidisciplinary basis.
need accreditation and credit points or certificates urologists, who see them from the early stages till the
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
another specialist at some stage of the disease but treatment is delivered by different organ based
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
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
they have taken the exam after having done the to follow. You treat the patient right from the oncology and organ-based radiotherapy.
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
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
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
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.
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
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
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
these advances. What we thought of was sort of a appropriate. oncological urology. But, what we are claiming is that
major course for the practicing urologist to update we can broaden their minds and give them the
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
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
therapy, systemic cytotoxic chemotherapy and
palliation.
Oncology plays the major role in every urologist´s
practice, so this course is focussing on the medical
therapies. And I think it has been a great success
because we were the first to do it in the world. We
have equal parts of participants from Europe and
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.
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
an increasing incidence randomized trial (Motzer, JCO 2007). In general, patients
(8-10/100.000) over the last with intermediate or poor prognosis should be referred
decade. About 90 percent of to a specialized center in order to tailor treatment
patients have stage I to II according to risk factors. Some patients may benefit
disease and the number of from early intensified treatment in view of the US
patients with advanced Intergroup trial (e.g. unsatisfactory marker decline).
disease in industrialised
Prof. Peter Albers countries decreased over Based on a randomized trial from UK, all patients
time. The overall survival of with standard chemotherapy should receive an
patients with low stage disease is at the 98 to 100 antibiotic prophylaxis with levofloxacine to reduce the
percent level, however, patients with advanced number of febrile neutropenia episodes (Cullen, NEJM
disease and intermediate/poor prognosis criteria still 2005). Results from another randomized trial from
face a risk of death of disease up to 50 percent. France in good prognosis patients (3 x BEP versus 4 x
EP) indicated that the rate of pulmonary toxicity by
Classification bleomycine is lower than expected, however, the rate
Most critical for a good outcome is the correct of peripheral neuropathy is higher than expected and
classification at diagnosis according to IGCCCG (see was more pronounced in the 3 x BEP arm with 16
table). The basic parameters are the location of percent versus 5 percent (Culine, Ann Oncol, 2007).
metastases and the level of serum tumor markers after
orchidectomy. Not only treatment is tailored according Residual tumor resection
to this classification, poor risk patients should be After major response to chemotherapy, RTR is
considered to be treated in centers with a lot of indicated in most patients with non-seminoma and
experience in chemotherapy and residual surgery. visible residual disease (usually > 1 cm). In patients
In addition, patients with good prognosis parameters with radiologically complete remission, it is an
should not be overtreated. They only need three individual decision of whether RTR will be
cycles of cytotoxic chemotherapy and residual tumor recommended or not (dependent on radiologic
resection thereafter in cases of non-seminoma and appearance, primary histology, marker decline,
visible disease. In contrast, patients with intermediate co-morbidities, location of residual disease). In
and poor prognosis will always need four cycles of patients with multiple metastatic sites, the site with
chemotherapy before residual tumor resection is the largest residuals will be the first to be resected.
indicated. There are only very few patients with In general, all residual tumors should be resected. In
seminoma and intermediate prognosis parameters patients with necrosis in the retroperitoneum and in
(non-visceral metastasis). one side of the lungs, it might be considered to
postpone the contralateral lung resection.
Standard chemotherapy In patients with seminoma, the indication for residual
According to IGCCCG, three or four cycles of tumor resection is limited. Only patients with a
chemotherapy are standard initial care for patients with positive PET/CT scan or growing masses after
advanced testis cancer. High-dose chemotherapy is chemotherapy may be candidates for surgery. More
The roadmap to cure cancer? “We need good quality trials”
Prof. Antonio Alcaraz describes the potential of
novel target therapy for RCC and prostate cancer
After knowing more about the molecular biology of the hormonal treatment.
the tumour, especially for the clear-cell type of the There are side effects, but
renal cell carcinoma, it is clear that the mutation of they are manageable by the
the VHL gene produces a stimulation of the vascular urologist. If the patient
endothelial growth factor (VEGF). The reason for this develops the hormone
is the accumulation of a molecule called HIF refractory disease we do not
producing the stimulation of the VEGF pathway. It is know much about the
also very well known that not only VEGF stimulation changes of the tumour.
but also the stimulation of other growth factors will Prof. Antonio Alcaraz There are only a few studies
end in an up regulation of mTOR, which will finally on the molecular changes of
increase the proliferation of the tumour cell. So VEGF the tumour.
and mTOR are pathways to be targeted by the novel
smart drugs…Today we have a wide range of drugs Because we do not know exactly what to target.
which can be used in the treatment of metastatic Regarding prostate cancer we do not know it with the
disease. same accuracy as is the case with renal cell cancer.
We know only a little about the changes in the
In the pre-antiangiogenetic therapy we were talking prostate cancer tumour after hormonal therapy. So
about an average survival of 16 months in the first line investigators should focus on these changes of
disease of metastatic renal cell carcinoma. Today the hormone refractory disease. What are the pathways?
new data presented at the ASCO meeting have
recently shown an overall survival of 26 months. for In future we will be able to collect an important
those patients treated with sunitinib. This means that number of tissue samples from hormone refractory
the survival of those patients has almost doubled. prostate cancer patients. We will define them
molecularly to see the genetic profile of those
I am not sure whether I would use the word “cure”, tumours. We will have to find the pathways activated
but I think we will be able to make it chronic, so that and then develop the right drug for these prostate
the patient will die from another cause totally cancer patients. Why are we so successful in case of
different from renal cell carcinoma. To some extent, in chronic myelocytic leukemia? Solid tumours use to
a few cases this has been achieved in prostate cancer have thousand of changes in genetics. Only a few are
using hormonal therapy. really important as signal channels. In leukemia they
could do it very easily. There is a single pathway and
The knowledge about the molecular changes in they know it very well. But this roadmap is still
prostate cancer is more difficult to understand. We unknown with respect to prostate cancer. We need to
have got a very attractive treatment for this disease, go back to basic science.
20 European Urology Today
than 90 percent of patients
will show necrotic residuals
as a result of a complete
histological remission after
standard chemotherapy,
more or less independent on
residual size.
The complication rate of
PC-RPLND / RTR has
decreased over the last
decades and in patients
without co-morbidities less
than 10 percent of
complications may be
anticipated, mostly minor. A
future development of the
surgical technique will be the
selection of patients for so Correct classification at diagnosis according to IGCCCG
called „template“ resections.
Not all patients benefit from
a full bilateral RTR with definitive loss of antegrade
ejaculation, especially if the initial primary tumor
metastasis was strictly located unilaterally. A
combined series from Germany has shown a 85
percent of preservation of ejaculatory function
without compromising the oncological outcome in
terms of retroperitoneal recurrences (Heidenreich,
Albers, GU-ASCO 2008).
Salvage treatment
Salvage chemotherapy should be given by specialized who really benefit from dose-intensified strategies.
centers after selection based on prognostic factors
(e.g. response to first line, location of metastases,
co-morbidities). Standard salvage chemotherapy
consists of four cycles of chemotherapy, usually as
different regimen compare to the initially given drugs. combination of chemotherapy and surgery and at
In some patients, high-dose regimens may be
benefitial and increase the overall survival to 40 to 50 treatment should be delivered in centers specialized
percent. This is a major improvement compared to
Noel Clarke summarizes systemic chemotherapy
for muscle-invasive bladder cancer
There are a number of schedules for treatment. The
ones proven to be most effective are those involving
platinum based combination chemotherapy. Most
groups have adopted Cisplatinum and Gemcitabine
as a popular standard.
Systemic platinum based combination chemotherapy
is a standard of care for metastatic bladder cancer.
This is effective in a proportion of patients as a
palliative therapy and will continue to be used in this
setting. However, it is not suitable for all patients,
particularly those with poor performance status and
patients with poor renal function. There is an urgent
requirement for new agents and trials of different
combinations to improve outcome and decrease
toxicity in this area of Urological Oncology. The use of
peri-operative chemotherapy is interesting. In many
countries, despite the evidence for benefit, neo-
adjuvant chemotherapy is used only sparingly.
“There is an urgent requirement for
new agents and trials of different
combinations to improve outcome ...”
This is because of the relatively limited overall
improvement in survival and the perceived risks of
toxicity and tumour progression whilst undergoing
chemotherapy prior to surgery. Better information
regarding which patients get the greatest benefit
would help enormously in this area. Regarding
adjuvant chemotherapy following definitive
survival figures from ten years ago demonstrating the
effect of centralization of treatment. In some of these
patients, salvage surgery is indicated and a close
interdisciplinary treatment strategy is recommended
at every stage of treatment.
Late toxicity issues get more and more important due
to detailled analysis of testis cancer survivors by
major European treatment centers. This should
remind everyone to reduce treatment in patients with
low stage disease and to tailor treatment to those
In summary, patients with advanced testis cancer face
a more favorable outcome compared to some years
ago mainly based on a better classification and
risk-adapted treatment. Treatment mostly consists of a
least in intermediate and poor prognosis patients this
in the treatment of testis cancer.
treatment, it is clear that
there is going to be limited
information from adjuvant
studies as these have
serially failed to recruit in
adequate numbers. There is
still a significant degree of
uncertainty as to the true
Mr. Noel W. Clarke benefit of this therapeutic
approach and the
Urological Oncological
community will have to be more innovative in
planning studies to answer questions about who
should receive this therapy and what the best drug
regimens are.
Cytotoxic chemotherapy should be used with
circumspection in the high risk and elderly groups.
The recent data from ASCO 2008 regarding EORTC
30986 shows that the toxicity rate in this group of
patients can be high, particularly if the renal function
is diminished significantly. We may need different
approaches in this group.
The current agents are effective to a degree but there
are significant problems. They are not curative in
patients with advanced disease, they don’t work for
everyone, there are toxicities and certain patients
cannot receive the existing drug combinations either
at all or at the optimum dose. We need good quality
trials of new agents / combinations and we need a
better understanding of the basic cancer biology of
this disease to enable us to develop more effective
therapies in this area of cancer medicine.
August/September 2008
Improved prognosis for patients
Indications, results and toxicity of novel targeted therapy
In Europe approximately
40,000 patients are
diagnosed with renal cell
carcinoma (RCC) annually.
Of these, around one third
have metastatic disease.1
The introduction of novel,
targeted therapies has
Prof. Joaquim Bellmunt dramatically improved
prognosis for patients with
metastatic RCC (mRCC). This article reviews the latest
information on targeted agents for mRCC.
Sunitinib is an oral, multitargeted receptor tyrosine
kinase (RTK) inhibitor, approved multinationally for the
first- and second-line treatment of mRCC. In a pivotal
phase III trial, sunitinib demonstrated superior efficacy
to interferon-alfa (IFN-a) for the first-line treatment of
mRCC.2 Median progression-free survival (PFS) with
sunitinib (11 months) was more than double that seen
with IFN-a (five months; P<0.000001).3 In the final
overall survival (OS) analysis, median OS was more than
two years (26.4 months) with sunitinib compared with
21.8 months in IFN-a treated patients (hazard ratio
0.821; P=0.0510). This is the first time OS of this duration
has been observed in first-line RCC treatment. Median
OS in patients without any post-study treatments was
28.1 months with sunitinib versus 14.1 months with
IFN-a (hazard ratio 0.647; P=0.0033).4 Sunitinib was
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
(MSKCC) prognostic risk groups.5 therapies. Sorafenib has demonstrated a consistent occurred in more patients receiving bevacizumab plus
tolerability profile and most AEs are of grade 1/2 IFN-a than IFN-a alone (28 percent versus 12 percent,
Sunitinib has also demonstrated activity in patients intensity. respectively). In the second trial, there was a
with cytokine-refractory mRCC. In a phase II study, significantly higher incidence of grade 3/4 AEs with
median PFS in sunitinib-treated patients was 8.8 The mammalian target of rapamycin (mTOR) inhibitor, bevacizumab plus IFN-a versus IFN-a alone.
months and median OS was 23.9 months.6 In an temsirolimus, is licensed in Europe for first-line use in
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
with mRCC, sunitinib demonstrated activity in a broad study with treatment-naïve mRCC patients considered endothelial growth factor receptor inhibitor axitinib
range of patients, including those with brain at poor risk (modified MSKCC risk criteria), and everolimus. Everolimus – an mTOR inhibitor –
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
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-
and are manageable with medical intervention or generally well tolerated; in the phase III trial serious treated patients achieved significantly longer median
dose modification.8 AEs occurred less frequently in temsirolimus-treated PFS compared with those receiving placebo (4.0
patients than IFN-a-treated patients.14 versus 1.9 months, respectively; P<0.0001).17 Incidence
Sorafenib is a multitargeted RTK inhibitor approved of AEs leading to withdrawal of treatment was higher
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
patients with cytokine-refractory mRCC, sorafenib had given in combination with IFN-a, is approved in percent, respectively).17
significantly longer median PFS versus placebo (5.5 Europe for first-line use in mRCC. First-line treatment
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
receiving placebo could crossover to sorafenib after compared with IFN-a plus placebo was assessed in patients with mRCC. As a result, they are
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
sorafenib was not significantly different from placebo bevacizumab to IFN-a significantly increased median treatment guidelines.1,18
(17.8 versus 15.2 months, respectively; P=0.146). In a PFS versus IFN-a alone (10.2 versus 5.4 months,
pre-planned analysis censoring for crossover, median respectively; P<0.0001). In the second trial, median
OS was significantly improved with sorafenib PFS was 8.5 months for patients treated with The references belonging to this article can be
(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
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

FGR: What about the relation between orchidectomy
and hormonal therapy of prostate cancer?
Aus: Hormonal therapy is a wide scope. Orchidectomy
is one way of delivering a hormonal therapy where
you remove the serum testosterone. So surgical
castration is a baseline hormonal therapy that works
well but it is a surgical procedure. You will of course
have all the side effects of not having your
testosterone any more. There is a risk to loose your
bone mineral density; your skeletal strength can go
down. You will loose your libido and with that goes
also the potency. It is an irreversible therapy, but the
compliance is 100 percent.
Equal to that in terms of efficacy is the GnRH
analogue therapy. When it comes to see the clinical
efficacy, it seems to be equal. But there are rare
cases where you will not have a full lowering of the
serum testosterone. If you have a patient who does
not respond as you expect from the medical therapy
you should test the serum testosterone to see that the
lack of efficacy is not due to the lack of efficacy of
your treatment instead of being that the tumour is not
sensitive to hormonal manipulation.
therapy, anti-androgens are one of them. How would
you summarize their role in treatment?
Aus: Today the role of anti-androgens is focused on
patients with locally advanced disease without known
metastases. The reasons to use anti-androgens
instead of LHRH analogue therapy are multi-focal.
One of them is that you maintain your serum
testosterone which means that you have a chance to
maintain your sexual interest and maybe also the
function. You will have no negative effects on the
bones but you have some other side effects. Especially
gynecomastia or breast pain… However, for most
patients, especially those sexually active, they have
less side effects. To take care of the bones is especially
important for those who will stand on the therapy for
a long time. They have a lot of gain not to be castrated
early. I think that for patients who are in locally
advanced disease and do not have metastases
anti-androgens are definitively a treatment option.
FGR: What about GnRH agonists?
Aus: They have been on the market for a long time.
They have not really evolved to it. The main problem
has been two-fold: One is that you do not have the
one has been that you have had histamine-like side
effects, even resulting in anaphylactic reactions… But
there are studies underway which might have better
results. This means there might be a coming market
for this kind of therapy. However the side effects are
equal to those with surgical or chemical castration. It
is just another way of delivering the chemical
castration meaning that they are most probably
restricted to patients with metastatic disease.
FGR: What is the best way to treat patients from your
point of view?
Aus: What we have learned during last year is that
hormonal therapy should not be given too early. Giving
it to a patient with a very low risk of progression the
hormonal therapy will only cause side effects. The
second important issue is that we have now shown
that the anti-androgen monotherapy seems to work. It
offers a possibility for treatment of those who are not
in a very bad shape with metastatic disease but have
locally advanced disease. This still maintains some
quality of life. For patients with metastatic disease, it
seems that you can choose either surgical or medical
castration with equal efficacy, although you have to
remember that medical castration sometimes does not
sometimes it is worthwile to
keep an eye on serum
testosterone.
FGR: What’s in the future?
Aus: What I would like to
hope and see is that we Prof. Gunnar Aus from
have not stopped the Göteborg (SE)
interest in hormonal
therapy. Why? Because given if you compare the side
effects of hormonal therapy to any other therapy, they
are quite low. For a cancer therapy it still has a very
favorable side effect profile. I envision that we can
develop local hormonal therapy. This means that you
will develop a vehicle that makes it possible to deliver
anti-androgens or other locally effective therapies
directly to the tumour. Local hormonal therapy as
targeted therapy… At the moment we are actually
performing a phase I study, where we give local
anti-androgen therapy, but it is very, very early… But
if we can find a depot formulation that works you can
do an injection every third month for example. In this
way it should be possible to minimize side effects and
optimize the local anti-tumour effect. We want to
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
order to have a meeting or course accredited by the
EBU in the future it will be necessary to evaluate the
course by a test.
During this year’s masterclass on medical treatment
for urological cancer in Barcelona, there was again a
multiple choice examination at the end of the course
that could be taken on a voluntary basis. The test
contained 100 MCQ’s delivered by the course teachers
and covering the topics that were dealt with during
the lectures. The MCQ’s were discussed beforehand in
order to have valid questions.
The participants in the examination (81 out of 150
registered) will receive the results of the test a couple
of weeks after the course and this will give the
candidate an impression about his/her performance.
For the future masterclasses, the intention is to
change the format of this evaluation in order to
enhance the learning process of the participants, but
also of the teachers. There will be an entrance test
and some of the MCQ’s asked during the entrance test
will be repeated during the exit test. In this way the
progress of the knowledge of the participants can be
evaluated and while also the teacher can have an
idea about his performance. Did he or she succeed in
delivering the important message to the urologists?
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
a comprehensive course was also presented during
the congress,” said Dr. Balaz Vladimir. Focusing on
urolithiasis and urinary tract infections, Professors
Anup Patel and Tarik Esen chaired the ESU course
which attracted a high number of participants. Esen
discussed epidemiology and etiology of urinary stones
and the pro- and metaphylaxis and medical treatment
of urinary stones.
Patel gave an overview of the latest methods in
urinary stones treatment and discussed some tips and
tricks in percutaneous nephrolithotripsy. From the
Slovak presenters, Ass. Prof. Jan Luptak (Martin) and
his colleagues from the organising urology clinic in
The Slovak Society of Urology expressed its thanks to
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
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
interesting cases from their practice. hopes that more ESU courses will become a
The local organisers also appreciated the EAU guest traditional offer in their future national meetings.
“Urolithiasis is a disease that we see everyday in our lecture on prostate cancer
practice. This ESU course gave a global and detailed presented by Prof.
view on disease from its etiology and diagnoses until Per-Anders
the treatment,” said Ledererova. “It also gave us the Abrahamsson. “We
opportunity to have an interactive discussion during appreciate his presence
the presentation. This was a chance for many of us to at our congress and the
compare our everyday work with European trends high quality of
since not all of us get the chance to attend the presentation which
European meetings.” Both the organisers and discussed the long term
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
European Association of Urology (EAU) and the
Chinese Urology Association (CUA), the first EAU-CUA
joint course, the Chinese Urological Resident
Education Programme (CUREP), will be held from 21
to 23 November 2008 in Shanghai.
With the EAU having established itself as an
important international European-based association,
a number of collaborative links in education have
been established with various associations
worldwide.
Last year 12 enthusiastic young Chinese urologists
participated in the annual European Urology
Residents Education Programme (EUREP) in Prague.
After assessing the participants’ reports and receiving
a positive feedback, the CUA has been in contact with
the EAU Education Office and have asked for input
from the European School of Urology (ESU) to set up a
similar programme in mainland China.
CUREP will cover four topics and will enroll 120 young
Chinese urologists. The course will be presented in
English and the faculty for this year will include Prof.
Christopher Chapple (United Kingdom), Prof. Walter
Artibani (Italy), Prof. Manfred Wirth (Germany) and
Prof. Didier Jacqmin (France).
From the CUA side, eight professors of urology from
China will join their European colleagues. They are Dr.
Liping Xie (Hangzhou), Dr. Yong Yang (Beijing), Dr.
Dingwei Ye (Shanghai), Dr. Ningchen Li (Beijing), Dr. The joint CUREP programme represents some of the
Kexing Xu (Beijing), Dr. Gang Zhu (Beijing), Kunjie important new initiatives to help boost urological
Wang (Chengdu) and Dr. Jianguang Qiu (Guangzhou). education worldwide.

European School of Urology

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

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

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
Is there any difference in the mixed incontinence patients?
The tension-free vaginal tape (TVT) procedure has
become one of the most popular procedures
worldwide for the treatment of female stress urinary
incontinence (SUI). Its high, long-term success rate
ranges from 84% to 95%. However, TVT procedure is
associated with concerns about operating safety in
terms of risk of injuries to the bowel and major blood
vessels, and of bladder and urethral perforation.
TVT is also associated with postoperative voiding
difficulties such as transient urine retention and
urgency. To avoid the complications associated with
the retropubic route, the transobturator route (TOT)
was developed. Insertion through the obturator
muscles reproduces the natural suspension fascia
of the urethra while preserving the retropubic space
by avoiding intrapelvic and retropubic blind
passages.
Consequently, the TOT approach seems to limit the
risks of visceral and vesical lesions and, more
importantly, of bowel and vascular injuries. In a
preliminary study, TOT was associated with a high
success rate, no bladder injury, and few perioperative
complications in women with SUI. At the 23rd Annual
European Association of Urology, Kocjancic and his
colleaguess (2008) compared TVT and TOT procedures
as a therapy for mixed urinary incontinence in a
prospective, multicentre, randomised study.
Surgical treatment of SUI: looking for a common ground
Case series show positive results for TVT and some obturators
Prof. D. Pushkar
At the course on vaginal surgery given by European
School of Urology (ESU) during the 23rd Annual
Congress of the European Association Urology held
last March in Milan, Italy, Professor Dmitry Pushkar
(Department of Urology, Moscow State Medico-
Stomatological University, Russia) focused on the
surgical treatment of stress urinary incontinence (SUI).
One of the goals of the course was to present clinical
experience that describe and evaluate newly
developed techniques in current clinical practice. The
main theories of the development of SUI were
explored with the audience in an interactive manner.
Special attention was given to new techniques that
use synthetic tapes in SUI surgery and the discussion
also covered the management of complications of
surgery for stress incontinence.
Furthermore, the course also included a detailed
coverage of pelvic anatomy for urologists to better
understand and apply modern surgical approaches to
pelvic organ prolapse. Vaginal approach to prolapse
and the use of different meshes were presented in a
critical way and based upon personal experience. The
management of periurethral cysts, fistulas and other
rare conditions were also shown during podium and
video presentations. Carefully prepared clinical cases
and video demonstration of various surgical
techniques and tricks provided a clear understanding
of the most common procedures to all participants.
Urinary
Incontinence
August/September 2008
Multicentre randomised trial
Between May 2002 and April 2005, 116 consecutive
women with SUI were randomised to TVT (61) or to
TOT (55). Inclusion criteria included stress or mixed
urinary incontinence, urethral hypermobility. Patients
with grade II prolapse in any vaginal compartment
were excluded. The Ulmsten and Delorne techniques
were used. Mixed incontinence was present in 25 out
of 61 patients in the TVT group 19 out of 55 in the TOT
group.
The pre-operative work-up included a detailed case
history, the voiding diary, the urogenital distress
inventory (UDI-6) and the impact incontinence quality
of life (IIQ-7) questionnaires, a clinical, neurological
and urogynaecological, 1-h pad test, urodynamic
study. Subjective assessment (calculated by
questionnaire scores), The Mann-Whitney, Wilcoxon,
Chi square and McNemar tests were used for the
statistical analysis.
SUI versus mixed incontinence. The preoperative
parameters of the two groups doesn’t show statistical
differences. The perioperative and postoperative
complication rates are acceptable for both the
procedures and not statistically different. The
subjective (questionnaire score) and objective (stress
test) assessments of results show a good efficacy for
both the procedure with no significant differences.
Female reconstructive urology
Professor Pushkar, who chaired the ESU course, said
female reconstructive urology, just like the entire field
of urology and, indeed, medicine as a whole, has
been influenced by the trend toward minimally
invasive procedures.
SUI affects millions of women in Europe and the
United States. Nowadays dozens of surgical
procedures are available although with limited data
used for treating SUI in female patients. Some
evidence-based medicine (EBM) data are available,
but not widely applicable in all disciplines. Current
approaches and clinical guidelines are country
dependent and in some places they consist of the
Burch procedure as standard care and the
conventional trans-vaginal tape (TVT) that are
performed in more severe cases and in patients with
recurrence.
The TVT procedure was introduced in 1996 and was
based on the so-called integral theory or, as some
authors claim, mid-urethral theory. It is misleading to
consider the TVT procedure as a modification of
traditional pubovaginal sling since this is a totally
new and different procedure.
Since the introduction of TVT, the procedure has
become one of the most widely used surgical
treatments for SUI. Despite numerous short-term
reports of its efficacy, Deval et al. (2002) were the first
to examine patients’ dissatisfaction with the TVT
procedure. In their study, 90.4% patients were
objectively cured leaving too few patients to analyse if
any complications led to dissatisfaction. However, they
noted a 70.6% subjective cure rate that was much
less than the objective cure rate. This was attributed
to new onset urge symptoms.
Synthetic sling
In 2001, Delorme (2001) described the use of a
synthetic sling with passage through the obturator
space called the transobturator tape (TOT). This
passage would theoretically reduce the risk of bowel,
bladder, and vascular injury during trocar passage. It
may also lead to less urge symptoms postoperatively.
Today, there are still many urologists who prefer to
perform either conventional suburethral synthetic
tapes or obturators.
During the course, Pushkar analysed the latest results
dealing with the efficacy of these procedures and
answered questions regarding novel approaches and
minimal procedures.
Pushkar pointed out and reiterated that it is a
misleading to consider the TVT procedure as a
modification of the traditional pubovaginal sling, as
Results
TOT TVT SUI
Mixed SUI Mixed - Dry
- Improved
- Not dry
36 25 36 19
30 (83%) 17 (68%) 30 (83%) 8 (42%)
3 (8.3%) 8 (32%) 4 (13%) 7 (37%)
3 (8.3%) 0 2 (5.5%) 4 (32%)
The more frequent late complication is de novo
urgency in both the procedures.
Equally efficient
In summary the results of this prospective randomized
study show no significant differences between TVT
and TOT procedures. A special consideration has to be
done for the storage symptoms. While in the TVT
group there were no statistical significant differences
of storage symptoms before and after the procedure,
this became significantly lower in the patients treated
with TOT. In the TOT group the storage symptoms
were cured in a bigger proportion (31% in the TVT
and 52% in the TOT).
In conclusion, TOT appears as efficient as TVT as a
therapy for female SUI, with minimal complications at
he stressed that the TVT is completely new and
different. The same applies to obturators as practice
has showed that this procedure leads to specific
postoperative complications as of approach.
Moreover, subjective and objective outcome of these
procedures are different.
Aware of the differences between objective and
subjective outcomes, Munir et al. (2005) developed
their own questionnaire which was adapted from the
Bristol Female Lower Urinary Tract Symptoms
Questionnaire since there were no suitable
questionnaires to help understand the patients’
perceptions that affect their satisfaction.
With 54 patients completing follow-up with a
response rate of 72%, Munir et al. reported that 59%
of patients were completely dry or leaked less than
once a week; 92% reported an improvement in their
symptoms with 80% stating a greater than 75%
improvement. Ninety-four percent of patients were
satisfied with their operation and 75% were very
satisfied. These rates were then compared to clinical
notes where physicians have documented that 96% of
patients reported improvement and 46% were
completely dry.
Patients’ reports
Not surprisingly, these rates did not differ much
between the questionnaire and the information
reported by the patient to their physician. This
indicated that most patients are as likely to report
their urinary symptoms to their surgeon as they
would in an anonymous manner. Instead of looking at
urodynamic definitions of cure versus subjective
assessment of cure, the Munir study analysed the
quantity of leakage compared to the patients reports
of improvement as well as satisfaction with the
procedure.
These rates demonstrate that patients may be
satisfied without being completely dry and some may
be satisfied with less than a 75% improvement of
their symptoms, which again confirms how patient
satisfaction does not rely upon the attainment of cure.
Nevertheless, all efforts were made to minimise the
procedures, and new procedures were developed
with the potential to reduce postoperative
complications and to improve continence results and
overall patients’ satisfaction.
Questions remain whether we should improve the
existing techniques or we should, instead, implement
the newest procedures, or whether it is possible to
improve the existing techniques, as compared to
whether we are prepared to implement to the routine
practice with the newest procedures given the limited
clinical data we have now.
Urinary
Incontinence
mean follow-up of 31 months. Postoperative voiding
symptoms are not different in the two groups. The
storage symptoms were lower in the TOT group of
patients. Urgency remains a post-operative problem
especially in the TVT group. No statistical significant
differences were observed in terms of cure rate in
mixed urinary incontinence.
Source: Kocjancic, E., Costantini, E., Frea, B., Crivellaro,
S., Degiorgi, G., Tosco, L., & Porena, M. (2008). Tension
free vaginal tape vs. Trans obturator tape: Is there any
difference in the mixed incontinence patients ? Results
of a multicentre randomised trial. European Urology
Supplements, 7(3), 123-123.
Key messages
Although it is not possible to provide thorough
answers to all these questions, Pushkar’s key
messages were:
1. Vaginal urological surgery is an essential part of
urological practice and should be implemented
accordingly.
2. TVT and some obturators provide encouraging
results in case series and randomly controlled
trials. The longest follow- up data of 11 years are
available now for conventional TVT procedure.
3. Mini slings are new procedures with limited
clinical data, so patients should be informed of
the experimental status of these procedures and
the lack of long-term follow up.
4. Synthetics are mostly used now – by both
urologists and gynaecologists.
5. Type of mesh to be used is Macroporous Prolene.
6. Be prepared for reconstruction in case of serious
complications after synthetic slings.
7. There is a need for pelvic surgeons training
among European urologists.
8. Vaginal prolapse surgery, using mesh, should
be performed only by urologists who are
specially trained in vaginal surgery and they
should have performed these procedures
regularly.
9. Careful anatomical considerations should be
taken during patient’s examination in order to
clarify indications.
10. Urologists should spend more time with
patients before and after the procedure.
11. Good results come only after a careful and
detailed patient data analysis.
12. Strict criteria for cure/ improvement/ failure of
incontinence should be defined based on
patient perception as well as on objective and
semi-objective tools such as validated
questionnaires, diaries and pad tests. Subjective
patient’s analysis is the most important
instrument.
Additional reading:
• Delorme, E. (2001). Transobturator urethral
suspension: a minimally invasive procedure to
treat female stress urinary incontinence. Progres
En Urologie, 11(6), 1306-1313.
• Deval, B., Jeffry, L., Al Najjar, F., Soriano, D., &
Darai, E. (2002). Determinants of patient
dissatisfaction after a tension-free vaginal tape
procedure for urinary incontinence. Journal of
Urology, 167(5), 2093-2097.
• Munir, N., Bunce, C., Gelister, J., & Briggs, T.
(2005). Outcome following TVT sling procedure:
A comparison of outcome recorded by surgeons
to that reported by their patients at a London
District General Hospital. European Urology,
47(5), 635-640.
European Urology Today 25
Translational research in renal cryosurgery technologies
Dr. Jorge Rioja
Urologist
AMC University
Hospital
Amsterdam (NL)
Prof.Dr. Jean De La
Rosette
Urologist
AMC University
Hospital
Amsterdam (NL)
J.J.Delarosette@amc.
uva.nl
Prof.Dr. Pilar Laguna
Urologist
AMC University
Hospital
Amsterdam (NL)
Cryosurgery is one of the minimally invasive
techniques used to treat renal tumours < 4 cm. In
renal cryosurgery needle-shaped probes are inserted between September 2003 and August 2007,
into the tumour, and by using argon gas or liquid
nitrogen an ice ball is formed. This ice ball should
engulf the entire tumour, thereby ablating the
cancerous tissue plus a safety margin of healthy
tissue between 0.5-1 cm.
The lethal effects of freezing arise from two major
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
which occurs in the thawing period (1). These
mechanisms are related to several parameters: freeze
rate, end temperature, duration of freezing, thaw rate, The presence of complications was correlated in the
and number of freeze cycles (1-3)
The rationale for performing cryosurgery are the
increasing diagnosis of small renal masses, the high
percentage of benign (small) masses, their low
biological potential, the incidence with elderly and ill significant entailing a higher risk of complication in
patients, and that partial nephrectomy (open or
laparoscopic) is still a challenging procedure with a
high complication rate (18%).
Therefore, nowadays the current indications for a
renal cryosurgery are peripheral enhancing mass up
to 4 cm, central masses if visible by ultrasound,
elderly patients and the presence of co-morbidity,
patient’s desire, congenital RCC syndromes and
solitary kidney.
The most extensively studied parameter is the lethal
or critical temperature, resulting in complete loss of
cell viability. Unfortunately, there are limited tools
available to identify the three-dimensional location of all the cases performed at our institution, in order to
the critical isotherm in cryosurgery. Nowadays, the
Figure 1: Photo of the customised template with one cryoprobe and 4 termosensor parallel to it
at 3 mm distance, and the development of the ice ball which engulfs the cryoprobe and the four
termosensors around it.
26 European Urology Today
employment of termosensors in order to measure the influence the freezing rate (8). Inclusion criteria were
temperature at several locations, in and around the laparoscopic cryoablations (either transperitoneal or
tumour, is critically important. retroperitoneal approach) with at least one
In cryosurgery it is crucial that the performance of termosensor placed central into the tumour, while
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
To evaluate it, different set ups were used, employing patients, from these 54 met
eight single probes during six freeze cycles, four inclusion criteria and were
single probes during four freeze cycles, multiple further analysed. Upon the
configuration with four probes during two freeze findings of the intraoperative
cycles and multiple termosensors. For testing the tumour biopsy, two groups were
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
at room temperature were used as homogeneous diagnostic biopsy and Group 2
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)
-20˚C. To measure cryoprobe performance a
customised template was used. It consists of three The overall rate of the
Plexiglas round discs (1 cm thick), space 5 cm apart, temperature decrease in the
with drilled holes to exactly fit 17-gauge needles freezing phase of the first freezing Figure 3: Cryoprobe performance
(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
Moving from the ‘bench’ to the ‘bedside,’ a that the rate of the temperature
prospective, multicentre study, which was run decrease for the RCC group, is
larger until it reaches -20˚C, but
evaluating the peri-operative morbidity (30 days) was afterwards, it becomes larger for
conducted. 81% of the treated patients had some the benign group.
co-morbidity associated, the ASA score was 2 (SD
0.65), the Charlson Index was 2 (SD 1.47) and the Analysing which are the influence
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
open approach, the mean time was 180 min and there univariate analysis, we found that
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
another into a partial nephrectomy. tumour, creatinine level prior group and the benign group.
surgery, ASA score monokidney,
cardiomiopathy, diabetes mellitus, COPD, use of
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
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
(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
presence of complications and the tumour size remain (with a significantly larger negative slope coefficient). correct placement. The strongest variable in the
multivariate analysis, which doubles the freezing rate,
the perioperative period. The only found factor that decreases significantly the is the presence of diabetes mellitus.
freezing rate is the presence of COPD, which we
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
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
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
clinical series in humans show that destruction is diabetes mellitus are independent influence factors in by clinical factors like the presence of diabetes
ensured by achieving cytotoxic freezing temperatures the temperature decrease rate, by accelerating the mellitus. More importantly though is that there are no
of -40˚C, with a double freeze-thaw cycle and 1 to 3.1 freezing process. short-term differences in the clinical outcome.
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
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
rate during cryotherapy which have not been have a faster freezing rate remains unclear. Although cryosurgery. Cryobiology. 37, 171-186 (1998)
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
upper pole, there is no evidence that differences exist cryosurgical injury. Urology. 60, 40-49 (2002)
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 2: Top view of the two templates employed and the temperature curves in agar and gel.
EAU Section of Uro-Technology
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

Thursday, 23 October 2008
16.00 – 20.00 Registration
Friday, 24 October 2008
07.00 – 09.00 Registration
09.00 – 09.10 Introduction
P-A. Abrahamsson, Malmö (SE)
M. Sosnowski, Lodz (PL)
09.10 – 10.40 Hot issues in prostate cancer
Identifying curable and significant
prostate cancer
L. Jarolim, Prague (CZ)
Reducing the morbidity of radical
prostatectomy
P. Chlosta, Kielce (PL)
Managing continence and erectile
dysfunction
A. Majoros, Budapest (HU)
The management of rising PSA after
curative therapy
N. Vodopija, Slovenj Gradec (SI)
Who should have chemotherapy, when
and how long?
P-A. Abrahamsson, Malmö (SE)
10.40 – 11.00 Coffee break
11.00 – 12.40 Poster session 1: Prostate cancer
diagnosis
11.00 – 12.40 Poster session 2: Urodynamics, Female
urology
11.00 – 12.40 Poster session 3: Andrology, BPH
European
Association
of Urology
Is varicocelectomy outdated?
R. Kocvara, Prague (CZ)
Update on uro-pathology of prostate
cancer
K. Sikora, Warsaw (PL)
Translational research in prostate
cancer: From the lab to the patient
P-A. Abrahamsson, Malmö (SE)
14.40 – 15.00 Coffee break
15.00 – 16.40 Poster session 4: External genitalia,
Testis tumour
15.00 – 16.40 Poster session 5: Bladder cancer
15.00 – 16.40 Poster session 6: Urinary diversion,
Renal transplantation
16.40 – 17.10 Pro-contra debate
Primary therapy of ureteric stones is
SWL today
Chair: I. Romics, Budapest (HU)
Pro: G. Böszörményi-Nagy,
Budapest (HU)
Contra: H.C. Klingler, Vienna (AT)
17.15 – 18.15 Symposium: Bladder cancer
developments; expert panel review
Chairs: M. Sosnowski, Lodz (PL)
M. Marberger, Vienna (AT)
Update on classification, grading and
staging of bladder cancer
J. Breza, Bratislava (SK)
Improving the diagnosis of bladder
cancer
M. Marberger, Vienna (AT)
Integrating Fluorescence cystoscopy/
PDD to improve the management of
non-muscle invasive bladder cancer
M. Babjuk, Prague (CZ)
Sponsored by GE Healthcare
This meeting is EU-ACME accredited
08.00 – 09.40 Renal Cell Cancer (RCC)
Improving the diagnosis of small renal
masses
M. Hora, Plzen (CZ)
Is active surveillance of small renal
tumours a valid option?
J. Dobruch, Warsaw (PL)
The limits of nephron sparing surgery for
RCC
I.C. Sinescu, Bucharest (RO)
New aspects in systemic therapy of RCC
C. Szczylik, Warsaw (PL)
09.40 – 10.00 Coffee break
10.00 – 11.40 Poster Session 7: Renal tumours
10.00 – 11.40 Poster Session 8: Urolithiasis,
Laparoscopic surgery
10.00 – 11.40 Poster Session 9: Prostate cancer therapy
11.40 – 12.40 Female Urology
Diagnostic work-up of the incontinent
woman
C. Oblak, Ljubljana (SI)
Does the tape take care of everything?
T. Hánuš, Prague (CZ)
The painful bladder
P. Radziszewski, Warsaw (PL)
12.40 – 13.40 Panel discussion
Pandora’s box: T1 G3 bladder cancer
Chair: M. Marberger, Vienna (AT)
Panel: M. Babjuk, Prague (CZ)
A.P. Borkowski, Warsaw (PL)
J. Breza, Bratislava (SK)
Z.F. Dobrowolski, Cracow (PL)
R. Fiala, Olomouc (CZ)
P.A. Geavlete, Bucharest (RO)
M. Sosnowski, Lodz (PL)
13.40 Awards and closing remarks
M. Sosnowski, Lodz (PL)
M. Marberger, Vienna (AT)
Chairman EAU Regional Office
M. Marberger, Vienna (AT)
Faculty
P-A. Abrahamsson, Malmö (SE)
M. Babjuk, Prague (CZ)
A.P. Borkowski, Warsaw (PL)
G. Böszörményi-Nagy, Budapest (HU)
J. Breza, Bratislava (SK)
P. Chlosta, Kielce (PL)
Z.F. Dobrowolski, Cracow (PL)
J. Dobruch, Warsaw (PL)
R. Fiala, Olomouc (CZ)
P.A. Geavlete, Bucharest (RO)
T. Hánuš, Prague (CZ)
M. Hora, Plzen (CZ)
L. Jarolim, Prague (CZ)
H.C. Klingler, Vienna (AT)
R. Kocvara, Prague (CZ)
A. Majoros, Budapest (HU)
M. Marberger, Vienna (AT)
C. Oblak, Ljubljana (SI)
P. Radziszewski, Warsaw (PL)
I. Romics, Budapest (HU)
K. Sikora, Warsaw (PL)
I.C. Sinescu, Bucharest (RO)
M. Sosnowski, Lodz (PL)
C. Szczylik, Warsaw (PL)
N. Vodopija, Slovenj Gradec (SI)
Advisory Board
P-A. Abrahamsson, Malmö (SE)
A.P. Borkowski, Warsaw (PL)
A. Borówka, Warsaw (PL)
J. Breza, Bratislava (SK)
Z.F. Dobrowolski, Cracow (PL)
J. Dvorácek, Prague (CZ)
P.A. Geavlete, Bucharest (RO)
T. Hánuš, Prague (CZ)
G. Janetschek, Linz (AT)
J. Kliment, Martin (SK)
O. Kraus, Zagreb (HR)
C. Oblak, Ljubljana (SI)
I. Romics, Budapest (HU)
I.C. Sinescu, Bucharest (RO)
M. Sosnowski, Lodz (PL)
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
Section editor
Liverpool (GB)
Philip.Cornford@
rlbuht.nhs.uk
Salvage radiotherapy
after radical prostatectomy
gives long term cures
An increasing PSA level following radical
prostatectomy is a cause of concern in both patients
and surgeon. Although surgery provides excellent
cancer control between 15% and 40% of men will
experience biochemical recurrence. In such cases is
difficult to distinguish between local recurrence and
occult distant metastasis and although salvage
radiotherapy is frequently considered, there is no data
to show it confirms a survival benefit.
Recent studies have suggested adjuvant radiotherapy
in patients with pT3 prostate cancer significantly
improves biochemical relapse-free and clinical
recurrence free survival and therefore there is current
on-going debate about whether patients should be
offered immediate adjuvant treatment or delayed
salvage therapy. This study evaluates a cohort of men
with biochemical or local recurrence following radical
prostatectomy who received either no salvage therapy,
salvage radiotherapy alone, or salvage radiotherapy
combined with hormonal therapy.
Recurrent disease
Between June 1982 and August 2004, 926 men had
developed recurrent disease following radical
prostatectomy and either did not receive salvage
therapy, received salvage radiotherapy alone, or
received salvage therapy combined with hormone
therapy. Men who received adjuvant hormonal or
radiation therapy or received salvage hormone
therapy alone were not included. Excluded from
analysis were 7 men who declined to participate, 6
men whose salvage treatment status could not be
determined, 4 men for whom survival time could not
be determined, 60 men censored with no follow up
data subsequent to prostate cancer recurrence and
214 men lacking sufficient data to calculate PSA
doubling time following recurrence leaving 635 men
for analysis. Of these, 397 received no salvage
treatment 160 received salvage radiotherapy alone
and 78 received radiotherapy combined with
hormonal therapy.
Amongst those men receiving radiotherapy the
median time from recurrence to initiating salvage
radiotherapy was 1 year and overall the median
follow-up from a diagnosis of recurrence was 6 years.
The 3 groups differed significantly for all prognostic
factors except surgical margin status. Notably, men
with no salvage therapy had a much higher
prevalence of positive lymph nodes (30% vs 3%-4%).
Men who received salvage radiotherapy and
hormonal therapy had significantly shorter time to
recurrence, shorter PSA doubling time, and higher
PSA level at the time radiotherapy was initiated.
Univariate analysis demonstrated significant
associations with prostate cancer-specific survival for
the logarithm of PSA doubling time (HR 0.38;
[0.31-0.46, p<0.001]), time from surgery to recurrence
(HR 0.80; [0.73-0.88. p<0.001]), post-operative
Gleason score of 8 or greater (HR 4.23; [2.21-8.09,
p<0.001]), positive lymph nodes (HR 2.45: [1.10-5.46,
p=0.03]) and salvage radiotherapy regardless of
whether given alone or with hormonal therapy (HR
0.42; [0.22-0.71, p=0.001]).
In multivariable models after adjusting for these risk
factors salvage radiotherapy was associated with a
significant reduction in the risk of death of more than
65% (HR 0.32, [0.17-0.57, p<0.001]). Although
pathological stage overall nor lymph node status were
statistically significant in the multivariate analysis,
because of the large imbalance in the distribution of
Key-articles EAU EU-ACME Office
28 European Urology Today
men with lymph node metastases between the
groups, the analysis was repeated after excluding all
men with positive lymph nodes. Again the results
were essentially unchanged (HR 0.34; [0.19-0.63]).
Analysis revealed that for salvage radiotherapy to be
effective it needed to be initiated before the PSA
reached 2ng/ml and less than 2 years after recurrence
was diagnosed.
Those men whose PSA level became undetectable had
the best outcomes and perhaps slightly surprisingly it
was the men with a PSA doubling time of <6 months
that experienced an improvement in prostate cancer
specific survival with salvage radiotherapy. The other
group with an improved outcome were those men
with a PSA doubling time of >6 months but Gleason
8-10 cancers and a positive surgical margin
This study challenges the common belief that local
recurrence is associated with relatively favourable
prognostic features (e.g. Gleason score <8, and slow
PSA velocity). Instead it suggests that local recurrence
with a potentially lethal phenotype but biologically
responsive to radiation can occur and suggests that
recurrent disease in the pelvis may be a more
frequent contributor to biochemical recurrence than
previously thought.
This is not a randomized prospective trial and in a
disease where the median time to death following
PSA recurrence after radical surgery is 13 years may
be considered immature but it does provide the first
evidence that early salvage radiotherapy is associated
with improved prostate cancer survival and the
magnitude of the survival benefit is similar to that
observed in adjuvant radiotherapy trials.
Source: Prostate cancer-specific survival
following salvage radiotherapy vs observation
in men with biochemical recurrence after
radical prostatectomy. Trock BJ, Han M,
Freedland SJ, Humphreys EB, DeWeese TL,
Partin AW, Walsh PC.
JAMA 2008; 299(23): 2760-9.
Squamous cell
carcinoma
of the penis
In this article Leijte et al retrospectively analyse the
recurrence patterns of penile carcinoma. Their
experience is based on the analysis of one of the
largest published database (700 patients) of two
major referral centres in The Netherlands and
Sweden. Because penile cancer is a rare disease in
the Western world most studies are hampered by the
small numbers of patients as well as limited
follow-up.
The authors published a follow-up over up to 358
months providing new insights for follow-up
recommendations for patients with penile carcinoma.
Recurrence rates were divided into local, regional and
distant recurrences and correlated with organ
preserving and amputational techniques. Patients
undergoing organ preserving surgery had the highest
risk for a local recurrence (27.7%); there was little
impact on the survival, however. In the amputation
group local recurrence was only 5.3%.
Distant recurrence
All regional recurrences occurred within 50 months,
the prognosis was strongly associated with this type
of recurrence. The resulting disease-specific survival
was 92% after a local recurrence and 32.7% after a
regional recurrence. The worst prognosis was in the
group of distant recurrence, all patients died within
22 months. Based on their data the authors
recommend a modification to the only available
international guidelines for penile cancer (EAU
guidelines). The majority of recurrence occurs within
the first 2 years after diagnosis, therefore a 3 months
follow-up interval for patients undergoing penile-
preserving therapy and a 6 months interval for
patients undergoing penile amputation is considered
to be sufficient.
To improve follow-up the authors recommend in
addition to physical examination of the inguinal
regions ultrasound and fine-needle aspiration
cytology on indication for early detection of regional
recurrence. Furthermore the authors outline the
importance of self-examination for local and regional
recurrence. The maximum follow up for all patients
should be 5 disease-free years.
A drawback of the study however is the fact that data
were collected retrospectively and patients were
included over an extremely long period beginning
back in 1956 when diagnosis and treatment of penile
cancer was certainly different from today’s modern
imaging and surgical techniques.
Source: Recurrence Patterns of Squamous Cell
Carcinoma of the Penis: Recommendations for
Follow-Up Based on a Two-Centre Analysis of
700 Patients. Leijte J, Kirrander P, Antonini N,
Windahl T, Horenblas S.
European Urology, Volume 54 , Issue 1 , p 161-169
Inflammatory marker predicts
outcome for androgen-
independent prostate cancer
Although docetaxel chemotherapy has been shown to and the majority of patients die of their disease within
prolong survival for men with metastatic androgen-
independent prostate cancer (AIPC) there is significant human lactoferrin. Lactoferrin is an important
variability both in the response to treatment and
overall survival. Improved stratification of patients by body but in the highest concentrations in breast milk.
risk would inform patients, aid clinical decision-
making and potentially improve clinical trial design.
Beyond the standard clinically variables of age,
performance status; Gleason score; the presence of
visceral disease; PSA concentrations and kinetics
interest has grown in the role of inflammation in the
development and progression of prostate cancer.
Certainly specific inflammatory cytokines as well as
non-specific measures of systemic inflammation such
as C-reactive protein (CRP) and albumin have been
found to be strongly correlated with prognosis in
patients with a broad variety of common cancers. This After oral administration talactoferrin is transported
study used samples and clinical outcomes data from
the ASCENT (AIPC study of Calcitriol enhancing
taxotere) to evaluate the role of a range of different
cytokines, chemokines and inflammatory markers.
160 of 250 men enrolled in the ASCENT trial had
baseline plasma samples stored and were evaluated
in this study. To be eligible men had to be
chemotherapy naive with metastatic AIPC. They
received 45μg of calcitrol or placebo by mouth on Day non-small cell lung cancer (NSCLC) talactoferrin
1 followed by docetaxel at a dose of 36 mg/m2
intravenously on Day 2 along with dexamethasone
(4mg 12 hours before, 1 hour before and 12 hours
after docetaxel). This regimen was administered
weekly for 3 consecutive weeks of a 4-week cycle.
Samples were analysed by multiplex immunoassays
using uniquely labelled flourescent microspheres
conjugated to anticytokine capture antibodies
measured IL-1α, IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα,
monocyte chemotactic peptide-1 (MCP-1), EGF, VEGF,
plasminogen activator inhibitor-1 (PAI-1), matrix
metalloproteinase-9, (MMP-9), coluble E selectin
(sE-Selectin), solubleintracellular adhesion molecule
(sICAM-1), soluble vascular cell adhesion molecule
(sVCAM-1) and CRP. All samples were tested in
duplicate and mean values were used for all analyses. followed by a 2 week break. A maximum of 2 addition
Overall survival was defined as the time from
randomisation to death from any cause. PSA decline
was defined as a >50% reduction from baseline PSA
that was confirmed by a repeat measurement at least scans at weeks 8, 14, 21, 27, 34, 41, 48 and 55. Patients
28 days later.
Elevated CRP
In a multivariate Cox proportional hazard model of
the 16 markers measured only CRP was found to be
independently associated with overall survival (HR
1.41: CI 1.199-1.647 [p<0.0001]). When categorised as
normal (<8 mg/L) or elevated an elevated CRP was
determined to be a significant predictor of decreased of bevacizumab in second line patients the placebo
survival (HR 2.96; 1.52-5.77 [p=0.001]). Elevated CRP
was also associated with a lower probability of PSA
decline (odds ratio of 0.74 for each In(CRP) increase;
CI 0.60-0.92 [p=0.007])
CRP is readily measurable and proved more predictive 70.5% of patients demonstrating stable disease for at
than conventional prognostic factors in this group of
men with metastatic AIPC who were initiating
docetaxel chemotherapy. A previous small study has
suggested that elevated CRP concentrations may also
predict shorter cancer-specific survival in men with
metastatic prostate cancer initiating androgen
deprivation. Certainly elevated CRP has been
described to be predictive of survival in other
advanced malignancies. However, it is not clear what
is the biologically mechanism underlying this
correlation.
Source: C-reactive Protein as a prognostic
marker for men with androgen-independent
prostate cancer. Beer TM, Lalani AS, Lee S,
Mori M, Eilers KM, et al.
Cancer 2008; 112:2377-83.
Breast milk protein
used to treat
renal cancer
Despite new treatment modalities for metastatic renal
cell carcinoma (RCC) it remains difficult to treat.
Complete response to treatment is exceedingly rare
1 to 2 years. Talactoferrin is a recombinant form of
immunomodulatory protein found throughout the
It plays an important role in helping establish the
immune system, including the gut-associated
lymphoid tissue (GALT) and is involved in cellular
growth and differentiation, antimicrobial defence,
anti-inflammatory activity, immune modulation and
cancer protection. Talactoferrin is produced in
Aspergillus niger and is structurally identical to native
human lactoferrin differing only in its glycosylation.
Oral talactoferrin
into Peyer patches of the GALT, in which it recruits
immature circulating dendritic cells (DCs) bearing
tumour antigens and induces their maturation. This
induces a strong innate and adaptive immune
response resulting in the activation of lymphocytes in
tumour draining lymph nodes, cellular infiltration of
distant tumours and tumour-cell death. In phase 1
studies oral talactoferrin was found to be well
tolerated with evidence of partial response in RCC. In
demonstrated an improvement in overall survival (OS)
with trends towards improvement in progression free
survival (PFS). As a consequence this phase 2 study in
patients with advanced RCC was conducted
44 patients with histologically confirmed metastatic or
unresectable RCC with predominantly clear cell
histology and having failed at least 1 systemic therapy
were included. The Karnofsky performance status had
to be >70 and patients with brain metastasis, active
ischaemic heart disease, symptomatic congestive
heart failure, serious active infection, autoimmune
disease, radiotherapy administered within 4 weeks,
and other malignancies diagnosed within 5 years
were excluded. Patients received recombinant human
lactoferrin (rhLF) 1.5mg orally twice a day for 12 weeks
cycles were permitted.
The first CT scan was obtained at baseline followed by
were followed for OS for 12 months from the initiation
of the study treatment or until the medial OS for the
study was determined
Twenty-nine patients (66%) completed cycle 1 of
therapy and 20 patients completed 2 cycles. 42
patients reported at least 1 adverse event (AE) and 23
(52%) reported at least 1 related AE, of which the
most common was fatigue, flatulence, abdominal
pain and diarrhoea, although none were >grade 2 in
severity. The 14-week PFS was 59%. In a recent trial
arm had a 4 month PFS rate of 20% and in the trial
comparing sorafenib to placebo after 3-months the
placebo arm showed partial response or stable
disease in just 34% of patients so this was though to
be significant. The response rate was 4.5% with
least 8 weeks. The median PFS was 6.4 months,
whilst the median OS was 21.1 months with 77% of
patients surviving at least 1 year.
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
The Prostate-Risk Indicator, the first easy-to-use
online tool for doctors, has been thoroughly revised.
The second version of the oncological risk-
assessment tool will be available as of 15 September.
“The second version,” underlines Prof. Fritz Schröder,
chairman of the Scientific Committee of the European
Randomized Study of Screening for Prostate Cancer
(ERSPC), “will offer two more levels of decision: men
who have had a previous negative PSA screen and
men who had a previous negative biopsy.” The new
version of the online tool will be more userfriendly,
more practicable and will be available on
uroweb.org and urosource.com soon.
New features in the task bar of the risk indicator will
allow urologists direct access to every module
required. The risk indicators 1 and 2 are targeted at
the man in the street. The text has been changed
according to the comments of many users.
They are meant to inform and be accessible to men
(aged 55 and older) who go for an initial risk
assessment. Using level 1 only requires information
that is readily available or known such as age, family
health history and voiding complaints.
Decision: PSA determination or not.
At level 2, a PSA determination has been made and
the result is available with the man´s family doctor. If
the PSA is elevated above 3.0 or 4.0 ng/ml the man is
advised to see a urologist (risk of having cancer at
biopsy is 17 to 21 per cent).
Decision: see a urologist or not.
The risk indicators 3 to 6 are made for doctors and
offer special services:
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
• 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
positive sextant biopsy in a man who was Netherlands. including the most recent ERSPC findings,” Schröder
never screened. The urologist adds digital summarized, “we can also identify with a high degree
rectal examination and ultrasound study. The development of the risk indicator is based on the of certainty those cases that may not require
• Risk indicator 4 predicts the chance of a ERSPC study. Launched more than ten years ago, the immediate treatment.”
positive sextant biopsy in a man who had a ERSPC-study the largest
PSA < 4.0 ng/ml and no biopsy at a previous randomised study on
screen. prostate cancer screening
• Risk indicator 5 predicts the chance of a ever, has recruited more
positive sextant biopsy in a man who had a than 250,000 men from
PSA ≤ 3.0ng/ml and had a prior negative eight participating
biopsy at a previous screen. countries: Belgium,
• Risk indicator 6 calculates the chance of Finland, France, Italy, the
having indolent prostate cancer which may not Netherlands, Spain,
require immediate treatment. The man had a Sweden and Switzerland.
prior positive biopsy at a previous screen. “At present we do not
know whether the
screening for prostate
In order to make the indicator more userfriendly and cancer actually does
to further increase the number of men and doctors more harm than good. In
taking access to the online tool, the language is easier this situation of
and more readable now. The website has been partly uncertainty it is important
re-designed and newly offers the doctors direct to provide balanced
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.
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
of Urology (F. Dong, F.H. Schröder, E.A. Klein, JUrol, final findings by 2011 at
vol 180, 1: 150-154). This study with 296 patients who the latest, Schröder says
underwent prostate biopsy and radical prostatectomy the Dutch ERSPC team in
validated the Kattan and Steyerberg nomograms. The Rotterdam took the
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
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
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
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)
The European Urological Scholarship Programme
(EUSP) provides young doctors in Europe not only a
superb opportunity to develop their urological skills
in the unique medical environment of another
country but also offers valuable contacts with some
of the best urological experts. Thus, knowledge
becomes truly continental and a feeling of community
is established in a setting where leading centres of
our specialty effectively collaborate.
Through the EUSP I had the opportunity to visit the
10-bed Neuro-Urology Department of the University
Hospital of lnnsbruck for three months, a highly
regarded centre of excellence in the field of neuro-
urology and incontinence. The University Hospital of
Innsbruck, a tertiary 1,500-bed hospital, is situated in
the centre of Innsbruck. Prof. Helmut Madersbacher,
one of the pioneers in the field of neuro-urology and
incontinence, is the department director aided by Drs.
Peter Rehder, Gustav Kiss and Thomas Berger. The
Neuro-Urology Department, equipped with a fully
developed outpatient unit complete with
urodynamics, video-urodynamics, physiotherapy,
non-invasive neuromodulation (IVES, TENS-P), etc.,
also provides urological training to a resident for 18
months.
My fellowship was aimed at obtaining a thorough
insight in neuro-urology, and my objectives were to
examine the evaluation, diagnosis, treatment
(conservative and invasive) and follow-up observation
of patients with neurogenic lower urinary tract
dysfunction and incontinence. Prof. Madersbacher is
an excellent surgeon and an inspiring teacher, while
Dr Rehder is an expert on female urology and pelvic
reconstruction. Dr. Kiss is a neurologist with extensive
experience in neuro-urology and neuromodulation.
Dr Berger has an excellent knowledge of neuro-
urology.
A high number of patients are examined daily in the
outpatient department, with many of them monitored
under close follow-up since the staff believes that a
regular and close follow-up minimise the risk of
deterioration and side effects. Urodynamic and
video-urodynamic studies are performed at least
twice in order to reproduce the findings.
A significant number of patients undergo daily
non-invasive neuromodulation (IVES, TENS-P) in the
outpatient department. The physiotherapist is a
valuable team member and plays an important role in
the evaluation and treatment (behavioural therapy,
PFMT, biofeedback, magnetic chair, etc.) of the
patients.
In the operation room botulinum toxin A injections
are performed usually under local anesthesia with the
use of a new smaller needle. Sacral neuromodulation
is performed with great success. Prof. Madersbacher
and Dr. Kiss use a different protocol with a prolonged
(2 to 5 weeks) first stage. A relatively new procedure
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
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
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
operation days when I can take part and perform
some operations. On Wednesdays and Fridays, I November 1-5, 2009
attended the Video-urodynamic department, where I Shanghai International Convention Center
can perform a lot of video-urodynamic studies.
I also attended daily the outpatient clinic, perform the
urodynamic studies and the non-invasive
neuromodulation procedures and join the ward
rounds. I had the opportunity to work as a regular
staff member in the outpatient clinic. On Thursday
afternoons there was an x-ray conference with the www.siucongress.org
radiologists where we discuss and interpret the
findings from the video-urodynamic studies.
In three months I gained a thorough knowledge in the
diagnosis of the most commonly encountered
conditions in neurogenic LUT dysfunction and
incontinence and improved my abilities by identifying
the indications, perform and interpret urodynamic
and video-urodynamic studies, and also learned to
classify the steps of treatment management, amongst
others.
Moreover, the training enabled me to assess the value
of physiotherapy and neuromodulation in the
treatment of these diseases. Prof. Madersbacher and
his staff members were all ready to answer my
questions. I participated in many operations such as
botulinum toxin A intradetrusor and intraprostatic CMYK SIU CONGRESS OFFICE
1155 University, Suite 1155, Montréal (QC) Canada H3B 3A7
injections, operations for sacral neuromodulation,
Tel: +1 514 875-5665 Fax: +1 514 875-0205
bladder augmentations with continent self-
catheterized stoma, and many other operations. I feel 1026_SIU2009_EUT_ad_JUN.indd 1 5/15/08 10:10:09 AM
that I can start my own practice with confidence. I
also did some scientific work and was responsible in Client: SIU 2009 Docket number: 28-1026 File Size: 100 %
a protocol for the pudendal nerve evaluation in Description: SHANGHAI Trim Size: 133,4 mm X 194,3 mm
PROOF #
1:0
diabetic and non-diabetic females with stress Publication : European Urology Today Ad number : 28-1026-P Type Size: N/A
incontinence and also helped in some research Date: 2008/06 Bleed Size: N/A DATE: MAY 14, 2008
protocols that were running. Operator: LAP Visible Size: N/A
Filename : 1026_SIU2009_EUT_ad_JUN.indd Lase Output @ 100%
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
review on the use of botulinum toxin A in male This proof is strictly for layout purposes only
patients with LUTS due to BPE, which was accepted
for publication in European Urology. We also
presented two abstracts in German urological
conferences and, hopefully, we will soon be ready to
submit two other original papers.
My stay at the Neuro-Urology department was very
effective, and I fully realized all of my expectations
from fellowship. It was an honor for me to attend the
fellowship and I thank the EUSP Board and the EAU
for the chance. My heartfelt thanks to Prof. Helmut
Madersbacher, Drs. P. Rehder, G. Kiss, T. Berger and
the nursing staff of the department for their interest
in my training and for the hospitality they have all
shown.
I would definitely recommend to young urologists to
apply for EUSP grants for them to have access to and
receive high-quality urological training in excellent
departments across Europe.
August/September 2008

The interest in the Fellow of the European Board of
Urology (FEBU) Examinations continues to increase
and to accommodate the large number of candidates
in Athens, Greece, the oral examination held in June
this year was expanded and sessions were also
scheduled on Saturday and Sunday mornings.
Out of the 261 oral exam candidates who took the
exams in three venues (Greece, Poland and Hungary),
238 passed the exams marking a 91% passing rate.
Oral exam candidates are examined on three selected
European Board of Urology (EBU)
The following urologists were granted the FEBU title after passing the oral examinations in Greece, Poland and Hungary, June 2008
Athens, Greece
Abascal Junquera, Jose Maria Spain
Abduljawad, Farouk Saudi Arabia
Abdullah, Aosama United Arab
Emirates
Akand Murat Turkey
Alfhaidi, Fahad Saudi Arabia
Al-Geizawi, Samer Jordan
Allam, Khaled Saudi Arabia
Al-Nahawi, Adnan Germany
Al-Qadhi, Mohammed M Saudi Arabia
Anantharamakrishnan, Krishnan United Kingdom
Aragona, Maurizio Santi Italy
Arslan, Murat Turkey
Assem, Akram Egypt
Attar-Bashii, Ali. A.M. Iraq
Babakerd, Maher Germany
Bach, Thorsten Germany
Bamberg, Hendrik Sweden
Bauer, Wilhelm Austria
Baumgartner, Martin Switzerland
Bayraktar, Necmi Turkey
Beatty, John United Kingdom
Bin Aggag, Abdulbari Saudi Arabia
Bingadhi, Abdul Raheem Omar Yemen
Birkhäuser, Frederic Switzerland
Birzele, Jan Switzerland
Bogris, Sotirios United Kingdom
Bosio, Andrea Italy
Bosl, Martin Germany
Bott, Simon United Kingdom
Bretschneider-Ehrenberg, Patricia Germany
BunyaratavejvChanatee Thailand
Chmelik, Reinhard Austria
Chrysanthakopoulos, Georgios Greece
Chun, Felix Germany
Coltoiu, Virgil Constantin Cristian Romania
Comploj, Evi Italy
Culty, Thibaut France
Damjanoski, Ilija Austria
Deirmentzoglou, Stavros Greece
Derflinger, Ines Austria
Dubosq, Francis France
Eberli, Daniel Switzerland
Ebinger, Nicole Switzerland
Eddu, Subhakara Srinadh Oman
Eisenhardt, Andreas Germany
El Hajj Hassan, Rabih France
Elgamal, Ahmed Saudi Arabia
Elizalde Benito, Angel Gabriel Spain
Elmasry, Yasser United Kingdom
El-Musbahi, Abduel Salem United Kingdom
Elnagar, Mahmoud United Arab
Emirates
Emara, Amr Egypt
Farikhullah Khan, Mohamad Afzal Malaysia
Fleury, Nicolas Switzerland
Frigo, Marta Italy
Fuchs-Samitz, Alexandra Austria
Fuller, Florian Germany
Galanakis, Ioannis Greece
Galvin, David Ireland
Gavis, Sotirios Greece
Georgalis, Athanasios Greece
Gholais, Lutf Yemen
Gkougkousis, Evangelos United Kingdom
Gomha, Faaz Salah Qatar
Gougousis, Anastasios Greece
Gözen, Ali Serdar Germany
Gregorin, Joel Patrick Switzerland
Grell, Daniel Germany
Hagemann, Jörn Germany
Hajj, Pascal France
Hassmann, Rene Germany
August/September 2008
Interest in FEBU exams remains high
238 new FEBUs, 91% passing rate in 2008
clinical cases, with the exam conducted by one Number of participants 2003-2008
examiner and a trustee.
2003 2004 2005 2006 2007 2008
The FEBU written and oral examinations are an Total Oral Exam Candidates 108 144 176 197 196 261
integral part of the residents training in urology in
Pass 103 133 166 186 179 238
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%
11 different languages, namely: Dutch, Danish, Paris/Athens 78 112 151 154 158 209
English, French, German, Greek, Italian, Portuguese,
Pass 77 105 145 144 145 193
Spanish, Polish and Hungarian.
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
Pass - - - 16 19 8
and 2008. Registration will start in December 2008.
Heinau, Marc Germany Ronchi, Piero Italy Stoeckelle, Eugen Austria
Heinrich, Tobias Peter Germany Ronkainen, Hanna-Leena Finland Straumann, Urs Switzerland
Hirschmann, Joachim Germany Ruggera, Lorenzo Italy Tahmatzopoulos, Anastasios Greece
Horstmann, Jörg Germany Saad, Rodrigue France Tanidir, Yılören Turkey
Huwyler, Mirjam Switzerland Saeger, Ulf Germany Tavares dos Santos, Sérgio Portugal
Isaakidis, Isaak-Savvas Greece Saghir, Hamayun Naeem Ireland Thomay, Günther Austria
Islam, Jawad-Ul Ireland Sangalli, Mattia Nicola Italy Toutziaris, Chrysovalantis Greece
Izol, Volkan Turkey Sanguedolce, Francesco Italy Trilla Herrera, Enrique Spain
Jaeger, Tobias Germany Sanli, Mehmet Oner Turkey Trottmann, Matthias Germany
Jepsen, Jan V. Denmark Sauermann, Peter Switzerland Tuckus, Grazvydas Denmark
Joshi, Hrishikesh United Kingdom Sayed Ahmed, Taha Ismail Taha United Arab Türker, Polat Turkey
Kaliská, Veronika Czech Republic Emirates Turi, Mubasher Saudi Arabia
Kalogeras, Nikolaos Greece Schauerte, Carsten Germany Van der Kolk, Marjan The Netherlands
Kalogeropoulos, Theodoros Greece Schlenker, Boris Germany Van Rhijn, Bas Canada
Karatas, Omer Faruk Turkey Schrey, Anton Austria Varadaraj, Haradikar Ireland
Karpf, Rainer Austria Schwartz, Julien Switzerland Vis, Andre The Netherlands
Kastner, Christof United Kingdom Sciberras, John Malta Vourekas, Stavros Greece
Katmawi-Sabbagh, Samer United Kingdom Seiler, Daniel Switzerland Waliszewski, Przemyslaw Germany
Kempkensteffen, Carsten Germany Shaat, Ahmed Qatar Yoong, How Fee Malaysia
Kessler, Thomas Matthias Switzerland Simon, Pascal France Zahran, Ahmed Fahmy Ahmed Egypt
Klotz, Axel Germany Spounos, Marios Greece Zahwa, Firas France
Konstantinopoulos, Angelis Greece Stanislaus, Peter Germany Z’Brun, Sebastian Switzerland
Koritsiadis, Georgios Greece Stathoglou, Dimitris Greece Zetterquist, Henrik Sweden
Koumentakis, Michail Greece Stathouros, George Greece Zougkas, Konstantinos Greece
Kozyrakis, Diomidis Greece Stockhammer, Mathias Austria
Krasnitski, Maksim Belarus
Lamche, Michael Austria
Lazarov, Boyan Bulgaria Warsaw, Poland
Lenz, Matthias Austria Bochynek, Kamil
Congratulations!
Luginbuehl, Thomas Switzerland Bondarenko, Marianna
Lumen, Nicolaas Belgium Brunowicz, Radosław
Luzar, Oliver Germany Ch˛eciński, Marcin
Lynn, Naing Naing Kyaw United Kingdom Ciszewski, Sebastian
Madaan, Sanjeev United Kingdom Dobrowolska-Glazar, Barbara
Madani, Ahmed, H.S. Iraq Dobruch, Jakub
Maffei, Nicola Italy Draczyński, Marek
Makris, Antonios United Kingdom Dworak, Jacek
Manu Ionita, Patricia Ingrid Romania El-Mohtar, Imad
Markić, Dean Croatia Gradzikiewicz, Szczepan
Mauermann, Julian Austria Hrab, Michał
Mazzoccoli, Bruno Italy Jakubiak, Jarosław
Mazzola, Brunello Switzerland Jaskulski, Jarosław
Mehta, Santbir Singh United Kingdom Kaliszczak, Agata
Mihalakis, Anastasios Greece Kalwas, Paweł
Mirzapour, Kiumars Germany K˛edzierski, Robert
Moazin, Maher Saudi Arabia Kies, Grzegorz
Moazzam, Mohammed United Kingdom Klim, Marcin
Mohammed, Gamal E. A. H. Saudi Arabia Krasnicki, Krzysztof
Moraitis, Konstantinos Greece Kupajski, Maciej
Muawad, Emad Sabet Egypt Kurant, Marcin Dr. Bunyaratavej from Thailand (right) receives his certificate from
Nader, Andreas Austria Kuskowski, Maciej Prof. Alivizatos.
Naderi, Nader The Netherlands Litarski, Adam
Naoum Alsaigh, Naimet K. United Arab Łoś, Jacek
Emirates Olejnik, Rafał
Neyer, Michael Austria Pietraszun, Oskar
Noor, M. Amjad Pakistan Potega,
˛ Jacek
Pace, Gianna Italy Przybyła, Jacek
Papadopoulos, Alexandros Greece Ruciński, Artur
Pape, Daniela Germany Sitko-Saucha, Aleksandra
Pernkopf, Dominik Austria Syryło, Tomasz
Peters, Robert Germany Szemplinski, Stanislaw
Pfleger, Gottfried Austria Trywiański, Tadeusz
Pietsch, Silke Germany Wenerski, Maciej
Poněšický, Jiří Czech Republic Zagórski, Piotr
Preusser, Stefan Switzerland Ziółkowski, Tomasz
Pushkar, Dmitry Russia
Rahulan, Sunil India Budapest, Hungary
Ravisankar, Gopakumarapillai Bulgaria Ashaber, David
Rein, Patrick Austria Bagheri, Fariborz
Remmele, Waltraud Germany Hencz, Lajos
Rentsch, Cyrill A. Switzerland Kerenyi, Gabor
Ribaritsch, Ursula Austria Lacó, László
Richter, Michael Germany Piróth, Csaba
Rith, Torsten Germany Pusztai, Csaba
Rogenhofer, Sebastian Germany Trautmann, Tibor Prof. Alivizatos congratulates Dr. Dmitry Pushkar (right).
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)

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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)

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

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
Authors:
Riccardo Valdagni, MD, PhD, Milan (IT),
Louis Denis, MD, Antwerp (Belgium) and
Peter T. Scardino, MD, New York (USA), Chairmen
The Inside Track Conference “Predictive Modelling in
Prostate Cancer” held in Venice on 17-19 April 2008
was organised by the European School of Oncology
as the first ever event dedicated to the exciting topic
of prediction in prostate cancer.
Louis Denis, Peter Scardino and Riccardo Valdagni
had the pleasure and honour of chairing this
conference and working with a faculty of
internationally acknowledged experts in their fields,
namely: Chris Bangma and Monique Roobol
(Rotterdam, the Netherlands), Joaquim Bellmunt
Molins (Barcelona, Spain), Michael Donovan (New
York, USA), Phillip G. Febbo (Durham, USA), Claudio
Fiorino (Milan, Italy), Michael Kattan (Cleveland, USA),
Rodolfo Montironi (Ancona, Italy), Francesco Montorsi
and Alberto Briganti (Milan, Italy), Carla Ripamonti
(Milan, Italy), Mack Roach III (San Francisco, USA),
Ash Tewari (New York, USA), Karim Touijer (New York,
USA) and Nadia Zaffaroni (Milan, Italy).
Prediction has always been considered a fascinating
topic. Fortune tellers, magicians, prophets, sibyls,
oracles and Cassandras have been trying to anticipate
the future. In oncology, the anatomic staging
classification known as the UICC/AJCC TNM
classification, has been the standard for decades.
Biological prognostic factors have complemented the
staging and stage grouping in most tumours. In the
past 15 years sophisticated mathematical models have
been developed to analyze tumour variables and
response to treatments. Since the first attempts to
assess the risk of positive nodes before pelvic
irradiation, developed at Stanford University in 1987,
and the clinical and pathological T&N characteristics
before surgery, studied by Partin and colleagues in
1993, more than 80 mathematical predictive models
have been so far formulated.
The conference has focused on the different aspects of
predictive modelling in prostate cancer, including the
prediction of aggressive disease, positive biopsies,
response to different treatments (active surveillance,
surgery, radiotherapy, brachytherapy, hormonal
therapy, chemotherapy), survival, mortality and
treatment-related side effects.
Genomic technologies
After the welcome address by Riccardo Valdagni, the
morning session of April 17 was opened by Phillip
Febbo, who presented the genomic approaches to
outcome prediction and highlighted the role for
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
progression, and response to therapy.
Nadia Zaffaroni lectured on biomolecular approaches
to outcome prediction, stressing the need for novel
molecular markers that are specifically associated
with biologically aggressive disease for improved
staging and prognostication, and also for providing
mechanistic information to facilitate treatment
selection. Rodolfo Montironi discussed the predictive
models in histopathology and the importance of a
diagnostic decision support system, defined as a
methodology that provides guidance in situations
involving complex decision sequences and resulting
in a systematic, ordered, and exhaustive evaluation of
evidence and weighting of individual items of
evidence as they are combined to form the basis for a
final decision.
Presenting the systems pathology for building
predictive models, Michael Donavan talked about the
novel approaches with molecular diagnostics and
predictive testing for guiding therapy and overall
patient management and discussed how a systems
pathology programme, which includes image analysis
and quantitative biomarker assessment with machine
learning analytics, has transformed the clinical
paradigm of personalized medicine.
In the afternoon session, Ash Tewari lectured on
predictive models in prostate cancer diagnosis. He
focused on a study aimed at predicting the incidence
and risk of Gleason score upgrading between biopsy
and final pathology after prostatectomy for Gleason
Effects and Actions: International Meeting Reports
August/September 2008
score 6 biopsy specimens using a novel biopsy based
variable, cancer density, defined as percent positive
cores divided by prostate volume.
Cancer density proved to be a better independent
predictor of GS upgrading from biopsy to
prostatectomy than total serum PSA. As a variable
based on biopsy data, cancer density adjusts for the
prostate volume and gives a numerical estimate of
tumour volume in relation to prostate size and helps
evaluate the risk of having a more aggressive cancer
present at prostatectomy.
Predictive models
Monique Roobol talked about predictive models in
diagnosing indolent cancer and the experience of the
Rotterdam section of the European Randomised Study
of Screening for Prostate Cancer who constructed an
ad hoc predictive tool.
Karim Touijer presented the Memorial Sloan Kettering
experience with predictive models before surgery,
started with the nomogram developed by Kattan et al
in 1998 and predicting the risk of disease recurrence
after radical prostatectomy for clinical localized
prostate cancer, and after surgery, by extending
Kattan’s preoperative nomogram to postoperative
data in 1999, with inclusion of information available
postoperatively. He also made a survey on possible
new nomograms being developed for prostate cancer
prostatectomy with the inclusion of image analyses
and molecular markers. A clinical case discussion on
the topics so far presented followed, thus stimulating
a proficient scientific debate.
In the morning session of April 18, Mack Roach III
lectured on predictive models in external
radiotherapy, designed to allow physicians and
patients to understand what outcomes might be
expected for patients with specific pre-treatment
clinical features, focusing on the prediction of
biochemical failure, the risk of metastasis and/or
death as well as the importance of predicting
pathological features (i.e. seminal vesicles,
extracapsular extension, lymph nodes involvement) to
Part of the faculty at the closing of the conference. From left: Dr. Michael Kattan, Dr. Riccardo Valdagni, Dr. Ash Tewari, Dr. Alberto
Briganti, Prof. Mack Roach, Prof. Louis Denis, Dr. Karim Touijer.
optimise selection of targets for radiation.
Michael Kattan discussed predictive models in
brachytherapy and the possibility of individualising
the treatment proposal. He presented a nomogram
predicting 5-years relapse-free survival, which is
based on pre-treatment PSA, Gleason sum, clinical
stage and presence of external beam radiotherapy
and a sub-sequent nomogram which takes into
account the quality of the brachytherapy implant.
Kattan’s conclusions underline that brachytherapy
nomograms are rare and that heterogeneity across
centres plays an important role in this treatment
outcome. Predictive accuracy appears lower with
brachytherapy nomograms, but probably we can still
obtain a better prediction than not using a
nomogram.
Joaquim Bellmunt Molins discussed predictive models
in medical oncology and pointed out the importance
of capturing clinically relevant and measurable
variables for routine use to inform patients, improve
palliation and treatment decisions, and create
homogeneous prognostic strata for randomised
comparative trials of therapeutic agents. Carla
Section Editor
Duncan Summerton
Leicester (UK)
Ripamonti dealt with predictive models in palliative
care, with reference to the prognostication of life
expectancy and the appropriate therapy for symptom
control.
Predictive models of toxicity
After the clinical case discussion, Karim Touijer went
through predictive models of toxicity in surgery. In his
presentation he pointed out that the goal of modern
prostatectomy is the complete removal of the prostate,
seminal vesicles, and pelvic lymph nodes, with
minimal perioperative morbidity, no blood
transfusions, and early return to normal activities,
with no positive surgical margins, and no long term
loss of continence or potency. He reported on the
Memorial Sloan Kettering experience in the field of
recording and grading erectile dysfunction and
urinary incontinence after prostatectomy and
compared recovery from morbidity after laparoscopy
and prostatectomy.
Claudio Fiorino introduced the dosimetric issues of
predictive models of toxicity in external radiotherapy,
analyzing predictive tools such as single/multiple
dose-volume constraints, Equivalent Uniform Dose or
Normal Tissue Complication Probability models. He
analysed literature based knowledge as well as new
unpublished results about dosimetric predictors of
toxicity for all the critical organs involved in prostate
irradiation: rectum, bladder, bowel and regions
suspected to cause radio-induced erectile dysfunction.
An accurate knowledge of the dose-volume
relationships concerning the side effects of the organs
at risk is of paramount importance to drive the
optimisation of the treatment in minimizing the risk of describe the state of the art in predictive modelling of
complications.
Riccardo Valdagni presented the clinical issues of
modeling toxicity in external radiotherapy, showing
the first set of nomograms predicting the rectal
syndrome. Nomograms should increase the predictive having cancer, the outcome of a treatment or the
accuracy of models based on dosimetric issues,
because they take important clinical factors (i.e.
comorbidities, concomitant use of drugs, androgen
deprivation, presence of previous abdominal surgery) occurs in older men with substantial co-morbid
into account. Careful prediction of treatment related
morbidity is important because a high probability of
toxicity, could avoid the single patient unnecessary
daily costs in terms of quality of life modification
during and after treatment, helping either patients in scenario the clinician needs a single, friendly,
the decision making process or clinicians to better
tailor the treatment to patient’s characteristics.
Mack Roach III highlighted the use of predictive
models of toxicity in brachytherapy. In this field a few A supplement of Cancer dedicated to the discussed
dosimetric issue are known concerning rectal, urethra topics is being prepared and detailed information and
and bladder doses, development of new models that
People
Prof. Peter Alken
AWARDED Prof. Peter Alken, director of the
Urology Department at the University Hospital
Mannheim, received the Gustav Simon Medal
from the Southwest German Urological Society.
Alken was cited for his major contributions in
developing and promoting German urology.
Amongst other positions, Prof. Alken is a faculty
member of the EAU’s European School of Urology
(ESU) and also leads the EAU’s working group on
urolithiasis.
Prof.Dr. Peter Albers
APPOINTED Prof. Dr. Peter Albers has been
appointed head of the urology department of the
Universitatsklinikum Düsseldorf , Germany,
replacing Prof. Dr. Rolf Ackermann. Born in
Nürnberg, Albers studied medicine in Mainz and
previously served in Montabaur Hospital,
Hannover and Mainz. He also heads the EAU’s
EAU Working Group on Testis Cancer.
APPOINTED The American Urological Association
(AUA) has appointed Priscilla Chatman, JD, as
Director of Government Relations and Advocacy
for the AUA’s greatly expanded government
relations program. Chatman, a health policy
attorney, previously served as Vice President for
Government for the Lupus Foundation of America,
Counsel and Director of Government Relations for
the National Committee to Preserve Social Security
and Medicare was a former Special Assistant for
then US Senator Harris Wofford.
ELECTED The American Society of Clinical
Oncology (ASCO) has elected Dr. Douglas Blayney
as president. Since joining ASCO in 1983, Dr.
Blayney has demonstrated a comprehensive
record of service to ASCO and has served on the
Cancer Education Committee as Chair of the
Education Technology Assessment
take clinical factors into account is need. The afternoon
session was ended by the clinical case discussion.
Future of predictive models
On April 19 Alberto Briganti discussed predictive
models in andrology, showing nomograms estimating
the risk of developing erectile dysfunction, and Ash
Tewari lectured on predictive models of long term
survival. After a clinical case discussion on these
issues, Michael Kattan, the “Grandmaster of
Nomograms,” forecasted the future of predictive
models and presented the take home messages.
The purpose of this innovative meeting was to
prostate cancer and to lay out future research trends
in the uro-oncologic community. Presentations and
debates highlighted that prediction models, although
imperfect, likely represent the most accurate
prediction methods for estimating the probability of
probability of exhibiting treatment morbidity.
Since prostate cancer is so heterogeneous and often
conditions, treatment should be tailored to each
individual patient and to the specific characteristics of
his cancer if we are to maximize cancer control and
minimize morbidity. In the face of this complex
computer interface to all relevant prediction models
for his patient. These topics are of growing interest
and need further work.
references will be available in our journal.
European Urology Today 37
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38 European Urology Today August/September 2008

Sacral Nerve Neuromodulation (InterStim®) Part II:
Review of the InterStim® System
While it is not critical for health care providers to know everything about the InterStim® (sacral nerve
neuromodulation) equipment and programming, Part II of this series will increase the provider’s
knowledge about InterStim therapy by describing the equipment, delineating patient education needs,
and discussing the art of programming. This article will assist the provider in trouble shooting the
system and provide some insight into the patient’s therapy.
Key Words: N’Vision programmer, external stimulator box, Interstim battery, patient programmer.
Helen Rittenmeyer, BSN, RN
Nurse Manager, University of Iowa,
Department of Urology, Iowa City, IA (USA)
The success of any InterStim® Sacral Nerve
Neuromodulation program depends on the positioning
of the chronic tined lead and electrodes in the S3
foramen and the sensation created when being
stimulated (Medtronic, 2006). A successful program
has a physician who knows how to place a chronic
lead in the best possible position as well as a
programming individual who knows how to set
parameters to provide excellent, long-term therapy.
This individual can be a nurse, medical assistant, or
designee who knows when it is necessary to
reprogram to maximize therapy.
The programmer needs to program and/or reprogram
once the neurostimulator (battery) is implanted or
whenever symptoms reappear, and when there is
discomfort or a loss of stimulation. An N’Vision®
Clinician Programmer Model 8840 is required to begin
programming the neurostimulator. With the N’Vision in
hand, the first programming occurs in the recovery
room or in the office a few days later.
Programming concepts
Programming requires an understanding of how to
change the electrical impulse parameters by
increasing, decreasing, or widening. The chronic tined
lead has 4 points (0, 1, 2, 3 electrodes) on the end,
placed in the S3 foramen. These electrodes will create
the electrical impulse and stimulation. The
neurostimulator (battery) located in an internal pocket
created over the hip is also called the case, a fifth point
used to create a circuit causing a stimulation/
sensation. The major
parameters that can be set are amplitude, which is the
intensity or strength of stimulation measured in volts,
and pulse width, which is the time or duration of the
stimulation measured in microseconds. The rate is the
number of times per second a pulse is delivered.
Increasing the rate makes the stimulation feel more
like a flutter, while decreasing the rate feels more like
a tapping. There are ranges associated with each of
these setting.
Other parameters associated with the InterStim®
include:
• Polarity is the current flowing between positive and
negative electrodes. Unipolarity occurs when the
case is positive and there is one negative electrode
on one of 0, 1, 2, 3. Bipolarity occurs when the case
is off and there is a negative and positive charge on
0, 1, 2, 3 electrodes (for example, 0 is negative and 3
is positive)
• Cycling is when the stimulation turns on and off; a
common setting would be 20 seconds on and 8
seconds off.
Figure 1: Example of N’Vision® Programmer
European Association of Urology Nurses
August/September 2008
• Soft start/stop is a ramp-up system for patient
comfort. When the programmer is turned on or if he
or she is cycling, the sensation gently ramps up to
the set amplitude in 4 to 30 seconds.
• Impedance/battery life documents baseline
impedance, the neurostimulator lifetime on the day
of the implant, and yearly review of battery longevity
and identification of broken leads.
These parameters are found on a special setting screen
of the N’Vision programmer (see Figure 1). The
ultimate goal is to manipulate parameters to optimize
the neurostimulator (battery) life. This is accomplished
by using the cycling mode (20 seconds on, 8 seconds
off); keeping the amplitude, rate, and pulse width
values as low as effectively possible; avoiding unipolar
(case positive) stimulation; and using the minimum
number of electrodes for effective therapy.
Figure 2: Component of External Stimulator Box
Programming external Neurostimulator/Patient
education
During both test phases, the patient has an external
stimulatory box attached to external wires. This
external stimulator box looks similar to a TENS unit
and is used to create the stimulation for the
percutaneous test or the 1st stage of the staged
procedure (see Figure 2). Patient education consists of
showing the patient how to use this box. It is helpful to
teach the patient about the external box prior to
surgery, and if that is not possible, the patient should
be taught on the day of the test.
Figure 3: Neurostimulator – R for
Resistance (Rate), A for Amplitude
It is imperative that the patient understands how to use
the external box before going home. Instructions
include how to manipulate the amplitude (A) button,
which increases and decreases the sensation, and
information about the resistance (R) button that is set
and taped by the practitioner (see Figure 3). The back
of the box is composed of two compartments: one is
for a 9-volt battery and the second compartment has
an additional amplitude button, a pulse-width button,
and electrode buttons. In the middle compartment is a
second amplitude button that can be set at 10 or lower
depending on how sensitive the patient is to the
stimulation. There are four small buttons that
correspond with the electrodes on the chronic tined
lead that are set and changed if needed during the test
(0, 1, 2, and 3) (see Figure 4). Patient education
includes teaching the patient that one button is positive
and one is negative, and moving the buttons around to
find the most comfortable sensation for the test. Once
Figure 4: 0, 1, 2, 3, 4 Correlates with
internal lead used for programming
a negative and positive
electrode is set, the amplitude
button is turned on, slowly
increasing until the patient
describes the stimulation/
sensation. The patient will
describe the stimulation/
sensation as a vibration,
flutter, or pulling between the
vagina/scrotum and rectum.
Direct or phone
communication with the
patient daily or every other
day is essential; it is during
these conversations that the
technician and patient will
make changes if necessary Figure 6: Model 3058 and 3023 Battery Life
and decide if the test is
successful or unsuccessful.
Success is determined by the diaries (objective) and
how the patient feels about their symptoms
(subjective). At the end of the test, if the test is
successful, the decision will be made to go on to the
2nd stage, when a neurostimulator (battery) is
implanted or the lead is removed. If there is minimal
symptom relief, changing the positive and negative
electrodes will increase the chances of a positive test. A
successful test remains the best indicator for patient
selection for implantation.
Programming the Internal Neurostimulator
After a documented positive test, a neurostimulator
(battery) is implanted; this is called the 2nd stage. The
internal neurostimulator (battery) is placed during
surgery in a small pocket created in the hip, and the
battery is then programmed using the N’ Vision
programmer. One way to begin programming is called
mapping; this is a systematic approach to
programming the internal neurostimulator (battery). To
determine the optimal electrode combination, the
programmer will elicit a patient response on each
electrode (0, 1, 2, 3). This is started by setting the
neurostimulator case to positive and then, one by one,
checking responses on the 0, 1, 2, and 3 electrodes as Figure 7: Example of N’Vison® Programmer
the negative. The amplitude is then increased by
increments of 0.1 (more sensitive 0.05) to elicit a enter multiple pre-set programs into the patient
response and document; additional documentation programmer. For example, the first program would
indicates where the patient feels the stimulation and have a positive case, negative 0, pulse width of 240,
what it feels like for each electrode. The same is done rate of 9.7, and no cycling (see Figure 7). The second
by making the #3 electrode a positive, eliciting program is the same but with cycles, stimulation will
responses with 0, 1, 2, as the negative, and again by be on for 20 seconds and off for 8 seconds, with a soft
using the #2 electrode as the positive and 0, 1, 3 as start of 4 seconds. The last program is a positive 3,
negative. The end of the session occurs when the negative 1 with a pulse width of 180, rate of 16, and
patient is comfortable with a pulsation or stimulation cycles. This ability to select different programs
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
least 48 hours and only changing if there is no to the clinic for reprogramming.
symptom relief.
The best response is a sensation described as a light There are two patient
flutter or tapping somewhere between the vagina/ handheld programmers
scrotum and rectum. on the market – the
Interstim Model 3031A
Equipment Neuro-stimulator (Battery) (see Figure 8) and the
InterStim iCon patient
programmer Model 3037
(see Figure 9). The
InterStim 3031A is no
longer given to patients
and will be eliminated in
Figure 8: Patient Programmer the future, but some
Model 3031A patients still use this
programmer. The 3031A
features a compartment for a 9-volt battery and buttons
for increasing and decreasing amplitude as well as on
and off buttons. The patient should be familiar with the
Figure 5: Neurostimulator Model 3058 (A) and Model 3023 (B) four buttons on the front: increase, decrease, off, and
with extension on. There are lights on the back of the programmer;
when a front button is pushed and no lights turn on,
In 2006, Medtronic introduced a smaller then the programmer needs a new battery.
neurostimulator battery, Model 3058 (see Figure 5). Other lights on the back panel address the functionality
This smaller battery does not replace Model 3023, the of the neurostimulator. A green light indicates the
battery most commonly used until 2006. This smaller neurostimulator is on, and orange indicates it is off. If
battery is used for patients who require lower there are no lights, the patient’s neurostimulator may
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
Patient Programmer piece of equipment compatible with both the InterStim
In 2006, Medtronic developed a new patient implantable neurostimulator (INS) and the InterStim II
programmer that increases programmable choices for
the patient. It allows the practitioner to create and Continued on page 40
European Urology Today 39
Ensuring continence in difficult cases
Join our search for the best nursing solutions
At the recent International EAUN Meeting in Milan
some colleagues remarked that in our latest Good
Practice in Health Care series titled ‘The Male External
Catheter’ (MEC) only ‘normal’ cases were described.
Although it is common practice for a guideline to
describe or focus on typical cases, the suggestion
implies that there is a need for information on the use
of MEC and other (in)continence devices in atypical
cases such as retracted penis, anatomic
abnormalities, allergic reactions, pressure sores.
This is where we need your help. If you are among
those who encounter these problems in daily practice
and have found your own solutions, we would like to
invite you to take a few photos and write a standard
protocol. We will provide you with a form with a list
of standard questions. The form should include a
description of the problem, the nursing intervention
provided, the material you have chosen to get the
patient continent and the final results.
Together with the EAUN you will share and pass on
this knowledge to other nurses. The EAUN will place
the material on her website as a unique opportunity
to learn from each other.
The cases will be evaluated by a jury of nurses and a
urologist. Those who submitted the 10 best cases will
Call for Difficult Cases
Deadline 1 December 2008
be granted a free registration for the 10th International
EAUN Meeting in Stockholm and will be invited to
present their case in 3 minutes during a workshop on
Thursday. The registrations are supported by an
unrestricted educational grant from Hollister Europe
Ltd. The EAUN holds the right to reproduce the
submitted photos and text material.
Carefully note the submission rules and criteria (check
our website), particularly a written patient consent
wherein approval is given for the photos and its
unrestricted use and the reproduction of the cases for
educational purposes.
If you are interested to take part in this project visit
www.eaustockholm2009.org/10th-eaun-meeting
EAUN Board
Board member Tina Christiansen (DK)
Board member Kate Fitzpatrick (IRE)
Board member Veronika Geng (DE)
Chair Bente Thoft Jensen (DK)
Board member Ulla Lindström (SE)
Vice chair Ronny Pieters (BE)
www.eaun.uroweb.org
(the Stockholm congress website) to download the
form, disclaimer, example of written consent and the
technical specifications for the photos.
We are looking forward to your contributions at
eaun@uroweb.org!

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

Figure 9: iCon Patient

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

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