Hot topics in urology

A number of important trends in urological research and practice were addressed today during the press-conference, which brought together experts from various fields and EAU opinion leaders. According to the participants, more research needed in the fields of robotic surgery, overactive bladder and PSA screening.

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Prof. Christopher Chapple (UK) gave insights into the latest trends in the management of overactive bladder, stating that while the use of botulinum toxin in the treatment for detrusor overactivity is currently not licensed in Europe, this approach is recommended for patients who do not respond to first-line oral medication. He mentioned that possible CVS side-effects have to be investigated, stating also that more research is needed into possible beneficial effects of a combined sub-therapeutic dose of antimuscarinic and beta-3 agonist. Chapple explained that gender of the patient is an important factor in determining the approach to OAB treatment.

Prof. Axel Merseburger (Germany) continued with the topic of robot-assisted surgery in urology, explaining that today there is not nearly enough evidence to definitively state that this technique is superior to more widely-accepted laparoscopic procedures. He said that without randomised clinical trials it is impossible to ascertain the real benefit of this procedure in relation to other techniques. Concerning the existing body of research on the topic he said that it is difficult to make valid comparisons, as there are usually many variables involved.

“If we compare studies on laparoscopic and robot-assisted procedures, we cannot be sure that the training level of operating teams is exactly the same – just to give one example,” explained Merseburger. “There are many other challenging factors, and that is one of the reasons why we still do not have any such trials today.”

“The training level of the surgeon is of utmost importance and the technique here has only partial relevance,” added Prof. P-A. Abrahamsson, EAU Secretary General, who chaired the press-conference. “This is where the EAU is trying to make a difference with its educational initiatives and policies, and there is much work to be done.”

“If we go into the airplane we expect that the pilot is well-trained, tested, and updated on his skill,” said Abrahamsson, “Surgeons also must have a license to operate, especially if it involves a complex surgical robot – and I mean it almost literally.”

The discussion continued with the presentation by Prof. Schröder, who raised the issue of PCa prevention and what a urologist should tell a patient who is interested in being screened for PSA. He noted that urologists can now give clearer answers to their patients as to the benefits and risks of screening, stating at the same time that the much-debated problem of over-diagnosis can be addressed by the use of various tool, such as that developed by his group and endorsed by the EAU – Prostate Cancer Risk Calculator. Schröder then described the new additions to the calculator, which already now include the possibility of assessing progression to metastatic disease and will soon feature the possibility of accounting for the ultrasound examination data.

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“It is of vital importance to note that much research has to be done in the field of PSA screening,” explained Schröder. “We still do not know how much aggressive cancer is missed in patients undergoing PSA screening and where the limit is to maximising the benefit of this preventive scheme.”

“The PSA screening will continue to be a hot and controversial topic in urology, especially in Europe, in the next decade,” commented Abrahamsson. “The EAU will not change its position on population-based screening as long as this controversy continues.”