This year the urology section of the RSM held their annual winter meeting in Saalbach, Austria hosted by Tom McNicholas and Rik Bryan.
Kicking off the meeting was a state of the art lecture by Professor Shahrokh Shariat, Professor of Urology at the Medical University of Vienna who presented a convincing perspective on whether we should really be calling Gleason 3+3 disease “prostate cancer” due to the lack of hallmarks of cancer compared with Gleason four disease, and clinical data suggesting that Gleason 3+3 cancer does not metastasise. Education of patients to ensure compliance of active surveillance is surely key to ensuring that change in disease pattern or small volume higher Gleason grade disease is not missed. Interestingly from Dominic Hodgson’s experience in Portsmouth approximately 50% of patients with Gleason 3+3 disease on TRUS were upgraded to Gleason 3+4 on template biopsy, although these patients who went on to have more extensive biopsies did so due to other concerning parameters.
The bladder and upper tract cancer session was also a highlight with Rik Bryan presenting data on the use of ‘Oncoscan’ to detect genomic profiles and aberrations in urinary DNA from cell free centrifuged urine. This however was not absolutely specific to bladder tumours as undiagnosed prostate cancer was also detected in one of the tested urine specimens.
The Bladder Path trial being set up by Professor Nick James was also discussed. This trial hopes to investigate the addition of MRI into the haematuria clinic pathway. TURBT in muscle invasive disease does not completely stage tumours and may lead to a delay in definitive treatment. There is no current evidence that debulking of tumour is necessary prior to radical treatment. This randomised controlled trial will review whether MRI as opposed to TURBT could be used for staging in likely muscle invasive tumours with the phase II and phase III aspects looking at time to definitive treatment and time to recurrence or progression.
Professor Karl-Dietrich Sievert from the Universitätsklinik für Urologie und Andrologie, Saltzburg demonstrated how his unit use Diffusion Tensor Imaging MRI to visualise white matter and plan for nerve sparing prostatectomy to preserve post-operative incontinence and erectile function. We also heard how Tim O’Brien has learned many of his lessons in complex renal cancer surgery the hard way, in an inspiring and candid talk.
For the benign urologists there were a plethora of sessions on male and female incontinence as well as male and female ejaculation! Matthew Bultitude and I (RT) debated on medical expulsive therapy for ureteric stones in the wake of the SUSPEND trial. Although the majority of the room seemed convinced of the lack of benefit for small ureteric stones, there appeared to be some doubt created by the regarding larger distal ureteric stones.
We also had a lot of interesting non-urological discussions. From Martin Mansell, Consultant Nephrologist we heard of the change in law since the Montgomery Judgment leading to the necessity for doctors when taking consent to inform patients of any risk no matter the likelihood of the risk occurring if that particular patient would attach significance to that risk. Mark Speakman pointed out that this may mean a change in the BAUS consent forms which many of us use to consent patients. We also heard of new educational tools such as MedShr from Asif Qasim, Consultant Cardiologist, which is an app serving as a platform to discuss complex cases with colleagues from around the world. BAUS President Mark Speakman presented the BJUI Knowledge tool which allows BAUS members to access interactive e-learning modules and log CPD activity.
2016 marked the 34th annual winter meeting for the urology section of the RSM and we paid tribute this year to Peter Worth who has been a regular attendee since the beginning. With a fantastic meeting already planned in Lake Tahoe for 2017 to mark the 35th year hosted by Professor Roger Kirby and Matthew Bultitude, I would encourage as many trainees and consultants to attend for both a rigorous transatlantic educational programme as well as a fantastic opportunity to meet new colleagues and, of course ski!
Rebecca Tregunna (ST4, Alexandra Hospital, Redditch (Worcestershire Acute Hospitals NHS Trust) – @rebeccatregunna
Dominic Hodgson (Consultant Urologist, Queen Alexandra Hospital, Portsmouth) – @hodgson_dominic