Tag: #BJUI

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The Social Media Revolution in Chinese Urology

June 23, 2015/5 Comments/by Wei Wang

It is well known that Twitter, Facebook and YouTube, the most popular social media platforms available in the West, are not easily accessible in China. It is also clear that urologists in the West have embraced these social media platforms (Twitter in particular), not just for personal interaction, but also for professional engagement, and journals such as BJUI have enthusiastically encouraged the use of social media for urologists through their use of Twitter, blogging, YouTube etc.

So what then of Chinese urology? Are we missing out on all this? Not at all! In fact, as a recent BMJ blog observed, China is among the most heavily connected populations on earth, and the smartphone revolution has seen this connectivity grow very rapidly in recent years, more than in many Western countries. The lack of access to Western websites has just meant that a host of home-grown websites have cropped up to allow the insatiable appetite for connectivity to be met. Therefore sites such as RenRen (like Facebook), Sina Weibo (like Twitter), and Youku (like YouTube). The BMJ have blogged about this and have highlighted the huge volume of activity on Chinese social media sites.

Figure from “Your quick guide to social media strategy in China”

At present, the most popular platform among Chinese urologists is WeChat. WeChat, (similar to WhatsApp), is connecting more than a half billion Chinese people now. Apart from free chat, video and voice call, group chat is perfect for professional online discussion. There are several major urological discussion groups. Each group has many hundreds of participants. It is estimated that more 3000 urologists (1/4) in China have been involved in one or more online discussion group. Earlier this month, Prof. Declan Murphy’s lecture slides were uploaded to our urology major discussion group after his presentation at the Asia Urology Prostate Cancer Forum in Shanghai.

More than 2000 Chinese urologists (1/6) watched his slides on smartphones that weekend and shared feedback using the app. Prof Murphy, one of the world’s foremost leaders in social media, even joined WeChat and engaged in dialogue with the discussion group.

At present, the top two most famous discussion groups are called scope art and Hippocrates group. A talented young urologist, Dr. QIan Zhang, set up scope art two years ago. More than 500 urologists from across the country were invited to join the group. New knowledge, case discussion and meeting information can be arranged in the group. Recently, the Top 10 WeChat urologists has been selected thorough WeChat vote platform system. More than 20,000 WeChat users voted for their favorite social medial stars. Several discussion groups were built based on the different specialties (stone disease, andrology etc.). Several leading uro-oncologists, urologists, pathologists, radiologists and related experts also built an MDT discussion group to discuss interesting uro-oncology cases to help select the best options for patients.

We are now also seeing these online discussions develop a physical presence. Recently, a WeChat integrated Hippocrates urological meeting was held in Jiaxing. When each speaker starts to talk, the slides were uploaded to the WeChat discussion group, allowing the entire membership of the discussion group to attach their comments and questions during the presentation. All the questions and comments are projected to the separate screen in the meeting hall. The speaker can discuss with all the members, wherever they are.

WeChat meeting in action in Jiaxing

As these examples demonstrate, social media significantly helps Chinese urologists communicate more effectively, especially in such a large country with a huge population. We are very keen to embrace these new communication platforms and to engage more with our colleagues in the West!

Dr. Wei Wang

Consultant Urologist, Beijing Tongren Hospital, Capital Medical University, China

WeChat ID: medtrip

Give the pill, or not give the pill. SUSPEND tries to end the debate

June 22, 2015/1 Comment/by Christopher Bayne

June 2015 #UROJC Summary

News of a landmark paper on medical expulsive therapy (MET) for ureteric colic swirled through the convention halls on the last day of the American Urological Association’s Annual Meeting in New Orleans, Louisiana. I watched the Twitter feeds evolve from my desk at home: the first tweets just mentioned the title, then the conclusion, followed by snippets about the abstract. As time passed and people had time to read the manuscript, discussion escalated. Without data to prove it, there seemed to be more Twitter chatter about the SUSPEND trial, even among conference attendees, than the actual AUA sessions.

Robert Pickard and Samuel McClinton’s group utilized a “real-world” study design to publish what many urologists consider to be the “best data” on MET. The study (SUSPEND) randomized 1167 participants with a single 1-10 mm calculi in the proximal, mid, or distal ureter across 24 UK hospitals to 1:1:1 MET with daily tamsulosin 0.4 mg, nifedipine 30 mg, or placebo. The study’s primary outcome was the need for intervention at 4 weeks after randomization. Secondary outcomes assessed via follow-up surveys were analgesic use, pain, and time to stone passage. Though the outcomes were evaluated at 4 weeks after randomization, patients were followed out to 12 weeks.

Some of the study design minutiae are worth specific mention before discussing the results and #urojc chat:

Treatment allotment was robustly blinded. Participants were handed 28 days of unmarked over-encapsulated medication by sources uninvolved in the remaining portions of the study
Medication compliance was not verified
The study protocol didn’t mandate additional imaging or tests at any point
Participants weren’t asked to strain their urine
Secondary outcomes assessed by follow-up surveys were incomplete: 62 and 49% of participants completed the 4- and 12-week questionnaires, respectively

The groups were well balanced, and the results were nullifying. A similar percentage of tamsulosin- , nifedipine-, and placebo-group patients did not require intervention (81%, 80%, and 80%, respectively). A similar percentage of tamsulosin-, nifedipine-, and placebo-group participants had interventions planned at 12 weeks (7%, 6%, and 8%). There were no differences in secondary outcomes, including stone passage. There was a trend toward significance for MET, specifically with tamsulosin, in women, calculi >5 mm, and calculi located in the lower ureter (see image taken from Figure 2).

The authors concluded their paper was iron-clad with results that don’t need replication.

“Our judgment is that the results of our trial provide conclusive evidence that the effect of both tamsulosin and nifedipine in increasing the likelihood of stone passage as measured by the need for intervention is close to zero. Our trial results suggest that these drugs, with a 30-day cost of about US$20 (£13; €18), should not be offered to patients with ureteric colic managed expectantly, giving providers of health care an opportunity to reallocate resources elsewhere. The precision of our result, ruling out any clinically meaningful benefit, suggests that further trials involving these agents for increasing spontaneous stone passage rates will be futile. Additionally, subgroup analyses did not suggest any patient or stone characteristics predictive of benefit from MET.”

Much of the early discussion focused on the trend toward benefit for MET in cases of calculi >5 mm in the distal ureter:

Journal Club participants raised eyebrows to the use of nifedipine and placebo medication in the trial:

A few hours in, discussion shifted toward the study design, particularly the primary endpoint of absence of intervention at 4 weeks rather than stone passage or radiographic endpoints. The overall consensus was that that this study was a microcosm of “real world” patient care with direct implications for emergency physicians, primary physicians, and urologists.

The $20 question (cost of 4 weeks of tamsulosin according to SUSPEND) is whether or not the trial will change urologists’ practice patterns. Perhaps not surprisingly, opinions differed between American and European urologists.

We owe SUSPEND authors Robert Pickard and Sam McClinton special thanks for their availability during the discussion. In the end, the #urojc banter for June 2015 was the largest and most-interactive monthly installment of International Urology Journal Club to date.

Christopher Bayne is a PGY-4 urology resident at The George Washington University Hospital in Washington, DC and tweets @chrbayne.

Further Randomised Controlled Trials are needed….No! say something original.

June 12, 2015/11 Comments/by Ben Challacombe

“As we all know, prostate/kidney/bladder cancer is a common disease…” aaargh!!! Of course it is, that’s why you are writing about it and trying to get this piece of work into this journal and why everyone who reads it might be interested; because it is so important and common! If we all know it anyway why are you bothering to tell us this whilst wasting time and your word count and not getting on with presenting the actual research? Anyone who doesn’t know that prostate cancer is pretty common isn’t a doctor let alone a urologist. This is found more often than I can stand and got me thinking about all the other scientific catchphrases and tactics that serve more to irritate than inform.

As the BJUI associate editor for Innovation and one of the triage editors, I read around 600 BJUI submissions each year as part of my role. This is not to mention the additional manuscripts I formally review for this journal and others and there are certain phrases and statements that really just make my blood boil. Time and time again the same statements come up that are put into medical papers seemingly without any thought and which add nothing other than serving to irritate the editor, reviewer and reader.

The throwaway statement that “further randomised trials are needed” is often added to the end of limited observational and cohort studies, presumably by young researchers and almost never adds anything. Anyone who has ever been involved with a surgical RCT will know how challenging it is to set one up and run one, let alone recruit to one which is why so few exist and why so many have failed. Just saying more RCTs are needed without thought to why they haven’t already been carried out just frustrates the reader and shows a lack of true comprehension of the subject. Suggesting an valid alternative to an RCT however might actually get people thinking.

So what else is in the wastebucket of things that cause journal irritation? Well conclusions that have no basis in the results that have been shown; such as XXX is a safe and generally acceptable procedure after 3 cases, of which one had a 2 litre blood loss; or we advise everyone to switch to our technique on the basis of this uncontrolled retrospective cohort. Another is YY is the “Gold Standard” even though this is just opinion that is usually very outdated and this way of doing things was really only the standard approach 20 years ago!

Failure to acknowledge the study limitations is another area that particularly winds me up especially when the authors did a procedure one way 500 times then subsequently did it 50 times in a subtly different way and state that the second is better without mentioning that they might have learnt a fair bit from the previous huge number of cases!

So please let me know what irritates you in a paper so I can watch out for it and makes sure never to use it myself

Ben Challacombe
Associate Editor, BJUI

Learning from The Lancet

June 12, 2015/by admin Z.9

The Lancet, established in 1823, is one of the most respected medical journals in the world. It has an impact factor of 39, and therefore attracts and publishes only the very best papers. Like most journals that have evolved with modern times, it has an active web and social media presence, particularly based around Twitter.

On a Monday morning, last autumn, the Editor of the BJUI had a meeting with the Web Editor of The Lancet at Guy’s Hospital. There was a mutual interest in surgical technology, particularly as Naomi Lee had been a urology trainee before joining The Lancet full-time. The topic of discussion was robot-assisted radical cystectomy with the emergence of randomised trials showing little difference between open and robotic surgery, despite the minimally invasive nature of the latter [1, 2]. Thereafter, The Lancet kindly invited the BJUI team to visit its offices in London. The location is rather bohemian with a mural of John Lennon on the wall across the street! Here is a summary of what we learnt that day.

1. Democracy – what gets published in The Lancet after peer review is decided at a team meeting, where editors of the main journal and its sister publications gather around a table to discuss individual articles. Most work full-time for The Lancet, unlike surgical journals that are led by working clinicians. No wonder that >80% of papers are immediately rejected and the final acceptance rate is ≈6%. Interesting case reports are still published and often highly cited because of the wider readership.

2. Quality has no boundaries – it does not matter where the article comes from as long as it has an important message. The BJUI recently published an excellent paper on circumcision in HIV-positive men from Africa [3]; the original randomised controlled trial had appeared some 7 years earlier in The Lancet [4].

3. Statisticians – the good ones are a rare breed and sometimes rather difficult to find. While we have two statistical editors at the BJUI, sometimes, it is difficult to approach the most qualified reviewer on a particular subject. The Lancet occasionally faces similar difficulties, which it almost always overcomes due to its’ team approach.

4. Meta-analysis and systematic reviews – they form a significant number of submissions to both journals. It is not always easy to judge their quality although a key starting point is to identify whether the topic is one of contemporary interest where there are significant existing data that can be analysed. Rare subjects usually fail to make the cut.

5. Paper not dead yet – this is certainly the case at The Lancet office, where its editors gather together with paper folders and hand-written notes. We are almost fully paperless at the BJUI offices, and are hoping to be completely electronic in the future. A recent live vote of our readership during the USANZ Annual Scientific Meeting in Adelaide, Australia, indicated that the majority would like us to go electronic in about 2–3 years’ time; however, ≈30% of our institutional subscribers still prefer the paper version and are reluctant to make the switch.

The BJUI and The Lancet are coming together to host a joint Social Media session at BAUS 2015, which will provide more opportunity to learn from one of the best journals ever. We hope to see many of you there.

References

1 Messer JC, Punnen S, Fitzgerald J, Svatek R, Parekh DJ. Health-related quality of life from a prospective randomised clinical trial of robot- assisted laparoscopic vs open radical cystectomy. BJU Int 2014; 114: 896–902

2 Lee N. Robotic surgery: where are we now? Lancet 2014; 384: 1417

3 Kigozi G, Musoke R, Kighoma N et al. Male circumcision wound healing in human immunodeﬁciency virus (HIV)-negative and HIV-positive men in Rakai, Uganda. BJU Int 2014; 113: 127–32

4 Gray RH, Kigozi G, Serwadda D et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007; 369: 657–66

Prokar Dasgupta @prokarurol

Editor-in-Chief, BJUI

Scott Millar

Managing Editor, BJUI

Naomi Lee

Web Editor, The Lancet

Men’s Health – Driving the Message Home

June 3, 2015/9 Comments/by Brian Stork

Gentlemen, Start Your Engines

Over the past couple of years, we have seen a growing number of fun and exciting ways to help raise awareness for prostate cancer and men’s health. Movember, for example, has become increasingly popular across the globe. This summer, a couple of high-octane, awareness and fund-raising events are taking place on both sides of the Atlantic. I encourage you to check out both of these events and consider participating – jump in and fasten your seat belts, we’re going for a ride!

The Drive for Men’s Health

Electron Powered

For the second straight year, American urologists Dr. Jamin Brahmbhatt and Dr. Sijo Parekattil have organized the Drive for Men’s Health. Last year, the team drove an all-electric powered TESLA from Clermont, Florida, to Manhattan, New York.

This year, on Thursday, June 11th, the Drive for Men’s Health will again start in Clermont, Florida. However, once they arrive in Manhattan, they’ll take a sharp left turn and head West to Los Angeles, California. The 6,000 mile journey is expected to take nine days to complete. Along the way, the team will need to stop over 60 times to plug in and recharge.

Putting a Plug In for Men’s Health

Over the course of the drive, the urology duo will host live webcasts, on a variety of men’s health topics, including the topic of home health care provided by our partners at www.oxford-healthcare.com/tulsa-home-care-services/, all this with the help of over 200 speakers from around the world. The drivers hope the car, and technology used during the drive, will function as a magnet to pull men and their loved ones into further discussions about healthy living, as well as knowing when to request respite care Tinton NJ once aware of what this kind of care entails. This year’s Drive for Men’s Health coincides with National Men’s Health Week in the United States.

The Banger 3K Rally for Prostate Cancer

Putting the Pedal to the Metal

As summer approaches, auto racing heats up in Europe. In July, amateur hockey player Adam Clark (Clarky) and his friend Robert Lamden (Lambo) will strap themselves into a 28-year-old Toyota MR2 Mk1 for the 2015 Banger Rally Challenge. The race is similar to the Gumball 3000 Rally, but with old cars that cannot be worth more than £350. These old cars needs to be modified with Remapping stages for better performance.

In England, an old car is referred to as “an old banger”. It’s not going to be easy by any stretch of the imagination, and we hope not to break down.” – Adam Clark, “Clarky”

Over the course of ten days, the team will attempt to drive 3,000 miles across France, Switzerland, Monaco, Italy, and thru the Alps. The purpose of the event is to raise awareness and money for Prostate Cancer UK, the largest men’s health charity in the UK, dedicated to helping men survive prostate cancer, and enjoy a better quality of life.

It’s a lighthearted race, but being the first one to the finish line does not mean you have won. There are lots of challenges along the way that need to be completed – and we have no idea what they are yet as it is all secret! It’s very much a social activity, many laughs, great memories. It will be competitive, but I think everyone will be happy just to get to the finish line without breaking down! – Adam Clark, “Clarky”

A Shot and a Goal

Clarky and Lambo have already raised nearly £9,000 for Prostate Cancer UK by selling sponsorship spaces on the car, and from donations. When the team finally arrives back home in London, England, Clarky will wrap up the fundraising event on the ice, as assistant captain, playing for Team Prostate in an All-Stars Charity Ice Hockey Tournament at the home of British ice hockey, Sheffield Arena.

Driving the Message Home

Every man has a unique set of interests. Some men respond to technology under the hood, while others enjoy the screeching of tires on pavement, or the excitement of a shot and a goal. When it comes to men’s health, this summer offers something for just about everyone.

Please consider giving a shout out to Jamin and Sijo on Twitter or Facebook as they drive across America, and/or consider donating to Clarky and Lambo who you can follow on Instagram and Twitter, and for updates along the Banger 3K, please “friend” on Facebook.

By donating and supporting the boys, you will not only help shift men’s health into high gear, but also help keep our patients and our friends out of the penalty box and firing on all cylinders.

Dr. Brian Stork is a community urologist who practices in Muskegon and Grand Haven, Michigan, USA. He is a member of the American Urological Association’s Social Media Workgroup, and is the Social Media Director at StomaCloak. You can follow Dr. Stork on Twitter @StorkBrian.

Capsaicin, resiniferatoxin and botulinum toxin-A – a trip down memory lane

May 31, 2015/1 Comment/by Prokar Dasgupta

Over 20 years ago, I went to work at Queen Square, the Mecca of Neurology, as Medical Research Council fellow to Prof. Clare Fowler, an international expert in the neurogenic bladder. She has now retired leaving a lasting legacy, which features in this edition of the BJUI.

I clearly remember my first meeting with Vijay Ramani (now Consultant Urologist in Manchester) and Dirk De Ridder (Associate Editor, BJUI), which led to a collaborative paper on the effects of capsaicin in refractory neurogenic detrusor overactivity (NDO) [1]. While we were busy studying suburothelial nerves in NDO, with many hours of computerised image analysis, a seminal paper describing the ‘capsaicin receptor’ appeared in Nature [2]. This was my first encounter with transient receptor potential (TRP) channels. They continue to excite urologists and neurologists alike as potential therapeutic targets in overactive and painful bladders [3].

Just like semisynthetic capsaicin, derived from chillies, which acted through TRP receptors, TRPV1 antagonists are effective but have numerous side-effects including hyperthermia. No surprises here But there are other subtypes, such as TRPV4 and TRPM8, which are generating a lot of interest in the field of drug discovery.

Life, of course, moved on. Capsaicin never received a license for NDO and was followed by resiniferatoxin (RTX), which also made a rapid exit as it adhered to the plastic bags that it was dispensed in as a solution. Botulinum toxin-A turned out to be the game changer [4]. After extensive trials and safety studies, it has changed the lives of many millions with incontinence secondary to DO, who have failed most other first-line treatments. It has a licence for clinical use and the science behind its mechanism of action has led to many fascinating discoveries.

So, are TRP inhibitors the next big thing in functional urology? After 20 years of fundamental research, they certainly have the potential. As with most eureka moments in translational research, only time will tell.

References

1 De Ridder D, Chandiramani V, Dasgupta P, Van Poppel H, Baert L, Fowler CJ. Intravesical capsaicin as a treatment for refractory detrusor hyperreﬂexia: a dual center study with long-term followup. J Urol 1997; 158: 2087–92

2 Caterina MJ, Rosen TA, Tominaga M, Brake AJ, Julius D. A capsaicin- receptor homologue with a high threshold for noxious heat. Nature 1999; 398: 436–41

3 Deruyver Y, Voets T, De Ridder D, Everaerts W. Transient receptor potential channel modulators as pharmacological treatments for lower urinary tract symptoms (LUTS): myth or reality? BJU Int 2015; 115: 686–97

4 Sahai A, Dowson C, Khan MS, Dasgupta P. Improvement in quality of life after botulinum toxin-A injections for idiopathic detrusor overactivity: results from a randomized double-blind placebo-controlled trial. BJU Int 2009; 103: 1509–15

Prokar Dasgupta @prokarurol

Editor-in-Chief, BJUI

Transarterial Embolisation of Angiomyolipomas – Not so Cut and Dry

May 29, 2015/by Anthony Noah

The month of May 2015 saw the International Urology Journal Club #urojc Twitter discussion move away from a cancer topic to a benign one. The discussion centred on the recent Journal of Urology paper entitled ‘Transarterial Embolization of Angiomyolipoma – A Systematic Review’. In this paper Murray et al presented a review of 524 cases of transarterial embolization (TAE) for AML in 31 studies (published between 1986 and 2013) with a mean follow up of 39 months.

The authors reported technical success of the procedure in 93.3% of cases with a mean AML size reduction of 3.4cm (38.3%). Post-procedural mortality was reported in 6.9% and unplanned repeat procedures in 20.9%.

The conversation kicked off on Sunday 3rd May at 22:00 (BST) with a flurry of tweets from around the world. Initially there were brief questions about the sample size and clarity of the results in the paper.

A few contributors were not convinced by the overall efficacy of embolisation in the study.

Post-procedure embolisation-related morbidity was reported in 6.9% of patients.

The suggestion of low morbidity moved the conversation away from the paper itself and on to the risks of AMLs if left untreated. The most significant risk of renal AML is bleeding.

There is also the important issue of misdiagnosis

Oesterling et al (1986) published a key paper suggesting that 82% of patients with symptoms had AMLs >4cm. This and other similar papers from the 1980s and 1990s form the basis of treatment protocols for renal AML. The lack of further literary knowledge regarding the natural history of AML became a key sticking point.

Cue the introduction of some more recent literature, suggestive that <2cm AMLs can be ignored (https://www.ncbi.nlm.nih.gov/m/pubmed/24837696/).

This caused further debate about the appropriate screening and management of AMLs. It became apparent that opinions on surveillance vary.

Growth is the important factor. Rate of growth is perhaps more important than actual size in small AMLs.

However there will be data published further supporting this approach to small AMLs.

Are we being overcautious?

Or are we shifting our anxieties to the patient?

There was the inevitable discussion of surgical treatment (partial nephrectomy preferred) instead of embolization. The reasoning for embolization versus surgery was sought out.

Partial nephrectomy allows for definitive treatment of the AML with preservation of renal function and acceptable complication rates.

Embolisation is less invasive without the risks of major surgery and so provides first line treatment for many.

Therefore local complication rates are important to consider, especially when considering nephron-sparing surgery.

CT angiography findings may aide in treatment choice if the vascular supply is amenable to a successful embolisation with minimal non-target embolisation.

Mammalian target of rapamycin (mTOR) is a protein which regulates cell growth, proliferation and survival. Everolimus, an oral mTOR inhibitor, has been shown to reduce the size and growth rate of Tuberous Sclerosis related AML.

As AMLs are benign tumours with significant potential complications, there may be wider variations in management protocols than would be seen with a malignant tumour. Perhaps patient preference, or urologist preference plays much more of a role in individual cases.

As always the debate was interesting and raised a number of key points. Discussion focussed more on overall issues around the management of angiomyolipoma following a brief discussion of the paper itself. The literature is lacking recent high level evidence for treatment of angiomyolipoma. Whilst most follow classical teaching of intervening in symptomatic and larger tumours (>4cm), there is wide variation in the follow up and surveillance of small tumours.

More recent data suggests smaller tumours may not require close follow up. Perhaps rate of growth, much like PSA dynamics in prostate cancer, is more important than the actual size of the tumour. There is also evidence lacking in the direct comparison of embolization versus nephron-sparing surgery for angiomyolipoma.

This draws to a conclusion the summary of the May #urojc summary blog. Please follow @iurojc on Twitter for updates and to get involved on the first Sunday/Monday of each month.

Anthony Noah

Urology Speciality Trainee, West Midlands, UK

Twitter: @antnoah

#AUA15 bursts to life in New Orleans

May 27, 2015/by Aine Goggins

Creole cuisine, bustling Bourbon street, beads and beignets and 16,000 urologists. #AUA15 has just drawn to a close in the birthplace of Jazz; New Orleans, Louisiana #NOLA. With 2,598 abstracts being presented, over 2,500 speakers and representation from more than 100 countries it was undoubtedly an educational and action packed five days.

This was my first AUA and while I knew it was going to be a big conference I was stunned by the size of it all. There were urologists everywhere, so much so that jiving to jazz on Frenchman became a game of ‘spot the urologist’ by the signature urology dance moves and stylish….ish dress code!!!! The scientific programme was so extensive it was difficult to find the time to attend all the sessions I wanted to. However, the committee deserve huge credit for developing the AUA2015 app and Daily news snippets that were available throughout the centre which made it easy to optimise your time at the meeting.

The French Quarter, NOLA

The conference got off to a heated beginning with the Crossfire: Controversies in Urology session sparking plenty of debate. Few topics have ignited as much argument as the question of focal ablation for prostate cancer and the discussion between Mark Emberton MD, UCL, London and Aaron E. Katz, MD,PhD, Winthrop University Hospital was no different. To call it a lively session is an understatement. The question of alpha blockers being sold over the counter for BPH was also discussed during this session. Although the drugs have proven safe over the last 25 years clinicians have concerns that the loss of patient contact as a result of this relabeling would causes a loss of control in the treatment of men with BPH.

Friday drew to a close with the urotwitterati enjoying the social media TweetUp encouraging newbie tweeters to get involved. It clearly worked because #AUA15 set a new record and almost trebled it’s tweeting volume since #AUA13.

Day two, Saturday saw the opening of the Science and Technology hall. A spectacle of testicular, penile devices and stalls I have never seen. I fear what one might have thought had they stumbled into the conference centre by accident!!

The @BJUIJournal #SoMe awards took place on Saturday evening. @DrHWoo deservedly bagged The Social Media Award 2015 for #UROJC. A well chosen venue there were no issues with Wifi for tweeting!!! Read the #SoMe blog for all award details

Enjoying the @BJUIjournal cult #SoMe awards

A personal favourite of mine at the conference was the 4th annual Residents Bowl which took place over three days; with residents engaging in a battle of the brains! Northeastern claimed the trophy in the end and team members on the winning side included this year’s BAUS representative @DerekHennessey.

BAUS, BJUI and USANZ came together on Sunday afternoon for a stellar line-up of speakers and topics. The session was well attended and speakers outlined the most recent data but more importantly shared the experience of techniques and outcomes in their centres and countries. I think this combined society session is a fantastic arena for all to both learn and educate each other on what is working best, where and why? The superb line up included Dan Moon, Jeremy Grummet, Henry Woo, Declan Murphy, David Nicol, Damien Bolton, Stephen Boorjian and Philip D. Stricker who all shared their clinical expertise.
BJUI Guest speaker Ben Challacombe discussed the evidence base for management of RCC by partial nephrectomy. Lower intraoperative complications and WIT were observed at their centre at Guy’s Hospital London, which is similarly reflected by low complication rates in the BAUS mandatory UK national nephrectomy audit. Professor Prokar Dasgupta started his up and down journey for the evidence supporting robotic cystectomy for TCC bladder by reminiscing on where it all began; kite-flying in India as a young boy.

Much anticipated CORAL trial found that 90 day complication rates and oncological control were comparable in ORC v LRC/RARC.

Finally the session closed with the presentation of the Coffey-Krane award to Gopa Iyer; Phase III Study of everolimus in metastatic urothelial cancer collected on Dr Gopa’s behalf by David Quinlan. This award is for trainees who are based in the Americas and judged by a panel as the best publication accepted to the BJUI.

Overall, some of the big points of the conference were the amendments to AUA guidelines including Castration-Resistant Prostate Cancer, which was updated from just last year. Perhaps, the most significant was the first ever draft of AUA Peyronie’s disease guidelines; outlining recommendations from medical therapy to surgery.

The huge rise in social media at urology conferences was demonstrated again by record-breaking figures via @symplur showing that the use of Twitter among the urology community continues to grow:

#AUA15 was both an educational and social experience. I had a blast, learned loads and also got to experience the culinary delights of Muffuletta and Gumbo, take the trolley up St. Charles to the Garden district and simply encounter the warmth and friendliness of both the Louisiana folk and the huge family of Urology. The AUA Scientific Committee deserve a huge congratulations on the success of a stimulating, enjoyable and extensive scientific programme. I know I heard echoes of ‘best AUA yet’ in my company.

Áine Goggins

Medical Student; Queens University Belfast, Ireland

@gogsains

The 3rd BJUI Social Media Awards – #AUA15 in New Orleans

May 27, 2015/by Declan Murphy

What a fun destination we had for the 3^rd Annual BJUI Awards! As you may know, we alternate the occasion of these awards between the annual congresses of the American Urological Association (AUA) and of the European Association of Urology (EAU). Our first awards ceremony took place at the AUA in San Diego in 2013, followed last year in Stockholm at the EAU. This year, we descended on New Orleans, Louisiana to join the 16,000 or so other delegates attending the AUA Annual Meeting and to enjoy all that the “Big Easy” had to offer. What a fun city; a true melting pot of food, music and culture all borne out of the eclectic French, American and African cultures on show. I think I met more key opinion leaders in the clubs on Frenchman Street than I did in some of the prostate cancer poster sessions!

You can read more about all that in our #AUA15 Conference Highlights blog, so on now to the Awards. The AUA Annual Meeting plays host to intense social media activity and it is fitting that the BJUI Social Media Awards gets to acknowledge the rapidly growing number of Uro-Twitterati in attendance. Over 100 of the most prominent tweeters turned up to the Ritz-Carlton to enjoy the hospitality of the BJUI and to hear who would be recognised in the 2015 BJUI Social Media Awards. Individuals and organisations were recognised across 16 categories including the top gong, The BJUI Social Media Award 2015, awarded to an individual, organization or innovation who has made an outstanding contribution to social media in urology in the preceding year. The 2013 Award was won by the outstanding Urology Match portal, followed in 2014 by Dr Stacy Loeb for her outstanding contributions. This year our Awards Committee consisted of members of the BJUI Editorial Board (Declan Murphy, Prokar Dasgupta, Matt Bultitude as well as BJUI Managing Editor Scott Millar whose team in London drive the content across our social platforms).

The full list of awardees, along with some examples of “best practice” in the urology social media sphere can be found on this Prezi. The winners are also listed here:

Most Read Blog@BJUI – “Are you ready to go to prison on a manslaughter charge?”. Accepted by Dr Ben Challacombe, on behalf of Prof Roger Kirby, London, UK
Most Commented Blog@BJUI – “Prof John Fitzpatrick – Life in the Fast Lane”. Accepted by Dr Ben Challacombe, on behalf of Prof Roger Kirby, London, UK
Best Blog Comment – Dr Brian Stork, Michigan, USA
Best BJUI Tube Video – Hospital volume and conditional 90 day post-cystectomy mortality. – accepted by Dr Angie Smith on behalf of Dr Matt Neilsen, North Carolina, USA.
Best Urology Conference for Social Media – SIU Annual Congress, Glasgow 2014. Accepted by Dr Sanjay Kulkarni on behalf of the SIU
Best Social Media Campaign – Dr Ben Davies, Pittsburgh, USA, for highlighting industry issues around BCG shortage
“Did You Really Tweet That” Award – Ben Davies, Pittsburgh, USA (three years running!)
Best Urology App – The Rotterdam Prostate Cancer Risk Calculator. Accepted by Dr Stacy Loeb on behalf of Dr Monique Roobol, ERSPC, Rotterdam, The Netherlands
Innovation Award 2015 – #eauguidelines. Accepted by EAU Guidelines panellists Dr Stacy Loeb and Dr Morgan Roupret, on behalf of Dr James N’Dow, Dr Maria Ribal, and the EAU Guidelines Committee.
#UroJC Award – David Canes, Boston, USA
Best Selfie – Morgan Rouprêt, Paris, France
Best Urology Facebook Site – European Association of Urology. Accepted by Dr Alex Kutikov, Digital Media Editor, European Urology
Best Urology Journal for Social Media – Nature Reviews Urology. Accepted by Editor-in-Chief, Annette Fenner
Best Urology Organisation – American Urological Association. Accepted by Taylor Titus, AUA Communications Office
The BJUI Social Media Award 2015 – International Urology Journal Club #urojc. Accepted by Dr Henry Woo, Sydney, Australia.

Most of the Award winners were present to collect their awards themselves, including the omnipresent Dr Henry Woo who received our top gong for his work on the very successful International Urology Journal Club #urojc. The #urojc now has over 3000 followers and its monthly, asynchronous 48hr global journal club has become a huge event. Many other specialties and #FOAMed resources have recognised #urojc and BJUI are delighted to publish a blog summarising each month’s discussions. Well done to Henry, Mike Leveridge and others in setting and maintaining this outstanding example of social media adding real value.

A special thanks to our outstanding BJUI team at BJUI in London, Scott Millar and Max Cobb, who manage our social media and website activity as well as the day-to-day running of our busy journal.

See you all in Munich for #EAU16 where we will present the 4^th BJUI Social Media Awards ceremony!

Declan Murphy

Associate Editor for Social Media at BJUI. Urologist in Melbourne, Australia

Follow Declan on Twitter @declangmurphy and BJUI @BJUIjournal

Editorial: Patients not p-values

May 27, 2015/by Jonathan Rees

A well powered study can attain statistical significance at a small effect size, but in real-life clinical practice, we do not routinely judge the success or failure of treatment based on the mean result for the hundreds of patients we have treated previously. Nor do we compare the response to treatment with what would have happened if we gave our patient a placebo; instead, clinical effectiveness is determined by the response of the individual patient seated across the desk in our clinic. In an ideal world, therefore, clinical significance, as well as statistical significance, should be built into study design and influence sample size and methodology in much the same way. In this way, we could attempt to assign objectivity to what is essentially a subjective metric: ‘did this treatment work for you?’

It is 25 years since the concept of ‘minimum clinically important difference’ (MCID) was first postulated [1] and almost 20 years since Barry et al. [2] applied this theory to LUTS and the IPSS in particular. MCID represents the smallest change as a result of treatment that is of clinical importance. In a measure such as blood pressure or diabetic control, this is the difference that makes a meaningful impact on complications, but in a quality-of-life field, such as measurement of urinary symptoms where we are predominantly treating the bother caused by the symptoms, the MCID is the smallest change that is noticeable to the patient. Barry et al. showed that a three-point improvement in IPSS is the minimum change required for a patient to notice a slight improvement in symptoms (five points correlating with a moderate improvement and eight points with marked improvement). For the IPSS quality-of-life item, the MCID is considered to be 0.5 points. This is based on two considerations: in other well studied questions with similar seven-point Likert scales, the MCIDs are usually ∼0.5, with the rule of thumb that the MCID is ∼0.5 of the standard deviation/one standard error of measurement. The 2010 National Institute for Health and Care Excellence LUTS in Men Guideline examined the concept of what constituted the MCID for flow rate changes; the evidence base is weak, but a change of 2 mL/s was taken as the MCID, based on the evidence available and expert opinion [3]. A change of three points in total IPSS, however, whilst noticeable, does not necessarily imply a significant improvement in overall or disease-specific quality of life. Furthermore, in a patient with severe symptoms, an improvement of three points may represent a much smaller change than in a patient with milder symptoms at baseline, and for this reason, an improvement in IPSS of ≥25% from baseline has also been proposed as a threshold for clinically meaningful improvement.

The study by Nickel et al. [4] is a rare example of an attempt to integrate the concept of MCID into LUTS trial reporting, analysing the proportion of men with LUTS/BPH, treated with tadalafil 5 mg once daily, who achieved a meaningful improvement in symptoms based on changes in both actual and percentage IPSS. This analysis again shows the power of placebo in LUTS treatment, with approximately half the patients in placebo arms of the four studies achieving the MCID on the IPSS. For those treated with tadalafil, a greater proportion achieved the MCID, with 71.1% seeing an improvement of ≥3 points on the IPSS, and 61.7% a ≥25% change in total IPSS. This benefit over placebo was greater when more demanding clinical thresholds were used, e.g. 50 or 75% improvement on IPSS.

It is encouraging to see a paper that reports clinical significance, but whilst of interest, the study is a post hoc analysis of four trials designed to test tadalafil vs tamsulosin or placebo, for licensing approval, and not a trial designed specifically to measure the clinical significance of changes in symptoms. It is a useful reminder to urologists, however, of the concept of MCID, which despite being well established is not widely known. MCID should be incorporated into the analysis of any results based on patient-reported outcomes [5] where the clinical significance of the results may not be immediately apparent to the clinician.

Read the full article

by Jonathan Rees

Backwell & Nailsea Medical Group, Nailsea, North Somerset, UK

References

1 Jaeschke R, Singer J, Guyatt G. Measurement of health status: ascertaining the minimally clinically important difference. Control Clin Trials 1989; 10: 407–41

2 Barry MJ, Williford WO, Chang Y et al. Benign prostatic hyperplasia speciﬁc health 30 status measures in clinical research: how much change in the American Urological 31 Association symptom index and the benign prostatic hyperplasia impact index is 32 perceptible to patients? J Urol 1995; 154: 1770–4

3 National Institute for Health and Clinical Excellence. The management of lower urinary tract symptoms in men. (Clinical Guideline 97.) 2010. https://guidance.nice.org.uk/CG97

4 Nickel JC, Brock GB, Herschorn S, Dickson R, Henneges C, Viktrup L. Proportion of tadalaﬁl-treated patients with clinically meaningful improvement in lower 1 urinary tract symptoms associated with benign prostatic hyperplasia – integrated data 2 from 1499 study participants. BJU Int 2015; 115: 815–21

5 McGlothin A, Lewis R. Minimal clinically important difference: deﬁning what really matters to patients. JAMA 2014; 312: 1342–3