The Article of the Month this issue comes from Copenhagen; the cover image shows the waterfront at Nyhavn, lined by brightly coloured 17th and early 18th century townhouses.
Image ©istock.com/scanrail
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By Ben Challacombe (@benchallacombe) and Jonathan Makanjuola (@jonmakurology)
The AUA meeting was starting to hot up with the anticipation of the Crossfire sessions, PSA screening and the MET debate that appeared to rumble on. We attended the MUSIC (Michigan Urological Surgery Improvement Collaborative) session. It is a fantastic physician led program including >200 urologists, which aims to improve the quality of care for men with urological diseases. It is a forum for urologists across Michigan, USA to come together to collect clinical data, share best practices and implement evidence based quality improvement activities. One of their projects is crowd reviewing of RALP by international experts for quality of the nerve spare in order to improve surgical outcomes.
The MET debate continues to cause controversy. In the UK there has been almost uniform abandonment of the use of tamsulosin for ureteric stones following The Lancet SUSPEND RCT.
The MET crossfire debate was eagerly awaited. The debate was led by James N’Dow (@NDowJames) arguing against and Philipp Dahm (@EBMUrology) in favour of MET. Many have criticised the SUSPEND paper for lack of CT confirmation of stone passage. Dr Matlaga (@BrianMatlaga) stated that comparing previous studies of MET to SUSPEND is like comparing apples to oranges due to different outcome measures. He recommended urologists continue MET until more data is published. More conflicting statements were made suggesting that MET is effective in all patients especially for large stones in the ureter. The AUA guidelines update was released and stated that MET can be offered for distal ureteric stones less than 10mm.
In a packed Endourology video session there were many high quality video presentations. One such video was a demonstration of the robotic management for a missed JJ ureteric stent. Khurshid Ghani (@peepeeDoctor) presented a video demonstrating the pop-corning and pop-dusting technique with a 100w laser machine.
One of the highlights of the Sunday was the panel discussion plenary session, Screening for Prostate Cancer: Past, Present and Future. In a packed auditorium Stacy Loeb (@LoebStacy), gave an excellent overview of PSA screening with present techniques including phi, 4K and targeted biopsies. Freddie Hamdy looked into the crystal ball and gave a talk on future directions of PSA testing and three important research questions that still needed to be answered. Dr. Catalona presented the data on PSA screening and the impact of the PLCO trial. He argued that due to inaccurate reporting, national organisations should restore PSA screening as he felt it saved lives.
There was a twitter competition for residents and fellows requiring participants to tweet an answer to a previously tweeted question including the hashtag #scopesmart and #aua16. The prize was Apple Watch. Some of the questions asked included; who performed the 1st fURS? And what is the depth of penetration of the Holmium laser?
UK trainees picked up the prizes on the first two days.
The British Association of Urological Surgeons (BAUS) / BJU International (BJUI) / Urological Society of Australia and New Zealand (USANZ) session was a real highlight of day three of the AUA meeting. There were high quality talks from opinion leaders in their sub specialities. Freddie Hamdy from Oxford University outlined early thoughts from the protecT study and the likely direction of travel for management of clinically localised prostate cancer. Prof Emberton (@EmbertonMark) summarised the current evidence for the role of MRI in prostate cancer diagnosis including his thoughts on the on going PROMIS trial. Hashim Ahmed was asked if HIFU was ready for the primetime and bought us up to speed with the latest evidence.
The eagerly awaited RCT comparing open prostatectomy vs RALP by the Brisbane group was summarised with regards to study design and inclusion criteria. It is due for publication on the 18th May 2016 so there was a restriction of presenting results. Dr Coughlin left the audience wanting more despite Prof. Dasgupta’s best effort to get a sneak preview of the results! We learnt from BAUS president Mark Speakman (@Parabolics) about the UK effort to improve the quality of national outcomes database for a number of index urological procedures.
Oliver Wiseman (@OJWiseman) gave us a flavour of outcomes from the BAUS national PCNL database and how they are trying drive up standards to improve patient care. A paediatric surgery update was given by Dr Gundeti. The outcomes of another trial comparing open vs laparoscopic vs RALP was presented. There was no difference in outcomes between the treatment modalities but Prof. Fydenburg summarised by saying that the surgeon was more important determinant of outcome than the tool. Stacy Loeb closed the meeting with an excellent overview of the use of twitter in Urology, followed by a drinks reception.
It was not all about stones and robots. The results of the Refractory Overactive Bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment (ROSETTA) trial results were presented. Botox came out on top against neuromodulation in urgency urinary incontinence episodes over 6 months, as well as other lower urinary tract symptoms.
The late breaking abstract session presented by Stacy Loeb highlighted a paper suggesting a 56% reduction in high-grade prostate cancer for men on long term testosterone. This was a controversial abstract and generated a lot of discussion on social media.
It has been an excellent meeting in San Diego and we caught up with old and met new friends. It was nice to meet urologists from across the globe with differing priorities and pressures. There was a good British, Irish and Australian contingent flying the flag for their respective countries. It was another record-breaking year for the #AUA16 on twitter. It surpassed the stats for #AUA15 with over 30M impressions, 16,659 tweets 2,377 participants. See you all in Boston for AUA 2017.
The Article of the Month for May 2016 is from Tehran, Iran. The cover shows the Azadi Tower, which marks the western entrance to Tehran City.
© istock.com/knet2d
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The lead author from April’s Article of the Month is based in Knoxville, Tennessee. The cover shows the Knoxville skyline including the Sunsphere, built for the 1982 World’s Fair.
©iStock.com/SeanPavonePhoto
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Most of the authors of this issue’s Article of the Month work in Zurich, Switzerland. The cover image shows the Sphinx Observatory, one of the highest astronomical observatories in the world, at Jungfraujoch in the Swiss Alps.
©iStock.com/TheYok
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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. SIN PIN keeps you connected to your loved ones around the world! All New Customers receive $1 FREE to try SIN PIN International Calling Service. Make High Quality International Calls to those who don’t have the SIN PIN App yet. Never go out of touch with the ones you care about most! SIN PIN keeps you connected! You can find here the free International calling app Ft Lauderdale FL.
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
This issue’s Article of the Month comes from three Danish institutions including Aarhus University Hospital. The cover shows Aarhus Old Town, an open air museum of traditional Danish buildings dating from the 16th to 19th Centuries
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The authors of January’s BJUI Article of The Month come from Hamburg and Mannheim in Germany. The cover shows Hamburg’s Speicherstadt, the largest warehouse district in the world and a UNESCO World Heritage Site.
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Here is a randomised trial from Denmark to uplift your mood this European summer. Penile vibratory stimulation may help with the recovery of erectile function after nerve-sparing radical prostatectomy [1]. However, it does not hasten recovery of continence. Building on the European theme, we were discussing alternative ways of influencing research communities and colleagues during the European Association of Urology (EAU) meeting in Stockholm. One obvious rising star is ResearchGate (Fig. 1).
ResearchGate (https://www.researchgate.net/) is a social networking site for scientists and researchers that allows them to share papers, exchange questions and find collaborators. ResearchGate has won the digital innovation of the year award from Focus Magazine in 2014. An important accolade in a world increasingly influenced and greatly amplified by the web and social media.
For a generation of scientists using Facebook, Twitter and similar social networks, ResearchGate has become a familiar site to exchange data and knowledge related to research. Similar to the other social network sites people can post comments, form groups, have profile pages and can ‘like’, ‘endorse’ and ‘follow’ other members. One can use it as an online bibliography and can even deposit published papers on the site. Members can also share negative results or experiments that are difficult to publish in peer-reviewed journals.
There is also a project section where groups can work together on projects in a secure environment. Forget Skype meetings at the last minute!
ResearchGate also introduces a new way of measuring the impact of a certain researcher on a scientific community. The ResearchGate score (RG score) is a new bibliometric tool that combines traditional parameters, such as the impact factor, with the user’s activity on the site, like posting or answering questions or the number of people that follow them. Also, the RG score of the peers that follow you will have an impact on your own RG score: the more influential your followers are, the higher your personal RG score will get.
Just as the Klout score is measuring the influence that one has in social media, ResearchGate could become an alternative measure not only of the scientific importance of a certain researcher but also of his or her interactivity. It is a measure for ‘scientific social network reputation’.
At the moment the relationship between impact factor, citation index and the RG score is difficult to establish, as the algorithm that is used to calculate the RG score is not widely known. If ResearchGate wants to establish the RG score as a respected measurement tool, some transparency will be helpful in future.
Since ResearchGate was founded in 2008 by Dr Ijad Madisch, Dr Sören Hofmayer and computer scientist Horst Fickensher, >4 million members have joined and the numbers are steadily increasing. Several other exchange platforms exist on the internet, but ResearchGate is certainly the most widespread at the moment. We think it is here to stay and claim a role as one of the tools to measure one’s scientific reputation.
Dirk De Ridder† and Prokar Dasgupta*
†BJUI Associate Editor, University Hospitals Leuven, Leuven, Belgium, and *Guy’s Hospital, KCL and Editor-in-Chief, BJUI
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