Why should urologists read the BJUI?
Watch the full conversation here https://youtu.be/wrjzBLiukpI
Why should urologists read the BJUI?
Watch the full conversation here https://youtu.be/wrjzBLiukpI
How time flies! It seems like only yesterday that I was appointed the 10th Editor‐in‐Chief of a 90‐year old major surgical journal. We assembled a dynamic team with a clear, modern vision and strategy. As we say goodbye, it is time to reflect fondly on our achievements.
Of the many ways to measure this, one is the number of downloads of BJUI articles from our publisher Wiley Online Library. This has increased steadily every year, reaching 3 million downloads in 2019 alone. In addition to this we are regarded as pioneers of web‐based publishing and social media. The BJUI itself and its editorial team have a large, devoted following especially on Twitter. Our infographics, podcasts, picture quizzes, polls and videos were deliberately designed to grab an audience with limited time and short attention spans. The BJUI blogs have often been read more than the articles themselves, bringing immediacy, wider engagement and sensible debate. The most visited blog on the death of Nobel Laureate Tagore from prostatic enlargement was read nearly 110 000 times.
Our impact factor has steadily increased since 2012, reaching the highest in its history and is as close to 5 as it ever has been. This has been achieved by decreasing the acceptance rate to 10% without any form of manipulation. This means that the BJUI papers are now “returnable” to any research excellence exercise of which many exist worldwide. As a clinician–scientist I could not accept anything else in academic circles. The BJUI is the only surgical journal to be rated in the Altmetric top 50 reaching a score of 1469 , compared to an average Altmetric score of 3. It is a testament to the hard work of our team above and beyond the impact factor. I suspect that with more fully open access journals such as the BJUI Compass , driven by Plan S, the importance of the impact factor as it now stands, may gradually diminish over time. We have also led on bringing innovation such as Artificial Intelligence  into our journal and making science accessible to a clinical audience through our “science made simple” section.
While many of our papers come from the UK, USA and Australia, we have also published the best articles from Uganda, China, Japan, Iran, Korea, India, Pakistan and Peru. We are and remain a global journal, associated with 10 international societies. The NICE guidelines have been well cited over the last 3 years  as have the papers in our Trials section and the ever‐popular Guideline of Guidelines . We have managed to co‐publish a number of high‐quality Cochrane reviews including the only one with a maximum AMSTAR score of 11 out of 11 comparing laparoscopic, robotic and open radical prostatectomy .
In this issue of the BJUI , we have published the protocol and curriculum development of the SIMULATE study – the world’s first and only multi‐centre randomised controlled trial of surgical simulation. What started as a BAUS study, expanded worldwide and recruited 1400 cases to see if simulation made better surgeons and improved patient outcomes .
The BJUI also brought innovative design from the fashion industry into academic publishing through the Glass magazine. As a parting gift, I therefore thought it fitting to publish a photograph of the courtyard of King’s College London where the SIMULATE trial first started. It was taken on a sunny day on my iPhone with no one in sight because of the pandemic. We have seen the viral crisis as an opportunity to learn from other nations and published a critical review to guide urological care for our colleagues, residents and patients .
I take this opportunity to thank a loyal group of friends at the BJUI Editorial offices, our trustees, the Associate and Consulting Editors, our wider editorial team of authors and reviewers and our publisher Wiley. I am proud to hand over the BJUI to my friend Freddie Hamdy in the best state of academic health and creativity.
As the year comes to a close, it is time to reflect fondly on the revolutionary reports in the world of scientific publishing. To me, the most exciting were the findings from the Cassini spacecraft diving within Saturn’s rings before destroying itself in its upper atmosphere. This so‐called ‘Cassini Grand Finale’ had begun with the launch of the spacecraft over 20 years ago with the hope of finding subsurface water and potentially habitable environments on Saturn’s moons . Our search for intelligent life continues, driven by advances in new technology. Back on earth, modern microscopy can allow single molecules to be observed and genomes can be precisely manipulated by Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)‐mediated gene editing. The handling of the large data that are generated is likely to be enhanced by the ever‐evolving role of artificial intelligence (AI) . Our New York Dedicated Servers come wіth a 100% network uptime SLA tо dеlіvеr a rеlіаblе dedicated ѕеrvеr hоѕtіng experience fоr уоur buѕіnеѕѕ.
This is the year when we have heard more about AI within the surgical community than any other . Most of us carry AI devices in our pockets in the form of our mobile phones. How can we use this to our benefit perhaps during the few minutes that we have between cases on a busy urological operating list? My usual trick is to ask ‘Siri’ (Speech Interpretation and Recognition Interface) on my iPhone® (Apple Inc., Cupertino, CA, USA) to play me a BJUI podcast, which provides me with a summary of a new paper without having to read any text. Many have told me that listening is becoming as fashionable as reading text, and this is one of our attempts at using AI to augment the BJUI experience.
We also set ourselves the target of becoming one of the first journals to embrace and embed AI. With this in mind, I requested Andrew Hung from California to join the BJUI as Consulting Editor for AI. Andrew has already been publishing novel and often paradoxical reports on surgical performance based on automated performance metrics. you can check our site rooftopyoga for latest updates. A team from Canada has found that machine‐learning (a subset of AI) algorithms can predict biochemical recurrence after radical prostatectomy more accurately than traditional statistical modelling . While being excited by these results, Hung  reminds us that this needs to be validated externally in a larger patient population before it is ready for prime time. Next year we hope to report more from the world of AI and perhaps even surprise our readers with embedded technology within the BJUI itself.
With such rapid advances in science and technology comes the description of a new kind of education for our generation and the next. Joseph Aoun , who leads Northeastern University, describes this as ‘Humanics’ in his new book on higher education in the age of AI. It involves the fundamental difference between what machines and AI can do better than humans but equally what humans do better than machines. This book is a must‐read, as it describes the pillars of technological, data and human literacy. So much so that I have started advising my scientifically minded students and colleagues to consider participating in short boot camps on data science.
I wish you all, wherever you are and whatever the weather, much happiness and greetings of the season!
1 Dougherty MK, Cao H, Khurana KK et al. Saturn’s magnetic field revealed by the Cassini Grand Finale. Science 2018; 362: 5434
2 Mao S, Vinson V. Power couple: science and technology. Science 2018; 361: 864–5
3 Dasgupta P. New robots – cost, connectivity and artificial intelligence. BJU Int 2018; 122: 349–50
4 Wong NC, Lam C, Patterson L, Shayegan B. Use of machine learning to predict early biochemical recurrence after robot‐assisted prostatectomy. BJU Int 2018.
5 Hung A. Can machine learning algorithms replace conventional statistics? BJU Int 2019
6 Aoun JE. Robot‐Proof: Higher Education in the Age of Artificial Intelligence. Cambridge, MA: The MIT Press, 2017
In 2018, the BAUS returns to Liverpool and we have taken this opportunity to renew the lasting friendship between the BAUS and the BJUI. We also celebrate a monumental achievement for the city of Liverpool itself – the Knighthood of Sir Ringo Starr. This has finally happened, 50 years after his MBE and is richly deserved. We therefore decided to feature Liverpool and The Beatles on the front cover of your journal.
This year, Duncan Summerton, a well‐respected Urologist and Andrologist, starts his 2‐year term as the President of the BAUS. In our ‘Guidelines’ section, we have featured two BAUS consensus documents from the Andrology Section on priapism  and testicular trauma . The former has an excellent flow chart on management of priapism with timelines of presentation, which every urologist will find clinically useful.
Finally, renal oncocytoma and its management may pose its own challenges as recorded by Neves et al. . We also present the BAUS radical prostatectomy audit, which is publicly accessible and reassures readers (and the public) that the majority of these operations are being performed in high‐volume centres (164/centre) by high‐volume surgeons with good outcomes . Nearly three in four operations are now performed robotically, which was certainly not the case when I started 15 years ago.
We look forward to meeting you at lunchtime on the Monday and Tuesday of the BAUS conference at the BJUI stand. I am particularly excited about the BJUI lecture and the National Clinical Entrepreneurship Programme, led by my friend Tony Young, on the second day of the meeting (https://www.baus.org.uk/agm/programme.aspx).
MRC Centre for Transplantation, King’s College London, London, UK
As the year comes to an end, one cannot help but reflect on the successes of 2017. The impact factor of the BJUI has gone up to 4.439. Our infographics have introduced an entirely different level of interaction with our readers, some of whom are hard pressed for time. We have simply relied on the age old idiom – ‘a picture is worth a thousand words’. And we have credited our reviewers for giving up their valuable time, through Publons and the entirely new Four Seasons, where we will recognise the best reviewers each quarter through BJUI blogs.
But perhaps the greatest accomplishment this year has been the publication of National Institute of Health and Care Excellence (NICE) Guidance for the very first time in the BJUI. Guidelines in general are now regarded as perhaps the highest level of evidence, which is obvious from the many hundred citations attracted by guidelines from the EAU and AUA. An absolute classic is the American Cancer Society Breast Cancer Screening Guideline from 2003, which was updated in 2015. In keeping with modern times and shorter attention spans, JAMAenhanced the guideline with an amazing infographic of a digital hand and pen drawing across a white paper! Whilst admiring such stunning quality, the team at the BJUI became acutely aware of our major weakness of being an international journal – we do not have society guidelines to publish. Until now…
NICE guidelines are based not just on the highest level of evidence; every effort is made to eliminate bias as far as possible. Every committee has at least two lay members. The processes and methods are based on internationally accepted criteria of quality, as detailed in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrumen ns are clear and unambiguous, making them easier to implement and understand.
A unique feature of NICE Guidance is not just ‘clinical effectiveness’ but engagement with economists to make clear statements on ‘cost effectiveness’. It is no wonder that although NICE is based mainly in London, these guidelines are now popular worldwide and not just for the NHS.
We have earlier published NICE Guidance on the GreenLight XPS laser for BPH avoiding high risk patients such as those with risk of bleeding, prostate volume >100 mL, and urinary retention . This technology would be cost effective if used on a day case basis.
NICE have also weighed the evidence for enzalutamide in hormone-relapsed prostate cancer before chemotherapy , in patients with mild symptoms, provided it is made available by the manufacturer on the agreed discounted price. Although expensive, it is regarded as an effective treatment amongst the new emerging therapies to prolong the lives of patients with prostate cancer.
In this issue of the BJUI, we feature the NICE Guidance on diagnosis and management of bladder cancer . Not only is smoking cessation important in these patients, but perhaps somewhat controversially, NICE recommend discharge to primary care of patients with low-risk non-muscle-invasive bladder cancer with no recurrence within 12 months. They make a number of research recommendations on biomarkers that are increasingly becoming important with next generation sequencing but also patient satisfaction, which is what ultimately matters in this cancer that can adversely affect quality of life of those who suffer with it.
Wishing you all Greetings of the season!
Editor in Chief, BJUI
John Wickham BSc, MB BS, MD, FRCS(Eng), FRCP(Hon), FRCR(Hon), FRSM(Hon)
1927 – 2017
The news of the passing of the legendary John Wickham on 26 Oct 2017 will sadden many. Here is a celebration of the life of a visionary thinker, innovator and pioneering surgeon.
Born in Chichester, John moved with his mother to Littlehampton and spent many happy years in rural Sussex. This year he published his book “An Open and Shut case – The story of Keyhole or Minimally Invasive Surgery” which describes his unique journey through life and his passion for reducing the trauma of surgery for the benefit of his patients. A couple of years before this, he sent me the “raw” version to read and comment on. This will forever remain a treasured possession along with a first signed copy of the final version which arrived on my desk in May 2017. A brilliant exercise in honest writing combined with his wry humour.
There were a number of exciting events in his childhood. He describes “epilation radiotherapy” to his scalp to eradicate ringworm which he provides as the explanation for the lack of hair in later life. Such personal touches keep the reader engaged as do his daily travels from Littlehampton to Bart’s (St. Bartholomew’s Hospital), costing £16 per quarter. He was interviewed by Sir William Girling-Ball for his entry into medical school and subsequently worked for Sir Ronald Bodley-Scott, physician to HM the Queen. Time spent in the Royal Air Force (RAF) toughened him up for the complexities of life as a surgeon.
He was trained in urology by Mr A W Badenoch, another legend in his own right. John describes his first inguinal hernia repair, during which his chief had to leave to take a phone call and he was saved by guidance from the anaesthetist. In his days the pass rate for the FRCS was around 10% and he was one of the lucky ones! He subsequently worked with Prof. Ian Aird of the textbook fame. He met his wife Ann, during a below knee amputation from behind a surgical mask. He was awarded a Fullbright scholarship to Lexington, USA which he thoroughly enjoyed. Despite the offer of a job to stay back, the family decided to return to the UK, where he became a Bart’s man, going on to lead the Department of Urology as its head with Bill Hendry as his colleague.
He was also the Director of the Academic Unit at the Institute of Urology at the then 3Ps (Peter, Paul and Phillips) Hospitals and after the move of St. Peter’s to the Middlesex Hospital. He was also Consultant Urological Surgeon to the King Edward VII Hospital and The London Clinic.
He is credited with a number of pioneering achievements. His device for renal cooling with coils was published in the BJU in 1967. He worked with the famous Sir David Innes Williams and was awarded the Hunterian Professorship. He also published a seminal paper on urethral pressure profile.
Very few will know that he was sidelined with an attack of acute pancreatitis and needed a cholecystectomy for gall stones.
He developed PCNL with Mike Kellett and then the Society and Journal for Minimally Invasive Therapy (SMIT) as well as the Intrarenal Society. He inspired the future generation of great innovators like Graham Watson, Ron Miller and Malcolm Coptcoat, to name a few. With the help of the Kuwait Health Office he managed to instal a Dornier lithotripter in Welbeck street which was revolutionary in those days.
John developed the PROBOT, the first autonomous surgical robot with Prof. Brian Davies at Imperial College. Initially tested in potatoes, it was then refined with the addition of a mapping ultrasound and a vaportome, leading to a world first clinical trial at Guy’s, where he had moved to with the support of Lord Ian McColl. In this project, he was ably helped by Malcolm Coptcoat, Anthony Timoney, Senthil Nathan and Bibhas Kundu. Many years later this device was displayed at a public exhibition at the Royal College of Surgeons of England. It is curious how autonomy is again being discussed amongst roboticists after some 30 years.
Following retirement from the NHS he continued to innovate by establishing a company called Syclix which allowed him to design laparoscopic instruments with pen like grips rather than the traditional handles. He arrived at Guy’s one summers morning to show me these instruments to try on one of my laparoscopic nephrectomy patients. At my request, he examined Ben Challacombe’s thesis on the first ever randomised trial of telerobotics and was then guest of honour at our first robotics symposium in 2004 and the inauguration of the King’s-Vattikuti Institute of Robotic Surgery in 2014.
While clinically active he did his best to spread his philosophy about Minimally Invasive Surgery throughout the world by lecturing and publishing articles in the BMJ, amongst other journals. Many did not believe in him, but he was clearly light years ahead of his time. He received numerous honours, which included the Cheselden Medal and the Galen Medal of the Society of Apothecaries.
It was a privilege to know him and he will remain a lasting inspiration to many.
Editor in Chief, BJUI
It’s hard to believe that we have been doing the BJUI Social Media Awards for five years now! I recall vividly our inaugural BJUI Social Media Awards in 2013, as the burgeoning social media community in urology gathered in the back of an Irish Bar in San Diego to celebrate all things social. At that time, many of us had only got to know each other through Twitter, and it was certainly fun going around the room putting faces with twitter handles for the first time. That spirit continues today as the “uro-twitterati” continues to grow, and the BJUI Awards, (or the “Cult” Awards as our Editor-in-Chief likes to call them), remains a fun annual focus for the social-active urology community to meet up in person.
As you may know, we alternate the Awards between the annual congresses of the American Urological Association (AUA) and of the European Association of Urology (EAU). Last year, we descended on Munich, Germany to join the 13,000 or so other delegates attending the EAU Annual Meeting and to enjoy all the wonderful Bavarian hospitality on offer. This year, we set sail for the #AUA17 Annual Congress in Boston, MA, along with over 16,000 delegates from 100 different countries. What a great few days in beautiful Boston and a most welcome return for the AUA to this historic city. Hopefully it will have a regular spot on the calendar, especially with the welcome dumping of Anaheim and Orlando as venues for the Annual Meeting.
On therefore to the Awards. These took place on Saturday 13th May 2017 in the City Bar of the Westin Waterfront Boston. Over 80 of the most prominent uro-twitterati from all over the world turned up to enjoy the hospitality of the BJUI and to hear who would be recognised in the 2017 BJUI Social Media Awards. We actually had to shut the doors when we reached capacity so apologies to those who couldn’t get in! Individuals and organisations were recognised across 12 categories including the top gong, The BJUI Social Media Award 2017, awarded to an individual, organization, innovation or initiative 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 individual contributions, and in 2015 by the #UroJC twitter-based journal club. Last year’s award went to the #ilooklikeaurologist social media campaign which we continue to promote.
This year our Awards Committee consisted of members of the BJUI Editorial Board – Declan Murphy, Prokar Dasgupta, Matt Bultitude, Stacy Loeb, John Davis, as well as BJUI Managing Editor Scott Millar whose team in London (Max and Clare) drive the content across our social platforms. The Committee reviewed a huge range of materials and activity before reaching their final conclusions.
The full list of winners is as follows:
Most Read [email protected] – “The optimal treatment of patients with localized prostate cancer: the debate rages on”. Dr Chris Wallis, Toronto, Canada
Most Commented [email protected] – “It’s not about the machine, stupid”. Dr Declan Murphy, Melbourne, Australia
Most Social Paper – “Novel use of Twitter to disseminate and evaluate adherence to clinical guidelines by the European Association of Urology”. Accepted by Stacy Loeb on behalf of herself and her colleagues.
Best BJUI Tube Video – “Combined mpMRI Fusion and Systematic Biopsies Predict the Final Tumour Grading after Radical Prostatectomy”. Dr Angela Borkowetz, Dresden, Germany
Best Urology Conference for Social Media – #USANZ17 – The Annual Scientific Meeting of the Urological Association of Australia & New Zealand (USANZ) 2017. Accepted by Dr Peter Heathcote, Brisbane, Australia. President of USANZ.
Best Urology App – The EAU Guidelines App. Accepted by Dr Maria Ribal, Barcelona, Spain, on behalf of the EAU.
Innovation Award – BJUI Urology Ontology Hashtags keywords. Accepted by Dr Matthew Bultitude, London, UK, on behalf of the BJUI.
#UroJC Award – Dr Brian Stork, Michigan, USA. Accepted by Dr Henry Woo of Brian’s behalf.
Best Urology Journal for Social Media –Journal of Urology/Urology Practice. Accepted by Dr Angie Smith, Chapel Hill, USA, on behalf of the AUA Publications Committee.
Best Urology Organisation – Canadian Urological Association. Accepted by Dr Mike Leveridge, Vice-President of Communications for CUA.
The BJUI Social Media Award 2017 – The Urology Green List, accepted by Dr Henry Woo, Sydney, Australia.
All the Award winners (except Dr Brian Stork who had to get home to work), were present to collect their awards themselves. A wonderful spread of socially-active urology folk from all over the world, pictured here with BJUI Editor-in-Chief, Prokar Dasgupta.
A special thanks to our outstanding BJUI team at BJUI in London, Scott Millar, Max Cobb and Clare Dunne, who manage our social media and website activity as well as the day-to-day running of our busy journal.
See you all in Copenhagen for #EUA18 where we will present the 6th BJUI Social Media Awards ceremony!
Peter MacCallum Cancer Centre, Melbourne, Australia
Associate Editor, BJUI
Canberra, our nation’s capital and the host city for the 2017 USANZ ASM, is a gem in its own right, but one which was created to satiate two feuding states locked in a bitter rivalry. In 1908, Canberra embodied the very meaning of compromise and collaboration, a technique which has garnered much success for our Country over the ensuing 100 odd years. Arguably the first official Australian collaborative effort, this way of thinking has become an almost uniquely Australian attribute and a strength imbued in our national pride.
Given this year’s mantra of: “Capitalising on our strengths” It is perhaps fitting then, that the 70th anniversary of the Urological Society of Australia and New Zealand (USANZ) Annual Scientific Meeting (ASM) including the Australia and New Zealand Urological Nurses Society (ANZUNS) 22nd ASM, should be held in such a location. In addition to providing some wonderful tourist opportunities for guests including the War Memorial, the National Gallery and Parliament House.
Convenors A/Prof Nathan Lawrentschuk and Kath Schubach went to great efforts to successfully welcome both national and international guests and Scientific Program Directors A/Prof Shomik Sengupta and Carla D’Amico ensured a star-studded academic program addressing contemporary updates in Urological evidence based practice, which were aptly discussed both inside and outside the confines of the National Convention Centre.
The representation by International faculty was exceptional, with countless urological household names from world leading centres across the globe both involved in the academic program and socially. Urological goliaths including Prof. Christopher Chapple, Prof. Prokar Dasgupta and Prof. Laurence Klotz weighed in on various topical issues providing an intercontinental perspective that complimented the equally impressive national line-up of speakers.
As with previous years, use of social media was rife, with those not able to attend kept in the loop via #Usanz17 and a steady stream from the ever focused twitterati. The ASM provided more than 5 million impressions and over 2800 individual tweets from more than 400 participants. The usual suspects were eminent as always, along with a few newcomers who provided impact in their own right. The official USANZ 2017 App also kept participants up to date via timely notifications and was user friendly.
Guests were spoilt for choice in the convention centre during well timed breaks, which was perpetually abuzz with attendees networking. In the background the ‘Talking Urology’ team headed by Mr Joseph Ischia and A/Prof Nathan Lawrentschuk provided a steady stream of captivating interviews with guests, regarding a myriad of urological topics. Simultaneously, numerous academics gave brief summaries of research posters during allocated presentation sessions. Exhibitors provided a captivating backdrop for these activities including many hands-on simulators and challenges for those keen to test their dextrous mettle. All the while guests relished a variety of delectable culinary options.
The meeting’s common themes were strong and pertinent to contemporary urology. They centred around collaborative research efforts such as the ANZUP trials group and the Young Urology Researchers Organisation (YURO), technology especially PSMA PET and social media and social justice including women in urology and operating with respect. Discussions were directed by chairpersons during purposefully allocated Q&A times at the conclusion of each session, a new and well received addition to this years meeting. This was generously embraced by both senior and junior academics and led to intriguing symposiums and at times heated debate.
The first official day of proceedings provided a smorgasbord of morning and afternoon workshops ranging from technical skills courses to the medico-legal implications of E-Health and technology. This was followed by an allocated networking session for Urology trainees with International faculty.
Officially opening the conference in the Royal Theatre of the convention centre, A/Prof Lawrentschuk introduced this year’s Harry Harris orator; Elizabeth Cosson, AM CSC. Her speech entitled “leading with grit and grace” eloquently detailed her journey in the armed forces and highlighted the difficulties of the unmistakably imbalanced workplace for women in the military. Her talk clearly underlined her role in not only forging a highly successful career for herself but also for those women following in her footsteps. Her inspiring dialogue was synchronous with contemporary issues surrounding Urological practice, especially concerning equality for women but more resolutely, appropriate equity both in training and established practice.
With the tone well established for an exceptional meeting, guests enjoyed a variety of canapés and drinks in the exhibition hall, unwinding with social discussion.
Plenary sessions aplenty began the second day of proceedings with International academic giants including Prof. Klotz, Prof. Chapple, Prof. Traxer and Prof Nitti mixed in with National heavy hitters such as Prof Frank Gardiner, Mr Daniel Moon and outgoing USANZ president Prof. Mark Frydenberg.
Afternoon sessions included subspecialty discussions and some stellar Podium Poster presentations, with an especially impressive mix of senior and junior researchers regarding countless and diverse urological topics.
Heralding the beginning of another exceptional day, the ‘Women in Urology’ breakfast symposium chaired by Dr Anita Clark along side distinguished panellists including Dr Caroline Dowling and Dr Eva Fong was a conference stand out for many.
Following this, more plenary sessions filled the remainder of the pre-lunch program, leading into the highly anticipated Keith Kirkland and Villis Marshall presentations by Urology SET trainees. The presentations did not disappoint. As in previous years, research of unyielding professional and academic quality was offered by the group of future urologists, who as is tradition weathered the gauntlet of probing and tough questions from the floor. All presentations were captivating in their own right. 2017 Villis Marshall winner Dr Marlon Perera presented ground-breaking research regarding the reno-protective role of zinc in contrast nephropathy. Dr Amila Siriwardana was deservedly awarded the Keith Kirkland
award for his multicentre retrospective review on Robot assisted salvage node dissection to treat recurrences detected by PSMA PET.
Following these presentations, the YURO annual meeting once again heralded a complement of enthusiastic, innovative and clever minds from all Australian states, eager to pursue research opportunities through collaborative means. Joined this year by Prof. Henry Woo, the group was fortunate to receive his valuable insight and feedback regarding past success and future direction. The group solidified upcoming positions of leadership and highlighted new directions in educational, research and mentorship avenues for younger members.
The Gala Dinner is a stand out affair during each ASM and this year was no exception. Guests were provided with the unique opportunity to see Australia’s Parliament House from the inside. The night began with surprise operatic renditions of many well known classics in the spacious foyer of the Great Hall and culminated with a climactic performance of Nesson Dorma. Guests then enjoyed a delectable 3 course meal in identical fashion to a rare collection of political royalty including; Barack Obama, Prince William and the Duke and Duchess of Cambridge.
The final day of proceedings saw once again provided an array of interesting and thought provoking topics. The clear highlight of the morning was the metaphorical prize fight between Mr Joseph Ischia and Dr Shankar Siva debating the roles of surgery and radiotherapy in Oligometastatic disease. Although these two went toe to toe over many rounds, the inevitable conclusion was understandably a draw. Although on PowerPoint slide pictures alone, Dr Siva’s extensive use of Star Wars based analogies won my vote.
Insight and introduction to the 71st USANZ ASM was then delivered and as a Melbournian my bias was admittedly hard to hide. Attendees received a taste of the excitement to come, with what is assured to be another blockbuster cast of national and international urologists led boldly by Convenor Mr Daniel Moon and Scientific Program Director Prof. Declan Murphy. I for one, eagerly anticipate the return of the ASM to out Nation’s culinary and cultural capitol and I’m sure guests in 2018 will be captivated by the world most liveable city!
It can be said with certainty that this years USANZ 70th ASM presented a scientific program as strong as ever within a fascinating and historical backdrop and complimented by a lively social atmosphere. This consensus of a highly successful meeting, I’m sure was shared by all.
I look forward to seeing you all next year and hope you are eagerly anticipating the ‘flat whites’.
Dr. Todd G Manning, Department of Surgery, Austin Health, Melbourne, and Young Urology Researchers Organisation (YURO), Australia. Twitter: @DocToddManning
Ever since 2002, I have performed live surgery almost every year where it is transmitted to an audience eager to learn. This year I was invited by Markus Hohenfellner to the unique conference, Semi Live 2017 in Heidelberg. To say that it was an eye opener is perhaps stating the obvious. One look at the program will show you that the worlds most respected Urological surgeons had been invited to participate, but with a difference. There was no live surgery. Instead videos of operations – open, laparoscopic and robotic were shared with the attendees “warts and all” as a learning experience. These were not videos designed to show the best parts of an operation. There were plenty of difficult moments, do’s and don’ts and troubleshooting, but all this was achieved without causing harm or potential harm to a single patient.
My highlights were laparoscopic sacrocolpopexy (Gaston), robotic IVC thrombectomy up to the right atrium (Zhang) and reconstructive surgery for the buried penis (Santucci). The event takes place every 2 years and the videos are all available on the meeting app which can be downloaded here and is an outstanding educational resource.
We were treated to a heritage session which included the superstars Walsh, Hautmann, Clayman, Mundy, Schroder and Ghoneim. This was followed by our host Markus Hohenfellner comparing and contrasting the art of Cystectomy and reconstruction by Ghoneim, Stenzl and Studer.
Open surgery is certainly not dead yet. The session ended with Seven Pillars of Wisdom from Egypt which turned out to be a big hit on Twitter.
The editor’s choice session, a new innovation for 2017, allowed me to showcase the Best of BJUI Step by Step, a section that has now replaced Surgery Illustrated with fully indexed and citable HD videos and short papers.
Many on Twitter seemed to agree that in 20 years time we might look back and say that it was not the right thing to do.
Surgeons do not operate “live” every day. Most doctors in a survey, would not subject themselves or their families to be patients during live surgery. Talk about hypocrisy!! Why should it be any different for our patients? Live surgery is NOT a blood sport practised in Roman times….
The counterpoint is that patients often have the services of the best surgeons during live surgery, recorded, edited videos are not quite the same and that the whole affair has become safer thanks to patient advocates and strict guidelines from some organisations like the EAU. Others have banned the practice for good reason. While the debate continues, I for one came away feeling that Semi-Live was as educational, less stressful and much safer for our patients.
The other day, as the New York Times was getting excited about Nobel Laureate Bob Dylan new album ‘Triplicate’, I had the opportunity of remembering one of his classic songs. Let me explain. I turned up at the School of Surgery in central London for an academic committee meeting early that morning only to find that it had been cancelled. Due to a IT problem the email with this information never reached me! Rather than brave the London tube again, I decided to walk back to my hospital, which took me past my old hospital which sadly no longer exists.
The old hospital in question was The Middlesex Hospital in Mortimer Street, London (Fig.1). The original institution was built in 1745 at Windmill Street and moved in 1757 to Mortimer Street. I arrived there over 20 years ago to train at the Institute of Urology/St. Peter’s Hospital, a highly desirable post amongst surgical residents.
The Middlesex Hospital was closed in 2005 and sold to developers. It now houses swanky apartments and businesses around a beautiful Pearson Square, named after John Loughborough Pearson, who designed the Fitzrovia Chapel (Fig. 2) in 1890 inside the hospital. The Chapel survived the redevelopment as it is a protected building. So did one of the walls of the old hospital along Nassau Street which housed the radiotherapy building (Fig. 3). That facade has been preserved beautifully although there are no patients housed behind it anymore (Fig. 4).
So why I am telling you all this? Nostalgia you may say. But in fact much more. The 3 mile walk that morning allowed me to reflect on my own contribution to science and that of two friends who although slightly ahead of me in the training program at The Middlesex Hospital are gentlemen that I greatly admire.
One is Mark Emberton, now Professor at UCL, who has, through the PROMIS study, established the use of MRI prior to prostate biopsies rather than random TRUS biopsies for patients with a raised PSA. The other is David Ralph, an acclaimed Andrologist, who has just published our Priapism Guidelines, a must read for everyone managing this emergency. There is no doubt that both have made significant contributions to British Urology and patient care in the last 20 years during which so many things have changed.
As for me, I headed to Queen Square from The Middlesex Hospital, where many years of basic research in a Medical Research Council (MRC) funded lab led to the description of the so called “Dasgupta technique” of injecting Botox into overactive bladders. I was pleasantly surprised to hear that it had made its way into a number of texts including Smith’s Textbook of Endourology.
There are however certain things that do not change much. Next to the Middlesex Hospital, on Cleveland Street was the legendary Ragam’s (Fig. 5), which many would regard as THE go to South Indian restaurant. The masala dosa (pancake with spicy potatoes and hot lentil soup) used to cost £3.95 in 1994; 20 years later the price has gone up by only £2 to £5.95 (Fig. 6), while the quality remains as outstanding as ever.