Below is a recap of the well-attended Souvenir Session which presented highlights of key developments in urology which were examined during the EAU18 Congress.
Benign prostatic disease
Regarding male lower urinary tract symptoms (LUTS), Dr. Jean-Nicolas Cornu (FR) specified surgical treatment-defining positions such as intraprostatic injections; MISP (minimally invasive simple prostatectomy) e.g. laparoscopic or robotic simple prostatectomy; and bipolar vaporisation.
Cornu also enumerated non-ablative options such as prostatic urethral lift (which the EAU Guidelines recommends to be offered to men (affected with LUTS) interested in preserving ejaculatory function, with prostates <70 mL and no middle lobe. Other non-ablative options include Aquabeam: Waterjet, TIND (temporary implantable nitinol device), and Rezum device.
Urolithiasis and endourology
Real-time spectral analysis through the laser fibre and the blocking of the laser when no stone is targeted were some of the developments of a laser system with automatic object analysis. Prof. Dr. Thomas Knoll (DE), who presented the advances in this field, said that between Mini Percutaneous Nephrolithotomy (PNL) and standard PNL for >20 stones, there is no difference when comparing 18F and 24F tracts.
Regarding the benefits of metabolic evaluation of stone formers, Knoll cited insights from Prof. Giovanni Gambaro (IT) who stated that “under-diagnosing, under-treatment, and under compliance are the key problems,” and from Prof. Dr. Thorsten Bach (DE) who said, “Advise what you know and not what you believe.” On obesity and stone formation, findings have shown urolithiasis is associated with metabolic syndrome, and β3-agonists stimulate adipocyte differentiation.
Renal cancer and transplantation
Prof. Dr. Marc-Oliver Grimm (DE) stated that the 3D printed hybrid model used for training for robotic kidney transplantation was made up of inorganic material for the life-sized printed pelvis and kidney transplant, and organic material of cadaveric iliac arteries and veins.
Grimm mentioned strategies to facilitate robotic partial nephrectomy, one of which was pre-operative trans-arterial bland embolization with the super-selective delivery of lipiodol-indocyanine green mixture into tertiary order arteries feeding the tumour.
Prostate cancer: Early detection and screening
Prof. Arnauld Villers (FR) stated that “Genetic testing needs to be ready soon for primetime. Genetic counselling and testing options should be clarified.” Villers said that magnetic resonance imaging (MRI) as a triage test before first biopsies will represent a new practice, and used in good quality MRI, possibly along with low prostate-specific antigen density (PSA-D). He added that baseline MRI results might be part of active surveillance (AS) selection criteria to reduce reclassification during surveillance.
Prostate cancer: Localised and advanced disease
Prof. Dr. Peter Albers (DE) said MRI helps classify patients for active prostate cancer (PCa) treatment \, and active surveillance (AS) should only be taken as an option following initial MRI (referring to low-risk PCA and AS). Albers said “If MRI is ‘normal’ (including PIRADS 3), use PSA-D to decide on re-biopsy. In this case, systematic biopsies still have to be performed. It is not advisable to rely on MRI-targeted (biopsy) to exclude patients with high-grade cancers (ASIST trial).”
On radical prostatectomy (RP) and salvage RP, delay of surgery is possible until 180 days; positive margins are only relevant if unfavourable (multiple, > 3mm), and salvage RP causes severe incontinence in at least a third of patients.
Systemic therapy in genitourinary cancer
According to some of the findings presented by Prof. Dr. Maria De Santis (GB) on palliative chemotherapy and the impact of cycles of platinum-based first-line chemotherapy for advanced urothelial carcinoma, six cycles are conventional for treating locally advanced unresectable or metastatic urothelial cancer. A study showed four cycles are effective; toxicity was reduced and facilitated a better transition to second-line and switch maintenance therapy.
On cystectomy after immunotherapy, Prof. Dr. Morgan Roupret (FR) stated there was no increase in morbidity nor complications rates after radical cystectomy in patients treated with neoadjuvant pembrolizumab. There was a decrease in the time between the end of systemic treatment and cystectomy, and a decrease of the global length of treatment. Furthermore, Roupret said that installation of the upper tract saves kidneys and is the standard care for CIS (carcinoma in situ).
In his presentation, Dr. John Heesakkers (NL) mentioned the conclusions of the 21-year follow-up of TAMPUS (Tampere Aging Male Urologic Study), which showed that half of the men aged over 50 with urinary urgency coped with their LUTS even if it is bothersome. The effect of first-line treatments was equal to spontaneous remission which reflects the multifactorial aetiology of urgency.
Imaging in urology
The feasibility and diagnostic efficacy of 4D ultrasound (US) cystoscopy with Fly Through in detecting and characterising urinary bladder lesions were assessed. Dr. Jochem Walz (FR) said that 33 lesions were detected in 30 patients with cystoscopy; 2D US detected 24 out of 33 (73%) and 4D Fly Through US detected 31 out of 33 (94%).
According to research developments presented by Prof. Dr. Zoran Culig (AT), tracking of genomic evolution using plasma can indicate treatment resistance. Culig said: “Plasma androgen receptor copy number gain associates strongly with a worse outcome on abiraterone or enzalutamide in both chemo-naive and post-docetaxel mCRPC (metastatic castration-resistant prostate cancer), which is a biomarker opportunity.
Zulig also said that three genes have been identified in association with enzalutamide resistance: HMGCS2, AKR1C3, and UGT1A1; and that intervening with cholesterol synthesis inhibited Du/CAF co-culture spheroids.
Dr. Maarten Albersen (BE) stated that a threshold value for testing Yq deletions of 0.5 million/mL (a ten-fold reduction compared to the current Guidelines), would increase the specificity without adversely affecting the sensitivity and greatly reduce costs.
Albersen said the use of robotic assistance in microsurgical vasovasostomy may have potential benefits over MVV (microsurgical vasovasostomy) in decreasing the operative duration and shortening the learning curve. Limitations include lack of information on female age and duration of obstruction.