ELUTS19 imparts crucial updates in urodynamics and nocturia management

01 November 2019

Esteemed faculty members EAU Secretary General Prof. Chris Chapple, Prof Sherif Mourad of the International Continence Society (ICS), Prof. Dr. David Manuel Castro Díaz and Prof. Francisco Cruz welcomed delegates on day two of the 3rd edition of the European Lower Urinary Tract Symptoms (ELUTS19), which is organised in collaboration with the International Continence Society (ICS).

During “Management of LUTS in men”, the first session of the meeting, Prof. Philip Van Kerrebroeck shared his expert insights in the management of nocturia.

He stated that more than 80% of male patients with nocturia have nocturnal polyuria (NP), and emphasised that NP comorbid with benign prostatic obstruction (BPO) and/or overactive bladder (OAB) must be addressed. 

According to Prof. Van Kerrebroeck, desmopressin can successfully and safely treat nocturia in men caused by NP. He stated that combination therapy (desmopressin + anticholinergics/β 3 agonists +  α1- blockers) is feasible to improve nocturia in men with BPO and/or OAB with NP.

The lecture was followed by Prof. Dr. Hashim Hashim’s presentationCan urodynamics improve the functional outcome of TURP? Lessons from the UPSTREAM study”.

The UPSTREAM study suggests that UDS is not a test for routine use prior to prostate surgery. For the selective use of UDS, additional analysis is needed to identify which cases UDS is applicable. 

The study also stated that overall treatment outcomes are modest and a significant patient subgroup have worsened. At baseline, there were serious issues with regard to the quality of UDS testing, interpretation and patient inclusion in decision-making.

According to Prof. Hashim, if assessed properly (i.e. through symptom score, a bladder diary, flow rate, and sexual function assessment), UDS is optional in men principally bothered by voiding LUTS. “There are significant flows in service provision in terms of urodynamics. We need to get assessment of patients adequately based on the EAU Guidelines for male LUTS.”

He added that inclusion of UDS in male LUTS assessment will achieve the equivalent symptomatic outcomes following treatment (non-inferiority). “Including urodynamics is still an option as part of the diagnostic pathway for patients prior to BPO treatment,” said Prof. Hashim. 

He stated that the key symptoms are best identified by the International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS), due to the inclusion of Urge Urinary Incontinence (UUI), post-micturition dribble (PMD) and individual symptom bother.

According to Prof. Hashim, many men experience a deterioration in symptoms, including post transurethral resection of the prostate (TURP).

Other notable sessions and workshop
The Joint Session of the EAU Section of Female and Functional Urology (ESFFU), ICS, and the EAU Section of Genito-Urinary Reconstructive Surgeons (ESGURS)  “Male Incontinence. What is new in 2019?” took place today, as well as, the Joint Session of  EAU Section of Andrological Urology (ESAU) and ESGURS. The latter session focused on surgery for erectile dysfunction with lectures on approaches on the treatment of post-prostatectomy incontinence; procedures for the inflatable penile prosthesis; and management of the infected penile prosthesis, to name a few.

The second part of the ESU-ESFFU Masterclass on Functional Urology resumed today and focused on overactive bladder and evolution in male LUTS.

Prof. Dr. Salvador Arlandis, Prof. Hashim and Prof. Enrico Finazzi Agrò lead the Urodynamic Workshop, which was centred on essentials in urodynamics and discussions on urodynamic traces. 

Twenty-one abstract presentations conclude the second day of ELUTS19.

[Pictured above is Prof. Van Kerrebroeck]