The treatment of lower urinary tract symptoms (LUTS) is something that every urologist deals with in daily practice, in the opinion of Prof. Francisco Cruz (Porto, PT). Cruz is chairman of the EAU Section of Female and Functional Urology (ESFFU) and co-chairman of ELUTS18. After a successful launch in 2017, the second edition of the LUTS-focused meeting will be coming to Milan on 20-22 September, 2018.
ELUTS18 now features a parallel scientific programme: one based on LUTS and primarily organized by the ESFFU, and one based on reconstructive surgery, primarily organized by the EAU Section of Genitourinary Reconstructive Surgeons (ESGURS) under Dr. Djinovic (Belgrade, RS).
Additionally, the ESU-ESFFU Masterclass on Functional Urology is structured around the ELUTS18 scientific programme, so that participants can also join regular sessions in between their masterclass curriculum. EAU Secretary General Prof. Chapple (Sheffield, GB) and Dr. John Heesakkers (Nijmegen, NL) complete the ELUTS18 Organising Committee.
Structuring the lectures
Speaking about the LUTS programme, Prof. Cruz highlighted the new structure of the talks, which are more case-based than usual. “Instead of simply having lectures that cover the different LUTS topics, we’ve made a more structured programme. We start with a case in daily practice, and immediately involve the audience by asking for their suggested treatment approach.”
Cruz is referring to the voting rounds that occur regularly in these sessions. The audience is asked for their preferred approach, given the case’s facts and new developments. “The audience will for instance be asked to advise single or combination treatment. The first speaker will elaborate on the audience’s answers. The next steps lead to more audience interaction. The patient in this case might also have erectile problems, which leads to a talk on how to solve this in LUTS patients, and so forth.”
“This is asking for a little more effort from the session moderator, as he or she has to tie every individual talk together and guide the audience through the session-long case discussion. The discussion has to be steered so that it flows into the next step of the procedure, and the next presentation.”
“We think this is a more attractive way to present the lectures, that is to say in the sequence of the problems that the urologist might encounter. The audience might be reminded of the patients that they saw before coming to ELUTS18.”
For ELUTS18, one of the main areas for improvement for the Organising Committee was to achieve more audience interaction than last year, through voting and more moments for discussion. Another innovation to achieve this comes on the afternoon of the meeting’s first day. During the real-life case discussions presented in that part of the meeting, the audience and faculty are split into three groups, covering urodynamics, neuro-urology and sacral neuromodulation. The groups and faculty will rotate, allowing every participant to follow each topic, with all the didactic advantages of a small group.
“The faculty of this part of the programme is the best and most experienced in the field,” Cruz explains. “The smaller groups will create a more intimate atmosphere, one that is closer to that of an educational course or masterclass than a conventional lecture. We also want to gauge if the lessons of the first part of the programme have been learned by the audience. That’s why we have more clinical cases in the afternoons.”
This year, the ESU Masterclass is more closely integrated into ELUTS18, as a true joint meeting. Cruz explains the reasoning for this change, compared to ELUTS17: “If ELUTS18 features good talks on LUTS, we thought it was a shame to have two days of masterclass that run parallel to the ELUTS programme, with 30 people who would also be interested in the rest of the meeting.”
“Last year, these participants did not join the regular programme at all, which is a shame, particularly as there is also an overlap topics. These include OAB and incontinence, and in some cases even the speakers were and the concept of the lectures was very similar. So we decided to combine the two and increase participation.”
The masterclass will take place on the Friday before the regular ELUTS18 programme, as well as on the afternoon of the Saturday. Masterclass participants are encouraged to join the ELUTS18 sessions on the Saturday morning. Topics covered by the masterclass on functional urology include: male and female anatomy, neuroanatomy, bladder pain syndrome, sexual dysfunction, urinary diversion and a lot of (submitted) case discussions.
Hot Topics in LUTS
When asked about the big topics at ELUTS18, as well as the significance of the meeting in general, Prof. Cruz reflected: “Functional urology is of course our daily practice. Even if we’re more focused on oncology, we have to cover patients with OAB symptoms, or LUTS in elderly men, for example as a result of prostate cancer or its treatment. Male LUTS might also be something we deal with as a part of active surveillance.”
“Stress urinary incontinence in females is a hot topic due to use of artificial meshes. There is no firm evidence that they cause serious harm, but our patients are being misinformed by incorrect information that flies around. If we are talking about 3% of patients developing a problem with artificial mesh use after five years, is it a serious problem? We need to discuss this, and (beginning) urologists need to be informed on possible options and their consequences for their patients.”
Prof. Cruz is also looking forward to ELUTS18’s last session, which will address the future of functional urology. “I think that, as urologists, we need to call to attention that functional urology is always there, whether we are practicing functional urology alone or as a component of wider urology. We cannot ignore that, following radical prostatectomy, 30% of the patients will have incontinency, independent of whether the procedure is open, laparoscopic or robotic.”
“We need to call attention to the fact that functional urology is the basis of daily practice. As urologists, we cannot only check PSA levels and do some biopsies. We see patients, and patients have more ailments than this. We need to call to attention of the audience.”