“Under threat” functional urology nevertheless has bright future

21 September 2018

EAU Secretary General Prof. Chris Chapple opened the 2nd European Lower Urinary Tract Symptoms meeting on September 21st, welcoming around 300 participants to Milan. Prof. Chapple (Sheffield, GB) said that while functional urology might at times feel “under threat” from onco-urology, which generally attracts more funding and indeed audiences, it is set to remain at the core of urology.

“With ageing populations, and the associated increase in LUTS, urologists will continue to treat patients,” Chapple explained. “With developments in immunotherapy and robotic surgery, the future of onco-urology is perhaps more uncertain for urologists.”

ELUTS18 marks the second time that the EAU has organized a meeting wholly devoted to lower urinary tract symptoms. The scientific programme was composed with involvement of its Reconstructive Urology and Female and Functional Urology sections (ESGURS and ESFFU respectively), as well as the European School of Urology, which organized a masterclass on the topic.

Cases, voting and good advice

Efforts were made to introduce a new form of scientific programme on LUTS: individual topics were structured around (hypothetical) case discussions. Each new development in the case would prompt a round of voting from the audience (using the EAU Events App), and then a lecture from an expert in the field. Topics this morning included the ideal first-line drug treatment for OAB, options for when that proves ineffective, and the role of age when using alphablockers.

A lot of discussion followed on the number of pharmaceutical options that should be tried before resorting to botox or sacral neuromodulation. While this would differ from country to country (and how patients are paying for their treatment), generally speaking, two rounds of drugs are recommended before other options should be considered.

The speakers and moderators also examined the EAU, AUA and NICE guidelines on OAB, offering their opinions on ever-changing definitions and treatment options. Some speakers expressed their hope that some guidelines be scrapped from future editions, as they are too vague or have come to contradict common clinical practice.

Urethroplasty

Meanwhile, the ESGURS-organised reconstructive part of the ELUTS18 scientific programme was dealing with surgical matters: urethral surgery including peyronie’s disease, male urethroplasty, female urethra strictures and incontinence surgery.

Dr. Alexei Zhivov (Moscow, RU) spoke on lower urinary tract fistulae (LUTF), concluding that the vast majority of LUTF in men are iatrogenic and represented by post-hypospadias repair and post-prostate cancer treatment fistulae.

“The main steps of fistulae closure are well-established, but the issue of which interposition flap is better for particular circumstances, and when it has to be used remains unsolved,” Dr. Zhivov said. “It seems that the use of transferred gracilis muscle or omentum flaps should not be limited to post-radiation therapy patients.”