RSM Urology Section Winter Convention, 2018

This years Winter Convention of the Royal Society of Medicine’s Urology Section was a meeting not to forget. This time we were surrounded by the beautiful scenery of Corvara, Badia in the heart of the Italian Dolomites. President Roland Morley and Honorary Secretary Sri Sripasad constructed a diverse educational programme of talks to ensure a full house at all sessions during the busy week.

We kicked off by ‘meeting the trainees’: an enthralling debate on which ‘clinically less important conditions’ should receive the benefit of treatment from a trust in financial difficulty. Surprisingly, the benign cases took the lead, with the debating skills of London trainee Nick Faure Walker successfully challenging all others involved. He emerged the victor after instilling anxieties in us about the risks of an infected, obstructed kidney in a patient with renal stone disease.

Joint sessions with the University of Milan and the University of Rome gave a European slant to the meeting. Professor Francesco Montorsi provided an honest review of how to improve accurate follow up and categorisation of complications following robotic assisted laparoscopic radical prostatectomy – following implementation of the EAU guidelines panel recommendations on the reporting and grading of complications (see below image).

Professor Bernardo Rocco discussed PRECE, a novel, validated and easily accessible tool based on a cohort of 6360 patients to predict risk and side effects of extracapsular extension of prostate tumours to aid perioperative planning and decisions on how to appropriately nerve spare (see below image). Professor Andrea Tubaro and his colleagues have also developed a new screening questionnaire for benign prostatic hyperplasia, which has been condensed into a validated short form for general practitioners to use, and translated into several languages.

Other highlights of the meeting included a lively debate on whether the impact of prostate cancer on urological resources was justified. Philip Cornford, from Liverpool, was in full support of such measures but faced a rebuttal from Tim O’Brien from Guy’s; who pointed out that other cancers, as well as benign but serious conditions, unfairly do not share the same volume of funding and resources as prostate cancer. The debate’s conclusion was that we need a more streamlined service for active surveillance enrolment and protocols. Philip Cornford used his talk to describe the several different surveillance schedules advised by different associations for, as we know, there is a considerable UK and worldwide variation in clinical practice (see below image).

Continuing the oncology theme, USA colleague Dr Daniel Shasha, a radiation oncologist from Memorial Sloan Kettering Cancer Centre, reviewed emerging radiation therapy techniques such as ultra-hypofractionated radiotherapy for prostate cancer (currently in trials)(see below image).

Trinity Bivalacqua, from Johns Hopkins, discussed current phase two trials of next generation intravesical therapies for BCG refractory high risk non-muscle invasive bladder cancer (see below image).

An illuminating talk from Tim O’Brien on ‘Illustration, metaphor and analogy’ focused on how clinicians talk to patients and use everyday scenarios and objects to describe conditions and treatments to help get their message across. It was made clear that only patients can tell us which one of our communication aids help them to understand medical information, and cultural differences often need to be taken into account.

Professor Justin Vale, from Imperial College London, gave an insight into his role as Deputy Medical Director and how to manage difficult colleagues (see below image). On this subject, Prof. Vale highlighted the importance of good documentation and not managing capability concerns off the record, as this can all lead to difficulty later on if serious concerns are raised.

In light of a cash-strapped NHS, Dominic Hodgson, from Portsmouth, presented his case series of day-case transurethral resection of the prostate (TURP) that showed it was a safe and feasible alternative to inpatient surgery. Peter Pietrzak, from Southend, presented his series of local anaesthetic ureterorenoscopies that demonstrated the procedure was well tolerated and successful in the majority of patients, which could be a milestone in the treatment of medically unfit patients with obstructing stones. Dr Rik Bryan, from Birmingham, presented the anticipated data on the centralisation of radical cystectomy that showed patients not treated in Improving Outcomes Guidance compliant centres were more likely to die and require re-intervention following their surgery (see below image).

A further improvement in urological services could be with the introduction of the ‘flume’ catheter, a novel, potentially game-changing catheter design presented to us by Roger Holmes, former M&S CEO, engineer and investor. The product is currently awaiting clinical trials, but it could reduce catheter blockages and possibly help our long-term catheter patients with the burden of pain, infections and recurrent hospital admissions.

After the talks there was plenty of time for questions and heated discussion, not least in the functional, oncology and stone MDT sessions where expert panels were presented with challenging cases that provided helpful information for trainees and consultants alike.

The week was rounded off with the President’s forum and a celebration of the life of John Wickham, presented by Dominic Hodgson. It was inspirational to see the lives and careers of many attendees in the audience that had been impacted by this recently deceased great man. Please read the obituary here

Sadly, after a heavy week of lectures and outstanding interactive education we had to hop on our early transfer back to the UK. I can’t wait to do it all again next year in Madonna Di Campiglio with some new faces and old friends of the Royal Society of Medicine.

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