RSM winter meeting 2016, Saalbach

Peter Worth

This photograph is of Peter Worth, a retired urologist from University College London, who has been the most consistent supporter of the RSM Urology Section winter meeting since its inception in 1983. Peter’s 80th birthday is looming soon, but he continues to join us annually in the mountains, attend every academic session, ask great questions and ski like a man 20 years younger! Peter we salute you and were proud to award you the ‘Silver Skier’ prize. This is awarded annually at our meeting and there is no question that Peter richly deserved it this year.

The Royal Society of Medicine (RSM) Urology Section winter meeting took place in Saalbach, Austria, in January 2016. President Professor Tom McNicholas, supported by Honorary Secretary Mr Rik Bryan, organised an extremely strong academic programme with an excellent mix of clinical urology, oncology, hospital management and general urology – enough to keep everyone happy and ensure all delegates went home with the latest updates in the field. The meeting has been well summarised in the BJUI blog, which should be read alongside this report.

Benign urological diseases are always of keen interest to all delegates and this meeting was no exception. Mr Freddie Banks shared his experience of setting up a Holmium laser enucleation (HOLEP) prostate service. Having learned the technique from its originator Professor Peter Gilling during a fellowship in New Zealand (sponsored by The Urology Foundation), he advocates ensuring the whole ‘team’ is onside when getting started with a new highly technological technique. This has paid dividends and this is now his standard procedure for all benign prostatic obstruction, replacing TURP, which is associated with greater blood loss and longer hospital stay.

Novel methods of treating male LUTS whilst preserving ejaculation as well as ‘ejaculatory sparing’ modifications to well-known standard surgical treatments were reviewed by Tom McNicholas. He was followed by Dr Josephine Mansell who gave an enlightening talk on the mysteries of female ejaculation.

Mr Zaf Maan discussed issues with stent encrustation and the problems with stent registries, and outlined his management strategies for dealing with such situations. Mr Matthew Bultitude chaired and took part in a debate on the use of medical expulsive therapy (for ureteric stone/colic) with ST4 trainee Miss Rebecca Tregunna. This was a lively and hard-fought debate with persuasive arguments put forward by both sides. What is clear is that this is a very topical area with similar debates planned for the AUA and BAUS meetings this year.

The other area of benign urological problems discussed was slings and tapes for urinary incontinence. Miss Isobel Morley gave an in-depth description of the anatomy of transobturator tapes. Roland Morley gave a very thorough overview of the current regulatory situation in the UK with warnings about the use of different types of MESH. Meanwhile, Roland Rees complemented this with a talk on slings in the management of male urinary incontinence. We will surely hear more about the controversies in the use of MESH over the coming months and years, as the complications such as infection, erosion and pain are so very difficult to deal with effectively.

In the sphere of prostate cancer Professor Nick James gave an excellent overview of the landmark STAMPEDE trial. One conclusion of this important study is that men with newly diagnosed metastatic prostate cancer may benefit from a course of chemotherapy with docetaxel at the time of initiation of hormonal therapy. (View Professor James’ video highlights.) In the diagnostic setting, Professor Alan McNeill from Edinburgh presented his work to date with the ‘e-finger’ device – a fingertip mechanical probe for measuring prostate gland stiffness during DRE. (View Professor McNeill’s video highlights.)

Subsequently Professor Roger Kirby gave a presentation concerning the lessons for prostate cancer that can be learnt from breast cancer. (View Professor Kirby’s article on this topic.) Both diseases afflict around one in eight men and women respectively in the UK. The lessons include the importance of charity fundraising to raise awareness and fund research, as well as to lobby the Government for improved care of the 45,000 men who are diagnosed each year as well the 250,000 men who are described as ‘survivors’ following treatment. Use of 3T MRI as a possible screening modality was also discussed and the use of this technology for localising tumours within the prostate was also the subject of an excellent presentation by Bruce Montgomery.

Honorary Secretary Rik Bryan gave a state-of-the-art lecture on the molecular genetics of bladder cancer, discussing his latest publication ‘Genomic complexity of urothelial bladder cancer revealed in urinary cfDNA’. Utilising the genome-wide Affymetrix OncoScan 3.0 platform, Rik and his team demonstrated the ability to comprehensively characterise the genomic aberrations associated with bladder cancer in urinary DNA. Furthermore, the profiles obtained from the fragmented cell-free DNA (cfDNA) in the urine supernatant much more closely resembled those obtained from the tumour tissue than from the cellular DNA extracted from the urine cell pellet. Since the majority of urinary biomarker work currently focuses on cell pellet DNA, these findings have important implications and bring us a step closer to a liquid biopsy for bladder cancer and possibly non-invasive diagnosis. A cfDNA profile consistent with malignancy was also found in a control patient who was subsequently diagnosed with prostate cancer, thus representing a tantalising prospect for non-invasive diagnosis in this setting as well.

Further cancer topics included a discussion on the historical and current status of intravesical BCG therapy by Mr David Badenoch, pelvic exenteration surgery by Mr Giles Hellawell, and diagnostic ureteroscopy for upper tract urothelial cancer by Mr Mark Sullivan from Oxford.

During a session relating to training and trainees, we heard about the paucity of urological exposure in British medical schools (Miss Isobel Morley), the emerging role of physicians assistants (Mr Roger Plail), the shape of urological training (Mr Roland Morley) and ongoing training for consultants via the seemingly excellent modules offered by the new BJUI Knowledge website (Mr Mark Speakman).

More controversial topics discussed during the week included ritual circumcision (Mr Tom Rosenbaum), health policy (Ms Pam Garside), the vicissitudes of the private health sector (Mr Simon Carter) and air travel after surgery (Mr Matt Bultitude).

Altogether this was an outstanding scientific meeting in most agreeable surroundings. Next year’s winter meeting will be held in Northstar, Lake Tahoe, California, with an extremely strong invited North American faculty, from the 27 January to 4 February 2017. Here is the link to the website. Do consider joining us there. You would be most welcome.

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