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The evidence for the suspicious CT scan lesions [4] and can give a correct use of adjuvant mitotane in patients with ACC is classification of the disease stage metastasis or based only on retrospective studies.

Terzolo et al primary [5]. According to the recommendations of various national and international registers of adrenocortical carcinomas, staging should be performed every three months with abdomino-pelvic CT scans and chest X-rays.

Since the patient apparently did not demonstrate any endocrinological tumour activity preoperatively, no routine hormonal studies are necessary.

Their analysis demonstrated a clear prolongation of recurrence-free survival in treated patients [10].

Some have suggested that mitotane should be used only in patients with a high likelihood of recurrence i.

Regarding adjuvant radiotherapy in patients at high risk of local relapse, a pilot study and a larger case series [12] suggested a potential reduction in local recurrence without an effect on overall survival.

Thus, radiotherapy may have a role in selected patients. The patient declined to undergo radical prostatectomy and instead chose to undergo HIFU treatment elsewhere in followed by adjuvant androgen ablation which led to a PSA nadir of 0.

PSA recurrence under continued androgen ablation occurred in With a PSA of 0. With a PSA of 2. Salvage radiotherapy was performed in November as external beam radiotherapy including the pelvic nodal fields with a dose of 50 Gy followed by saturation of the prostatic field with an additional 16 Gy.

This was well tolerated but the PSA continued to rise during the 50 days of radiotherapy and was 5.

Another bone scan was negative. Throughout the patient has been physically and mentally well, being very fit for his age and biologically younger, with a healthy life-style including regular jogging, swimming and cycling.

The patient now requests, if possible, further salvage treatment short of chemotherapy. Discussions points: 1.

What treatment options are available? Is salvage lymphadenectomy indicated? Is any other salvage treatment reasonable?

Case provided by O. Hakenberg, Dept. However, a CT performed nine months postoperatively for persistent persistent cough showed newly developed multiple pulmonary metastases more than 10 with the largest one in the apical segment of the left upper lobe and the presence of a large metastatic mass in the right lobe of the liver, measuring 17 x 11 cm.

In our institute we are currently working on 80 projects, which we divide in various categories. In training, it was appendectomy.

There is the challenge of shrinking resources which may lead to decrease discovery. That would mean we are not advancing our field as much as we could, both scientifically and clinically.

If I were not a physician I would have probably chosen architecture. I try to read a book at least once a month, but most are so-so.

The last thing that surprised me was when I found out that the US spends more money in potato chips than the FDA spends in regulation.

But what is more relevant is the statistic that life expectancy for a male in was approximately 40 years.

A hundred years later life expectancy almost doubled. As a child, I collected stamps and coins. Definitely, the early hours. I usually wake around 4 or in the morning.

I guess the design of the universe. Maybe my biggest concern is the continued conflicts around the world. Alici, Istanbul TR S.

Deger, Ostfildern DE O. Demirkesen, Istanbul TR Deger, Ostfildern DE S. Palminteri, Arezzo IT Esen, Izmir TR Moncada, Madrid ES Alici, Istanbul TR I.

Austoni, Milan IT Ergen, Ankara TR Ozyurt, Izmir TR V. Pansadoro, Rome IT Dahlem, Hamburg DE Dahlem, Hamburg DE A. Djinovic, Belgrade RS A.

Tarcan, Istanbul TR Seckin, Konya TR Demirkesen, Istanbul TR T. Kural, Istanbul TR Panel: Deger, Ostfildern DE A. Mottrie, Aalst BE V.

Deger, Ostfildern DE E. Austoni, Milan IT G. Barbagli, Arezzo IT E. Belgrano, Trieste IT M. Fisch, Hamburg DE A.

Mundy, London GB M. Stackl, Vienna AT T. Alici, Istanbul TR E. Austoni, Milan IT R. Dahlem, Hamburg DE S. Demirkesen, Istanbul TR R.

Ergen, Ankara TR A. Esen, Izmir TR A. Kural, Istanbul TR I. Moncada, Madrid ES A. Mottrie, Aalst BE C. Ozyurt, Izmir TR E. Palminteri, Arezzo IT V.

Pansadoro, Rome IT B. Tarcan, Istanbul TR S. Paul Meria Section Editor Paris FR cancer and related problems such as screening, diagnosis and treatments, including current minimally invasive therapies.

Prostate physiological movements and their interference with the treatments were considered in the third part. Their mechanisms of occurrence were described such as various methods of adaptive re-planning, based on imaging systems for treatment guidance.

Many tables and illustrations completed each chapter. Undoubtedly, this textbook is intended for radiotherapists and oncologists. Nevertheless, urologists involved in prostate cancer management will find ample amount of information, essential in pluri-disciplinary clinical exchanges.

Ponsky, D. Fuller, R. Meier, C. Currently, it remains of little use in the field of urology. Besides technical aspects, one of the limiting factors is probably the need of a pluri-disciplinary team, requiring various practitioners involved in different fields.

Nevertheless, many applications have to be developed in the future. Sexual Dysfunction in Women Lee Ponsky and co-editors, helped by more than 40 worldwide experts, wrote an original textbook dedicated to urological applications of radiosurgery.

The first part provided the reader with general information. Historical aspects and current indications of radiosurgery were described, focusing on intracranial diseases.

Forthcoming developments were separately considered, including advances in genitourinary diseases.

Practitioners involved in sexual dysfunctions management and who are faced with women problems will have to determine their origin and schedule the most accurate treatment.

Marta Meana compiled in this textbook a comprehensive amount of information dealing with a rarely considered problem. Special consideration was given to the organisation of radiosurgery of prostate cancer, including a description of the required team members and their specific role.

The second part dealt with prostate Sexual problems are probably underestimated in women population. The decrease of desire, arousal and orgasm intensity occur frequently and such difficulties may be associated with painful intercourse.

These problems raise important questions and debates about women sexual function. An important part of the book was dedicated to hypofractionated radiation therapy and based on radiobiological aspects of the treatment.

This chapter addressed the rationale and the results of hypofractionated treatments, supported by various studies.

High-dose brachytherapy and stereotactic treatments of prostate cancer were also described in this chapter.

The meeting takes place in Istanbul from December 14 to 15 later this year. Serdar Deger explained which surgeons the meeting hopes to attract.

In the past two to four years, we have seen an increased interest in minimally invasive procedures among reconstructive surgeons.

A scientific programme see previous page , which has been carefully prepared, features lectures, poster presentations and discussions about submitted cases.

Participants are encouraged to submit abstracts on male and female urethroplasty, hypospadias repair, penile corporoplasty, surgical treatment of male incontinence, pelvic organ prolapse and any other surgical techniques using minimally invasive surgery, including laparoscopy and robotics in reconstructive urology.

The meeting will also feature live surgery sessions and will be broadcasted from Istanbul University, with the support and coordination of the Cerrahpasa Medical Faculty.

Nevertheless, many concerns remain regarding various sexual problems in men. Current treatments are frequently based on drugs, and a psychosexual approach remains very important for many patients.

This textbook complemented the previous one dedicated to women problems and the aims and scope of both editions were identical.

Author David Rowland aimed to provide the reader with a strong basis of information, which is helpful in clinical practise.

The first part was dedicated to descriptive information, including epidemiology, definitions and various considerations such as diagnostic procedures for each sexual problem in men.

A brief paragraph described psychophysiology of male sexual function. Questionnaires, useful for clinical assessment of various problems such as erectile dysfunction and premature ejaculation, were described.

The first part included epidemiologic data and various descriptions and definitions of sexual problems in women. The succeeding part described theories and models of sexual dysfunction.

Different theories were described, and the selective review of such theories demonstrated the complexity and wide range of female sexuality.

Diagnosis and treatment problems were described in the third part. Organic, psychological and sociocultural origins of sexual dysfunctions were considered, focusing on various difficulties encountered in practise.

The methods of treatment were considered in the fourth part and the author emphasised the paucity of psychological interventions.

Pre-therapeutic assessment was described including measures of global sexual function, followed by a thorough review of current methods of management.

Multicultural issues were considered in this chapter, including religious and cultural norms and sexual identity.

A case report concluded the textbook and corroborated the complexity of sexual problems in women, and the ambiguity of treatment outcome success.

A summary of selected readings was added. We have seen a significant increase in EBU fellowships, and the number of participants attending international meetings and congresses has also increased.

Turkey has also proven to be an attractive location for meetings, partly due to the relatively lower costs of holding a conference in the city.

The first part was dedicated to diagnosis and evaluation of the problem including identification of etiological factors, either psychosexual or organic.

A comprehensive part was dedicated to the treatments of each clinical problem. Psychosexual approach and pharmacotherapy were described.

Erectile dysfunction, the most common of the encountered problems, was exhaustively considered and various methods of treatment were described.

The management of other problems, such as low desire, premature or delayed ejaculation were also addressed. The authors emphasised psychosexual approaches, such as behavioural, and the combination of methods.

Resource books were listed and an appendix summarised male sexual functioning questionnaires and the dedicated websites where one can obtain such questionnaires.

Deger also noted that the Turkish Urological Association is involved in many meetings which have examined minimally invasive procedures.

This textbook, clearly and exhaustively written, was intended for most practitioners, including urologists and sex therapists.

Readers will obtain accurate information, which is very useful in daily practise. Undoubtedly, all practitioners will have a new and better approach of these problems after reading this textbook which adequately presented useful information.

More recently there has been some observational data suggesting a possible increase in the reported incidence of bladder cancer especially in patients who Intermittent VEGF therapy for have been on the medication for over 24 months.

This paper reports a population-based study to evaluate if metastatic RCC- is it safe? Using the UK general practice research database to Although this has been shown to extend overall interrogate the medical records of more than 10 survival, this is not felt to be curative and a high million people in more than practices, they proportion of patients treated with these agents have identified all patients who were prescribed their first to discontinue treatments secondary to adverse ever oral anti-diabetic agent between 1 January events.

This study assessed the consequences of and 31 December , and who also had at least one stopping treatment in patients who had achieved year of previous medical history in the database.

Patients who started treatment with insulin were A total of 40 patients, treated in either Institut excluded as were those under the age of 40 years or Gustav-Roussy 18 or the Cleveland Clinic 22 , with a known history of bladder cancer.

Participants between January and December were were followed until a diagnosis of bladder cancer, included.

Patients had achieved stable disease, a death from any cause or end of registration with the partial response or a complete response by RECIST general practice.

Data was collected on The primary objective was to measure time-to-disease progression. A nested case-control analysis was carried out.

Therapy window. Perhaps of more concern was the finding that 8 patients developed metastases in new sites during expectant management With a median follow-up of Despite RECIST evidence of progression 8 patients chose to continue expectant management given the low volume and pace of disease.

The other 17 had a variety of treatments and, unfortunately, information on the response to re-initiation of systemic therapy is not available.

On multivariate analysis the more favourable Heng risk group HR 2. Perhaps of more concern was the finding that 8 patients developed metastases in new sites during expectant management.

One patient with brain metastasis and one with bone metastasis presented with clinical symptoms requiring immediate radiation therapy.

There is no evidence that this would have been avoided with continuous therapy, but patients are bound to question this.

There is a current phase II clinical trial underway at Cleveland Clinic which might help answer some of the questions raised by this retrospective study.

Source: Cessation of vascular endothelial growth factor-targeted therapy in patients with metastatic renal cell carcinoma.

Cancer ; Key articles 12 A study cohort of , patients met the inclusion criteria. The mean age was A total of cases with adequate information were matched to 6, controls.

This effect was not seen with use of rosiglitazone, the other thiazolidinedione available in the UK during the study period.

All men underwent histological verification of locally recurrent disease as well as cross-sectional imaging and radioisotope bone scan to exclude macroscopic regional and distant metastases.

Radiological T3a disease was allowed but patients with clinical T3a disease were excluded. HIFU treatment required the insertion of a suprapubic catheter and treatment to the complete prostate.

The catheter was removed weeks later as soon as urethral voiding was adequate. Patients were reviewed every 3 months for the first year and then every 6 months.

Seventeen of 84 patients required intervention for bladder outflow obstruction and 2 men developed rectourethral fistulae interestingly 2 further men out of 6 retreated with HIFU also developed fistulae.

Mean follow-up was Seven men showed no PSA response and were assumed to have metastatic disease. Repeat HIFU should clearly be avoided.

Although there is not a clearly understood biological mechanism to explain the findings it would appear that pioglitazone is associated with an increased risk of bladder cancer.

The absolute rates are relatively low but doctors and patients should be aware of this association when assessing the overall risks and benefits of this therapy.

Source: The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study. Global cancer transitions according to the Human Development Index : A population-based study Cancer is set to become a major cause of morbidity and mortality in the coming decades in every region of the world.

The authors aimed to assess the changing patterns of cancer according to varying levels of human development.

BMJ ; e Does HIFU for prostate cancer work? Whole gland high-intensity focused They used four levels low, medium, high, and very high of the Human Development Index HDI , a composite indicator of life expectancy, education, and gross domestic product per head, to highlight cancer-specific patterns in on the basis of GLOBOCAN estimates and trends on the basis of the series in Cancer Incidence in Five Continents , and to produce future burden scenario for according to projected demographic changes alone and trends-based changes for selected cancer sites.

In low HDI regions, cervical cancer was more common than both breast cancer and liver cancer. Nine different cancers were the most commonly diagnosed in men across countries, with cancers of the prostate, lung, and liver being the most common.

Breast and cervical cancers were the most common in women. In medium HDI and high HDI settings, decreases in cervical and stomach cancer incidence seem to be offset by increases in the incidence of cancers of the female breast, prostate, and colorectum.

If the cancer-specific and sex-specific trends estimated in this study continue, we predict an increase in the incidence of all-cancer cases from The authors conclude that their findings suggest that rapid societal and economic transition in many countries means that any reductions in infectionrelated cancers are offset by an increasing number of new cases that are more associated with reproductive, dietary, and hormonal factors.

Targeted interventions can lead to a decrease in the projected increases in cancer burden through effective primary prevention strategies, alongside the implementation of vaccination, early detection, and effective treatment programmes.

Source: Global cancer transitions according to the Human Development Index : A population-based study. A midurethral sling to reduce incontinence after vaginal prolapse repair Women without stress urinary incontinence undergoing vaginal surgery for pelvic-organ prolapse are at risk for postoperative urinary incontinence.

A midurethral sling may be placed at the time of prolapse repair to reduce this risk. The authors performed a multi-center trial involving women without symptoms of stress incontinence and with anterior prolapse of stage 2 or higher on a Pelvic Organ Prolapse Quantification system examination who were planning to undergo vaginal prolapse surgery.

Women were randomly assigned to receive either a midurethral sling or sham incisions during surgery. One primary end point was urinary incontinence or treatment for this condition at 3 months.

The second primary end point was the presence of incontinence at 12 months, allowing for subsequent treatment for incontinence.

At 3 months, the rate of urinary incontinence or treatment was At 12 months, urinary incontinence allowing for subsequent treatment of incontinence was present in The number needed to treat with a sling to prevent one case of urinary incontinence at 12 months was 6.

Source: Sirolimus and secondary skin-cancer prevention in kidney transplantation. Above all, the definition of efficacy of radical prostatectomy cannot simply be defined by looking at disease-specific survival.

Prostate cancer is becoming a chronic disease and the long period of living with metastatic disease would be a much more relevant end-point when discussing the potential efficacy of treating localised prostate cancer.

N Engl J Med. The authors conclude that a prophylactic midurethral sling inserted during vaginal prolapse surgery resulted in a lower rate of urinary incontinence at 3 and 12 months but higher rates of adverse events.

Source: A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med ; , June 21, Sirolimus has proven antitumoral effect in renal transplant recipients Renal transplant recipients are at increased risk of developing malignancies and the most common of these are cutaneous squamous-cell carcinomas with a high risk for multiple subsequent skin cancers.

This risk is attributable to immunosuppression. This study investigated whether sirolimus is useful in the prevention of secondary skin cancers in organ transplant recipients.

This trial reports data which fit into the ongoing debate about PSA-based screening and early prostate cancer detection programmes.

The authors stated that Coffee drinkers live longer effectiveness of surgery versus observation alone for men with localised prostate cancer detected by means unless they smoke of prostate-specific antigen PSA testing is not known.

Coffee is one of the most widely consumed beverages. Whether coffee is beneficial or unhealthy is a matter They conducted a study in which from November of opinion and this can change over time.

This large through January , men with localised prostate study looked at the potential association between cancer were randomly assigned to radical coffee consumption and the risk of death remains prostatectomy or observation and followed through to unclear.

January Mean patient age was 67 years and the median PSA value was 7. During the median follow-up of In this multicenter trial, transplant recipients who were taking calcineurin inhibitors and had at least one cutaneous squamous-cell carcinoma were randomly assigned either to receive sirolimus as a substitute for calcineurin inhibitors in 64 patients or to maintain their initial treatment in The primary end point was disease-free survival regarding squamous cell skin cancer at 2 years.

Secondary end points included the time until the onset of new squamous-cell carcinomas, occurrence of other skin tumours, graft function, and problems with sirolimus.

Among men assigned to radical prostatectomy, 21 5. The effect of treatment on all-cause and prostate-cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor.

There were 60 serious adverse events in the sirolimus group, as compared with 14 such events in the calcineurin-inhibitor group average, 0.

There were twice as many serious adverse events in patients who had been converted to sirolimus with rapid protocols as in those with progressive protocols.

Graft function remained stable in both study groups. The authors concluded from their study that switching from calcineurin inhibitors to sirolimus has an antitumoral effect in kidney-transplant recipients with previous squamous-cell carcinoma.

Thus, in patients after renal transplantation who have had a squamous-cell skin cancer converting the Source: Radical prostatectomy versus observation for localized prostate cancer.

Obviously, the data do not ascertain whether these were causal or associational findings In a large epidemiological study the association of coffee drinking with subsequent total and causespecific mortality among , men and , women in the National Institutes of Health-AARP Diet and Health Study who were 50 to 71 years of age at baseline was examined.

Participants with cancer, heart disease, and stroke were excluded. Coffee consumption was assessed once at baseline. In age-adjusted models, the risk of death was increased among coffee drinkers.

However, coffee drinkers were also more likely to smoke, and, after adjustment for tobacco-smoking status and other potential confounders, there was a significant inverse association between coffee consumption and mortality.

Adjusted hazard ratios for death among men who drank coffee as compared with those who did not were as follows: 0.

Inverse associations were observed for deaths due to heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections, but not for deaths due to cancer.

Results were similar in subgroups, including persons who had never smoked and persons who reported very good to excellent health at baseline.

A serious drawback of the study may have been that coffee consumption was assessed only once and habits may change.

However, in summary, in this large prospective study, coffee consumption was inversely associated with total and cause-specific mortality.

Obviously, the data do not ascertain whether these were causal or associational findings. Source: Association of coffee drinking with total and cause-specific mortality.

During 5,, person-years of follow-up between and , a total of 33, men and 18, Do not forget to share your event at www.

Adverse events within 30 days after surgery occurred in The authors concluded that among men with localised prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up.

Absolute differences were less than 3 percentage points. However, this study is not free of significant bias.

This mortality was e. The high mortality suggests severe comorbidity in both groups which would certainly affect an outcome looking at mortality.

Gesa Kellermann University of Rostock Dept. That is one of the most frequently asked questions I encounter as a resident. It is a question that I consider a bit awkward since nowadays women are active in all medical specialties.

I used to get really annoyed with this question, but now I instead ask a counter-question: why are there so many male gynaecologists and no one ever asks them why they choose that specialty?

Why are you so interested in prostate glands? This brings us to the fact that if one surveys the medical field one will discover that more and more women are specialising in urology.

Recently, at the OR, an anaesthesiologist said he would never marry a surgeon or urologist. When I asked him why, he replied that she would never have any free time, especially to build or have her own family.

Some men are afraid of strong women, or rather women who have careers or go into specialties that used to be a purely male-dominated field.

I believe it is very important that there are roughly the same number of men and women in a department since they complement each other with their special abilities.

But there are also many things that both genders succeed at equally, such as surgical operation, among other things. My experience With my colleagues in the department, I experience, thankfully, an absolutely respectful and equal work environment.

Like with other people my interest on a career in urology began during my medical studies. My last clinical rotation at the Department of Urology at the University of Rostock Hospital impressed me so much that I chose urology as my elective rotation during my final year in medical school.

University of Rostock Hospital After completing my medical board exams, I began my residency in urology. What impressed me so much about urology?

I always wanted to enter a specialty that requires good manual skills. General surgery failed to interest me since that would have been too unremarkable - being in the OR and never seeing patients- well, never seeing patients not under anaesthesia-- I do not want that.

I consider urology a specialty with many small procedures as well as long operations, while at that same time allowing me to still have patient contacts in the ward and outpatients, which to me is very important.

I like the challenge not only of kidney transplantations, but other small routines or procedures, even if it is just as simple as making a patient really happy with a well-performed circumcision.

Throughout my first year in Rostock, I am lucky to have the chance to operate and assist in many cases. In the OR, I am taught a lot and encouraged to be critical and ask questions.

I also have a lot of responsibility in the ward, which I found pretty daunting during the first month. Now I really appreciate making decisions on my own and having consultations with patients, seeing their contentment and relief after treatment.

My first few nights on-call were no piece of cake, but I am glad that my colleagues offered to let me join them on a few calls during my first few weeks in the department.

I learnt so much in those first few weeks which greatly helped me when, months later, I had my first night call of my own.

On my very first call a patient with urosepsis came in. The consultant gave me immediate back-up and we managed the situation together.

I did not feel left alone at any time and that feeling has stayed with me in all of my calls. I am working in a good team all the way down to the medical student doing rotations where no one is ever left to fend for him or herself since everyone is in the same boat.

Getting support both personally and professionally is almost equally important in the choice of a field of medicine to go into. Rostock offers other interesting aspects with very attractive recreational activities due to its seaside location.

If one works efficiently, one can usually leave the hospital at around p. She discussed the long-term effects of chemotherapy on fertility and the Empathy with patients andrological aspects.

These issues included nerve and In his last lecture, Dr. Mayer discussed the topic of vascular damage, disturbances on gonadal and informing patients about the diagnosis and treatment, endocrine function e.

Also discussed in which also tackled the emotional challenges in such her lecture were the role of testosterone and sensitive situations.

Mayer, as he stressed that including sperm cell cryopreservation. Graefen and Dr. Steuber, associate professor, who treatment options for all types of urologic tumours with patients.

Oncology, as a main topic in urology and a Prof. Sauter, Head of the Department of Pathology, major part in the training of residents, means that University Hospital in Hamburg-Eppendorf specialises options for different stages of prostate cancer, including indications for early and delayed treatment both practicing urologists and residents have to be on urologic tumours.

He gave an overview about the such as radiotherapy and hormonal therapies. Steuber focused on the therapy for advanced disease and relapses in prostate cancer including has organised the 4th workshop on urologic oncology carcinoma as an example.

Over 50 participants from Regarding urologic tumours, Dr. Protzel, associate chemo-naive patients and second-line chemotherapy.

Since penile cancer is a rare disease, The programme included the diagnostic workup, Protzel gave a comprehensive overview on diagnostic second-line therapy in castration refractory prostate cancer.

His presentation included not only guideline tumours. The workshop was specifically organised recommendations but also practical tips for surgery Dr.

Wagner, Head of the urological department at the for residents as they may have other queries and medical treatment based on his daily clinical Federal Armed Forces Hospital, a testis cancer centre compared with veteran oncologists and specialist routine experience and taking into account the newest and host for the workshop, lectured on testicular consultants.

Thus, the workshop also dealt not only scientific results. He gave an overview of the treatment options with therapy regimes but also practical tips and tricks.

Jocham, Head of the Urological Clinic of the of disease. He included a diagnostic work-up and The first speaker, Dr. He also highlighted special cases such as Germ Cell Cancer held in November in Berlin , oncology.

This included the effects on the body, doses, tumours refractory, instillation therapy and following the newest guidelines from the EAU Guidelines necessary previous investigations and knowledge and from his own personal experience.

In the treatment options. The second lecture was about about and treatment of possible side effects. Mayer also presented the treatment of oncologic the correct therapy regimen and the use of secondProf.

Asklepios Hospital in Hamburg-Altona , gave a lecture chemotherapeutic agents and the indication of on renal cell carcinoma.

His presentation included supportive treatment, such as antiemetic drugs, Prof. Kliesch, Head of the Center of reproductive pre-operative staging and classification e.

He also gave an overview on the therapy of advanced disease and new drugs. He also presented clinical cases and asked the audience about their recommended treatment strategies.

Finally, Dr. Buntrock, urologist and Head of the Urologic Centre for Rehabilitation in Bad Wildungen, lectured on the possibilities and limitations of rehabilitative procedures in urologic cancer patients.

He focused on prostate cancer patients after surgical treatment but also included other urologic tumours.

He showed data on the effects of rehabilitation on continence and sexual functions and pointed out the importance of the psychological effects in cancer patients.

Interactive summary The last session was an interactive summary of the two-day event. Some of the speakers joined this session and it was used as a preparation for the exam on medical therapy in urologic oncology.

Participants positively assessed this workshop, describing it as properly oriented on actual practice, comprehensive, with a special focus on the educational needs of residents.

The GeSRU is also satisfied to offer a resident-focused, low-budgeted workshop but with the participation of excellent speakers. Many participants described this feature of the event as very helpful and outstanding compared with other similar meetings.

The GeSRU pointed out that such a quality can only be possible since all speakers did their presentations free-of-charge and shared their time to provide high-quality training.

The GeSRU team conveyed its appreciation to all speakers and to the Federal Armed Forces Hospital in Hamburg for providing the free use of the rooms and workshop equipment.

They also thanked the various companies for the generous support, without which it would have been difficult to organise and offer such a comprehensive workshop.

With its , inhabitants, it is a city where life is not only pleasant but also offers something not only to the eye, but also to the soul. In other words, Bozen is a people-friendly city.

The Department of Urology has 30 beds plus two paediatric beds. Having someone who can lend support in difficult times is therefore important.

Certified training centre On our first day, we received a handbook listing the duties and goals of our training.

We were required to attend once every week the continuing education programme and prepare our own lessons with short presentations and case reports.

We are also expected to actively participate in the pathological meeting and assist in a tele-conference with two partner hospitals in Austria.

Attendance in national and international congresses that are held every year is also required. But the people of Bozen have a more leisurely pace.

There is a good network of bike paths also in the surroundings of the city that will satisfy even the most demanding cyclist.

Thus, places outside the city limits are all conveniently accessible by bicycle. As trainees it is our responsibility to fill in a log-book and an OP catalogue.

After a short meeting we are assigned to either the major surgery OR, the endo-urology OR, the ward, the ambulance or the stone unit.

Our training programme was prepared in such a way that we have the chance to observe, join in or perform a wide range of surgical procedures, every step of which we received constant guidance and instruction.

In the first year, we focused on the external genitalia and were introduced step-by-step in endo-urology. We also have the chance to assist in major surgeries like prostatectomy or renal tumour enucleation.

In the second year we progressed in open surgery and begun with endoscopical resection of the prostate and bladder.

In the third year we took up laparoscopy to improve our skills and competences. Unfortunately, we do not have a personal mentor. There are discotheques for music lovers and partying.

But since the city is not big, there are a limited number of shops, museums and cinemas. A visitor therefore cannot expect the varied attractions usually found in a bigger metropolitan centre.

However, Bozen compensates for it with very good sport facilities, and sports enthusiasts can find or engage in virtually any sport.

In summer one can hike through green woods and climb to the top of the Alps. In winter, there are how to achieve effective communication with patients.

Some in order to avoid errors. Therefore, we have to be skiing slopes, on certain days, are also open until completely reliable and must have the opportunity to It is therefore easy to have the perform many procedures.

Many students practise in feeling that one is working in a holiday resort. Twice to four times a year we host a visiting professor who presents alternative diagnosis paths and operation techniques, providing us valuable tips to improve our skills and gain more experience.

Living in Bozen There is always a lot to do in our department. We residents have to manage the ward, the stone unit and the smaller procedures that take place in endourology such as removing urethral catheters or injecting contrast medium for a urography.

Since it often happens that we have to perform these procedures by ourselves, we have hectic daily schedules. Careful research and planning is crucial to residents in search of sub-speciality training Mr.

All NHS jobs are advertised on www. But I did note that the advertised jobs do not always offer training opportunities.

Most often these jobs are either locum or temporary posts, where a fully trained and experienced urological specialist is hired to provide services such as seeing patients in outpatient clinics, conducting flexible cystoscopies and other minor surgical interventions.

Anuj Goyal, a final-year urology resident explained the following: means the training within the fellowships is usually of a very high standard.

Commonly offered are the Endourology Fellowships for stone disease and upper urinary tract laparoscopy urology department.

As a fully trained urologist, these or Uro-oncology Fellowships, nowadays, usually with a focus on laparoscopic or robot-assisted laparoscopic posts did not appeal to me as they hardly offer any surgery.

More interesting were the so-called LAT Locum Appointment for Training jobs, which are deaneryapproved training posts and open to applicants outside the official UK residency-training programme.

According to the specific job description, these posts can offer good opportunities for developing surgical skills and training, thereby opening doors to a further career in the NHS.

To enter the formal structured five-year UK speciality training programme did not seem an alternative since the prospect of another five years of training was unappealing to me, notwithstanding that this requires a lot of determination due to its competitive nature, and is therefore quite difficult especially for non-UK graduates.

It quickly became evident to me that the best choice for high quality training was to enter a fellowship programme.

But what exactly is a fellowship and how does it work in the UK? This way of sub-specialised post-residency training is usually pursued by the UK residents too usually undertaken post award of Certificate of Completion of Training.

A key advantage to this is that in the UK there is a clear and growing trend towards subspecialisation leading to individual surgeons performing a limited variety of urological operations in centralised facilities.

Centres performing such high-volume and complex work would allow for the attached Fellow to gain excellent exposure to the desired area of super specialisation.

Noor Buchholz and Mr. Junaid Masood. It is certified by the International Endourology Society IES as a subspecialty training centre and became the first European Board of Urology EBU -certified subspecialty centre for the treatment of upper urinary tract stone disease in Moreover, I encountered no problems with visa requirements.

However, there are highly interesting fellowships are offered worldwide. With my fellowship now coming to an end after two years, I must emphasise that my experience is highly valuable to my professional and personal development - a unique opportunity that I can only highly recommend to trainees who are planning to hone their skills in a sub-specialty.

Hein Van Poppel. One of the first urologists in the US to offer penile injection therapy for erectile dysfunction ED , Lue is credited with breakthrough work in treating male dysfunction.

What is the major gene responsible for male sexual differentiation? What is the normal size of the urethral meatus of a 2-year old boy usually?

Kavoussi, MD, Andrew C. Novick, MD, Alan W. Peters, MD eds. Reprinted with permission. This research was also the subject of his PhD thesis that he successfully defended on June His research team has pioneered on a new class of compound which later led to the development of ED drugs such as Viagra and Levitra.

At the same time, social networks are so much more that an opportunity to be in touch with friends and colleagues, there are also a great platform for professional discussions, global networking, job hunting, profiling and forming partnerships.

No wonder, with ,, users, Facebook has ceased to be just a playground for college students. The majority of those who use social media have completed college or postgraduate education and have medium to high-income jobs.

With such high-potential demographic statistics, companies and organisations are eager to communicate through these channels.

How can urologists use social media to achieve professional goals? There are many ways to approach this, but first and foremost it is important to decide whether you will be using social media as an individual urologist, as a representative of an organisation society, hospital department, university department, research group etc.

Many of the other urology associations, as well as pharmaceutical and medical technology companies are also on Facebook so it is a great way to network and come in contact with people interested in the same field of work.

You can easily do it from your personal profile. This is a good opportunity not only to communicate your own information to your audience, but also get feedback from them.

For example during the last congress, the EAU and more than congress participants marked all their updates with eau This way we could all see the photos, opinions and expressions in one Twitter feed, which we conveniently integrated into the congress website for everybody to see.

This made the EAU Congress more human, we heard a lot of useful feedback and it was also a great platform for everybody to post their impressions as the day progressed.

Twitter This microblogging site makes it easy to follow short updates from all the people and organisations that you find interesting.

If you are representing a company, you can organise tweetchats with those who follow you to discuss an issue or event. One large professional association set up a tweetchat about their accreditation programme, which was a useful means for people to get all their questions answered and promote the programme among the potential candidates.

You can find the EAU on Twitter under the name uroweb. LinkedIn LinkedIn is a social network which allows people to build professional contacts and maintain their professional portfolio.

LinkedIn is all-in-one: it offers an easy tool to maintain your online resume, an opportunity to grow professionally, participate in professional discussions and meet new people in your line of work.

Organisations are also allowed to profile themselves in two different ways. They can have a company page which is more like a short profile and they can also have their own group, where discussions, promotions, polls and event announcements can be hosted.

The EAU has such groups, as do many other national and international associations. The EU-ACME programme provides online access to the accounts, allowing its members to register and check, at any time, the listed attended events.

Some members have already used our online system and have sent copies of documented proof of participation in an accredited event in to the EU-ACME office.

Kindly also check your online account by logging in at www. I do not wish to receive a copy by regular mail. To increase awareness about on-line CME and promote this modern educational approach, which have seen further success in , the EU-ACME committee decided to continue with this initiative.

Walz, Marseille FR Ahmed, London GB G. Salomon, Hamburg DE J. Frauscher, Innsbruck AT Scattoni, Milan IT Ahmed, London GB Loch, Flensburg DE Wijkstra, Amsterdam NL Salomon, Hamburg DE Simmons, London GB Villers, Lille FR Giovacchini, Milan IT Huland, Hamburg DE The winning members will be formally notified in early January next year, with their names published in the February issue of this newsletter.

Good luck! Carey, Leeds GB D. Georgescu, Bucharest RO Schneider, Homburg DE Maurer, Munich DE Geavlete, Bucharest RO Panebianco, Rome IT Joniau, Leuven BE C.

Trombetta, Trieste IT A. Volpe, Novara IT Joniau, Leuven BE Laguna, Amsterdam NL Zigeuner, Graz AT Klingler, Vienna AT Frauscher, Innsbruck AT V.

Scattoni, Milan IT H. Draga, Amsterdam NL Fortuin, Nijmegen NL Eder, Heidelberg DE Teber, Heilbronn DE Ritter, Mannheim DE Ahmed, London GB C.

Bangma, Rotterdam NL K. Barwari, Amsterdam NL A. Bossi, Villejuif FR B. Carey, Leeds GB J. Draga, Amsterdam NL M. Eder, Heidelberg DE M.

Fortuin, Nijmegen NL F. Frauscher, Innsbruck AT B. Geavlete, Bucharest RO D. Georgescu, Bucharest RO H. Huland, Hamburg DE S.

Klingler, Vienna AT M. Laguna, Amsterdam NL T. Loch, Flensburg DE T. Panebianco, Rome IT M. Ritter, Mannheim DE G. Salomon, Hamburg DE V.

Scattoni, Milan IT G. Schneider, Homburg DE L. Simmons, London GB T. Steuber, Hamburg DE D. Teber, Heidelberg DE C.

Villers, Lille FR A. Volpe, Torino IT J. Walz, Marseille FR H. Wijkstra, Amsterdam NL R. Huland, Hamburg DE T. Bangma, Rotterdam NL Steuber, Hamburg DE Carey, Leeds GB M.

Geavlete, Bucharest RO H. Heynemann, Halle DE T. Loch, Flensburg DE C. Trombetta, Trieste IT H. Bossi, Villejuif FR Ferreira Coelho, Lisbon PT Trombetta, Trieste IT With an impact factor of 8.

Candidates should All members of the EAU receive the journal as a benefit of their membership. All subscribers to European Urology automatically receive this publication.

Or use this QR code to access the information on your mobile device. The Editor-in-Chief maintains the uniformity of editorial policy.

The two EAU Prizes for Best Paper published in Urological Literature are tools through which the EAU encourages young and promising urological scientists to continue their work and to communicate their achievements to the European urological community.

These papers have to be prepared, published or accepted for publication between 1 July and 30 June All applicants have to be a member of the EAU.

Medical Videos provides easy navigation. Medical Videos, however, is not only a video website but also offers the possibility to upload your own video for the community, and to have access to several forums ranging from residency, nursing, surgery to dentistry.

Bastian, Munich, Germany Vienna S. Joniau, Leuven, Belgium Barcelona J. Ribal, Barcelona, Spain Milan V.

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POP repair These findings add to evidence from the Colpopexy and Urinary Reduction Efforts CARE trial3 which reported that a prophylactic Burch colposuspension at the time of transabdominal prolapse surgery reduced the risk of postoperative urinary incontinence, but resulted in more postoperative complications.

Adding a bladder-neck suspension at the time of abdominal prolapse surgery in women without preoperative stress incontinence significantly reduced the risk of postoperative stress urinary incontinence Clearly colposacropexy alone does not cause post-operative incontinence as UI was present only in 9.

The surgical technique for POP repair may account for the discrepancies in the findings. The technique was designed to provide support and suspension, to restore the pelvic floor and to replace ruptured ligaments using meshes.

In this matter it is possible to correct anterior and posterior segments, central and lateral defects, vault, uterine prolapse and enterocele.

Conflicting evidence Taking into consideration all this conflicting evidence, the Cochrane Review on Surgical management of POP in women9 concluded that 1 continence surgery in concomitance with prolapse surgery in continent women did not significantly reduce the rate of post-operative or the novo SUI RR 1.

Surgical approaches that are associated with high post-operative incontinence rates should be analysed carefully for appropriateness.

References 1. Nager, L. Brubaker, H. Litman, H. Zyczynski, R. Varner, C. Amundsen, L. Sirls, P. Norton, A. Arisco, T. Chai, P. Zimmern, M.

Barber, K. Dandreo, S. Menefee, K. Kenton, J. Lowder, H. Richter, S. Khandwala, I. Nygaard, S. Kraus, H. Johnson, G. Lemack, M. Mihova, M.

Albo, E. Mueller, G. Sutkin, T. Wilson, Y. Hsu, T. Rozanski, L. Rickey, D. Rahn, S. Tennstedt, J. Kusek, E. Gormley for the Urinary Incontinence Treatment Network.

The New Engl Journal of Medicine 2. Wei, I. Nygaard, H. Richter, C. Nager, M. Kenton, C. Amundsen, J. Schaffer, S. Meikle and C. Spino, for the Pelvic Floor Disorders Network.

Brubaker, G. Cundiff, P. Fine et al. Matthew J. Prophylactic Burch colposuspension at the time of abdominal sacrocolpopexy: a survey of current practice patterns.

Costantini, A. Zucchi, A. Giannantoni, L. Mearini, V. Bini, M. Costantini, M. Lazzeri, V. Del Zingaro, A. Zucchi, M. J Urol , Vol.

J Urol , 9. Surgical management of pelvic organ prolapse in women. After a general surgery internship and residency at Johns Hopkins, Grayhack spent a year at Brady Research Laboratory and became interested in urology.

He completed his urological training at Brady in He was an assistant professor at Hopkins and served two years in the Air Force before moving in to Northwestern University where he was appointed chairman and Herman Kretchmer Professor of Urology in , a position he held until He was awarded the Keyes Medal and the Barringer Medal Grayhack also edited the Yearbook of Urology and the Journal of Urology Grayhack and his late wife Betty were married for 62 years.

His children and grandchildren remember with fondness his passion for hunting, fishing and summers on Diamond Lake in Canada.

Surgery can finally raise its head above the stars, as high as never in the past. Therefore, we must establish with admiration that currently this art is trying to surpass medicine: in France it strives at least to be at the same level.

However, if today the opinion of other nations still counts for anything, one would have to conclude unambiguously that the French surgery is already regarded as greater than the French medicine.

Already under Louis XIV, by the edict of November , there was a partial separation of these two professional groups. By a decree in the year , it was considered equal to the medical faculty.

The great upsurge was mainly due to these mentioned measures, which the French surgery took during the latter period, of which indirectly therefore, Mareschal has become the initiator.

In the first few pages, however, one can find his account of being an outsider in Paris at the time of the resurgence of surgery at the beginning of the 18th century.

They are excellent surgeons in their own right, and they are also prepared to instruct students of surgery, who are sent by the rest of the world to France, suggesting there is a market for these arts medicine, surgery over there.

How many methods are already available to us nowadays to treat the bladder by incision without any risk?

After all he quotes, in a footnote to his report, the English medical historian John Freind Surgery in Vienna Our second commentary, concerns the comparison of the state of surgery in Paris with the situation in Vienna.

Furthermore, the Vienna academy aimed particularly at the discipline of surgery and a notable surgeon and organiser played an important role in its emergence-Giovanni Alessandro Brambilla , Knight of Carpiano who was the chief army doctor of the Austrian monarchy in Vienna, and who - just like the surgeons in Paris- had good relations with the monarchy.

We do note a difference with the monarch himself. Since while it is actually not known from Paris how significant the establishment of the surgical academy was for both French kings, Joseph II repeatedly declared that the establishment of the Josephinische Akademie was the most important achievement during his reign.

STEPS programme. Maurizio Brausi. Prostate cancers will be covered in two sessions, one focusing on screening, diagnosis, staging and treatment, while the other will examine advanced and metastatic disease.

How to identify low risk PCa Genetic profiles to identify biologically aggressive low-risk PCa Debate: The time for radical prostatectomy in low risk desease is over Discussion Discussion Sessions will be delivered by international leaders in the field who will take part in state-ofthe-art lectures, panel discussions, head-to-head debates, and, demonstrations of surgical techniques.

Vincenzo Altieri, local organiser, welcomed the hosting of the ESOU meeting which has attracted in recent years the participation of many urological cancer experts from various disciplines such as oncology, radiology and gynaecology.

In addition: Renal cancer will be examined in two sessions: localised and advanced. The sessions on urothelial tumours will take up non- muscle invasive bladder cancer and muscle invasive and advanced disease.

Debates and update lectures by key opinion leaders will look into emerging therapies and their impact on the delivery of optimal services for cancer patients.

In testicular and penile cancers, among the salient issues to be examined are organ preservation techniques, inguinal lymphadenectomy and post-chemo retroperitoneal lymph node dissection RPLND.

As in previous years, ESOU will award the best publication in uro-oncology in Discussion Debate: Adjuvant radiotherapy after radical prostectomy who, how and when?

Complications during laparoscopic and robotic radical prostatectomy: How to avoid them Testicular cancer Organ preservation for solid testis neoplasm: When?

Open vs. Bladou, Montreal CA M. Brausi, Modena IT S. Brewster, Oxford GB B. Govorov, Moscow RU A. Heidenreich, Aachen DE J.

State-of-the-art lecture: Incontinence and age State-of-the-art lecture: Is ageing a disease? Case discussion: From above or below: Flexible, rigid or percutaneous management of upper urinary tract stones Update: Observation and deferred intervention in the management of stones Simultaneous Abstract Sessions Simultaneous Thematic Sessions Thematic Session 1: EAU guidelines recommendation updates Thematic Session 2: How minimally invasive should we be?

When, where and how they work? Registration opens on 1 October Registration for the 28th Annual EAU Congress opens on 1 October and participants are encouraged to register early before 4 January to benefit from reduced fees.

Already today you can get a glimpse of what is planned for this event, and follow the programme as we add more exciting topics, presentations, courses and features!

We update the programme regularly, as speakers confirmations come in almost daily! Furthermore, you can always save the sessions of interest in your EAU Planner and export them into your Outlook calendar.

Faxed, e-mailed or posted abstracts will not be accepted. Before submitting your abstract, carefully read the abstract submission rules on our website.

A short exam that deals with three topics from a vast curriculum, one has to be thoroughly prepared by having a very good knowledge of the EAU Guidelines, a strong clinical experience and be abreast with current urological issues to succeed in this exam.

Having sat for previous clinical all these give the candidate the necessary confidence. The cases were purely clinical and I was pleased that my years in urology and general surgery training helped a lot.

Feedback was given to me during the exam. My response to the questions included the basics in patient management such as discussing thorough patient history, physical examination, list of investigations, differential diagnosis and treatment.

Professional links In my opinion an excellent knowledge or grasp of the EAU Guidelines is essential to pass this exam. And as I mentioned earlier, having an updated knowledge of deserve the best treatment..

I consider this examination as a step in the right direction for attaining or affirming a specialist status in urology.

Moreover, my participation in this exam reflects the close ties between the EBU and Malta. For a urologist in Malta, having the FEBU title also links our small island nation, with its proud track record of medical excellence, to the recognised European body that invests and pioneers in the training of urology residents.

Furthermore, the challenge and necessary discipline to pass the whole process makes one a well-read and pro-active urologist who is well-informed of the latest literature and recommended best practice.

Hence the exam, ultimately, also serves our patients who rightly deserve the best treatment they can have. Tips for candidates To reiterate, it is necessary to be very familiar with the EAU Guidelines and have a working knowledge of the basic sciences.

Obviously, candidates also have to believe in themselves, keeping a level-headed, confident appearance when responding to the examinees.

I will also recommend to the exam candidate to enroll in a reputable training centre preferably EBU-certified since the examination focuses on or reflects what we have learned in our clinical practice and training.

With this in mind, I convey my thanks gratitude to my programme director Mr. German and consultant urologists Mr. Zammit, Mr. Mattocks and Prof.

Cutajar who is a pioneer in urological training in Malta. Internet access is the only requirement to participate.

There are no restrictions as to where and at what time on 1 March the test is taken. For more information and registration visit our website www.

Ackaert, Belgium D. Ackermann, Switzerland I. Adamakis, Greece G. Alivizatos, Greece A. Antoniewicz, Poland J. Bellringer, United Kingdom M.

Bitker, France G. Bogaert, Belgium E. Breinl, Austria L. Campos Pinheiro, Portugal J. Campos Pinheiro, Portugal M.

Cracco, Italy H. Danuser, Switzerland A. Feyaerts, Belgium A. Figueiredo, Portugal F. Fusco, Italy N. George, UK S. Giannakopoulos, Greece A.

Giannantoni, Italy M. Gunst, Switzerland M. Heuser, Germany W. Hochreiter, Switzerland J. Hofbauer, Austria U. Humke, Germany C.

Imbimbo, Italy E. Lledo, Spain N. Longo, Italy C. Mamoulakis, Greece L. Martinez Pineiro, Spain A. Matos Ferreira, Portugal D.

Mitropoulos, Greece E. Montanari, Italy B. Montgomery, United Kingdom G. Moutzouris, Greece J. Nawrocki, United Kingdom J.

Nijman, Netherlands P. Nunes, Portugal A. Papatsoris, Greece A. Pytel, Hungary C. Radmayr, Austria T.

De Reijke, Netherlands D. Rengifo Abbad, Spain K. Van Renterghem, Belgium O. Rodriguez Faba, Spain C.

Romano, Italy C. Saussine, France S. Siracusano, Italy A. Skolarikos, Greece A. Strauss, Germany S. Tekgul, Turkey C. Terrone, Italy V.

Tzortzis, Greece A. Volpe, Italy S. Walter, Denmark P. Whelan, United Kingdom T. Zellweger, Switzerland Budapest I.

Buzogany, Hungary L. Farkas, Hungary A. Majoros, Hungary P. Pajor, Hungary A. Varga, Hungary Warsaw W.

Demkow, Poland P. Dobruch, Poland T. Drewa, Poland P. Jarzemski, Poland A. Listopadzki, Poland J. Matych, Poland W.

Pypno, Poland A. Sikorski, Poland M. Sosnowski, Poland T. Szostek, Poland Z. Wolski, Poland S. Zdrojowy, Poland H. Almost participants from 10 different countries attended this masterclass which offered the opportunity to discuss and focus on the potential indications, future perspectives and current limitations of the novel single-site platform in urology recently created by Intuitive for the da Vinci Si system.

The new da Vinci single-site platform has been specifically designed to allow surgeons to properly apply the robotic technology to the concept of LESS surgery.

It includes a multichannel port that provides access for two single-site semi-rigid robotic instruments, the 8.

The first day of the masterclass offered a limited number of urologists the possibility to train with the Uro-Technology new platform during a dry lab session and learn the basic skills in single-site robotic surgery.

Live surgeries The second day of the masterclass offered a full day interactive course outlining the robotic assisted single-site surgical technique with enhanced step-bystep video material and lectures, which focused on the codification of the robotic single-site pyeloplasty.

The masterclass also included two live surgeries. The first one featured a simple case symptomatic renal cysts decortication to demonstrate all steps in properly placing the single-site port, trocars, robotic arm docking and to explain how the new platform works.

The second surgery, a single-site pyeloplasty Fig. The day ended with a lecture updating participants on what to expect for single-site surgery in the future including new Intuitive instruments.

The da Vinci Single-Site Masterclass international faculty, panellists and moderators have shared valuable insights gained through veteran experience in robotic or LESS surgery.

Its principle objective is to guarantee and promote the highest standards of healthcare in the field of Sexual Medicine, by ensuring that training in Sexual Medicine in Europe is established at an optimal level.

Eligibility The exam is set under the auspices of the UEMS but all physicians of all nationalities, including countries outside the EU, are able to take the exam.

Who can apply? However, new instruments, namely bipolar forceps and monopolar scissors must be introduced into clinical practice to expand the range or types of procedures to be performed.

Some sort of endowrist technology to offer an even greater range of motion should be implemented in the single-site technology as mentioned by Prof.

Giorgio Guazzoni during his lecture. This new device could potentially be used for vascular pedicles control in robotic radical cystectomy procedures and mesenterial work during the urinary diversion steps.

A robotic articulating linear stapler should also be available in the market in the future which would allow for further implementation of the armamentarium for robotic surgery.

Furthermore, an update on Firefly technology was given. The discussions also closely examined and focused on all aspects of single-site surgery in combination with robotic technology.

This will be published in mid by the ESSM educational committee. The courses are intended for physicians with experience of specialistlevel practice in Sexual Medicine who wish to increase their chance of passing the exam.

The teaching faculties for courses will include recognised experts in the field of Sexual Medicine. The location and dates are published on the ESSM website.

Further details are available on the ESSM website: www. The radiological evaluation reported that the lesion arose from the upper pole of the left kidney, displaced the stomach and bowel loops, and abutted the splenic hilum and the posterior aspect of the pancreas which was displaced superiorly and anteriorly.

However, no evidence of definite invasion of any of the adjacent organs could be seen on the CT films. The left adrenal gland was not visualised, nor were any enlarged lymph nodes seen.

There were only a few small left paraaortic lymph nodes reported, with the largest measuring 1. The lungs were clear without any evidence of pleural or pericardial effusion.

Case study No. Histopathology reported adrenocortical carcinoma with negative resected lymph nodes and negative surgical margins. Discussion points: 1.

Are further post-operative investigations needed? Is any adjuvant treatment indicated? What follow-up should be done?

Case provided by M. CT of the chest, abdomen and pelvis showed a huge mass of soft tissue density mass, approximately 22 x 20 x 15 cm Adjuvant radiation therapy is a management option Comments by Axel Heidenreich Aachen DE The patient described was diagnosed with a large adrenocortical carcinoma infiltrating the left kidney and he was treated by radical nephrectomy and locoregional lymphadenectomy.

The resection margins and the resected lymph nodes were negative. Preoperative staging included a CT scan of the chest, the abdomen and the pelvis and it did not reveal lymphpnodular or systemic metastases.

Discussion points Based on the information given the patient has locally advanced adrenocortical carcinoma which represents stage pT4pN0cM0 according to the WHO classification.

The recently modified staging system aimed at improving the prognostic accuracy has been proposed by the European Network for the Study of Adrenal Tumors.

Applying this system, however, does not change the classification of the patient. To adequately assess the risk of relapse and metastases in this patient, we would need some important information regarding the mitotic index and the number of dissected lymph nodes.

Locoregional lymphadenectomy including the first-order drainage lymph nodes at the renal hilum, the paraaortic or paracaval and the celiac regions is mandatory according to the international recommendations of a standardised Chemotherapy is an option Comments by Joaquim Bellmunt Barcelona ES surgical approach to adrenocortical carcinomas.

According to a recent retrospective study by the German ACC registry, local recurrence rates hazard ratio: 0. But adjuvant RT did neither improve cancer-specific nor overall survival.

Based on the high probability of local recurrence in this specific case, I would strongly recommend adjuvant radiation treatment with Staging Due to the size and the stage of the carcinoma and taking into account the increased frequency of osseous and brain metastases seen in association with advanced adrenocortical carcinoma, I recommend to complete staging with a bone scintigram and brain MRI for complete baseline staging.

The role of adjuvant mitotane treatment is limited due to the lack of prospective randomised trials. There is evidence from a case-matched control study indicating that adjuvant mitotane might increase the recurrence-free survival from 25 to 42 months.

Therefore, I would not advise adjuvant mitotane treatment in this patient. Since the patient exhibited most of these prognostic risk factors, there seems to be a rationale for an adjuvant treatment.

There, however, is no evidence from prospective randomised clinical phase-III trials available to support this. This represents the only chance of cure.

Radical resection without any microscopic residual Adrenocortical carcinoma ACC is a rare disease disease R0 resection and low proliferative activity with an incidence of approximately one per million based on mitosis count or Ki67 expression are the [1] and with an overall five-year survival rate of most important prognostic factors for a good outcome in ACC.

It behaves aggressively even if detected early. Most cases are diagnosed at an advanced order to minimise tumour spillage in tumours stage.

Currently, the best treatment is a intervention are more questionable [8]. Due to the aggressive behaviour and the high risk of systemic relapse after surgery, the use of In addition to whole body CT, 18 F-fluorodeoxyadjuvant mitotane is considered in patients with glucose positron emission tomography 18 F-FDG clinically or histologically aggressive tumours even PET is useful.

The evidence for the suspicious CT scan lesions [4] and can give a correct use of adjuvant mitotane in patients with ACC is classification of the disease stage metastasis or based only on retrospective studies.

Terzolo et al primary [5]. According to the recommendations of various national and international registers of adrenocortical carcinomas, staging should be performed every three months with abdomino-pelvic CT scans and chest X-rays.

Since the patient apparently did not demonstrate any endocrinological tumour activity preoperatively, no routine hormonal studies are necessary.

Their analysis demonstrated a clear prolongation of recurrence-free survival in treated patients [10]. Some have suggested that mitotane should be used only in patients with a high likelihood of recurrence i.

Regarding adjuvant radiotherapy in patients at high risk of local relapse, a pilot study and a larger case series [12] suggested a potential reduction in local recurrence without an effect on overall survival.

Thus, radiotherapy may have a role in selected patients. The patient declined to undergo radical prostatectomy and instead chose to undergo HIFU treatment elsewhere in followed by adjuvant androgen ablation which led to a PSA nadir of 0.

PSA recurrence under continued androgen ablation occurred in With a PSA of 0. With a PSA of 2. Salvage radiotherapy was performed in November as external beam radiotherapy including the pelvic nodal fields with a dose of 50 Gy followed by saturation of the prostatic field with an additional 16 Gy.

This was well tolerated but the PSA continued to rise during the 50 days of radiotherapy and was 5. Another bone scan was negative.

Throughout the patient has been physically and mentally well, being very fit for his age and biologically younger, with a healthy life-style including regular jogging, swimming and cycling.

The patient now requests, if possible, further salvage treatment short of chemotherapy. Discussions points: 1. What treatment options are available?

Is salvage lymphadenectomy indicated? Is any other salvage treatment reasonable? Case provided by O.

Hakenberg, Dept. However, a CT performed nine months postoperatively for persistent persistent cough showed newly developed multiple pulmonary metastases more than 10 with the largest one in the apical segment of the left upper lobe and the presence of a large metastatic mass in the right lobe of the liver, measuring 17 x 11 cm.

In our institute we are currently working on 80 projects, which we divide in various categories. In training, it was appendectomy.

There is the challenge of shrinking resources which may lead to decrease discovery. That would mean we are not advancing our field as much as we could, both scientifically and clinically.

If I were not a physician I would have probably chosen architecture. I try to read a book at least once a month, but most are so-so.

The last thing that surprised me was when I found out that the US spends more money in potato chips than the FDA spends in regulation. But what is more relevant is the statistic that life expectancy for a male in was approximately 40 years.

A hundred years later life expectancy almost doubled. As a child, I collected stamps and coins. Definitely, the early hours.

I usually wake around 4 or in the morning. I guess the design of the universe. Maybe my biggest concern is the continued conflicts around the world.

Alici, Istanbul TR S. Deger, Ostfildern DE O. Demirkesen, Istanbul TR Deger, Ostfildern DE S. Palminteri, Arezzo IT Esen, Izmir TR Moncada, Madrid ES Alici, Istanbul TR I.

Austoni, Milan IT Ergen, Ankara TR Ozyurt, Izmir TR V. Pansadoro, Rome IT Dahlem, Hamburg DE Dahlem, Hamburg DE A.

Djinovic, Belgrade RS A. Tarcan, Istanbul TR Seckin, Konya TR Demirkesen, Istanbul TR T. Kural, Istanbul TR Panel: Deger, Ostfildern DE A.

Mottrie, Aalst BE V. Deger, Ostfildern DE E. Austoni, Milan IT G. Barbagli, Arezzo IT E. Belgrano, Trieste IT M. Fisch, Hamburg DE A. Mundy, London GB M.

Stackl, Vienna AT T. Alici, Istanbul TR E. Austoni, Milan IT R. Dahlem, Hamburg DE S. Demirkesen, Istanbul TR R.

Ergen, Ankara TR A. Esen, Izmir TR A. Kural, Istanbul TR I. Moncada, Madrid ES A. Mottrie, Aalst BE C.

Ozyurt, Izmir TR E. Palminteri, Arezzo IT V. Pansadoro, Rome IT B. Tarcan, Istanbul TR S. Paul Meria Section Editor Paris FR cancer and related problems such as screening, diagnosis and treatments, including current minimally invasive therapies.

Prostate physiological movements and their interference with the treatments were considered in the third part.

Their mechanisms of occurrence were described such as various methods of adaptive re-planning, based on imaging systems for treatment guidance.

Many tables and illustrations completed each chapter. Undoubtedly, this textbook is intended for radiotherapists and oncologists.

Nevertheless, urologists involved in prostate cancer management will find ample amount of information, essential in pluri-disciplinary clinical exchanges.

Ponsky, D. Fuller, R. Meier, C. Currently, it remains of little use in the field of urology. Besides technical aspects, one of the limiting factors is probably the need of a pluri-disciplinary team, requiring various practitioners involved in different fields.

Nevertheless, many applications have to be developed in the future. Sexual Dysfunction in Women Lee Ponsky and co-editors, helped by more than 40 worldwide experts, wrote an original textbook dedicated to urological applications of radiosurgery.

The first part provided the reader with general information. Historical aspects and current indications of radiosurgery were described, focusing on intracranial diseases.

Forthcoming developments were separately considered, including advances in genitourinary diseases. Practitioners involved in sexual dysfunctions management and who are faced with women problems will have to determine their origin and schedule the most accurate treatment.

Marta Meana compiled in this textbook a comprehensive amount of information dealing with a rarely considered problem. Special consideration was given to the organisation of radiosurgery of prostate cancer, including a description of the required team members and their specific role.

The second part dealt with prostate Sexual problems are probably underestimated in women population. The decrease of desire, arousal and orgasm intensity occur frequently and such difficulties may be associated with painful intercourse.

These problems raise important questions and debates about women sexual function. An important part of the book was dedicated to hypofractionated radiation therapy and based on radiobiological aspects of the treatment.

This chapter addressed the rationale and the results of hypofractionated treatments, supported by various studies. High-dose brachytherapy and stereotactic treatments of prostate cancer were also described in this chapter.

The meeting takes place in Istanbul from December 14 to 15 later this year. Serdar Deger explained which surgeons the meeting hopes to attract.

In the past two to four years, we have seen an increased interest in minimally invasive procedures among reconstructive surgeons.

A scientific programme see previous page , which has been carefully prepared, features lectures, poster presentations and discussions about submitted cases.

Participants are encouraged to submit abstracts on male and female urethroplasty, hypospadias repair, penile corporoplasty, surgical treatment of male incontinence, pelvic organ prolapse and any other surgical techniques using minimally invasive surgery, including laparoscopy and robotics in reconstructive urology.

The meeting will also feature live surgery sessions and will be broadcasted from Istanbul University, with the support and coordination of the Cerrahpasa Medical Faculty.

Nevertheless, many concerns remain regarding various sexual problems in men. Current treatments are frequently based on drugs, and a psychosexual approach remains very important for many patients.

This textbook complemented the previous one dedicated to women problems and the aims and scope of both editions were identical.

Author David Rowland aimed to provide the reader with a strong basis of information, which is helpful in clinical practise.

The first part was dedicated to descriptive information, including epidemiology, definitions and various considerations such as diagnostic procedures for each sexual problem in men.

A brief paragraph described psychophysiology of male sexual function. Questionnaires, useful for clinical assessment of various problems such as erectile dysfunction and premature ejaculation, were described.

The first part included epidemiologic data and various descriptions and definitions of sexual problems in women.

The succeeding part described theories and models of sexual dysfunction. Different theories were described, and the selective review of such theories demonstrated the complexity and wide range of female sexuality.

Diagnosis and treatment problems were described in the third part. Organic, psychological and sociocultural origins of sexual dysfunctions were considered, focusing on various difficulties encountered in practise.

The methods of treatment were considered in the fourth part and the author emphasised the paucity of psychological interventions.

Pre-therapeutic assessment was described including measures of global sexual function, followed by a thorough review of current methods of management.

Multicultural issues were considered in this chapter, including religious and cultural norms and sexual identity.

A case report concluded the textbook and corroborated the complexity of sexual problems in women, and the ambiguity of treatment outcome success.

A summary of selected readings was added. We have seen a significant increase in EBU fellowships, and the number of participants attending international meetings and congresses has also increased.

Turkey has also proven to be an attractive location for meetings, partly due to the relatively lower costs of holding a conference in the city.

The first part was dedicated to diagnosis and evaluation of the problem including identification of etiological factors, either psychosexual or organic.

A comprehensive part was dedicated to the treatments of each clinical problem. Psychosexual approach and pharmacotherapy were described.

Erectile dysfunction, the most common of the encountered problems, was exhaustively considered and various methods of treatment were described.

The management of other problems, such as low desire, premature or delayed ejaculation were also addressed. The authors emphasised psychosexual approaches, such as behavioural, and the combination of methods.

Resource books were listed and an appendix summarised male sexual functioning questionnaires and the dedicated websites where one can obtain such questionnaires.

Deger also noted that the Turkish Urological Association is involved in many meetings which have examined minimally invasive procedures.

This textbook, clearly and exhaustively written, was intended for most practitioners, including urologists and sex therapists.

Readers will obtain accurate information, which is very useful in daily practise. Undoubtedly, all practitioners will have a new and better approach of these problems after reading this textbook which adequately presented useful information.

More recently there has been some observational data suggesting a possible increase in the reported incidence of bladder cancer especially in patients who Intermittent VEGF therapy for have been on the medication for over 24 months.

This paper reports a population-based study to evaluate if metastatic RCC- is it safe? Using the UK general practice research database to Although this has been shown to extend overall interrogate the medical records of more than 10 survival, this is not felt to be curative and a high million people in more than practices, they proportion of patients treated with these agents have identified all patients who were prescribed their first to discontinue treatments secondary to adverse ever oral anti-diabetic agent between 1 January events.

This study assessed the consequences of and 31 December , and who also had at least one stopping treatment in patients who had achieved year of previous medical history in the database.

Patients who started treatment with insulin were A total of 40 patients, treated in either Institut excluded as were those under the age of 40 years or Gustav-Roussy 18 or the Cleveland Clinic 22 , with a known history of bladder cancer.

Participants between January and December were were followed until a diagnosis of bladder cancer, included. Patients had achieved stable disease, a death from any cause or end of registration with the partial response or a complete response by RECIST general practice.

Data was collected on The primary objective was to measure time-to-disease progression. A nested case-control analysis was carried out.

Therapy window. Perhaps of more concern was the finding that 8 patients developed metastases in new sites during expectant management With a median follow-up of Despite RECIST evidence of progression 8 patients chose to continue expectant management given the low volume and pace of disease.

The other 17 had a variety of treatments and, unfortunately, information on the response to re-initiation of systemic therapy is not available.

On multivariate analysis the more favourable Heng risk group HR 2. Perhaps of more concern was the finding that 8 patients developed metastases in new sites during expectant management.

One patient with brain metastasis and one with bone metastasis presented with clinical symptoms requiring immediate radiation therapy.

There is no evidence that this would have been avoided with continuous therapy, but patients are bound to question this.

There is a current phase II clinical trial underway at Cleveland Clinic which might help answer some of the questions raised by this retrospective study.

Source: Cessation of vascular endothelial growth factor-targeted therapy in patients with metastatic renal cell carcinoma.

Cancer ; Key articles 12 A study cohort of , patients met the inclusion criteria. The mean age was A total of cases with adequate information were matched to 6, controls.

This effect was not seen with use of rosiglitazone, the other thiazolidinedione available in the UK during the study period.

All men underwent histological verification of locally recurrent disease as well as cross-sectional imaging and radioisotope bone scan to exclude macroscopic regional and distant metastases.

Radiological T3a disease was allowed but patients with clinical T3a disease were excluded. HIFU treatment required the insertion of a suprapubic catheter and treatment to the complete prostate.

The catheter was removed weeks later as soon as urethral voiding was adequate. Patients were reviewed every 3 months for the first year and then every 6 months.

Seventeen of 84 patients required intervention for bladder outflow obstruction and 2 men developed rectourethral fistulae interestingly 2 further men out of 6 retreated with HIFU also developed fistulae.

Mean follow-up was Seven men showed no PSA response and were assumed to have metastatic disease. Repeat HIFU should clearly be avoided.

Although there is not a clearly understood biological mechanism to explain the findings it would appear that pioglitazone is associated with an increased risk of bladder cancer.

The absolute rates are relatively low but doctors and patients should be aware of this association when assessing the overall risks and benefits of this therapy.

Source: The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study.

Global cancer transitions according to the Human Development Index : A population-based study Cancer is set to become a major cause of morbidity and mortality in the coming decades in every region of the world.

The authors aimed to assess the changing patterns of cancer according to varying levels of human development.

BMJ ; e Does HIFU for prostate cancer work? Whole gland high-intensity focused They used four levels low, medium, high, and very high of the Human Development Index HDI , a composite indicator of life expectancy, education, and gross domestic product per head, to highlight cancer-specific patterns in on the basis of GLOBOCAN estimates and trends on the basis of the series in Cancer Incidence in Five Continents , and to produce future burden scenario for according to projected demographic changes alone and trends-based changes for selected cancer sites.

In low HDI regions, cervical cancer was more common than both breast cancer and liver cancer. Nine different cancers were the most commonly diagnosed in men across countries, with cancers of the prostate, lung, and liver being the most common.

Breast and cervical cancers were the most common in women. In medium HDI and high HDI settings, decreases in cervical and stomach cancer incidence seem to be offset by increases in the incidence of cancers of the female breast, prostate, and colorectum.

If the cancer-specific and sex-specific trends estimated in this study continue, we predict an increase in the incidence of all-cancer cases from The authors conclude that their findings suggest that rapid societal and economic transition in many countries means that any reductions in infectionrelated cancers are offset by an increasing number of new cases that are more associated with reproductive, dietary, and hormonal factors.

Targeted interventions can lead to a decrease in the projected increases in cancer burden through effective primary prevention strategies, alongside the implementation of vaccination, early detection, and effective treatment programmes.

Source: Global cancer transitions according to the Human Development Index : A population-based study. A midurethral sling to reduce incontinence after vaginal prolapse repair Women without stress urinary incontinence undergoing vaginal surgery for pelvic-organ prolapse are at risk for postoperative urinary incontinence.

A midurethral sling may be placed at the time of prolapse repair to reduce this risk. The authors performed a multi-center trial involving women without symptoms of stress incontinence and with anterior prolapse of stage 2 or higher on a Pelvic Organ Prolapse Quantification system examination who were planning to undergo vaginal prolapse surgery.

Women were randomly assigned to receive either a midurethral sling or sham incisions during surgery.

One primary end point was urinary incontinence or treatment for this condition at 3 months. The second primary end point was the presence of incontinence at 12 months, allowing for subsequent treatment for incontinence.

At 3 months, the rate of urinary incontinence or treatment was At 12 months, urinary incontinence allowing for subsequent treatment of incontinence was present in The number needed to treat with a sling to prevent one case of urinary incontinence at 12 months was 6.

Source: Sirolimus and secondary skin-cancer prevention in kidney transplantation. Above all, the definition of efficacy of radical prostatectomy cannot simply be defined by looking at disease-specific survival.

Prostate cancer is becoming a chronic disease and the long period of living with metastatic disease would be a much more relevant end-point when discussing the potential efficacy of treating localised prostate cancer.

N Engl J Med. The authors conclude that a prophylactic midurethral sling inserted during vaginal prolapse surgery resulted in a lower rate of urinary incontinence at 3 and 12 months but higher rates of adverse events.

Source: A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med ; , June 21, Sirolimus has proven antitumoral effect in renal transplant recipients Renal transplant recipients are at increased risk of developing malignancies and the most common of these are cutaneous squamous-cell carcinomas with a high risk for multiple subsequent skin cancers.

This risk is attributable to immunosuppression. This study investigated whether sirolimus is useful in the prevention of secondary skin cancers in organ transplant recipients.

This trial reports data which fit into the ongoing debate about PSA-based screening and early prostate cancer detection programmes.

The authors stated that Coffee drinkers live longer effectiveness of surgery versus observation alone for men with localised prostate cancer detected by means unless they smoke of prostate-specific antigen PSA testing is not known.

Coffee is one of the most widely consumed beverages. Whether coffee is beneficial or unhealthy is a matter They conducted a study in which from November of opinion and this can change over time.

This large through January , men with localised prostate study looked at the potential association between cancer were randomly assigned to radical coffee consumption and the risk of death remains prostatectomy or observation and followed through to unclear.

January Mean patient age was 67 years and the median PSA value was 7. During the median follow-up of In this multicenter trial, transplant recipients who were taking calcineurin inhibitors and had at least one cutaneous squamous-cell carcinoma were randomly assigned either to receive sirolimus as a substitute for calcineurin inhibitors in 64 patients or to maintain their initial treatment in The primary end point was disease-free survival regarding squamous cell skin cancer at 2 years.

Secondary end points included the time until the onset of new squamous-cell carcinomas, occurrence of other skin tumours, graft function, and problems with sirolimus.

Among men assigned to radical prostatectomy, 21 5. The effect of treatment on all-cause and prostate-cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor.

There were 60 serious adverse events in the sirolimus group, as compared with 14 such events in the calcineurin-inhibitor group average, 0.

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