2nd ESU-ASU joint course in Manila tackles paediatric urology, uro-oncology issues

December 2010- The 2nd Asian School of Urology (ASU) and the European School of Urology (ESU) Joint Course opened today in Manila , Philippines , with speakers tackling current issues in paediatric urology, prostate cancer and upper tract transitional cell carcinoma (TCC) and the orthotopic bladder.

Held concurrently with the 53rd Philippine Urological Association (PUA) Annual Convention in Manila , Philippines , the ESU-ASU course aims to strengthen international collaborations in urological education and training.

“A lot of intensive work has been exerted by members of the Education Office of the European Association of Urology (the European School of Urology or ESU) and the Asian Society of Urology, and we are indebted to Prof. Rainy Umbas and his colleagues,” said ESU Chairman Prof. Hein van Poppel.

For his part Umbas said the collaboration with the EAU under the auspices of the ESU has been well received in Asia, and that participants value the knowledge and skills exchange particularly with the recent advances made in Europe with regards to surgical techniques and medical treatment strategies. The first joint course of the ASU and the ESU was held last December 2009 in Bali , Indonesia during the 32nd Annual Scientific Meeting of the Indonesian Urological Association.

The faculty composed of Dante Dator (Philippines), Sim Hong Gee (Singapore), Manish Patel (Australia), Rien Nijman (the Netherlands), Hideyuki Akaza (Japan) and Noel Clarke (UK) covered topics such as distal hypospadias surgery, medical and surgical management of vesico-ureteral reflux (VUR), radical prostatectomy outcomes and complications, radical cystectomy outcomes, management of NMIBC and urinary diversions and the orthotopic neobladder.

A few of the take-home messages are:

•In VUR, medical treatment is a primary option whilst surgery is considered for specific indications. However renal scars may occur following successful treatment and surgery does not prevent urinary tract infections (UTI) (Nijman);

•Regarding treatment options for castration refractory prostate cancer, denosumab has shown to be superior to zoledronic acid in preventing/delaying first and multiple SREs. Notable adverse events occurring in both treatment groups included hypocalcemia and osteonecrosis of the jaw (Patel);

•On risk-stratified management of non-muscle invasive bladder cancer (NMIBC), a randomised controlled trial (conducted by Japanese researchers) of prophylactic intravesical instillation chemotherapy in combination with the oral administration of a Lactobacillus casei preparation versus intravesical instillation chemotherapy alone for recurrence after a transurethral resection of superficial bladder cancer, has shown that Lactobacillus casei preparation (BLP) or a fermented milk drink (‘Yakult’) leads to decrease bladder cancer risk and prevents tumour recurrence after TURBT (Akaza);

•In the cost-effective detection of prostate cancer, PSA remains a good test whilst current risk calculators have inherent pitfalls due to the extrapolation of European/American data to Asian context. Regarding initial prostate biopsy, it involves transrectal 10-12 cores laterally directed biopsy, with patient taking a recommended analgesia during biopsy. More cores can also be considered in cases of large prostates (Hong Gee); •Radical cystectomy (RC) is still considered the gold standard procedure for invasive bladder cancer and post operative mortality at 30- and 60-days has decrease progressively over the decades, and with it, a concomitant and significant decline in reoperation rates (Clarke).