EAU-ICUD Consultation sparks debate

Friday’s EAU-ICUD Consultation on minimally-invasive surgery in urology (MISU) marked an end to the “closed shop” that typified consultation meetings of the past. As the chapter editors of the upcoming ICUD publication took the audience through the drafts of the chapters, the audience was invited to, and indeed did, ask questions and provide feedback on the preliminary conclusions. “Your thoughts on the presentations are greatly appreciated,” said Prof. Mani Menon (Detroit, USA), co-chairing the session and co-editor of the volume.

Prof. Günter Janetschek (Salzburg, AT) started proceedings by presenting the preliminary contents of the chapter on minimally-invasive lymphadenectomy. He was helped by Dr. Alberto Briganti (Milan, IT), who spoke up from the audience to clarify some results from a study that was included in the chapter.

The room was filled by the time Prof. Claude Abbou (Paris, FR) and Dr. Bernardo Rocco (Milan, IT) jointly presented the chapter on minimally-invasive radical prostatectomy, providing insight into the writing process. Abbou: “At this moment, the chapter represents only the point of view of the authors, but consensus is the next step. There was also a lot of available data, and not a lot of evidence-based information.” The presenters also gave a brief overview of the field: in particular, they highlighted the ubiquity of robotic surgery following its introduction in the late 1990s.

“Seven years after its introduction, we already saw that more than 70% of patients undergoing a prostatectomy were treated with robotic assistance,” said Abbou. Other topics included the importance of patient positioning and bladder neck preservation and symptoms of incontinence following the procedure.

Evidence and surgical techniqueSome of the conclusions raised questions from the chairs and audience alike. Saying that robot-assisted laparoscopic radical prostatectomy “here to stay as a standard of care for PCa” caused some discussion about the “haves and have nots” division between urologists with and those without robots. Prof. Abbou was quick to point out that it should be considered a standard, not necessarily the standard.

Further discussion addressed the need for randomized controlled trials. Initially one of Prof. Abbou’s conclusions, Prof. Menon acknowledged the comments from an audience member that randomized trials might not be useful as techniques rapidly evolve. Prof. Rassweiler, who was also co-chairing the session later told EUT that this quite rightly was a hot topic: “Surgeons who decide to start using new techniques lose training for the old ones, making the designing of trials difficult. The same goes for comparing individual surgeons.”

Other topics covered as part of the EAU-ICUD consultation include the minimally invasive versions of adenomectomy, radical cystectomy, nephrectomy and nephron-sparing surgery.