EAU15: Decision-making challenges in China and the world

20 March 2015

Continuing with the tradition of cooperation and information exchange, the EAU-World Chinese Urologists session focussed on the importance of correct diagnosis to improve the decision-making process regarding treatment for patients presenting with a range of urological maladies, from LUTS to OAB, and from Prostate Cancer to urinary diversion.

Keeping in mind that the prevalence of LUTS especially in younger people is growing in China, the first part of the session zoomed-in on lower urinary tract symptoms, their diagnosis, and challenges. Chun-Hou Liao (TW) offered insights into the management of male LUTS. In his view, “calculating IPSS-V/S can be a useful tool to differentiate and guide initial treatment.” Moreover, this tool is important as another marker to complement the practical guidance provided by symptom – oriented guidelines such as those of the EAU.

Later in the session, Limin Liao (CN) shared data from the LUTS-China I-III survey with the audience. This survey provides much welcome data on preferred medical treatment of male LUTS and on the incidence of lower urinary tract symptoms in the country. It was conducted among more than 12,180 patients across some 150 hospitals throughout China.

Most interestingly, “most LUTS patients with moderate to severe symptoms visit the hospital or their doctor relatively late in the progression of their symptoms.” The survey further showed that around 90% of LUTS patients chose drug treatment to manage their symptoms, and that roughly 60% of them choose alfa blockers as their first treatment option.

Much remains to be done, particularly in terms of awareness, as “the perception of long-term treatment for BPE and OAB needs to be improved”.

The theme of personalised medicine was of course a recurrent theme throughout the session, and it was considered pivotal for further developments in diagnosis and treatment. The LUTS-China I-III survey will hopefully help provide data that allows to better establish individualised treatment for LUTS patients based on the exact cause.

To complement the views on treatment, Marcus Drake (GB) asked how to best adapt the treatment to each patient. He stressed that the assessment of LUTS should always seek to identify whether the symptoms of the lower urinary tract are caused by more serious conditions. This is important because drug treatment primarily seeks to treat the symptoms, and treatment for other, and serious, underlying causes could be delayed. He also stressed that drug options are heavily dependent on the patient phenotype. In his view “It is essential not to use LUTS to deal with systemic symptoms”.

The rest of the session was dedicated to answering questions on OAB, urinary diversion, and prostate cancer. The latter, a topic that has gained relevance in recent years. The disease is currently the 5th leading malignancy in Taiwan, and its incidence is on the rise. As with LUTS, the issue of late diagnosis needs to be addressed adequately to ensure appropriate treatment, a challenge for urologists in China, Taiwan, and the rest of the world.