Plenary Session on urology for the young and the elderly

16 March 2013

Experts from pediatrics, reconstructive, female and functional urology examined today during Plenary Session 1 a range of controversial issues and stressed the need for doctors to look at evidence-based medicine and tailor their treatment options accordingly.

“We need an evaluation of new techniques such as meshes, and we need an emphasis on training and education when we embark in the field of prolapse. And regarding old age, it’s important to keep fit and consider alternative diet such as Mediterranean food, and when we see an elderly patient in our clinics we should consider their cognitive functions and above all we should stay healthy ourselves, ” said Prof. Dirk De Ridder who co-chaired the session  “Urology, From Young to Old,” with Prof. Walter Artibani.

Artibani said the session highlighted the need to re-examine thorny issues such as vesicoureteral reflux (VUR) and hypospadias in pediatric urology, as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in female urology, and issues in elderly patients such as urinary incontinence and the impact of co-morbidities.

Prof. Goran Lackgren spoke on VUR and the impact of endoscopic treatment. Prof. Anthony Mundy gave a lecture on hypospadias in boys, stressing long-term complications. A debate on pelvic floor implants and whether to use mesh or not were discussed by gynaecologist Ursula Peschers, while Francois Haab took the urologist’s viewpoint. The latter segment featured two state-of-the-art lectures by Adrian Wagg who spoke on urinary incontinence among the elderly, and Michael Kirby who gave a comprehensive talk on the genetic basis of the ageing process and the need for holistic approaches.

Lackgren said that endoscopic treatment has changed the management of VUR in children. He cited the long-term study by his group in Sweden  and recommended the combined treatment of VUR and bladder dysfunction.  “We believe that endoscopic treatment of children with high-grade reflux is worthwhile and have a high success rate in the long-term and without serious adverse events,” he said.

In his succinct lecture, Mundy emphasized and discussed the long-term follow-up of hypospadias. He said there are complications after hypospadias surgery and posed the query whether surgery for distal hypospadias should be deferred until the patient can give informed consent. “More often the surgery is being done for the parents of these boys, not for the child themselves,” said Mundy.

Meanwhile, Peschers and Haab provided opposing views on the benefits of using artificial mesh implants in women with POP. Peschers hammered on the chronic and serious complications in women with mesh implants. “New techniques are not always better. Beware of the salesmen in the operation room, and besides one operation does not fit all our patients,” she said.

In his rebuttal, Haab underscored the importance of training and the surgeon’s skills, and the fact that mesh materials have evolved through the years.

“There is a need to evaluate new techniques…meshes are part of surgical treatment and improve efficacy results,” said Haab as he noted that physician education should focus on refining skills and evaluation.

Regarding ageing and incontinence, Wagg gave the key message for doctors to address co morbid conditions and consider the benefits of physical exercise. “We also have to address polypharmacy by altering or recommending  stopping on drugs which adversely affect continence status,” he added.

For his part, Kirby said physicians should pursue management strategies which focused on a personalized approach, considering the advances being made in genetic research regarding the ageing process.