Prof. P. Abrams: “More exposure to incontinence issues is necessary”

One of the main objectives of the Annual EAU Congress is to stimulate cooperation in the field of urological science and practice. The EAU actively pursues this objective by organising a number of joint sessions with national and international organisations which work to advance urological care around the world.

Within this framework, the EAU and ICUD will hold the 5th joint International Consultation on Incontinence during the 27th Annual EAU Congress in Paris. There will be a full-day session on Friday 24th Febuary, with five further presentations the next morning, that will tackle incontinence management from multiple perspectives, offering a comprehensive expert discussion and identifying new directions of research for the future.Prof. Paul Abrams, who serves in the EAU Strategy Planning Office and is the current president of ICUD, will chair the joint consultation. In this interview with EUT he discusses the main objectives of the session, some of the current developments in the field of incontinence management and how these developments with be addressed during the joint consultation.

1. What is the format of the session and what is the main focus?We have an established format which enables us to offer an all-in coverage of the topic. Our main focus lies with providing an exhaustive overview of incontinence management and not one specific issue or trend. This implies that we organise a very intensive information-packed session and a clear subdivision of the programme into topic clusters.

To be more specific, we will be covering epidemiology, basic science, pathophysiology, patient investigation and managements, as well as pelvic organ prolaps, faecal incontinence and others. These topics correspond with the ICUD structure which consists of 23 committees, and since the subject of incontinence falls under the competence of several committees, we will be able to hear a truly multifaceted discussion addressing the entire field.

2. Another way of looking at the field of incontinence management is through subdividing the topic into issues pertinent to various patient groups. How will this be tackled during the joint EAU-ICUD session?We will be talking about several groups of patients, including children, neurogenic patients, frail elderly, men and women with indication for surgery. We have the commitment of excellent speakers to cover these topics - Prof. R. Nijman (NL), Prof. M. Drake (UK), Prof. A. Wagg (Canada), Prof. S. Herschorn (Canada) and Prof. R. Dmochowski (USA).

Additionally, it is vital that within this international setting, we address the management of a very large group of patients with fistulas, especially obstetric fistulas. This condition is overwhelming in many African and South-East Asian countries affecting millions of women and we need to stress the need for international cooperation in tackling this issue. This presentation will be prepared by Prof. D. De Ridder (BE).

The last but not least of the patient groups discussed at the session will be those who suffer from faecal incontinence. This condition often coexists with urinary incontinence and urology specialists must be aware of the implications. We have two presentations on this subject – by Prof. D. Bliss (USA) and R. Madoff (USA).

3. Who should be attending this session?Since the range of topics is so comprehensive, I imagine that this session will be of interest to most of the delegates attending the 27th Annual EAU Congress, whether they wish to refresh their overall knowledge in the field, or to deepen the understanding of very specific issues.

And while, of course, we target the audience which has incontinence management as their professional focus, we believe that the session will be of practical relevance for many experts working in the adjacent subspecialties. For instance, here we can mention urologists who work with prostate cancer patients treated with prostatectomy. I also think that the overview format of the session will be of benefit to the residents and young urologists – they are very welcome to join!

4. What new developments will the session cover?One of the main objectives is, of course, to discuss the data which has become available since the last consultation four years ago. For one, the discussion about urodynamics promises to offer new insights – we need to discuss whether there is a consensus as to whether or not urodynamics should be performed before stress-incontinence surgery.

Furthermore we need to take a closer look at the role of ultrasound in assessing the pelvic flour, as well as assess the new data on the use, the outcomes and the side-affects botulinum toxin in incontinent patients.Another topic that is still very much a matter of debate is the use of the artificial urinary sphincter compared to existing alternatives. Additionally we are looking forward to the new information on various types of tapes in the treatment of stress-incontinence – interesting research have been recently published in this field and we will be examining the value of this information in terms of clinical application.

5. What are the challenges in the treatment of incontinence today?There are many challenges, but I would like to stress one in particular. A great number of men and women who suffer from incontinence choose not to deal with their condition – even in the European countries it is still perceived by many as embarrassing. I believe that our role as medical practitioners is not only to treat the patients who come to us for help, but also to create exposure to these issues and to educate the general public. Urologists can do so much today to improve the quality of life of incontinence patients, and this message must reach all those who can be helped but have not yet sought treatment.

6. What will be the outcomes of the joint session?As a result of the consultation, we will produce a book, accompanied by a CD, in which the consensus statements and review of the data will be presented. We expect the book to be published within six months of the consultation. Furthermore, we will encourage the contributors to submit their work to peer-reviewed journals. In this way we can make sure that the information that we generate during the joint ICUD-EAU will be available to the larger scientific community.

Image: EAU-ICUD at the Annual EAU Congress in Barcelona 2010