Examining the near future of uro-technology

17 December 2019

Urologists pride themselves on using the latest technology to better treat their patients: from minimally invasive surgery to robotics, improved imaging and even the construction of artificial implants, technology drives innovation. At EAU20, technology is of course represented by the EAU Section of Uro-Technology and its live surgery sessions, but more specialised sessions can also point at developments that are not yet ready for demonstration.

Prof. Chris Bangma (Rotterdam, NL) is co-chairing Thematic Session 21 (Monday, 23 March, 10:30), New Technology in Urology. As chairman of the Erasmus University urology department and an experienced prostate cancer researcher, Prof. Bangma is well placed to offer a glimpse of the future of the field. In this interview he gives a preview of Thematic Session 21 and what urologists can expect from medical technology in the coming decades.

Practical applications
“Technology is all about practical applications for the health professional,” Bangma explains, “…and urology is a profession for ‘doers’. We remove, replace, remake, reconstruct organs, tissues, or cells in the urinary tract. In order to improve our results and renew our skills, we often borrow the innovations of others, and integrate their findings into our profession.”

“Can we operate better if we can see what a radiologist sees in the diagnostic phase, during the operation? Can we replace diseased tissue with a tissue similar in quality to what mother nature makes at birth? How can we learn from the experiences of thousands of patients to help the one person in front of me? The ‘New Technology’ session at EAU20 highlights some of the challenging technological developments needed to improve current urological practice just now or in the immediate future.”

All these topics will be discussed in the first part of Thematic Session 21, with experts presenting the latest developments in single cell capturing, so-called 4D regenerative medicine and printing technologies for complex tissue models.

New ‘organs’
Bangma also considers a post-surgical future for urological conditions: “Maybe surgery can be improved with additional technology, maybe it will even disappear in the long run. One might argue that recent innovations in robotic surgery are good enough to handle cancer in the abdomen, but molecular sciences have designed targets that may beat surgery with so-called magic bullets. Intra-operative imaging with novel probes might enhance precision surgery, and improve functional and oncologic outcome.”

“Perhaps we can also make entirely new kidneys, or bladders, or urethras, and urologists are the ones who are going to insert them into the body. We are inserting new ‘organs’ already: we place neuromodulators to alter and correct bladder function, corpora cavernosa, and urinary sphincters. It is likely that these inserts will be improved: smarter, smaller, and personalised to the demands of the patient. Will we be able to integrate with the neurosurgical expertise of others, and stimulate the brain on top of the spinal cord?”

Topics to be discussed in Amsterdam include modulation of urological nerves, brain stimulation and the effect of EU directives on urology implants.

Joint ESOU-ERUS-ESUT session with ECCO during EAU19, Barcelona.

Putting data to use
Information technology is also transforming urologists’ knowledge of cancers. “The age of information has started with an explosion of genomic data,” says Bangma.

“Massive amounts, unstructured, and therefore often lacking sufficient meaning. To find patterns between genomic profiles, epigenetic changes, immunologic alterations and environmental factors, we need more than our brain to create meaningful algorithms: artificial intelligence. Automatic pattern recognition in radiologic images and histology is already feasible. In cancer diagnostics, this provides the technology to stratify patients in high or low-risk groups, and use this classification to select the patients for a more intensive work up by the pathologist making a diagnosis.”

“Clinical applications are around the corner, and can be incorporated in clinical decision tools. In the future, urologists might have a ‘second digital me’, or ‘digital twin’: an avatar that collects all of your data over time and allows information from different sources to be combined. This digital twin’s data can be applied during surgical procedures. The EAU is involved in projects (like PIONEER) preparing for such networks.”

Innovations in data use will be covered in the section “Patterns & Computers”, which has talks on image recognition, decision support and the potential of the ‘digital me’.

Clinical relevance
Advances in technology should ultimately end up in urologists’ hands and be a benefit to their patients. The practical application (and implications) of new technology is a primary concern of the EAU, and this is reflected in each speaker’s presentation at Thematic Session 21.

Reflecting on the aforementioned topics, Prof. Bangma points out: “These developments are not for everyone, at least not immediately. But thirty years ago flexible cystoscopy was too expensive for routine care, and nowadays people are considering the idea of scopes for one-time use only.”

“We realise that not all developments are going to make it into the clinic. We only want to be there in time if they do, and we want them to be in our hands.

Chris Bangma is professor and chairman of the department of Urology at Erasmus University Medical Hospital since 2001. Prof. Bangma has been on the EAU scientific committee for 8 years. He is PI of the worldwide networks PRIAS and Movember GAP3 for active surveillance in low risk prostate cancer, and contributes to various research activities for the development of markers in bladder and prostate cancer. He is initiator of the Anser Prostate Cancer Network in the Netherlands.

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