On 5-7 September 2013, the EAU Section of Urolithiasis (EULIS) will convene for the second time at their dedicated meeting, this time in Copenhagen, Denmark. After their successful pilot in 2011, the section is compiling a very intensive and interactive programme, featuring sessions of various formats. The EULIS chairman, Prof. Palle Osther, answered several questions about the upcoming meeting and the most pressing developments in the field of urinary stones.What has changed in the field of urolithiasis since the last EULIS meeting? Which new developments will be addressed this time?
Palle Osther: The incidence and prevalence of urolithiasis are steadily increasing throughout Europe. In the last ten years stone prevalence has increased by 30% in industrialised countries. At EULIS, we strongly believe that increasing awareness of the kidney stone disease is needed both from the perspective of the doctors and the society in order to provide the best care to this huge population of patients. This was also reflected in the recent EAU Patient Information initiative launched with materials on kidney and ureteral stones.
At the 2013 edition of the EULIS meeting in Copenhagen, we will focus on trends in the field of stone disease, both with regard to its epidemiological aspects, basic research and pathophysiology as well as medical and surgical management.
For instance, we will debate why ureteroscopic management in some areas of Europe is now the dominant treatment scenario, whereas in others SWL is still preferred for the majority of patients. Furthermore, new knowledge on the role of Randall’s plaques on the pathogenesis of calcium nephrolithiasis and the link between the metabolic syndrome and uric acid and calcium nephrolithiasis will be discussed intensively. Hopefully this will add to our knowledge in order to provide better means for preventing stone formation.
Which topics, do you expect to raise a lot of discussion– why? How are they dealt with within the programme?
Palle Osther: Previously most of our knowledge on the pathophysiology of stone formation was based on whole urine studies, and saturation theories were the talk-of-the-town. Recent research looks more at the initial steps of stone formation as a micro-environmental process occurring in different parts of the nephron, and at the meeting urinary saturation controversially will be discussed as casual or causal in stone disease in a pro-and-con debate.
Furthermore, shifting trends in the endourological management of large renal stones will be undoubtedly heavily debated – PCNL versus flexible ureteroscopy, conventional PCNL versus mini-PCNL, micro-PCNL, ultra-mini PCNL. At present these minimal invasive therapies are fighting to prove their eligibility.
Surely, I am looking forward to some very interesting and inspiring debates. These different modalities also will be addressed in live-surgery sessions, and I am sure this will add to our common knowledge database on tips-and-tricks in everyday stone management.
The programme includes a large section on stents and the role of metal in stents – this is a very specialist topic, how can it be of use and interest to practicing urologists?
Palle Osther: That’s right. The meeting will include a pre-congress workshop on ureteral stenting. Recently, much debate has been on when to stent and when not to stent. On one hand the possibility to use stents has been revolutionised and is now a vital part of modern endourology. On the other hand, these stents may have undesirable side-effects, such as irritative bladder symptoms and sexual dysfunction, which means that the decision of placing a stent should be based on specific indications rather than as a routine procedure.
Different stents have been manufactured to overcome potential side-effects, including metal stents. The workshop will deal with overall stent issues such as indications for stent placement, durability and problems with incrustations as well the role of metal stenting.
Also the workshop will include live stent insertions transmitted from the OR of Rigshospitalet in Copenhagen. In this way the participants will get both state-of-the-art scientific knowledge on stents in urology as well as tips and tricks regarding placement procedures of the different stents and on how to deal with complications.
At the meeting workshops on SWL, URS, PCNL as well as medical and dietary management of kidney stones will be offered as well. World-renowned experts from both Europe and overseas will be conducting these workshops, and the participants will have the opportunity to meet urologists who have become legends for their outstanding work in urolithiasis.
There is also going to be a discussion on how to train an academic stone doctor – why is this discussion relevant and what do you expect to draw from it?
Palle Osther:At our EULIS workshops all around the world throughout the years we have seen different health care systems with different standards with regard to offered treatment modalities as well as training possibilities. These events have created a global fruitful and friendly atmosphere in the urolithiasis community – we are so to speak sisters and brothers in stone.
This very open forum allows us to take what is best from different areas of the world, and gives us an optimal basis for discussions on how to train an academic stone doctor. These ties enable us to take into consideration the best available knowledge and local treatment opportunities, thereby creating the foundation of evidence-based medicine in the stone field - tracking down the best external evidence with which to answer our clinical questions.
There is a large variety of formats at the meeting – from workshops and state-of-the art lectures, to live surgery and hands-on training sessions. How do you match the format of the session with the topics that need to be covered?
Palle Osther: At an international meeting on stone disease a huge format of scientific and educational activities are mandatory. That is why we will have a large variety of sessions, including state-of-art lectures, pro-and-con debates, poster-sessions, hands-on-training courses and live surgery sessions. Only in this way we will be able to appropriately confront the complexity of basic research and practical clinical management of the great varieties of stone diseases.
Stones are different – urinary tracts are different – patients are different. The variability of stone disease is tremendous. That is what makes treatment of urolithiasis so challenging, unique and rewarding at the same time.
The strategy on how to manage stone disease should be based on a thorough individual assessment including history, stone burden, composition and structure, metabolic abnormalities, anatomy of collecting system and the patient in general, patient’s physical condition and co-morbidity, patient’s mental and social conditions, kidney function, bleeding disorders and medication, symptoms and last but not least patient’s expectations and preferences. Also, the physician’s preferences, his or her skills and possibilities affect treatment decision.
I strongly believe that this meeting, with all its formats will help up on our way towards personalised management of urolithiasis, which is the only way to go. The event will certainly achieve what it set out to do, help the participants to ‘bridge the gap between basic science and clinical practice in urolithiasis’.
Abstract submission for 2nd EULIS is now open and will close on 6 May 2013. Online registration for this meeting will open on 1 March 2013.