New chair of the EAU Section of Functional Urology

How do you feel about being elected as the new Chair of the EAU Section of Functional Urology?

Prof. Finazzi-Agrò: “I am honoured and have a little bit of fear, because it's an important role but difficult! I hope to rise to the challenge of this role. Of course, I also have a profound sense of happiness and joy at the opportunity to meet and work with people from all around Europe and other countries outside Europe. In my opinion, and I say this as a motivation for younger doctors, the opportunity to meet people from other countries with different experiences and different cultures, but with the same passion for urology, for the patients we follow, for the scientific field we are interested in, is probably the best part of working life. Please let me also thank Prof. Francisco Cruz (PT), who did a great job in the last eight years as the previous ESFU Chair.”

ESFU or ESFFU?

Prof. Finazzi-Agrò: “Well, this is an important question. The previous ESFU (ESFFU) board, led by Prof. Cruz, in which I was board member, felt this acronym ‘ESFFU’ was a little bit too complicated. We discussed also the possibility to include the word “incontinence” in the new acronym but again we found the results unsatisfactory. Thus, we decided to remove an ‘F’: just to be clear, the EAU section is now called ‘of functional urology’ instead ‘of functional and female urology’. Does this mean that we do not want to take care of our female patients? Absolutely not: ‘functional urology’ includes ‘female urology’. We did not want to omit parts of our scientific field of interest, but, on the other hand, we have made it broader.”

Can you explain what ‘functional urology’ is?

Prof. Finazzi-Agrò: “The first thing I would say is that it's a very interesting and extensive field, comprising of neurourology, female urology (OAB, female incontinence, pelvic organ prolapses), Male LUTS (BPO, OAB and incontinence in male patients), chronic pelvic pain, recurrent urinary tract infections… Please, don't underestimate this subspecialty!”

What unique challenges does functional urology present that are distinctively different from those encountered in other fields of urology?

Prof. Finazzi-Agrò: “I think the major challenge is that, in many cases, pathophysiology is not immediately clear and evident. Sometimes, for instance, you must also use invasive tests, like urodynamic investigations, to better evaluate your patients. You can't just use imaging and have a diagnosis and solution. You need to understand the underlying pathophysiology, then you will be able to treat your patients correctly. Luckily, the problems are functional, not tumours. It's not oncology. I mean your patients won't die from incontinence, for instance. And this is good, of course. But, on the other hand, sometimes our hospitals are full of patients with bladder cancer and prostate cancer. The space for functional urology patients in the clinics and in the operating theatres is limited, often with long waiting lists. Our patients must wait, because you must first operate on the tumours, the stones, and all the rest. So, the other challenge of this subspecialty is to find space in the hospitals and in theatres.”

Continence health problems are a major health issue with significant impact on patients, national health systems, the economy, the environment and society in general. In your opinion, are continence health problems receiving the necessary focus and attention they deserve?

Prof. Finazzi-Agrò: “No. I think that the awareness should be increased among politicians, administrators, people who make decisions, but also among our citizens. Because, sometimes incontinence is considered as something connected with aging. People think that they must suffer from incontinence and that this problem is incurable. This is simply not true, and for this reason, I think it's very important that the EAU is conducting, with other scientific societies and the European Union, the "An Urge to Act" campaign to raise awareness at a European Parliament level. But this activity should also be done in the different nations of Europe. The costs of incontinence are 70 billion euros per year, in Europe. This is between 35% and 70% of the costs of oncology and it is quite a lot of money! Another important point is that it's also an environmental issue, because the disposing of the pads increases environmental pollution. If we could reduce the use of pads, this would also reduce the impact on the environment. So, we must push on these points. Incontinence was initially considered a minor problem, but it's a very important problem. We need to intensify our efforts to raise awareness about incontinence.”

Can you tell us about any new initiatives that we can anticipate from the ESFU?

Prof. Finazzi-Agrò: “In collaboration with other EAU Offices, providing educational activities is a key component’ of the ESFU section. The European School of Urology is also organising a Masterclass with us this September in Leuven, Belgium. We have developed several webinars this year and have more planned for the future. It is likely that we will announce new working groups on the different topics in functional urology, so we need young and motivated people to help us with these initiatives. Finally, ESFU should contribute to the research in urology, for example, promoting consensus papers among experts on controversial topics where the evidence is limited. Also, we will continue to contribute to the programme of the EAU Annual Congress. My personal wish would be to have space reserved to ESFU in national meetings around Europe to promote interest in functional urology, which is sometimes a little bit limited when compared to other fields of urology, like oncology, robotics, etc. Also, the ESFU could act as a link between the EAU and other national and international scientific societies in the field of functional urology.”

What message would you like to give young colleagues interested in functional urology?

Prof. Finazzi-Agrò: “Functional urology is challenging! You need a mentor, to grow up and gain experience. In this sense, fellowships and mentorships are encouraged. Furthermore, don’t forget to collaborate with other colleagues who can help you with their different experiences (gynaecologists, neurologists, rehab doctors) but also with other professionals (nurses, physios) who contribute to the proper care management of your patients. Finally, always consider your patients as the most important part of your working activities: ‘functional’ patients, usually, are not at risk to die for their pathologies, but they do suffer a lot. We need to take care of them, cure them whenever possible, and manage them when a cure is not available. A good relationship with patient representatives is also very important for ESFU and for all professionals, to better understand patient needs.”