Report: 2023 EAU Meets National Societies Meeting

Instead of being in competition, the EAU can offer services and products that would be impossible to achieve for solitary national societies: annually-updated Guidelines, the highest-level scientific events, international training opportunities, data management and the political voice that comes with representing thousands of members. European urologists can benefit from cross-border initiatives and platforms and the EAU can complement each country’s own efforts.

As is a well-established custom, the EAU welcomed representatives of Europe’s national urological societies to the Dutch Riviera (with appropriate temperatures) for a wide-ranging meeting on 10 June, 2023. Representatives from 35 countries took part. In the break-out sessions smaller groups of representatives addressed several topics of shared interest and this was a valuable forum for an exchange of national perspectives. Prof. Stenzl made his debut as Secretary General at the National Societies Meeting, also taking the opportunity to introduce himself to the representatives.

The European School of Urology is one of the most direct ways in which the EAU can serve Europe’s urologists, offering training programmes, educational materials and scholarship opportunities. The ESU was represented in Noordwijk by its chairman, Prof. Evangelos Liatsikos (Patras, GR).

“Standardisation is the magic word,” said Prof. Liatsikos, pointing to the highly-systematic European training in basic laparoscopic urological skills (E-BLUS) programme as the direction for the ESU’s other courses. Prof. Liatsikos encouraged the national societies to nominate young talent for active roles in the ESU, making sure that faculty is as diverse as the audiences they served.

In the break-out sessions, there was a chance to evaluate if the ESU was meeting the needs of the different regions of Europe or individual countries. Currently, work is being done to come up with a syllabus for urology, which aims to compile everything that medical students need to know to pursue a career in urology. Prof. Liatsikos also hailed recently-introduced ESU “Urology Boot Camps” for first year residents have had positive results, increasing the flow and quality of people choosing careers in urology. This model could be useful all across Europe.

The School was joined in its efforts to reach young urologists by the chairman of the YUO, Dr. Juan Luis Vásquez (Copenhagen, DK) who announced a brand new initiative: the EAU Talent Incubator Programme. In his presentation Dr. Vásquez explained that the programme was designed to help foster a new generation of leadership in urology. The medical side of being a urologist can be trained, but skills in leadership, communication and mentoring should be stimulated as well: “our mission at the EAU is to raise the level of urological care, but this includes efficiency and compassion in hospitals and healthcare services.”

The programme offers 25 seats for highly-motivated young urologists and will take place in Innsbruck, Austria on 11-13 January 2024. The deadline to apply is 15 September 2023.

Despite the European Union’s successes in creating transnational institutions and the harmonisation of many laws, healthcare policy in Europe is still very much a national concern. The differences in national practice and regulation mean that several unique obstacles exist to a successful Europe-wide approach to early detection of prostate cancer as advocated by the EAU Policy Office and its chairman Prof. Hein Van Poppel (Leuven, BE). The National Societies Meeting was a unique opportunity for those leading the recently-launched Praise-U project to get a better picture directly from the national representatives.

Prof. Monique Roobol (Rotterdam, NL) and her team of researchers are in the process of learning about the status quo of early detection of Prostate Cancer across the EU, and mapping out the barriers to effective screening. Questions discussed in Noordwijk included whether official statements or positions on PCa screening already exist in countries, how reimbursement of PSA screening is arranged and who the key decisionmakers are. The EAU Policy Office could play a role in helping national societies overcome political barriers they might face in the adoption of early detection.

The Policy Office was also represented in Noordwijk by its Vice-Chair, Prof. Philip Van Kerrebroeck (Antwerp, BE), who shared the office’s efforts beyond prostate cancer prevention and specifically when it comes to a Europe-wide approach on (in)continence health. “Continence is a major problem that affects a large part of Europe’s population and it is currently not addressed as it should be. We need preventive measures, a cure and care.”

Prof. Van Kerrebroeck pointed out that this ties into European health initiatives, such as collaborative programmes on non-communicable diseases (NCDs) and research, as well as European legislation on waste management, green policies and the classification of continence-related products, and that the upcoming European elections were a great time to get continence health on the agenda. Current national approaches to continence are being documented by the Policy Office. All these insights will be published in a manifesto that will be presented at a Summit in the European Parliament in November this year. The EAU has also commissioned a report on the socio-economic costs of continence problems which will be launched at the same Summit. An extensive European campaign will follow to raise awareness for continence health and to align European policies for a more sustainable management of continence care.

Adjunct Secretary General Prof. James N’Dow (Aberdeen, GB) was on hand in Noordwijk to update the national societies on the progress that was being made with the EAU UroEvidenceHub, a recently-launched initiative to collect and process real-world data in order to fill in gaps in current knowledge.

EAU Guidelines Office chair Prof. Maria Ribal (Barcelona, ES) gave an update on the IMAGINE project, which documents and strives to analyse adherence to the EAU Guidelines’ recommendations. This has been a collaborative project recruiting data across European centres compiling data on almost 7000 patients. The project is a good example of the EAU working together with Europe’s national societies, already yielding the first results in a recent paper with a huge list of collaborators.

Prof. Ribal announced the launch of IMAGINE Study 2, which aims to describe adherence to Guideline recommendations for antibiotic prophylaxis in cystoscopy, and encouraged the assembled national societies representatives to join the research network.

“Our aims are for the incorporation of real-world evidence from the EAU UroEvidenceHub, alongside traditional clinical trials evidence, into the evidence profiles that underpin our recommendations. Ultimately this will further cement the EAU Guidelines’ place as a leader in the field, and we could not have achieved this without the support and collaboration of the National Societies!”

Prof. N’Dow: “IMAGINE has shown us that meaningful collaboration between different countries can yield great and concrete results. For the UroEvidenceHub, we will do the heavy lifting for you, and support you to get ethical approval to use the platform. The EAU is committed to maintaining and managing the database infrastructure, but we rely on your participation and contributions to make the larger project work.”

Concerns raised and discussed in one break-out session include the labour-intensity of data management and the required computer literacy for patients who might be contributing directly via Patient-reported outcome measures. Potential risks of bias by collecting data from only the most motivated centres were also discussed, as were the technical complexities of customising the database with optional “bolt-ons” and issues like anonymisation.

Prof. N’Dow thanked discussants and promised that, “in a bespoke way, the EAU will assist participating sites to fix specific problems that they may face at the local country level; however, to achieve this we need your feedback.”

While Patient Information is now a long-running project for the EAU, it has only recently been reorganised into its own Office, led by Prof. Eamonn Rogers (Galway, IE). In Noordwijk, the suitability and use of patient information materials was discussed with the national societies’ representatives, leading to some interesting points.

Discussion revealed that while urology patients may have similar problems and concerns across Europe, it would be dangerous to assume a one-size-fits-all approach to patient information, particularly when treatment options still differ so much across Europe. Informative videos that might serve as explainers for routine robotic prostatectomies in some countries, could raise unrealistic expectations for patients in countries where such procedures are much more exclusive.

The need for trustworthy and accessible patient information was universally accepted, particularly in the fight against unreliable online information. A major challenge for wide adoption is the need for regularly-updated and accurate local translations, an area where the EAU and national societies might have shared concerns and needs.

The day-long meeting was ended with concluding remarks from the discussion leaders, back in a group setting. Prof. Stenzl thanked all participants and was proud to have every corner of Europe represented in one room, with urologists strengthening ties and working together to improve the level of care for their patients: “You have given us valuable feedback and we look forward to hearing a lot more from you in the coming months!”