The 1st Bi-Annual Meeting of the EAU Section of Urolithiasis convened in London from 7-10 September, delivering a varied programme that brought together urologists, surgeons and scientists. The scientific programme consisted of poster sessions, keynote lectures and workshops, and it is a reflection of the varied audience. Striking a balance for all involved was a key point in structuring the Meeting’s schedule.
Meeting Chairman Mr. Noor Buchholz: “What makes EULIS special is that we deal about 50% with stone surgery, but 50% of the time we deal with the metabolic side of stones, and basic research on prevention. We talk about diets, crystal formation and fluid intake. This meeting brings together all of those interests, and we try to have something for everybody. The meeting is set up to have parallel sessions, with one focussing more on the metabolic side, and one more on the surgical side.”
The basic science and preventive side of stone formation was well-represented in the sessions. In particular, the role of diet in stone formation gave participants a good overview of the latest findings in the field.
Dr. Alberto Trinchieri of the Lecco Hospital in Italy looked at the properties of various beverages and their effect on stone formation. He pointed out that evidence had changed drastically over the past decades, rendering evidence from forty years ago largely redundant. Rather than assuming that a lack of fluids promotes formation, it has now been demonstrated that a higher intake of fluids is actually related to lower stone formation.
According to Trinchieri, a more sophisticated look needs to be taken at the chemical properties of fluids. Preliminary findings were presented on citrus juices (protective effect in the short term, but a long-term risk), beer (inconclusive) and the calcium concentration of tap water.
Dieting advice also went beyond fluid intake during Workshop 4 on non-surgical stone treatment. Dr. Roswitha Siener (University Clinic, Bonn) presented findings of different foodstuffs and their effect on stone formation. Calcium oxalate, an important component in stone formation can be ingested through rhubarb, spinach, cacao, almonds and particularly sesame seeds. Meat and fish are high in purines, which make the body produce uric acid, another contributing factor. Obesity is also addressed as a risk factor, as is a diet that is not nutritionally balanced.
Dr. Trinchieri pointed out the “problem of compliance”, of getting patients to increase their fluid intakes and adjust their lifestyles. An innovative development in this direction was explained as a poster presentation during the 8th Session. Zainab Al-Jaberi of the Erasmus MC, Rotterdam introduced positive results on using an internet-based programme to effect real change in patient behaviour. Patients enter details on their diet, exercise regimen and physical dimensions, and the programme can predict the composition of the urine. Advice is given based on these factors, and preliminary results indicate a high percentage of positive feedback from patients, and even a change in lifestyle as a result of taking part.
Much of the research and basic science surrounding stone formation is thanks to animal research. Dr. Brian Catchpole of the Royal Veterinary College spoke on the genetics of stone disease, specifically in research on dogs. Dogs are particularly useful for genetic research, as the genome assembly was sequenced and assembled in 2004. Catchpole points out that “translational research” should yield promising results, as genetic research can be translated in between rats and dogs, and finally be applied to humans. He noted on the remarkable genetic diversity between breeds of dogs, but also the close similarity within the same breed. In-breeding results in a perpetuation and even worsening of stone problems through homozygosis. Dalmatians are a breed particularly sensitive to stone formation.
The surgical side of urolithiasis was also well-represented in the scientific programme. Several hands-on training workshops were open for participation from visitors who had signed up, although they proved so popular that they were all promptly filled. Friday featured a day-long sub-plenary live surgery session that was broadcast from St. Bartholomew’s hospital. Visitors could follow proceedings from the meeting venue’s auditorium. Several approaches to surgery were tackled, including PCNL prone and fURS.
Mr. Konstantinos Moraitis presented his findings on effective follow-up for the stone former. His research mainly uncovered that very little data was available on structural guidelines for follow-up procedures: “We know what to do, but not for how long, and not on which patients in particular.” Patients’ recurrent risk is under-researched, and there is too little data to form guidelines. More data is also needed to form a cost-effective protocol.
Many treatment options are available for physicians dealing with renal colic. With his extensive presentation on pathophysiology in the treatment of “rolling stones”, Prof. Bernhard Hess gave an informative keynote lecture on the meeting’s last day. After presenting and evaluating the options, including the installation of a pacemaker on the kidney, and a caution about using pethidine. Prof. Hess warned that the effects are similar to cocaine, and recalled how patients would request pethidine for its euphoric feelings. Suggestions were given at the end of the overview, stressing that forced hydration should not be applied in any case. NSAID and alpha blockers were good first steps toward treatment, with non-opioids like intravenous paracetamol as an intermediary step. Finally, opioids should only be used in acute situations.
The meeting was a great success according to its organiser, Mr. Noor Buchholz, and the EULIS chairman, Prof. Palle Osther. Attendance was beyond expectation, with 400 visitors and 200 abstracts being presented at the Mermaid Conference & Events Centre in central London. The next meeting takes place in Copenhagen in 2013.