Refractory problems in functional urology open Day 4 of the EAU Congress

"What is needed is more involvement from urologists at the urodynamic lab,” said Prof. Paul Abrams (Bristol, GB), during the Société Internationale d’Urologie Lecture at Plenary Session 3. For him, the usefulness of urodynamics is still doubted by some not only because of the absence of clear, level 1 evidence, but also because of a usage issue. In his view, older urologists may not trust urodynamics tests because they are relatively new, whereas young urologists may lack the training. Further compounding the issue, some urodynamics labs still operate with lower quality standards, which make the results unreliable in most cases. However, as the tests become more widespread, all these constraints are bound to fade.

Continuing the international lectures, Dr. Mauricio Plata (Bogotá, CO) then discussed the management of bladder emptying problems during the Confederación Latinoamericana de Urología Lecture, which focussed on Latin American issues. “Finding better ways to manage bladder emptying problems is pressing in Latin America since in 10 years there will be a 50% growth in the number of patients with LUTS.” The most important step is to identify patients with high risk of LUT deterioration at an early stage, and provide adequate diagnoses that identify the underlying cause. Only then will doctors be able to provide the focussed treatment that patients need.

Prof. Marcus John Drake (Bristol, GB) followed with his State-of-the-art discussion on the limits and possibilities of pharmacological therapy for OAB. He made a case for further development of drug therapies within the mechanisms responsible for sensation, and those for motor dysfunction, namely the urothelium, interstitial cells and afferent sensory nerves. While he recognised the challenges that are ahead, particularly because knowledge of the physiology is still limited, and the pathologies are many and complex. More challenging, however, pharmacological therapy would target mechanisms that could be present in other organs, thus risking potential side effects. Nevertheless, he concluded on a positive note that “while many challenges will be faced in the development of new pharmacological therapy, a means to moderate sensation or motor disfunction may well be possible if we target the urothelium, interstitial cells and afferent nerves.”

Presenting the updated EAU Guidelines on male LUTS, Prof. Stavros Gravas, (Larissa, GR) provided an insight into the decision-making process for the new recommendations. The so-called Delphi Method for reaching consensus allowed for “anonymity and it allowed opinions to be expressed free from peer-group pressure. The group converged towards a consensus ‘correct’ answer, after several rounds of anonymous debate.”

After the presentation of guidelines, Prof. Matthias Oelke (Hanover, DE) continued with another State-of-the-art discussion, this time on the management of residual LUTS after prostatic surgery. Among the reasons he mentioned for postoperative LUTS were: the use of wrong surgical techniques, an equivocal diagnosis, co-morbidities that were not diagnosed before the surgery and, in some cases, even poor surgical skills. To prevent all of these, he recommended following the established guidelines, treating residual LUTS according to their specific pathophysiology and, for surgeons he recommended “performing computer or mentor training at the beginning of your learning curve to improve your surgical skills.”