Urology in Maghreb region developing at a fast rate

Urology in the Maghreb region has seen rapid growth in recent years, prompting urological experts and leaders from Morrocco, Tunesia and Algeria to bond together and join for the first time this year’s Urology Beyond Europe programme at the 27th Annual EAU Congress.

“Urology in Maghreb countries is now going on the right track, with a more stable growth seen in recent years. But we expect to further develop urology in our respective countries. Our aim is to see more specialisation and enhance the quality of patient care,” said Dr. Abdennabi Joual (Casablanca), meeting chairman of the Magreb Union session with the EAU. Joual said there are around 840 urologists from the three countries, and the region itself has about 20 university hospitals. “During the last year we have had 100 more new members, and I see a lot of interest among young doctors to specialise in urology,” he added.

There are challenges, however, for the Maghreb countries, according to Joual, saying that more in-depth expertise and specialised training are needed by young urologists in the region. “For instance, we hope to develop expertise in areas like renal transplantation and uro-oncology,” he said. “We definitely are interested to engage with our colleagues in Europe, learn from their experience and participate in the knowledge exchange that is happening now.”

Asked in what specific ways can associations like the EAU assist urologists in the Maghreb region, Joual said that already education and training programmes have been organised by the EAU through the European School of Urology (ESU). “We certainly would like to see the strengthening of collaboration with the EAU because each year we organised ESU courses in the Maghreb countries, and these meetings have been very beneficial, particularly for our young urologists since these programmes provide high quality training,” Joual noted.

Meanwhile, the EAU and the Iranian Urological Association (IUA) discussed salient issues in uro-oncology. PSA levels are crucial in the follow-up of prostate cancer patients, according to Professors S. Shakeri and H. Van Poppel during the joint session. Van Poppel mentioned that not merely PSA, but rather PSA doubling time is an important factor in cancer specific survival rates. Data shows that a doubling time of less than three months is critical.

Van Poppel said PSA doubling time after radical prostatectomy is crucial and must be analysed carefully, and when considered too short it should trigger intervention. However, determining actual doubling time is a complex matter and depends on how often the patient’s PSA levels are tested.

During the clinical discussion, Professors Zargar Shoshtari and Bob Djavan presented two rather unusual cases which emphasised a lack of consensus for treatment options among urologists. For instance what PSA level is considered ‘a recurrence’ differs among doctors, partially due to the different medical facilities available in Iran, Europe and the US, according to several Iranian urologists.

Van Poppel commented to the EUT that salvage treatment options for PSA failure, such as radiation and hormone therapy, are available all over the world, including Iran. Other treatment options, such as cryotherapy and HIFU, are not standard treatment options and more research is needed in these approaches.

The well-attended EAU-IAU joint session highlighted the good relations between both associations, which have plans to translate the EAU Guidelines into Farsi. If the project pushes through the translation can be used by the speakers at the next joint session in Milan next year.

Photo: Joint Session of the EAU and the Maghreb Union Countries attracted a sizeable audience