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Ackermann, Switzerland I. Adamakis, Greece G. Alivizatos, Greece A. Antoniewicz, Poland J. Bellringer, United Kingdom M.

Bitker, France G. Bogaert, Belgium E. Breinl, Austria L. Campos Pinheiro, Portugal J. Campos Pinheiro, Portugal M. Cracco, Italy H.

Danuser, Switzerland A. Feyaerts, Belgium A. Figueiredo, Portugal F. Fusco, Italy N. George, UK S. Giannakopoulos, Greece A. Giannantoni, Italy M.

Gunst, Switzerland M. Heuser, Germany W. Hochreiter, Switzerland J. Hofbauer, Austria U. Humke, Germany C. Imbimbo, Italy E.

Lledo, Spain N. Longo, Italy C. Mamoulakis, Greece L. Martinez Pineiro, Spain A. Matos Ferreira, Portugal D. Mitropoulos, Greece E.

Montanari, Italy B. Montgomery, United Kingdom G. Moutzouris, Greece J. Nawrocki, United Kingdom J. Nijman, Netherlands P. Nunes, Portugal A.

Papatsoris, Greece A. Pytel, Hungary C. Radmayr, Austria T. De Reijke, Netherlands D. Rengifo Abbad, Spain K.

Van Renterghem, Belgium O. Rodriguez Faba, Spain C. Romano, Italy C. Saussine, France S. Siracusano, Italy A.

Skolarikos, Greece A. Strauss, Germany S. Tekgul, Turkey C. Terrone, Italy V. Tzortzis, Greece A. Volpe, Italy S. Walter, Denmark P.

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Matych, Poland W. Pypno, Poland A. Sikorski, Poland M. Sosnowski, Poland T. Szostek, Poland Z.

Wolski, Poland S. Zdrojowy, Poland H. Almost participants from 10 different countries attended this masterclass which offered the opportunity to discuss and focus on the potential indications, future perspectives and current limitations of the novel single-site platform in urology recently created by Intuitive for the da Vinci Si system.

The new da Vinci single-site platform has been specifically designed to allow surgeons to properly apply the robotic technology to the concept of LESS surgery.

It includes a multichannel port that provides access for two single-site semi-rigid robotic instruments, the 8. The first day of the masterclass offered a limited number of urologists the possibility to train with the Uro-Technology new platform during a dry lab session and learn the basic skills in single-site robotic surgery.

Live surgeries The second day of the masterclass offered a full day interactive course outlining the robotic assisted single-site surgical technique with enhanced step-bystep video material and lectures, which focused on the codification of the robotic single-site pyeloplasty.

The masterclass also included two live surgeries. The first one featured a simple case symptomatic renal cysts decortication to demonstrate all steps in properly placing the single-site port, trocars, robotic arm docking and to explain how the new platform works.

The second surgery, a single-site pyeloplasty Fig. The day ended with a lecture updating participants on what to expect for single-site surgery in the future including new Intuitive instruments.

The da Vinci Single-Site Masterclass international faculty, panellists and moderators have shared valuable insights gained through veteran experience in robotic or LESS surgery.

Its principle objective is to guarantee and promote the highest standards of healthcare in the field of Sexual Medicine, by ensuring that training in Sexual Medicine in Europe is established at an optimal level.

Eligibility The exam is set under the auspices of the UEMS but all physicians of all nationalities, including countries outside the EU, are able to take the exam.

Who can apply? However, new instruments, namely bipolar forceps and monopolar scissors must be introduced into clinical practice to expand the range or types of procedures to be performed.

Some sort of endowrist technology to offer an even greater range of motion should be implemented in the single-site technology as mentioned by Prof.

Giorgio Guazzoni during his lecture. This new device could potentially be used for vascular pedicles control in robotic radical cystectomy procedures and mesenterial work during the urinary diversion steps.

A robotic articulating linear stapler should also be available in the market in the future which would allow for further implementation of the armamentarium for robotic surgery.

Furthermore, an update on Firefly technology was given. The discussions also closely examined and focused on all aspects of single-site surgery in combination with robotic technology.

This will be published in mid by the ESSM educational committee. The courses are intended for physicians with experience of specialistlevel practice in Sexual Medicine who wish to increase their chance of passing the exam.

The teaching faculties for courses will include recognised experts in the field of Sexual Medicine. The location and dates are published on the ESSM website.

Further details are available on the ESSM website: www. The radiological evaluation reported that the lesion arose from the upper pole of the left kidney, displaced the stomach and bowel loops, and abutted the splenic hilum and the posterior aspect of the pancreas which was displaced superiorly and anteriorly.

However, no evidence of definite invasion of any of the adjacent organs could be seen on the CT films. The left adrenal gland was not visualised, nor were any enlarged lymph nodes seen.

There were only a few small left paraaortic lymph nodes reported, with the largest measuring 1.

The lungs were clear without any evidence of pleural or pericardial effusion. Case study No. Histopathology reported adrenocortical carcinoma with negative resected lymph nodes and negative surgical margins.

Discussion points: 1. Are further post-operative investigations needed? Is any adjuvant treatment indicated? What follow-up should be done?

Case provided by M. CT of the chest, abdomen and pelvis showed a huge mass of soft tissue density mass, approximately 22 x 20 x 15 cm Adjuvant radiation therapy is a management option Comments by Axel Heidenreich Aachen DE The patient described was diagnosed with a large adrenocortical carcinoma infiltrating the left kidney and he was treated by radical nephrectomy and locoregional lymphadenectomy.

The resection margins and the resected lymph nodes were negative. Preoperative staging included a CT scan of the chest, the abdomen and the pelvis and it did not reveal lymphpnodular or systemic metastases.

Discussion points Based on the information given the patient has locally advanced adrenocortical carcinoma which represents stage pT4pN0cM0 according to the WHO classification.

The recently modified staging system aimed at improving the prognostic accuracy has been proposed by the European Network for the Study of Adrenal Tumors.

Applying this system, however, does not change the classification of the patient. To adequately assess the risk of relapse and metastases in this patient, we would need some important information regarding the mitotic index and the number of dissected lymph nodes.

Locoregional lymphadenectomy including the first-order drainage lymph nodes at the renal hilum, the paraaortic or paracaval and the celiac regions is mandatory according to the international recommendations of a standardised Chemotherapy is an option Comments by Joaquim Bellmunt Barcelona ES surgical approach to adrenocortical carcinomas.

According to a recent retrospective study by the German ACC registry, local recurrence rates hazard ratio: 0. But adjuvant RT did neither improve cancer-specific nor overall survival.

Based on the high probability of local recurrence in this specific case, I would strongly recommend adjuvant radiation treatment with Staging Due to the size and the stage of the carcinoma and taking into account the increased frequency of osseous and brain metastases seen in association with advanced adrenocortical carcinoma, I recommend to complete staging with a bone scintigram and brain MRI for complete baseline staging.

The role of adjuvant mitotane treatment is limited due to the lack of prospective randomised trials. There is evidence from a case-matched control study indicating that adjuvant mitotane might increase the recurrence-free survival from 25 to 42 months.

Therefore, I would not advise adjuvant mitotane treatment in this patient. Since the patient exhibited most of these prognostic risk factors, there seems to be a rationale for an adjuvant treatment.

There, however, is no evidence from prospective randomised clinical phase-III trials available to support this. This represents the only chance of cure.

Radical resection without any microscopic residual Adrenocortical carcinoma ACC is a rare disease disease R0 resection and low proliferative activity with an incidence of approximately one per million based on mitosis count or Ki67 expression are the [1] and with an overall five-year survival rate of most important prognostic factors for a good outcome in ACC.

It behaves aggressively even if detected early. Most cases are diagnosed at an advanced order to minimise tumour spillage in tumours stage.

Currently, the best treatment is a intervention are more questionable [8]. Due to the aggressive behaviour and the high risk of systemic relapse after surgery, the use of In addition to whole body CT, 18 F-fluorodeoxyadjuvant mitotane is considered in patients with glucose positron emission tomography 18 F-FDG clinically or histologically aggressive tumours even PET is useful.

The evidence for the suspicious CT scan lesions [4] and can give a correct use of adjuvant mitotane in patients with ACC is classification of the disease stage metastasis or based only on retrospective studies.

Terzolo et al primary [5]. According to the recommendations of various national and international registers of adrenocortical carcinomas, staging should be performed every three months with abdomino-pelvic CT scans and chest X-rays.

Since the patient apparently did not demonstrate any endocrinological tumour activity preoperatively, no routine hormonal studies are necessary.

Their analysis demonstrated a clear prolongation of recurrence-free survival in treated patients [10]. Some have suggested that mitotane should be used only in patients with a high likelihood of recurrence i.

Regarding adjuvant radiotherapy in patients at high risk of local relapse, a pilot study and a larger case series [12] suggested a potential reduction in local recurrence without an effect on overall survival.

Thus, radiotherapy may have a role in selected patients. The patient declined to undergo radical prostatectomy and instead chose to undergo HIFU treatment elsewhere in followed by adjuvant androgen ablation which led to a PSA nadir of 0.

PSA recurrence under continued androgen ablation occurred in With a PSA of 0. With a PSA of 2. Salvage radiotherapy was performed in November as external beam radiotherapy including the pelvic nodal fields with a dose of 50 Gy followed by saturation of the prostatic field with an additional 16 Gy.

This was well tolerated but the PSA continued to rise during the 50 days of radiotherapy and was 5. Another bone scan was negative. Throughout the patient has been physically and mentally well, being very fit for his age and biologically younger, with a healthy life-style including regular jogging, swimming and cycling.

The patient now requests, if possible, further salvage treatment short of chemotherapy. Discussions points: 1. What treatment options are available?

Is salvage lymphadenectomy indicated? Is any other salvage treatment reasonable? Case provided by O. Hakenberg, Dept.

However, a CT performed nine months postoperatively for persistent persistent cough showed newly developed multiple pulmonary metastases more than 10 with the largest one in the apical segment of the left upper lobe and the presence of a large metastatic mass in the right lobe of the liver, measuring 17 x 11 cm.

In our institute we are currently working on 80 projects, which we divide in various categories. In training, it was appendectomy. There is the challenge of shrinking resources which may lead to decrease discovery.

That would mean we are not advancing our field as much as we could, both scientifically and clinically. If I were not a physician I would have probably chosen architecture.

I try to read a book at least once a month, but most are so-so. The last thing that surprised me was when I found out that the US spends more money in potato chips than the FDA spends in regulation.

But what is more relevant is the statistic that life expectancy for a male in was approximately 40 years. A hundred years later life expectancy almost doubled.

As a child, I collected stamps and coins. Definitely, the early hours. I usually wake around 4 or in the morning. I guess the design of the universe.

Maybe my biggest concern is the continued conflicts around the world. Alici, Istanbul TR S. Deger, Ostfildern DE O.

Demirkesen, Istanbul TR Deger, Ostfildern DE S. Palminteri, Arezzo IT Esen, Izmir TR Moncada, Madrid ES Alici, Istanbul TR I.

Austoni, Milan IT Ergen, Ankara TR Ozyurt, Izmir TR V. Pansadoro, Rome IT Dahlem, Hamburg DE Dahlem, Hamburg DE A. Djinovic, Belgrade RS A.

Tarcan, Istanbul TR Seckin, Konya TR Demirkesen, Istanbul TR T. Kural, Istanbul TR Panel: Deger, Ostfildern DE A. Mottrie, Aalst BE V.

Deger, Ostfildern DE E. Austoni, Milan IT G. Barbagli, Arezzo IT E. Belgrano, Trieste IT M. Fisch, Hamburg DE A.

Mundy, London GB M. Stackl, Vienna AT T. Alici, Istanbul TR E. Austoni, Milan IT R. Dahlem, Hamburg DE S.

Demirkesen, Istanbul TR R. Ergen, Ankara TR A. Esen, Izmir TR A. Kural, Istanbul TR I. Moncada, Madrid ES A. Mottrie, Aalst BE C. Ozyurt, Izmir TR E.

Palminteri, Arezzo IT V. Pansadoro, Rome IT B. Tarcan, Istanbul TR S. Paul Meria Section Editor Paris FR cancer and related problems such as screening, diagnosis and treatments, including current minimally invasive therapies.

Prostate physiological movements and their interference with the treatments were considered in the third part. Their mechanisms of occurrence were described such as various methods of adaptive re-planning, based on imaging systems for treatment guidance.

Many tables and illustrations completed each chapter. Undoubtedly, this textbook is intended for radiotherapists and oncologists.

Nevertheless, urologists involved in prostate cancer management will find ample amount of information, essential in pluri-disciplinary clinical exchanges.

Ponsky, D. Fuller, R. Meier, C. Currently, it remains of little use in the field of urology.

Besides technical aspects, one of the limiting factors is probably the need of a pluri-disciplinary team, requiring various practitioners involved in different fields.

Nevertheless, many applications have to be developed in the future. Sexual Dysfunction in Women Lee Ponsky and co-editors, helped by more than 40 worldwide experts, wrote an original textbook dedicated to urological applications of radiosurgery.

The first part provided the reader with general information. Historical aspects and current indications of radiosurgery were described, focusing on intracranial diseases.

Forthcoming developments were separately considered, including advances in genitourinary diseases. Practitioners involved in sexual dysfunctions management and who are faced with women problems will have to determine their origin and schedule the most accurate treatment.

Marta Meana compiled in this textbook a comprehensive amount of information dealing with a rarely considered problem. Special consideration was given to the organisation of radiosurgery of prostate cancer, including a description of the required team members and their specific role.

The second part dealt with prostate Sexual problems are probably underestimated in women population.

The decrease of desire, arousal and orgasm intensity occur frequently and such difficulties may be associated with painful intercourse.

These problems raise important questions and debates about women sexual function. An important part of the book was dedicated to hypofractionated radiation therapy and based on radiobiological aspects of the treatment.

This chapter addressed the rationale and the results of hypofractionated treatments, supported by various studies. High-dose brachytherapy and stereotactic treatments of prostate cancer were also described in this chapter.

The meeting takes place in Istanbul from December 14 to 15 later this year. Serdar Deger explained which surgeons the meeting hopes to attract.

In the past two to four years, we have seen an increased interest in minimally invasive procedures among reconstructive surgeons.

A scientific programme see previous page , which has been carefully prepared, features lectures, poster presentations and discussions about submitted cases.

Participants are encouraged to submit abstracts on male and female urethroplasty, hypospadias repair, penile corporoplasty, surgical treatment of male incontinence, pelvic organ prolapse and any other surgical techniques using minimally invasive surgery, including laparoscopy and robotics in reconstructive urology.

The meeting will also feature live surgery sessions and will be broadcasted from Istanbul University, with the support and coordination of the Cerrahpasa Medical Faculty.

Nevertheless, many concerns remain regarding various sexual problems in men. Current treatments are frequently based on drugs, and a psychosexual approach remains very important for many patients.

This textbook complemented the previous one dedicated to women problems and the aims and scope of both editions were identical.

Author David Rowland aimed to provide the reader with a strong basis of information, which is helpful in clinical practise.

The first part was dedicated to descriptive information, including epidemiology, definitions and various considerations such as diagnostic procedures for each sexual problem in men.

A brief paragraph described psychophysiology of male sexual function. Questionnaires, useful for clinical assessment of various problems such as erectile dysfunction and premature ejaculation, were described.

The first part included epidemiologic data and various descriptions and definitions of sexual problems in women.

The succeeding part described theories and models of sexual dysfunction. Different theories were described, and the selective review of such theories demonstrated the complexity and wide range of female sexuality.

Diagnosis and treatment problems were described in the third part. Organic, psychological and sociocultural origins of sexual dysfunctions were considered, focusing on various difficulties encountered in practise.

The methods of treatment were considered in the fourth part and the author emphasised the paucity of psychological interventions.

Pre-therapeutic assessment was described including measures of global sexual function, followed by a thorough review of current methods of management.

Multicultural issues were considered in this chapter, including religious and cultural norms and sexual identity.

A case report concluded the textbook and corroborated the complexity of sexual problems in women, and the ambiguity of treatment outcome success.

A summary of selected readings was added. We have seen a significant increase in EBU fellowships, and the number of participants attending international meetings and congresses has also increased.

Turkey has also proven to be an attractive location for meetings, partly due to the relatively lower costs of holding a conference in the city.

The first part was dedicated to diagnosis and evaluation of the problem including identification of etiological factors, either psychosexual or organic.

A comprehensive part was dedicated to the treatments of each clinical problem. Psychosexual approach and pharmacotherapy were described. Erectile dysfunction, the most common of the encountered problems, was exhaustively considered and various methods of treatment were described.

The management of other problems, such as low desire, premature or delayed ejaculation were also addressed.

The authors emphasised psychosexual approaches, such as behavioural, and the combination of methods. Resource books were listed and an appendix summarised male sexual functioning questionnaires and the dedicated websites where one can obtain such questionnaires.

Deger also noted that the Turkish Urological Association is involved in many meetings which have examined minimally invasive procedures.

This textbook, clearly and exhaustively written, was intended for most practitioners, including urologists and sex therapists.

Readers will obtain accurate information, which is very useful in daily practise. Undoubtedly, all practitioners will have a new and better approach of these problems after reading this textbook which adequately presented useful information.

More recently there has been some observational data suggesting a possible increase in the reported incidence of bladder cancer especially in patients who Intermittent VEGF therapy for have been on the medication for over 24 months.

This paper reports a population-based study to evaluate if metastatic RCC- is it safe? Using the UK general practice research database to Although this has been shown to extend overall interrogate the medical records of more than 10 survival, this is not felt to be curative and a high million people in more than practices, they proportion of patients treated with these agents have identified all patients who were prescribed their first to discontinue treatments secondary to adverse ever oral anti-diabetic agent between 1 January events.

This study assessed the consequences of and 31 December , and who also had at least one stopping treatment in patients who had achieved year of previous medical history in the database.

Patients who started treatment with insulin were A total of 40 patients, treated in either Institut excluded as were those under the age of 40 years or Gustav-Roussy 18 or the Cleveland Clinic 22 , with a known history of bladder cancer.

Participants between January and December were were followed until a diagnosis of bladder cancer, included. Patients had achieved stable disease, a death from any cause or end of registration with the partial response or a complete response by RECIST general practice.

Data was collected on The primary objective was to measure time-to-disease progression. A nested case-control analysis was carried out.

Therapy window. Perhaps of more concern was the finding that 8 patients developed metastases in new sites during expectant management With a median follow-up of Despite RECIST evidence of progression 8 patients chose to continue expectant management given the low volume and pace of disease.

The other 17 had a variety of treatments and, unfortunately, information on the response to re-initiation of systemic therapy is not available.

On multivariate analysis the more favourable Heng risk group HR 2. Perhaps of more concern was the finding that 8 patients developed metastases in new sites during expectant management.

One patient with brain metastasis and one with bone metastasis presented with clinical symptoms requiring immediate radiation therapy.

There is no evidence that this would have been avoided with continuous therapy, but patients are bound to question this. There is a current phase II clinical trial underway at Cleveland Clinic which might help answer some of the questions raised by this retrospective study.

Source: Cessation of vascular endothelial growth factor-targeted therapy in patients with metastatic renal cell carcinoma.

Cancer ; Key articles 12 A study cohort of , patients met the inclusion criteria. The mean age was A total of cases with adequate information were matched to 6, controls.

This effect was not seen with use of rosiglitazone, the other thiazolidinedione available in the UK during the study period. All men underwent histological verification of locally recurrent disease as well as cross-sectional imaging and radioisotope bone scan to exclude macroscopic regional and distant metastases.

Radiological T3a disease was allowed but patients with clinical T3a disease were excluded. HIFU treatment required the insertion of a suprapubic catheter and treatment to the complete prostate.

The catheter was removed weeks later as soon as urethral voiding was adequate. Patients were reviewed every 3 months for the first year and then every 6 months.

Seventeen of 84 patients required intervention for bladder outflow obstruction and 2 men developed rectourethral fistulae interestingly 2 further men out of 6 retreated with HIFU also developed fistulae.

Mean follow-up was Seven men showed no PSA response and were assumed to have metastatic disease. Repeat HIFU should clearly be avoided.

Although there is not a clearly understood biological mechanism to explain the findings it would appear that pioglitazone is associated with an increased risk of bladder cancer.

The absolute rates are relatively low but doctors and patients should be aware of this association when assessing the overall risks and benefits of this therapy.

Source: The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study.

Global cancer transitions according to the Human Development Index : A population-based study Cancer is set to become a major cause of morbidity and mortality in the coming decades in every region of the world.

The authors aimed to assess the changing patterns of cancer according to varying levels of human development.

BMJ ; e Does HIFU for prostate cancer work? Whole gland high-intensity focused They used four levels low, medium, high, and very high of the Human Development Index HDI , a composite indicator of life expectancy, education, and gross domestic product per head, to highlight cancer-specific patterns in on the basis of GLOBOCAN estimates and trends on the basis of the series in Cancer Incidence in Five Continents , and to produce future burden scenario for according to projected demographic changes alone and trends-based changes for selected cancer sites.

In low HDI regions, cervical cancer was more common than both breast cancer and liver cancer. Nine different cancers were the most commonly diagnosed in men across countries, with cancers of the prostate, lung, and liver being the most common.

Breast and cervical cancers were the most common in women. In medium HDI and high HDI settings, decreases in cervical and stomach cancer incidence seem to be offset by increases in the incidence of cancers of the female breast, prostate, and colorectum.

If the cancer-specific and sex-specific trends estimated in this study continue, we predict an increase in the incidence of all-cancer cases from The authors conclude that their findings suggest that rapid societal and economic transition in many countries means that any reductions in infectionrelated cancers are offset by an increasing number of new cases that are more associated with reproductive, dietary, and hormonal factors.

Targeted interventions can lead to a decrease in the projected increases in cancer burden through effective primary prevention strategies, alongside the implementation of vaccination, early detection, and effective treatment programmes.

Source: Global cancer transitions according to the Human Development Index : A population-based study. A midurethral sling to reduce incontinence after vaginal prolapse repair Women without stress urinary incontinence undergoing vaginal surgery for pelvic-organ prolapse are at risk for postoperative urinary incontinence.

A midurethral sling may be placed at the time of prolapse repair to reduce this risk. The authors performed a multi-center trial involving women without symptoms of stress incontinence and with anterior prolapse of stage 2 or higher on a Pelvic Organ Prolapse Quantification system examination who were planning to undergo vaginal prolapse surgery.

Women were randomly assigned to receive either a midurethral sling or sham incisions during surgery. One primary end point was urinary incontinence or treatment for this condition at 3 months.

The second primary end point was the presence of incontinence at 12 months, allowing for subsequent treatment for incontinence.

At 3 months, the rate of urinary incontinence or treatment was At 12 months, urinary incontinence allowing for subsequent treatment of incontinence was present in The number needed to treat with a sling to prevent one case of urinary incontinence at 12 months was 6.

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Hi there! The challenge, however, may not only be in threshing out persuasive or fine arguments, but rather the more difficult task of finding the balance that takes into full account the unsaid and, therefore, unexamined human need to find diagnosis and treatment at all costs.

We have to acknowledge and take this into consideration for concerned patients and to those looking for early detection.

The ASCO provisional opinion discouraged PSA screening of men with a life expectancy of less than 10 years, while at the same time recommending individualised decision-making for patients with a longer life expectancy.

Of further interest in the ASCO statement is the careful nuance given to the strength of evidence for each recommendation.

Meanwhile, in the Rochester retrospective review, the study warns that eliminating PSA testing would triple the number of men who have advanced prostate cancer at diagnosis.

Some centres have advised against it in patients without symptomatic stress incontinence due to high rates of voiding dysfunction and de novo urge incontinence when procedures were performed concomitantly5.

Since the CARE Trial was a single trial, providers might well prefer to see more data before changing clinical practice.

One Is urogynaecology a new star in medicine? It may single centre RCT included continent patients who seem so considering that in recent months the underwent colposacropexy with or without Burch prestigious New England Journal of Medicine has colposuspension.

At a mean follow-up of Today, one of the hot topics in urogynaecology is urinary incontinence UI after pelvic organ prolapse POP repair.

It is beset by many open controversies due to lack of 1 diagnostic tools to evaluate UI in patients with POP before surgery, and 2 data on urinary incontinence after POP repair because many studies reported objective data on POP resolution and little or nothing on functional results.

Cestari, Milan IT Mr. Cornford, Liverpool GB Prof. Hakenberg, Rostock DE Prof. Meria, Paris FR Prof. Rassweiler, Heilbronn DE Prof.

Reich, Munich DE Dr. Lurvink, Arnhem NL E. Starkova, Arnhem NL J. Vega, Arnhem NL L. The comments of the reviewers are their own and not necessarily endorsed by the EAU or the Editorial Board.

The EAU does not accept liability for the consequences of inaccurate statements or data. Despite of utmost care the EAU and their Communication Office cannot accept responsibility for errors or omissions.

Furthermore, divergent results are due to differences in surgical techniques for POP repair abdominal, vaginal, laparoscopic and how various defects in different compartments are corrected.

For example central compartment POP can be corrected by the vaginal route using a range of apex fixation methods: sacrospinoous, utero-sacral, ileococcigeus suspension etc.

More variations are added with a prophylactic anti-incontinence procedure. Different surgical procedures often lead to different results.

Wei and colleagues reported the results of the Outcomes Following Vaginal Prolapse Repair and Midurethral Sling OPUS trial which included women without symptoms of stress incontinence and patients with positive prolapse-reduction tests2.

The study was designed to determine whether prophylactic placement of a midurethral synthetic sling during vaginal repair of prolapse reduced the risk of postoperative urinary incontinence.

Compared with women in the sham-incision group, women who had been randomly assigned to the sling group had lower rates of urinary incontinence three months postoperatively We might well argue that In almost half of the patients POP surgical repair corrected one problem but created another, probably worsening, rather than improving, quality of life.

And how are the More surgery worsens results and incontinence rates are generally higher than after a primary MUS.

Furthermore, there is no evidence to show which procedure is the best. POP repair These findings add to evidence from the Colpopexy and Urinary Reduction Efforts CARE trial3 which reported that a prophylactic Burch colposuspension at the time of transabdominal prolapse surgery reduced the risk of postoperative urinary incontinence, but resulted in more postoperative complications.

Adding a bladder-neck suspension at the time of abdominal prolapse surgery in women without preoperative stress incontinence significantly reduced the risk of postoperative stress urinary incontinence Clearly colposacropexy alone does not cause post-operative incontinence as UI was present only in 9.

The surgical technique for POP repair may account for the discrepancies in the findings. The technique was designed to provide support and suspension, to restore the pelvic floor and to replace ruptured ligaments using meshes.

In this matter it is possible to correct anterior and posterior segments, central and lateral defects, vault, uterine prolapse and enterocele.

Conflicting evidence Taking into consideration all this conflicting evidence, the Cochrane Review on Surgical management of POP in women9 concluded that 1 continence surgery in concomitance with prolapse surgery in continent women did not significantly reduce the rate of post-operative or the novo SUI RR 1.

Surgical approaches that are associated with high post-operative incontinence rates should be analysed carefully for appropriateness.

References 1. Nager, L. Brubaker, H. Litman, H. Zyczynski, R. Varner, C. Amundsen, L. Sirls, P.

Norton, A. Arisco, T. Chai, P. Zimmern, M. Barber, K. Dandreo, S. Menefee, K. Kenton, J. Lowder, H. Richter, S. Khandwala, I.

Nygaard, S. Kraus, H. Johnson, G. Lemack, M. Mihova, M. Albo, E. Mueller, G. Sutkin, T. Wilson, Y.

Hsu, T. Rozanski, L. Rickey, D. Rahn, S. Tennstedt, J. Kusek, E. Gormley for the Urinary Incontinence Treatment Network.

The New Engl Journal of Medicine 2. Wei, I. Nygaard, H. Richter, C. Nager, M. Kenton, C. Amundsen, J. Schaffer, S. Meikle and C.

Spino, for the Pelvic Floor Disorders Network. Brubaker, G. Cundiff, P. Fine et al. Matthew J. Prophylactic Burch colposuspension at the time of abdominal sacrocolpopexy: a survey of current practice patterns.

Costantini, A. Zucchi, A. Giannantoni, L. Mearini, V. Bini, M. Costantini, M. Lazzeri, V. Del Zingaro, A. Zucchi, M. J Urol , Vol.

J Urol , 9. Surgical management of pelvic organ prolapse in women. After a general surgery internship and residency at Johns Hopkins, Grayhack spent a year at Brady Research Laboratory and became interested in urology.

He completed his urological training at Brady in He was an assistant professor at Hopkins and served two years in the Air Force before moving in to Northwestern University where he was appointed chairman and Herman Kretchmer Professor of Urology in , a position he held until He was awarded the Keyes Medal and the Barringer Medal Grayhack also edited the Yearbook of Urology and the Journal of Urology Grayhack and his late wife Betty were married for 62 years.

His children and grandchildren remember with fondness his passion for hunting, fishing and summers on Diamond Lake in Canada.

Surgery can finally raise its head above the stars, as high as never in the past. Therefore, we must establish with admiration that currently this art is trying to surpass medicine: in France it strives at least to be at the same level.

However, if today the opinion of other nations still counts for anything, one would have to conclude unambiguously that the French surgery is already regarded as greater than the French medicine.

Already under Louis XIV, by the edict of November , there was a partial separation of these two professional groups. By a decree in the year , it was considered equal to the medical faculty.

The great upsurge was mainly due to these mentioned measures, which the French surgery took during the latter period, of which indirectly therefore, Mareschal has become the initiator.

In the first few pages, however, one can find his account of being an outsider in Paris at the time of the resurgence of surgery at the beginning of the 18th century.

They are excellent surgeons in their own right, and they are also prepared to instruct students of surgery, who are sent by the rest of the world to France, suggesting there is a market for these arts medicine, surgery over there.

How many methods are already available to us nowadays to treat the bladder by incision without any risk? After all he quotes, in a footnote to his report, the English medical historian John Freind Surgery in Vienna Our second commentary, concerns the comparison of the state of surgery in Paris with the situation in Vienna.

Furthermore, the Vienna academy aimed particularly at the discipline of surgery and a notable surgeon and organiser played an important role in its emergence-Giovanni Alessandro Brambilla , Knight of Carpiano who was the chief army doctor of the Austrian monarchy in Vienna, and who - just like the surgeons in Paris- had good relations with the monarchy.

We do note a difference with the monarch himself. Since while it is actually not known from Paris how significant the establishment of the surgical academy was for both French kings, Joseph II repeatedly declared that the establishment of the Josephinische Akademie was the most important achievement during his reign.

STEPS programme. Maurizio Brausi. Prostate cancers will be covered in two sessions, one focusing on screening, diagnosis, staging and treatment, while the other will examine advanced and metastatic disease.

How to identify low risk PCa Genetic profiles to identify biologically aggressive low-risk PCa Debate: The time for radical prostatectomy in low risk desease is over Discussion Discussion Sessions will be delivered by international leaders in the field who will take part in state-ofthe-art lectures, panel discussions, head-to-head debates, and, demonstrations of surgical techniques.

Vincenzo Altieri, local organiser, welcomed the hosting of the ESOU meeting which has attracted in recent years the participation of many urological cancer experts from various disciplines such as oncology, radiology and gynaecology.

In addition: Renal cancer will be examined in two sessions: localised and advanced. The sessions on urothelial tumours will take up non- muscle invasive bladder cancer and muscle invasive and advanced disease.

Debates and update lectures by key opinion leaders will look into emerging therapies and their impact on the delivery of optimal services for cancer patients.

In testicular and penile cancers, among the salient issues to be examined are organ preservation techniques, inguinal lymphadenectomy and post-chemo retroperitoneal lymph node dissection RPLND.

As in previous years, ESOU will award the best publication in uro-oncology in Discussion Debate: Adjuvant radiotherapy after radical prostectomy who, how and when?

Complications during laparoscopic and robotic radical prostatectomy: How to avoid them Testicular cancer Organ preservation for solid testis neoplasm: When?

Open vs. Bladou, Montreal CA M. Brausi, Modena IT S. Brewster, Oxford GB B. Govorov, Moscow RU A. Heidenreich, Aachen DE J.

State-of-the-art lecture: Incontinence and age State-of-the-art lecture: Is ageing a disease? Case discussion: From above or below: Flexible, rigid or percutaneous management of upper urinary tract stones Update: Observation and deferred intervention in the management of stones Simultaneous Abstract Sessions Simultaneous Thematic Sessions Thematic Session 1: EAU guidelines recommendation updates Thematic Session 2: How minimally invasive should we be?

When, where and how they work? Registration opens on 1 October Registration for the 28th Annual EAU Congress opens on 1 October and participants are encouraged to register early before 4 January to benefit from reduced fees.

Already today you can get a glimpse of what is planned for this event, and follow the programme as we add more exciting topics, presentations, courses and features!

We update the programme regularly, as speakers confirmations come in almost daily! Furthermore, you can always save the sessions of interest in your EAU Planner and export them into your Outlook calendar.

Faxed, e-mailed or posted abstracts will not be accepted. Before submitting your abstract, carefully read the abstract submission rules on our website.

A short exam that deals with three topics from a vast curriculum, one has to be thoroughly prepared by having a very good knowledge of the EAU Guidelines, a strong clinical experience and be abreast with current urological issues to succeed in this exam.

Having sat for previous clinical all these give the candidate the necessary confidence. The cases were purely clinical and I was pleased that my years in urology and general surgery training helped a lot.

Feedback was given to me during the exam. My response to the questions included the basics in patient management such as discussing thorough patient history, physical examination, list of investigations, differential diagnosis and treatment.

Professional links In my opinion an excellent knowledge or grasp of the EAU Guidelines is essential to pass this exam. And as I mentioned earlier, having an updated knowledge of deserve the best treatment..

I consider this examination as a step in the right direction for attaining or affirming a specialist status in urology.

Moreover, my participation in this exam reflects the close ties between the EBU and Malta. For a urologist in Malta, having the FEBU title also links our small island nation, with its proud track record of medical excellence, to the recognised European body that invests and pioneers in the training of urology residents.

Furthermore, the challenge and necessary discipline to pass the whole process makes one a well-read and pro-active urologist who is well-informed of the latest literature and recommended best practice.

Hence the exam, ultimately, also serves our patients who rightly deserve the best treatment they can have.

Tips for candidates To reiterate, it is necessary to be very familiar with the EAU Guidelines and have a working knowledge of the basic sciences.

Obviously, candidates also have to believe in themselves, keeping a level-headed, confident appearance when responding to the examinees.

I will also recommend to the exam candidate to enroll in a reputable training centre preferably EBU-certified since the examination focuses on or reflects what we have learned in our clinical practice and training.

With this in mind, I convey my thanks gratitude to my programme director Mr. German and consultant urologists Mr.

Zammit, Mr. Mattocks and Prof. Cutajar who is a pioneer in urological training in Malta. Internet access is the only requirement to participate.

There are no restrictions as to where and at what time on 1 March the test is taken. For more information and registration visit our website www.

Ackaert, Belgium D. Ackermann, Switzerland I. Adamakis, Greece G. Alivizatos, Greece A. Antoniewicz, Poland J. Bellringer, United Kingdom M.

Bitker, France G. Bogaert, Belgium E. Breinl, Austria L. Campos Pinheiro, Portugal J. Campos Pinheiro, Portugal M. Cracco, Italy H.

Danuser, Switzerland A. Feyaerts, Belgium A. Figueiredo, Portugal F. Fusco, Italy N. George, UK S.

Giannakopoulos, Greece A. Giannantoni, Italy M. Gunst, Switzerland M. Heuser, Germany W. Hochreiter, Switzerland J.

Hofbauer, Austria U. Humke, Germany C. Imbimbo, Italy E. Lledo, Spain N. Longo, Italy C. Mamoulakis, Greece L. Martinez Pineiro, Spain A.

Matos Ferreira, Portugal D. Mitropoulos, Greece E. Montanari, Italy B. Montgomery, United Kingdom G.

Moutzouris, Greece J. Nawrocki, United Kingdom J. Nijman, Netherlands P. Nunes, Portugal A. Papatsoris, Greece A. Pytel, Hungary C. Radmayr, Austria T.

De Reijke, Netherlands D. Rengifo Abbad, Spain K. Van Renterghem, Belgium O. Rodriguez Faba, Spain C. Romano, Italy C. Saussine, France S.

Siracusano, Italy A. Skolarikos, Greece A. Strauss, Germany S. Tekgul, Turkey C. Terrone, Italy V.

Tzortzis, Greece A. Volpe, Italy S. Walter, Denmark P. Whelan, United Kingdom T. Zellweger, Switzerland Budapest I. Buzogany, Hungary L.

Farkas, Hungary A. Majoros, Hungary P. Pajor, Hungary A. Varga, Hungary Warsaw W. Demkow, Poland P.

Dobruch, Poland T. Drewa, Poland P. Jarzemski, Poland A. Listopadzki, Poland J. Matych, Poland W. Pypno, Poland A. Sikorski, Poland M.

Sosnowski, Poland T. Szostek, Poland Z. Wolski, Poland S. Zdrojowy, Poland H. Almost participants from 10 different countries attended this masterclass which offered the opportunity to discuss and focus on the potential indications, future perspectives and current limitations of the novel single-site platform in urology recently created by Intuitive for the da Vinci Si system.

The new da Vinci single-site platform has been specifically designed to allow surgeons to properly apply the robotic technology to the concept of LESS surgery.

It includes a multichannel port that provides access for two single-site semi-rigid robotic instruments, the 8.

The first day of the masterclass offered a limited number of urologists the possibility to train with the Uro-Technology new platform during a dry lab session and learn the basic skills in single-site robotic surgery.

Live surgeries The second day of the masterclass offered a full day interactive course outlining the robotic assisted single-site surgical technique with enhanced step-bystep video material and lectures, which focused on the codification of the robotic single-site pyeloplasty.

The masterclass also included two live surgeries. The first one featured a simple case symptomatic renal cysts decortication to demonstrate all steps in properly placing the single-site port, trocars, robotic arm docking and to explain how the new platform works.

The second surgery, a single-site pyeloplasty Fig. The day ended with a lecture updating participants on what to expect for single-site surgery in the future including new Intuitive instruments.

The da Vinci Single-Site Masterclass international faculty, panellists and moderators have shared valuable insights gained through veteran experience in robotic or LESS surgery.

Its principle objective is to guarantee and promote the highest standards of healthcare in the field of Sexual Medicine, by ensuring that training in Sexual Medicine in Europe is established at an optimal level.

Eligibility The exam is set under the auspices of the UEMS but all physicians of all nationalities, including countries outside the EU, are able to take the exam.

Who can apply? However, new instruments, namely bipolar forceps and monopolar scissors must be introduced into clinical practice to expand the range or types of procedures to be performed.

Some sort of endowrist technology to offer an even greater range of motion should be implemented in the single-site technology as mentioned by Prof.

Giorgio Guazzoni during his lecture. This new device could potentially be used for vascular pedicles control in robotic radical cystectomy procedures and mesenterial work during the urinary diversion steps.

A robotic articulating linear stapler should also be available in the market in the future which would allow for further implementation of the armamentarium for robotic surgery.

Furthermore, an update on Firefly technology was given. The discussions also closely examined and focused on all aspects of single-site surgery in combination with robotic technology.

This will be published in mid by the ESSM educational committee. The courses are intended for physicians with experience of specialistlevel practice in Sexual Medicine who wish to increase their chance of passing the exam.

The teaching faculties for courses will include recognised experts in the field of Sexual Medicine. The location and dates are published on the ESSM website.

Further details are available on the ESSM website: www. The radiological evaluation reported that the lesion arose from the upper pole of the left kidney, displaced the stomach and bowel loops, and abutted the splenic hilum and the posterior aspect of the pancreas which was displaced superiorly and anteriorly.

However, no evidence of definite invasion of any of the adjacent organs could be seen on the CT films. The left adrenal gland was not visualised, nor were any enlarged lymph nodes seen.

There were only a few small left paraaortic lymph nodes reported, with the largest measuring 1. The lungs were clear without any evidence of pleural or pericardial effusion.

Case study No. Histopathology reported adrenocortical carcinoma with negative resected lymph nodes and negative surgical margins.

Discussion points: 1. Are further post-operative investigations needed? Is any adjuvant treatment indicated? What follow-up should be done?

Case provided by M. CT of the chest, abdomen and pelvis showed a huge mass of soft tissue density mass, approximately 22 x 20 x 15 cm Adjuvant radiation therapy is a management option Comments by Axel Heidenreich Aachen DE The patient described was diagnosed with a large adrenocortical carcinoma infiltrating the left kidney and he was treated by radical nephrectomy and locoregional lymphadenectomy.

The resection margins and the resected lymph nodes were negative. Preoperative staging included a CT scan of the chest, the abdomen and the pelvis and it did not reveal lymphpnodular or systemic metastases.

Discussion points Based on the information given the patient has locally advanced adrenocortical carcinoma which represents stage pT4pN0cM0 according to the WHO classification.

The recently modified staging system aimed at improving the prognostic accuracy has been proposed by the European Network for the Study of Adrenal Tumors.

Applying this system, however, does not change the classification of the patient. To adequately assess the risk of relapse and metastases in this patient, we would need some important information regarding the mitotic index and the number of dissected lymph nodes.

Locoregional lymphadenectomy including the first-order drainage lymph nodes at the renal hilum, the paraaortic or paracaval and the celiac regions is mandatory according to the international recommendations of a standardised Chemotherapy is an option Comments by Joaquim Bellmunt Barcelona ES surgical approach to adrenocortical carcinomas.

According to a recent retrospective study by the German ACC registry, local recurrence rates hazard ratio: 0. But adjuvant RT did neither improve cancer-specific nor overall survival.

Based on the high probability of local recurrence in this specific case, I would strongly recommend adjuvant radiation treatment with Staging Due to the size and the stage of the carcinoma and taking into account the increased frequency of osseous and brain metastases seen in association with advanced adrenocortical carcinoma, I recommend to complete staging with a bone scintigram and brain MRI for complete baseline staging.

The role of adjuvant mitotane treatment is limited due to the lack of prospective randomised trials. There is evidence from a case-matched control study indicating that adjuvant mitotane might increase the recurrence-free survival from 25 to 42 months.

Therefore, I would not advise adjuvant mitotane treatment in this patient. Since the patient exhibited most of these prognostic risk factors, there seems to be a rationale for an adjuvant treatment.

There, however, is no evidence from prospective randomised clinical phase-III trials available to support this. This represents the only chance of cure.

Radical resection without any microscopic residual Adrenocortical carcinoma ACC is a rare disease disease R0 resection and low proliferative activity with an incidence of approximately one per million based on mitosis count or Ki67 expression are the [1] and with an overall five-year survival rate of most important prognostic factors for a good outcome in ACC.

It behaves aggressively even if detected early. Most cases are diagnosed at an advanced order to minimise tumour spillage in tumours stage.

Currently, the best treatment is a intervention are more questionable [8]. Due to the aggressive behaviour and the high risk of systemic relapse after surgery, the use of In addition to whole body CT, 18 F-fluorodeoxyadjuvant mitotane is considered in patients with glucose positron emission tomography 18 F-FDG clinically or histologically aggressive tumours even PET is useful.

The evidence for the suspicious CT scan lesions [4] and can give a correct use of adjuvant mitotane in patients with ACC is classification of the disease stage metastasis or based only on retrospective studies.

Terzolo et al primary [5]. According to the recommendations of various national and international registers of adrenocortical carcinomas, staging should be performed every three months with abdomino-pelvic CT scans and chest X-rays.

Since the patient apparently did not demonstrate any endocrinological tumour activity preoperatively, no routine hormonal studies are necessary.

Their analysis demonstrated a clear prolongation of recurrence-free survival in treated patients [10]. Some have suggested that mitotane should be used only in patients with a high likelihood of recurrence i.

Regarding adjuvant radiotherapy in patients at high risk of local relapse, a pilot study and a larger case series [12] suggested a potential reduction in local recurrence without an effect on overall survival.

Thus, radiotherapy may have a role in selected patients. The patient declined to undergo radical prostatectomy and instead chose to undergo HIFU treatment elsewhere in followed by adjuvant androgen ablation which led to a PSA nadir of 0.

PSA recurrence under continued androgen ablation occurred in With a PSA of 0. With a PSA of 2. Salvage radiotherapy was performed in November as external beam radiotherapy including the pelvic nodal fields with a dose of 50 Gy followed by saturation of the prostatic field with an additional 16 Gy.

This was well tolerated but the PSA continued to rise during the 50 days of radiotherapy and was 5. Another bone scan was negative.

Throughout the patient has been physically and mentally well, being very fit for his age and biologically younger, with a healthy life-style including regular jogging, swimming and cycling.

The patient now requests, if possible, further salvage treatment short of chemotherapy. Discussions points: 1.

What treatment options are available? Is salvage lymphadenectomy indicated? Is any other salvage treatment reasonable? Prezzo con ricetta medica , Dove acquistare generico - Acquisto on line pagamento alla consegna : Dove comprare lo.

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