Report from the 2004 Meeting of the European Association of Urology: Selected Editorial Observations

DAY 1: The European Association of Urology (EAU) opened its nineteenth meeting in Vienna Austria on March 24, 2004. The EAU President Michael Marberger announced that over 2000 abstracts had been submitted to the conference. The venue change from Istanbul, due to political events, only postponed the Istanbul meeting until the year 2005.

Scientific presentations, discussions and controversies filled the program in every field of urology, including management of prostate, renal, testicular, and penile and bladder cancers. Other subjects included endoscopic and robotic surgeries, functional disorders of the urinary and sexual organs, and the management of male infertility.

Selections from this program follow.

During the joint session of the EAU and the Confederacion Americana de Urologia (CAU), D. Pushkar of Moscow, Russia discussed Female Reconstructive Surgery. He first noted that, in a PubMed search for evidence based medicine (EBM) on this subject, he had no “hits”. He concluded that there is a deficiency of controlled studies in this area.

Regarding bladder/vaginal prolapse, he believes that urologists represent the best surgeons for repair because of their knowledge of both organ systems. He projected a video of his vaginal cystocele repair using soft Prolene mesh that he correlates with “decreased chances of failure”. He also reviewed urologic repair of vaginal cyst, urethral diverticulum, the loss of urethra by trauma or prior surgery, and repair of vesico-vaginal fistula. He performs fistulae repairs via vaginal approach 98% of the time. His steps include identification of the margins, mobilization and separation of vaginal tissues and bladder mucosa followed by excision of the margins. He closes in several layers. His experience now includes “over 3000 cases.” In conclusion, he stated, “Urologists must be prepared to tackle pelvic surgery”.

P. Palmas of Campinas, Brazil spoke on the best treatment for male incontinence. Most approaches thus far include behavioral or surgical treatments. He mentioned a 2001 Cochrane database that concluded no EBM showed that conservative (behavioral) management was of value to the patient. He then reviewed surgical approaches: injections (25/40 patients dry) after up to three injections; artificial sphincters (4% totally dry, 68% using 1 pad per day), or the male sling (cure 75%). Thus, he uses male slings. He described his new trans-obturator approach for a polypropylene sling, which he believes to be very successful. Every procedure must be critically evaluated by comparison of results, complications, be preferably minimally invasive and consider the skill of the surgeon.

Written by George W. Drach, MD, a Contributing Editor with UroToday.

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