EAU 2018

EAU 2018: SabreSource: A Novel Percutaneous Nephrolithotomy Apparatus to Aid Collecting System Puncture - A Preliminary Report

Copenhagen, Denmark (UroToday.com) Dr. Moore, clinical urologist from the Groote Schuur Hospital in Cape Town, South Africa, presented her experience on the use of a novel device to facilitate nephrostomy puncture access during percutaneous nephrolithotomy (PCNL). To begin her presentation, Dr. Moore reiterated the cruciality of an accurate puncture to the surgeon’s preferred calyx. The learning curve for this procedure is excessively difficult, requiring some new surgeons to experience 60-100 cases before proficiency is obtained. It was also reported that only 11% of American Urologists obtain percutaneous access themselves, as they often rely on the radiologists to create the puncture before the case begins. To facilitate with this problem, a novel image guidance system known as SabreSource™ was developed with a locator for ease of access for urologists. Dr. Moore describes her center’s initial use of the system and compared the amount of radiation required for successful puncture while using the device versus conventional techniques. 

EAU 2018: The Guy’s Stone Score, STONE Nephrolithometry, CROES Nomogram and S-ReSC Score

Copenhagen, Denmark (UroToday.com) Dr. Bibi, clinical urologist from the Hospital La Rabta in Tunis, Tunisia, presented his research study on the various nephrolithometry scores that are commonly used to classify stone burden in patients. The different classifications Dr. Bibi and his team explored were Guy’s stone score (GSS), S.T.O.N.E. score, CROES score, and S-ReSC score to compare predictive accuracy of stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL). 

EAU 2018: Assessing the Diagnostic Accuracy of Low and Ultra-Low Radiation Dose CT of the Urinary Tract for the Investigation of Urolithiasis

Copenhagen, Denmark (UroToday.com) Acute renal colic, or abdominal pain commonly caused by kidney stones, is of significant prevalence in young patients. While CTKUB is the current gold standard test to assess the cause of acute renal colic, the radiation dose associated with CTKUB is unfavorable for these young patients and even more so for those with recurrent or chronic renal colic. As such, low and ultra-low dose CT of the urinary tract has been suggested as an alternative in this patient subset.

EAU 2018: Who Benefits from Neoadjuvant Chemotherapy and Who Needs Immediate Radical Treatment?

Copenhagen, Denmark (UroToday.com) Dr. Peter Black from Vancouver, Canada discussed neoadjuvant chemotherapy versus those who need immediate treatment. Dr. Black started by stating that we have level 1 evidence supporting the use of neoadjuvant chemotherapy for MIBC [1], in addition to several large retrospective studies and meta-analyses. Furthermore, EAU guidelines tell us that neoadjuvant cisplatin-containing combination chemotherapy improves overall survival (OS) by 5-8% at 5 years. Additionally, the NICE guidelines in the UK state that we should offer neoadjuvant chemotherapy using a cisplatin combination regimen before radical cystectomy or radical radiotherapy to people with newly diagnosed MIBC for whom cisplatin-based chemotherapy is suitable. Finally, the AUA/ASCO/ASTRO/SUO guidelines suggest utilizing a multidisciplinary approach and clinicians should offer cisplatin-based neoadjuvant chemotherapy to eligible radical cystectomy patients prior to cystectomy. 

EAU 2018: Who are the Optimal Candidates for Bladder Preservation in Cases of Muscle Invasive Bladder Cancer?

Copenhagen, Denmark (UroToday.com)  Dr. Van der Heijden discussed which patients with muscle invasive bladder cancer (MIBC) are optimal candidates for bladder preservation. Dr. Van der Heijden started by making it clear that the EAU guidelines on MIBC state that the preferred recommendation is for radical cystectomy and urinary diversion. However, there is precedent for organ preservation in other malignancies, including breast cancer, kidney cancer, prostate cancer, and anal cancer. 

EAU 2018: Utility of Lymph Node Dissection for Clinical Node Negative Upper Tract Urothelial Cell Carcinoma: A Multicenter Study

Copenhagen, Denmark (UroToday.com)  Dr. Derweesh from UC San Diego discussed results of a multi-center study evaluating clinical node negative UTUC lymphadenectomy. Although the use of a lymph node dissection for urothelial cell carcinoma of the bladder has survival benefit even in setting of negative nodal status, therapeutic benefit of LND in the setting of clinical node negative disease for UTUC is unclear. The objective of this study was to evaluate survival outcomes for UTUC after lymphadenectomy.

EAU 2018: 4D Ultrasound Cystoscopy with Fly Through in the Evaluation of Urinary Bladder Tumors: Feasibility and Outcomes

Copenhagen, Denmark (UroToday.com)  Dr. Grande and colleagues from Italy discussed their experience with 4D ultrasound cystoscopy with Fly Thru. Cystoscopy represents the gold standard both for the diagnosis and the surveillance of patients treated conservatively for bladder cancer. To date, a reliable, non-invasive, imaging method for bladder cancer detection has yet to be established and follow-up is based on regular cystoscopy. The recently introduced Fly Thru technology virtually travels through a body cavity and produces endoscopic images from outside the body. This provides the opportunity to assess masses and plan for appropriate management.