ESU Course in Morocco
Lecturers cover prostate biopsies and management of urethral diseases
Prof. Abdennabi passages, urethritis and bleeding, which would lead Thus, once the oncological diagnosis is definite, the
Joual to longer ad denser strictures. next stage is to establish the stage of the disease, so
President that one may decide on the correct therapeutic
Moroccan Urological Laser urethrotomy generally produces results similar strategy. The different stages of prostatic neoplasia
Association to cold knife urethrotomy in 45% to 70% of cases of are localised tumours, locally advanced tumours,
Casablanca (MO) recurrence. On the other hand, urolume stent appears advanced or metastatic tumours, and hormone
to occur specifically in cases involving elderly patients refractory tumours.
with bulbar strictures, limited spongiofibrosis and no From left: Prof. Abdennabi Joual, Prof. Luis Martínez-Piñeiro en
previous urethral surgery. Finally, for the majority of The clinical stage of prostatic cancer is principally Prof. Giuseppe Morgia
firstname.lastname@example.org patients, urethroplasty is the only curative treatment. established by digital rectal examination (DRE), by
Transrectal Ultrasound of the Prostate (TRUS), and by
Urethroplasty technique Prostate Specific Testing (PSA). Other commonly used and/or vary the anatomical areas whence the cores
The European School of Urology (ESU) held its fifth Reviews of recent publications, supplemented by the tests are Magnetic Resonance Imaging (MRI), are taken.
course in Morocco during the Moroccan Urological authors’ personal experiences, have focused on the Computerised Tomography (CT), Radio Immuno-
Meeting from May 21-23, 2009 in Skhirat, a coastal most successful urethroplasty procedures. Currently, Scintigraphy and PET Scan, and, more recently, Repeat biopsy
city near the Moroccan capital Rabat. With the the most common types of stricture are relatively short molecular staging methods. Naturally, the biopsy and According to Morgia, since there is no objective
participation of well-known urological experts, the and are located in the bulbar urethra. The best its related parameters are also highly relevant when consensus on the issue of repeated sets of biopsies,
meeting certainly provided tremendous benefit to all treatment is excision and end-to-end anastomosis, if establishing disease stage. the decision has to be made on a patient-by-patient
the Moroccan urologists who participated in the the strictures are short enough, or patch urethroplasty basis. Regarding the role of transurethral resection
annual conference. using buccal mucosal graft if they are longer. Distal Amongst Morgia’s take home messages are: (TURP) after repeated negative biopsies, Morgia said
penile urethral strictures are the most common type of • Digital rectal examination (DRE), Prostate Specific the procedure, combined with a set of transrectal
This year featured two courses, namely, the stricture, and a strategy of effecting the reconstruction Testing (PSA), and transrectal echography are still needle biopsies of the lateral portion of the gland, is a
management of urethral diseases presented by Prof. in different stages (a ¨staged approach¨) is often the methods most used for establishing the clinical safe procedure with high diagnostic efficacy in cases
Luis Martinez-Pineiro from Madrid, and the second required again using buccal mucosal grafts. stage. of repeated negative biopsies in patients with
course regarding new insights on prostatic biopsies • All other methods, such as MRI, CT, Prostascin, persistently high PSA levels.
presented by Prof. Giuseppe Morgia from the Unfortunately, paucity of data overshadows other PET scan, and molecular methods, are not in
University of Messina (Italy). Both courses attracted a types of strictures and salvage surgery, specialised routine use and indeed, in certain cases, are still The PCA 3 gene has a much higher presence in 95%
high attendance which clearly reflected the areas which rely heavily on experience and judgment. to be considered experimental. of malignant prostate tissue compared to benign and
significance of these highly-awaited courses. • Lymphadenectomy is the gold standard in lymph normal prostate tissue. Men with PCA 3 scores greater
Traumatic urethral injuries node staging even though there is some than or equal to 35 had a 39% probability of a
Management of urethral disease Anterior urethral injuries are associated with penile controversy about extending its use. positive repeat biopsy compared to a 22% such
There is an extensive list of surgical techniques for the fracture. In cases where the patient exhibits an • Nomograms used in evaluating the risk classes probability in men with a PCA 3 score less than 35.
treatment of urethral stricture disease, but at the inability to void, and there is blood at meatus or are good prognostic systems which are not
same time it is important to know that no surgical haematuria, we need to do an urethrography. In cases universally used. To the query, how many repeated biopsies are
procedure is able to correct every stricture. This where the stricture is short ( < 1 cm), internal required, Morgia mentioned the following points:
implies that urologists have to select the best urethrotomy can be attempted once. Whilst if the • No more than four biopsy sets are required.
procedure for each patient. The ideal operation would stricture is longer than 1 cm, the correct treatment is • HGPIN is not a risk factor which would call for a
be one which allows the excision of the stricture anastomotic end-to-end urethroplasty. repetition of the biopsy.
urethra and re-approximate the ends without • Atypical small acinar proliferation (ASAP) is a risk
placement of foreign tissue. Excision and primary Regarding posterior urethral distraction defect, the factor in the detection of prostate cancer.
re-anastomosis meet these requirements. Moreover, it following are the symptoms: blood at external urethral • The number of findings of insignificant cancer
is important to differentiate between a urethral meatus, inability to pass urine, palpable distended increases after one has performed a third set of
stricture and a urethral distraction defect. bladder, and scrotal and/or perineal butterfly hematoma biopsies.
Basic principles of urethroplsty Amongst the emergency treatment procedures are: A successful course
There is no single technique appropriate for all • Immediate suprapubic urinary diversion Both young and more experienced urologists
urethral strictures. The selection procedure is dictated • Endoscopic urethral realignment, 7-15 days attended the courses, and there were also
by stricture site, the cause of stricture, length of following the trauma Regarding sextant techniques, Morgia said these have participants who, while not yet handling high patient
stricture, multiplicity and adverse local factors • Delayed urethroplasty, 4-6 months following the long been the worldwide gold standard prostate volumes, are keen to have updates on the tricks and
trauma biopsy method. Moreover, one should procure six pitfalls involved in difficult cases. Unfortunately, the
It is important to know that traditional treatments • Early open realignment, if bladder neck-rectal biopsies with specimens obtained from the base, limited time did not allow a deeper discussion.
(dilatation and internal urethrotomy) present only a injury is present, or if open orthopedic repair is middle and apex of the prostate in the mid lobar
temporary solution. Thus, the best indication of chronic performed. parasagittal planes bilaterally. Overall, the participants expressed satisfaction with
urethral dilatation is the stricture of membranous • Delayed optical incision only if early endoscopic However, these techniques are not suitable for 80% saying their participation in the course will help
urethra after prostatic surgery. realignment was performed previously prostates larger than 50 cc (30% false negative rate). them improve patient care, whilst majority or 98%
said the course should be repeated next year.
Concerning repeated urethrotomies, a urethroplasty New insight on prostatic biopsies “These techniques have been modified to include Certainly, these courses are of scientific importance
must be perfomred after one failed urethrotomy. Prof. Giuseppe Morgia discussed the proper therapy more laterally directed biopsies,” said Morgia, and represent a wonderful opportunity to further
Furthermore, the specialist must avoid multiple for prostatic carcinoma which mainly depends on adding that the new extended biopsy protocols improve the cooperation between the European and
urethrotomies because they may cause false tumour stage, such as in the case for all neoplasia. increase the number of biopsy cores (up to 32 cores ) Moroccan urological associations.
ESU-SUS forge ahead with educational partnership
Well-attended ESU course at Syrian Urological Society (SUS) 27th Annual Congress
Dr. M. Ghanem Al- information on the date of the next national congress the surgical management of kidney cancer. Both were Beyond expectations
Sibai to the carefully planned topics for the course, Jacobijn presented by Prof. Kirkali. The succeeding lectures We are delighted with the successful conclusion to
Secretary General unfailingly comes up and return to us with all the fine included a detailed lecture on surveillance, MIS and this year’s ESU course, which exceeded the
Syrian Urological details, a reliable collaboration that ensure the ablative therapies presented by Prof. Laguna Pes. Prof. expectations of both the organizers and participants.
Society success of the ESU course in our national congress. Kirkali also delivered a lecture that posed the query: The number of participants has also steadily increased
Tartous (SY) “Is systemic treatment the next revolution?” over the years, providing proof of the high quality of
The 27th Annual Congress of the Syrian Urological the programme, which we would not have achieved
Society took place from October 1 to 3, 20009 in After each presentation sufficient time was allotted without the support of our highly experienced
dr.sibai-mg@ Lattakia, Syria., with Friday (October 2) fully devoted for the lecturers to respond to questions which led to speakers.
scs-net.org to the ESU course “What is new in kidney and testis a dynamic discussion between the audience and the
cancer.” More than 300 urologists, mostly Syrians, faculty. Aside from the insightful course lectures, a Clearly, the ESU provides an invaluable contribution to
attended the course. The day was exclusively session for case discussion was held at the end of the the development of urology in our country. In behalf
The Syrian Urological Society (SUS) forges ahead with calendared for the ESU course to allow participants to morning session, which offered another thorough of the SUS, I thank the ESU Board and the ESU staff
its educational collaboration with the European School focus on the full-day sessions. discussion of clinical cases that covered history taking, with the hope that the ESU courses will continue to be
of Urology (ESU) as exemplified by the continuing series physical examination, proper diagnosis and successfully held in the years to come. We are also
of courses annually organised by the ESU. A one-day For this year, we were honored with the participation therapeutic options- all topics excellently commented thankful to Professors Kirkaly and Laguna Pes for
course participated in by well-known European of Prof. Ziya Kirkali from Turkey as course chairman on and discussed by the lecturers. joining the 27th Annual SUS Congress. Our grateful
experts, Syrian urologists consider the ESU Course as and Prof. Maria Pilar Laguna Pes (The Netherlands). appreciation, too, to Claudia Herrmann of the ESU
one of the highlights in the scientific programme of the As the SUS current secretary general, I delivered the After the lunch break, the afternoon session tackled office who did a great job by closely preparing and
annual congress organised by the SUS. welcome word, with Prof. Kirkali giving a short testicular tumours with Prof. Laguna Pes discussing coordinating the ESU Course with all enthusiasm.
introduction regarding the ESU’s unique educational the management of stage 1 testis cancer. Prof. Kirkali
Our regular contacts through the years with ESU courses and training opportunities for urologists. gave a comprehensive lecture on the treatment of Looking forward, the 28th Annual Urological Congress
manager Mrs. Jacobijn Sedelaar – Maaskant helped a The morning sessions were devoted to renal cell advanced testis cancer. Prof. Laguna Pes presented the of the SUS will be held on October 7 to 9, 2010, and
lot in the successful planning for this annual course. carcinoma (RCC) including a general overview, last session regarding the treatment toxicity and we hope that you will join us in Syria next year for
From the initial steps of providing Jacobijn followed by a session on the changing paradigms in follow up of testis cancer patients. another successful conference.
22 European Urology Today December 2009/January 2010