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					NEWSLETTER
   2007
                              NEWSLETTER FOR SOUTH AFRICAN UROLOGISTS


                Pee Line               by Dr Trevor Borchers
2007 has been an interesting year for the SAUA. Reminiscent of
the old Chinese curse “may you live in interesting times”. We
have had many highlights and a few, fortunately only a few,
problems.
We have established an Ethics Committee and seen it come to
fruition, working to make our Association more cohesive and
stronger supporting our members in their pursuit of good
urological practice. We see it more in a supportive role than
wielding a big stick.
We have encouraged, funded and helped in the production of
numerous projects. The Registrars Forum proved to be a great
success. Registrar funding to our congress, prizes, research funding,
visiting lectureships to the SIU and PAUSA and the Guy de Klerk
Lectureship are but some of these. We have gratefully accepted
the Sanofi-Aventis Fellowship and have disbursed these funds to
very worthwhile projects. Our SAUA Handbook and Lecture
Notes are in the pipeline and hopefully will be ready for
disbursement at the 2008 SAUA Congress at Champagne Sports.
We are grappling with a number of challenging problems such
as the establishment of Brachytherapy and HIFU. Threats to our
speciality from the Gynaecologists, the Oncologists, the Paediatric
surgeons and the interventionalist Radiologists are very real and
                                                                           Four old fellows and Anel learning about sex!
need attention. “Adapt or die” as Darwin might say in this
evolutionary process. We unfortunately have had one urologist
suspended and a second under review this past year.
This Association has a vital role to play in the life of every South
African Urologist. We need to support this Association in every
way we can.
TM Borchers                                                             “This Association has a vital
  DR TREVOR BORCHERS
  President of the South African Urology Association                    role to play in the life of every
  Turrett House, Claremont, 7708
  Tel: 021 683 1974                                                       South African Urologist.
  Fax: 021 683 5142
  urology@worldonline.co.za                                               We need to support this
    Please email your contribution to Estie Beukes:
                                                                          Association in every way
             estie.beukes.eb@bayer.co.za
             or fax on (011) 921 5041
                                                                                   we can.”
    or Trevor Borchers: urology@worldonline.co.za
             or fax on (021) 683 5142
                 (email is preferable).
     Index
1.   Peeline                                                 1



2.   Combined 26th SAUA and 28th SIU Congress 2006        3
       • Overview by Chris Heyns                          3
       • Local Organising Committee & Invited Speakers 4
       • Instructional Course review by Thys Engelbrecht 5
       • My Highlights by Delon Bhagaloo                  7
       • The SAUA Gala Banquet                            8
       • Prize Giving & Merit Awards                     10



3.   Minutes of the SAUA General Meeting                    14
        • Proposed SAUA Constitution                        17
        • Private Healthcare is Under Siege!                22
        • SAUA Ethics Committee                             24
        • Treasurer’s Report                                25



4.   In Memoriam
        • Theo Arndt                                        26
        • Abrie Schmidt                                     27
        • Johan Botma                                       29



5.   College of Urologists                                  33



6.   Academic Committee Report/Registrars Forum             35



7.   Prostate Cancer Foundation                             37



8.   SAUA News
       • Brachytherapy                                      39
       • Urogynaecology                                     44
       • The Robot                                          44
       • HIFU                                               45



9.   The Guy de Klerk Memorial Lecture 2007                 46



10. SAUA Congress 2008                                      47



11. Urology & PMBs                                          49



      URO SA is proudly sponsored by Bayer Healthcare.
     The editorial comments expressed are not necessarily
                     those of the company.
                            Combined SAUA/SIU Congress 2006
The 26th Congress of the South African Urological Association      excellent opportunity, not only to learn from these experts, but
took place in the Cape Town International Convention Centre        to meet them personally. More than 1,000 abstracts were
on 12 November 2006 in the form of a full-day session, held in     presented in podium, poster and video sessions or as unmoderated
conjunction with the 28th Congress of the Société Internationale   posters displayed in the Exhibition Hall. There were also several
d’Urologie.                                                        Instructional Courses on various topics. Subspecialty meetings
                                                                   held in conjunction with the SIU included the World Urological
The invited guest speakers at the SAUA session were six eminent
                                                                   Oncology Forum, the Society of GU Reconstructive Surgeons,
and internationally recognized experts.The management of early
                                                                   the Endourological Society and the International Continence
stage kidney cancer was discussed by Michael Jewett from Canada.
                                                                   Society.
Rien Nijman from the Netherlands spoke on current approaches
to vesico-ureteric reflux. Claus Roehrborn from the USA spoke      Despite the ominous date of 13 November, the notoriously fickle
on combination treatment for BPH.                                  Cape weather played along on Monday evening for the SIU Night
                                                                   at Ratanga Junction. There was an abundance of good food and
Mark Soloway discussed the management of Ta and T1 bladder
                                                                   wine, a variety of music and entertainment, and towards the end
cancer. Urs Studer from Switzerland shared his keys to success
                                                                   of the evening a rock band that killed all serious conversation,
with orthotopic bladder substitution. Alexander Zlotta from
                                                                   but coerced even the most staid and stuffy Urologists on to the
Belgium spoke on the evolving place of chemotherapy in prostate
                                                                   dance floor.
cancer. A total of 36 papers and posters on various topics were
also presented by South African attendees.                         Unfortunately the weather on Tuesday evening ruined the Table
                                                                   Mountain Picnic, which had caused the LOC endless hours of
Sponsorships for the SAUA Scientific Session were provided by
                                                                   planning and agonizing about alternatives, should the weather
Bayer HealthCare, Ethicon Endo-surgery, Lilly, Pfizer and sanofi
                                                                   turn foul. Fortunately an additional boat could be hired for the
aventis.
                                                                   Table Bay Dinner Cruise, and apparently the food, wine and music
The Opening Ceremony of the SIU Congress took place on             was good enough to make up for the bad weather.
Sunday evening 12 November. Dr Gregg Webb from Cape Town
                                                                   The SAUA banquet took place at Kelvin Grove on Tuesday evening
was the Master of Ceremonies and introduced the speakers to
                                                                   14 November, and was a great success, with a jovial atmosphere,
the enthusiastic audience. Prof Chris Heyns welcomed the
                                                                   good food and even better wine, music, dancing and generally
delegates and thanked the Local Organizing Committee for their
                                                                   great fun, which was enjoyed by everyone.
hard work over more than five years, preparing for this major
event which brought more than 3,500 attendees to Cape Town.        The SIU Gala Banquet was held at Groot Constantia on Wednesday
The members of the LOC were drs Martin Bigalke, Trevor             evening, and the famous beauty of this venue served as a great
Borchers, Ilse Breytenbach, André Naudé, Bernie Stopforth, Paul    draw-card. Contrary to the fears of the LOC that the pricey
Whitaker and ms Netha Smuts.                                       tickets would result in poor attendance, extra tickets had to be
                                                                   provided at the last minute. Despite the poor acoustics, which
The formal welcoming speech was delivered by Dr Willem
                                                                   made the few (but essential) speeches inaudible in the more
Laubscher, former President of the SAUA, and organiser of the
                                                                   raucous recesses of the venue, the evening was greatly enjoyed
SIU Congress in 1976 in Johannesburg. Other speakers at the
                                                                   by all.
Opening Ceremony were the SIU President, dr Jack McAninch
from the USA, the General Secretary of the SIU, dr Mostafa         The feedback that was received from most attendees, local as
Elhilali, and the Chairman of the SIU Congress Organizing          well as from all corners of the globe, was very positive and
Committee, dr Luc Valiquette. The SIU Félix Guyon award was        enthusiastic. It is clear that the combined SAUA / SIU Congress
presented to prof Mohamed Ghoneim from Mansoura, Egypt,            will be long remembered as a highly successful meeting that made
certainly one of the internationally best known pioneers in the    a major contribution towards placing South African Urology on
field of bladder cancer surgery. Entertainment at the Opening      the world map.
Ceremony was provided by a marimba band, Cape Malay choir,
singers and a gumboot dance troupe, and the guests were led by
                                                                      DR CHRIS HEYNS
a joyful Cape Minstrel group to the cocktail reception in the
                                                                      Departement Urologie, Fakulteit Gesondheidswetenskappe
Exhibition Hall.
                                                                      Universiteit Stellenbosch en Tygerberg-hospitaal
The SIU scientific program included a large number of                 Tel: 021 938 9282
internationally renowned speakers, far too many to name               Fax: 021 933 8010
individually. Their attendance provided SA Urologists with an         email: cfh2@sun.ac.za




                  pg 3
Combined SAUA/SIU Congress 2006




                                  pg 4
                                                 Instructional Course
                             MANAGEMENT OF THE SPINAL INJURED PATIENT
                               Pathophysiology of spinal                  More than 90% of patients will develop a neurogenic bladder
                               cord lesions                               after SCI. The role of the urologist is twofold:
                               - H Madersbacher                               • Ensure survival (Upper tract protection)
                                                                              • Increase quality of life
                               Pathophysiological changes after
                               SCI can be divided into 3 phases:
                                     •        Acute phase
                                                                          Diagnostic management during spinal shock phase
                                     •        Recovery period
                                                                          - JJ Wyndaele
                                     •        Chronic phase
                                                                          1. Indwelling catheter or CISC
                               In the acute phase the patient
                                                                                If CISC is preferred a voiding diary should be kept and
                               presents with spinal shock. There
                                                                                the bladder should never be allowed to fill to more than
                               is absence of all spinal reflex activity
                                                                                450 ml.
                               with concomitant detrussor
                               areflexia.                                 2. Weekly urine analysis if CISC
                                                                               Any positive culture must be treated, even if the patient
During the recovery phase the pathology depends on the level
                                                                               is asymptomatic.
of injury.
                                                                               If indwelling catheter is used asymptomatic bacteriuria is
In suprasacral lesions there is loss of detrussor inhibition as well           not treated.
as detrussor sphincter dysinergia.
                                                                          3. Clinical observation: for example leakage during movement.
This has the following effect on bladder physiology:
    • Functional infravesical obstruction                                 4. Basic urologic and neurological examination.
    • Increased detrussor activity                                        5. Urodinamic studies as soon as possible.
    • Most importantly – increased bladder pressures:                           It is important to remember that return of autonomic
                 Increased bladder pressures is during filling as               reflex activity is much earlier than somatic reflex activity
                 well as during voiding                                         and that within 1 month most patients are in the recovery
                 Most of the pathophysiological urogenitary                     phase even though they might still have total loss of
                 changes is due to high filling or storage pressures            somatic reflex activity.
                 as we are 99,8% of the day in the storage phase.               The ice water test is useful in patients where there is
                 Increased pressures during this phase is mainly                uncertainty.
                 due to decreased bladder compliance
                 An increased pressure during storage is mainly           6. Upper tract imaging with ultrasound or IVU is acceptable.
                 due to infravesical obstruction.
There is furthermore an increase in C-fiber activity after                Diagnostic management during recovery and chronic
suprasacral lesions.These fibers have a low cold threshold, which         phase - JJ Wyndaele
gives the rationale for a positive ice water test in upper motor
neuron lesions.                                                           1. Yearly visits that includes:
                                                                             a. Urine analysis
Patients with sacral lesions presents with decreased detrussor               b. Blood test for renal function
contraction and absent external sphincter contraction. They                  c. Upper tract imaging with ultrasound
therefore present with decreased voiding and stress incontinence.
Important to remember in these patients is that the crede                 2. Urodinamic studies for the following indications:
maneuver to facilitate voiding will only lead to urethral kinking            a. If any change in LUT function is suspected
with subsequent bladder outlet obstruction and increased voiding             b. If the patient presents with any unexplainable symptoms
pressures.                                                                   c. If there is deterioration of the upper tracts
                                                                             d. Routinely every 2nd or 3rd year
During the chronic phase the Lower urinary tract dysfunction
is not static, which therefore nictitates constant urological
surveillance.




                   pg 5
                                               Instructional Course
                                                             continued
Conservative treatment of SCI – M Stoehrer                                        •   Bulking agents
                                                                                  •   Bladder neck reconstruction
The aim of treatment is:
   1. Low pressure storing                                            This should however only be considered in a patient with normal
   2. Continence                                                      bladder control and capacity.
Treatment options for detrussor overactivity:                            2. Surgery to facilitate bladder emptying
   1. Medical treatment
                                                                             The aim is to either
           a. Antimuscarinics
                                                                                  • Increase detrussor contraction
               • Increases cystometric capacity
               • Decreases storing pressures                                      •   Decrease outlet resistance

             b. Capsaicin                                             Options to increase detrussor contraction include:
                                                                                  • Sacral anterior root stimulation (usually combined
             c. Botolinum toxin
                                                                                     with posterior root rhizotomy)
                • For failure of anticholinergic therapy
                                                                                                Long-term studies for the efficacy of
             d. Neuromodulation                                                                 this procedure are still awaited.
   2. Intermittent self catheterization                               Options to decrease outlet resistance:
           • Decreases not only incontinence episodes, but                        • Sphincterotomy
               also infection rate.                                                            This is mainly indicated in tetraplegic
                                                                                               males with high intravesical pressures,
Lowering the storage pressures in the bladder decreases the
                                                                                               that is not capable of intermittent self
infection rate. It is proposed that the increased bladder pressure
                                                                                               catheterization.
causes a relative detrussor ischemia, which in turn promotes
                                                                                  • Urethral stents
bacterial translocation. High intravesical pressures by itself also
promote bacterial translocation with concurrent cystitis.             3. Surgery that circumvents the problem:
                                                                                  • Urinary diversion
Treatment options for detrussor hypoactivity
   1. Transurethral electrical bladder stimulation (TEBS)             4. Reconstructive surgery:
                                                                                 • Neuro urological repair with tissue engineering
                                                                                     is still experimental.
Surgical treatment of SCI - Yasuhiko Igawa
   1. Surgery to facilitate bladder storing
                                                                        Report by:
The aim is to either:
                                                                        DR THYS ENGELBRECHT
             • Decrease bladder storage pressures
                                                                        Unitas Hospital, Pretoria
             • Increase sphincteric resistance
                                                                        Cell: 082 872 4880
Options to decrease bladder storage pressures include:                  email: drthys@urologie.co.za
            • Detrussor myomectomy
                         Limited proof of efficacy
                         Not for routine use
             •   Sacral posterior root deaferentiation
                            Should in most case be combined with          "To be a doctor, then, means much
             •
                            anterior root stimulation.
                 Augmentation enterocystoplasty
                                                                          more than to dispense pills or to
                          Still considered the gold standard,             patch up or repair torn flesh and
                          despite high long-term complication
                          rate.                                           shattered minds. To be a doctor is
Options to increase outlet resistance include:
            • Artificial urinary sphincter
                                                                           to be an intermediary between
            • Sling                                                                 man and God."
                                                                                           Felix Marti-Ibanez



                                                                                                             pg 6
Report of the 28th Congress of the Societe Internationale de Urology
                               Highlights for me                        was brief and very informative, especially with regard to various
                               throughout the congress                  treatment modalities.
                               included:
                                                                        The SIU Gala Banquet was held at Simons in Groot Constantia.
                               A spectacular opening ceremony           Many people used Wednesday afternoon to prepare for this
                               on Sunday, 12th November 2006,           event, which apparently was a grand affair.
                               which introduced the rest of the
                                                                        A colleague of mine, Dr Shiven Ramkissoon, received the Bard
                               world to South African culture.
                                                                        prize the SAUA dinner on Tuesday night for his poster presentation
                                 On Monday, 13th November 2006,         on the Bosniak Classification of renal cystic masses. This was a
                                 Professor Mark Soloway from the        great achievement, one that I am sure that he is honoured to
                                 USA had a session on bladder           have received and has made everyone at the Nelson R Mandela
                                 cancer: case management, where         School of Medicine very proud.
                                 different patient scenarios were
                                                                        Finally, I feel very fortunate to have had the opportunity to attend
                                 presented. This was particularly
                                                                        such a well organised and enlightening congress. Professor Heyns
interesting since he actively involved the panel chairing the session
                                                                        and his team need to be commended for this and for the very
by asking them how they would manage the various scenarios.
                                                                        high standards that have been set.
It was interesting to note how urologists from different parts of
the world had various approaches on how to manage certain               I am looking forward to the next SIU Congress.
cases.                                                                  Hopefully I will see you all there.
Dr Gordan Williams from the U.K., whose work over the past
twenty years in Ethiopia developing a vaginal fistula hospital was         Dr Delon Bhagaloo
heart warming and admirable.                                               Registrar in Department of Urology
                                                                           Nelson R Mandela School of Medicine.
The session on congenital anomalies of the external genitalia




                   pg 7
                                                    The SAUA Gala Banquet
                                                     Kelvin Grove 14th November 2006

  A lovely evening of wining and dining amongst friends.                       Merit Awards were presented to Theo Arndt(posthumous), Abrie
                                                                               Schmidt(posthumous), and Philip Reyneke.
  The highlights included the Presentation of the History of Urology:
  the little red book compiled and presented by Prof Naas Viljoen.             Honorary Membership was bestowed upon Jaques Bogdanowicz.




                           Lesley & Paul Porteous                                   Trevor Borchers, Johann Pretorius, Donal Barnes & Alan Pontin




     George Bell & his wife and Piet de Bruin                Bavi Naidoo and Megan Fisher              Egor Vaz from Mozambique & Sunil Sinha from UCT




              Prof. L Klotz & his wife                Andre van der Merwe, his wife & Lybon Rikotso                 Bernie Stopforth & his wife




Gerhard Pietersen                                                                                                              Albie Botha & his wife
    and wife




                                                                                                                           pg 8

				
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