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,
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
firstname.lastname@example.org We need to support this
Please email your contribution to Estie Beukes:
Association in every way
or fax on (011) 921 5041
or Trevor Borchers: email@example.com
or fax on (021) 683 5142
(email is preferable).
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.
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
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
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
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
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: firstname.lastname@example.org
Combined SAUA/SIU Congress 2006
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
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
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
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
• 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
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
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: email@example.com
• 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.
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."
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.
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
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