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Interview with Prof. Christopher Chapple - Breaking News and Highlights from EAU 2017
Professor Christopher Chapple MD
EAU Secretary General
Department of Urology
Sheffield Teaching Hospital NHS Foundation Trust, UK
Lowly tract symptoms are a very important aspect of urological practice and it's an area where I've had a long-standing interest. There was an excellent session which I chaired today on one of the two plenary sessions which are now synchronous of the EAU so we have two a day, and this was a packed session where we dealt with the latest developments in the management of men with benign prostatic disease causing lowly tract symptoms.
In this context we heard from experts in the field, the latest developments relating to the diagnosis and management of lowly tract symptoms in the male. Moving on from that, we discussed the under-active bladder as a clinical problem, and we also had an excellent review which is the AUA Lecture from Professor Claus Roehrborn which epitomised the areas which we really need to focus on, aspects such as the large post-fording residual and under-active bladder and the importance of the pronounced or enlarged median lobe and intravesical protrusion of the prostate into the bladder, and he emphasised that in diagnostic terms both of these were extremely important issues.
We then went on to discuss the whole aspect of management of patients, both in terms of pharmaco-therapy with existing drug therapy, and experts in the field reviewed not only existing surgical techniques using the standard transurethral resection whether mono-polar or bipolar, but also reviewed the application of laser energy, the nucleation of the prostate and some of the new techniques coming along such as the use of the plastic straps to pull the prosthetic lobes apart or even the use of water jets for the treatment of benign prostatic enlargement.
So, in this discussion it was very clear that we have a whole spectrum of treatments available from the male patient with benign prostatic enlargement causing outlet obstruction and consequent symptoms, but it was emphasised that one has to take a holistic approach to the management of the patient, considering their other medical conditions that are pre-existing, which may impact on the lowly tract, so adequate assessment of patients is essential. One shouldn't rush into medical treatment without the use of the frequency volume chart, and if one moves beyond that and medical treatment doesn't work, then adequate assessment of the patient is important. There was a vote at the end of one of the debates about whether pressure-flow urodynamics is important before surgery, and the consensus view is that it is because otherwise you can't differentiate the under-active bladder from bladder outlet obstruction and moving beyond that in terms of surgical treatment the consensus view is that, whilst we have a whole spectrum of new treatments coming along for surgical intervention, one mustn't forget the gold standard trans-urethral resection of the prostate or nucleation of the prostate using laser or radio energy or electrical energy in other words, and that we could of course look at new emerging therapies, but not rush into using them until we have more robust long-term data.
So really, EAU 2017 has been a fantastic meeting where we have looked at the evidence-base from the guidelines and we've looked at new emerging treatments and emphasised at this meeting the most appropriate way of treating our patients for their benefit to get the best results.
In this video, Prof. Christopher Chapple summarizes the important sessions and their take-home messages from the EAU Congress 2017. He gives an overview of two plenary sessions which focussed on lower tract symptoms in men with benign prostatic disease and on management of underactive bladder respectively. He concludes that EAU 2017 has been a fantastic meeting which evaluated evidence base from the guidelines and which also looked at new emerging treatments to emphasize the best possible way to treat patients with urological disorders.