Day 2: Quality of life and bladder underactivity

13 October 2017

The first day of the regular ELUTS17 scientific programme brought many current topics to the attention of the assembled delegates. One day earlier, ELUTS17 had already begun for participants of the ESU-ESFFU Masterclass, which also continued this morning. EAU Secretary General Prof. Chris Chapple, who together with Prof. Francisco Cruz chaired the ELUTS17 Organising Committee welcomed the delegates in his introduction:

“With this meeting, we are bringing together two of the EAU’s functional sections [ESFFU and ESGURS] for a two-day programme that features hands-on training parallel sessions with urogynaecologists and satellite symposia. There might be a divide between functional urologists and those involved in oncology, but I consider functional urology to be at the very core of our discipline.”

Today’s scientific programme featured state-of-the-art lectures on OAB, nocturia and quality of life in female urology, and discussions on clinical trials, female stress urinary incontinence and the underactive bladder. In the afternoon, the programme was split to accommodate the parallel sessions of the EUGA (European Urogynaecological Association) and ESGURS, the EAU Section of Genitourinary Reconstructive Surgeons.

Morbidity and quality of life

Later, Chapple reflected on the goals of the ELUTS17 meeting: “by bringing together ESFFU and ESGURS for this meeting, we combine two sections that are concerned mainly with female and male functional issues, respectively. This way, ELUTS17 can provide resources for all aspects of functional urology.”

“The problems covered at this meeting will affect 40-60 percent of the population by the age of 60-70. Functional urology and LUTS is somewhat considered a passé area for surgeons. We are always interested in new techniques, and technological breakthroughs like minimally invasive surgery and robotics.”

“We must take care to not forget our core, basic principles of urology. If one becomes too dependent on technology to the exclusion of the core principles of the specialty, it  may have a detrimental effect for the future of practice.”

“Did this also spur on the organizing of this meeting? Partially. Oncology is extremely important and a key area for our Association. But LUTS is a very important area that causes significant morbidity. It might not directly cause mortality, it has a significant impact on our patients’ quality of life.”

The underactive bladder

Chapple also participated in the hour-long  session on the underactive bladder, chaired by Prof. Philip Van Kerrebroeck (Maastricht, NL). The session mostly underlined the need for a consensus on definitions, and the fact that there was still a lot of research to be conducted into the condition. One of the main problems for diagnosis is formed by overlap of symptoms with other lower urinary tract dysfunctions.

Generally speaking, the session concluded that the working definition of the underactive bladder is a symptom complex suggestive of detrusor underactivity, characterized by prolonged urination time, with or without a sensation of incomplete bladder emptying, usually with a hesitancy, reduced sensation on filling and a slow stream.

Prof. Van Kerrebroeck explained the difficulty in identifying the condition for the clinician. “Patients will present with complaints that might potentially indicate underactive bladder. But there are also patients that come without specific symptoms, or symptoms where an underactive bladder could be a contributing factor to their more global problem. Most urologist are familiar with patients with outlet obstruction based on an enlarged prostate, but we have to realise that the bladder itself might also be to blame for poor flow.”

“With the current set of diagnostic tools available to us, diagnosing poor flow and attributing it to obstruction or an underactive bladder (or a combination of the two) can only be done invasively. You need proof that bladder underactivity is playing a role in the patient’s situation, which is very difficult to distinguish.”

“Thankfully, in recent years there’s been a realization the patients can have bladder underactivity, which can explain disappointing results after surgery on, or removal of the prostate. The flow might remain poor or the bladder might not empty properly purely due to the underactive bladder. With research in Maastricht and Hannover, we can find the right tools for a (preferably non-invasive) prediction of obstruction, underactivity or a combination of the two.”