Urology and Urogynaecology working together for LUTS treatment

17 August 2017

“The ELUTS meeting represents a good opportunity to share competences amongst urogynaecologists and urologists. This is the second time since becoming President of the European Urogynaecological Association (EUGA) that a multidisciplinary LUTS meeting features an EUGA session in its scientific programme,” says Prof. Stefano Salvatore (Milan, IT).

ELUTS17 is a new event for the EAU, offering delegates a comprehensive two-day scientific programme focused on a wide variety of lower urinary tract symptoms. The meeting also features an ESU-ESFFU Masterclass and contributions to the scientific programme by ESFFU, ESGURS and EUGA.

Prof. Salvatore is also head of the Urogynaecology Unit at the San Raffaele Hospital, Vita-Salute University in Milan: “In my unit we provide all the diagnostic procedures for female pelvic floor dysfunctions (ultrasound, urodynamics, cystoscopy) and we do any kind of surgery for incontinence and pelvic organ prolapse using a vaginal or laparoscopic approach.”

The European Urogynaecological Association  is officially the Urogynaecological Section of the European Board and College of Obstetrics and Gynaecology (EBCOG). Together with the European Association of Gynaecological Oncology, The European Association of Fetal Medicine and The European IVF Society, it represents one of the four subspecialties of OBGYN that have been identified by EBCOG. EUGA was founded by Ulf Ulmsten in 2003.

Scientific Programme Contributions
Due to the wide variety of conditions that fall under the more general banner of LUTS, the scientific programme has to involve several subspecialties of urology: female and functional urology (represented by ESFFU), genitourinary reconstructive surgery (ESGURS) and the aforementioned partnering with EUGA.

This year, the EUGA contributions to ELUTS17 will be focused on pelvic organ prolapse management, in the different phases of a woman’s life. “After what has happened worldwide with meshes, we will try to cover new perspectives in prolapse management, but also re-evaluate, in a critical way, the traditional surgical approaches.”

“After the launch of Tension-free Vaginal Tape (TVT) in the middle of the 1990s, and with all the following evolutions, there have not been any notable, game-changing breakthroughs in recent years. Unfortunately, even in the pharmacological field I am not aware of any big upcoming developments. I do think that a possible future improvement could be achieved through increased research in regenerative medicine and tissue engineering.”

On learning from each other’s specialties, Salvatore looks forward to further cooperation. “A regular, structured exchange of knowledge between urologists and urogynaecologists would certainly be welcome, so we look forward to recurrent iterations of the ELUTS meeting. This could also involve educational courses organised throughout Europe by the EAU/European School of Urology and EUGA together.”

Urology and Urogynaecology
Prof. Salvatore anticipates discussion between urologists and urogynaecologists: “As EUGA we hope that our contribution to ELUTS17 could help in covering some arguments related to pelvic floor dysfunctions that are more familiar to gynaecologists. In general we believe that an exchange of knowledge and competences in a multidisciplinary approach could improve the level of discussion.”

Regarding the division of labour between gynaecologists and urologists when it comes to LUTS treatment, there is no clear picture. “It is quite difficult to generalise, and I would not draw a clear line between urogynaecologists and urologists in the management of LUTS. I do think that it is a matter of personal competence. Usually urologists are more competent in neurourological problems, whereas urogynaecologists are more competent in pelvic floor dysfunctions secondary to pregnancy and delivery, or in problems related to the genitourinary syndrome of menopause.”

“Surgically, urogynaecologists are more confident with a vaginal or laparoscopic approaches whereas urologists are more likely to use robotic surgery. But, again, this is not a rule.” Speaking generally on the relationship between urologists and gynaecologists, Prof. Salvatore draws on his personal experience:

“I have always worked in Academic Hospitals where the cooperation between urologists and urogynaecologists have been very loyal and productive. This has to be the case for the sake of the patient. It is then a matter of the strategic vision of each specific hospital management to organise and set-up a multidisciplinary unit (e.g. a Pelvic Unit), where urologists, urogynaecologists, proctologists and physiotherapists could work together. This would be the ideal situation.”