European Urology Forum: The Davos Experience The European Urology Forum in Davos, Switzerland, is a very special meeting organized each year since 1990 by the European Association of Urology (EAU). As usual, all European key opinion leaders and people involved in the EAU gave outstanding presentations—state-of-the-art lectures, cutting-edge science, and views of future development as well as case presentations. What makes this forum particularly attractive is the high level of interaction among presenters, experts, and attendees. The Urological Challenge is integrated into the meeting each morning and evening. During these special sessions, the lights change, and an expert panel is invited onstage. In front of the audience, young academic urologists present lectures on topics of their choice. Each participant gives three presentations, followed by questions from the experts and the audience. Challengers are then evaluated according to 10 different criteria, including the quality of the presentation, their performance, and their ability to answer the questions. The participants covered a wide range of topics including urinary incontinence, infections, prostate cancer, and benign prostatic obstruction. My own three talks were titled, “Ablative Surgery for Benign Prostatic Obstruction Relief: Which Technique for Which Patient,” “Defining the Role of Male Slings for Post-prostatectomy Incontinence Management,” and “Regenerative Therapy of the Urinary Sphincter: Myth or Reality?”
Surgery for benign prostatic obstruction
I must admit, the first talk you give is a special moment because that is when the competition begins. You have to be prepared for this: Polish your presentations, and train to try to make a hit at the beginning. My first presentation, about surgical techniques for benign prostatic obstruction relief, was based on a very extensive review of the literature and meta-analysis of available data. I explained the results of currently used techniques of enucleation, resection, and vaporization according to level 1 evidence and then discussed the particular indications for each technique, the energy source for big prostates, patients at risk of bleeding, frail patients, and sexually active patients (including ejaculation sparing techniques). The discussion with the experts and the audience was intense regarding the translation of my data to clinical practice.
Surgery for male incontinence
For my second talk, I chose to focus on male incontinence after radical prostatectomy. This talk was less a state-of the art lecture than a report of personal data. I presented original data about the number of prostatectomies in France and subsequent surgical treatment. I then covered all of the evidence available for the male slings currently on the market, with particular focus on the transobturator sling. To further illustrate my expertise on the topic, I presented previously unpublished data about a large cohort of men with >5 yr of follow-up who were treated with the AdVance male sling (American Medical Systems, Minnetonka, MN, USA) or the I-Stop TOMS (B. Braun Melsungen AG, Melsungen, Germany), showing that sling implantation was followed by recurrence of leakage in the long term. These new original data raised questions about the durability of the male sling and opened the door for a discussion of clinical decision making, patient information, and second-line surgical treatment for postprostatectomy incontinence.
Regenerative therapy for the urinary sphincter
For this topic, I chose to focus on experimental data and basic research. By reporting previous and personal data about intrasphincteric injection of muscle-derived stem cells, I tried to draw a picture of the status of regenerative therapy. I also took care during this talk to make the presentation practical and straightforward for the broad audience. I was challenged in many ways about the relevance of the approach, the fate of stem cells after urinary sphincter implantation, and the future of the approach. As I expected, all of the experts were greatly involved in the discussion, which led to consideration that the stem cell approach is going to be a dead end unless we can develop innovative techniques that are more focused on molecular biology.
The Davos experience
In the evenings, we had great moments of friendship and an outstanding social program. In a very kind atmosphere, we shared dinners together, especially with the other challengers. In a way, Davos is both an occasion to discover people you would never have met under other circumstances and a place to gather with your friends under the same banner. The dinner on the last night was unique.
For the people who love to ski, the place is outstanding, with famous slopes and a wonderful environment. On the whole, we had four incredible days—very intense and fruitful. Davos is a perfect example of how the EAU promotes academic excellence in urology, international friendship, knowledge sharing, and networking.
Department of Urology, Charles Nicolle Hospital, University of Rouen, Rouen, France