Foreword
Hein Van Poppel is Chairman of the Department of Urology at the University Hospital Gasthuisberg at the Katholieke Universiteit Leuven. He is a Board Member of the European Association of Urology (EAU) and the European Society of Surgical Oncology (ESSO), Treasurer of the International Consultation on Urological Diseases (ICUD) and was for many years Treasurer of the European Organisation for Research and Treatment of Cancer Genitourinary (EORTC GU) Group. Professor Van Poppel is Chairman of the educational office of the EAU and Director of the European School of Urology (ESU). Professor Van Poppel is also a Member of the American Association of Genitourinary Surgeons (AAGUS). He is Past President of the Belgian Society of Urology (BVU), Chairman of the Scientific Committee of Europa Uomo and a Faculty Member of the European Society of Medical Oncology (ESMO). Professor Van Poppel has published more than 200 papers as first author on uro-oncological surgery and has co-authored more than 250 other papers.
W
elcome to European Urological Review, which covers various topics in current urological practice and highlights the importance of inter-disciplinary collaboration. Today, urology is engaged with myriad medical and paramedical disciplines, which heightens the importance of our discipline on modern patient care.
Prostate cancer remains one of the most discussed diseases in urology. With the advent of effective cytotoxic chemotherapy in the field of prostate cancer, and the advent of new targeted therapies in other fields of urological oncology, medical oncologists become more involved in urological cancers; therefore, a first important contribution illustrates how urologists want medical oncologists to get insight in decision-making and treatment strategy planning in the wide field of prostate cancer in general and localised prostate cancer in particular. Further increased interaction between urologists, radiologists, pathologists, radiation and medical oncologists should improve the quality of personalised patient care for which each expert needs to share knowledge of all disease stages that our patients will experience.
While radical prostatectomy remains the gold standard of localised, and more recently more and more for locally advanced prostate cancer, the side effects of the best local treatment remain relevant, certainly in the younger patients. Temporary or definitive erectile dysfunction after surgery can be dealt with since we have the availability of phosphodiesterase inhibitors, injection therapy or vacuum device, but prevention of post-operative sexual dysfunction is most important. Correct evaluation of post-operative sexual function is reviewed by authors from one of the highest volume centres in the world. While the prostate cancer mortality in most countries is slowly decreasing due to partly early detection and use of prostate-specific antigen (PSA), partly because of better local treatment possibilities and better medical treatment, prevention is another challenge, not only for malignant but also for benign prostate conditions.
In terms of bladder cancer, fortunately most patients will suffer from non-muscle-invasive bladder cancer but still a significant number of patients will be faced with muscle-invasive bladder cancer where radical cystectomy is the mainstay of the treatment. In recent years, more female patients have become candidates for radical cystectomy. While in men, bladder substitution procedures have been extensively used in most urological centres, neobladders in women have a worse reputation because of the problem of nocturnal enuresis and hypercontinence during the day. Attention to pre- and post-operative counselling and remaining diligent in terms of surgical details should improve the final functional outcome for female patients as well. As well as oncological topics, this article pays extensive attention to functional urological problems. First, overactive bladder syndrome, which has become established as a common urological disorder, certainly has important implications on sexual function that are often not taken into account. The uro-andrological perspective will be helpful in integrating bladder and sexual function.
Premature ejaculation remains an always returning and prevalent disorder where in recent years progress in management has been made. Ways to objectify and measure early ejaculation during sexual activity necessitates the help of experts with a background in psychological education in order to help urologists to evaluate this disturbing disorder and enable pre-treatment counselling and post-treatment evaluation.
A special topic dealt with in this issue is the ejaculatory disorders in men with spinal cord injury where it is of utmost importance to understand the underlying mechanism, the psychological repercussions and, in order to take optimal decisions, the way of treating these patients.
The prevalence of erectile dysfunction becomes more prominent since this topic recently became less taboo. Since urologists dispose of multiple treatment strategies, these erectile disorders have become more easy to discuss. Conservative management of erectile dysfunctions is quite straightforward with excellent results in most patients. The different conservative treatments are discussed and should be properly selected for the personalised patient and adapted to his personal sexual and relationship situation.
In the urogynaecology section, the focus switches to female urological sexual function following urogenital prolapse. Finally, a couple of complex case histories in erectile dysfunction are reported and the results of an online survey on the impact of premature ejaculation are given.
It is clear that urology today concerns not only prostate and incontinence. We are happy that in this issue of European Urological Review next to urologists, also gynaecologists, andrologists, medical oncologists, sexologists and psychologists are involved. It clearly shows that urology is an important speciality that affects not a minority but a majority of our patients. The panel of experts that participate in this issue is absolutely outstanding and I am sure that all readers will find something that is in their field of interest. I want to thank all those involved in preparing this issue and wish you enjoyable reading. n
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© TOUCH BRIEFINGS 2011
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