here - European Association of Urology

AUA-EAU International Academic
Exchange Programme 2014
Experiencing European expertise in urology
Dr. Stephen Boorjian
Mayo Clinic
Minnesota (USA)
Boorjian.Stephen@
mayo.edu
held on a regular basis
and provided
opportunities for
technological
collaborations between
Hospital Tenon and
industry.
interesting to observe that all Belgium citizens have
health insurance which is supported through several
taxes, although some Belgians choose to carry
additional private insurance.
The department is very active academically,
particularly in urologic oncology and neurourology/
incontinence, and there is basic science research in
bladder wall physiology, bladder pharmokinetics, and
prostate cancer. Prof. Van Poppel is part of the EAU
leadership and is active in many educational efforts
and guideline developments.
Dr. Brant Inman
Duke University
Medical Center
North Carolina (USA)
The OR team in Leuven at work
interests to the UZ Department of Urology and were
informed about their current projects. The best part of
the visit, however, was the time spent with the UZ
Leuven urologists and their residents at dinners in
Leuven and Brussels. Again, we wish to personally
thank Prof. Van Poppel for organizing our visit and for
generously showing us his university and city.
brant.inman@
duke.edu
Dr. John Stoffel
University of
Michigan
Michigan (USA)
jstoffel@
med.umich.edu
Steve Boorjian, Brant Inman, and Prof. Hein van Poppel
“The world is a book and those who do not travel read
only one page.” – St. Augustine
As part of the 2014 AUA-EAU International Academic
Exchange, the authors had the great opportunity to
visit four different academic centers in Europe and
learn about how urology was practiced in different
healthcare environments. The trip was an outstanding experience and the hospitality at each site
was unparalleled. The following report described our
experience and impressions of the trip.
UZ Leuven Gasthuisberg Hospital (BE)
Leuven is a beautiful city in northern Belgium and is
home to KU Leuven, one of Europe’s oldest
universities. University of Leuven was founded in 1425
and there are records documenting organized medical
education in Leuven as early as 1426. Medical care in
the city has existed even longer and there has been
an established hospital in Leuven since 1080.The city
has produced many medical scholars, including
Andreas Vesalius, the father of modern anatomy, who
studied at Leuven in the early 16th century.
We visited UZ Leuven, the main academic hospital of
KU Leuven and one of Europe’s largest hospitals. The
university hospital was constructed in the early 1970’s
to replace an older hospital in the city. The modern
hospital currently has 1,995 beds and employs almost
9,000 people. The Urology Department at UZ Leuven,
chaired by Professor Hein van Poppel, sees over
20,000 patients per year and performs more than
2,000 procedures. The patient mix includes both
public and private insurance patients. It was
Leuven City Square. The statue shows a student ‘pouring’
knowledge into his/her head
8
European Urology Today
After observing the urology clinics at UZ Leuven, we
were all extremely impressed by how the department
integrated physician extenders and other medical
disciplines for patient care. A great example was the
spina bifida transition clinic staffed by Professors De
Ridder and Van Der Aa. Pediatric spina bifida patients
were initially linked with a nurse coordinator after
establishing care and the nurse helped the patients
with everything from supplies, transport to social
arrangement. After a certain age, the patient was
transitioned to an adult clinic but the nurse
coordinator remained the same. This allowed for a
relatively easy transition into adult urologic care while
still maintaining a consistent care delivery system.
Another unique aspect of the UZ Leuven Urology
department was how integral uro-radiology was to
their daily clinical practice. Urology specific
radiologists were located close to the urology clinics,
allowing for immediate discussion with staff
urologists about CT and MRI findings, as well as
real-time coordination for combined interventions.
We observed Prof. Van Poppel reviewing a patient’s
urethral sphincter anatomy with the radiologist prior
to a radical prostatectomy and he confirmed that each
MRI is reviewed with a radiologist prior to surgery to
optimize the understanding of anatomy and disease.
Radiofrequency ablations were also easily
coordinated with this approach.
The department also had a robust urology residency
training program. The department has six residents in
their 4th, 5th or 6th year of training and the residents
rotate through pediatric, functional (female and
neurourology), endourology/laparoscopy, oncology/
reconstruction, and general urology. Unique to the
Belgium educational system, prospective urology
residents spend a year as a “co-assistant” prior to
being accepted into the training program. The
“co-assistant” performs rounds on all the patients
and assists in surgery. Co-assistants who excel could
then be offered residency positions. Residency is six
years and includes a period of research with
opportunities for basic science research. Residents
rotate at other Belgian hospitals and keep a log book
of procedures, which is reviewed by a national board
yearly. Many of Belgium’s academic urologists trained
at UZ Leuven.
Overall, we were extremely impressed with the
department and the hospital. On a personal note, we
deeply appreciate Prof. Van Poppel and his
department for the time and hospitality they
generously shared with us. During the visit, we had
the opportunity to present some of our research
Hospital Tenon, Paris (FR)
After leaving Belgium, we traveled south via high
speed rail to Paris and met Prof. Oliver Traxer at
Hospital Tenon in the 20th arrondissment. The
hospital was built in 1870 named after Jacques-Rene
Tenon, an 18th Century French surgeon and historian
on French hospitals. Until the Renaissance, Paris had
only one hospital, the Hôtel-Dieu de Paris, and its
mission was chiefly to serve the poor and sick.
The Tenon urology
residents were also
extremely generous with
their time with us and we
learned that urologic
training in France is
similar to US training
although it differs in
some key areas. Like US
medical students, there is
a match process but it is
based on testing scores
rather than interviews or resume. After finishing
medical school, French “externs” choose both a
specialty and a city. First preference is given to externs
with higher testing scores. Once matched, the
students become “internes” and study urology for five
years followed by two Chief Assistant years. Chief
Assistants were tasked with rounding out the resident
education and ran many of the medical conferences
for the department. We participated in a case review
conference with the Chief Assistants and their breadth
of knowledge was impressive (as was their generosity
by performing the conference in English for their
visitors). According to our hosts at Tenon, residents
must publish as first author in a journal and pass an
oral exam to become certified in urology.
As with Leuven, we enjoyed incredibly generous
hospitality in Paris from the Tenon residents, fellows
Currently, there are both public and private hospitals
and Prof. Traxer. Besides taking time to explain their
in Paris, reflecting the public and private insurance
hospital and medical system to us, our hosts also
plans, although there are few purely private hospitals. arranged tours of the Louvre Museum, Montmarte’
Although Hospital Tenon is a public hospital (564
district and Notre Dame Cathedral. We also took a
beds), we learned that both public and private
river cruise on the Seine and saw a cabaret show.
patients are treated here. Public patients cannot select When I asked Prof. Traxer at the end of our visit what
which doctor they would see and have a consultation made healthcare in Paris different from the rest of
in a medical ward. Private patients can select an
Europe, he laughed and said that since everything in
individual physician and have consultations in the
Paris is special, why wouldn’t healthcare here be
doctor’s office.
equally excellent?
Hospital Tenon, Paris, France
Although hospitals provided comprehensive urologic
care, many Parisian hospitals have subspecialized in
specific service lines. For example, it was impressive
to learn that Prof. Traxer performed over 800
ureteroscopy procedures per year and is referred
numerous complex cases from across France and
Southern Europe. Different than many US hospitals,
the operating rooms and schedule at Tenon were
structured to allow rapid turnover for these
endoscopic cases. For example, Prof. Traxer had 18
ureteroscopes available for his personal use. We were
also fortunate to sit in masterclass courses on
ureteroscopy and percutaneous nephrolithotomy with
Profs. Traxer and Jean De La Rosette from AMC
University Hospital in Amsterdam. These courses were
Professors De la Rosette and Traxer
Prof. Traxer during surgery
VU University Medical Center, Amsterdam (NL)
From Paris, we traveled again by high-speed rail to
Amsterdam and were met by Dr. Garry Pigot, a
reconstructive urologist at VU University Medical
Center. VU University in Amsterdam is a relatively
young university by European standards, since it was
founded “only” in 1880. From the University website, it
says that the university, initially, was only open to
Reformed Christians and was financed by their
fund-raising efforts and donations. However, since the
1960s, VU University Amsterdam has been open to
everyone and is funded in the same way as the other
Dutch universities. VU University Medical Center has
733 beds and is one of the main teaching hospitals of
the University as well as one of the largest hospitals in
the Netherlands. The Department of Urology at VUMC
is chaired by Professor R.J.A. Van Moorselaar and has
specialization in urologic oncology, pediatric urology,
neurourology and gender reassignment surgery.
July/September 2014
We observed several robotic cases during our visit to
VUMC, including a robotic prostatectomy and robotic
ureterolysis. Themes discussed by the VU urologists
regarding robotics centered on how to integrate
teaching into a robotic learning curve and the cost
effectiveness of robotics for the Dutch medical system.
The Dutch urologists were surprised to hear that
many US institutions such as University of Michigan,
Duke, and Mayo Clinic had several surgical robots
compared to the single unit at VUMC. The acuity of
adoption of robotics into VUMC urologic care is likely
related to a combination of insurance reimbursement,
outcome reporting, and other factors specific to the
Dutch healthcare system.
VUMC, urology residents rotated through different
services with attending physicians similar to
US-based systems. As part of the academic program
at VUMC, we gave lectures to residents and staff on
our research interests and were impressed by the
VUMC residents’ knowledge on physiology and
research methodology. The research projects they
presented were also creative and hypothesis driven.
Returning to the quote at the beginning of this report,
we can say that participating in the AUA-EAU
Exchange Programme opened our eyes to the
diversity of urologic practice across the world. We
would strongly encourage faculty, both in the US and
Europe, to consider applying for professional
exchanges such as this one. We consider this trip as
one of the most memorable academic experiences in
our careers and it has inspired us to see the manifold
opportunities in our field.
As with the other places we visited, Professors Pigot
and Van Moorselaar gave us a master course on
hospitality. The department hosted two dinners for us
as well as biking tours of Amsterdam. Interacting with
the staff and residents sparked great exchange of
ideas and potential future collaborations.
Our hosts said that the Netherlands has an acute and
chronic healthcare system, where acute care is
covered by obligatory private insurance and long-term
care for chronic and terminal conditions are covered
by governmental social insurance. The government
also discloses outcomes to the public on a provider
level. Their consensus was that urologic surgery is
expected to transition more towards robotics as payer
system invests in new technology, with the use of the
technology spreading across the country, and learning
curve outcomes are considered.
A highlight of our visit was observing Dr. Pigot create
a neourethra during a gender reassignment
procedure. The surgery was extremely wellcoordinated with plastic surgery and the technical
skill was impressive. We learned about the VUMC
multidisciplinary gender reassignment clinics and
about how they have grown in surgical volume over
the past several years. Overall, we left VUMC
tremendously impressed with the gender
reassignment program.
Academic Exchange Programme. The dinner was held
at the Stockholm City Hall Gold Room where Noble
Prize winners receive their awards. We were a small
part of the award ceremony that night and it was
moving to be in a place of such contemporary
historical significance.
Golden Hall, Stockholm City Hall
Finally, we attended the EAU Annual Congress in
Stockholm. A highlight of the conference for us was
receiving a plaque at the EAU Friendship Dinner
which marked our participation in the AUA-EAU
Our host, Prof. Gary Pigot in Amsterdam
Karolinska University Hospital, Stockholm (SE) and
the EAU conference
We traveled by plane to Stockholm and met Professors
Olaf Akre and Peter Wiklund from the Department of
Similar to the previous institutions, we had the great
Urology at Karolinska Hospital. A famous son from
opportunity to spend time with the VUMC residents
Karolinska was Anders Retzius (of the famed
both at the hospital and during social outings, such as retropubic space) who studied here in the early 19th
a canal cruise and a visit to the Rijksmuseum, the
century. While at Karolinska University, we discussed
Netherlands’ national museum. We learned that
prostate cancer outcomes research with Prof. Akre
residency training in the Netherlands was similar to
and also observed Prof. Wiklund perform a robotic
US training in educational goals but different in
cystectomy/ intracorporal orthotopic bladder
selection process. After medical school, new
substitution. Both experiences reinforced the concept
graduates frequently work as residents “not in
that innovation is not limited by health systems or
training” in academic urology departments. These
geography. Our time at Karolinska was brief due to
residents take care of patients, gather data and
the Urology department’s obligations for the EAU
participate in research projects. The residents who are Annual Congress, but we enjoyed a very nice dinner
selected into a urology program then complete two
with the department at a restaurant in Gamla Stan,
years of general surgery and four years of urology. At the oldest district in Stockholm.
Golden Hall, Stockholm City Hall
Montmarte in Paris and beside that statue of “The Man Who
Can Walk Through Walls.” The work was inspired by a classic
French story, published in 1943 by Marcel Aymém, where the
story’s protagonist can walk through walls but ultimately
pushes his luck too far and got stuck forever inside one.
Metaphor anyone?
American
Urological
Association (AUA)
A chance to join the ...
International Academic Exchange Programme
American Urological Association (AUA) in collaboration with the
European Association of Urology (EAU)
2015 American Tour
To date 11 American and 11 European tours have been organised and each of those
proved extremely successful. Therefore the European Association of Urology (EAU) and
the American Urological Association are pleased to announce the 2015 American tour!
The AUA/EAU International Exchange Programme will send American faculty to Europe
and European faculty to the United States. The programme aims to promote
international exchange of urological medical skills, expertise and knowledge.
This upcoming 2015 American Tour will provide grants which will enable 3 EAU
members to travel to and attend the AUA congress in New Orleans (May, 15-19, 2015)
and to participate in an extended ten days travel programme, taking them to several
urology centres in the United States.
Eligibility criteria
• Less than 42 years of age
• Minimum academic rank of assistant professor
• Letter from the departmental chairman of the applicant’s commitment to academic medicine
• Membership of the EAU
Information and application forms
For all further information and programme application forms please visit www.uroweb.org, and
select International Relations, AUA-EAU International Academic Exchange Programme or contact
the EAU Central Office, T +31 (0)26 389 0680, F +31 (0)26 389 0674, E: [email protected].
We look forward to receiving your application before 3 November 2014.
EAU Central Office, Attn. Secretariat, P.O. Box 30016, 6803 AA Arnhem, The Netherlands
EAU Section of Urolithiasis (EULIS)
July/September 2014
European Urology Today
9

Download Report