The future of lasers in urology

The use of laser applications in urology has undergone significant advances over the past 20 years. Laser technology is now used in a wide variety of procedures, and has become the primary treatment modality or standard of care for many urologic conditions. Despite these advances, a number of challenges still face laser utilization in urologic practice. Recent work has illuminated the potential improvement and further optimization of this field. Improvements in types of lasers, the wavelength of energy used, optical fiber delivery systems, precision of laser application and cost reduction have served to further improve laser technology and extend the potential applications.     

Symposium 3 "female urology in the future"

Symposium 3 entitled "Female Urology in the Future" is very timely as female urology, a urological subspecialty mainly managing stress urinary incontinence (SUI), pelvic organ prolapse (POP) and overactive bladder (OAB), is now beginning to blossom in Japan. In 1986, the first Japanese female incontinence clinic was opened at the Department of Urology, Nagoya University. In 1999, the tension-free vaginal tape (TVT) procedure using polypropylene mesh tape to support the mid-urethra was introduced into Japan, and it dramatically changed the SUI treatment with less era"). invasiveness and durability ("mesh Recently, a variation of the TVT procedure, transobuturator tape (TOT) procedure, and POP repair using polypropylene mesh such as tension-free vaginal mesh (TVM) procedure, are the focus of concern among Japanese urologists and gynecologists practicing female pelvic floor medicine. The International Continence Society derived a new symptomatic definition of overactive bladder (OAB) in 2002. The Neurogenic Bladder Society in Japan published the OAB guideline aiming at public education and shared care in 2005. Five symposists discuss the advantages and pitfalls of the new mesh procedures for SUI and POP, conservation of the uterus in POP repair, gender specificity of OAB, basic research to develop OAB drugs other than anticholinergics, collaboration between urologists and gynecologists, and pediatric female urology.     

The future of urology in Europe: an overview from the European association of urology

INTRODUCTION: In order to be able to influence and monitor future developments for urologists, strategies should be promoted in advance to guarantee the future of the speciality and to accommodate the inevitable changes. Faced with this challenge, the EAU, through its Strategy Planning Office (SPO), has prepared a document which is offered, here, in abbreviated form, to the European and international urological communities for general consideration. MATERIAL AND METHODS: A group of subjects, related to the domains and internal consistency of urology as a speciality, were selected and discussed among the members of the SPO and later submitted to open consultation among distinguished members of the urological community. The topics selected for discussion included: what is urology; urology in the university; sub-specialization in urology; training in urology; does kidney transplantation belong to urology, and others. RESULTS: It is shown that urology is going through an exciting and hazardous transition period. Urology has conflicting problems in its traditional domains due to changes in health care policy, and internal identification problems due to its permanent expansion and sub-specialization options. Weaker points are its relation with primary care medicine (shared care options), the presence and role of urology in institutions such as the university, department of surgery, children's hospitals, administration, etc.; the desegregating effect of the sub-specialities; the increasing encroachment of other specialities, and the increasing outpatient effect of technological progress. CONCLUSION: An action plan is proposed to confront these changes without loosing manpower, internal consistency or social image and improving patient care quality, excellence of training and scientific progress.     

The future of healthcare and the pharmaceutical industry – a CEO view

In the century or so since the birth of the research-based pharmaceutical industry, there has never been a more demanding time. The most pressing issue facing virtually all big pharmaceutical companies today is research and development productivity. Despite huge investments in research and development, the number of new medicines cleared for market has declined. On the other hand, there has never been a more exciting time to do healthcare research. New sciences and technologies are opening up radically new perspectives and opportunities for the future. Medical practice is undergoing a historic shift towards more personalized medicine. Over the next 10 years we can expect significant progress in the treatment of major diseases.     

Education in sexual medicine – a nationwide study among German urologists/andrologists and urology residents

Although sexual‐related problems are very prevalent, inadequate training for physicians has been reported. The aim was to investigate the educational situation in sexual medicine, including sexual dysfunctions, gender dysphoria and paraphilia, among German physicians in urology and andrology. Additional, barriers when addressing sexual health issues and confidence in taking care of patients with sexual‐related problems were evaluated. A questionnaire was sent to 5955 urologists, urology residents and andrologists throughout Germany. The results of this study emphasise the need for continuing education and training in sexual medicine including sexual dysfunctions (83.9%), gender dysphoria (58.2%) and paraphilia (56.6%). Physicians, especially when working in urology, need basic skills in order to feel confident (89.0% in taking care of patients with sexual dysfunctions, 25.8% with gender dysphoria and 22.9% with paraphilia) and be able to reduce several barriers when addressing sexual health issues. The main reported barriers were lack of time (61.0%), inadequate financial compensation (42.5%), lack of necessity (29.9%) and the assumption of patients feeling uncomfortable (20.9%). It is within the competence of urologists and andrologists to correctly assess the situation and to refer patients to multidisciplinary support, such as psychologists, psychosomatics or couple therapists.     

Microcomputers and microprocessors in urology: present and future

Urology departments have a heavy outpatient workload requiring efficient secretarial, appointments and records services. Microcomputers are relatively inexpensive and can facilitate efficient routine clinical and research work. Unlike mainframe computers, formal training is not usually required, a simple introduction being sufficient for the enthusiast. An Apple computer is used in this department for word processing incorporating standard letters, paragraphs and phrases. With more sophisticated programs urological screening by computer interrogation could be linked to an appointments system to coordinate investigations, minimising hospital visits. Microprocessors can facilitate a wide variety of measurement recording and data handling. Urodynamic measurements can be computed and graphs superimposed to facilitate interpretation.