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Social media use is becoming common in medical practice. Although primarily used in this context to connect physicians, social media allows users share information, to create an online profile, to learn and keep knowledge up to date, to facilitate virtual attendance at medical conferences, and to measure impact within a field. However, shared content should be considered permanent and beyond the control of its author, and typical boundaries, such as the patient-physician interaction, become blurred, putting both parties at risk. The European Association of Urology brought together a committee of stakeholders to create guidance on the good practice and standards of use of social media. These encompass guidance about defining an online profile; managing accounts; protecting the reputations of yourself and your organization; protecting patient confidentiality; and creating honest, responsible content that reflects your standing as a physician and your membership within this profession. © 2014 European Association of Urology.

Background: Intravesical instillation of bacillus Calmette-Guérin (BCG) is an accepted strategy to prevent recurrence of non-muscle-invasive bladder cancer (NMIBC) but associated with significant toxicity., Objective: NIMBUS assessed whether a reduced number of standard-dose BCG instillations are noninferior to the standard number and dose in patients with high-grade NMIBC., Design, Setting, and Participants: A total of 345 patients from 51 sites were randomised between December 2013 and July 2019. We report results after a data review and safety analysis by the Independent Data Monitoring Committee based on the cut-off date of July 1, 2019., Intervention: The standard BCG schedule was 6 wk of induction followed by 3 wk of maintenance at 3, 6, and 12 mo (15 instillations). The reduced frequency BCG schedule was induction at wks 1, 2, and 6 followed by 2 wk (wks 1 and 3) of maintenance at 3, 6, and 12 mo (nine instillations)., Outcome Measurements and Statistical Analysis: The primary endpoint was time to first recurrence. Secondary endpoints included progression to ≥ T2 and toxicity., Results and Limitations: In total, 170 patients were randomised to reduced frequency and 175 to standard BCG. Prognostic factors at initial resection were as follows: Ta/T1: 46/54%; primary/recurrent: 92/8%; single/multiple: 57/43%; and concomitant carcinoma in situ: 27%. After 12 mo of median follow-up, the intention-to-treat analysis showed a safety-relevant difference in recurrences between treatment arms: 46/170 (reduced frequency) versus 21/175 patients (standard). Additional safety analyses showed a hazard ratio of 0.40 with the upper part of the one-sided 97.5% confidence interval of 0.68, meeting a predefined stopping criterion for inferiority., Conclusions: The reduced frequency schedule was inferior to the standard schedule regarding the time to first recurrence. Further recruitment of patients was stopped immediately to avoid harm in the reduced frequency BCG arm., Patient Summary: After surgical removal of the tumour, patients with high-grade non-muscle-invasive bladder cancer are treated with bacillus Calmette-Guérin to prevent recurrence and progression. This is associated with significant side effects. We report the results of a clinical trial showing a reduction in the number of instillations (from 15 to nine in total) being inferior to the standard protocol. From today's perspective, complete tumour resection and a standard number of instillations remain the standard of care., (Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Bacillus Calmette-Guérin (BCG) maintenance therapy for 3 yr following BCG induction can reduce the progression of urothelial bladder carcinoma versus BCG induction alone, but is associated with high toxicity., Objective: To investigate whether a modified 3-yr BCG maintenance regimen following induction therapy is more effective than standard BCG induction therapy alone and exhibits a low toxicity profile., Design, Setting, and Participants: Patients from the outpatient clinics of the participating centres with high-risk non-muscle-invasive bladder carcinoma (NMIBC) were randomised between October 1999 and April 2007., Intervention: Participants received BCG induction once-weekly for 6 wk (no maintenance arm) or BCG induction followed by one BCG instillation every 3 mo for 3 yr (maintenance arm)., Outcome Measurements and Statistical Analysis: Primary endpoints were disease-free interval (DFI) and time to progression (TTP). Secondary endpoints included survival duration and toxicity. Differences between treatment arms were tested using Student's t test and χ(2) and log-rank tests., Results and Limitations: A total of 397 patients were randomised, 195 to the no-maintenance and 202 to the maintenance arm. A median time to recurrence was not reached in either treatment arm. DFI was similar between the arms (hazard ration [HR] 0.83; 95% CI 0.61-1.13; p=0.2) with disease relapse at 5 yr of 33.5% and 38.5%, respectively. TTP was also similar between the treatment arms (HR 0.79; 95% CI 0.50-1.26; p=0.3), with a progression rate at 5 yr of 16% and 19.5%, respectively. There were no significant differences between the treatment groups for overall survival and cancer-specific survival at 5 yr. Twenty and five patients in the maintenance and no-maintenance arms, respectively, stopped treatment because of toxicity. The most common local side effects were frequency (65% of patients), dysuria (63%), and haematuria (43%); the most frequent systemic side effects were general malaise (7.2%) and fever (34%)., Conclusions: In NMIBC patients treated with maintenance therapy comprising a single BCG instillation every 3 mo for 3 yr following standard induction BCG, we did not observe a decrease in recurrence and progression rates versus induction therapy alone., Patient Summary: Patients who undergo surgery to remove bladder cancer are usually treated with bacillus Calmette-Guérin (BCG) for 6 wk if there is a high risk of disease recurrence. Extending BCG therapy by 3 yr can further minimise disease recurrence and progression, but is associated with more side effects. We report that a modified 3-yr BCG treatment regimen showed low toxicity, but seemed to be no more effective than 6-wk treatment., Trial Registration: CUETO 98013., (Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Context: Live surgery is an important part of surgical education, with an increase in the number of live surgery events (LSEs) at meetings despite controversy about their real educational value, risks to patient safety, and conflicts of interest., Objective: To provide a European Association of Urology (EAU) policy on LSEs to regulate their organisation during urologic meetings., Evidence Acquisition: The project was carried out in phases: a systematic literature review generating key questions, surveys sent to Live Surgery Panel members, and Internet- and panel-based consensus finding using the Delphi process to agree on and formulate a policy., Evidence Synthesis: The EAU will endorse LSEs, provided that the EAU Code of Conduct for live surgery and all organisational requirements are followed. Outcome data must be submitted to an EAU Web-based registry and complications reported using the revised Martin criteria. Regular audits will take place to evaluate compliance as well as the educational role of live surgery., Conclusions: This policy represents the consensus view of an expert panel established to advise the EAU. The EAU recognises the educational role of live surgery and endorses live case demonstration at urologic meetings that are conducted within a clearly defined regulatory framework. The overriding principle is that patient safety must take priority over all other considerations in the conduct of live surgery., Patient Summary: Controversy exists regarding the true educational value of live surgical demonstrations on patients at surgical meetings. An EAU committee of experts developed a policy on how best to conduct live surgery at urologic meetings. The key principle is to ensure safety for every patient, including a code of conduct and checklist for live surgery, specific rules for how the surgery is organised and performed, and how each patient's results are reported to the EAU. For detailed information, please visit www.uroweb.org., (Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

The European Association of Urology Research Foundation has proposed that alternatives to perioperative chemotherapy should be evaluated. The MAGNOLIA study represents a unique opportunity to investigate the concept of immunotherapy in muscle-invasive bladder cancer., (Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Context: These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries., Objective: To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject., Evidence Acquisition: A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation., Evidence Synthesis: The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines., Conclusions: Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma., (Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objectives: The true incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing laparoscopic radical prostatectomy is unknown. Our aim was to determine the incidence of symptomatic DVT and PE and the risk factors for these complications., Methods: Fourteen surgeons from 13 referral institutions from both Europe and the United States provided retrospective data for all 5951 patients treated with laparoscopic radical prostatectomy (LRP), with or without robotic assistance, since the start of their institution's experience. Symptomatic DVT and PE within 90 d of surgery were regarded as venous thromboembolism (VTE). DVT was diagnosed mostly by Doppler ultrasound or contrast venography and PE by lung ventilation/perfusion scan or chest computed tomography or both. Statistical analysis included evaluation of incidence of symptomatic DVT and PE and risk factors as determined by exact methods and logistic regression., Results: Of 5951 patients in the study, 31 developed symptomatic VTE (0.5%; 95% confidence interval [CI], 0.4%, 0.7%). Among patients with an event, 22 (71%) had DVT only, 4 had PE without identified DVT, and 5 had both. Two patients died of PE. Prior DVT (odds ratio [OR]=13.5; 95%CI, 1.4, 61.3), current tobacco smoking (OR=2.8; 95%CI, 1.0, 7.3), larger prostate volume (OR=1.18; 95%CI, 1.09, 1.28), patient re-exploration (OR=20.6; 95%CI, 6.6, 54.0), longer operative time (OR=1.05; 95%CI, 1.02, 1.09), and longer hospital stay (OR=1.05; 95%CI, 1.01, 1.09) were associated with VTE in univariate analysis. Neoadjuvant therapy, body mass index, surgical experience, surgical approach, pathologic stage, perioperative transfusion, and heparin administration were not significant predictors., Conclusions: The incidence of symptomatic VTE after LRP is low. These data do not support the administration of prophylactic heparin to all patients undergoing LRP, especially those without risk factors for VTE.

Purpose: To determine the optimal evaluation and management of genitourinary (renal, ureteral, bladder, urethral and genital) injuries by review of the world's literature on the subject., Methods: A consensus committee convened by the Health Care Office of the European Association of Urology (EAU) to summarize the literature concerning the diagnosis and treatment of genitourinary trauma., Results: Findings of 350 citations are reviewed., Conclusions: The genitourinary trauma literature still relies heavily on expert opinion and single-institution retrospective series. Future prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates practitioner behavior.

Purpose: To compare the effectiveness of intracavernous administration of sodium nitroprusside and prostaglandin E1 to induce penile erection in men with erectile dysfunction., Material and Methods: 100 patients with erectile dysfunction entered the study prospectively. As part of the diagnostic workup, each patient received an intracavernous injection of 20 microg prostaglandin E1 and a second injection of 600 microg sodium nitroprusside 1-7 days later. A tourniquet was placed at the base of the penis before each injection. The data recorded included time required to initiate tumescence, local and systemic side effects, objective and subjective quality of erections, duration of tumescence and patient satisfaction by means of a personal questionnaire., Results: Prostaglandin E1 induced better overall responses than sodium nitroprusside, the difference being almost significant (p = 0.055). The overall duration of erections was also significantly longer with prostaglandin E1 (mean 81.3 min) than with sodium nitroprusside (mean 65.4 min; p < 0.04). 67% of the patients considered the erections induced with prostaglandin E1 to be of better quality than those with sodium nitroprusside, and only 11% stated that sodium nitroprusside was superior. Side effects were minimal with both drugs, the most frequent side effect being systemic hypotension, which was induced by sodium nitroprusside in 7% of the patients., Conclusions: The moderate risk of systemic hypotension and the lower potency of sodium nitroprusside to induce erections compared to prostaglandin E1 rules out sodium nitroprusside as a routine alternative intracavernous drug in men with erectile dysfunction at the doses employed. Sodium nitroprusside, however, could be used in patients who have intolerance or penile pain with intracavernous prostaglandin E1.

BCG is currently the most active immunotherapy agent for intravesical use and is considered the first-line treatment for patients with aggressive T1 G3 and Tis superficial tumors of the bladder. Its main drawback, toxicity, is being addressed by several prospective studies that try to find the lowest active dose and optimal schedule, as well as by studies investigating the efficacy of antigenic bacterial fractions, devoid of the toxicity of the living bacilli. Efforts to improve the efficacy by combination with chemotherapy and biomodulating natural remedies are also under way. In this review we discuss: (1) the indications, limits and contraindications of BCG; (2) the efficacy; (3) the strains; (4) route of administration; (5) dose; (6) schedule; (7) the problem of toxicity, and (8) how to improve BCG therapy.

Purpose: To analyze the results of a series of end-to-end urethroplasties performed in our service from 1968 to 1995 and of the factors contributing to failure., Material and Methods: 150 men (mean age 35.9 years) with urethral stricture disease underwent excision of the stricture and end-to-end anastomosis; in 95 it was the first attempt at repair while in 55 it was a secondary attempt. Eighty-two patients (54.6%) had a trauma-related stricture; of them, 56 followed a pelvic ring fracture with posterior urethra distraction defect, 24 (16%) had inflammatory strictures, 26 (17.3%) iatrogenic, 9 (6%) congenital, and 9 (6%) of unknown etiology; 81 (54%) were located in the bulbous urethra, 9 (6%) in the penoscrotal junction and 2 (1.3%) in the penile urethra. Ninety-one (60.6%) of the strictures or obliterative defects measured between 1 and 3 cm, 42 (28%) less than 1 cm and only 16 (10.6%) more than 3 cm. A perineal approach was used in 138 of the cases, while combined abdominoperineal route was necessary in 12; of these, 5 were children. The follow-up has ranged from 6 to 168 months (mean 44.4). The results were classified as good, fair (some re-stricturing, not needing treatment) and poor (recurrence)., Results: One hundred and twenty-six (84%) good outcomes, 10 (6.6%) fair, 14 (9.3%) poor. The factors influencing success or failure were: (1) primary or secondary character of the operation; (2) etiology; (3) length, and (4) location. Postoperative early complications consisted of 2 wound infections and 2 hematomas; as late complications, 1 chordee, 2 incontinence, 7 erectile dysfunction (in previously potent patients). The 14 patients considered as failures were operated again, all successfully; in 4 of them, a repeat excision and end-to-end anastomosis was performed, elevating the final success rate of the series to 93.3%., Conclusion: Excision and anastomotic repair represent the optimal mode of stricture repair for single lesions located from the penoscrotal junction to the membranous part of the urethra.

We report the use of a modified rat model for the study of the mechanisms of penile erection. In 92 Sprague-Dawley rats, the cavernous nerve was stimulated with different pulse intensities and frequencies, and the intracavernous pressure, time to maximal pressure and total duration of tumescence were measured. A maximal response was elicited at 20 pulses per second (pps) and 1.5 mA. Using this as 100%, we determined the relative pressure responses obtained with other frequencies: 5 pps, 57.3% (p = 0.007), 10 pps, 84.9% (p = 0.043); 30 pps, 99.5% (p = 0.832); 40 pps, 97.8% (p = 0.168); 50 pps, 90.9% (p = 0.021); 100 pps, 76.1% (p < 0.001). The time to maximal pressure varied with different frequencies, but was in all cases significantly different from the 20-pps response. Erection time during continuous cavernous nerve stimulation was significantly longer with frequencies below 20 pps (10 and 5 pps). In 30 rats, the physiologic response to intracavernous injection (0.03 ml) of acetylcholine, atropine, guanethidine, norepinephrine, phenylephrine, papaverine, terbutaline (intravenous also) and phentolamine was measured. Papaverine caused a dose-dependent rise in pressure; acetylcholine, atropine (a parasympathetic blocking agent) and guanethidine all had minimal effects. Phentolamine and norepinephrine increased systemic blood pressure, whereas phenylephrine decreased the intracavernous pressure in response to electrostimulation significantly.(ABSTRACT TRUNCATED AT 250 WORDS)