As part of the organising committee, it was a pleasure to attend and support this inaugural nurses meeting at the Societé International d’Urologie (SIU) in Melbourne.
The meeting, supported by the Victorian Urological Nurses Society (VUNS), the Australia and New Zealand Urological Nurses Society (ANZUNS) and the EAUN, provided the SIU the very first opportunity to involve urology nurses in their programme, an idea supported by SIU Congress Director Valérie Guillet.
The objective of the nurses programme was to “snap shot” a number of topics in urological care with a global perspective, with many of the sessions offering a multi-professional perspective involving urologists and urology nurses.
In the opening presentation, the author and co-speaker Prof. Laurence Klotz outlined the role of hormone therapy in metastatic castrate resistant prostate cancer (mCRPC), from biological treatment principles, changing treatment modalities, practical day-to-day considerations when looking at treatment options, and the importance of survival alongside health related quality of life. In addition Prof. Klotz addressed the area of the androgen receptor gene and how various molecular mechanisms played a role in the development of resistance to androgen deprivation therapy in mCRPC, including AR mutations, amplifications and splice variants.
A topic common to all urology nurses working in bladder cancer was discussed by Kath Schubach – chair VUNS, that being the shortage of BCG therapy for patients with newly diagnosed High-Risk Non-Muscle Invasive Bladder Cancer (HR NMIBC) and those who are already undergoing BCG treatment. General recommendations included: that all patients with HR NMIBC be counselled appropriately and reassured that their care would not be substantially compromised and in general terms:
- management of HR NMIBC with TURBT and cystoscopic surveillance alone is not appropriate, even if local BCG supplies have run out and patients should always be offered an alternative
- patients should not be counselled that radical cystectomy (RC) is the only safe option in this setting.
- as should already be the case, all patients with HR NMIBC should be discussed at the bladder MDT meeting.
In addition, further guidance suggesting where possible, patients should be offered 1/3 dose BCG for induction courses and maintenance up to one year. This is based on an EORTC randomised trial, which showed no difference in progression rates between full dose and 1/3 dose BCG.
In the area of Catheter Acquired Urinary Tract Infection (CAUTI), Trish White, nurse practitioner from New Zealand, discussed the management of urinary catheters and provided a key insight in urinary tract infections, which account for 40% of all hospitalacquired infections, with 80% being catheter related. Trish highlighted the fact that urinary catheterisation when hospitalised and insertion could be unjustified in up to 50% of cases. Of note, as was clear to the audience, was the risk of CAUTI increased with the duration of catheterisation, with evidence suggesting that 26% of patients with an urinary catheter in-situ for between 2 to 10 days will develop bacteriuria, with 25% of these patients developing a CAUTI.
Other risk factors to consider also included catheter care violations and older age. The key take home messages from this session were that there are many opportunities for nurses to reduce the incidence of CAUTI by applying best practice to the insertion, maintenance and removal of catheters. Urology nurses are in an ideal position to bring about the changes required and that CAUTI prevention is a quality and safety initiative.
In the management of female urinary continence, Chris Murray, nurse consultant (Australia) and Dr. Eva Fong (New Zealand) provided a key insight from assessment to treatment including sling procedures, sacral nerve stimulation and the use of Botulinum toxin injections to treat urge incontinence and overactive bladder syndrome.
For our mid-programme break, we had high tea supported by Bard which gave a great opportunity for networking and to catch up with old colleagues and, of course, the obligatory photo opportunity.
The highlight of the day for me was a very thought provoking and quite humbling talk regarding volunteer teaching in developing counties and career opportunities. Kate Newell, senior project officer from the Royal Australasian College of Surgeons (RACS) gave an initial overview of the Colleges Pacific Island Programme, which provides specialist surgical and medical services, education and training to local surgeons, anaesthetists, nurses and allied health workers in 11 Pacific countries.
Chris Redpath and Stu Wilder, two Australian urology nurses involved in volunteer work in the South Pacific islands, and also in Pakistan during the earthquakes, shared their experience of what it was like to work as a volunteer and nurse educators, which was truly fascinating. It gave me a real insight into what we take for granted regarding access to health care in the western world, and what people have to endure. I had the utmost respect for their work and their ‘can-do’ attitude. Being a “jack-of-all-trades” and making the best of what you have in these far-flung and remote places is so essential.
I would like to take this opportunity to thank personally the following for making this event and my participation possible: SIU congress director Valérie Guillet, Lynda Rigby and Michelle Commane (Astellas Australia), Maryanne Sinon (ANZUNS president), my delightful co-chairs, Kath Schubach and Kay Talbot and, lastly but by no means least, my nursing colleagues from Australia and New Zealand for making me feel so welcome.
I look forward to SIU 2016.
By Lawrence Drudge-Coates, Urological Oncology Clinical Nurse Specialist, Chair EAUN, London (UK)
European Urology Today Vol. 27 No. 5 October/December 2015