BAUN Conference 2017
The BAUN conference was held from Sunday the 26th November until Tuesday the 28th November in the majestic city of Glasgow. From start to finish this conference contained all the elements that make a conference truly inspiring and educational, from excellent speakers, to wide variety of exhibits and most important aspect of all-an Irish win in the Poster Competition. Congratulations to Robert McConkey, Candidate ANP Urology-Galway on winning the poster competition at the conference, award was presented to Robert at the Gala Dinner making it a memorial night for all of us privileged to be there. His poster which gave an overview of the findings of his research study on Exploring Gay men’s experience of living with Prostate Cancer-a phenomenological study gives food for thought for all nurses who manage prostate cancer patients; it gives an epic insight into the experience of gay men with prostate cancer. An excellent read for all-please seek it out at the IAUN conference at the end of this month.
My experience at the BAUN conference began on the Sunday at the RED study day which gave an insight into the management of Hypogonadal Man-testosterone deficiency. Male menopause does exist but unlike us ladies not all men experience it. Life style modifications can improve testosterone levels such as BMI management, Hypertension control, diabetes and cholesterol monitoring. Hypogonadism is diagnosed based on clinical symptoms plus chemical evidence of reduced testosterone. Bloods such as LH, FSH, Testosterone, Lipids, glucose, and Fasting testosterone levels by 2 taken between 8-10am can assist in accurate diagnosis. EAU guidelines on Male Hypogonadism 2015 are available on www.uroweb.org.
Monday the 27th
Monday began early with a Hollister symposium on Clinical Improvements Processes and how Hollister assisted 6 nurses in the UK to plan and implement a change process, progressing then to presenting this process at BAUN. This was an excellent presentation into how nurses can present their develop and present service developments and that with the correct support and guidance we can all in act a service change.
The Conference was opened by Julia Taylor-President of BAUN with an emotional tribute to an esteem BAUN colleague Mr Bruce Turner, who passed away and who will be eternally remembered for his stamina, love for education and BAUN in the Bruce Turner legacy award which was awarded to two nurses who have recently started working in Urology. The aim of the award is to promote Urological Nursing education which was a passion throughout his career.
There were numerous excellent presentations during this day. One in particular was given by Jerome Marley who spoke passionately about the need for an International Urological Nursing curriculum which would standardise Urological Nursing education and give recognition to Urological Nursing as a speciality. Over the next year we will hear more on this subject as International organisations such as BAUN, EAUN and the University of Ulster strive to achieve this objective and capture viewpoints from stakeholders throughout Europe, so that this curriculum contains urological Nursing educational needs.
Professor Hashim Ahmed spoke about ‘Opening our eyes to prostate cancer diagnosis’, he reflected on the PROMIS study which advocates parametric MRI prior to prostate biopsy, it also advocates that template biopsy is gold standard. In the study if MRI was positive or suspicious then biopsy is required. Study noted that 1 in 3 cancers were missed with TRUSS biopsy compared to 1 in 10 with MRI. 40% men avoid biopsy with MRI completed first. Survivorship issues post radical prostate cancer treatments is the challenge for the future. Charing Cross Hospital has started a RAPID pathway which sees patients having MRI first and if positive/Suspicious, they have the biopsy on the same day.
Stefano Terzoni gave an excellent presentation on Pelvic Floor Rehabilitation and evidence that supports the efficacy of same. It is recommended that Pelvic Floor Rehabilitation begins prior to Radical Prostatectomy and that patients require on-going support to maintain concordance. However insufficient studies available to date on effective strategies. Tibial Nerve stimulation is effective and is recommended by the EAU however more research is required which will require multicentre studies in order to have adequate study sample. EAU guidelines on Urinary Incontinence last published in 2014 and updated in 2017, not available on website yet.
Tuesday the 28th
Tuesday saw the programme split in two- oncology and benign urology. I went the benign route and Robert ventured to the oncology sessions.
Mr Bijani (Consultant Urologist) gave an update on renal stone management. He advocates that 50% patients will have stone recurrence in 10 years with 7-10% having recurrence within 1 year. He gave an overview of classification of stones and risk factors. Treatment modalities were also discussed with ESWL first line treatment in sub centimetre stone who Houndsfield unit is <1000. In the case of obstructive stones, nephrostomy tube insertion is gold standard if Intervention radiology is available otherwise Ureteroscopy & JJ stent insertion. He stated that the Holium laser has revolutionised stone management. He advocated the comprehensive workup of the following patients with regards to Urolithiasis-<18years, Bilateral Recurrent stones, Non Calcium stones, Pure Calcium Phosphate stones, Solitary Kidney and Systematic Disease. Stones <4mm have a 90% chance of spontaneous passage, 4-7mm stones have 50% chance and >7mm have 10% chance of spontaneous passage.
Ms P Granitsiotis (Consultant Urologist) discussed asymptomatic Bacteriuraemia (ABU). Females can be prone to same and requires two consecutives urine samples. Males with ABU prostatitis should be considered and uncontrolled diabetes should also be considered with ABU. E-coli colonisation has been shown to be beneficial in nature and not harmful as previously thought. Consider methenamine hippurate 1g 2-3 times a day for ABU with odour and mild dysuria. Recommended by NICE. Trimethoprim resistance becoming an issue. Counselling and behavioural modifications essential, please eliminate urological risk factors such as residuals and obstruction. Consider CISC for residuals. Probiotics and Cranberry juice effectiveness not proven to date.
Dr Gavin Boyd (Microbiologist) spoke about antimicrobial stewardship and urinary tract infections. Take home message is that ‘No new antibiotic on the horizon’ and multi-resistance a global issue. We need to apply ‘good practical tips’ to practice: 1) Don’t treat ABU. 2) Consider STI’s for UTI symptoms 3) Remove urethral catheters asap to prevent CAUTI 4) treat symptomatic UTI’s. What is an allergy? Question patient and Gp regarding same, some allergies are side-effects (Diarrhoea, thrush) versus allergy.
The oncology program had a strong focus on men’s health, particularly cancers that affect men only, such as prostate, testicular and penile cancers. In addition there were very insightful presentations on cancer survivorship on behavioural research for cancer prevention.
Professor Dame Lesley Fallowfield opened with a discussion on metastatic bone disease in prostate cancer. When it comes to ‘the end of treatment options’…It is important to be truthful about the prognosis and likely outcomes with and without treatment. She suggests that there should be a focus on good palliation, rather than implausible outcomes from further anti-cancer treatments. Men should be informed that something can always be done to relieve many of the worst symptoms. Take a positive approach to pain relief, improving appetite and stopping nausea.
Professor Linda Bauld, Professor of Health Policy, University of Stirling, spoke on ‘Behavioural research for cancer prevention’. This presentation focussed on the modifiable risk factors such as smoking, alcohol and obesity in cancer prevention. She presented evidence on how four in ten UK cancers could be prevented by focusing on strategies that reduce smoking and alcohol and promote a healthy diet and lifestyle. While preventing cancer through behaviour change will make a significant difference, changes to public policy, societal will and further research will be required see real progress.
Rob Cornes, Male Cancer Information Nurse, highlighted fact that if caught early, 98% of testicular cancers are curable. It is important that men and boys are not only familiar with the signs and symptoms, and know how to check themselves for lumps or bumps, but that they feel comfortable enough to seek professional advice. Men with signs and symptoms of penile cancer can be reluctant to seek help due to feeling embarrassed and going into denial about the condition. It is an important area for assessment and education.
An excellent conference which I thoroughly enjoyed and a large Irish contingent was present from hospitals in Dublin, Waterford, Cork, Galway and Northern Ireland. It is always an excellent conference for networking and gaining advice/support from Urological Colleagues in UK/Ireland. If you get the opportunity to go to BAUN, it is an experience you will not regret.
Therese Kelly, Advanced Nurse Practitioner Urology
Galway University Hospital.