Asian Urological Surgery Training & Education Group (AUSTEG)

14 Aug 2025 08:30 12:10
TICC - 1F 102
Management of UTUC and RIRS Updates
Time Session
08:30
10:10
Bannakij LojanapiwatThailand Moderator PSA Kinetics Following PADT in mHSPC. Is It a Real-World Tool for Predicting Oncologic Outcome?PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) in mHSPC. Is it a Real-world Tool for Prediction Oncologic Outcome? Bannakij Lojanapiwat, M.D. Professor of Urology, Chiang Mai University, Thailand. Of recent guidelines, upfront primary androgen deprivation monotherapy or combination therapy (PADT) is recommended for the treatment of metastatic hormone sensitive prostate cancer (mHSPC). Limitation of real-world treatment such as culture difference, financial barrier, geographic access to treatment and high operation/ radiation risks associated with medical comorbidity led to underutilization of combination therapy as the standard guideline. Prognostic factors are important in clinical practice which can predict the clinical outcome that offer the pre-treatment counseling for patients to select the optimal treatment. Prostate specific antigen (PSA) levels is one of the important key prognostic markers. PSA kinetics of nadir PSA level and time to nadir PSA following the treatment are the important role for progression to CRPC and oncologic outcome. Our study and the previous studies reported better oncologic outcome especially overall survival, cancer specific survival and time to developed CRPC in mHSPC patients received upfront PADT who decline PSA≥95% (deep responder), PSA nadir ≤ 0.2 ng/ml (low PSA nadir level), time to PSA nadir ≥ 6 month and PSA decline velocity <11 ng/ml/month. PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) is one of a real-world tool for prediction oncologic outcome in the treatment of mHSPC.
Chen-Hsun HoTaiwan Moderator Laser Lithotripsy in RIRS: Choosing the Right Settings for Better Outcomes
08:30
08:50
Kay Seong NgooMalaysia Speaker Overview of UTUC: from Diagnosis to Treatment to SurveillanceUpper tract urothelial carcinoma (UTUC) accounts for approximately 5% to 10% of all urothelial carcinomas, with an annual incidence of about 2 per 100,000 population. It predominantly affects men, who are typically diagnosed at a younger age. At the time of diagnosis, approximately two-thirds of UTUC cases involve the intrarenal collecting system, 70% are high-grade, and around two-thirds are invasive. Established risk factors include cigarette smoking, exposure to aristolochic acid, and Lynch syndrome. The majority of patients present with locally advanced disease. Diagnostic workup typically includes contrast-enhanced computed tomography (CT) urography, ureteroscopy with tissue biopsy, and selective urinary cytology. Technological advancements in ureteroscopy, including the integration of optical coherence tomography and confocal laser endomicroscopy, have shown promise in improving in vivo tumour grading and staging. Treatment strategies are guided by risk stratification and the potential for disease progression. In low-risk cases—and in selected high-risk patients with imperative indications—nephron-sparing approaches such as endoscopic ablation, segmental ureterectomy, and chemoablation may be considered. Recent evidence suggests comparable oncologic outcomes between nephron-sparing surgery (NSS) and radical approaches. Advances in endoscopic techniques, including newer laser technologies, have further improved the feasibility and efficacy of NSS. Due to higher recurrence rates following NSS, adjuvant intraluminal therapy is recommended. For high-risk UTUC, radical nephroureterectomy with bladder cuff excision remains the gold standard, irrespective of surgical modality. This is typically followed by a single postoperative intravesical instillation of chemotherapy. Adjuvant platinum-based chemotherapy has demonstrated improved disease-free survival, and emerging data suggest a potential role for immunotherapy in the perioperative setting. Given the high risk of local recurrence, especially after nephron-sparing interventions, long-term and rigorous surveillance is essential. This includes periodic CT urography, cystoscopy, and urinary cytology. Surveillance protocols vary across guidelines, particularly in terms of recommended frequency and duration.
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09:10
09:30
Hammad Ather Pakistan Speaker Current Evidence Supporting Adjuvant and Neo-Adjuvant TreatmentThe Upper Tract Urothelial Cancer (UTUC) is increasingly being considered as a genetic disorder. Following RNU, the IHC can detect a deficiency in mismatch repair proteins or microsatellite instability (MSI) using PCR. In the presence of MSI, it is necessary to undergo germline testing. High-grade UTUC is an aggressive cancer and is often associated with micrometastases, resulting in early recurrence and development of metastases. Risk classification and recognising more aggressive cancers in whom adjuvant or even neoadjuvant chemotherapy may be of benefit. One of the most crucial steps in considering patients for chemotherapy is the platinum eligibility, renal function (<30ml/min), functional status (ECOG >2) and comorbidities >2 grade are considered ineligible. There is good-quality evidence of improved survival for adjuvant chemotherapy in eligible patients following RNU for pT2–T4 and/or pN+ disease. The 2025 EAU guidelines recommend discussing adjuvant nivolumab with PD-L1-positive patients unfit for, or who declined, platinum-based adjuvant chemotherapy for ≥ pT3 and/or pN+ disease after previous RNU alone or ≥ypT2 and/or ypN+ disease after previous neoadjuvant chemotherapy, followed by RNU. However, the evidence supporting this recommendation is weak. Single intravesical chemotherapy is strongly recommended. There is currently no level 1 evidence supporting neo-adjuvant chemotherapy; however, non-randomised series have shown a decreased incidence of positive surgical margins, recurrence, and improved survival over RNU alone.Avoiding Complication in Orthotopic NeobladderIn most large series from Europe, approximately 1-2 of every 10 patients undergoing radical cystectomy have an orthotopic neobladder (ONB). Data is supporting ONB in terms of quality of life, cosmetics, and improved patient satisfaction. Early and late morbidity in up to 22% of patients is reported. The terminal ileum is the GI segment most often used for orthotopic bladder substitution. With ileo-ureteral anastomoses, there is UUT reflux, and renal functional deterioration is a concern. Various forms of UUT reflux protection, including a simple isoperistaltic tunnel, ileal intussusception, tapered ileal prolongation implanted subserosally, and direct (sub)mucosal or subserosal ureteral implantation, have been described. Superiority of one over the other is not proven. Urethral recurrence is a significant concern; therefore, patient selection must be optimal. Short-term complications are related to the GI tract, including atelectasis and metabolic acidosis. They are all preventable with standardised post-operative measures. The ERAS protocol is particularly useful in avoiding short-term complications and decreasing postoperative hospital stay, among other benefits. The key to success in preventing complications is meticulous patient selection and the implementation of preemptive measures to avoid common complications.Prostate Biopsy Technique: Current EvidenceOptimal prostate biopsy is critical in risk-stratifying patients for appropriate patient care. The traditional TRUS-guided biopsy is associated with UTI sepsis and other infectious complications. Recently, the use of the transperineal route has been advocated for the diagnosis of prostate cancer. Biopsy is either systematic or targeted. There is evidence supporting the notion that MRI-targeted biopsy without systematic biopsy significantly reduces the over-diagnosis of low-risk disease, compared to systematic biopsy. This seems true even when systematic biopsies are indicated after risk stratification with the Rotterdam Prostate Cancer Risk Calculator. EAU recommends performing prostate biopsy using the transperineal approach due to the low risk of infectious complications and better antibiotic stewardship. They also recommend using either target prophylaxis based on rectal swab or stool culture, or augmented prophylaxis (two or more different classes of antibiotics), for transrectal biopsy.
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09:50
Lukman HakimIndonesia Speaker Multidisciplinary: Metastatic Disease
09:50
10:10
Hammad Ather Pakistan Speaker Current Evidence Supporting Adjuvant and Neo-Adjuvant TreatmentThe Upper Tract Urothelial Cancer (UTUC) is increasingly being considered as a genetic disorder. Following RNU, the IHC can detect a deficiency in mismatch repair proteins or microsatellite instability (MSI) using PCR. In the presence of MSI, it is necessary to undergo germline testing. High-grade UTUC is an aggressive cancer and is often associated with micrometastases, resulting in early recurrence and development of metastases. Risk classification and recognising more aggressive cancers in whom adjuvant or even neoadjuvant chemotherapy may be of benefit. One of the most crucial steps in considering patients for chemotherapy is the platinum eligibility, renal function (<30ml/min), functional status (ECOG >2) and comorbidities >2 grade are considered ineligible. There is good-quality evidence of improved survival for adjuvant chemotherapy in eligible patients following RNU for pT2–T4 and/or pN+ disease. The 2025 EAU guidelines recommend discussing adjuvant nivolumab with PD-L1-positive patients unfit for, or who declined, platinum-based adjuvant chemotherapy for ≥ pT3 and/or pN+ disease after previous RNU alone or ≥ypT2 and/or ypN+ disease after previous neoadjuvant chemotherapy, followed by RNU. However, the evidence supporting this recommendation is weak. Single intravesical chemotherapy is strongly recommended. There is currently no level 1 evidence supporting neo-adjuvant chemotherapy; however, non-randomised series have shown a decreased incidence of positive surgical margins, recurrence, and improved survival over RNU alone.Avoiding Complication in Orthotopic NeobladderIn most large series from Europe, approximately 1-2 of every 10 patients undergoing radical cystectomy have an orthotopic neobladder (ONB). Data is supporting ONB in terms of quality of life, cosmetics, and improved patient satisfaction. Early and late morbidity in up to 22% of patients is reported. The terminal ileum is the GI segment most often used for orthotopic bladder substitution. With ileo-ureteral anastomoses, there is UUT reflux, and renal functional deterioration is a concern. Various forms of UUT reflux protection, including a simple isoperistaltic tunnel, ileal intussusception, tapered ileal prolongation implanted subserosally, and direct (sub)mucosal or subserosal ureteral implantation, have been described. Superiority of one over the other is not proven. Urethral recurrence is a significant concern; therefore, patient selection must be optimal. Short-term complications are related to the GI tract, including atelectasis and metabolic acidosis. They are all preventable with standardised post-operative measures. The ERAS protocol is particularly useful in avoiding short-term complications and decreasing postoperative hospital stay, among other benefits. The key to success in preventing complications is meticulous patient selection and the implementation of preemptive measures to avoid common complications.Prostate Biopsy Technique: Current EvidenceOptimal prostate biopsy is critical in risk-stratifying patients for appropriate patient care. The traditional TRUS-guided biopsy is associated with UTI sepsis and other infectious complications. Recently, the use of the transperineal route has been advocated for the diagnosis of prostate cancer. Biopsy is either systematic or targeted. There is evidence supporting the notion that MRI-targeted biopsy without systematic biopsy significantly reduces the over-diagnosis of low-risk disease, compared to systematic biopsy. This seems true even when systematic biopsies are indicated after risk stratification with the Rotterdam Prostate Cancer Risk Calculator. EAU recommends performing prostate biopsy using the transperineal approach due to the low risk of infectious complications and better antibiotic stewardship. They also recommend using either target prophylaxis based on rectal swab or stool culture, or augmented prophylaxis (two or more different classes of antibiotics), for transrectal biopsy.
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Michael WongSingapore Moderator Introduction to Asia School of UrologyAsian School of Urology 2022-2026 – New initiatives Dr Michael YC Wong Principal Director of ASU 2022-2026 President Endourological Society and WCET 2026 Introduction Asian School of Urology (ASU) officially started in 1999 with the appointment of her first director Prof Pichai Bunyaratavej from Thailand (1999-2002) Subsequent directors were Dato Dr Rohan Malek from Malaysia (2002-2006) Prof Foo Keong Tatt from Singapore (2006-2010) Prof Rainy Umbas from Indonesia (2010-2014 ) and Prof Shin Egawa from Japan ( 2014-2022 ). One of the highlights of the ASU in the early days were the organization of several workshops outside of UAA congress by three active sub-specialty sections of UAA namely Asian society of Endourology (over 16 workshops held from 1998-2008), Asian Society of Female Urology and Asia-Pacific society of Uro-Oncology. Other subspecialty sections were subsequently introduced and have matured very well including Asian Society of UTI and STI, Asian-Pacific Society of Andrological and Reconstructive Urology Surgeons. In the last 8 years, ASU has seen tremendous growth under the steady leadership of Prof Shin Egawa with introduction of UAA lecturers at national Meetings and further maturation of the subspecialty sections of UAA e.g., Conversion of Asian society of endourology to Asian Robotic Urological Society to reflect the growth and development of UAA. During the past 8 years, ASU-South-East Asia section has also managed to organize 15 physical workshops and 4 webinars outside of UAA congress. The Growth Trajectory for the next 4 years 2022-2026 There are many areas where ASU can grow further. Bearing in mind our limited resources and our excellent relationships with the world urological leaders at this point in our history. There are three areas which I will focus on. Please remember that ASU is always open to other new initiatives as we must stay relevant to our Asian urological community. 1. Lasting and strong Relationships 1.1 AUA. Over a dish of chili crab with AUA secretary general Gopal Badlani, we explored the common desire to elevate Asian Urology and strengthen UAA Family. This led to our first joint UAA-AUA residency course at UAA Singapore 2016. After successful completion, a MOU was signed at AUA 2017 with Richard Babayan, Manoj Monga, Allen Chiu and myself in attendance. The AURC at UAA Hong Kong under Prof Eddie Chan was the result of this signed MOU. We are extremely grateful for the generosity of AUA for this program. What may not be obvious is that Gopal Badlani, Manoj Monga, John Denstedt and I served as faculty and board directors at WCE. We will sign the extension MOU in 2023 for another three years. 1.2 EAU. We have a very successful UAA-EAU Youth program since UAA Thailand 2012. This has been the work of several UAA senior members. From 2023, we are exploring joint webinars with EAU to build on this relationship. 1.3 SIU and WCE. We will further explore options based on available resources and manpower. Joint Webinar are planned for early 2026 2. Education Platform for Asian Urology Residents From 2023, we will continue to grow our relationship with BJUI. BJUI has developed a world class online learning platform with tremendous investments since 2013. This platform is called BJUI Knowledge. ASU will reach out to all Asian residents via their national urological association president and secretary to encourage every resident to sign up for a free access to more than 420 interactive 30-minute modules covering the whole urology syllabus suitable for learning, exit exams and recertification exams. I am personally involved in developing all modules under Endourology and urolithiasis Section and have been associate editor since May 2013. The modest aim is for at least 10 residents per country to sign up by UAA 2023. We will report progress at each UAA council meeting. Pls see attached information and if there are any questions pls email me personally at email@drmichaelwong.com 3. Re-Strategize Training cum fellowship sites for ASU. 3.1 In the past we have always talked about the possibility about training sites for UAA and ASU. It has always been a difficult task due to financial and multiple logistics issues. 3.2 What can we do that is possible? Let us consider two options in the next 4 years. 3.3 For the last 6 years a group of Asian urologists started AUGTEG to design and provide two-day surgical training which includes lectures as well as dry and wet lab to develop surgical skills. AUSTEG has direct access to physical training centres in Thailand, South Korea, and China. ASU will work with AUGTEC to pool resources since we are the same people working on both sides e.g., Anthony Ng (chairman of AUSTEG) Michael Wong (vice chairman) Eddie Chan (treasurer). AUGTEG is registered in HK. 3.4 The second option is to recognise elected university or training Asian centres to allow an attachment for young urologist post residency in a flexible format. ASU will recognise officially these sites as endorsed by UAA. At UAA 2025 , several potential ASU/UAA fellowship sites directors will be presenting their programmes to kickstart this initiative 4. In conclusion, ASU will continue to grow and serve the Asian Urological Community. The above initiatives are only the beginning of a next chapter. Can you contribute your ideas and current available resources for this purpose? If you can, Pls email me personally at email@drmichaelwong.com Which Position is the Best for PCNL in 2025?With tremendous advances in both technique and technology , the MIS approach to staghorn calculi has evolved significantly over the last 30 years. It is timely to review all the landmark articles on patient positioning as this ultimately determines renal access which in turn plays a major role in stone free rates. We will gain much insight as we debate and attempt to answer the question of which position is best in 2026!
Takaaki InoueJapan Moderator New Advancement on Retrograde Intrarenal SurgeryRetrograde intrarenal surgery (RIRS) has dramatically grown up around world for stone management. Why has RIRS been getting popullar and increasing nowadays?. The reaseon are absoulutely "Technological development with collaborated engineering comapny" and " Global communicaton and collaboration in Endourology". Endourology has still been improving and expanding more and more. Thereby, many novel devices and machine are launching faster. We, urologists should catch up this faster trend and acquire these knowledge for our clinical use. However, most of urologists can not catch up it. Therefore, I will share you all these novel chage of mind and tech-knowledge of stone field in this session. Do We Need Augmented Reality for Renal Stone Management?What is Augmented reality and Vertual reality in medicine?. The paradigm shift of medicine which includes AI, Robotics, VR, and AR etc named Digital transformation has been still emerging. Of course, these shift is gradually permeating in stone field. Especially, in terms of VR, AR, we wonder if this kind of DX is useful in stone management. if so, how do we use it in clinical practice? Today, I will talk these future role in stone management, and expectation. Which Laser for RIRS: Pulsed Thulium YAG Laser We can use three kind of laser such as Holumium YAG, Thulium YAG, and Thulium fiber laser for stone management. Which lase are best option for stone patients? I will talk about featurs and advantage of pulsed-Thulium YAG laser. There are two kinds of p-Tm;YAG laser machine nowadays. P^Tm;YAG has unique characteristics as laser wave. Therefore, this laser would be able to use Stone, BPH, UTUC. Especially, p-Tm YAG laser can utilize for Stone ablation, fragmentingand and UTUC ablation, shock wave. We will share our experoence and thoughts. New Advancement on Retrograde Intrarenal Surgery
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Chen-Hsun HoTaiwan Speaker Laser Lithotripsy in RIRS: Choosing the Right Settings for Better Outcomes
10:50
11:10
Shuji IsotaniJapan Speaker ECIRS in Daily Practice: How to Achieve Better Stone-Free Rates with Fewer Complications
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Joseph LiHong Kong, China Speaker Troubleshooting in Endoscopic Stone Surgery: How to Handle Unexpected Challenges in RIRS and ECIRS
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Steffi YuenHong Kong, China Speaker The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel. The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue. The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones. FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
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Sung Yong Cho Korea (Republic of) Speaker Robotic URS: Can It Really Improve Precision and Reduce Surgeon Fatigue?Use of AI and Robots in Endourology