Plenary Session 4

Hio Fai LaoMacau, China Moderator

Stephen S. YangTaiwan Speaker UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required. In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.

Samuel Vincent G. YrastorzaPhilippines Moderator

Rajeev KumarIndia Speaker Troubleshooting in Endoscopic Stone Surgery: How to Handle Unexpected Challenges in RIRS and ECIRSProstate Cancer Nomograms and Their Application in Asian MenNomograms help to predict outcomes in individual patients rather than whole populations and are an important part of evaluation and treatment decision making. Various nomograms have been developed in malignancies to predict and prognosticate clinical outcomes such as severity of disease, overall survival, and recurrence-free survival. In prostate cancer, nomograms were developed for determining need for biopsy, disease course, need for adjuvant therapy, and outcomes. Most of these predictive nomograms were based on Caucasian populations. Prostate cancer is significantly affected by race, and Asian men have a significantly different racial and genetic susceptibility compared to Caucasians, raising the concern about the generalizability of these nomograms. There are very few studies that have evaluated the applicability and validity of the existing nomograms in in Asian men. Most have found significant differences in the performance in this population. Thus, relying on such nomograms for treating Asian men may not be appropriate and collaborative efforts are required within Asian countries to develop locally relevant nomograms.What Is Critical Appraisal?Critical appraisal is the process of systematically evaluating research studies to assess their validity, relevance, and trustworthiness. The goal is to determine whether a study’s results are credible and useful for clinical decision-making, research, or policy. This has become increasingly important as there has been a massive increase in the number of scientific journals and not all published research is of equal quality. Critical appraisal helps healthcare professionals avoid being misled by poor-quality studies, make evidence-based decisions and improve patient outcomes. The key purposes are to assess validity of the study and its results and determine applicability to the specific population. It involves assessing the study design, methodological quality, completeness of reporting, potential sources of bias and potential for misconduct. There are number of reporting guidelines that can be used for performing critical appraisal. Additionally, being aware of essential reporting standards and common problems with studies can help readers make informed decisions.Scientific Misconduct and PitfallsNo abstractExample of the “Ideal” AbstractNo Abstract

Yeong-Shiau PuTaiwan Moderator

Freddie HamdyUnited Kingdom Speaker BJUI Lecture: 2025 Protect Trial update & the Caveats of Its GeneralizabilityIntroduction

Eddie ChanHong Kong, China Moderator How to Escape Surgical ComplicationsSurgical complications can significantly impact patient outcomes and healthcare resources. This talk will focus on practical strategies to minimize complications in urologic surgery, tailored specifically for urology fellows. Real-life case examples will illustrate how thoughtful preparation and proactive communication can prevent or mitigate complications. Additionally, we will discuss structured approaches to managing complications when they arise, including communication with the patient and team, documentation, and timely intervention. Through real-life case examples, this session aims to enhance surgical judgment, promote patient safety, and build confidence in complication management.

Mikio SugimotoJapan Speaker Active Surveillance for Early Prostate CancerActive surveillance for early prostate cancer The global incidence of prostate cancer is steadily increasing. While the prevalence has historically been lower in Asia compared to Western countries, recent trends suggest a significant rise in prostate cancer cases across the region. This increase is likely attributed to the Westernization of dietary habits and the aging population. The widespread use of prostate-specific antigen (PSA) screening has led to an increase in the detection of early-stage prostate cancer, which is a positive development. However, this has also resulted in the identification of a substantial number of low-grade, indolent cancers that are unlikely to impact life expectancy, raising concerns about overdiagnosis and overtreatment. Active surveillance has emerged as a practical and effective strategy to address overtreatment in the PSA era. Although the adoption of active surveillance has increased dramatically in Western countries, its implementation in Asia remains limited. In Japan, a large-scale prospective observational study, PRIAS-JAPAN, has been underway since 2010, with over 1,400 patients enrolled to date. In this report, we briefly present the findings of PRIAS-JAPAN and explore strategies to promote the broader and more effective use of active surveillance in clinical practice.

Bannakij LojanapiwatThailand Speaker 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.

Horie ShigeoJapan Moderator

Seung Il JungKorea (Republic of) Speaker The Potential Role of Urinary Microbiome in Benign Prostate Hyperplasia/Lower Urinary TractHistorically, urine in the urinary tract was considered “sterile” based primarily on culture-dependent methods of bacterial detection. However, the advent of enhanced quantitative urine culture (EQUC) and 16S ribosomal RNA gene sequencing has revealed the presence of bacterial DNA and live bacteria in the urinary tract, fundamentally changing our understanding of the urogenital microbiome. Recent studies have demonstrated that healthy men, like women, possess distinct urinary tract microbiota. While evidence linking the urinary microbiota to lower urinary tract symptoms (LUTS) in women is accumulating, the association between urinary microbiota and LUTS in men, particularly those with benign prostatic hyperplasia (BPH), remains under investigation. Emerging evidence suggests that dysbiosis of the urinary microbiota may contribute to BPH development and symptom severity through mechanisms such as chronic prostatic inflammation, inflammasome activation (e.g., NLRP3), and microbial-driven DNA damage in prostate epithelial cells. Notably, organisms like Escherichia coli and Burkholderia spp. have been implicated in intraprostatic inflammation and progression of BPH. Additionally, the gut–prostate axis has gained attention as gut microbiota composition—particularly a high Firmicutes/Bacteroidetes ratio—has been associated with BPH via metabolic and immunological pathways. These findings open new avenues for microbiome-targeted therapies, including probiotics and modulation of intestinal microbiota, to prevent or manage male LUTS/BPH. This lecture reviews current evidence linking the urogenital microbiome to BPH pathogenesis and symptomatology in men. Despite promising findings, clinical translation remains limited due to heterogeneity in sampling methods and lack of robust, large-scale studies. Further research is required to validate microbial biomarkers and develop evidence-based, noninvasive strategies for prevention and treatment of male LUTS/BPH.