Canadian Urological Association-European Association of Urology 2025 Exchange

The Canadian Urological Association-European Association of Urology (CUA-EAU) exchange program was initiated in 2011 by CUA Past-President, Jerzy Gajewski, along with counterparts from the EAU. It was designed to foster closer relationships between the EAU and CUA and, more importantly, allow research exchange between members of both societies. The program was structured to work with a team consisting of three Canadian junior urologists and one Canadian senior urologist working within the academic or mixed (hybrid) academic setting.

Eligibility criteria for the junior urologists included age under 45 years, excellent track record in research and/or education, and active membership in the CUA. The criteria for the senior are over 10 years in practice, recognized leader/educator in the field, and evidence of CUA commitment. The three junior urologists selected were: Dr. Jennifer Bjazevic, Dr. Udi Blankstein, and Dr. Rano Matta. The senior guide was Dr. Sender Herschorn.

The team visited three centers in Europe, including the Martini Klinik in Hamburg, Germany, the Fondacion Puijvert in Barcelona, Spain, and La Paz Hospital in Madrid, Spain. The trip culminated with participation in the 40^th Annual EAU Congress in Madrid.

Hamburg, March 12–14

The Martini Klinik is a highly specialized public and private hospital solely devoted to the treatment of prostate cancer. It offers a complete portfolio for the diagnosis and treatment of prostate cancer and, together with the University Medical Centre Hamburg-Eppendorf (UKE), they care for about 7000 outpatients and perform about 2600 radical prostatectomies annually, the highest number of any single institution. The new six-story facility was opened in October 2024 and houses ambulatory clinics, diagnostic testing, clinical and research offices, eight operating rooms, and 100 beds.

For two days, the Canadian contingent was included in their prostate cancer management system. Every morning, a radiologist projected scans of the patients to be operated on that day as the medical team — surgeons, oncologists, urologists, residents, nurses, and supporting staff —listened. The discussion was open and focused on management decisions.

The surgical facility is a model of efficiency and innovative design. Each patient is anaesthetized on a transportable tabletop in an anteroom adjacent to the OR. The tabletop is then transferred to the OR and placed on a base. At the end of the procedure, the patient is awakened and transferred, still on the tabletop, to the PACU. All the patients are admitted for a five-day hospital stay, which is considerably longer than in Canada. The urologists attribute this to German reimbursement rules.

Each day, we visited the OR and observed live surgeries of robotic-assisted radical prostatectomies with daVinci Multiport/Singleport and HUGO RAS systems (Figure 1). Dr. Tobias Maurer demonstrated a robotic-assisted removal of a pelvic lymph node recurrence using a drop-in gamma probe. The patient had been injected preoperatively with [^99mTc]Tc-PSMA-I&S, a pharmaceutical for radio-guided surgery.¹

Figure 1.

The Canadian team visiting the OR at the Martini Klinik, with 3-D goggles watching a radical prostatectomy performed on the HUGO RAS robotic system. From left to right Drs. Udi Blankstein, Rano Matta, Jennifer Bjazevic, and Sender Herschorn.

Another highlight was the use of NeuroSAFE (Neurovascular Structure Adjacent Frozen Section Examination), a technique developed by the Martini Klinik involving frozen section of the prostate margins immediately after prostate removal to determine the feasibility of neurovascular bundle preservation.²

Scientific exchange time was supplemented with visits to the Hamburg Miniature Wonderland, nighttime views of the harbor atop the new Hamburg Opera House, and a guided tour of the Saint Pauli district with the iconic Reeperbahn red-light area.

Barcelona, March 15–18

In Barcelona, we spent two days at the Fundacio Puijvert (Figure 2), founded in 1961 by Professor Antoni Puigvert i Gorro as a single-speciality healthcare institution in urology, nephrology, andrology, and reproductive medicine that operates as a privately owned, nonprofit, university hospital center. It is a self-sufficient facility with an emergency department, clinics, inpatient beds, and ORs, and is very close to the main University Hospital. The urology department has 34 urologists, including the Chair, Dr. Joan Palou, five unit heads, five clinical heads, 23 members, and 15 residents.

Figure 2.

The Canadian team visiting the Fundacion Puijvert in Barcelona. Left to right Drs. Sender Herschorn, Udi Blankstein, Jennifer Bjazevic, and Rano Matta.

Dr. Palou organized a series of lectures given to us by members of the department:

• – Dr. I. Schwartzmann and Dr. Ponce de Leon presented on BPH, buccal mucosal urethroplasties, and ureteral substitution.

• – Dr. A. Gallioli spoke about management of upper tract urothelial carcinoma.

• – Dr. A. Territo presented on the group’s very large experience with robotic-assisted renal transplants.

• – Dr. O. Angerri spoke about mini-PCNL.

• – Dr. A. Kanashiro discussed lasers in endourology.

• – Dr. R. Jimenez and Dr. A. Bujons presented on complex functional urology. voiding dysfunction, endoscopic combined, and retrograde intrarenal surgery.

• – Dr. O. Rodriguez-Faba spoke on NMIBC.

• – Dr. F. Sanguedolce spoke on locally advanced prostate cancer.

• – Dr. J. Palou spoke about the management of testis cancer and the future of urothelial cancer.

• – Dr. A. Breda presented on robotic telesurgery.

• – Dr J.M. Gaya discussed neobladder in women and minimally invasive lymphadenectomy for penile cancer.

• – Dr. C. Errando presented on were vaginal mesh removal, complex artificial sphincter problems, male and female Remeex slings.

All the lectures were supplemented with questions and substantial open discussion.

While in Barcelona, we took the opportunity to go on a guided tour of the restored Sant Pau Art Nouveau Site, built between 1902 and 1930 and home to a hospital from 1906–2009 (Figure 3), as well as La Sagrada Familia basilica, Gaudi’s unfinished masterpiece.

Figure 3.

A visit to the old Sant Pau Hospital, which been restored as an Art Nouveau Site Museum. The Canadian team is pictured with members of the Fundacion Puijvert urology department.

Madrid, March 19–20

The Hospital Universitario La Paz is a large tertiary teaching hospital situated in the La Paz neighbourhood, an area in the north of Madrid that takes its name from the hospital. It is affiliated with the Madrid Regional Health Care System. The hospital opened in July 1964 as the first modern hospital center in the country. It was named to celebrate 25 years of peace after the Spanish Civil War. Today, it remains one of the largest hospitals in Madrid by number of inpatients and serves a population of more than 500 000 people. It is affiliated with the Autonomous University of Madrid.

We participated in the academic rounds in the urology department at La Paz Hospital. Dr. Martinez-Piñeiro gave a complete presentation on urethral reconstruction. He covered urethroplasty for posterior urethral reconstruction, including his results and his technique for repair of complicated rectourethral fistulas.³

After the session, we went to the operating room to observe Dr. Martinez-Piñeiro skilfully perform the procedure on a patient with a complex fistula. Simultaneously, we observed a colleague perform a PCNL for a renal pelvic stone.

We also had a chance to visit the CNIO (National Oncology Research Center) (Figure 4). The center was founded in 1998 and integrates basic and translational research (i.e., applied to diagnostics, drug discovery, and clinical approaches). It has 49 groups and units grouped into three basic research programs (molecular oncology, structural biology and biocomputing, and cancer cell biology), and two translational research programs (human cancer genetics and clinical research). It also has an Innovation Area, which includes a biotechnology program that offers support services to the rest of the programs, an experimental therapies program focused on drug development, and a technology transfer and valorization office.

Figure 4.

The Canadian team visits the CNIO (National Oncology Research Centre) in Madrid with Dr. Luis Martínez-Piñeiro (center).

During the session at the CNIO, Dr. Cristina Rodriguez-Antona spoke about inherited tumors and new insights in the molecular pathogenesis of renal cell cancer.

Spain has demonstrated global leadership in organ transplantation,⁴ culminating in record achievements in 2024, with 6464 transplants performed. Spain reached a donation rate 52.6 per million population, surpassing all other countries, including Canada. This has been attributed to a highly coordinated system that encompasses the 1979 Transplantation Act, which guarantees transparency and equity in organ allocation, a national network of transplant coordinators, and public education and coordination provided by the National Transplant Organization.⁵ Spain operates a soft opt-out system: everyone is an organ donor by default, with families of the deceased having the final say.⁴ We were given a presentation about La Paz Hospita’s renal transplant program and their experience with about 60 adult and 10 pediatric renal transplants per year.

After a tour of the outpatient clinic, we observed Dr. Martinez-Piñeiro carry out a laparoscopic live-donor nephrectomy using a high-resolution 3D video system. His colleagues then transplanted the kidney into the recipient in an adjacent room (Figure 5).

Figure 5.

Members of the urology transplant team preparing a live-donor kidney for transplant at La Paz Hospital in Madrid.

EAU Congress, March 21–24

For the next three days, we attended sessions of the EAU at IFEMA Madrid on the outskirts of the city.

On the final evening of our exchange, we were invited to the EAU President’s & International Friendship dinner held in the Crystal Gallery of the Cibeles Palace, which opened in 1919 and houses the Madrid City Hall. At the end of the dinner, Dr. Arnulf Stenzl, EAU Secretary General, presented each of with a personalized plaque commemorating the 2025 exchange program (Figure 6).

Figure 6.

The smiling Canadian team after receiving commemorative plaques for the CUA-EAU exchange at the EAU President’s & International Friendship dinner held in the Crystal Gallery of the Cibeles Palace in Madrid. From left to right: Drs. Jennifer Bjazevic, Sender Herschorn, Rano Matta, and Udi Blankstein.

The 2025 CUA-EAU Exchange Program gave us a unique and memorable opportunity to visit major academic centers and experience excellence in European urology. Each center provided a unique model of care and demonstrated scientific innovation. Each is an example of how multidisciplinary local, national, and international collaboration fosters progress.

During the visit, we also had discussions about challenges that we share. The main difference between our two systems is the availability of a private system in Europe and the incorporation of both public and private healthcare in the same facility.

We thank our respective societies for sponsoring and coordinating this initiative and for providing such a rich experience.