Committees and Guidelines in Onco-urology. From science to politics.

Surgery is a demanding discipline requiring rigorous technique andsound theoretical knowledge to ensure precise diagnosis and appropriatesurgical management. Good training involves continuousrigorous evaluation. How can we manage training and informationwhen knowledge and surgical techniques are undergoing a permanentdeep evolution? Confronted with this dilemma French Urologistscreated in 1989 an oncology committee, to evaluate and discussresearch, teaching and practical management of urooncologicalpathology with the aim to improve patient management.The committee is composed of 40 to 60 urologists known fortheir commitment in this field from all over France both from teachinghospitals and from private clinics. The committee is organisedin subcommittees in relation to the pathology of individual organs(Prostate, bladder, kidney, testis). In 1992 some «recommendationsof sound clinical practice» were published to be followed by otherrecommendations on the different oncological disciplines withregular updates. Patient information booklets are also being regularlypublished and updated. Confronted with the permanent evolutionof urological thinking and practice the involved specialists areprogressively «tuning» their practice with national guidelines ratherthan with local management habits which may not always abide bygenerally accepted principles. Regular meetings of urologists fromall over France help to unify urology within the French UrologicalAssociation.Claude Abbou and Bernard Lobel, in charge of this uro-oncologycommittee widened in 1998 the principle of a unifying committee ata European level with the help of the European Urological Association.The European Committee is organised along the lines of theFrench committee. Supra-national guidelines are particularly suitedto countries where either urologists are split in different organisations(e.g. North and South Italian Urological Associations) orwhere such organisations do not exist. Regular meetings of urologistfrom all over Europe have allowed better understanding andharmonisation of different clinical practices taking into account thetechnological means of each individual country.