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Gustavo Villoldo: Hello, my name is Gustavo Villoldo, I am a urologist at the Alexander Fleming Institute. I want to tell you a little about the role of urology or urological surgery in the context of multidisciplinary teams. I think that the development of multidisciplinary teams has been extremely strong in uro-oncology, and it seems to me that this is directly related to the fact that surgery usually occurs in the middle of perioperative treatments.

Maybe in other specialties, surgery is either at the beginning or at the end of the treatment. Maybe that has a negative effect so that the interaction is somewhat less. In the specific case of urological or uro-oncological surgery, it seems to me that this interaction is increased by the fact that operations are done pretty much in the middle of their treatment. Then we have to discuss continually with colleagues about what we started with at the beginning, surgery or other perioperative treatments.

I think it is also important to mention that in recent years, there has been a kind of technological explosion, and that has positively impacted surgery and it has also had an impact in other areas. Radiation therapy is increasingly of better quality.

Diagnostic imaging, I would say, almost has taken on a leading role. I think I could mention that lately, half of the presentations in uro-oncology conferences are related to images, something that didn’t use to happen. So, it seems to me that the interdisciplinary or multidisciplinary group, whatever we want to call it, is getting bigger.

And also, far from having an inflow of people, we are increasingly incorporating new agents and people: radiologists, radiation oncologists, pathologists, geriatricians, in addition to the urologists and medical oncologists who have always been involved. So it seems to me that this has generated a large increase in the number of clinical trials. I also believe that there has been a resounding change in oncology with new molecules, with new drugs with new action mechanisms, for which we also need to discuss how we are going to sequence these treatments, what goes first, what goes after, the benefits, and the disadvantages.

So, it seems to me that there is no going back. I think that a multidisciplinary team is already here. I’d say it’s a thing of the past because we already started a while ago, but I see a much stronger future with multidisciplinary teams. I also find it interesting talking from a urologist’s standpoint, how technology has changed the way we treat patients and also how we are adapting in Latin America, which is a region that has more slowly incorporated these technologies, and that is obviously related directly to two things: one is the heterogeneity of the region.

Although Latin America is one continent, each country is different from the others. And the second thing has to do with access. Unfortunately, in Argentina, perhaps the most relevant technology is linked to robotic surgery, and its incorporation has been extremely slow.

Possibly… I wish I could say that… many of us do laparoscopic surgery. But few of us have access to use a robotic system, and of course, there are very few patients who can afford the cost. In general, healthcare systems in Argentina do not reimburse high-tech operations which generally have to be paid out of pocket by the patients.

For this reason, it seems to me that countries that allow more access... There are some like Brazil or Chile, for example, where insurance reimburses these procedures; there are more patients who have access to new technologies. Argentina, for the time being, is very slowly working on that. There are exceptions, but in fact, the rule is that costs are paid for by the patients themselves, and this makes the system unfair.

Very few patients have access, and somehow, that’s something that is not right. And something that we should change. I think it also happens somewhat with drugs in oncology; perhaps Argentina is a country that is very prone to quickly approving new drugs. So, we usually have patients who can access medications very efficiently, but not so much for surgical innovations. And this changes from country to country.

In Chile, for example, it is quite the opposite. It’s much easier to get access to surgical technology, but it is very difficult to access medications, and so we could list each country with its different systems. The reality is that, beyond all this, I think at least at the institution where we work, which is an institution specializing in oncology, we try to offer the best to the patients: the best treatment, the best medications, the best technological access, not only with regard to surgery but also regarding radiation therapy.

But I think that the best thing that we offer to patients is that we no longer give individual opinions. I no longer give my personal opinion to a patient, but rather, they are given institutional opinions, and it seems to me that this has much more weight. And as always, those kinds of decisions benefit patients.

Well, lastly, I want to thank UroTarget for the invitation. I am part of the group. I feel I am almost a founder; I was not a founder at the beginning, but I am almost. So, I’m thankful. This environment where we learn, socialize and we share pleasant times with friends.

And I also want to thank UroToday. I think opening the door to people who speak Spanish is very important.

I think a foothold was missing in the region, and I am very grateful for that.