Dra. M. José Ribal: “We are working to treat all urological diseases in Europe in the same way”

Interview with Dr. M. José Ribal, Head of the Urological Onocology Unit. Dra. Ribal has been appointed the new president of the Office of Clinical Guidelines of the European Association of Urology. It is the first time that a woman has joined the executive of the European Association of Urology. 

Dra. M. José Ribal has been appointed the new president of the Office of Clinical Guidelines of the European Association of Urology.

What does being the new president of the European Association of Urology’s Clinical Guidelines Office involve? 

The European Association of Urology (EAU) is one of the most influential scientific associations in the world. It has 19,000 members and has links with all the other scientific associations. One of the tasks of the European Association, which represents the leading authority on urology worldwide, is to draw up the recommendations ––guidelines–– to ensure that all urological diseases are treated in the same way across the globe, based on well established and scientifically proven data. Our protocols at the Hospital Clínic for treating kidney stones or prostate cancer, to quote just two examples, are based on these guidelines.  Thus, the aim is to ensure all patients have access to the best treatment and to proven methodologies and processes. 

However, there are other factors that can influence how the guidelines are applied… the location, the quality of the professionals, the resources, etc. 

Exactly, one of the main aims that we have with the European guidelines is to verify that these guidelines reach everyone in the same way. One of the research projects focusing on the guidelines is to check precisely this in public, private, large and small centres everywhere... in order to analyse how the European guidelines are implemented.  When we are able to see how these guidelines reach the different centres, we will be able to establish policies for improving the ways in which all these guidelines reach everyone. 

How are these guidelines evaluated in such a large geographical area? 

First of all, it is very important that the guidelines reach everyone and we do that with a dissemination campaign.  The guidelines are available free of charge to all members. The guidelines are also delivered to all European congresses – in the past, paper copies of the guidelines they were sent out; now this is done virtually. And, for example, the EAU guidelines are one of the textbooks used by urology residents across Europe for their European certification exam   

Then, it is important to be endorsed by other associations. The European Association is endorsed by 75 associations across the globe, which recommend our guidelines as guidelines for action. The next step is to improve the way in which these guidelines are implemented.  Therefore, it is important to create more direct relationships in order to ensure the guidelines are used.  So as to do this, we have created a programme with representatives of scientific associations all over Europe with which we are working directly, so that they help us to ensure everyone receives the guidelines.  I think these guidelines are very highly regarded by other associations. The Scientific/European*** Society for Medical Oncology, for example, often recommends the guidelines. 

We want to include a way of interpreting the results of the treatments we carry out based on the patients’ perception

What role do patients play in all this? They are still beneficiaries of all this work… 

It is clear that one of our main objectives is to involve patients in the preparation of the guidelines.  In fact, we have a programme for incorporating the patients’ opinions and points of view into all the panels, because it is clear that medicine is changing and becoming increasingly patient-centred, and we are very aware of this.  

In addition to incorporating the patients’ opinions, we want to include a way of interpreting the results of the treatments we carry out based on the patients’ perception.  And this is based on results, reported by patients.  In this way, we will be able to evaluate the things we do. Moreover, patients are critical when it comes to writing our guidelines, and this helps us a lot.  

The first time a Spanish woman has taken on this post.  What has this experience been like for you?  

It is the first time that a woman has joined the executive board of the European Association of Urology, and is the first time that a woman has been a president of the Guidelines.  The truth is that I don't know whether it is representative that after so many years we had to wait until 2021 to see a female urologist in an executive position. However, it is true that urology is a very male-dominated speciality, and today that makes no sense.  In fact, at the European Association of Urology we are launching a campaign and creating a working group to work on equality, diversity and equality in every sense, not just in terms of gender.  I am proud to have reached this point. I am very moved when other, younger female urologists tell me that I am a role model for them.  Organizations made up of men over 50 are biased and unable to see the leadership capacity of women in this field.  

Your nomination also puts Catalan urology back in the first division again, doesn’t it? 

I think Catalan urology can be very proud of its professionals.  Many Catalan urology professionals are represented in the European Association.  For the Hospital Clínic and for Catalan urology, I think the fact that one of is members directs the European Guidelines is also a source of pride. This means we do excellent work and we are able to export it. 

What would your priorities be during your presidency of the Guidelines? 

The first thing you have to do to implement the guidelines is to have a good method, to ensure that what you are proposing is reliable and replicable. We have to consolidate, improve and expand on the current method. We have to be firmly committed to prevention, to include how to monitor our patients, and we have to incorporate how we listen to our patients' opinions and how we explain the results in their words. We want the guidelines to be an influential tool throughout Europe. Only in this way will we be able to use the resources better and improve the quality of our work. The Guidelines must also be a tool for helping to plan health policies at a European level with a fluent dialogue with the European Commission.   

People think that urological diseases only affect men, but that is not true

The challenge is enormous, because urological diseases are highly prevalent...  

Urological diseases are a major health problem. People think that urological diseases only affect men, but that is not true. Men have major health problems such as prostate cancer and benign prostatic hyperplasia. However incontinence also affects a lot of people, and kidney stones and urinary tract infections are serious health issues, in both men and women. Urologic cancers are among the 10 most frequent types of cancer in the population as a whole. We also need to bear in mind that people are living longer and longer. We are living longer and with a better quality of life.  With urological health problems prevention is important, as is a maintaining a healthy diet and doing physical exercise… We would like to have a screening programme for prostate cancer. We have them for bowel cancer and breast cancer. We need to make the male population aware that the sooner we detect cancer, the easier we can cure it.