Tenth “Baltic25” Meeting Brings Together Baltic Urologists in Vilnius

According to Dr. Marius Kinčius, urologist and president of the Lithuanian Urological Society (LUD), this year’s conference program focused on the challenges of expanding robotic surgery in the Baltic States, the integration of AI in medicine, the importance of centralizing treatment for rare uro-oncological diseases—especially penile and testicular cancers—and the relevance of theranostics in prostate cancer treatment.
"Although the younger generation of doctors shows great interest in minimally invasive methods, their application is limited by insufficient access to equipment and training facilities. Therefore, for the fourth time, the ESU Boot Camp workshops have provided invaluable hands-on experience and are planned to continue in order to prepare the younger generation for modern urology," said Dr. Marius Kinčius.
"Oncological urogenital diseases such as prostate, bladder, or kidney cancers remain a significant challenge, despite the adoption of advanced treatment technologies in the Baltic States, particularly in Lithuania—such as laparoscopic and robotic surgeries, including the Retzius-sparing prostatectomy technique. Still, access to early diagnostics like PSMA PET/CT remains limited, and insufficient funding hinders the expansion of robotic surgery. In recent years, diagnostic and treatment algorithms for prostate cancer have evolved—PSA testing is increasingly combined with multiparametric MRI to reduce unnecessary biopsies, and molecular tests such as BRCA1/2 mutation analysis and miRNA 371 for testicular cancer help personalize treatment.

"We had an engaging session on theranostics—the ability to simultaneously diagnose and treat. We discussed the need to centralize the treatment of rare urological diseases and the expansion of robotic systems. Lithuania has four robotic systems, while Latvia and Estonia still do not have any. These are critically important regional issues. Artificial intelligence also received a lot of attention at the conference. The AI session explored its application, legal and ethical dilemmas, and the risks certain medical specialties might face," Dr. Kinčius noted.

According to LUD board member Prof. Mindaugas Jievaltas, when shaping the congress’s scientific program, the focus is typically placed on real-world issues urologists face in their everyday work in Lithuania, Latvia, and Estonia.

"Although oncology is not every urologist’s main area, a significant portion of the program was dedicated to it. Regarding oncological topics, much attention was given to surgical treatments, especially robotic technologies, which are becoming increasingly accessible in the Baltics. Lithuania is ahead in this field—we’ve had these technologies in everyday practice for several years. Although funding remains an issue, it’s clear that working without these technologies will be increasingly difficult in the future. There was also considerable discussion on advanced diagnostic tools, such as PET/PSMA scans. Latvia has used them for some time, while Lithuania has only recently begun implementing them. Throughout the congress, there were many presentations and sessions on the significance and application of these tests. Advanced cancer treatment also received much attention, with new reimbursed treatment regimens emerging, making it essential to share the latest information with physicians,” said Prof. Jievaltas about the relevance of the program’s topics.

One session was dedicated to artificial intelligence, including ethical and legal aspects, as AI increasingly becomes a support tool in medicine. However, as in other fields, it also poses challenges—for instance, how it might impact the demand for certain specialties, particularly radiology and pathology, where AI already performs a large share of the assessments.

"As surgeons, we cannot work in isolation—we must collaborate with other specialties. Sometimes this goes smoothly; sometimes, it presents challenges, but the key is the quality of care and patient benefit. The scientific program addressed various clinical topics—from cancer to stone disease and reconstructive issues. Much attention was given to the use of robotic systems, opportunities to acquire them, and the need for them. Across the Baltic urological community, similar trends are being observed. Cross-border collaboration and shared events help us better understand the major challenges and how we can solve them together by drawing on each other’s experiences," Prof. Jievaltas summarized.

According to Martin Kivi, head of the Estonian Urological Association, the scientific program—which included plenary sessions, ESU courses, practical workshops, scientific presentations, and expert lectures—provided a balanced and purposeful overview of urological issues in the Baltic region and across Europe.
"Friday morning’s plenary session ‘Prostate Cancer: Challenges and Future Directions’ highlighted one of the most pressing clinical issues—uneven access to modern diagnostic tools and treatment strategies. While guidelines recommend mpMRI before biopsy and PSMA PET/CT for staging, these tests are still unevenly available and not always reimbursed in the Baltic States. In the session on benign urological diseases, regional differences in treating BPH and urinary incontinence were emphasized—especially regarding the implementation of minimally invasive surgical techniques and standardized patient pathways.
The 2025 program was strategically aligned with current clinical challenges. Advanced prostate cancer was a dominant topic in many plenary and expert sessions, reflecting both its prevalence and the complexity of new treatment innovations. Special attention was given to optimal sequencing of antiandrogen therapy, changes in radioligand therapy criteria, and the impact of molecular imaging on treatment planning.
At the ‘Baltic25’ conference, the importance of diagnostic innovation was highlighted in presentations on molecular imaging diagnostics and targeted therapy, particularly in the context of PSMA PET and theranostics. The integration of new biomarkers, genomic classifiers, and radioligand therapy was discussed not as a distant future but as an emerging clinical reality.
A dedicated ESU session on testicular and penile cancers also emphasized the role of molecular diagnostics in identifying aggressive disease subtypes and selecting appropriate treatment. However, the full implementation of these innovations in the region will depend on healthcare infrastructure and political support," M. Kivi reviewed the congress topics.

The balanced program—from clinical plenary sessions, ESU training, and skill-building workshops to scientific presentations—reflected the ambition to improve at all levels of practice. The open, collegial atmosphere reaffirmed that the Baltic urology community not only follows international trends but actively contributes to shaping the future of the field.

"The ESU Boot Camp courses held during the conference provided a unique opportunity for young urologists to practice laparoscopic suturing, endoscopic stone removal, and use of simulation trainers. The courses were fully booked, and participant feedback was overwhelmingly positive—showing the necessity of such initiatives. Sessions like ‘Robotic Surgery Training and Mentorship’ again highlighted the need to develop sustainable training models. Although progress is evident, continued investment in structured skill development is essential to ensure new technologies are implemented safely and effectively.
Multidisciplinary approaches were frequently emphasized in plenary and expert sessions, especially for advanced prostate and bladder cancers. Clinical case discussions included insights from radiologists and oncologists, particularly in interpreting imaging and planning treatment sequences. Still, it would be beneficial to include more formalized tumor board simulations or joint sessions with specialists from other fields. Stronger ties with geneticists, pathologists, and radiation oncologists will become increasingly important as personalized medicine grows in significance in uro-oncology," shared M. Kivi.

Training Young Doctors – An Investment in the Future

The 10th Baltic Meeting kicked off a day early for seven participants from Lithuania, Latvia, and Estonia who attended the ESU Boot Camp, aimed at strengthening their skills and boosting confidence.

“The most valuable part of the training was the instructors’ willingness to share their knowledge and practical experience,” said resident Rokas Abaturovas. “What stood out most was their openness and readiness to answer questions and offer useful clinical advice. I especially appreciated the personalized format – instructors responded instantly to mistakes made during practice and answered questions right away. Thanks to that, we not only completed all the tasks efficiently but also had time to try the da Vinci robotic system. This experience significantly contributed to my growth as a urologist – I was able to perform procedures I hadn’t done before, like transurethral resections. The Boot Camp helped me deepen my skills, expand my professional knowledge, and gain valuable insights from experts in the field.”

Baltic25 Awards – Honoring the Region’s Brightest Young Specialists

Young doctors were once again recognized for their outstanding work. Among them was Mantas Fabijonavičius, a resident physician at Vilnius University Hospital Santaros Clinics, who earned the Best Poster Presentation Award for the study “Spatial Shift of CD8+ Cell Density Toward the Tumor Predicts Worse Progression-Free Survival in Patients with Clear Cell Renal Cell Carcinoma,” conducted with the team led by Prof. A. Laurinavičius.

“I’m very happy that my poster gained such interest and was awarded,” said Fabijonavičius. “Clear cell renal cell carcinoma (ccRCC) has a highly complex and heterogeneous tumor microenvironment where immune cells play a key role. While in many other cancers a higher number of CD8⁺ T cells correlates with better outcomes, their prognostic significance in ccRCC remains unclear. We aimed to determine whether the spatial distribution of CD8+ cells in the tumor–stroma interface could predict disease progression after surgery. Using digital pathology and machine learning tools, we analyzed 214 ccRCC cases treated between 2009 and 2019 at Santaros Clinics. Our results showed that a greater spatial shift of CD8⁺ cells toward the tumor center independently predicted shorter progression-free survival.”

He emphasized the importance of enhancing prognostic models with molecular biomarkers in the era of personalized medicine:
“Digital pathology opens up opportunities to study image-based biomarkers. Scanned slides with high resolution generate vast data volumes reflecting the disease phenotype in a spatial tissue context. Alongside traditional analysis, deep learning and spatial image analysis methods are rapidly evolving. Our goal is to develop a multimodal prognostic model for kidney cancer combining digital pathology, AI, and molecular marker analysis.”

Fabijonavičius also praised the congress:
“It was excellently organized, with a strong presence of urologists and other specialists from across the Baltics and Europe. The high quality of the scientific content and smooth logistics stood out. I was particularly impressed by the presentations on AI’s influence in medicine, which aligns with my research interests. I also found the European School of Urology courses especially practical and valuable for clinical work.”

Personalized Risk Tools in Prostate Cancer

Dr. Gytis Cholstauskas of the Urology Clinic at the Lithuanian University of Health Sciences (LSMU) was recognized for his scientific contribution to improving prostate cancer risk assessment through genetic markers.

“My research focused on evaluating the role of PCA3 and TMPRSS2:ERG genes in enhancing the PCPTRC2 prostate cancer risk calculator,” explained Dr. Cholstauskas. “While this calculator is commonly used to estimate prostate cancer risk, its sensitivity remains limited. By integrating these genetic tests, we achieved a significantly higher sensitivity for detecting overall prostate cancer risk. Unfortunately, the results did not reach statistical significance when it came to identifying clinically significant prostate cancer. However, this approach could still improve pre-biopsy risk assessment and help reduce the number of unnecessary biopsies.”

Dr. Cholstauskas also emphasized the broader value of the congress:
“The invited lecturers from Lithuania delivered strong, evidence-based presentations on both common and rare pathologies—highly valuable for both clinical work and research. I found the sessions on crafting impactful scientific presentations and exploring opportunities for young urologists through the European Board of Urology especially useful. These topics are directly relevant to improving my own communication skills and considering potential fellowship pathways. Naturally, I also followed with great interest the discussions on prostate cancer, as well as the latest advancements in robotic urology and the role of artificial intelligence in medicine. The congress truly provided meaningful insights for all attendees, regardless of their specific interests.”

Strengthening the Baltic Urology Community – A Key Goal

According to the Lithuanian delegates, one of the missions of this congress is to maintain close ties among urologists from the Baltic countries. While specialists frequently attend global congresses in countries like France, Germany, or Italy, there are region-specific issues that are more effectively and meaningfully addressed through collaboration within the closest geographic context.

“The scientific program was focused on innovation and current issues, but another essential aspect of the congress was communication – the relationships among colleagues. This event is not only about hearing the latest updates but also about sharing ideas, establishing or strengthening connections, and discussing developments in Lithuania, Latvia, and Estonia. Currently, medical communities collaborate closely – for example, in the field of prostate cancer, both diagnostics and treatment are quite aligned across the region. However, treatment approaches for kidney or bladder cancer may vary slightly. This congress helps to explore these differences and, where necessary, find common ground. Additionally, these meetings offer a valuable opportunity to learn from colleagues and gain insights that can be applied in one’s own country,” said Dr. Marius Kinčius.

Next Stop – Latvia

The tradition of rotating “Baltic25” meetings annually among the Baltic states continues. This year’s event in Vilnius was organized by the Lithuanian Urological Association in collaboration with the European Association of Urology (EAU). The annually held congress dedicated to the Baltic urological community is a unique opportunity to strengthen professional ties, share experiences, respond to the needs of doctors and patients, and shape the future of urology in the region through knowledge exchange.

We extend our sincere thanks to the EAU, the Lithuanian Urological Association community, partners, lecturers, residents, and everyone who contributed to making this year’s event in Vilnius scientifically valuable and a unifying experience for Baltic urologists. “Baltic26” will take place in Latvia in 2026.

We are proud, grateful, and appreciative of the members of the Lithuanian Urological Association who contributed to the scientific program and organization of the congress: R. Abaturovas, Dr. P. Aniulis, E. Buržinskis, Assoc. Prof. Dr. A. Čekauskas, G. Cholstauskas, M. Fabijonavičius, Dr. A. Gaižauskas, A. Grybas, Prof. M. Jievaltas, Dr. M. Kinčius, A. Ladukas, P. Lenčiauskas, I. Lukošius, R. Maleckaitė, U. Mickevičiūtė, G. O. Morkūnaitė, I. Noreika, Assoc. Prof. Dr. A. Patašius, G. Platkevičius, J. Purvaneckas, G. Sasnauskas, K. Snarskis, Prof. D. Trumbeckas, V. Valatkaitė, D. Vajauskas, and V. Žeromskienė.

Photo by Artūras Žukas