KSS/London South Regional Meeting incorporating the annual ...€¦ · English CL, Afshar M,...

transcript

In partnership with the Ministry of Defence

Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604

KSS/LondonSouthRegionalMeetingincorporatingtheannualDerekPackhamMemorialMedialandinauguralBillChoiaward.

Tuesday20thNovember2018

PostgraduateEducationCentre,FrimleyParkHospital,SurreyGU167UJ.

Convenors:MrAhmedAli,MrMuddassarHussain,MrAndrewChetwood

Programme:

1000 ArrivalandCoffee:

1030-1230 KSSSTCmeeting(consultantsandtraineereps)

1230-1300 JointKSS/LondonSouthMeeting

1300-1400 Lunch(Includingsponsorsexhibits)

1400-1530 Traineepresentations,Session1(Uro-oncology)

1530-1600 Coffee(includingsponsorsexhibits)

1600-1730 TraineePresentations,Session2(Benignurology)

1730-1800 PresentationfromMrIanEardley,ConsultantUrologist,LeedsTeachingHospitalsandVicePresident,RoyalCollegeofSurgeons.

1800-1815 BAUSQ&AwithMrTimO’Brien,VicePresidentofBAUS

1815-1830 Trainingupdates,AwardofDerekPackhamMemorialMedal,PrizesandtheinauguralBillChoiaward

1830-1930 DrinksandcanapesinthePGECwithdinnerafterwardsatVillaBianca,FrimleyHighStreetGU167JF(5minswalkfromhospital)

WelookforwardtowelcomingyoutoFrimleyParkforagreatdayofpresentationsandacademicdiscussion.Eachpresentationwillbe7minswith3minsforquestions.Pleasecontactanyofuswithquestionsaboutthedayandpleasecontactoneofustoconfirmyourattendancefordinner.

Nearestmainlinestation:FarnboroughMain(35minstoWaterloo),Frimley(1hourstowaterlooviaAscot)

Hopetoseeyouonthe20th

Withbestwishes

Ahmed,MuddassarandAndrew.

Ahmed.Ali6@nhs.net,muddassar.hussain1@nhs.net,a.chetwood@nhs.net

Session1–Uro-oncology

14.00 Oncological and Functional Outcomes following Salvage High-Intensity Focused Ultrasound(HIFU): A single centre evaluation 10 years later.Down C,Malthouse T, Sturch P,White E, Larner T.,Brighton&SussexUniversityNHSTrustPresentingauthor:ChrisDown

14.10Roboticassistedradicalprostatectomyafterfocaltherapy:oncological,functionaloutcomesandpredictors of recurrence. T. Stonier, L. Marconi, R. Tourinho-Barbosa, C. Moore, M. Emberton, HUAhmed, X. Cathelineau, R. Sanchez-Salas, P. Cathcart, Guy's and St. Thomas' NHS Foundation TrustPresentingauthor:ThomasStonier

14.20ConcordanceofclinicalT3stageasreportedonmulti-parametricmagneticresonanceimagingtofinalpathologicalstagingof radicalprostatectomyspecimen.MStanowski,MKQuraishi, IMorrison,EStreeterandBEddy,EastKentUniversityHospitalsNHSFoundationTrustPresentingauthor:MKQuraishi

14.30PSAScreeningTsunami-TheStephenFryEffect?MattStanowskiandBenEddy.EastKentUniversityHospitalsNHSFoundationTrustPresentingauthor:MattStanowski

14.40TREXIT-oneyearon.Canwemakeacleanbreakfromthetrans-rectalbiopsy?StromanL,NealeA, ElHageO, ChallacombeB, Cathcart P,O’Brien TS, PopertR,Guy's and St. Thomas'NHS FoundationTrustPresentingauthor:LukeStroman

14.50Longtermevaluationofqualityassuranceandlearningcurvefordynamicsentinelinguinallymphnode biopsy in penile cancer.Toomey, D, Yan S, Harrison J, AgerM,Heenan S, Ayres B, Horenblas S,WatkinN,StGeorge'sHospitalPresentingauthor:SylviaYan

15.00 Is Age an Independent Predictor for SurvivalOutcomes in Penile Cancer.English CL, AfsharM,Pickering L, Tree A, Ayres B, Watkin N., St George's Hospital, St George's University Hospitals NHSFoundationTrustPresentingauthor:DrCarolineLouiseEnglish

15.10 Retroperitoneal robotic-assisted partial nephrectomy in in patient with high BMI. RoxanneGeorgiou,ManarMalki,MuddassarHussain,NeilBarber.FrimleyHealthNHSFoundationTrustPresentingauthor:RoxanneGeorgiou

15.20 Specialist MDT for Upper Tract Urothelial Carcinoma – does it change anything? Tay LJ,ChattertonK,ColemeadowJ,AmeryS,PolsonA,ChandraA,PrezziD,RottenbergG,NairR,BultitudeM,ThomasK,Guy'sandSt.Thomas'NHSFoundationTrustPresentingauthor:JuneTay

Session2–Benignurology

16.00 Is vitamin B6 supplementation needed for cystinuric patients taking Penicillamine? NaeemaFarrah, LindaRoss,HayleyWells,DavidGame, Kay Thomas,MatthewBultitude.Guy's and St. Thomas'NHSFoundationTrust.Presentingauthor:NaeemaFarrah

16.10TotallyTubelessUltra-miniPercutaneousNephrolithotomyintheManagementofRenalCalculi:ASingleCentreUKExperience.GabrielJ,PaiA,WaiH,TheakerM,AliM,MackieS,WatsonG.EastbourneDistrictGeneralHospital.Presentingauthor:JosephGabriel

16.20Investigatinguretericcolic:aretheBAUSguidelinesfeasible?A.Brown,A.White,A.Sujenthiran,Dr R. Bendor-Samuel,N.Wijesekera, S.Dutta, F.Mugabe,Miss R. Singh. KingstonHospital.Presentingauthor:AndrewBrown

16.30Istheanswerintheirgenes?Phenotypeoffirst-degreerelativeswithcystinuria.F.Kum,K.Wong,R. Mein, M. Bultitude, K. Thomas. Guy's and St. Thomas' NHS Foundation Trust. Presenting author:FrancescaKum

16.40 Initial single centre experience of 4D prostatic Urethral lift (Urolift): A minimally invasivetechnique for symptomatic benign prostatic hyperplasia (BPH).Raghav Verma, Keng Ng, Neil Barber.FrimleyHealthHNSFoundationTrust.Presentingauthor:RaghavVerma

16.50BacterialProstatitisisasignificantfindinginpatientswithsymptomaticurethralstricturediseaseToomey D, Harrison J, Adimonye A, Bendig J, Patel P, Watkin N. St George's University NHS Trust .Presentingauthor:DeliaToomey

17.00 Patient satisfaction and service evaluation following post prostatectomy stress urinaryincontinencesurgery.YoussefChedid,KieranSheimar,ClaireTaylor,SachinMalde,ArunSahai.Guy'sandStThomas'NHSFoundationTrust.Presentingauthor:YoussefChedid

17.10IntravesicalBotulinumToxinAInjectionsinpatientsonanti-plateletandanticoagulationtherapy.ElsieEllimahMensah,BogdanToia,AndrewBrown,LinhTrangNguyen,RizwanHamid,MahreenPakzad,Roger Walker, Jeremy Ockrim, Davendra Sharma, Tharani Nitkunan, Tamsin Greenwell, Jai Seth . StGeorgesHealthcareNHSTrust.Presentingauthor:ElsieMensah

17.20 The Development of a Validated Patient Reported Outcome Measure (PROM) for PenileCurvatureSurgery.D.Akiboye,P.Patel,A.A.Campbell,N.Watkin.Epsom&StHelierUniversityHospitalNHSTrust,London.Presentingauthor:DejiAkiboye

TitleofpresentationOncologicalandFunctionalOutcomesfollowingSalvageHigh-IntensityFocusedUltrasound(HIFU):Asinglecentreevaluation10yearslater

AuthorsDownC,MalthouseT,SturchP,WhiteE,LarnerT.

InstitutionBrighton&SussexUniversityNHSTrust

PresentingauthorChrisDown

Contactemailaddressc.down@nhs.net

AbstractIntroductionBiochemicalfailurefollowingradicalradiotherapyforlocalisedprostatecancerremainshigh.Traditionallythesepatientsareofferedandrogendeprivationtherapywhichisnon-curativeandhasnotablesideeffects.SalvageHIFUisaminimally-invasivetreatmentoptionforthesepatientswithcomparableoncologicaloutcomestoradicaltreatments,withimprovedfunctionalresults.WeaimtoassesstheoncologicalandfunctionaloutcomesofsalvageHIFUinourcentreoverthepastdecade.MethodsSeventy-twopatientswithbiochemicalrecurrencefollowingradicalradiotherapyforprostatecancertreatedwithHIFUinasingleinstitutionwerefollowedupforfunctionalandoncologicaloutcomes.ResultsSeventy-twopatientswithameanageof73.1yearsunderwentsalvageHIFUforprostatecancerbetween2006-17.MedianPSApre-HIFUwas5.1(1.1–17.7)ng/ml.Patientswereclassifiedashavinglow-22.2%(16/72),intermediate-57.0%(41/72)andhigh-riskdisease20.8%(15/72).Themediantimetorecurrencefollowingradiotherapywas8(2-16)years.Medianfollow-upwas4years(1–10years).Regardingincontinence;15.2%,0%,and2.8%ofpatientshadGrade1,2,and3stressincontinencerespectively.6.9%experiencedurgeincontinence.Erectiledysfunctionaffected16.7%ofpatients.Complicationsincludedurinarytractinfections(8.3%),urethralstricture(5.6%),prostatenecrosis(2.8%)andbleeding(1.4%).MedianPSA(ng/ml)at1,3and5yearspost-HIFUwere0.77,1.02and1.27.Overallbiochemicalrecurrencefreesurvivalwas75%.DiscussionSalvageHIFUisanemergingminimally-invasivetreatmentoptionforlocalisedprostatecancer.HIFUofferslowerratesofmorbidity,withencouragingshort-tomedium-termoncologicaloutcomes.

TitleofpresentationRoboticassistedradicalprostatectomyafterfocaltherapy:oncological,functionaloutcomesandpredictorsofrecurrence

AuthorsT.Stonier,L.Marconi,R.Tourinho-Barbosa,C.Moore,M.Emberton,HUAhmed,X.Cathelineau,R.Sanchez-Salas,P.Cathcart

InstitutionGuy'sandSt.Thomas'NHSFoundationTrust

PresentingauthorThomasStonier

ContactemailaddressTomstonier@gmail.com

AbstractBackground:FollowingprostateFocalTherapy(FT),aproportionofpatientswilldeveloprecurrentdiseaseand,someofthemwillultimatelyrequiresalvagetreatment.ThetoxicityofsalvageradicaltreatmentsafterFTisnotclearlyunderstood.RoboticAssistedRadicalProstatectomyafterFT(S-RALP)isoneoftheoptionsforthemanagementofrecurrentdiseaseafterFThoweververyscarcedataexistsconcerningtheperioperative,oncologicalandfunctionaloutcomesofthisprocedureObjective:Describethesurgicaltechniqueandcharacterizetheperioperative,oncologicandfunctionaloutcomesafterS-RALP.DeterminetheriskfactorsforS-RALPfailure.Design,Setting,andParticipants:Multi-centrecohortstudyof82patientssubmittedtoS-RALPpostFT.Weincludedpatientswithalifeexpectancyofatleast10years,prostatespecificantigen(PSA)<30ng/mlandhistologicalconfirmationofresidual/recurrentprostatecancer(afterFT)withinthesixmonthsprevioustoradicalprostatectomy.InallpatientsmetastaticdiseasewasexcludedwithapelvicMRI,bonescanand/orPET-CT.Intervention(s):S-RALPOutcomeMeasurementsandStatisticalAnalysis:TheprimaryoutcomewasProgressionFreeSurvival(PFS).Secondaryoutcomeswereperioperativeandfunctionaloutcomes.ResultsandLimitations:PFSwas73.9%,48%and36.2%at12,24and36months,respectively.Therecurrencerateinthehighandintermediateriskgroupswas64.3%and34.4%,respectively.Thecontinencerate-definedbytheuseofnopads-atmostrecentfollowupwas83.1%.Onmultivariateanalysis,onlyInfieldRecurrence(HR[95%CI]=4.88[1.3-18.34];p=0.019)andpT3bstage(HR[95%CI]=3.96[1.22-12.82];p=0.02)wereindependentpredictorsofrecurrence.Majorlimitationsaretheretrospectivedesignandabsenceofacomparativearm.Conclusions:RoboticRadicalProstatectomypostFTissafewitharguablyexcellenturinarycontinenceoutcomes.MenidentifiedashavinginfieldrecurrenceafterFTappeartohavephenoypicallyaggressivediseaseshouldbecounselledaccordinglyregardingthepotentialneedforamultimodaltherapeuticapproach.

TitleofpresentationConcordanceofclinicalT3stageasreportedonmulti-parametricmagneticresonanceimagingtofinalpathologicalstagingofradicalprostatectomyspecimen

AuthorsMStanowski,MKQuraishi,IMorrison,EStreeterandBEddy

InstitutionEastKentUniversityHospitalsNHSFoundationTrust

PresentingauthorMKQuraishi

Contactemailaddressmohammedkamil.quraishi@nhs.net

AbstractIntroductionandObjectiveMulti-parametricmagneticresonanceimaging(mpMRI)oftheprostatehasdevelopedintoavitalinstrumentinthearmamentariumoftheurologist.Itisincreasingbeingusedpre-biopsyfortargeting,andasanadjuncttoguideoperativetechniqueinordertoattainsafeoncologicalmargins.Weareretrospectivelycomparingtheconcordanceofpre-biopsympMRIsoftheprostatereportedasT3tothepathologicalstageofthefinalradicalprostatectomyspecimenfromourseries.MaterialsandMethodsWeundertookaretrospectiveauditof422mpMRIstudies(1.5or3T)performedatasingleinstitutionbetween2011and2018thatwerereportedashavingT3disease.ThesewerecomparedtothepathologicalTstagereportedforeachradicalprostatectomyspecimen.ResultsOf422mpMRIs,74.2%(313)hadpositiveconcordancecT3(all)topT3(all).Ofthe109mpMRIs(25.8%)whichhadnegativeconcordance,most(102)weredowngradedtopT2.DirectTstageconcordance(cT3atopT3a,cT3btoPT3b)waspresentin61.6%ofcases(260of422).ConclusionWehaveshownthatmpMRIoftheprostateatourcentreconveysareasonablelevelofaccuracywhenusedtopredictpT3disease.However,itislessreliableinpredictingtheexactpathologicalTstageofthedisease.Thisinformationcouldbeusedincounsellingpatientsinregardstotheirindividualisedoncologicalriskofnervesparing.WeaimtoprogressthisfurtherandlearnourpositivepredictivevalueforpT3diseasebasedonmpMRI.

TitleofpresentationPSAScreeningTsunami-TheStephenFryEffect?

AuthorsMattStanowskiandBenEddy

InstitutionEastKentUniversityHospitalsNHSFoundationTrust

PresentingauthorMattStanowski

Contactemailaddressmatthew.stanowski@nhs.net

AbstractIntroductionInFebruarythisyear,thenewsthatStephenFryhadbeentreatedforprostatecancerwasmadepublic.Shortlyafterthis,BillTurnbullannouncedhehadbeendiagnosedwithmetastaticprostatecancer.WeaimtoassessandreporttheimpactofincreasedmediaattentionandawarenessofProstateCanceronatertiaryurologicalservice.MethodsWehaveassessedthevolumeofnewPSARapidAccessreferrals,DiagnosticInvestigations–PSApathologytest,multi-parametricMagneticResonanceImagingoftheProstate(mpMRI)andtransrectalultrasoundguidedbiopsyofprostate(TRUSBx),diagnosisofnewprostatecancers,volumeofRoboticAssistedRadicalProstatectomies(RALPs)andimpactoncancertargetsfromJanuary2017toAugust2018.Results:Followingtheincreasedmediaattentiontherewasasuddenriseof60%inthetotalvolumeofPSAtestsorderedacrosstheEastKentTrust.Thiswassustainedforaround2monthsandtherewereapproximately3000additionalPSAteststhanusualperformedinthisperiod.NewrapidaccessPSAreferrals,mpMRISandTRUSBxmorethantripledinthefollowingweeks.Therewasadoublingofnewprostatecancerdiagnosesinthisperiod.ConclusionsTherewasasharpriseinPSAtestingintheEastKentregionfollowingtheincreasedmediaawareness.Thisresultedina“tsunami”ofpatientsbeingreferredthroughtherapidaccesspathway.Theflowoneffectofthistsunamiwasrecordablethrougheachstepofthediagnosticpathway.ItislikelythattheEastKentexperiencewasmirroredinothercentresintheUnitedKingdom.

TitleofpresentationTREXIT-oneyearon.Canwemakeacleanbreakfromthetrans-rectalbiopsy?

AuthorsStromanL,NealeA,ElHageO,ChallacombeB,CathcartP,O’BrienTS,PopertR

PresentingauthorLukeStroman

Contactemailaddressstromanl@doctors.net.uk

IntroductionOn1stSeptember2017atGuy'sHospitalinLondon,wedeclaredourintentiontomovetoaprostatebiopsypathwayinvolvingonlyTPapproaches.Wetermedthisday,TREXIT,viz,acomplete&cleandivorcefromtrans-rectalprostatebiopsy.Wehypothesisedthatourstrategymightbesuccessfulifwecouldminimisetheneedforgeneralanaesthetic(GA)andmaximiseutilisationoffreehandTPbiopsiesperformedunderlocalanaesthetic(LA)orIVsedation(IVS)doneineitherdaysurgeryoroutpatientclinic.PatientsandMethodsAllconsecutivepatientsundergoingTPbiopsyoveraoneyeartimeperiodwereanalysedformethodofanaestheticandlocation.TPbiopsiesweredoneeitherusingacognitivefreehandtechniqueorstepperwithorwithoutMRIfusiontechnology.Complicationsweregatheredretrospectivelyfromelectronicpatientnoterecords,morbidityandmortalitymeetingsandA&Eattendances.Results678menunderwentTPbiopsy1stSeptember2017–31stAugust2018.0menunderwentTRUSbiopsy.Medianagewas60.5(range44-88).LAbiopsieswereperformedin395(58%)ofwhich168(42%ofLA)wereperformedintheoutpatientclinic.GAwasusedin205(30%)andIVSin78(11%).Provenpost-operativeurinarytractinfectionwasseenintwopatients,ofwhichone(0.15%)wasadmittedwithpost-operativesepsiswhichsettledwithIVantibioticsandfluids.Onepatientwasadmittedforclotretentionandsettledwithirrigation.Urinaryretentionwasseenin4(0.5%)andallpassedTWOC.Vasovagalepisodeswhichselfresolvedwereseenin7(1%)patients.TherewerenoClavien3orabovecomplications.ConclusionAswitchtoaTPonlybiopsystrategyhasprovedfeasibleandhasbeendeliveredwithlowcomplicationrates.Usingmoderntechniques,nearly60%oftheseTPbiopsiescanbedeliveredunderLA.

TitleofpresentationLongtermevaluationofqualityassuranceandlearningcurvefordynamicsentinelinguinallymphnodebiopsyinpenilecancer

AuthorsToomey,D,YanS,HarrisonJ,AgerM,HeenanS,AyresB,HorenblasS,WatkinN

InstitutionStGeorge'sHospital

PresentingauthorSylviaYan

Contactemailaddresssylvia.yan@doctors.org.uk

AbstractIntroductionTheroleofdynamicsentinelinguinalnodebiopsy(DSNB)inthestagingofintermediateandhighriskcN0squamouscarcinomaofthepenis(SCCp)isestablished.However,variabilityinsensitivityandconcernoverfalsenegativestudieshaslimitedtheadoptionofthetechniqueworldwide.Thereisalsoaneedtoestablishanacceptablenon-visualisationrate(N-VR)fortraceruptakeforqualityassuranceofaunit.Forthesereasons,weevaluatedourprospectivecohorttodeterminewhetherthereisalearningcurveandestablishabenchmarkforN-VR.MethodsAprospectivestudyofDSNBinourunithasbeenundertakenfrom2003-2018.Regularreviewof(N-VR)ofinguinalbasinsandclosemonitoringoffalsenegativestudyoutcomeshasbeenperformed.Attheonsetofthestudy,theunithadnotperformedanymentoredproceduresbuthadadoptedthetechniqueofacollaboratinghighvolumeunit.ThenuclearmedicinedepartmenthadconsiderableexperiencewithothertumourDSNBprocedures.Themethodologyhasremainedunchangedwiththesamedosageandsiteofinjectionofnannocolloid,gammaprobe,imagereporting,surgicalapproach,surgicalteamandhistologicalreportingthroughout.WehaveanalysedtheincidenceofourfalsenegativeproceduresandanyvariationinN-VRinconsecutivecohorts.Results1500inguinalstudieswereperformed.Eachcohortof250casesconfirmedameanN-VRof0.4%,99%CI[0.16-0.5%];therewasnostatisticallysignificantdifferencebetweenanycohort.Thefalsenegativestudiesoccurredatrandomthroughoutthe15yearsobservationwithameansensitivityrateof99.1%(Range98.8-99.6%)ineachcohort.Inthefirstcohortthefalsenegativeprocedureswereno.15,98and201.ConclusionThisisthelargeststudyreportinglongtermoutcomeoftheperformanceofDSNBforSCCp.Wehavenotdemonstratedanylearningcurveandconsistentperformanceofthetestoverthelongterm.Wehaveconfirmedabenchmarkforqualityassuranceandseenoreasontopreventpenilecancerunitsadoptingthistechnique.

TitleofpresentationIsAgeanIndependentPredictorforSurvivalOutcomesinPenileCancer

AuthorsEnglishCL,AfsharM,PickeringL,TreeA,AyresB,WatkinN.

InstitutionStGeorge'sHospital,StGeorge'sUniversityHospitalsNHSFoundationTrust

PresentingauthorDrCarolineLouiseEnglish

Contactemailaddresscarolinelouise.english@nhs.net

Introduction:Penilecancerismostcommonlybeingdiagnosedinmen>60years.However,thereisanon-validatedcommonlyheldpresumptionthatyoungerpatientshaveamoreaggressivephenotypewithhigherriskofprogressionanddeath.Methods:Aprospectivelycollecteddatabaseofpatientswithpenilecancerbetween2002-2017referredtooursupra-regionalcentre,wasinterrogated.Patientsweresplitintothreeagegroups:<55,55-74,and>74years,straddlingthemedianage.Survivalwascalculatedfromdateofindexsurgery/referraltodateofdeath.Causeofdeathwascollected,andcancerspecificmortalitycalculated.HazardratiosfordeathwerecorrectedforT-stage,gradeandlymphnodestatus.StatisticalanalysiswasperformedusingIBMSPPS25.TheKaplanMeiermethodwasusedtoanalysesurvival,andCoxregressiontablestoanalysehazardratiosfordeath.Patientswerefollowedupto5years.Results:900patientswereincludedinthestudy.Themedianagewas63(range19-91).270patientswereinGroup1,438patientsinGroup2,and192patientsinGroup3.Kaplan-Meiercurvesshowacleardisparityinsurvivalrates(LogRankp<0.027).Agreaterproportionofpatientsintheolderagegroupshadhigherstage/gradeofdiseaseandN2/N3disease.However,whencorrectedforstage,gradeandnodalstatus,thehazardratiofordeathbetweengroupswasstillsignificantat1.44(p=0.03)Discussion:Thisstudyshowsthatpenilecancerspecificsurvivalisincrementallyworsewithincreasingage,andfactorsotherthanrecognisedprognosticindicatorsareinvolved.Wepostulatethatwithincreasingageandco-morbidity,patientsmayhavelessaccesstoradicalandadjuvanttreatment.

TitleofpresentationRetroperitoneal Robot-Assisted Partial Nephrectomy in obesepatientsAuthors

RGeorgiou,MMalki,MHussain,NBarber

Institution

FrimleyHealthNHSFoundationTrust

Introduction:Obesityhasastrongassociationwithan increasedriskofrenalcancer. Nephronsparingsurgery is thegold standard treatment for clinically diagnosed T1a tumours. There are a number of studies in theliterature reporting the outcomes of transperitoneal robot-assisted partial nephrectomy in obesepatients. However, there is paucity in the literature about the role retroperitoneal RAPN in obesepatients.Inthisstudy,wereportourexperiencewithretroperitonealrobot-assistedpartialnephrectomy(RAPN)inobesepatients.

Methods:Obesity isdefinedaspersonwithbodymassindex(BMI)≥30kg/m².FromApril2012toJuly2018,109patients with BMI ≥ 30 kg/m² underwent RAPN, of whom 96 patients has retroperitoneal RAPN. Wereviewed patients’ demographic, operative data, peri-operative and postoperative complications,postoperativehistology.

ResultsTheaverageBMIwas34.51kg/m² (range30 -56.02).Theaverageageof thepatientswas57.96years(range27-79).Themedianhistologicalsizeoftumourwas32mm(range8-65).Themediantotalsurgicaltimewas127.5minutes(range64-255)withmedianwarmischaemiatimeof22.0minutes.Thelocationofthetumourinmoreonethirdofpatientswasanterior.MedianR.E.N.A.Lnephrometryscorewas6.Themedianestimatedbloodloss(EBL)is20mL(range0-2000).Threecaseswereconvertedtoopenpartialnephrectomybecauseofbleeding(3.1%).Twopatientsneededperi-operativebloodtransfusionbecauseofbleeding.Themedianlengthofstaywas2days(range1-12).BMIdidnothavean impacton the totaloperating time (p=0.735),warm ischaemia time (p=0.5),post-operativecomplicationsandlengthofstay(p=0.178).Onunivariateanalysis,obesepatients(BMIclassIII,classIIandclassI)hadhigherestimatedmeanbloodloss(296.7mL,148.33mLand43mLrespectively)(p=0.036).Ourtotalsurgicaltime,estimatedbloodlossandpost-operativecomplicationratewerefavourablewhencomparedtotheoutcomesoftransperitonealstudies(table1).

Conclusions:RetroperitonealRAPNisfeasibleinpatientswithhighBMIandprovidesgoodsurgicalaccesstotreatnon-anteriorrenalmasses.RetroperitonealRAPNisassociatedwithlessbloodloss,shortersurgicaltimewhencomparedtotransperitonealRAPNstudies.

TitleofpresentationSpecialistMDTforUpperTractUrothelialCarcinoma–doesitchangeanything?

AuthorsTayLJ,ChattertonK,ColemeadowJ,AmeryS,PolsonA,ChandraA,PrezziD,RottenbergG,NairR,BultitudeM,ThomasK

PresentingauthorJuneTay

ContactemailaddressTAYLJ85@GMAIL.COM

AbstractIntroductionUpperTractUrothelialCarcinoma(UTUC)remainsachallengingconditiontotreatduetomultipleco-morbidity,radiologicaluncertainty,difficultywithbiopsytogradeandstage,concernaboutfalsenegatives,potentialforseedinganddelaystotreatment.Toimprovequalityofcare,wecreatedaspecialistUTUCmultidisciplinaryteammeeting(SMDT)withendourologistsanduppertractoncologicalsurgeonswithinourbladdercancerMDTatourtertiaryreferralcentre.MethodsDataofthepatientsdiscussedintheSMDTwasprospectivelyrecordedbetweenJanuaryandSeptember2018.Clinical,radiologicalandpathologicalfactorswereanalysed.ResultsOf893casesinthebladdercancerMDT,167cases(100patients)werediscussedinSMDT(mean4.4cases/meeting).Meanage67years(range28-92),with63men.FromtheSMDT,48patientswithsuspecteduppertractmalignancyhadeitheradiagnosticureteroscopyand/orbiopsy,ofwhich22(45.9%)werebenignand26(54.1%)weremalignant.Theremaining52patientshadtheirdiagnosisbasedonimaging(benignn=15;malignantn=22;previousUTUConsurveillancen=4)andurinetuberculosisculture(n=1).Nineareawaitingfurtherdiagnosticinvestigationsandonepatienthadanon-urologicalmalignancy.25patientsunderwent26radicalnephroureterectomy(RNU).Ofthese,weproceededwithoutpriorureteroscopyorbiopsyin12patientsbasedonMDTdiscussion.AllwhounderwentRNUhadmalignantpathology.Twopatientsunderwentureteroscopictreatmentandsurveillance.Fourunderwentdistalureterectomy:twohaduretericstrictures,twohaddistaltumourswithassociatedbladdermalignancy.Thirteenpatientsweremanagedexpectantlyforuppertractmalignancyduetodiseaseburdenandassociatedco-morbidities.Twopatientsareundergoingchemotherapy:oneformetastaticdiseasearisingfromarenalcarcinoma,andanotherforconsiderationofpalliativenephroureterectomy.Threepatientsdeclinedsurgery.ConclusionIntroductionofanSMDTforUTUChasledtostreamlinedcarewithlessresorttoureteroscopicconfirmationandtreatmentreducingtimetodefinitivesurgerywithoutcompromisingoncologicaloutcomesasnobenignpathologyonfinalRNU.

TitleofpresentationIsvitaminB6supplementationneededforcystinuricpatientstakingPenicillamine?

AuthorsNaeemaFarrah,LindaRoss,HayleyWells,DavidGame,KayThomas,MatthewBultitude

PresentingauthorNaeemaFarrah

ContactemailaddressNaeema.farrah@kcl.ac.uk

AbstractINTRODUCTION:

D-Penicillamineisacystinechelatorthatformsadisulphidecomplexwithcysteinetoincreaseitssolubility.StudieshavesuggesteditcancausevitaminB6deficiencyandsomerecommendroutinesupplementationwithpyridoxine.Weassessedourpatientcohorttoseeifsupplementationisrequired.

METHODS:

Weanalysedourprospectivedatabaseofpatientswithcystinuriaandidentifiedpatientsrecordedastakingorpreviouslytakenpenicillamine.Weanalysedbloodcountsrenal/liverfunction,vitaminB6levels,urinarydipstickforproteinuriaandprotein:creatinineratiowhereavailable.Werecordedside-effectsandreasonfordrugcessation.

RESULTS:

From175patientsinourdatabase,30patientshaveusedpenicillamine.Ofthese17arecurrentlystilltakingthemedicationforvariableduration(4for0-5years;4for6-10years;4for11-20years;5for>21years).Noneofthesepatientshaveexperiencedhaematologicalside-effectsorsignificantproteinuriaAllpatientshavehadtheirVitaminB6levelsassessedandonly1hadamildlyreducedlevel(27.4(nmol/L))andwasofferedsupplementation.NopatientsreportedsignsorsymptomsofvitaminB6deficiency.1patientreportschronicskinchangesafter30yearsofdruguse.

13patientsarenolongeronpenicillamine;8stoppedduetoside-effects;2hadonlytakentemporarilyduetotioproninshortage;3hadtakenpenicillaminehistoricallywithnoinformationavailable.Ofthese13patients,4nowtaketiopronin.

CONCLUSIONS:

Wehaveonly1patientfoundtohavereducedvitaminB6levels.Thuswefeelthisdoesnotjustifyroutinesupplementationforallpatientsandweadvocatetestingserumlevelsandonlyofferingsupplementsifrequired.Cessationofpenicllamineduetootherside-effectsiscommon.Patientsintoleranttopenicillaminecansuccessfullybetrialledontiopronin(andvice-versa).

TitleofpresentationTotallyTubelessUltra-miniPercutaneousNephrolithotomyintheManagementofRenalCalculi:ASingleCentreUKExperience.

AuthorsGabrielJ,PaiA,WaiH,TheakerM,AliM,MackieS,WatsonG

InstitutionEastbourneDistrictGeneralHospital

PresentingauthorJosephGabriel

Contactemailaddressjgabriel@doctors.org.uk

AbstractIntroductionThereisemergingevidencethatminiaturisedtractsize,withan11-13Frtract,isassociatedwithreducedmorbidityandacceptableoutcomesinPercutaneousNephrolithotomy(PCNL).ThereishoweveranunderstandablereticencewithintheUnitedKingdomtosubjectpatientswithsmallerstoneburdentotheinvasivenatureofPCNL.OursinglecentrestudyevaluatestheoutcomesofUltra-miniPercutaneousNephrolithototmy(umPCNL)inthemanagementofsmalltomoderatevolumerenalcalculi.MethodsWeperformedaretrospectiveanalysisof44patientswhoweretreatedwithumPCNLatourinstitutionoverathreeyearperiod.AllpatientsunderwentumPCNLusinga3Frnephroscope,7.5Frinnersheathand13Froutermetallicsheath.WeusedaholmiumYAGlaserandusedabasketforstoneretrievalifnecessary.ResultsMedianstonesizewas9mm(range7to17mm).35patientsweretreatedinthesupineposition,with9prone.Stonefreerateswere98%(n=43).OnepatientintheumPCNLgroupwasleftwithapercutaneousnephrostomy;allotherpatientswerelefttubeless.Themeanoperativetimewas55minutes.Theminorcomplicationratewas15%.Therewerenomajorcomplications.Medianlengthofstaywasoneday.ConclusionumPCNLissafeandhasexcellentstonefreerates.Itisausefuladditiontothearmamentariumoftreatmentoptionsforsmallervolumerenalcalculi.

TitleofpresentationInvestigatinguretericcolic:aretheBAUSguidelinesfeasible?

AuthorsA.Brown1,A.White1,A.Sujenthiran1,DrR.Bendor-Samuel2,N.Wijesekera3,S.Dutta3,F.Mugabe3,MissR.Singh1

InstitutionDepartmentofUrology1,EmergencyMedicine2andRadiology3,KingstonHospital,GalsworthyRoad,KT27QB

PresentingauthorAndrewBrown

Contactemailaddressandrew.brown36@nhs.net

AbstractIntroductionUretericcoliciscommon.BAUSguidelinesrecommendNSAIDsas1stlineanalgesia,thatcalciumanduratearemeasuredandaCTKUBisperformedwithin14hours.MethodsTheprimaryaimofthisauditwastoevaluatewhetherCTKUBwasperformedwithin14hoursofacutepresentationinourTrust.WeauditedtheuseofNSAIDanalgesiaandthemeasurementofcalciumandurate.RetrospectivedatacollectionandinitialauditJanuary-February2018.Therenalcolicpathwaywasupdatedandare-auditperformedJuly-August2018.AllpatientswhohadaCTKUBorganisedbyA&EtoaiddiagnosiswereincludedResults120patientswereincludedintheinitialaudit(30%confirmedurolithiasis)and164inthere-audit(50%confirmedurolithiasis).TheaveragetimetoCTKUBimprovedfrom1day,2hoursand23minutesto18hoursand46minutes.TimetoCTKUBwassignificantlylongerifpatientsweresenthometoawaitanout-patientscan,thisimprovedby10hours.Thenumberofpatientswithcalciumanduratemeasuredoninitialpresentationwaspoor(7.5%and15%)aswasNSAIDusage(32%and23%).ConclusionThetimetoCTKUBimproved,althoughtheaveragetimeisstilloutsidethatrecommended.Mitigatingfactorsmayincludeinabilitytocontactpatientsawaitingoutpatientinvestigationandprioritisingclinicalworkload.Giventhelowyieldofpositivescans,itwouldbemorecosteffectivetomeasurecalciumandurateonlyinpatientswithconfirmedstones.

Titleofpresentation

Istheanswerintheirgenes?Phenotypeoffirst-degreerelativeswithcystinuria

AuthorsF.Kum,K.Wong,R.Mein,M.Bultitude,K.Thomas

PresentingauthorFrancescaKum

Contactemailaddressfrancesca.kum@gmail.com

AbstractIntroduction:Thereare2genesresponsibleforthedifferentmodesofinheritanceofcystinuria;SLC3A1(autosomalrecessive)andSLC7A9(autosomaldominant,withincompletepenetrance).Over150mutationsareknown,henceanalyzingthegenotype:phenotypecorrelationischallenging.Studyingfirst-degreerelativesinisolationmayofferusabetterinsight.Methods:30first-degreerelatives,including3twinpairs(1identical)wereidentifiedfromourcohortof160genotypedpatientswithcystinuria.MutationsweredetectedwithDNAsequencing.Phenotypicdatawerecollectedprospectively.Results:Allfirst-degreerelativeshadthesamemutation.Medianagewas37years(18-73).ThegenderdistributionwasM:F2:1,whichisdifferentfromourentirecliniccohort(M:F,1:1).TherewasanequalsplitofSLC3A1andSLC7A9genes,unlikethe2:1ratioofSLC3A1:SLC7A9seeninourcliniccohortandreportedliterature.Amongstavarietyofmutations,c.1400T>Cp.(Met467Thr)andduplicationofexons5to9werethetwomostcommonlyfoundmutationsinSLC3A1.Noneofthepatientshadthesamephenotypeastheirrelativeforstoneformation,medications,surgicalinterventions,renalfunction,urinarycystinelevelsorkidneyloss.Conclusion:Thoughitseemslogicalthatsharingagenotypeinfirst-degreerelativeswouldleadtosimilardiseaseseverity,wewereunabletodemonstratethis,evenintheidenticaltwinpair.Thecomplexityofmultiplefactorsmayresultinthevariancesinstoneformation.Furtherresearchintodiseaseepigeneticsmayprovideabetterinsightintopredictingphenotypicdifferences.Thiscouldfacilitateindividualizedtreatmentbasedonapredictionofpatients’diseaseseverity.

TitleofPresntation

Initialsinglecentreexperienceof4DprostaticUrethrallift(Urolift):Aminimallyinvasivetechniqueforsymptomaticbenignprostatichyperplasia(BPH).

Authors

RaghavVerma,KengNg,NeilBarber.

Institution

FrimleyHealthNHSFoundationTrust.

Presentingauthor

RaghavVerma

Contactemail:

Raghav.verma@nhs.net

Abstract

Introduction:

UroLiftisatransurethral,minimallyinvasiveprocedureusedtoholdtheprostaticlaterallobesawayfromurethrallumenforpatientssufferingwithsymptomaticBPH.IthasbeenshowntobeeffectiveinrelievinglowerurinarytractsymptomsinBPHwhilemaintaininggoodsexualfunction.4DUroliftisanewtechniqueinimplantdeliveryusedtomaximallywidentheprostaticurethraatbladderneck.

Methods:

Prospectiveandretrospectivedataoffiftypatientswhounderwent4DUroLiftfromSeptember2017toSeptember2018werecollected:preandpost-operativeInternationalProstateSymptomaticScore(IPSS)andQualityofLife(QoL)questionnaires,sexualfunction(IIEFandMSHQ-EjD)questionnairesandpreandposturoflowmetrydata.StatisticalanalysiswascompletedusingPairedt-test.

Results:

Therewas54%reductioninmeanIPSSfrom22.3+/-7.2to11.9+/-6.9(p<0.001).SignificantQoLscoresimprovedfrom4.6+/-1.1to2.1+/-1.8(p<0.001).ImprovementinQmaxfrom10.1+/-2.6to14.6+/-6.4mls/sec(p0.002)wasnoted.Therewerenoreportsofworseningsexualfunctionandretrogradeejaculation,withtheaverageMSHQ-EjDpost4DUroliftbeing11.5+/-3.7.Theseimprovementinresultswerecomparabletopreviousstudies(averageresultsat1year)–Graph1.

Conclusion:

Initialresultsfrom4DUrolifthasshowngoodcomparable,ifnotbetteroutcome,withimprovementoflowerurinarytractsymptomswithoutcompromisingsexualfunction.

TitleofpresentationBacterialProstatitisisasignificantfindinginpatientswithsymptomaticurethralstricturedisease

AuthorsToomeyD,HarrisonJ,AdimonyeA,BendigJ,PatelP,WatkinN.

InstitutionStGeorge'sUniversityNHSTrust

PresentingauthorDeliaToomey

Contactemailaddressdeliatoomey@doctors.org.uk

AbstractIntroductionUrinarytractinfectionsarecommonlyassociatedwithurethralstrictures,buttheevidenceforbacterialprostatitisislimitedtoonebriefreportover30yearsago.(1)Urethralstricturesymptomsandprostatitis-likesymptomsaresimilarandweconsideredthatundiagnosedbacterialprostatitismaybecontributingtothepatient’spresentation.MethodsA3yearprospectiveobservationalstudywasconducted.Malepatientswithsymptomaticpenileandbulbarurethralstrictures,whowerebeingassessedforurethroplasty,consentedtoprostateculturesusingthemodifiedMeares-Stameytechnique.Patientswithconcurrentpositiveurinecultureswereexcluded.Patientsunderwentcystoscopicassessment,stricturedilatation,cleancatchurineandprostatemassage.Prostatefluidwascollectedalongwithfirstvoidurine.Sampleswereindividuallyculturedbyadedicatedmicrobiologist.Resultswerecomparedwithculturesobtainedfromacontrolgroupofpatientswithprostatitis-likesymptomsoverthesametimeperiodwithnohistoryorevidenceofstricture.NIH-prostatitissymptomscoreswererecordedinbothgroups.Significanceofthecultureswasassessedbythemicrobiologistwhowasblindedfromthepatient’sclinicalpresentation.StatisticalsignificancewasassessedbyChisquare.Results100patientsunderwentthe3potculture.57(Group1)hadaconfirmedstricture(15%penile,56%bulbar,29%panurethral).43(Group2)hadnoevidenceofstricture.Meanprostatitissymptomscoreswere7forpain,5forurinaryand5forbotherinbothgroupsrespectively.InGroup1,47%ofpatientshadauniquelypositivebacterialculturewitharecogniseduropathogen.InGroup2,21%ofpatientshadpositivebacterialcultures.15%group1,and2.56%ofGroup2hadpositivecleancatchurine.Thefindingswerestatisticallysignificant(p=0.0087).ConclusionThisstudyhasshownforthefirsttimeincontemporarypractice,thatbacterialprostatitisispresentinalargenumberofsymptomaticpatientswithurethralstrictures.Itisalsoconfirmedtobeastatisticallysignificantlyhigherincidencethaninacohortofpatientswithclinicalprostatitisalone.Werecommendvalidationofourfindingsandsuggestthatpatientswithurethralstricturesshouldbescreenedforbacterialprostatitisbeforeanyurethralreconstructivesurgeryisundertaken.

TitleofpresentationPatientsatisfactionandserviceevaluationfollowingpostprostatectomystressurinaryincontinencesurgery

AuthorsYoussefChedid,KieranSheimar,ClaireTaylor,SachinMalde,ArunSahai

InstitutionGuy'sandStThomas'NHSFoundationTrust

PresentingauthorYoussefChedid

Contactemailaddresssonnyroth@yahoo.com

AbstractAims:Toevaluatepatientexperienceandsatisfactionfollowingpostprostatectomystressincontinencesurgeryusingvalidatedpatientreportedexperienceandoutcomemeasures.Methods:Inthissinglecentrestudy,patientswhoreceivedtreatmentwithamalesling(MS;AdVanceXP™)orartificialurinarysphincter(AUS;AMS800™)withaminimumofa1yearfollowupwerecontactedandcompleted2questionnaires;theclientsatisfactionquestionnaire(CSQ-8),andtreatmentbenefitscale(TBS).HigherCSQ-8scoresindicatebetterserviceevaluation.LowerTBSshowedbetterpatientsatisfactionwithtreatment.Results:79procedureswereundertakenon78patients(34MS,45AUS)withatleast1yearfollowup.8patientswerelosttofollowup,leaving71procedures(31MS,40AUS)in70patients.Bothersomestressincontinencewasasaresultofradicalprostatectomyin92%ofcases.Themeanfollowupwas34months(range13to60).ThemeanCSQ-8scorewas29.8(S.D.3.70)outof32.ThemeanTBSscorewas1.55(S.D.0.86)outof4.Sixtypatients(85%)gaveascoreofatleast1or2showingthatthetreatmentimprovedorgreatlyimprovedtheircondition.Conclusion:Responserateswerehighat90%.MeanCSQ-8scoreswerehigh,alongwithindividualdomainsindicatingaveryhighserviceevaluationfromthestudycohort.TBSscoreswerelowindicatinghighpatientsatisfactionwithtreatment.Patientreportedexperiencemeasuresinadditiontopatientreportedobjectivemeasuresshouldbemorewidelyutilisedtofullycapturethepatientexperience.

TitleofpresentationIntravesicalBotulinumToxinAInjectionsinpatientsonanti-plateletandanticoagulationtherapy

AuthorsElsieEllimahMensah1,BogdanToia3,AndrewBrown4,LinhTrangNguyen2,RizwanHamid3,MahreenPakzad3,RogerWalker4,JeremyOckrim3,DavendraSharma1,TharaniNitkunan4,TamsinGreenwell3,JaiSeth1

Institution1StGeorgesHealthcareNHSTrust.2StGeorges,UniversityofLondon.3UniversityCollegeLondonHospitals4Epsom,StHelierHospital

PresentingauthorElsieMensah

Contactemailaddresseellimah@doctors.org.uk

AbstractIntroductionThereislittleevidenceregardingthesafetyofIntravesicalbotulinumToxin-A(Botox)injectionsinpatientsonanticoagulant/anti-platelet(AC/ACP)medication.Thecessationofwhichmaypredisposetothromboembolicorischaemicevents.WereviewedsignificantbleedingeventsafterBotoxinjectionwithconcurrentAC/APuse.MethodsAretrospectivereviewofallpatientshavingBotoxin3LondonhospitalswasconductedbetweenJanuary2016-July2018toexaminethosewithcontinuedAC/APtherapy.Demographicdata,indicationforinjection,andside-effectsofsignificantbleedingrequiringinterventionwererecorded.Results532patientshadBotoxinjectionsduringthistime.63patients[meanage69years(range19-89),hadatotalof114separateroundsofBotoxinjectionswhilstontreatmentdoseAC/APtherapy.Eachpatienthadbetween1-7repeatBotoxinjections.AC/APuseincluded;aspirin44,clopidogrel37,warfarin19,NOAC(novel/non-vitaminKoralanticoagulant)14.PatientsonwarfarinwhohadpointofcaretestingallhadINR<3.Therewas1/114(0.88%)episodeofpost-injectionhaematuriarequiringovernightadmissionresolvingspontaneously,withcatheterisation.Thispatient,onrivaroxibanhad300UofBotoxinjectedthrough20sites,onabackgroundofpreviousprostateradiotherapy.Therewasnoreportofbladderwashoutunderanaesthesiaortransfusion.ConclusionsVeryfewsignificantbleedingeventsoccurreddespitecontinuationofAC/APtherapyduringintravesicalBotoxtreatment.Somepatientswithinthisgroupmayhaveotherfactorsthatfurtherincreasebleedingrisk.Thisisanimportantconsiderationduringpatientcounselling,andwhentreatingpatientswhohavehighriskofthrombosiswithAC/AP.

TitleofpresentationTheDevelopmentofaValidatedPatientReportedOutcomeMeasure(PROM)forPenileCurvatureSurgery

AuthorsD.Akiboye,P.Patel,A.A.Campbell,N.Watkin.

InstitutionEpsom&StHelierUniversityHospitalNHSTrust,London.

PresentingauthorDejiAkiboye

ContactemailaddressDafrochild@doctors.org.uk

AbstractIntroductionandObjectivesSubjectivemeasuresofsuccessfulpenilecurvaturesurgeryarepoorlydefined.Wedescribea6yearprospectivestudyofthedevelopmentofaPROMforpatientswithstablePeyronie'sdisease(PD)undergoingsurgeryinasinglecentre.MethodsStructuredinterviewsidentifiedfourdomainsforassessment-penileappearance(PA),erectilefunction(EF),sexualrelationshipsandgenericqualityoflife(GQoL).ARANDconsensusgroupofUKandrologistsdefinedPROM1.PAquestionswerecreatedde-novo.EFandGQoLquestionswerebasedonIIEFandEQ5-Dquestionnairesrespectively.PROM1waspilotedonallpatientsundergoingPDsurgerywithtest-retestdesign.AseconditerationPROM2wascreatedafterstatisticalanalysisandpatientfeedback,andretested.InternalconsistencywasassessedusingCronbach'salpha(CRα).WilcoxonSignedRanktestwasusedtoassesstestandretestconsistency.VariabilityandbiaswasassessedusingaBlandAltmanplot.ResultsPROM2wascompletedpre-operativelyby88menwithresponserates>90%.CRαforPAconstructshowedconsistency(0.66)omittinglengthandpainquestions.EDandsexualrelationshipconstructsshowedconsistency(CRα=0.86,1.46).GQoLconstructwasnotconsistent(0.56).GQolpain/anxietyquestionscoupledwitherectilepainquestionsfromPAconstructshowedconsistency(CRα=0.98).WilcoxonSignedRanktestforPAindicatednosignificantdifferencebetweentestandre-testscores(P>0.126).VariabilityremainedconsistentforincreasingPAscores.ConclusionsRelationshipandEDquestionswereansweredconsistentlyanddemonstratedcontentvalidityandreliability.Pain,lengthandGQoLquestionswereinconsistentlyanswered.Generalisedpain/anxietyaffectedpenilesensation.Interestingly,lengthisminimallybothersome.WearenowabletoconfirmafinalvalidatedPROM3forexternaltesting.

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