ABSTRACT SIU 2016 BUENOS AIRES, ARGENTINA
book
Featuring the SIU-ICUD Joint Consultation on the Urologic Management of the Spinal Cord Injured Patient and the 2nd SIU Nurses’ Educational Symposium
www.siu-urology.org
ABSTRACT SIU 2016 BUENOS AIRES, ARGENTINA
book
Featuring the SIU-ICUD Joint Consultation on the Urologic Management of the Spinal Cord Injured Patient and the 2nd SIU Nurses’ Educational Symposium
COMMITTEES
SCIENTIFIC PROGRAMME COMMITTEE CHAIRS Gopal Badlani, United States Margit Fisch, Germany
MEMBERS
REVIEW COMMITTEE The SIU wishes to extend its gratitude to the urologists who contributed their time to review abstract submissions for the 36th SIU Congress
Damien Bolton, Australia Raymond Costabile, United States
Pamela Ellsworth, United States Tarik Esen, Turkey Margit Fisch, Germany Robert C. Flanigan, United States Keong Tatt Foo, Singapore Jerzy B. Gajewski, Canada Petrisor Aurelian Geavlete, Romania Peter Gilling, New Zealand Sidney Glina, Brazil Reynaldo Gomez, Chile
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SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Sanjay Balwant Kulkarni, India Pilar Laguna, The Netherlands Dirk Lange, Canada Paul H. Lange, United States Howard Lau, Australia Nathan Lawrentschuk, Australia
V
COMMITTEES
REVIEW COMMITTEE cont. Mohamed A. Lezrek, Morocco
Antonio Carlos Lima Pompeo, Brazil
Ahmad Shamsodini, Qatar
William J. Lynch, Australia
Fu Quing, China
Shahrokh Shariat, Austria
Sunny Doodu Mante, Ghana
Pradeep Rao, India
Joseph A. Smith Jr, United States
Tadashi Matsuda, Japan
Oliver Reich, Germany
Raimund Stein, Germany
Jack W. McAninch, United States
Ricardo Rendon, Canada
Yinghao Sun, China
Jean McDonald, United Kingdom
Jerome P. Richie, United States
Simon Tanguay, Canada
Philip M. McDougall, Australia
Alejandro Rodriguez, United States
George N. Thalmann, Switzerland
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Michael Metro, United States
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Judd W. Moul, United States
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Igor Vaz, Mozambique
Masaru Murai, Japan
Fernando Secin, Argentina
Remigio Vela Navarrete, Spain
Declan Murphy, United States
Arnauld Villers, France
Seiji Naito, Japan
Isabel A. M. Sesterhenn, United States
Osamu Ogawa, Japan
Rupin Shah, India
Manfred Wirth, Germany
VI
Luc Valiquette, Canada
Nick Watkin, United Kingdom
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
TABLE OF CONTENTS
ABSTRACT SIU 2016 BUENOS AIRES, ARGENTINA
book MODERATED ePOSTERS Moderated ePosters Session 1 Minimally Invasive Surgery Friday, October 21, 1425–1555
Moderated ePosters Session 13
1
Moderated ePosters Session 2 Adrenal, Kidney & Ureter Friday, October 21, 1425–1555
Friday, October 21, 1425–1555
7
Friday, October 21, 1425–1555
11
Friday, October 21, 1615–1745
Prostate Cancer—Advanced & Localized Disease Saturday, October 22, 1615–1745
Infections & Inflammatory Diseases Sunday, October 23, 1425–1555
17
Bladder Cancer Sunday, October 23, 1425–1555
22
Sexual Function & Dysfunction Sunday, October 23, 1425–1555
Moderated ePosters Session 18
Pediatric Urology
Stones II
29
Moderated ePosters Session 7 Prostate Cancer—Various Topics Friday, October 21, 1615–1745
34
Moderated ePosters Session 8 BPO/LUTS Friday, October 21, 1615–1745
40
Moderated ePosters Session 9 Kidney & Ureteral Cancer—Various Topics Saturday, October 22, 1425–1555
48
Saturday, October 22, 1425–1555
53
Moderated ePosters Session 11 Reconstruction and Trauma II Saturday, October 22, 1425–1555
87
Sunday, October 23, 1425–1555
93 99
UNMODERATED VIDEOS Thursday, October 20 to Saturday, October 22, 0800–1800 Sunday, October 23, 0800–1600
105
RESIDENTS’ FORUM Saturday, October 22, 1425–1745
121
UNMODERATED ePOSTERS
Moderated ePosters Session 10 Prostate Cancer—Detection & Screening
82
Moderated ePosters Session 17
Moderated ePosters Session 6 Friday, October 21, 1615–1745
76
Moderated ePosters Session 16
Moderated ePosters Session 5 Urinary Incontinence
71
Moderated ePosters Session 15
Moderated ePosters Session 4 Stones I
Saturday, October 22, 1615–1745
Moderated ePosters Session 14
Moderated ePosters Session 3 Reconstruction and Trauma I
Kidney & Ureteral Cancer—Treatment
Thursday, October 20 to Saturday, October 22, 0800–1800 Sunday, October 23, 0800–1600
129
59
Moderated ePosters Session 12 Basic Science Saturday, October 22, 1615–1745
65
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
VII
Bringing Urologists Together
www.siu-urology.org
MODERATED ePOSTERS
Moderated ePosters Session 1 Minimally Invasive Surgery Friday, October 21 1425–1555 MP-01.01 Analysis of Laparoscopic Simple Prostatectomy and Holmium Laser Enucleation for Large Prostates Thanigasalam R1, Juaneda R2, Theveniaud PE3, Baumert H3 1
Concord Hospital, Sydney, Australia; 2Centro Medico de Cordoba, Cordoba, Argentina; 3Hopital Paris Saint Joseph, Paris, France Introduction and Objective: To compare efficacy and outcomes of two minimally invasive techniques, holmium laser enucleation of the prostate (HoLEP) with laparoscopic simple prostatectomy (LSP) in the treatment of bladder outlet obstruction due to large prostatic adenomas. Materials and Methods: Prospectively collected data was analysed retrospectively, comparing outcomes of 20 trans-vesical laparoscopic simple prostatectomies with 20 HoLEP procedures performed by the same surgeon (HB). Patients in the two groups were pairmatched. Study variables included operative and catheterization time, hospital stay, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax) and complication rates. Results: There were no significant differences in patient age (p=0.6630), estimated preoperative prostatic size (p=0.9181), operating time (p=0.1694) or specimen weight (p=0.1461) between the 2 groups. Duration of catheterization (p=0.0008) and hospital stay (p<0.0001) were significantly less in the HoLEP group. No patient in either group required a blood transfusion. In the HoLEP group, mean IPSS decreased from 21 to 4.8 after surgery (p <0.0001), and mean urinary flow rate (Qmax) also improved from 6.45 ml/sec to 24.75ml/sec (p =0.0007). In the laparoscopic group IPSS improved (23.5 to 7.65; p <0.0001) and Qmax increased (8.95 to 24.81; p <0.0001). There was a significant difference in postoperative IPSS between HoLEP and LSP (p = 0.0103) in favor of the HOLEP group. There was no significant difference in postoperative Qmax at 3 months (p = 0.9872). In the HoLEP group, 4 patients (20%) experienced complications according to the modified Clavien classification system. Three were grade I and one IIIb. In the laparoscopic group, 5 patients suffered complications (25%). Four of them were grade I and one grade II. Conclusion: HoLEP has similar functional results and
complication rates when compared with laparoscopic simple prostatectomy in large glands, with the advantage of providing a shorter catheterization time and reduced hospital stay.
MP-01.02
MP-01.03
Results and Benefits of the Prostatic Adenomectomy Transvesical Laparoscopic Extraperitoneal
Efficacy and Safety of Photoselective Laser Vaporization of the Prostate (PVP) in High-Risk Surgical Patients
Geddo D
Tomaskin R, Kliment Jr. J, Sulgan J, Jonas M, Kliment J
City Clinic, Bra, Italy Introduction and Objective: We evaluate the results
and the benefits of prostatic adenomectomy transvesical laparoscopic extraperitoneal in a series of a single surgeon. Materials and Methods: Between January 2010 and September 2015, 200 patients underwent prostatic adenomectomy transvesical laparoscopic extraperitoneal for obstructive prostatic hypertrophy. The average age of patients was 67.74 years (range 54-84). The average weight of the adenoma was 90.84 gr (range 80-165). The mean operative time was 133 minutes (range 60-240). The average amount of blood lost during surgery was 80 ml (range 30-200). The bladder catheter was positioned in the bladder and not in the prostatic bed. It has never been positioned continuous bladder washing. No patient needed blood transfusion or urgent intervention to macrohaematuria. The bladder catheter was removed for the first 10 patients on the seventh postoperative day, for the next 50 on the fiftieth day, and for the last 140 on the third day. Results: All patients urinated spontaneously and were continent. At follow-up, the uroflowmetry demonstrated a maximum normal flow with a negative bladder residue (average flow max 34.12 ml/ sec, range 25-47 ml/sec). A total of 63 patients had urinary disorders for overactive bladder resolved with anticholinergic therapy for 90 days. All sexually active patients had retrograde ejaculation. Patients who had normal erectile activity before surgery have reported an improvement of the same function, in particular those who had very bulky adenomas. No patients had stricture scar of the urethra and the bladder neck.
Dept. of Urology, Jessenius School of Medicine, University Hospital, Martin, Slovakia Introduction and Objective: The ageing of the population becomes a challenge for urologists, considering that an increased proportion of BPH patients require surgery with higher ASA status. TURP/open prostatectomy, despite being the gold standard in BPH treatment, is unsuitable for many of those patients, with a high incidence of peri- and postoperative complications. PVP can significantly improve QoL in comparison to long-term urinary bladder catheterization. This study evaluates the efficacy and safety of PVP technique performed in patients with grade 3-4 according to ASA classification of preoperative risk. Materials and Methods: Patients with BPH and ASA
III-IV treated by GreenLight XPSTM 180 W at our department since November 2012 were included in the study. Prostate volume (PV), PSA, uroflowmetry (Qmax), voiding status before PVP (urinary retention requiring catheterization yes/no), middle lobe presence (yes/no), active laser time and total procedure time, surgical and post-operative complications were recorded for each patient and analyzed by descriptive statistical methods.
• absence of pain or discomfort on the part of the patient for the failure positioning or the catheter balloon inflated in order styptic in the prostatic bed;
Results: PVP was performed in 61 high-risk patients (median age 73 years, range 56-89). Mean PV (±SD) was 60.6±27.4 ml, including 19 (31.1%) patients with prostate volume exceeding 70 ml (70-138 ml). Significant middle lobe was present in 25 (41%) cases. Urinary retention with failure of catheter removal occurred in 26 (42.6%) patients. Initial PSA was 4.1±3.8 ng/ml, Qmax 10.0±4.7 ml/s. Recorded active laser time was 41.0±22.3 min and total procedure time 54.3±28.0 min. Two patients experienced peri-operative complications (1 bladder perforation requiring open surgery and 1 prolonged bleeding requiring bipolar electrocoagulation). Blood transfusion wasn’t necessary. The urinary catheter was successfully removed at first or second attempt in 55 (90.2%) and 4 (6.6%) of cases, respectively. Two patients required minimal TURP nearby verumontanum. Median duration of hospital stay was 2 days, and with catheterization, was 1.2 days. All patients urinated spontaneously. Postoperative complications included 4 febrile UTI, 2 gross haematuria managed conservatively and 1 prolonged refractory urgency. Incidence of some urgency was 30% and 1 patient suffered from mixed urinary incontinence.
• no risk of postoperative macrohaematuria.
Conclusion: PVP is a very safe and highly effective
• On the basis of these data, we believe that prostatic adenomectomy transvesical laparoscopic extraperitoneal can be one of the therapeutic options in the treatment guidelines of obstructive prostatic hypertrophy.
mini-invasive approach in high-risk BPH patients. Effectiveness and complication rate is comparable to TURP, and prostate volume limitation even exceeds it. PVP, in comparison to TURP, allows faster recovery and shorter time of catheterization and hospitalization.
Conclusion: In addition to the known advantages of
the laparoscopic surgery, by this work results: • without stricture scar of the urethra and the bladder neck, compared to most statistical incidence (5-6%) in endoscopic transurethral surgery; • a shorter hospital stay, as in endoscopic surgery; • failure to use the continuous bladder washing;
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
1
MODERATED ePOSTERS MP-01.04 Clinical and Oncological Outcomes of Robot-Assisted Anterior Exenteration for Urinary Tract Cancer Shah SH, Singh A, Chatterjee S, Bansal P, Shukla H, Rawal S Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India Introduction and Objectives: Anterior pelvic exenteration is the treatment of choice for localized urinary tract cancer in females. Robot-assisted surgery is proving to be beneficial in most pelvic surgeries but studies on robot-assisted anterior exenteration (RAAE) are few. The present study aims to assess the clinical, oncological and survival outcomes of RAAE in urinary tract malignancies. Materials and Methods: This is a single institutional,
prospective study, which includes patients undergoing RAAE for urinary tract cancer, from May 1, 2011 to December 31, 2015. Operative details, histopathological reports and perioperative outcomes were analyzed using descriptive statistics. Patients were followed every 3 months for the first 2 years, and every 6 months thereafter. Overall and disease free survival were calculated using Kaplan Meier method.
Galiano M2, Salonia A1, Briganti A1, Montorsi F1, Cathelineau X2 1
Div. of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; 2 Dept. of Urology, Institute Mutualiste Monsouris, Paris, France; 3Dept. of Urology, Hospital Central Militar, SEDENA, D.F., Mexico
Introduction and Objectives: Over the last two decades, minimally invasive surgery (MIS) has been widely developing in urological oncology. We provide updated estimates of perioperative morbidity, cancer control trends and survival of prostate cancer, bladder cancer and kidney cancer treated at European minimally invasive surgery referral center. Materials and Methods: Between 2000 and 2010,
patients who underwent minimally invasive radi-
cal prostatectomy, radical cystectomy, and radical nephrectomy or partial nephrectomy, respectively, were identified in our Institutional prospectively maintained oncology database. Mean operative time (MOT), mean blood loss (MBL), mean hospital stay (MHS), transfusion rate (TR) and complication rate (CR) were assessed. Cancer control was defined as BCR free survival rate (BFSR) and BCR free survival mean time (BFSMT) for prostate cancer and clinical relapse free survival rate (CRFSR) and clinical relapse free survival mean time (CRFSMT) for bladder cancer and kidney. Cancer specific survival (CSS) was assessed. Results were matched with historical open series performed in the same time period. Results: Overall, 4922 patients underwent minimally invasive oncologic surgery, of which 3947 radical prostatectomies, 251 radical cystectomies, 486 radical
MP-01.05, Table 1. Surgical Procedure
Variable
Minimally invasive surgery
Open surgery
Radical prostatectomy
Mean operative time, min (SD)
Mean blood loss, ml (SD)
Mean hospital stay, days
5
7
Results: Twenty-seven patients undergoing RAAE were included in study with a mean age of 60.3 +/2.15 (37-82) years and a mean BMI of 23.3 kg/m2. Most patients had comorbidities. Clinically, 70.4% patients had muscle-confined disease (cT2/T3/ T4 = 19/7/1) and 70.4% patients had node negative disease (cN0/N1 = 19/8). RAAE was completed in mean duration of 153.26 +/- 8.10 (110-270) minutes with average blood loss of 194.81 mL without any intraoperative injury, bleeding or conversion to open surgery. Urinary diversion comprising ileal conduit, neobladder and cutaneous ureterostomy was done in 18, 8, 1 patients in total surgical duration of 312.22 +/- 17.16 (230-420), 371.25 +/- 20.74 (300-450) and 220 minutes respectively. The mean ICU stay was 3.7 days and time to oral diet was 4 days. None of the patients had wound-related complications, while grade ½ complications (rising creatinine, sepsis) were seen in 2 patients and grade 4 ureteric leak in 1 of our patients. Histopathology showed high-grade urothelial carcinoma in 77.8%, extravesical extent in 55.5% and nodal positivity in 25.9% patients. Average lymph node yield was 22.3 +/- 1.6 and all patients had R0 resection. Four-year actuarial overall and disease free survival was 74.2% and 72.1%. Local and systemic recurrence was seen in 3 and 2 patients.
Transfusion rate, %
3.6
9.6
Complication rate, %
23.2
12
BCR free survival rate, %
80.2
53
BCR free survival mean time, months (SE)
Cancer specific survival rate, %
Cancer specific survival mean time, months (SE)
187.58 (0.1)
N/A
Radical cystectomy
Mean operative time, min (SD)
243.7 (69.9)
500.6 (109.7)
Mean blood loss, ml (SD)
611.2 (626)
1063 (893)
Mean hospital stay, days
16.7
27.1
Transfusion rate, %
26.5
56.7
Complication rate, %
29.9
74
Clinical relapse free survival rate, %
69.3
58
Clinical relapse free survival mean time, months (SE)
Cancer specific survival rate, %
Cancer specific survival mean time, months (SE)
174.37 (1.7)
N/A
Radical nephrectomy
Mean operative time, min (SD)
122.8 (55.7)
182 (61)
Mean blood loss, ml (SD)
179.2 (300)
388 (359)
Complication rate, %
18.9
15.5
Clinical relapse free survival rate, %
78.9
92.8
Clinical relapse free survival mean time, months (SE)
Conclusion: RAEE has acceptable oncological and
Cancer specific survival rate, %
Cancer specific survival mean time, months (SE)
186.55 (0.7)
N/A
Partial nephrectomy
Mean operative time, min (SD)
133.9 (49.5)
152 (18)
Perioperative Complications, Cancer Control and Survival of Surgically Treated Urological Cancers (Prostate, Bladder and Kidney) at European Minimally Invasive Surgery Referral Center
Mean blood loss, ml (SD)
296.6 (396)
417 (202)
Complication rate, %
29.8
4
Clinical relapse free survival rate, %
Clinical relapse free survival mean time, months (SE)
Russo A1, Sanchez-Salas R2, Sivaraman A2, PerezReggeti JI2, Linares E2, Hernandez G3, Di Trapani E1, La Croce G1, Castiglione F1, Barret E2, Rozet F2,
Cancer specific survival rate, %
Cancer specific survival mean time, months (SE)
survival outcomes with less blood loss and early recovery.
MP-01.05
2
167.9 (42)
208.5 (76)
447.6 (330.2)
821.4 (582)
155 (1.1)
N/A
99.7
98%
47 (3.5)
N/A
97.2
75%
134.9 (4.6)
N/A
99.2
96.6
94
96
148.9 (3.4)
N/A
99.6
96
187.31 (0.7)
N/A
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS nephrectomies and 238 partial nephrectomies. The results are summarized in Table 1. For radical prostatectomy, the minimally invasive approach achieved shorter MOT and MHS, lower MBL and TR than open surgery as well as a cancer control and CSS at least were comparable to open surgery. Minimally invasive cystectomy showed shorter MOT and MHS, lower MBL and TR and CR than open surgery and cancer control and CSS at least was comparable to open surgery. Minimally invasive radical nephrectomy revealed shorter MOT and lower MBL than open surgery. Cancer control was better in open radical nephrectomies but CSS was similar in both groups. Minimally invasive partial nephrectomies presented shorter MOT and lower MBL than open surgery with comparable cancer control and CSS in both cohorts. Conclusions: MIS positively impacted results in terms of complications, cancer control and survival even during the initial experience with these techniques for all urological cancers.
MP-01.06 Laparoscopic Partial Nephrectomy with 3D Modeling of Retroperitoneum Space for Preoperative Planning and Intraoperative Navigation Dubrovin V1, Egoshin A1, Batukhtin D2, Chernyshev D2, Eruslanov R2, Rozhentsov A2, Furman I2 1
Dept. of Urology, Republic Clinical Hospital, YoshkarOla, Mari El Republic, Russia; 2Volga State University of Technology, Yoshkar-Ola, Mari El Republic, Russia Introduction and Objective: Laparoscopic partial
nephrectomy holds a leading position in the management of small renal tumors. We present the method of intraoperative navigation for laparoscopic partial nephrectomy with the original computer program “Volga-M” (cert. n°2015660462), based on the function level and active contours and the initial clinical studies of using intraoperative navigation with 3D digitizer during laparoscopic partial nephrectomy. Materials and Methods: Original software “Volga-M”
based on the mathematical models of the structural elements of the body we accepted a law of probability distribution of the brightness and dispersions values. A method for combining a virtual model of the body image with video 3D printed model, using a video camera, combined with the 3D digitizer. When using augmented reality technology, we combined the 3D model image with the video of kidney tumor. The method performed for the 10 patients with small renal tumors, who needed in surgical treatment. Laparoscopic partial nephrectomy underwent 10 patients, 4 (40%) men and 6 (60%) of women middle age 43.7 (38-54) years, with clear cell renal cell carcinoma size 26.8 (15-40) mm. Results: 3D modeling kidney with the tumor performed in all cases. Virtual surgery was conducted for the training of the surgeon and the patients understood the character of the procedure. All procedures performed with augmented reality were successful, segmental vascular clip was possible in 5 (50%) cases. Mean warm ischemia was 15.3 (12-25) min. Mean surgery operation time was 110.7 (80-155) minutes. Blood loss was an average of 200.2 (100-400) ml. There were no cases of positive surgical margins.
Conclusion: Designed tomographic image segmenta-
tion algorithm based on the function level and active contours can be effective in medical practice in the development of medical imaging software, simulation of preoperative planning and intraoperative navigation. This method is particularly perspective for training programs. Preliminary results of our clinical studies have shown the significance of 3D modeling to improve visualization of the affected organ during surgery for the surgeon and for the understanding of the nature of the pathological process of the patient.
MP-01.07 Early Vascular Unclamping Reduces Warm Ischaemia Time in Laparoscopic Partial Nephrectomy Wu Z, Gao P, Feng C, Wang L, Mao S, Ding Q, Seng Z Dept. of Urology, Huashan Hospital, Fudan University, Shanghai, China Introduction and Objective: Laparoscopic partial ne-
phrectomy (LPN) is increasingly utilized in the management of small renal masses. It is imperative that warm ischaemia time (WIT) be kept to a minimum to maintain renal function. The aim of this study was to assess the outcomes of early vascular release in LPN to reduce WIT and minimize renal dysfunction. Materials and Methods: LPN was performed via a
retroperitoneal approach. The renal artery was individually clamped with vascular bulldog clamps to allow cold scissor excision of the tumor. The cut surface was then sutured with one or two running 2-0 V-Loc (TM) sutures, following which the vascular clamps were released. Specific bleeding vessels were then selectively over sewn and the collecting system repaired. Results: A total of 76 patients underwent LPN with
a median WIT of 27.8 minutes (range 15-29). The mean operative time was 112 minutes (range 92-165) and the mean blood loss was 140 mL (range 60-800). Blood transfusion occurred in 4 patients (5.2%). There were no secondary hemorrhages or urine leaks. With a median of 12.7 (range 3.5 to 18) months follow-up, the glomerular filtration rate (GFR) was not significantly different compared to pre-operative values (P>0.05). Conclusion: LPN with early vascular release effec-
tively minimized WIT and maintained renal function, without compromising perioperative safety.
gust 2012 to March 2015. Twenty patients were male and 36 patients were female. Preoperative ultrasound and CT scan indicated that the tumor of 40 patients was in the left side, while in 16 patients, it was in the right side. Images showed that the maximum diameter of the tumors was 4.5-11.9 cm, with an average of 6.7 cm. The reasons to choose RALA included large tumor size (≥5 cm) in 35 cases, patients being overweight or obese in 29 cases, the need or the desire to save the normal adrenal tissue in a great extent in 11 cases, tumors compressing large vessels or important organs in 13 cases, and the possibility that the tumor may be a metastasis in 3 cases. Twenty-two cases had 2 or more reasons described above. All surgeries were performed by lateral transperitoneal approach started with the paracolic gutter. General anesthesia was used in all cases. Four trocars (3 robotic arms and 1 assistant port) were used in the left-sided adrenalectomies and 5 trocars (3 robotic arms and 2 assistant ports) were used in the right-sided adrenalectomies. Results: All the operations were successful without conversion to open surgery. The mean docking time of the da Vinci surgical system was 10 min. The operative time was 30-100 min, with an average of 62 min. The estimated blood loss was 10-300 ml, with an average of 90 ml. No transfusion was needed during the surgeries. The length of postoperative hospital stay was 4.0-10.0 days, with an average of 5.7 days. Postoperative pathology showed pheochromocytoma in 12 cases (including 4 paraganglioma), macronodular adrenal hyperplasia in 4 cases, adenoma with hyperplasia in 8 cases, adenoma in 16 cases, myelolipoma in 4 cases, metastatic tumor in 3 cases, large cyst in 5 cases, and calcified cyst in 4 cases. No recurrence was found during the follow-up of 2 to 10 months. Conclusion: For patients with adrenal tumors that are
unfit for conventional laparoscopic surgery, RALA may provide an alternative option, with the advantage of delicate manipulation and three-dimensional magnifying image.
MP-01.09 Laparoscopic Versus Open Elective Adrenalectomy: Urologic Outcomes from a National Prospective Database Raup V, Lu P, Meyer C, Vetterlein M, Loeppenberg B, Trinh QD, Eswara J Brigham and Women’s Hospital, Harvard Medical School, Boston, United States
Shen Z, Zhang M, Zhong S, Chen S
Introduction and Objective: For elective adrenalectomy, the decision between laparoscopic versus open adrenalectomies is made largely based on surgeon preference, and these surgeries are performed by both general surgeons and urologists. Here, we sought to examine the perioperative outcomes of laparascopic versus open elective adrenalectomies when performed by a urologic surgeon.
Huashan Hospital Fudan University, Shanghai, China
Materials and Methods: The American College of
MP-01.08 Clinical Study of Robot-Assisted Laparoscopic Surgery for Complicated Adrenal Tumors That Are Unfit for Conventional Laparoscopic Adrenalectomy
Introduction and Objective: To discuss the feasibility, safety and efficacy of robot-assisted laparoscopic adrenalectomy (RALA) in the treatment of complicated adrenal tumors that unfit for conventional laparoscopic adrenalectomy. Materials and Methods: Fifty-six patients with com-
plicated adrenal tumors underwent RALA from Au-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072012) was queried using Current Procedural Terminology adrenal gland explorations (60540), laparoscopic adrenalectomy (60650), and adrenal gland exploration with excision of adjacent/ retroperitoneal tumor (60545). Only surgeries performed by urologic surgeons were included. Prolonged length of stay
3
MODERATED ePOSTERS (pLOS), prolonged operative time (pOT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed. pOT and pLOS were defined as an operating time and a hospital lengthof-stay greater than the 75th percentile, respectively (pOT=193 minutes and pLOS>4 days).
older patients who underwent NSS were not significantly different from their RN-treated counterparts (hazard ratio (HR): 0.961; 95% confidence interval (CI): 0.276-2.321, P = 0.795). Kidney function was significantly better preserved after NSS than after RN at all ages. However, stage IV CKD in the older patients did not occur more frequently in the RN arm than in the NSS arm.
Results: Two hundred and ninety-one patients who underwent adrenalectomy were identified. Of those, 73 underwent open and 218 underwent laparoscopic elective adrenalectomy. Laparoscopic approach was utilized more frequently in patients with a body mass index (BMI) of >25 (p=0.0155), yet approach was not associated with ASA score (p=0.3897). The overall complication rate was 6.2% (18/291), 9.6% for open approach and 4.6% for laparoscopic (p=0.1468). When compared to the open approach, laparoscopic adrenalectomies were associated with a shorter operative time (p<0.0001), and a shorter length of stay (p<0.0001). The laparoscopic approach was also associated with lower rates of postoperative deep vein thrombosis (p=0.0142) and a decreased need for blood transfusions (p<0.0001). However, there was no significant difference in the need to return for reoperation (p=0.1277).
Conclusions: Although NSS was associated with improved renal function compared with RN, it did not confer a benefit of higher survival rate in older patients (≥65 years old).
Conclusions: Despite its more common utilization in overweight individuals, laparoscopic adrenalectomy is faster and results in a shorter length of stay, decreased need for blood transfusions, and fewer deep vein thromboses. Otherwise, the 30-day post-operative outcomes between the laparoscopic and open approaches are comparable. Therefore, laparoscopic adrenalectomy should be attempted when possible.
MP-01.10 Overall Survival and Renal Function After Nephron Sparing Surgery and Radical Nephrectomy Among Older Patients with Localized Renal Cell Carcinoma Smaoui W, Touaiti T, Rebai N, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Academic Medical Center, Sfax, Tunisia Introduction and Objectives: To evaluate the overall
survival (OS) rate and renal function after radical nephrectomy (RN) and nephron sparing surgery (NSS) in patients aged ≥65 years with localised renal cell carcinoma. Materials and Methods: Patients who underwent RN
(n = 220) or NSS (n = 112) for renal cell carcinoma (pT1-pT2 N0M0) between 1990 and 2015 were propensity-score matched in our monocenter database. To investigate the relative effect of NSS on OS according to age, we divided the patients into two age subgroups (<65 and P65 years). The 5-year OS rates and probabilities of freedom from chronic kidney disease (CKD III or IV) were estimated using the Kaplan-Meier method and separate Cox proportional hazards models. Results: The 5-year OS rates after surgery were 94.3% for NSS and 92% for RN in the older patients (P = 0.688). The corresponding rates in the younger patients were 99.6% for NSS and 96.1% for RN (P = 0.015). In separate Cox hazards models for OS, the
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MP-01.11 Laparoscopic Treatment of Ureteropelvic Junction Disease: Outcome of 63 Procedures Vitagliano G, Guglielmi JM Hospital Alemán, Buenos Aires, Argentina Introduction and Objective: The objective is to report our experience with laparoscopic pyeloplasty (LP). Materials and Methods: This is a descriptive, observational and retrospective study. A total of 63 procedures were analyzed. We analyzed sex, age, reason for consultation, anteroposterior diameter of the renal pelvis, radiorenogram curve, type of obstruction, operative time, need for conversion, drainage time, time to removal of ureteral catheter, complications, re-stenosis and type of surgical solution in failed cases. Results: A total of 63 laparoscopic procedures (61 pyeloplasties, 1 nephropexy, 1 ureterocaliceal anastomosis) in 61 patients (two procedures in 2 patients) were performed. There were 32 women and 29 men between the ages of 17 and 75 years, with an average age of 39 years. Presenting symptoms were 68% lower back pain, recurrent urinary tract infection 6%, urolithiasis 4%, hypertension 4%, abdominal pain 2%, fever 2% and hematuria 2%. Incidental diagnosis was 8%. The anteroposterior diameter of the pelvis was between 18 and 73 mm, being 55% over 30 mm (severe). All cases presented with radiorenogram obstructive curve, 13% present response to furosemide, 43% present partial response and 43% had no response. In all cases, the procedure was completed laparoscopically with an average operating time of 120 minutes. There were no conversions to open surgery. No intraoperative complications were recorded. UPJ obstruction was caused by a polar vessel in 57% of cases. Average hospital stay was 2.4 days. Average drainage time was 3 days (2-15 days). Average ureteral catheter time was 5 weeks (1-9 weeks). Postoperative complication rate was 11% (3 cases of pyelonephritis, 2 cases of anastomotic filtration, 1 case of immediate re-stenosis and 1 infected urinoma due to an excluded calyx). Average pelvic diameter deflation was 43%. Average follow-up was 4.5 years. Failure was observed in 12.7% of cases. Re-stenosis was resolved by endoscopic, laparoscopic and conventional surgery in 4, 1 and 2 cases respectively. Conclusion: Laparoscopically, resolution of uretero-
pelvic junction disease is feasible, with surgical time and complications comparable to open surgery but with the benefits of the first.
MP-01.12 Initial Experiences of Laparoscopic Pneumovesical Fistulectomy for Vesicovaginal Fistula Kim T1, Moon KH2 1
Dong-A University Hospital, Busan, South Korea; Ulsan University Hospital, Ulsan, South Korea
2
Introduction and Objectives: To report the safety and efficacy of laparoscopic pneumovesical fistulectomy for vesicovaginal fistula. Materials and Methods: Five adult female underwent
laparoscopic pneumovesical fistulectomy from September 2013 to March 2015. The procedure requires three ports into the bladder. The fistula tract in the bladder was dissected fully to the vaginal anterior wall and the inflammatory tissues around the tract were removed. The anterior vaginal wall was sutured by monofilament suture and then, the bladder mucosa was sutured. Results: The operative time was measured from the start of cystoscopy to closure of the skin incision. Operative complication was recorded and the catheterization time and postoperative hospital stay were checked. Voiding cystography was performed postoperatively. The average operative time was 73.4 minutes (range 55 to 115 min). Mean catheterization time was 7.6 days (range 5 to 9 days) and the mean postoperative hospital stay was 8.1 days (range 6 to 10 days). The median follow-up period was 8.9 months (range 6 to 24 months). One patient showed persistent transvaginal incontinence and was performed classic fistulectomy. Conclusions: Laparoscopic pneumovesical fistulectomy is technically safe and feasible. Considering the main advantages of less morbidity and better cosmesis, our new vesicoscopic technique may be an optional replacement for the other surgical methods.
MP-01.13 Analysis of Outcomes for Single Site Sacrocolpopexy for Patients with Pelvic Organ Prolapse Thanigasalam R1, Girard F2, Baumert H2 1 Concord Hospital, Sydney, Australia; 2Hopital Paris Saint Joseph, Paris, France
Introduction and Objectives: Laparoscopic sacrocolpopexy is recognised as the gold standard for the treatment of pelvic organ prolapse (POP). With the advance of robotic surgery, it is now possible to perform robotic sacrocolpopexy with greater ease. Robotic single site surgery is a relatively new innovation with all the benefits of laparoscopic surgery via a single port. We describe our surgical technique and outcomes for single robotic sacrocolpopexy. Materials and Methods: A prospective cohort study
analyzing thirty patients who underwent Robotic Single Site Sacrocolpopexy (RSSS) for POP at our institution between 2012 and 2013 was performed. RSSS was performed with polypropylene mesh in all cases, with fixation to the sacrum using the v-loc suture, via a single port using a three armed configuration with the Da Vinci Surgical System. Clinical and operative data was collected prospectively and stored in a secure database. Operative variables, complications and
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS functional outcomes were assessed. Statistical analysis was performed using the SPSS statistical program.
MP-01.14, Table 1. Demographic and Perioperative Factors
Results: Mean age was 54 (39-66). Mean operating time was 238 minutes for SAM (165-337), and 259 for DM (190-406). No vaginal, bladder, or rectal injuries occurred. Four patients had a conversion to the standard laparoscopic technique (1 oversized uterus, 1 bleeding on the sacrum which could not be resolved with the single site technique, 1 complex organ diversion with bladder injury, 1 malfunction of the system with a rotating canula). A recurrence of POP was noted in one patient. The median follow up of 15 months (11-22). De novo urgency was noted in 2 patients, which resolved spontaneously a few weeks after the operation. De novo bowel or sexual symptoms were not noted. All patients were followed in outpatient clinic at one and three months with satisfactory anatomical results.
n=270
54.2±13.4
Age (years) Gender, male: female, n (%)
171 (63.3): 99 (36.7)
BMI (kg/m2)
25.1±3.5
Hospital stay (day)
3.4±1.9
Ureteral stent insertion, n (%)
112 (41.5)
Operative time (min)
132.9±49.0
Stone size (mm)
23.1±12.1
Stone location, n (%)
Renal pelvis
155 (57.4)
Conclusions: RSSS for the treatment of POP is a effec-
Upper pole
48 (17.8)
tive treatment with good mid-term results. It is associated with a low complication profile and is relatively safe procedure in experienced hands. RSSS presents an alternative to RASC for patients via a small solitary umbilical incision.
Mid pole
96 (35.6)
Lower pole
181 (67.0)
UPJ
44 (16.3)
MP-01.14
Stone-free status
151 (55.9)
Nephrostomy Sheath Retraction Maneuver: A Novel Objective Method for Deciding Tubeless Percutaneous Nephrolithotomy
Residual fragment <4 mm
89 (33.0)
Suh YS1, Kwak KW2, Jeong BC1, Jeon SS1, Lee HM1, Lee SW1, Han DH1 1
Dept. of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Dept. of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea Introduction and Objective: To investigate the feasibility of a Nephrostomy Sheath Retraction (NSR) maneuver as a method for deciding tubeless PCNL.
Medical records of 270 patients who underwent tubeless PCNL from August 2008 to December 2015 were retrospectively reviewed. Percutaneous renal access was achieved about 20° laterally from the vertical direction under fluoroscopic guidance in prone position. Renal access was performed by using the bull’s eye technique. After stone clearance, Amplatz sheath was retracted about 5 mm from the margin of collecting system to expose renal parenchyme. By this NSR maneuver, renal parenchymal bleeding through the nephrostomy sheath could be visible. For about 1 min after Amplatz sheath was retracted, bleeding severity was checked by the level of blood in the Amplatz sheath. When the bleeding did not overflow top of Amplatz sheath, performing tubeless PCNL was decided. By this maneuver, it can be confirmed that the bleeding pressure was less than 11.4 mmHg (16.5 cm (length of Amplatz sheath) x cos 20° x 760 mmHg/1033 cmH2O). In all patients, non-contrast computed tomogram (CT) was done on the first post-operative day (POD) to evaluate even subclinical intracorporeal change. Materials
and Methods:
Results: Demographics and perioperative factors
are summarized in Table 1. The CT finding at first POD was as follows: 49 (18.1%) perirenal hemato-
Stone-free rate, n (%)
BMI: body mass index
ma, 3 (1.1%) subcapsular hematoma, 64 (23.7%) intra-pelvocalyceal hematoma (23.7%), and 12 (4.4%) urinoma. Most of these fluid collections were subclinical. In only 3 (1.1%) cases, selective angioembolization was necessary because of significant bleeding. Mean hemoglobin change at first POD was -0.9±0.9 g/ dL and postoperative transfusion was required only in 5 (1.9%) cases. Mean pain VAS was 3.2±2.3, 3.2±2.2, 2.1±2.2, and 2.1±1.8 in POD 1,2,3 and 4, respectively. In 8 (2.9%) cases, ureteral stent placement was needed after operation because of blood clots (4 cases, 1.5%), ureter stones (3 cases, 1.1%), and ureteral swelling (1 case, 0.4%). A total of 13 (4.8%) patients visited emergency room after discharge for flank pain (8 cases, 3.0%) and hematuria (5 cases, 1.8%). Conclusion: The NST maneuver is a novel technique
offering objective measurement of bleeding risk after PCNL. This maneuver is reproducible, time-efficient, and cost-free.
MP-01.15 Initial Experience with Uventa: A Segmental Metallic Ureteric Stent Kulkarni M1, Smith T2, Kulkarni R 1
Brighton and Sussex University Hospitals NHS Trust, United Kingdom; 2Ashford and St Peter’s NHS Trust, United Kingdom, Surrey, United Kingdom
Introduction and Objectives: We present our very early experience with a new metallic segmental stent named ‘Uventa’. Materials and Methods: After ethical committee approval, a pilot study was established to evaluate the Uventa metallic ureteric stent. The aims of this study are ease of insertion, success in decompression of upper tracts, longevity of the benefit and assessment
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
of complications. Ten patients were included in this study, all with malignant ureteric obstruction with a minimum life expectancy of 6 months. In a period of 1 year, we have inserted 5 stents so far. The underlying pathology was colonic cancer in 3, cervical in 1 and prostate in 1. All the strictures were located in the lower third of the ureter. Follow-up protocol included upper tract imaging, renal function tests and urine culture. Results: Initial success in decompression was observed. There were no immediate complications. One patient developed worsening of renal function due to inadequate expansion and needed a JJ stent within 2 days. Three patients needed insertion of JJ stent through the Uventa due to tumor progression. One died due to advanced malignancy. One patient is alive. Stent removal or re-deployment was not possible. Conclusions: This new stent is relatively easy to insert, and successfully decompresses the upper tracts. However, re-adjustment is very difficult. Tumour progression prevented long-term evaluation in the majority of the patients. A large cohort of patients is needed to evaluate this promising device.
MP-01.16 A Minimally Invasive Angioembolization Technique to Treat Delayed Hemorrhage After Percutaneous Nephrolithotomy Maghsoudi R1, Kashi AH1, Etemadian M1, Banaei M1, Soleimani AH2, Soleimani MJ1 1
Hasheminejad Kidney Center, Tehran, Iran; 2Tehran University of Medical Sciences, Tehran, Iran
Introduction and Objective: Angioembolization is a costly procedure, which is occasionally needed to treat delayed bleeding after percutaneous nephrolithotomy (PCNL). We present the results of our new less costly technique of angioembolization for delayed refractory bleeding after percutaneous nephrolithotomy. Materials and Methods: The records of all patients
who underwent PCNL in our referral center from 2012 to 2016 were investigated for angioembolization to treat refractory postoperative bleeding. In our new technique, we use crushed cardiac stents to embolize pseudoaneurysm or arteriovenous fistula. Results: A total of 12 cases were treated by angioembolization. Two patients were treated by the standard protocol incorporating 2 coils with satisfactory results in one session. Ten patients were treated with angioembolizaion using crushed cardiac stents. Preoperative Color Doppler ultrasonography had revealed pseudoaneurysm in 4, arteriovenous fistula in 5 and both in 1 patient. Nine patients were successfully treated in the first session using our new technique. In one patient, a second angioembolization session was needed with our new technique to control bleeding. In 8 patients, 2 crushed stents were used to control bleeding under angiographic monitoring. In 2 patients, 1 coil was enough to stop bleeding. The cost of standard angioembolization coils is several times higher than the cardiac stents used in this report. Conclusion: Our new technique was able to control
refractory postoperative bleeding in PCNL in most patients with considerably lower cost in comparison with the standard protocol.
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MODERATED ePOSTERS MP-01.17 Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Lower Caliceal Calculi Less than 2 cm: A Prospective Study El Anzaoui J, Ghoundale O, El Harrech Y, Touiti D, Moufid K Dept. of Urology, Military Hospital, Marrakech, Morocco Introduction and Objective: Percutaneous nephroli-
totomy (PCNL) is a procedure that became the gold standard of management of stones up to 2 cm. For smaller stones, the extracorporeal shockwave lithotripsy (ESWL) is the option of choice. However, the inferior caliceal localisation, due to anatomic reasons, makes ESWL less efficient. We intend to study to measure the efficiency and the safety of both procedures for LCC of less than 2 cm. Materials and Methods: We present comparative
prospective study including 100 patients divided in two groups: group 1(50 patients) underwent ESWL, group 2 (50 patients) underwent PCNL. We compare results for clearance rate, complications, and the need of a supplementary procedure. Results: The clearance rate is 56% for ESWL and 92% for PCNL. PCNL: 46 stone-free, 3 cases of bleeding just after dilation forcing to stop the procedure. One case of blood transfusion. Two cases of bleeding at the final step of the intervention. Two failures of re-
6
nal puncture and 2 cases of migration of the calculus. LEC: 28 cases of stone-free. Two cases of subcapsular hematoma, and 8 cases of renal colic, of which 3 cases required ureteral stenting.
with regard to stone burden, number of tracts, number of procedures, operation time, total operative blood loss, postoperative hospital stay, complications rate, and stone clearance rate.
Conclusion: PCNL is more efficient and safe than
Results: A total of 458 renal units in 418 patients (246 men and 172 women) were treated. Of the 458 renal units, 121 (26.4%) had complete staghorn calculi, 187 (40.8%) had partial staghorn calculi and 150 (32.8%) had multiple large calculi (mean number of stones was 3.9, range 3-12; mean stone maximal diameter was 3.8 cm, range 2.1 to 6.1 cm). A total of 542 tracts were established in the 458 renal units. The mean number of tracts used in a single renal unit was 1.3 (range 1-2). The mean number of primary procedures was 1.8 (range 1-3). The mean operating time was 82 min (range 45-150 min). The mean duration of postoperative hospital stay was 5.0 days (range 3-8 days). Mean estimated operative blood loss was 182 ml (range 71-620 ml). The complications included blood transfusion in 22 (5.3%) patients, postoperative fever in 57 (13.6%), sepsis in 28 (6.7%), hydrothorax in 4 (1.0%), and hydroabdomen in 8 (1.9%). A complete stone clearance rate of 78.2% (327/418) was achieved after one session of PCNL. This rate increased to 85.9% (359/418) and 89.2% (373/418) after a second and a third look procedure respectively.
ESWL for LCC of less than 2 cm. The rare hemorrhagic complications can be managed by immediately stopping the intervention and placing a nephrostomy. More studies are required to confirm our results.
MP-01.18 Standard Tract Percutaneous Nephrolithotomy Assisted by LithoClast Master for Complicated Renal Calculi: Report of 418 Cases Wu Z, Wang L, Gao P, Mao S, Seng Z, Ding Q Dept. of Urology, Huashan Hospital, Fudan University, Shanghai, China Introduction and Objective: The objective of the study is to evaluate the safety and efficacy of standard tract percutaneous nephrolithotomy (PCNL) assisted by LithoClast master for the treatment of complicated renal calculi. Materials and Methods: From May 2012 to February 2016, 418 patients with complicated renal calculi underwent standard tract PCNL in our hospital. The combined pneumatic and ultrasonic powered lithotripter (EMS LithoClast master) was used to fragment and remove the calculi. The size of the standard tract was F22-F24. The data were retrospectively analyzed
Standard tract PCNL assisted by EMS LithoClast master is safe and effective in achieving a great stone clearance rate with acceptable morbidity for the treatment of complicated renal calculi.
Conclusion:
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 2 Adrenal, Kidney & Ureter Friday, October 21 1425–1555 MP-02.01 Impact of a Bladder Cuff Excision During Radical Nephroureterectomy on Cancer Specific Survival in Patients with Upper Tract Urothelial Cancer Ha YS1, Chung JW1, Lee JN1, Choi SH1, Kwon SY2, Kim G3, Kim BS1, Kim HT1, Kim TH1, Yoo ES1, Kwon TG1, Chung SK1, Kim BW1 1
Kyungpook National University School of Medicine, Daegu, Korea; 2Dongguk University College of Medicine, Seoul, Korea; 3CHA Gumi Medical Center, Junggu, Korea Introduction and Objective: Radical nephroureter-
ectomy (RNU) with a bladder cuff excision (BCE) stands for the surgical principles of treatment for upper tract urothelial cancers (UTUCs). However, not all RNUs are performed with a BCE. We quantified the prognostic impact of BCE at RNU on cancer-specific survival (CSS) in a large patient population. Materials and Methods: In total, 505 patients with
UTUC were enrolled from four different institutions. The clinicopathologic parameters of patients with a BCE and without a BCE were compared. Kaplan-Meier and multivariate Cox analyses were performed to assess the influence of a BCE on CCS. Results: In all, 60 (11.9%) patients did not receive a BCE during RNU. Compared to patients with a BCE, these patients were older (P<0.001) and had a higher American Society of Anesthesiologists score (P=0.009). UTUC without a BCE was more likely to be associated with pathologic stage T3 or greater than UTUC with a BCE (P=0.026). Tumors in patients without a BCE were related to a positive surgical margin (P=0.001), and localized to the renal pelvis (P=0.001). Among the patients with ureter cancer, there were no significant differences in clinicopathological parameters except margin status (P= 0.010) between two groups. Kaplan-Meier estimates revealed that a BCE during RNU was not significantly associated with CCS in all UTUC patients and in the subgroup of renal pelvis cancer. However, Kaplan-Meier curves showed that patients without a BCE had a significantly worse rate of CSS than patients with a BCE (log-rank test, P=0.024) in the subgroup analysis of patients with ureteral cancer. Multivariate analysis revealed that a BCE [hazard ratio, 0.232 (95% confidence interval, 0.075-0.717); P=0.011] was an independent prognostic factor of CSS in patients with ureteral cancer. Conclusion: In our study, RNU without a BCE result-
ed in significantly worse CCS in ureteral cancer patients and a BCE should be performed in patients with ureteral cancer. Conversely, a BCE could be omitted for patients with renal pelvis cancer because RNU
without a BCE in this group did not compromise the CCS.
MP-02.02 Spontaneous Perirenal (Retroperitoneal) Hemorrhage (Wunderlich Syndrome): Analysis of 20 Cases Park JJ, Kim JW, Ahn ST, Cheon J, Park HS Dept. of Urology, College of Medicine, Korea University, Seoul, Korea Introduction and Objective: This study aimed to an-
alyze the characteristics, etiology and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome, WS). Materials and Methods: We retrospectively reviewed
the records of 18 patients hospitalized for WS in single center between 2011 and 2016. All patients consulted for perirenal hemorrhage found by computed tomography (CT) in emergency department. Clinical variables (age, underlying diseases, symptoms, shock and hospitalization period), laboratory test results (differential cell blood count (CBC), prothrombin time (PT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and urinalysis), radiologic results, and pathologic results were reviewed. Results: The series includes 20 events of 18 patients. Ten cases (55%) had visible renal lesion and associated hematoma and 8 presented only perirenal hematoma. Five cases (27%) had shown angiomyolipoma definitely in CT, and did not undergo surgery. Including 3 patients with shock, 11 patients (61%) underwent exploration and total nephrectomy. The pathological study showed 3 cases (16%) of renal cell carcinoma (one associated with polycystic kidney disease), 4 cases of renal cyst (two associated with polycystic kidney disease), 1 case of extraskeletal Ewing sarcoma, 1 case of malignant PEComa, and 2 cases of chronic pyelonephritis. Conclusions: Renal masses are the main cause of WS, and CT is the diagnostic procedure of choice. Surgical treatment is preferred in patients diagnosed with renal malignancy, and in cases of hemodynamic instability.
MP-02.03 Surgery in Patients with Angiomyolipoma: 15 Years of Experience Holmberg G1, Lundstam S1, Swärd J2 1 Sahlgrenska University Hospital, Gothenburg, Sweden; 2Uddevalla Hospital, Sweden
Introduction and Objective: Angiomyolipoma is a
benign renal tumor that most often is handled conservatively or by angioembolization. In some cases surgery is indicated due to size, bleeding or uncertain diagnosis. In this study we analyze a 15-year material of patients treated surgically at a tertiary referral center. Materials and Methods: Between 1998 and 2012, 33
patients (7 men and 26 women) were operated on for angiomyolipoma. Median age was 54 years (27-73 years). Two patients had tuberous sclerosis (TS), one of them with bilateral giant angiomyolipomas. Final diagnosis was angiomyolipoma in 32 patients and liposarcoma in one.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Results: In 19 patients, the indication for surgery was suspicion of renal carcinoma because the tumor did not show fat on CT-scan. The median size of the tumors was 25 mm (15-80 mm). Partial nephrectomy with resection of the tumor was performed in 13 of these patients. Six patients went through total nephrectomy. Eleven patients were operated because of the size of the tumor, median diameter 110 mm (60-306 mm), one of them with bilateral nephrectomy. Two patients were operated because of bleeding, one with nephrectomy and the other with tumor resection. No patients had emergency surgery. One patient with the typical findings at CT of a large angiomyolipoma was primarily treated with angioembolization but later went through nephrectomy as the tumor did not diminish. The final histopathology revealed a liposarcoma. Regarding complications, one patient had thrombosis of deep femoral veins and another pulmonary embolism. Two patients had wound infections and one had a late incisional hernia. Conclusions: The majority of the patients in this study had fat-poor angiomyolipoma and were operated on due to suspicion of malignancy. Preoperative tumor biopsy might have spared some of these patients an operation especially in elderly cases. In patients with larger tumors, treatment was indicated because of the risk of bleeding but today angioembolization is an attractive alternative to surgery. In patients with the largest tumors, surgery was indicated because of bothersome symptoms. Liposarcoma is a rare differential diagnosis but must be considered in big tumors.
MP-02.04 Renal Angiomyolipoma: Patient Characteristics and Tumor Treatment Lyrdal D1, Henriksson O2, Lundstam S3 1 University of Göteborg, Sahlgrenska Academy, Göteborg, Sweden; 2Dept. of Radiology, Sahlgrenska University Hospital, Göteborg, Sweden; 3Dept. of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
Introduction and Objective: The natural history of renal angiomyolipoma is poorly known. In this study, we analyzed the characteristics of the patients and the procedures following the diagnoses in a patient material of angiomyolipma from a tertiary referral center. Materials and Methods: Ninety-eight patients (18 men, 80 women) diagnosed in 1987-2014 were included in a retrospective analysis. Median age was 52 years (13-89). Eleven (11%) of the patients were diagnosed with tuberous sclerosis (TS), three men and eight women. Results: Seventy-three patients (74%) had one tumor only, mean size 40 mm (10-200mm), 7 patients (7%) had 2 tumors, 41 mm (15-80), 2 patients had 3 tumors 65 mm (30-100) and 16 had 4 or more tumors, 87 mm (5-300 mm) Bilateral tumors were found in 16 (16%). All patients with tuberous sclerosis had multiple tumors but one, mean tumor size was 85 mm, n=11. A total of 32 patients were diagnosed due to acute (n=16) or chronic abdominal pain (n=17), 5 due to macroscopic hematuria and 5 during work up for TS. In 56 patients AML was an incidental finding, n=55 (56%). Thirty-four patients were treated with embolization, mean tumor size 72 mm (20-200mm). Thirty patients underwent surgery, 8 patients with
7
MODERATED ePOSTERS nephrectomy and 22 patients had partial nephrectomy, average tumor sizes were 49 respectively 41mm. Thirty-three patients were elected for surveillance and had an average tumor size of 33 mm. One patient deceased at the time of diagnose. An increase of embolization and partial nephrectomy was noticed until 2009 meanwhile nephrectomy decreased. Since 2010, there has been a consistent increase in embolization to be the most preferred treatment, an increase from 44% in the first three years of the study to 80% in the last three years of the period. Conclusion: Abdominal pain was the most common
symptom but in 56% of the patients, renal angiomyolipoma was an incidental finding. Patients with TS had the largest and often multiple tumors. About one third of the patients were treated with surgery, angioembolization or surveillance only, but surgery was increasingly replaced by angioembolization with time.
MP-02.05 Characterization of Large Adrenal Tumors in a Community Hospital Valero G1, Vera N2, Valenzuela A2, Ortiz F2, Silva M2 1
Hospital Clinico Fusat, Rancagua, Chile; Hospital Regional, Rancagua, Chile; 2Hospital Clinico Fusat, Rancagua, Chile Introduction and Objective: A large adrenal tumor
is defined as a tumor greater than or equal to 6 cm in diameter, diagnosed incidentally or by clinical orientation. In general, it is a rare clinical condition and malignant disease becomes more relevant, which confronts us with a diagnostic and therapeutic challenge. The objective is to describe clinical-pathological characteristics in patients surgically resolved. Materials and Methods: This was a retrospective review of 41 patients who underwent transperitoneal laparoscopic adrenalectomy for large adrenal tumor between November 2003 and December 2015. Results: Age ranged between 28 and 80 years. A total of 28 female patients (68.2%) and 13 males (31.8%) were included. A total of 63.4% of the tumors were right-sided, and 36.6% were left-sided. Mean operating time was 79 minutes (22-210). Mean hospital stay was 1.7 days (1-7). Only one intraoperative complication occurred, consisting of pancreatic laceration (Clavien I). There was no need for blood transfusion. One patient presented with incisional hernia as a delayed complication. Malignant histology was reported in 24.4% of patients (22% adrenal carcinoma and 2.4% metastasis). In all other patients, benign histology was reported: adrenal adenoma 24.3%, ganglioneuroma 4.9%, adrenal hyperplasia 12.2%, myelolipoma 31.7%, pheochromocytoma 2.4%. Conclusion: Incidence of malignant adrenal tumors
reported in our study is similar to that reported internationally. The high percentage of benign disease may not require surgical treatment. For this reason, it is essential to do a critical clinical and radiologic case by case review. In patients who require surgery, laparoscopy is an effective, safe and quick alternative when performed by an experienced surgical team.
8
MP-02.06
Introduction and Objective: Advances in surgical
Elective Adrenalectomies: Do Obesity and Diabetes Affect Surgical Outcomes?
safety have made many procedures which were once considered too morbid to become reasonable treatment options for the elderly population. However, as the US population ages, it is important to recognize that there still remain increased risks associated with relatively safe elective surgeries when performed in the elderly. Here, we evaluated the perioperative outcomes of elective adrenalectomies, which is generally a low-risk procedure, when performed in elderly patients.
Lu P, Raup V, Vetterlein M, Meyer C, Trinh QD, Eswara J Brigham and Women’s Hospital, Harvard Medical School, Boston, United States Introduction and Objective: Given the rising rate of
obesity in the US, surgeons must take into consideration the role of obesity in the perioperative period. Here we examined obesity and associated metabolic derangements and their effects on perioperative complications of elective adrenalectomies. Materials and Methods: The American College of
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072012) was queried using Current Procedural Terminology (CPT) codes for adrenal gland explorations (60540), laparoscopic adrenalectomy (60650), and adrenal gland exploration with excision of adjacent/ retroperitoneal tumor (60545). Only surgeries performed by urologic surgeons were included. Prolonged length of stay (pLOS), prolonged operative time (pOT), 30-day complications, and need for reoperation were analyzed with obesity defined as Body Mass Index (BMI) >30. pOT and pLOS were defined as an operating time and a hospital length of stay greater than the 75th percentile, respectively (pOT=193.25 minutes and pLOS=4 days). Results: Two hundred and ninety-one patients who
underwent elective adrenalectomy by a urologist were identified. Median BMI was 29.6 (16.9-68.3), with 136 patients having a BMI>30 (46.7%). Obesity was associated with a higher rate of prolonged operative time (p=0.0326) and overall complications (p=0.0009), specifically pulmonary embolus (p=0.0131) and need for re-intubation (p=0.0131). Forty-four patients (15.1%) were found to have diabetes, seventeen of whom were insulin dependent (5.8%). Diabetes alone was associated with a higher rate of overall 30day complications (p<0.0001), wound complications (p<0.0001), specifically superficial wound infection (p<0.0001), pLOS (p=0.0044), and acute renal failure (p=0.0122). Like diabetes, insulin dependence was also associated with any wound complication (p<0.0001) and superficial skin infection (p<0.0001). In addition, it was significantly associated with organ space infection (p<0.0001). Conclusions: We found that both obesity and dia-
betes were both significantly associated with higher rates of perioperative complications. Practicing surgeons in the US must take into account the increasing prevalence of obesity, and implications of associated metabolic derangements. Efforts should be made to medically optimize obese and diabetic patients prior to elective surgeries.
MP-02.07 Elective Adrenalectomy in Elderly Patients: Proceed with Caution Raup V, Lu P, Loeppenberg B, Meyer C, Vetterlein M, Trinh QD, Eswara J Brigham and Women’s Hospital, Harvard Medical School, Boston, United States
Materials and Methods: The American College of
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072012) was queried using Current Procedural Terminology (CPT) codes for adrenal gland explorations (60540), laparoscopic adrenalectomy (60650), and adrenal gland exploration with excision of adjacent/ retroperitoneal tumor (60545). Only surgeries performed by urologic surgeons were included. Advanced age was defined as >70 years old. Prolonged length of stay (pLOS), prolonged operative time (pOT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed. pOT and pLOS were defined as an operating time and hospital length of stay greater than the 75th percentile, respectively (pOT=193.25 minutes and pLOS=4 days). Results: Out of 291 patients who underwent an elective adrenalectomy, 44 patients (15.1%) were older than 70 years. The overall post-operative complication rate for elective adrenalectomy for all ages was 6.2%. We found an association between advanced age and major post-operative complications, including return to OR (p<0.0001), septic shock (p=0.0008), pneumonia (p=0.0122), re-intubation (p=0.0008), ventilator support for >48 hours (p=0.0122), and readmission (p=0.0010). Advanced age was also associated with minor complications including UTI (p=0.0008). Conclusions: Overall, elective adrenalectomies are associated with a low rate of complications. However, this procedure should be undertaken with caution in the elderly as they are at a significantly higher risk of developing major post-operative complications. Therefore, special consideration should be made to medically optimize these patients perioperatively.
MP-02.08 Risk Factors for Hypertensive Attack During Resection of Pheochromocytoma Kwon SY1, Lee KS1, Kim KH1, Seo YJ1, Kim TH2, Lee JN2, Ha YS2, Kim G3 1
Dongguk University College of Medicine, Gyeongju, Korea; 2Kyungpook National University School of Medicine, Daegu, South Korea; 3Gumi CHA Medical Center, Bundang, South Korea Introduction and Objectives: To evaluate retrospec-
tively the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS Materials and Methods: Data from 53 patients diagnosed with pheochromocytoma at our institution between January 2000 and June 2012 were retrospectively analyzed. The subjects were divided into two groups depending on the presence/absence of hypertensive attack at the time of surgery. Patient demographic characteristics, preoperative evaluations were assessed for their prognostic relevance with respect to hemodynamic fluctuation. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed. Results: In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were found to associate significantly with the development of hypertensive attack. The multivariate analysis revealed that the preoperative epinephrine level and the tumor size were the independent factors that affected hypertensive attack. The highest odds ratio of tumor size (2.169) was obtained at a cutoff value of 4.25 cm, and the highest odds ratio of preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 μg/day. Conclusions: In this study, a large tumor size and an elevated preoperative urinary epinephrine level were found to be risk factors for intraoperative hypertensive attack in patients with pheochromocytoma.
MP-02.09 Surgical and Hemodynamic Outcomes in Patients Undergoing Pheochromocytoma and Paraganglioma Surgery: A Prospective Cohort Study Rao N, Ramachandran R, Tandon N, Singh P, Kumar R All India Institute of Medical Sciences, New Delhi, India Introduction and Objective: Surgery for pheochro-
mocytomas is associated with both surgical and hemodynamic morbidity in the form of intraoperative hypertension and postoperative hypotension with need for vasopressor support. We aimed to prospectively evaluate the hemodynamic and surgical morbidity associated with patients undergoing such surgery and attempt to identify perioperative factors associated with them. Materials and Methods: Data for patients undergoing surgery for pheochromocytoma or paraganglioma through open, laparoscopic or robotic approach was prospectively recorded in an institutional review board approved study. Apart from standard demographic and operative parameters, data included type and duration of adrenergic blockade, need for intraoperative vasodilators and need for vasopressor support after surgery. Complications were graded according to the Clavien-Dindo classification till the time of discharge from hospital. Results: A total of 40 patients underwent 45 proce-
dures including five bilateral adrenalectomies over the 2-year study period. This included 40 adrenalectomies and 5 paraganglioma excisions. A total of 25 patients had laparoscopic surgery, 4 robot-assisted and 11 open surgery. The mean tumor size was 5.17 cm
(range 0.7-16 cm). Sixty percent of patients required intraoperative vasodilators for hypertensive crisis and this was significantly related to the size of the tumor but not to the surgical approach. The need for postoperative vasopressors was not related to the tumor size or type of preoperative antihypertensive preparation. Five percent of patients suffered a complication greater than grade 2 on the Clavien-Dindo scale. Conclusions: Pheochromocytoma and paraganglio-
ma surgery is associated with minimal incidence of postoperative morbidity. Larger tumors may be associated with greater intraoperative pressure surges but this does not impact patient outcomes.
MP-02.10 A Single Institution Experience with Posterior Retroperitoneoscopic Adrenalectomies García Marchiñena P, Jurado A, Costabel J, Gueglio G, Daruich M, Paissan A, De Miguel V Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: Minimally invasive adre-
nalectomy has become the procedure of choice for benign adrenal pathology. Although the adrenal glands are located in the retroperitoneum, most surgeons prefer the transperitoneal laparoscopic approach to adrenal tumors. The aim of this report is to evaluate the effectiveness of Posterior Retroperitoneoscopic Adrenalectomy (PRA). Materials and Methods: Clinical characteristics and outcomes of 10 consecutives PRA were prospectively evaluated. Results: Nine patients underwent 10 PRA (8 unilateral, 1 bilateral). Eight patients underwent total adrenalectomy, while partial adrenalectomy was performed in 1 patient. Three patients had previous major abdominal surgeries that contraindicate a transperitoneal approach. Indication for surgery was ectopic adrenocorticotropic hormone syndrome (n=1), Conn’s adenoma (n= 2), pheochromocytoma (n=3) and incidentaloma (n=3). Mean tumor size was 38.6 mm (SD 19.1). Mean age was 52.7 years. Mean operative time was 101.3 minutes (SD 21.3). Conversion to open surgery was not necessary. The mean complication rate was 11%. Mean postoperative hospital stay was 2.44 days (SD 0.88). Complete clinical and biochemical resolution was observed postoperatively in patients with functional lesions. At a median follow-up of 10 months, there was no recurrence. Conclusion: For patients with small adrenal tumors,
major abdominal surgeries and bilateral affection of adrenal glands, PRA is recommended.
MP-02.11 Haemangioma of the Kidney in a Five-Year-Old Boy Ilievski A1, Ilievski P2, Jordanoski J3, StojovskaJovanovska E4 1 Urology Clinic, Skopje, Macedonia; 2Clinical Hospital, Bitola, Macedonia; 3Medical Center, Prilep, Macedonia; 4Radiology Clinic, Skopje, Macedonia
Introduction and Objective: Haemangioma are be-
nign vascular lesions and are very rare in the kidney. They are more common on renal parenchyma
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
in adults but very rare in children. In the literature, we found about fifteen cases. Among the fifteen cases, four are in the calyces and pelvis in adults but extremely rare in children. In the literature, we found one case only in a 5-year-old boy, and we present our case in this meeting. Materials and Methods: As was mentioned, these
tumors are described more in adults but very rare in children. We are presenting one case in a 5-yearold who had gross haematuria. After careful examination on ultrasound, CT scan and IVP showed filing defect as a mass and was planned for surgery in our hospital as soon as possible. Results: We present the case of a 5-year-old boy who had a chief complaint of gross haematuria with dark red color with small clots. The patient was sent to us by pediatrics because the ultrasound showed a mass in the left pelvis hyperechogenic without shadow. On CT scan, rhw mass in the left pelvis as a filing defect that was seen on IVP too. The mass on the left kidney was big enough to make obstruction because the boy had infection that brought attention for investigation as to what caused this infection. Our decision as urologists was that the mass should be removed by surgery. We found and removed the mass and preserved the kidney. The result from pathology showed haemangioma of the calyces and pelvis. After surgery, the patient was without haematuria, and follow-up after surgery and now after twenty years is asymptomatic and in good health. Conclusion: This kidney mass as haemangioma is very
rare in adults and extremely rare in children. When they are found in children, as in our case, it is better to remove the mass and save the kidney. After surgery, the patient was asymptomatic, and even twenty years after surgery, and remains in good health.
MP-02.12 The Use of Laparoscopy in the Treatment of Renal Hydatid Cyst Rabii R, El Moutawakkil T University Hassan II, Casablanca, Morocco Introduction and Objective: The renal localization
of the hydatid cyst is rare. Different therapeutic procedures were proposed, but surgery remains the best therapeutic option. Laparoscopic treatment was proposed for the treatment of the hydatid hepatic, pulmonary cysts and recently renal. We report 23 cases of renal hydatid cyst treated in a retroperitoneal laparoscopic manner. Materials and Methods: There were 13 women and 10 men, with a mean age of 39.6 years (22 to 55 years). Clinical pain was found in all our patients, 16 cases had lumbar pain and the remaining patients had renal colic pain. Seven patients had an isolated pain syndrome (three right and four left). Five patients had associated burns, one patient had hematuria. A palpable mass was found in three patients. The radiologic assessment (echography + TDM) found a type I (10 cases), II (5 cases) and III hydatid cyst (8 cases) (11 right and 12 left), the other upper polary in four cases, the inferior polary in five cases and a mediorenal in four cases. The hydatid serology was positive in four cases. There were no other hydatid localizations associated in 13 patients.
9
MODERATED ePOSTERS Results: All patients were operated in a retroperitonial laparoscopic way using 5 trocarts. During the intervention, the principles of the conventional surgery of the hydatid cyst were respected (protection, sterilization, punction with resection of protruding dome. The operation duration was 77 minutes (40-115 min). Blood loss was minimal without anaphylactic shock. The ablation of the Redon drain was carried out on the first postoperative day in 23 patients. The duration of hospital stay was 1 day in 18 patients and 2 days in 5 patients. After a mean relapse of 1 year (1-15 years), no clinical and no radiological recidivation was detected. Conclusion: Retroperitonial laparoscopy with cyst re-
section seems to be a simple mini-invasive approach respecting the peritoneal cavity and reproducing the conventional surgeries of the hydatid cyst yielding common advantages of laparoscopy.
MP-02.13 Laparoscopic Radical Nephrectomy: Does Incision Matter? Lopez Fontana G1, Lopez Fontana R1, Lopez Fontana C2, Lopez Laur JD1 1
Clinica Andina de Urologia, Mendoza, Argentina; Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Mendoza, Argentina
2
Introduction and Objective: Laparoscopic radical
nephrectomy (LRN) has become the gold standard treatment for renal masses not feasible for nephron sparing surgery in order to avoid painful incision such us lumbotomy. Usually, expanded port site incision is performed for intact specimen extraction. Pfannenstiel incision demonstrated to have less incisional hernia and, probably less pain. Therefore, the aim is to compare Pfannenstiel incision versus expanded port site incision for intact specimen extraction during laparoscopic radical nephrectomy. Materials and Methods: Ten patients between 50 and 80 years old who underwent LRN were randomly di-
10
vided into 2 groups; those who specimen extraction was performed through a Pfannenstiel incision (n=5) and those through port site expanded incision (n=5). We analyzed age, body mass index (BMI), tumor localization, size (cm), surgical time (min), perioperative and incision complications, incision size, hospital stay (hours) and return to work. Finally, pain score was analyzed using visual analog score. Statistical analysis was performed using Student T test (p<0.05). Results: There were no statistical differences among
groups in age (57.8 vs. 60.8 years), BMI (26.8 vs. 28.8) and tumor size (5.56 vs. 5.72 cm). There were also no differences in surgical time, incision size, perioperative and incision complications. However, hospital stay (p<0.05) and the return to work (p< 0.01) were significantly lower for group 1. Moreover, men with Pfannenstiel incision had a lower visual analog score compare to those with expanded port incision (p<0.01). Conclusion: Pfannenstiel incision has better surgical
outcomes regarding pain, hospital stay and return to work. Therefore, this incision may be adopted for specimen extraction during laparoscopic radical nephrectomy. Nevertheless, more cases are necessary to confirm these results.
MP-02.14 Young Age at Diagnosis Is Closely Related to Favorable Pathologic Features, but Is Not an Independent Survival Prognosticator in Patients with Surgically-Treated Renal Cell Carcinoma: A Multicenter Study Kang HW1, Kim YJ1, Hwang EC2, Kang SH3, Hong SH4, Chung J5, Kwon TG6, Kim HH7, Kwak C7, Byun SS8, Yun SJ1 1
Chungbuk National University College of Medicine, Cheongju, South Korea; 2Chonnam National University Hwasun Hospital, Jeonnam, South Korea; 3 Korea University School of Medicine, Seoul, South
Korea; 4The Catholic University of Korea, Seoul, South Korea; 5National Cancer Center, Goyang, South Korea; 6 Kyungpook National University College of Medicine, Daegu, South Korea; 7Seoul National University College of Medicine, Seoul, South Korea; 8Seoul National University Bundang Hospital, Seongnam, South Korea Introduction and Objective: The prognostic signif-
icance of age in patients with renal cell carcinoma (RCC) is a subject of debate. Here, we evaluated the impact of age on clinicopathological features and its role as an independent prognostic factor for survival in a large cohort of patients with RCC. Materials and Methods: The study was a retrospec-
tive analysis of 5 178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011. Patients were categorized into three groups according to age at diagnosis as follows: young age (<40 years, n=541), middle age (≥40 and <60 years, n=2 551), and old age (≥60 years, n=2 096) groups. Clinicopathological variables and survival rates were compared between the three groups. Results: Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion, and were more likely to have undergone partial nephrectomy than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P=0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. Conclusions: Young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 3 Reconstruction and Trauma I Friday, October 21 1425–1555 MP-03.01 Management of Sphincter Weakness Incontinence (SWI) in Patients with Concomitant Bladder Neck Contractures (BNC) After the Treatment of Prostate Cancer Bugeja S, Ivaz S, Frost A, Andrich DE, Mundy AR University College London Hospital, United Kingdom Introduction and Objectives: There is a significant association between SWI and BNC complicating the treatment of prostate cancer. The BNC must be dealt with first to avoid problems once the sphincter is in place. This study evaluates the outcome after AUS insertion in patients with BNC managed either endoscopically or by open surgical reconstruction. Materials and Methods: A total of 157 bulbar AUS
(AMS 800TM) were implanted in a single unit over a 6-year period (January 2009 to December 2014) after radical prostatectomy with or without adjuvant radiotherapy. Mean patient age was 67.9 years and patients were followed up for a mean of 22.4 months (range 6-62.9 months) after AUS insertion. A total of 69 of 157 (44%) had BNC diagnosed radiologically or endoscopically. Results: BNC were managed endoscopically (trans-
urethral resection or dilatation) in 50 of 69 patients (72.5%) (21 had only resections (one attempt n=18; 2 attempts n=3); 22 had only dilatations (one attempt n=10; two attempts n=10; 3 attempts n=2). A total of 7 had a combination of resection and dilatation up to a maximum of 5 procedures (range 2-5). A total of 14 of the 50 (28%) performed self-dilatation for a mean of 3 months in addition to endoscopic procedures to stabilize the contracture (only 3 continued self-dilatation after AUS implantation). Of the 50 patients, only 2 (4%) required further intervention for recurrent BNC after AUS insertion. A total of 19 of 69 (27.5%) patients were managed by open transperineal revision of the vesico-urethral anastomosis. These patients had undergone a median of 4 failed endoscopic procedures (range 0-8). Those with no previous intervention had been managed by a suprapubic tube for obliterative strictures. None had recurrent strictures after reconstruction and AUS insertion. A total of 40 of 50 (80%) patients managed endoscopically and 17 of 19 (89%) undergoing surgical reconstruction, were restored to functional normality (unobstructed and dry). Conclusion: An AUS can be safely implanted in se-
lected patients with BNC stabilized by endoscopic measures with a very small risk of contracture recurrence once the device is in place with a good functional outcome. Generally, however, contractures which recur after more than 2 endoscopic attempts at treatment are best managed (and cured) by open reconstruction prior to insertion of the AUS.
MP-03.02 Male Urethral Stricture Disease Etiology in a Latin American Referral Center Giudice CR, Galarza GA, Olivares Salazar AM, Favre GA, Santillán D Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: To describe the etiology of male urethral stricture disease in a Latin American referral center and analyze differences in etiology regarding patient age and stricture site. Materials and Methods: We reviewed a prospectively
collected database of male patients who underwent urethroplasty for urethral stricture disease between January 2011 and December 2015. Stricture etiology, patient age and stricture site were identified for each patient. We analyzed overall stricture etiology as well as etiology by age (≤/>60 years) and location (penile bulbar - multifocal/panurethral - posterior). Results: A total of 544 patients underwent urethroplasty with a mean age of 56 years (17-91). The most important stricture causes were urethral cateterization (25%), benign prostatic hyperplasia treatment (22%), idiopathic (17.1%) and trauma (13%). Overall iatrogenic causes were the etiology in 62.3% of strictures. In patients under 60 years, main causes were urethral catheterization, idiopathic, trauma and failed hypospadias repair, and in patients over 60 years, the main causes were strictures after BPH treatment and urethral catheterization. Bulbar urethra (n=143) was the most frequent urethral stenosis site followed by multifocal/panurethral (n=127) strictures, penile strictures (n=77) and posterior strictures (n=64). Penile urethra was mostly affected after failed hypospadias repair, lichen sclerosus and urethral catheterization while in the bulbar urethra, idiopathic strictures, urethral catheterization and strictures after BPH treatment were equally prevalent. Urethral catheterization was the main cause of multifocal/panurethral strictures while trauma and strictures after BPH and prostate
cancer treatment were the most important causes of posterior urethral stenosis. See Table 1. Conclusions: Iatrogenia is responsible for over 60% of urethral strictures in our population. Idiopathic causes and trauma are also important causes of stricture. Etiology is significantly different between age groups and within stricture localization.
MP-03.03 Ureteral Reconstruction Using Bowel Segments Results in Reliable Patency in Complex Patients: A 13-Year Experience Blakely S, Higuchi T, Maroni P, Flynn B University of Colorado, Denver, United States Introduction and Objectives: Surgical correction of ureteral obstruction is often accomplished by primary anastomosis of the urinary structures i.e. dismembered pyeloplasty, ureteroureterostomy, or ureteroneocystotomy. Complex cases of ureteral obstruction are often not amenable to these techniques. Factors contributing to complexity include prior reconstruction, prior radiation therapy, fibrosis, and long segment ureteral loss. We present our experience managing these cases with enteric interposition. Materials and Methods: We reviewed consecutive
cases of ileal or colonic ureteral interposition performed by three surgeons at a single institution over a 13-year period. Patient demographics, obstruction length and etiology, surgical techniques, success and complication rates are presented. Success was defined as radiographic demonstration of drainage, resolution of hydronephrosis or improved eGFR in the absence of ureteral stent or nephrostomy tube. Results: A total of 35 patients, mean age 53 years, underwent reconstruction (25 unilateral, 10 bilateral, 45 renal units). The most common etiologies of ureteral obstruction were surgical (failed prior reconstruction, iatrogenic injury during gynecologic, colorectal, or urologic surgery) in 17 patients and radiation-induced stricture or fistula in 7 patients.
MP-03.02, Table 1.
Urethral Stricture Disease Etiology ≤60 years (n=261)
>60 years (n=283)
Catheter (p=0,457)
69
67
BPH treatment (p=0,00001)
12
108
Prostate cancer treatment (p=0,002)
3
Failed Hypospodias Repair (p=0,0087)
19
Instrumentation (p=0,0001)
7 7
Trauma (p=0,0001)
33
63
8
Infection (p=0,425)
6
Liquen Sclerosus (p=0,537)
3
14
Idiopathic (p=0,0001)
11
66
27
Urethral cancer (p=0,229)
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
19
2 90
60
30
0
30
60
90
120
11
MODERATED ePOSTERS Overall, 22 patients had prior radiation therapy. Mean stricture length was 7.6 cm. The type of repair included ileal ureteral replacement in 25 units, reverse seven ileal ureteral replacement for bilateral disease in 8 units, colonic ureteral replacements in 7 units, and ileal Monti tube ureteral replacement in 5 units. At median follow-up of 65 months, 42 of 45 units (93.3%) were successfully managed without additional procedures. One patient underwent redo colonic interposition, one patient progressed to nephrectomy for non-functioning kidney and one patient was managed with chronic nephrostomy tube. Only 4 patients had a complication requiring an additional procedure (urine leak in 3, intra-abdominal collection in 1). Conclusions: Even in the setting of the most complex
cases of ureteral reconstruction, reliable upper tract drainage can be achieved safely and effectively using enteric ureteral interposition procedures.
MP-03.04 Perioperative Outcomes of Male OneStage Urethroplasty: Outcomes from a National Prospective Database Raup V, Lu P, Loeppenberg B, Meyer C, Vetterlein M, Trinh QD, Eswara J Brigham and Women’s Hospital, Harvard Medical School, Boston, United States Introduction and Objective: There are few surgeons
who perform a large number of male one-stage urethroplasties. Thus, the majority of the studies evaluating this specific surgery are retrospective and/ or single-institution studies. We sought to assess the patient and perioperative characteristics of male onestage urethroplasty using a large multi-institutional prospectively collected database. Materials and Methods: The American College of
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072013) was queried using Current Procedural Terminology (CPT) codes for one-stage urethroplasty (53410, 53415, 53431). Medical comorbidities, length of stay (LOS), operative time (pOT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed. Results: Four hundred and eighty male patients having undergone single stage urethroplasty were identified, with a median age of 48 years at the time of surgery (18-85). Median body mass index (BMI) was 29 (17-65) and median ASA score was 2 (1-3). The median procedure length was 167 minutes (65-507 minutes), and the median length of stay was 1 day (0-17). Twenty-nine patients developed post-operative complications within 30 days of surgery (6.0%), including 13 urinary tract infections (UTIs), 3 superficial wound infections, 4 deep wound infections, 3 wound dehiscences, 1 post-operative pneumonia, 1 deep vein thrombosis, 2 myocardial infarctions, and 2 cases of sepsis. Two patients required blood transfusions, and 2 different patients required reoperation. There were no 30-day mortalities. Conclusions: To our knowledge, our study represents the largest multi-institutional cohort of male patients having undergone single-stage urethroplasty. The pa-
12
grade IV blunt renal trauma. An immediate decision regarding hemostatic intervention may be considered in grade IV blunt renal trauma patients with risk factors before worsening of the hemodynamic condition occurs.
tients in this study were relatively healthy and most patients were discharged within 24 hours. UTIs and wound infections/dehiscences were the most common 30-day complications recorded. While the rate of more severe complications was low, they did occur on occasion. Thus, patients should be counseled that while one-stage urethroplasty is an overall safe procedure with very few perioperative complications, infectious complications are the most likely complication to occur. Also, as with any surgery with a lengthy operative time, post-operative thromboembolic, pulmonary, and cardiac complications are possible.
MP-03.06
MP-03.05
Adi K
Risk Factors for Hemostatic Intervention in Grade IV Blunt Renal Trauma
Dept. of Urology, Hasan Sadikin Hospital, University of Padjadjaran, Bandung, Indonesia
Lee JN1, Chung JW1, Ha YS1, Choi SH1, Kwon SY2, Kim G3, Kim BS1, Kim HT1, Kim TH1, Yoo ES1, Kwon TG1, Chung SK1, Kim BW1
Introduction and Objective: The transition to de-
1
Kyungpook National University School of Medicine, Daegu, South Korea; 2Dongguk University College of Medicine, Seoul, South Korea; 3Gumi CHA Medical Center, CHA University, Bundang, South Korea
Introduction and Objective: The challenge lies in immediately deciding which of the patients with grade IV renal trauma may require hemostatic intervention before hemostatic instability occurs. Therefore, we analyzed the risk factors for hemostatic intervention in grade IV blunt renal trauma. Materials and Methods: From January 2003 to June
2015, 43 patients were diagnosed as grade IV blunt renal trauma by the AAST grading scale. All patients underwent computerized tomography (CT), and hemostatic intervention (selective angio-embolization or nephrectomy) was performed when hemodynamic instability and/or persisting hemorrhage was presented. We retrospectively analyzed medical records of these 43 patients to determine the risk factors for hemostatic intervention according to presence of associated injury, size of perirenal hematoma rim distance (PRD), intravascular contrast extravasation (ICE), and laceration site on initial CT. Results: Mean patient age was 43.3 years and male to
female ratio was 28/15. Causes of blunt renal trauma were traffic accident (n=26), a fall (n=11) and violence (n=6). There were no significant differences in mean age, sex, laterality and hospital stays between the hemostatic intervention group (Group A, n=10) and the successful conservative group (Group B, n=33). In univariate analysis, mean PRD of group A and B was 4.4 cm and 2.3 cm, respectively (p=0.024). Using ROC curve, optimal cutoff value of PRD was 3.0 cm (sensitivity 0.60 and specificity 0.82). Presence of ICE in group A and B was 6/10 patients (60.0 %) and 5/33 patients (15.2 %), respectively (p=0.004). In addition, the main laceration was located in the inferior-medial portion of the kidney was observed more often in patients who underwent hemostatic intervention compared with patients with successful conservative management (p=0.001). Multivariate analysis showed that PRD was an independent risk factor of hemostatic intervention in grade IV blunt renal trauma (p=0.046, OR = 2.19 (1.02 - 4.71)). Conclusion: PRD of greater than 3.0 cm, presence of
ICE, and inferio-medial side renal laceration served as useful risk factors for hemostatic intervention in
Transperineal Anastomotic Urethroplasty in Children and Adolescents with Pelvic Fracture Urethral Injury: 3-Year Experience of Bandung Urethral Reconstructive Centre, Indonesia
finitive treatment with urethral reconstructive surgery started in 2012 in our institution. Up to 2012, most of the urethral stricture diseases, including posterior urethral stricture, were managed mostly with direct vision internal urethrotomy (DVIU). We present our initial experience with delayed repair with transperineal anastomotic urethroplasty in children and adolescents with Pelvic Fracture Urethral Injury (PFUI). Materials and Methods: We retrospectively reviewed
traumatic urethral stricture due to PFUI cases treated with delayed repair urethral reconstructive surgery by transperineal anastomotic urethroplasty approach at least 3 months after the initial injury. Children and adolescent age were the inclusion criteria. Data cases ranged from 2013 to 2015, and patient characteristics, length of gap, operation time and previous operations were analyzed. Pericatheter urethrography was performed 4 weeks after the procedure to evaluate the anastomotic. The clinical outcome was evaluated with uroflowmetry and evidence of incontinence at least up to 12 months of the procedure. Any treatment after the procedure or unable to urinate was considered a failed case. Results: A total of 70 patients with PFUI of 253 patients with urethral stricture disease from 2013 to 2015 were recorded in our institution. Four patients meet the criteria of children group (2-12 years old) and 16 patients were in the adolescent group (13-18 years old). The trauma mechanism for PFUI was 95% (19/20) motorcycle accident. The previous history in acute trauma treatment is 2 patients with history of PER (Panendoscopic Urethral Realignment), 2 patients with bladder repair, 1 patient with bladder neck repair and 1 patient with laparotomy due to other reason. We found 4 cases with redo anastomotic urethroplasty. The median patient age was 15 (9-18). The mean operation time was 180 minutes (150-380) for the children group and 183 minutes (90-235) for the adolescent group. The average length of the urethral gap in the children group cases was 4 cm (2-6), while it was 3.9 cm (1-6) in the adolescent group. In order to achieve tension free of anastomotic urethroplasty, 25% (5/20) of PFUI patients underwent crural separation, 55% (11/20) patients with inferior pubectomy and 15% (3/20) patients for supracrural re-routing. Overall success rate for delayed repair transperineal anastomotic urethroplasty for children and adolescent PFUI was 80%. The success rate for redo cases was 75% (3/4). The suc-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS cess rate for children group was 75% (3/4) and 81% (13/16) for adolescent group. Conclusion: In short-term follow up, delayed repair
urethral reconstructive surgery by transperineal anastomotic urethroplasty in children and adolescent with PFUI achieved a significant, good result, and showed a promising outcome in our institution.
MP-03.07 Open Reanastomosis for Obliterative or Recalcitrant Bladder Neck Contracture Following Radical Prostatectomy: Functional Outcomes Giudice CR, Galarza GA, Olivares Salazar AM, Favre GA Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: To report our experience
in open surgical treatment of obliterative or recalcitrant bladder neck contracture following radical prostatectomy as well as functional outcomes (recurrent contracture and urinary continence) and post-operative complications. Materials and Methods: A total of 46 patients were
treated for vesicourethral anastomosis stricture between 2002 and 2015, and 14 underwent open reanastomosis for obliterative or recalcitrant bladder neck contracture following radical prostatectomy. Recalcitrant stricture was defined as the failure of more than two endoscopic treatments. Urinary continence status after prostatectomy determined whether to perform a perineal approach (if not continent) or abdominal approach (if continent) in order to preserve the external sphincter, and therefore urinary continence. Complications were recorded using Clavien score system. Follow-up consisted in uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with patent urethral lumen to 14 french flexible cystoscope. Post-operative urinary incontinence was defined as the use of more than 1 pad per day. Results: Median age was 63 years (52-74) and median follow-up was 30 months (3-104). Eight patients underwent perineal surgery while the other six patients underwent an abdominal approach with a partial pubectomy. No significant intra or post-operative complications were recorded (Clavien IIIa and over). Ten patients (71.5%) were recurrence-free while 4 (28.5%) recurred after reanastomosis and were treated successfully with minimally invasive procedures achieving an overall success rate of 100%. All 8 patients that underwent perineal approach were completely incontinent following reanastomosis, as expected, and were treated with anti-incontinence devices or are scheduled for treatment. In contrast, only 1 (16.6%) of 6 patients that underwent abdominal approach developed “de novo” urinary incontinence and was treated with a urinary sphincter. Conclusions: Open reanastomosis is a safe and useful treatment option in cases of recalcitrant or obliterative bladder neck contracture following radical prostatectomy. Success rates are acceptable and recurrences are often liable to be treated endoscopically with good results. Abdominal approach may be a good option to try to keep previous urinary continence.
MP-03.08
Introduction and Objective: The high frequency
What Constitutes Complexity in the Surgical Reconstruction of Pelvic Fracture-Related Urethral Injuries?
of urethral complications after adult female to male gender reassignment surgery (including phalloplasty or metoidioplasty) is well documented. We aim to examine and understand these complications in order to improve outcomes of salvage reconstruction.
Bugeja S, Ivaz S, Frost A, Andrich DE, Mundy AR University College London Hospital, United Kingdom Introduction and Objectives: Bulbo-prostatic anas-
tomotic urethroplasty (BPA) for urethral injuries associated with traumatic disruption of the pelvic ring is notoriously a surgical challenge, often requiring various manouvres to straighten the course of the bulbar urethra and bridge the resulting defect. There are however other factors which may render the reconstructive procedure more complex. This study investigates these factors. Materials and Methods: A total of 360 BPAs were performed in a single tertiary referral center between October 1996 and October 2014. A total of 77 (21%) were revision procedures. Mean patient age was 37.9 years. Mean follow-up was 51 months (range 9-115 months). Recurrence was defined radiologically and/ or by the need for any further surgical intervention including dilatation or urethrotomy. Results: A total of 286 (79%) procedures were carried out transperineally (Steps 1-4) while 74 (21%) required additional abdominal exposure to mobilize the bladder base (n=16), repair associated injuries (n=41) or perform an entero-urethroplasty (n=17). A total of 29 of 74 (39%) abdomino-perineal (AP) procedures were revisions. A total of 48 of 77 revisions (62%) were performed via a transperineal approach. The restricture rate was higher for revision procedures compared to primary ones when approached transperineally (15% vs. 8%) but not for AP procedures (21% in both primary and revision cases). Overall, the recurrence rate for AP procedures was 21% compared to 9% for the transperineal approach. Associated bladder neck injury (n=18), uro-rectal/perineal fistulae (n=15), perineal degloving injury (n=6), anterior urethral stricture (n=19) and osteomyelitis/pelvic sepsis (n=10) were identified as factors adding complexity to the procedure. Conclusion: A longer defect and revisional surgery
often require corporal separation, inferior wedge pubectomy and rerouting of the urethra around the crura in a stepwise fashion in order to guarantee a tension-free anastomosis. These render the procedure more difficult but do not necessarily imply increasing complexity. Factors necessitating a change in approach (usually but not exclusively requiring additional abdominal exposure) to deal with multiple pathologies such as the need for bladder neck reconstruction or concomitant anterior urethral strictures are what render the procedure complex.
Materials and Methods: Consecutive patients who presented to our institutions from August 2013 to October 2015 for salvage reconstruction after urethral complications of adult female to male gender-reassignment surgery were identified and reviewed. Patient demographics, clinical presentation, pre and intraoperative findings and pathologic data are reported. Results: Twenty patients, mean age 33.2 years (1854), were included in the study. The median time of presentation from surgery was 4 months (1-13). Phalloplasty (17) predominated over metoidoplasty (7) as the initial reconstruction (4 patients underwent both repairs). The most common subjective complaint was urinary retention in 12/20 patients. Eleven patients presented with suprapubic catheter, 4 with urethral self-calibration and 3 with perineal urethrostomy. The most common preoperative findings were neourethral stricture (16/20), cutaneous fistulization from the neourethra (10/20), and anastomotic leak from the native urethral opening to a pelvic cavity (10/20). Intraoperatively, the pelvic cavity was identified as vaginal remnant in 11 of 20 patients despite history of vaginectomy in all patients. Pathologic evaluation confirmed vaginal epithelium in 7 patients, while the remaining four had no pathology specimen recorded. Neourethral stricture was identified in 16/20 patients, 7 of which were pan-urethral. The remaining 9 patients had anastomotic strictures, of which 6 also had meatal stenosis. Sixteen of the 20 patients had at least two of the following: neourethral stricture, remnant vagina, urethrocutaneous fistula, or meatal stenosis. Conclusion: The majority of patients with urethral
complications after adult female to male gender reassignment surgery will have multiple concurrent pathologies. Distal obstruction by a neourethral stricture may predispose to fistulization proximal to the anastomosis causing urethrocutaneous fistula and dilation of previously obliterated vaginal cavity. These findings are important in understanding urinary complications after female to male gender reassignment, and show the complex nature of salvage reconstruction.
MP-03.10 Adult Buried Penis: Experience and Outcomes Miller B, Soto-Aviles O, Santucci R Detroit Medical Center, United States
MP-03.09
Introduction and Objectives: Adult buried penis
Urethral Complications After Female to Male Gender Reassignment: Common Causes, Consequences and Considerations for Salvage Reconstruction
pathophysiology clearly differs from that of the pediatric buried penis. The data on the management of adult buried penis is limited. We present our experience with the management of adult buried penis and describe outcomes and complications associated with its surgical treatment.
Blakely S1, Bryk D2, Cornwell L1, Caza T1, Landas S1, Zhao LC2, Nikolavsky D1 1
SUNY Upstate Medical University, Syracuse, United States; 2New York University, United States
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: A retrospective chart review was performed for patients who underwent buried penis repair at our institution from 2007 to 2015 with
13
MODERATED ePOSTERS at least 6 months follow-up. A total of 34 patients were included in our analysis of surgical techniques, demographics, medical history, incidence of urethral strictures and surgical outcomes. Results: In our cohort, the mean age at time of surgery was 46 years (range 18-72) with a BMI of 45.7 (range 24.5-68.1) and an incidence of diabetes mellitus in 53% of patients (n=18). A total of 79% of patients needed a split-thickness skin graft at the time of repair (n=27), 59% needed excision of the suprapubic fat pad or escutcheonectomy (n=20), and 47% of patients needed a partial scrotectomy (n=16). Four patients needed additional surgery for reburying for an overall success rate of 88%. The overall incidence of urethral stricture for our cohort was 62% (n=21), from which 48% were meatal stenosis. Surgical complications were separated into early (<30 days) and late (30-90 days) as well as minor (Grade 1-2) and major (Grade 3 and above) complications. A total of 58% (n=22) of patients developed early minor complications. Most of these were surgical site infections or wound dehiscence managed conservatively. A total of 13% (n=5) developed an early major complication, and 1% of patients (n=3) developed a minor late complication. No patients had a major late complication. Conclusions: Surgical repair of adult buried penis is technically feasible with an overall success rate of 88% and a high complication rate most of which were minor complications in the early post-operative period, 58% (n=22). The incidence of urethral stricture is highly prevalent in this population for which clinical suspicion is warranted at the time of surgery and during follow-up.
bladder neck (2x). UI was found in 80% (16/20) and aggravated in 18.8% (6/20) after surgery; no de novo UI occurred. Implantation of an artificial urinary sphincter (AUS) has been performed successfully in 81% (17/21 patients), 2 refused implantation, and 1 is still scheduled for surgery. Erectile dysfunction was present in 76.2% (16/21). Compared to the preoperative status, 58.8% (10/21) complained about impaired erectile function after TPRA. A good, very good or excellent subjective overall health status was noted in 81% (17/21). An improvement in QoL was noted in 75% (15/21). Patient satisfaction with the outcome of TPRA was high or very high in 80% (16/21). Reason for a subjective unsatisfying result was postoperative persistent UI. Conclusions: After repeated endoscopic treatment, TPRA is a valuable therapeutic option in selected patients with high post-operative patient satisfaction and an overall success rate of 85.7% (18/21) for anastomotic patency. This can even be raised to 100% by further transurethral surgery. TPRA offers the advantage of surgery in virginal tissue conditions after retropubic access, suturing of the anastomosis under direct visual control and the possibility of urethral mobilization and resection of scarred tissue in distal and proximal direction. UI can be easily treated by implantation of an AUS.
MP-03.12 Predictors of Erectile Dysfunction Post Pelvic Fracture Urethral Injury: A Multivariate Analysis Kammoun O, Sallami S, Daas S, Abou El Makarim S, Chtouru M
MP-03.11
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia
An Extended Follow-Up on the Postoperative Results of Transperineal Reanastomosis for the Treatment of Recurrent Anastomotic Strictures After Radical Retropubic Prostatectomy
Introduction and Objective: Erectile dysfunction
Schüttfort V1, Reiss P1, Pfalzgraf D2, Kluth L1, Fisch M1, Dahlem R1 1
University Medical Center Hamburg-Eppendorf, Germany; 2Medical Faculty Mannheim, Heidelberg University, Germany
Introduction and Objective: To re-evaluate the safe-
ty and efficacy of open transperineal reanastomosis (TPRA) for highly recurrent anastomotic strictures (AS) after radical retropubic prostatectomy (RRP). While the majority of AS can be managed successfully by endoscopic treatment, in highly recurrent AS (at least three prior unsuccessful operations), open reanastomosis represents a viable therapeutic option. Materials and Methods: Retrospective analysis by standardized questionnaire, inquiring for recurrence, urinary incontinence (UI), sexual function, satisfaction and changes in quality of life (QoL) was performed in 23 patients undergoing TPRA from May 2009 to June 2015. Results: Mean patient age was 71.8 years (53-79) and mean follow-up 47 months (4-77). On average, a patient had undergone 4.75 operations before TPRA (min 2 max 12). Success rate was 85.7% (18/21). Three recurrences were successfully treated by cold knife incision (1x) and transurethral resection of the
14
(ED) is a common sequel of pelvic fracture urethral injury (PFUI). We determine the incidence of ED after PFUI and identify the related risk factors. Materials and Methods: Between January 1995 and March 2014, 68 patients were operated for post traumatic posterior urethral injury. Patients were examined after a minimum of 2 years from the time of trauma to assess their erectile function (EF) using the short form of the International Index of Erectile Function (IIEF-5). Medical records were reviewed with a focus on variables that may predict ED, including age, pattern of pelvic fracture, presence of pubic diastasis, and length of bulboprostatic urethral gap and management procedures. The patients were aged 39.3 ± 6.2 years (range 18-68 years), and the interval between injury and treatment was 6.3 ± 9.8 months (range 1 day-85 months). Treatment consisted in a primary endoscopic realignment (n=47) and delayed urethroplasty (n=21). Analysis of the results took into consideration, the quality of micturition, the continence and the EF. Univariate and multivariate analyses were used to identify parameters predictive of ED. Results: Median follow-up was 42 months. Satisfacto-
ry results were reported in 35 patients. Three patients had urinary incontinence, 31 developed uretral stenosis and two had chronic pelvic pain. A post operative ED (with absent of spontaneous nocturnal erections and absence of response to treatment with sildenafil 100 mg) was noted in 19 patients (27.9%): 8 patients from the realignment group and 11 from the urethro-
plasty group. On univariate and multivariate analysis, 4 variables were significant factors for prediction of ED: diastasis of pubic symphysis (p=0.01), bilateral rami or Malgaigne’s fractures (p<0.001), long urethral gap (p<0.001) and management with delayed urethroplasty (p=0.02). No relationship was evidenced between ED and age at traumatism. Conclusion: ED after PFUI can be predicted by 4 fac-
tors, which include diastasis of pubic symphysis, bilateral rami or Malgaigne’s fractures, long urethral gap and delayed urethroplasty.
MP-03.13 Augmented Non-Transecting Urethroplasty for Bulbar Urethral Strictures Bugeja S, Ivaz S, Frost A, Andrich DE, Mundy AR University College London Hospital, United Kingdom Introduction and Objectives: Long non-traumatic bulbar strictures are routinely managed by an augmentation procedure, most commonly using an oral mucosal graft, without excision of the stricture. We describe the augmented non-transecting technique (ANTABU) using oral mucosal graft for long non-traumatic bulbar strictures with a short obliterative segment. Materials and Methods: Between July 2012 and December 2014, 26 ANTABU for idiopathic bulbar strictures were performed in a single unit. Through a dorsal stricturotomy, the spongiofibrosis in the obliterative segment was excised in a non-transecting fashion leaving the ventral spongiosum intact and anastomosing the mucosal edges to reconstitute the urethral plate to an adequate caliber. The entire length of the stricturotomy was then augmented with oral mucosal graft. Patients were followed up objectively (urethrogram and flow rate) and subjectively (PROMS) for a mean of 19.2 months (range 6-37 months). Results: Mean stricture length was 5.3 cm (range 3-8 cm). The mean length of obliterative spongiofibrosis excised from the stricture in a non-transecting fashion was 1.2 cm (range 0.5-2cm). The oral graft was harvested from the cheek in 22 (84.6%) patients and sublingually in the remaining 4 (15.4%). None of the 26 patients had radiological evidence of stricture recurrence. The mean flow rate of the cohort postoperatively was 26.6 ml/s. A total of 19 out of 20 patients (95%) reported that they were satisfied or very satisfied with the outcome of their surgery. A total of 7 patients (26.9%) reported post-micturition dribble, which was not bothersome in all. Erectile dysfunction lasting longer than 6 months and requiring treatment was reported in 1 patient (3.8%). Conclusion: ANTABU allows excision of the narrow-
est segment of a longer bulbar stricture, reconstituting the urethral plate to a wider caliber, avoiding an almost circumferential substitution (which is associated with suboptimal results) in this area. This also permits the use of narrower and shorter oral grafts with reduced donor site morbidity. The technique is associated with excellent objective and subjective outcomes.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-03.14 The Use of Divided Fasciocutaneous Penile Flap in the Repair of Non-Contiguous Double or Multiple Urethral Strictures Okorie C Dept. of Surgery, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria Introduction and Objective: Double or multiple
urethral strictures with a healthy urethral segment in between are infrequently encountered. Presently, the surgical outcome of using divided fasciocutaneous penile flap to manage such urethral strictures has been rarely reported. We hereby present our experience on the use of divided fasciocutaneous penile flap for the repair of double or multiple urethral strictures separated by a healthy urethral segment. Materials and Methods: Between September 2009 and January 2016, 11 patients with double or multiple urethral strictures that were separated by a healthy urethral segment underwent reconstructive urethroplasty using fasciocutaneous penile flap. To bypass the healthy urethral segment, the fasciocutaneous penile flap was partially divided to obtain two shorter flaps that matched the length of the strictured urethral segments in each case. A successful outcome was defined as absence of post-operative instrumentation or revision of the repair. The patients’ outcome data was collected prospectively. Results: The mean patient age was 47.8 years (range
of 25 to 77 years), the mean combined urethral stricture length was 7.3 cm (range of 4 to 10.5 cm). The etiology in nine of the patients was assumed to be consequent to gonorrhea infection in the past. Both the bulbous and penile urethral segments were variably affected in all the patients. Postoperatively, one patient developed superficial wound infection that subsequently led to the development of urethrocutaneous fistula, necessitating further surgical intervention. Two other patients reported post void dribbling. Over a mean follow-up period of 33.4 months, the overall success rate was 91%. Conclusion: In cases of double or multiple urethral
strictures separated by a healthy urethral segment, the use of divided fasciocutaneous penile flap can be a good surgical option with a low complication rate as noted in this report.
MP-03.15 Female Urethral Stricture Reconstruction: Is It Challenging? Shah SA Bodyline Hospitals, Ahmedabad, India Introduction and Objective: Female urethral stricture is a rare and challenging entity for a reconstructive urologist. Hence we reviewed our experience of female urethroplasty in the last four years with a minimum follow-up of two years and maximum of 5 years. Materials and Methods: Out of twenty-eight patients
(28-62 years) with mid to distal urethral stenosis, twenty two underwent urethroplasty between 2010 to 2014. The rest (six) who were mainly of post menopausal age not having vaginal flap and not ready for oral mucosa underwent excision of strictured meatus
accepting hypospadiac urethra. Two RTA patients had damaged their total urethra sparing bladder neck partially. They required pedicle labial flap urethroplasty. Two young female had trauma following earthquake where we tried end to end urethroplasty. One out of two required bladder flap urethroplasty thereafter. Four patients had vaginal flap urethroplasty and twelve patients had BMG urethroplasty. Stricture was diagnosed by calibration, MCU, Urethroscopy and UDS in selected patients. Results: Six patients who underwent meatal excision
are happy and doing well. Four vaginal flaps fared well while one out of them required dilatation after three years. Out of two who had labial pedicle flap urethroplasty one had restenosis so regular endoscopic dilatations for 6 months made her urethra normal. Out of two end to end urethroplasty, one had lost continence due to short urethra so tanagho procedure was done. Twelve BMG urethroplasty did very well and did not have incontinence, in any of them. Conclusion: Out of twenty eight patients three re-
quired reprocedure so success rate is 89.28%. Thus management of female stricture urethra is not for challenging reconstructive urologist. Selection of right procedure and experience of surgeon makes management easy.
MP-03.16 Management Options in PostTransplant Ureteral Strictures Han E, Malkawi I, Santucci R Detroit Medical Center, United States Introduction and Objective: We describe a series of
transplant ureteral strictures, some with intravesical obstruction, which can be treated cystoscopically with good success. Materials and Methods: This was a retrospective chart review of 14 transplant ureteral stricture patients who underwent cystoscopic incision, laparotomy/reimplantation, or chronic stent exchanges. Results: A total of 14 patients were reviewed: average age 44 years (range 21-66), 100% African American, 50% female. Strictures averaged 2 cm (range 1-8 cm). Three had balloon dilation before referral with 0% success. Six had intravesical obstruction, 4 had anastomotic obstruction and 4 had proximal or panureteral obstruction. A total of 6/6 with intravesical obstruction had endoscopic incision, all of whom were cured, after the 1st attempt (n=2), 3rd attempt (n=3), 4th attempt (n=1). Four patients underwent laparotomy, 3 with simple reimplant, 1 requiring vesico-renal pelvis anastomosis. One reimplant failed from subsequent new proximal obstruction after successful repair of the distal obstruction. Four patients needing open surgery elected stent changes for life: 2 because of graft loss due to rejection and 2 because of comorbidities making them poor surgical candidates. Conclusion: We saw a high incidence of transplant
ureteral stenosis that prolapsed into the bladder; this was treatable cystoscopically. This is not well-described in the literature, but may result with the Taguchi (“one stitch”, aka Minnesota) technique that creates an intravesical portion of ureter that is too long, which subsequently stenoses. More proximal strictures are treated with standard open techniques,
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
with good success rates. Some patients with ureteral stricture are not salvageable because of poor graft or poor patient health.
MP-03.17 Artificial Urinary Sphincter Reintervention: Outcomes From a National Prospective Database Raup V, Lu P, Vetterlein M, Meyer C, Trinh QD, Eswara J Brigham and Women’s Hospital, Harvard Medical School, Boston, United States and Objective: Artificial urinary sphincter (AUS) placement is a generally safe treatment for stress urinary incontinence with low rates of complication. However, the management of AUS failure (revision, replacement, removal) is associated with worse outcomes. Here, we examine perioperative variables and outcomes of AUS reintervention (revision, replacement, and removal).
Introduction
Materials and Methods: The American College of
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072012) was queried using Current Procedural Terminology (CPT) codes for AUS placement (35445), revision (53449), replacement (53447/53448), and removal (53446). Prolonged length of stay (pLOS), prolonged operative time (pOT), 30-day complications, and need for reoperation were analyzed. pOT and pLOS were defined as an operating time and a hospital length-of-stay greater than the 75th percentile, respectively (pOT=111 minutes and pLOS>1 day). Results: A total of 957 patients were identified, and included 611 insertions, 145 removals, 172 removals with subsequent replacement, and 29 revisions. Initial insertions had a complication rate of 3.3% with the most common complications being UTI (1.8%) and wound infections (0.98%). AUS reinterventions had a complication rate of 6.9%, with the most common complications also being UTI (4.0%) and wound infections (1.7%). Reinterventions had a significantly higher number of overall post-operative complications (p=0.0093), specifically post-operative UTIs (p=0.0364), and a greater number of patients who were admitted for a prolonged hospital stay (p<0.0001). When compared to AUS replacements and revisions, AUS removals were associated with a higher rate of pLOS (p<0.0001), pOT (p=0.0001), and overall post-operative complications (p=0.0001), specifically UTIs (p=0.0043) and sepsis (p=0.003). In contrast, AUS replacements were associated with a lower rate of pLOS (<0.0001) and pOT (p<0.0001), as well as fewer overall post-operative complications (p<0.0001), specifically UTI (p=0.0044) and sepsis (p=0.0084). AUS revisions were associated with fewer prolonged stays (pLOS p=0.0115). When compared, the post-operative complication rate and LOS of AUS replacements and revisions were found to be equivalent, although replacements had a significant increase in pOT (p=0.0257). Conclusions: AUS reintervention carries a perioperative complication rate of approximately twice that of virgin AUS placement. Of the reinterventions, AUS replacements and revisions have equally low rates of complications, although replacements have a significantly prolonged operative time. AUS removal,
15
MODERATED ePOSTERS however, has a higher rate of pOT, pLOS, and overall surgical complications, especially UTI and sepsis. Thus, patients undergoing AUS removal should be counseled about these potential risks.
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36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 4 Stones I
1 Catholic University of Korea, Uijeongbu St.Mary’s Hospital, Gyeonggi-do, South Korea; 2Catholic University of Korea, Yeouido St.Mary’s Hospital, Seoul, South Korea
Introduction and Objectives: The urinary tract cal-
Friday, October 21 1425–1555 MP-04.01 Analysis of the Incidence and Prevalence of Urolithiasis in Korea in the past 10 Years by Using National Health Insurance: Standard Cohort Data 1
1
1
1
1
Han C , Bae S , Park B , Lee Y , Kang S , Cho Y
2
MP-04.01, Table 1. The Incidence of Urolithiasis in Korea from 2002 to 2013 Character Gender
Age
Year
N
%
Male
24 350
59.1
Female
16 865
40.9
0
7
0.0
1-4
47
0.1
5-9
112
0.3
10-14
316
0.8
15-19
995
2.4
20-24
1 686
4.1
25-29
2 796
6.8
30-34
3 893
9.4
35-39
4 445
10.8
40-44
4 895
11.9
45-49
5 327
12.9
50-54
4 921
11.9
55-59
3 868
9.4
60-64
3 079
7.5
65-69
2 266
5.5
70-74
1 421
3.4
75-79
732
1.8
80-84
293
0.7
85+
116
0.3
Materials and Methods: The National Health Insur-
ance-Standard Cohort Data (NHI-SCD) consisted of a dynamic cohort database and about 1,000,000 patients in each year from January 2002 to December 2013. Urolithiasis was defined as ICD code for N20 or N132 in primary or secondary diagnosis. The exclusion criteria were patients who were diagnosed with urolithiasis before the cohort period. Data were analyzed from 2003 to 2013 to identify incidence and from 2002 to 2013 to look at prevalence. For each year, male-to-female ratio and age group were also analyzed. Results: From January 2003 to December 2013, 1 110 853 patients were selected for population. During the period under observation, the total number of patients who were diagnosed urolithiasis was 41 215 in 10 945 446.16 person-year. Total incidence was 3.77 per 1000 person-year. Male-to-female ratio was 1.44:1. The 45-49 years age group had the highest incidence in all age groups. The incidence by age and year is presented in Table 1. The prevalence was 0.36 in 2002 and increased to 0.67 in 2013. Maleto-female ratio was 1.37:1 in 2002 and 1.79:1 in 2013. The detailed results are presented in Table 2. Conclusion: Total incidence of urolithiasis in Korea
from 2002 to 2013 year was 3.77 per 1000 person-year. The prevalence of urinary tract calculi was 0.67 during cohort. Male patients had a higher incidence and prevalence of urolithiasis than females and maleto-female ratio was slightly increased.
3D CT Reconstruction Versus Ellipsoid Formula for Measuring Stone Volume Omar M, Sivalingam S, Kahn L Cleveland Clinic, United States Introduction and Objective: Kidney stone size is
usually estimated either by the largest diameter or an ellipsoid formula, as recommended by the European Association of Urology. Given the irregularity of stones, two-dimensional (2D) measurements may be inaccurate method to predict stone volume especially for large irregular stones. A more precise measurement could be obtained through 3D reconstruction of the stone, imaged by NCCT. The objective was to evaluate different methods of stone volume measurement, through comparing the accuracy of ellipsoid volume formula estimated by a KUB and the three-dimensional (3D) reconstructed volume measurement over a CT. Materials and Methods: We scanned a 90 radio-opaque phantom stones with both X-ray and CT (1 mm slices) where different size and shapes of stones were included. Stone volume calculation was done through a 3D volume program and Ellipsoid formula (stone volume = π*l*w*d*0.167). A matched pair analysis was done between different methods of calculation and the gold standard measurement of stone volume through the water displacement method and Archimedes’ principle. Results: The median stone volume was 4.75 (0.539.3), 4.7 (0.47-36.1), 5.9 (0.49-47) for the CT, water displacement and ellipsoid formula, respectively. There was a significant difference between ellipsoid measurement and water displacement (p<0.0001) while it was not significant for CT and water displacement (p=0.5). When stratified by volume, stones >6 cm3 were the only significantly difference for the ellipsoid formula group (p=0.0001). Conclusions: Stone volume calculation through a 3DCT program provides an accurate way for preoperative assessment of stone size, especially for larger di-
MP-04.01, Table 2. The Prevalence of Urolithiasis in Korea from 2002 to 2013 Year
The number of patients
Total number of population in cohort
Prevalence (%)
Total
Male
Female
Total
Male
Female
Total
Male
Female
2003
3 851
9.3
2002
3 669
2 124
1 545
1 025 340
513 258
512 082
0.36
0.41
0.30
2004
3 908
9.5
2003
4 690
2 722
1 968
1 017 468
509 212
508 256
0.46
0.53
0.39
2005
4 009
9.7
2004
5 079
3 061
2 018
1 016 580
508 223
508 357
0.50
0.60
0.40
2006
3 661
8.9
2005
5 489
3 263
2 226
1 016 820
508 317
508 503
0.54
0.64
0.44
8.7
2006
5 327
3 274
2 053
1 002 005
500 808
501 197
0.53
0.65
0.41
2007
Total patients
culi are relatively common disorders and have a significant impact on patients’ quality of life because of severe pain and high recurrence rate. But there is little study about incidence and prevalence of urolithiasis through nationwide analysis. The objective of this study is to identify the exact incidence and prevalence of urolithiasis in Korea by using cohort data.
MP-04.02
3 579
2008
3 638
8.8
2007
5 362
3 251
2 111
1 020 743
510 009
510 734
0.53
0.64
0.41
2009
3 611
8.8
2008
5 600
3 494
2 106
1 000 785
501 019
499 766
0.56
0.70
0.42
2010
3 652
8.9
2009
5 856
3 568
2 288
998 527
499 689
498 838
0.59
0.71
0.46
2011
3 749
9.1
2010
6 042
3 817
2 225
1 002 031
501 338
500 693
0.60
0.76
0.44
2012
3 835
9.3
2011
6 383
3 977
2 406
1 006 481
503 428
503 053
0.63
0.79
0.48
2013
3 722
9.0
2012
6 787
4 210
2 579
1 011 123
505 614
505 509
0.67
0.83
0.51
41 215
100.0
2013
6 810
4 352
2 458
1 014 730
507 289
507 441
0.67
0.86
0.48
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
17
MODERATED ePOSTERS ameter and irregular stones where no single formula for stone volume calculation would be precise.
MP-04.03 Predictive Model of Success to Improve Results of Extracorporeal Lithotripsy in Upper Urinary Tract Stones Bengió RG, Arribillaga L, Montedoro A, Epelde J, García Öntö H, Orellana S, Cordero E, Bengió RH Centro Urológico Profesor Bengió, Córdoba, Argentina Introduction and Objective: To present a predictive tool of success of ESWL adapted to our environment for upper urinary tract stones. Materials and Methods: We performed a retrospective, descriptive and analytical study of patients with renal and upper uretheral stones who underwent ESWL with DUET MAGNA lithotripter between January 2014 and March 2015. We included 114 patients, and demographics and tomographic characteristics were studied for each. Multivariate analysis was used to determine independent predictors of success in ESWL made by logistic regression. A ROC curve was used to determinate success cut-off values of ESWL in each significant variable. The score was determined based on the numbers of variables under the cut-off value in each patient. In every one of these categories, percentage of stone free was determined. Finally, an area under the curve of our score related to success of ESWL treatment was made. Results: Of 114 patients studied, 58 (51%) were stonefree. After a multivariate study, independent predictors of success with ESWL were tomographyc density of lithiasis (UH), body mass index (BMI) and lithiasis diameter (mm). Ideal cut off point of success of treatment in each one of the score parameter was: density of lithiasis 900 UH, BMI of 27 and lithiasis diameter of 11 mm. Percentages of free stone was 31.8% to score 0, 37.1% to score 1, 57.5% to score 2 and 88.3% to score 3. Under curve area to score was 0.723 (p<0.001). Conclusions: This score could represent a predictive
tool in our environment for the prognosis of ESWL results. Utilization of this score could limit the use of this therapy to patients with a favorable profile (score2-3), improving in this way the cost-effectiveness aspect of this procedure.
volume, location, skin-to-stone distance, stone HU values, and stone composition were assessed. Success of SWL was defined as (1) being stone-free or (2) residual stone fragments <4 mm after three months by radiography.
MP-04.06
Results: Of the 260 assessed patients, 141 (54.2%) were stone-free, 32 (12.3%) had residual stone fragments <4 mm (clinically insignificant stone fragments), and 87 (33.5%) had residual stone fragments ≥4 mm after one round of SWL. Multivariate analysis revealed that stone location and mean HU were significant predictive factors of treatment success. Receiver operating characteristic curves defined cut-off values for predicting treatment outcome rates were significantly higher for stones <815 HU than with stones >815 HU (P<0.0265). HU of calcium oxalate and calcium phosphate stones were higher than those of uric acid stones, but we could not differentiate between calcium oxalate monohydrate and calcium oxalate dihydrate stones.
Cano-García MdC1, Arrabal-Polo MA2, HuertasBrunel J3
Conclusions: Evaluation of stone HU values prior to SWL can predict treatment outcome and aid in the development of treatment strategies.
MP-04.05 Trends in PCNL: Surveying the Endourological Society Omar M1, Alshazly M2, Alnahas A3 1
Cleveland Clinic, United States; 2Menoufia University, Egypt; 3Mansoura Urology and Nephrology Center, Egypt Introduction and Objective: To report current prac-
tices of percutaneous nephrolithotomy (PCNL) among endourologists in relation to the number of cases performed per year. Materials and Methods: An Internet survey was administered to Endourological Society members. Responses were distributed into 3 groups according to number of PCNL cases per year (A=<50, B= 50-100, C=>100). PCNL technique details were evaluated and compared by each group. Statistical analysis was performed using JMP™.
evaluate the utility of the Hounsfield unit (HU) values as a predictive factor of shock wave lithotripsy (SWL) outcome for ureteral and renal stones. We also assessed the possibility that HU values could be used to predict stone composition.
Results: Two hundred and ninety-five completed responses were received. A total of 77% of respondents used the prone position while 16% in supine position and only 7% in modified lateral decubitus. There was no significant difference between the three groups regarding patient position (p=0.1), puncture acquisition by urologist or radiologist (p=0.2) and fluoroscopic puncture technique (p=0.2). Endourologists with high annual PCNL practice (>100) had the lowest probability of utilizing a safety guidewire (p=0.001), nephrostomy tube (p=0.0005) or use Balloon dilator (p=0.0001) and at the same time, had the highest probability of performing mini perc (p=0.0001) and multiple access PCNL for staghorn cases (p=0.02). Endourologists with <50 cases per year preferred a subcostal approach as the ultimate access (57%), while the other two groups didn’t differ between the subcostal or the supracostal approach (p=0.0001)
Materials and Methods: A retrospective study was
Conclusions: Prone positioning is still the preferred
performed to measure stone HU values in 260 patients who underwent SWL for solitary renal and ureteral stones from July 2007 to January 2012. Stone
position among endourologists. More experienced endourologists would avoid the use of nephrostomy tube or safety guidewire whenever possible.
MP-04.04 Evaluation of Hounsfield Units as a Predictive Factor for the Outcome of Shock Wave Lithotripsy and Stone Composition Ogawa Y, Nakasato T, Morita J, Matsui Y, Ogawa Y, Oshinomi K, Shichijo T, Naoe M, Fuji K Showa University Hospital, Tokyo, Japan Introduction and Objectives: This study aimed to
18
Differences in Density of Renal Papillae Measured in Hounsfield Units Between Stone-Forming Patients with Single Episode Versus Recurrence Episodes
1 Institute IBS Granada, Spain; 2Granada University Hospital, Spain; 3La Inmaculada Hospital, Almeria, Spain
Introduction and Objective: The aim of this work is to
study the density of the renal papillae in stone-forming patients and to determine its usefulness in these types of cases. Materials and Methods: This study includes a total of 79 patients diagnosed with renal stones and on whom a computed tomography without contrast was performed from June 2014 to May 2015. The patients were divided into two groups: Group 1 (single episode) included 43 patients, and Group 2 (recurrent episodes) included 36 patients. The density of six renal papillae (3 per kidney) was measured, and the means obtained were compared between Group 1 and Group 2. The statistical analysis was performed using SPSS 20.0. Results: The mean papillary density in Group 1 was 32.26 (SD 4.07) HU compared to 42.36 (SD 8.03) HU in Group 2 (p=0.00001). A ROC curve was constructed, obtaining an optimal cut-off point of 36.8 HU [area under the curve, 0.881 (95% CI; 0.804-0.958); p=0.0001], with a sensitivity of 80% and a specificity of 90%. The relative risk was estimated at 40.3 (95% CI; 10.8-151.1), meaning that a patient with a mean papillary density greater than 36.8 HU would have a 40 times greater risk of having recurrent renal stones. The positive predictive value (PPV) was 81% and the negative predictive value (NPV) was 90%. Conclusion: The measurement of renal papillary
density could be useful in predicting recurrent stoneformers. These results need to be confirmed in future studies with a greater number of patients and a longer follow-up.
MP-04.07 Patient Tolerance and Satisfaction During Rigid Cystoscopic Ureteral Stent Removal: A Prospective Randomized Controlled Study Comparing Non-Opioid, Opioid, and Rapid Opioid Analgesics Khouni H1, Sallami S2, Boulma R1, Ben Rais N3 FSI University Hospital, La Marsa, Tunisia; 2Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; 3 Military University Hospital, Tunis, Tunisia
1
Introduction and Objectives: The cystoscopic retrograde approach is standard in the removal of ureteral stents. There is no standardized optimal analgesic method. The aim of our study is to compare the efficacy and safety of three analgesic drugs during cystoscopic ureteral stent removal. Materials and Methods: From December 2014 to July 2015, 64 patients with a history of prior URS and ureteral stent placement due to ureteral stones were enrolled. They were subclassified randomly in three groups according to pain controlled analgesic
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS drugs given intravenously 1 hour before cystocopic procedure (Group 1: 22 patients were treated by Paracetamol IV, Group 2: 19 patients Received Tramadol IV, Group 3 : 23 patients were given Remifentanil injected with continuous infusion). Procedural pain and post procedural pain at three hours post operatively were evaluated with a 10-point visual analog scale (VAS). Mean arterial pressure (MAP) and heart rate (HR) were recorded. The treatment satisfaction questionnaire included five subscales: very satisfied, satisfied, average, not satisfied and totally not satisfied. The level of significance P was fixed at 0.05.
Results: The mean age of Group 1 was 52.1 years compared to 49.6 years in Group 2, with no significant differences (P=0.07). Vitamin D levels were lower in Group 2 compared to Group 1 (25.7 vs. 28.4 ng/ml, P=0.02). A vitamin D deficiency was observed in 28% of the Group 2 stone-forming patients versus 15.7% in Group 1 (P=0.009), with an Odds Ratio (OR) of 2.09 (95% CI;1.19-3.63). In the stone-forming patients with a vitamin D deficiency, the only difference observed was the higher levels of iPTH compared to those stone-formers with a normal vitamin D (56.9 vs. 45.5 pg/ml, respectively; P=0.0001).
Results: During the procedure, group 3 (Remifentanil) showed significantly less pain than group 1 (Paracetamol) and group 2 (Tramadol) (p<0.0001) with mean VAS respectively 1.51±0.671 vs. 4.31±0.825 vs. 4.71±0.884. We noted a significant increase of PAM in group 1 and 2 compared with group 3 (p=0.008). Comparison of group 1 and group 2 revealed a comparable mean VAS per operatively (p= 0.733). At three hours post cystoscopic ureteral stent removal, we noted a significant decrease of mean VAS in group 3 compared with group 1 and group 2 (1.25±0.703 vs. 2.19±0.626 vs. 2.58±1.164, respectiely). There was no significant difference in mean VAS post-operatively between group 1 and group 2 (p=0.887). A significant increase in mean HR and PAM was significantly remarked in group 1 and 2 than group 3 (p=0.008). Satisfaction scale of group 3 was lower than that of group 1 and group 2 (p=0.006).
Conclusion: Calcium stone-forming patients have
Conclusion: There is no difference in the perception
of discomfort and pain by patients during cystoscopic ureteral stent removal when opioid or non-opioid analgesics are used. However, rapid opioid analgesics are associated with lower intraoperative and postoperative pain score and dissatisfaction, with no increase in the complication rate, and should be considered during procedures. Our results have to be confirmed by other controlled studies with a larger study population.
MP-04.08 Vitamin D Deficiency in StoneForming Patients Arrabal-Martín M1, Cano-García MdC2, GirónPrieto MS3, Arrabal-Polo MA1, Poyatos-Andujar A4, Quesada-Charneco M1, De Haro-Muñoz T1, AbadMenor F1, Cózar-Olmo JM1 1
Granada University Hospital, Spain; 2Institute IBS Granada, Spain; 3Granada Primary Care, Spain; 4 Santa Ana Hospital, Granada, Spain Introduction and Objective: The aim of this study is to analyze the percentage of hypovitaminosis D, as well as its relationship with the various parameters of calcium-phosphate metabolism. Materials and Methods: A case control study was
conducted on 366 patients, divided into two groups (Group 1: 127 non stone-forming patients, and Group 2: 239 calcium stone-forming patients). A study was performed on calcium-phosphate metabolism and urinary lithogenic factors. The percentage of vitamin D deficiency (25-OH-vitamin D levels less than 20 ng/ ml) between the groups was analyzed and compared. The SPSS 20.0 statistics program was used for the analysis, with a P≤0.05 being considered significant.
lower mean levels of vitamin D and a higher percentage of hypovitaminosis D than in non stone-forming patients. This was only related to increased iPTH levels, with urine calcium and other lithogenic parameters having no obvious effect.
MP-04.09 Laservac: Laser with Suction as an Energy Source in Mini PCNL Singh A, Sabnis R, Ganpule A, Chhbra J, Desai M Mulgibhai Patel Urological Hospital, Nadiad, Gujarat, India Introduction and Objective: A common criticism
against mini PCNL (percutaneous nephrolithotomy) is the long operative time. Laser is the lithotripter of choice for stone fragmentation in mini PCNL. To date, no laser with suction device is available for mini PCNL. Dust generated and clots make visualization difficult during nephroscopy in mini PCNL. Using a device, which has laser with suction, may thus improve operative time and vision by sucking out all the dust and clots. We present our experience with using a laser with suction device for mini PCNL. Materials and Methods: Laservac is a laser with suction device manufactured by EMS TM; it is a 4.5 French hollow metal suction tube made of stainless steel. This tube has another small tube, which allows passage of 200-365 micron laser fiber. This tube is connected to a hand held suction device, which can control both laser fiber and suction. Patients with a stone load between 1.5 cm to 3 cm with no previous attempt at stone extraction were planned for mini PCNL using this device. Standard steps were followed in doing mini PCNL: ureteric catheter was placed and in prone position ultrasound/fluoroscopy guided puncture was done. Tract was dilated using Karl StorzTM 15/16 fr or 16.5/17.5 fr dilators. Nephroscopy was done using 12 fr Storz MIP-MTM nephroscope (working channel: 6.7 fr). Stone fragmentation/dusting and suction was done using laservac. A 365 micron end firing optical fiber with pulsed holmium:yttrium-aluminum-garnet (Ho:YAG) laser was used with setting of long pulse, 0.5-1.5 J and 6-20 hz. We have operated on 90 patients using this device to date. Parameters evaluated include demography, stone size, operative time, vision score on a scale of 1-5, stone clearance and complications. Results: All patients were demographically matched. Average stone size was 21.36 mm± 11.54 mm. The use of laser with suction in our study has decreased the operative time (56.2 min vs. 60.7 min) and nephroscopy time (30.2 min vs. 35.5 min). The vision during nephroscopy was markedly improved on a subjective
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
scale of 1-5 judged by the operating surgeon. Stone clearance rate was 100%. There was no major postoperative complication. Conclusion: Laser with suction is a promising device.
It improves vision, decreases the operative time as compared to the standard literature, and has comparable clearance rates.
MP-04.10 Flexible Ureteroscopic Stone Dusting with Holmium: YAG Laser for Treatment of Renal Stones Wu Z, Gao P, Feng C, Wang L, Mao S, Ding Q, Seng Z Dept. of Urology, Huashan Hospital, Fudan University, Shanghai, China Introduction and Objective: We evaluate the efficacy
and safety of flexible ureteroscopic stone dusting with holmium: YAG laser for treatment of renal stones and further stratify the efficacy by stone burden less than and greater than 20 mm. Materials and Methods: A total of 468 patients (pts)
with renal stones underwent flexible ureteroscopic stone dusting with holmium: YAG laser from July 2010 to February 2016. The maximal diameter of renal stones was less than 20 mm (range 11 to 19.5 mm) in 325 pts and greater than 20 mm (range 21 to 30 mm) in 143 pts. The overall mean stone maximal diameter was 16±8.2 mm (range 11 to 30 mm). Of the 468 patients, 397 had primary renal stones (first choice of this procedure for 117 pts, history of failed SWL for 280 pts), and 71 had secondary renal stones from retrograde migration of the proximal ureteral stones during the holmium: YAG laser lithotripsy with a semirigid ureteroscope. Energy settings of holmium: YAG laser were adjusted according to stone composition, location and size, varying from 0.2-0.5 Joules (J) and rate between 30-60 Hz. Stone-free status was determined by KUB plain film and/or renal ultrasound 3 months after the last procedure and was defined as the absence of fragments in the kidney or fragments ≤3 mm. Results: We demonstrate effective dusting technique to treat large stones in kidneys. The dusting strategies include use of chipping, dancing and popcorning techniques. The mean number of primary procedures was 1.5±0.7 (range 1-2). No retrieval devices were used during the procedures. The overall stonefree rates after one and two procedures were 81.8% (383/468) and 91.7% (429/468), respectively. The stone-free rates for patients with a stone burden less than and greater than 20 mm were 89.9% (301/335) and 78.2% (104/133), respectively. The overall complication rate was 12.8% (60/468). Complications included: 45 pts (9.6%) with urinary tract infections (16 with urosepsis), and 15 pts (3.2%) with hematuria. No intraoperative perforations or ureteral avulsions were encountered during the procedures. Conclusion: Flexible ureteroscopic high-power hol-
mium laser lithotripsy is a highly effective, minimally invasive and safe therapy for patients with renal stones by permitting a dusting approach that ablates stones into powder.
19
MODERATED ePOSTERS MP-04.11 Initial Experience of Using High Power Holmium Laser for Dusting of Large Bulk Renal Stones by RIRS Singh A, Sabnis R, Ganpule A, Chhabra J, Desai M Mulgibhai Patel Urological Hospital, Gujarat, Nadiad, India Introduction and Objective: RIRS (retrograde intrarenal surgery) has become an accepted treatment modality for treating small renal stones, with low wattage (20-30 W) holmium laser being used as the energy source. However, for large stones, it has disadvantages of prolonged operation time, requirement of multiple stages, decreased clearance rate and increased chances of infection. We present our experience of RIRS for large burden renal stones using high power laser as the energy source. Materials and Methods: A total of 15 patients with renal stone bulk >2 cm underwent flexible ureteroscopic holmium laser lithotripsy using high power laser (P120H, LumenisTM, Israel). While dusting the stone energy used, varied from 0.3 to 1 J and frequency varied from 35 to 80 Hz. A 200-micron ball tip fiber was used (200 D/F/L, LumenisTM). Either an OlympusTM P6 or a Storz Flex X2 ureteroscope was used, with access sheath being utilized in all the cases. A double J stent was used post operatively in all the cases. The end points in the study were total lasing and procedure time, use of accessories for stone clearance, need of auxiliary procedures and stone clearance at 1-month follow-up. Results: The mean age of patients was 49.2±11.7 years. The average number of stones in each renal unit was 1.53±0.7, with a mean stone size of 29.46±7.3 mm and a mean stone density of 1232±400 HU. One patient had staghorn with secondary calculi, 10 had stones in pelvis with calyceal extension, whereas 4 patients had multiple calyceal calculi. Renal access time was 4.53±3.6 minutes. The average lasing time and total operative time was 21±14 minutes and 39.3±12 minutes respectively. Accessories were not needed in any of the procedures. At the end of one month, stone clearance was achieved in 11 (73.3%) patients after a single treatment. Of the remaining 4 patients, 3 required PCNL and 1 required 2nd stage RIRS. Two patients had fever (clavien Grade I) and one patient had urinary tract infection (clavien Grade II) as complications. Conclusion: High power laser energy with dusting
protocol is effective in clearing large bulk renal stones in a short amount of time.
MP-04.12 Predictive Factors of Unsuccessful Extracorporeal Shock Wave Lithotripsy Monotherapy for Ureteral Stones Aoyagi T, Murakumo M, Shindo J, Taniguchi N Kushiro City General Hospital, Hokkaido, Japan Introduction and Objective: Predictive factors of unsuccessful extracorporeal shock wave lithotripsy monotherapy for ureteral stones were evaluated retrospectively. Materials and Methods: Between June 2001 and May
2015, 1 193 patients with ureteral stones were treated
20
with extracorporeal shock wave lithotripsy (ESWL) at Kushiro City General Hospital. Factors such as age, sex, stone size, side and location of the stone, grade of hydronephrosis, result of first treatment, and stone components were compared between successful and unsuccessful ESWL monotherapy groups. Results: Based on multivariate logistic regression analysis, three predictive factors of unsuccessful ESWL monotherapy were obtained: (1) stones>11 mm with predictive value (PV), (2) severe hydronephrosis (PV), (3) failure of first session (PV). If these three factors were presented, the estimated rate of unsuccessful ESWL revealed 84%. Conclusion: These predictive factors could be help-
ful for selecting the treatment modalities for ureteral stones.
MP-04.13 A Study of Predictive Factors for Complications After Retrograde Intrarenal Surgery: The Concordance of the Different Urine Cultures Rivero A, Cepeda M, Mainez A Hospital Burgos, Spain Introduction and Objective: Preventing urinary sepsis is a major concern during the development of stone surgery. Identify and prevent risk factors that cause such complications is one of the major objectives today. The previous and intra-operative culture can be helpful when further treatment. The aim of this study was to define which of them could give us more detailed information for a correct diagnosis. We prospectively determined the correlation between preoperative bladder urine cultures, intraoperative renal pelvis cultures and stone cultures in patients undergoing retrograde intrarenal surgery (RIRS). Materials and Methods: From July 2013 to December 2015, bladder urine samples were collected the week before and directly from the renal pelvis during the intervention from patients undergoing retrograde intrarenal surgery. Extracted stones were also sent for culture analysis. The concordance of urine and stone cultures across different sites was examined. The stone burden never exceeds 2 cm and we excluded patients with a previous catheterization. Results: A total of 164 RIRS were done of whom 68 (41.4%) presented in several or some of the three samples a positive culture. In the stone culture, there was a higher percentage of positive results (78%) following intraoperative culture (71%). In 11 cases (6.7%), there was culture positive preoperative and intra-operative negative. The concordance between stone and intra operative was 72%, in 61% agreed the three samples. The most frequent isolated germ was E. Coli followed by Proteus. Conclusions: Renal pelvic urine and stone cultures
may be a correct way to identify the best therapy to manage the systemic inflammatory response syndrome after stone surgery. Collecting an intraoperative sample as well as a urolithiasis culture should be common in our surgical practice to have more information against the urosepsis.
MP-04.14 Primary Hyperoxaluria in Populations of Pakistani Origin: A Preliminary Report Hulton SA, Talati JJ2, Milliner DS3, Memon A2, Nazir Z4, Biyabani SR2, Qazi S4, Aziz W2, Ahmed J2, Jafri L5, Zeeshan M5, Khan AH5, Zafar A6, Azam I7 1
Birmingham Children’s Hospital NHS Trust, Birmingham, United Kingdom; OxalEurope Consortium; 2Section of Urology and the Oxalate Group, Aga Khan University Hospital, Karachi, Pakistan; 3Div. of Nephrology, Dept. of Internal Medicine and the Mayo Clinic Hyperoxaluria Center, United States; 4Section of Pediatric Surgery and the Oxalate Group Aga Khan University Hospital, Karachi, Pakistan; 5Dept. of Pathology and the Oxalate Group, Aga Khan University Hospital, Karachi, Pakistan; 6Dept. of Pathology, Aga Khan University Hospital, Karachi, Pakistan; 7Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
Introduction and Objective: Primary Hyperoxaluria (PH) is a devastating disease causing oxalate crystal deposition, renal stones and ESRD. In emigrant Pakistani-origin (P-o) patients, its incidence is higher than in Europeans. We present a summary of reported cases, genetic analysis and estimated prevalence in Pakistan. Materials and Methods: World medical literature, media, and the Aga Khan University database was searched for documented PH among P-o patients and information added from the Rare Kidney Stone Consortium PH Registry (RKSCPHR) and OxalEurope Registry. Reported genetic mutations were listed. Models were constructed to estimate existing disease burden in Pakistan using assumption, actuals or estimates of: (i) population demographics, (ii) prevalence/incidence in other countries, and in P-o patients in UK; (iii) rates in patients with chronic renal failure or in ESRD and (iv) population/ genetic risks of disease in siblings. Results: There are 210 reported cases in literature in P-o patients; 4 in the RKSCPHR, and 44 in the OxalEurope registry (24 PH 1, 19 PH 2 and 1 PH 3 confirmed genetically and documented including 4 classified from Indian subcontinent). Overlap between registry documentation and reported cases could exist. Only one series from Pakistan studied 150 patients by direct sequencing of the AGXT gene. Mutations in another 7 patients are reported in international literature. The mutations differed from those in European populations. Our disease burden estimates range from 1003- 49,987 [based on Hutcheson’s findings on P-o patients in UK)] to 27,521-31,928 [modeled on incidence in Moroccans]. Conclusion: Documented cases of PH possibly repre-
sent only a fraction of the disease burden. The degree of awareness of PH and appropriate investigations required among Pakistani physicians is not known. Further information from other hospital records needs to be obtained. To create awareness, a scorecard suggesting the degree to which symptoms/findings indicate likelihood of PH should be on each urologist’s/ nephrologist’s desk.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-04.15 Ultra-Mini PCNL Versus Flexible Ureteroscopy for Treatment of Lower-Pole Renal Stones Sized 1535 mm: A Matched-Pair Analysis Xu K, Shah AK, Huang J, Li Z Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Introduction and Objective: We compare the clinical outcomes of ultra-mini PCNL (UMP) and flexible ureteroscopy (fURS) for the treatment of medium- to large-sized lower-pole renal stones. Materials and Methods: Between January 2015 and
January 2016, twenty-five patients who had lower-pole renal stones ranging from 15 to 35 mm were treated with UMP were matched to data of 25 fURS patients using matched-pair analysis. Variables studied were size and number of stones as well as age, gender, BMI, degree of hydronephrosis, presence of previous procedures, stone free rates, operating time, intra-operative and post-operative complications and hospital stay. Data were analyzed using Fisher’s exact test, Student’s t test and the Mann-Whitney U test. Results: Perioperative outcome variables showed no
significant difference except for mean operating times (UMP 69.48 ± 24.35 mins, fURS 115.22 ± 41.82 mins [p<0.01]), postoperative Hb drop (UMP 13.64 ± 9.06 g/L, fURS 8.17 ± 4.82 g/L [p=0.01]) and post-operative hospital stay (UMP 3.68 ± 1.31 days, fURS 2.65 ± 1.34 days [p<0.01]). A total of 19/25 (76%) of UMP and 13/25 (52%) of fURS patients had stone sized 1020 mm, while 6/25 (24%) of UMP and 12/25 (48%) of fURS patients had stone sized >20 mm. Early stone free-rate was 84.0% (21/25) and 32% (8/25) in UMP and fURS respectively while delayed stone free rate was 92.0% (23/25) and 72% (18/25). Minor complications classified as Clavien I or II occurred in 4/25 (16%) and 4/23 (17%) in UMP and fURS, respectively. No major complications (Clavien III-V) occurred in either group. Conclusion: UMP compared to fURS showed the ad-
vantage of lower operating time and higher stone-free rate, while fURS had the advantage of lower blood loss and shorter postoperative hospital stay. UMP and fURS are both safe and effective treatment options for medium- to large-sized lower calyx renal stones.
MP-04.16 Complications Associated with Ureteroscopy Related to Treatment of Urolithiasis Somani B1, Giusti G2, Sun YH3, Osther P4, Frank M5, De Sio M6, Turna B7, de la Rosette J8 1
University Hospital Southampton, United Kingdom; IRCCS San Raffaele Scientific Institute, Milan, Italy; 3 Changhai Hospital, Shanghai, China; 4Lillebaelt Hospital, Fredericia, Denmark; 5City Hospital No. 40, Saint Petersburg, Russia; 6Second University of Naples, Caserta, Italy; 7Ege University School of Medicine, Izmir, Turkey; 8AMC University Hospital, Amsterdam, The Netherlands 2
Introduction and Objective: The CROES URS Global study was set up to assess the outcomes of URS in
a large worldwide cohort of patients involving multiple centers. The aim of this study is to evaluate the intra-operative and post-operative complications associated with URS. Materials and Methods: The CROES database was
established via collaboration between 114 centers in 32 countries worldwide and electronic data was collected on both intra-operative and post-operative complications. Results: On analysis of a total of 11885 patients, the overall complication rate is 7.1% respectively. The intraoperative and post-operative complication rates were 4.2% and 2.6% respectively, and 0.5% cases had both an intra and post-operative complication. In total, 5 deaths were reported in the study period. The vast majority of lower grades (I-II: n = 283) of the Clavien classification scores were related to bleeding, fever, urinary tract infection (UTI) and pain. Events with Clavien grade III or IV (n = 84) were related to sepsis, stent misplacement, urinary retention or complications from the ‘other’ category. When compared to the different world economies, there was no difference in the complication rates between the developing and developed nations or between different centers from different continents. Conclusion: Ureteroscopy is a safe and effective pro-
cedure for treatment of stones, the outcomes of which are broadly comparable in different parts of the world for similar patient and stone demographics.
MP-04.17 Prospective Randomized Comparison of Microperc and RIRS for Lower Calyceal (LC) Calculus of Less Than 15 mm Singh A, Sabnis R, Ganpule A, Chhabra J, Desai M Mulgibhai Patel Urological Hospital, Nadiad, Gujarat, India Introduction and Objective: The management of lower calyceal calculus has always been a matter of debate. The objective of this study is to compare the outcome of retrograde intrarenal surgery (RIRS) and microperc for lower calyceal (LC) stones of less than 15 mm. Materials and Methods: After institutional ethical committee approval and informed consent, we prospectively randomized 32 patients with LC stones of less than 15 mm into RIRS and Microperc. Parameters analyzed were stone size, operative time, hospital stay, blood loss, pain score, need for auxiliary procedures and complications. Results: Of the 32 patients, 17 patients were randomized to Microperc (Group A) and 15 to RIRS (Group B). Age, stone size, operative time and hospital stay were comparable in both the groups (39.0±19.2 vs. 41.1 ±11.2 years, 9.7 ± 2.5 vs. 10.26 ± 2.63 mm, 30±12.74 min vs. 35.5 ± 10.1 minutes, 74±20 hours vs. 62±12 hours respectively). The hemoglobin drop and pain score was calculated by VAS at 24 hours was significantly low in the RIRS group (0.7±0.36 vs. 0.08±0.22 gm/dl, p=0.02 and 3.43±1.13 vs. 2.6±0.7, p=0.04). Four patients in RIRS required conversion to other procedures (microperc in 2 and miniperc in 2) in view of difficult access. One patient in the Micro-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
perc group required conversion to miniperc in view of bleeding and poor vision. DJ stenting was required in 29% in the Microperc group and in 73% in RIRS group. Two patients in the Microperc group and 3 patients in the RIRS group had postoperative fever (Clavien Grade 1 complication), which settled with conservative measures and one patient in the Microperc group required post-operative DJ stenting (Clavien Grade 3a complication) in view of solitary kidney and pain with hydroureteronephrosis. In both groups, the stone-free rate at 1 month was 100%. Conclusion: Both Microperc and RIRS are efficient
and comparable procedures for the management of LC calculus. Microperc is associated with fewer conversions to other procedures and a lesser need for DJ stenting. RIRS patients have decreased blood loss compared to Microperc patients.
MP-04.18 Tubeless Management of Colon Perforation During Percutaneous Nephrolithotomy Maghsoudi R1, Etemadian M1, Kashi AH1, Mehravaran K1, Soleimani MJ1, Soleimani AH2 1 Hasheminejad Kidney Center, Tehran, Iran; 2Tehran University of Medical Sciences, Tehran, Iran
Introduction and Objective: We present our experi-
ence with tubeless management of intraoperative or early postoperative diagnosis of colon perforation in percutaneous nephrolithotomy (PCNL). Materials and Methods: All PNL operations between April 2004 and December 2015 were reviewed for the occurrence and management of colon perforation. We typically performed PNL with insertion of nephrostomy tube before mid 2007 and after mid 2007, we mostly performed tubeless PNL and inspected access tract during nephroscope removal. Results: A total of 8 956 PCNL operations were performed during the study period. Colon perforation complicated 16 PCNl operations within the studied period. The first 3 cases were diagnosed with 2 or more days of the operation, and in 2 patients, open surgery was employed for repair. The next 13 cases were diagnosed intraoperatively or in the early postoperative period and were managed by broad spectrum antibiotics, bowel rest, and urinary Dj and Foley catheter insertion but without a colostomy tube or retroperitoneal drain. This management was successful in all 13 cases, with no need for an invasive intervention or exploration. Patients were followed in the outpatient clinic 2 and 6 weeks after the operation with physical exam, abdominopelvic ultrasonography, and renal functional studies. No complications were observed during follow-up outpatient visits. Conclusion: Intraoperative or early postoperative di-
agnosed colon perforation in PCNL can be managed without the insertion of colonic or retroperitoneal drain in stable patients. In cases of delayed diagnosis, observation of persistent fever or abdominal signs of peritonitis, the standard protocol should be performed, including the insertion of a colonic or retroperitoneal drain or abdominal exploration as appropriate.
21
MODERATED ePOSTERS
Moderated ePosters Session 5 Urinary Incontinence
patient-reported urinary incontinence outcomes that is free of interview bias. This may impact prostate cancer treatment discussions.
MP-05.02 Impact of Preoperative and Postoperative MRI-Measured Membranous Urethral Length on Urinary Continence Recovery After RoboticAssisted Radical Prostatectomy
Friday, October 21 1615–1745 MP-05.01 Are We Underestimating the Rates of Incontinence After Prostate Cancer Treatment? Results from NHANES
Suh YS, Choi T, Jeong BC, Lee SW, Jeon SS Samsung Medical Center, Sungkyunkwan University School of Medicine, Dept. of Urology, Seoul, Korea
Chelluri R, Daugherty M, Bratslavsky G, Byler T SUNY Upstate Medical University, Syracuse, United States Introduction and Objectives: Definitive local therapy
for prostate cancer (PCa) includes surgical prostatectomy (RP) and radiotherapy (XRT), both of which share a complication of urinary incontinence. Studies report incontinence rates of anywhere from 7-22% following these therapies, yet no truly patient-centered report has been compiled. We evaluated patient-reported incontinence rates and bother scores after treatment for prostate cancer. Materials and Methods: The NHANES database was queried for all men who reported a diagnosis of PCa from 2001-2010 and received treatment in the form of RP or XRT. Data on urinary incontinence were collected. A control arm of men without a diagnosis of PCa age 50-69 years was constructed for baseline incontinence rates within the population. Three additional cohorts were created for patients treated with RP, XRT or combination RP & XRT. Prevalence was estimated using appropriate sampling weights. Results: We identified 316 men diagnosed and treat-
ed for prostate cancer who were compared to 3 534 controls. Men who underwent RP experience incontinence rates of 62.4% compared to 46.3% of those patients treated with XRT; whereas those patients with combined therapy had incontinence rates of 80.6% (p<0.0001). There was no significant difference seen in bother scores between treatment groups. Table 1 breaks down the type and amount of incontinence between groups. Conclusion: Surprisingly, we found increased rates of
incontinence compared to previously published literature. This provides data from a nationwide sample of
Introduction and Objective: After robotic-assisted
radical prostatectomy (RARP), loss of urinary control remains a problem with incidence ranging 6% to 20%. The development of magnetic resonance imaging (MRI) has led to improved anatomical understanding of structures that affect urinary continence recovery. Urethral length is one of the important factors directly correlated with urinary continence recovery after RARP. In this study, we investigate the impact of membranous urethral length (MUL) measured by preoperative and postoperative MRI on urinary continence recovery after RARP. Materials and Methods: We reviewed 1 332 patients
who underwent RARP between June 2008 and December 2013. Of these patients, we identified 190 patients who had preoperative and postoperative prostate MRI. After excluding patients with adjuvant radiation therapy and follow-up of less than 1 year, 186 patients were finally analyzed. The 3.0-Tesla MRI (Intera Achieva 3T, Philips Medical System, Best, the Netherlands) with a phased-array coil (USA Instruments, Aurora, OH, USA) was used. On T2-weighted MRI, preoperative MUL was measured from the prostate apex to the urethra at the penile bulb. Postoperative MUL was measured from the bladder neck to the urethra at the penile bulb. The percent change of MUL was calculated by dividing the difference of MUL to preoperative MUL. Patients without pad or protection were considered continent. Results: The mean (standard deviation) age at surgery was 64.5 (7.6) years. The mean preoperative MUL and postoperative MUL were 15.6 (2.7) mm and 14.7 (2.7) mm, respectively. At 6 months and 12 months after RARP, 140 (75.3%) patients and 165 (88.7%) patients restored continence. On multivariate logistic regression analysis, age (95% CI 1.01-1.14, P =0.022) is only
MP-05.01, Table 1. Groups
Any UI
Stress
Urge
Mixed
Bother
Moderate or Severe Incontinence
Controls (n=3534)
18.9% [17.3-20.6]
4.5% [3.7-5.4]
15.4% [14.0-16.8]
4.3% [3.6-5.2]
10.9% [9.7-12.1]
2.9% [2.3-3.8]
RP (n=136)
62.4% [50.2-73.2]
50.9% [38.3-63.3]
27.3% [17.8-39.6]
36.9% [26.4-48.7]
40.5% [29.5-52.5]
23.2% [14-35.9]
XRT (n=125)
46.3% [36.5-56.3]
18.1% [11.0-28.4]
35.9% [27.0-45.9]
15.9% [9.1-26.3]
29.8% [21.1-40.1]
12.8% [7.3-21.6]
RP&XRT (n=55)
80.7% [65.1-90.3]
73.2% [59.1-83.7]
31.1% [18.1-47.9]
26.2% [15.7-40.3]
52.5% [38.9-65.8]
52.4% [36.9-67.5]
associated with urinary incontinence at 6 months, while both age (95% CI 1.02-1.23, P =0.017) and diabetes mellitus (DM) (95% CI 1.03-12.74, P =0.046) were associated with urinary incontinence at 12 months. After adjusting for these factors, preoperative MUL ≤16 mm (95% CI 1.01-1.14, P =0.022), postoperative MUL ≤15 mm (95% CI 1.75-8.07, P =0.001) and percent change of MUL >18% (95% CI 1.17-7.23, P =0.021) were associated with urinary incontinence at 6 months, while postoperative MUL ≤15 mm (95% CI 1.05-9.18, P =0.041) was associated with urinary incontinence at 12 months. Conclusion: Preoperative and postoperative MUL
were significantly associated with urinary continence recovery after RARP. Therefore, efforts to preserve MUL are highly recommended during surgery for optimal continence outcomes after RARP.
MP-05.03 Transverse Myelitis: A Cause of Refractory Neurogenic Bladder Hamid R, Omar I, Warner N, Shah J Royal National Orthopaedic Hospital, London, England Introduction and Objective: Transverse myelitis (TM) can cause a variety of neurological symptoms for a variable length of time. Almost all patients with TM have co-existing neuropathic bladder dysfunction (NBD). However, the course of NBD is variable and quite often does not follow the improvement in neurological changes in other organs of the body. The aim of the study was to identify the course of bladder changes associated with TM and effects of management of NBD in patients with TM. Materials and Methods: A prospective study on all
patients diagnosed and followed up in our spinal rehabilitation center was carried out since 2011. All relevant data were collected; age, gender, date of diagnosis, ASIA classification of the lesion, initial investigations, management and follow-up investigations. All patients had a skeletal neurological insult in addition to their bladder dysfunction. Results: In two years, 8 patients were diagnosed were TM. They were mainly children and adolescents, with an average age of 9.37 (range 4 to 15 years). There were 4 males 4 females. Three of 8 patients (37.5%) had ASIA spinal cord injury (complete). Two of 8 patients (25%) had cervical lesion causing tetraplegia, and the remaining 6 patients (75%) had thoracic lesions causing paraplegia. All patients had an ultrasound scan and urodynamics for the evaluation of NBD. All had neurogenic detrusor overactivity (NDO) on urodynamics with a mean maximum detrusor pressure of 44 H2O (range 5-112). The management involved clean intermittent catheterization in 6 patients (75%) and spontaneous void in the remaining 2. Three patients have gained complete motor function and 2 regaining partial motor function whilst the remaining 3 are still wheelchair bound. However, the bladder remained neuropathic in all patients. Four patients (50%) rely on intradetrosur Botox injections and 6 out of 8 (75%) continue to take antimuscuranics for persistent bladder symptoms. Conclusion: We conclude that TM invariably leads to
almost NBD. Importantly, this dysfunction appears to
22
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS persist even with improvement of neurology. Hence, patients with NBD secondary to TM require a long term neurourological follow-up to optimize lower urinary tract function.
regarding elective surgery. Here, we examine how an increasing body mass index (BMI) affects the peri-operative outcomes of artificial urinary sphincter (AUS) placement.
MP-05.06
MP-05.04
Materials and Methods: The American College of
Perioperative Complications of Artificial Urinary Sphincter Placement Among the Elderly
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072012) was queried using Current Procedural Terminology (CPT) codes for AUS placement (35445). Prolonged length of stay (pLOS), prolonged operative time (pOT), 30-day complications, and need for reoperation were analyzed with obesity defined as BMI >30, as well as with BMI organized into standard quartiles. pOT and pLOS were defined as an operating time and a hospital length-of-stay greater than the 75th percentile, respectively (pOT=114 minutes and pLOS=1 day).
Tillou X1, Ait Said K1, Leroux Y2, Menahem B2, Alves A2, Doerfler A1
Raup V, Lu P, Vetterlein M, Meyer C, Trinh QD, Eswara J Brigham and Women’s Hospital, Harvard Medical School, Boston, United States and Objective: Artificial urinary sphincter (AUS) placement is a durable treatment for stress urinary incontinence. However, the use of AUS in the elderly has not been specifically examined. We sought to evaluate the perioperative outcomes of AUS placement among the elderly.
Introduction
Materials and Methods: The American College of
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072012) was queried using Current Procedural Terminology (CPT) codes for AUS placement (35445). Advanced age was defined as >70 years old. Prolonged length of stay (pLOS), prolonged operative time (pOT), 30-day complications, and need for reoperation were analyzed. pOT and pLOS were defined as an operating time and a hospital length-of-stay greater than the 75th percentile, respectively (pOT=114 minutes and pLOS=1 day). Results: A total of 607 patients who underwent initial
AUS placement were identified, with a median age at time of surgery of 71 years (18-89). Of these patients, 307 were >70 years old (50.6%). AUS placement was associated with a post-operative complication rate of 3.3% (20/607). Advanced age was found to be associated with a higher rate of overall post-operative complications (p=0.0230), specifically superficial skin infections (p=0.0428), wound dehiscence (p=0.0428), and cardiac complications (p=0.0428). Advanced age was also associated with prolonged operative time (p=0.0269). Conclusions: AUS placement was found to be a very safe procedure with a post-operative complication rate of only 3.3%. Advanced age was associated with prolonged operative time and overall post-operative complications after AUS placement, specifically superficial wound and cardiac complications. Given the increased risk of cardiac events, AUS placement should be undertaken with caution in elderly patients, and every effort should be made to medically optimize these patients pre-operatively.
MP-05.05 Artificial Urinary Sphincters: Does Obesity Affect Surgical Outcomes? Raup V, Lu P, Vetterlein M, Loeppenberg B, Meyer C, Trinh QD, Eswara J Brigham and Women’s Hospital, Harvard Medical School, Boston, United States Introduction and Objective: As the waist size of the
average American continues to grow, it becomes increasingly important to acknowledge the ways in which obesity affects surgical outcomes, particularly
Results: A total of 611 male patients who underwent
an initial AUS insertion were identified, with a median age at time of surgery of 71 years (18-89). BMI quartiles were as follows: <18.5 (4 patients, 0.6%), 18.5-24.9 (89 patients, 14.6%), 25-29.9 (270 patients, 44.2%), >30 (249 patients, 40.8%). BMI was not associated with pOT (p=0.668; quartiles p=0.666) or pLOS (p=0.487; quartiles p=0.582). BMI was also not associated with need for reoperation (19 patients, 3.1%; p=0.537; quartiles p=0.320) or other post-operative complications (20 patients, 3.3%; p=0.318, quartiles p=0.516). However, when broken into subcategory, obesity (BMI >30) was associated with increased wound dehiscence (p=0.019), urinary tract infection (UTI) (p=0.018), and deep vein thromboses (0.019). A detailed analysis of specific post-operative complications can be reviewed in Table 1. Conclusions: We found no association between increasing BMI and need for reoperation or overall rate of complications from initial AUS insertion. However, obesity was associated with increased wound dehiscence, post-operative urinary tract infection and deep vein thrombosis, although rates of these complications were quite low. Hence, AUS placement is an excellent option to treat urinary incontinence in obese patients, but special attention should be paid to optimizing perioperative antibiotic coverage, wound care, and post-operative ambulation.
MP-05.05, Table 1. Post-Operative Complications Compared to BMI Complication
Effect of Bariatric Surgery on Urinary and Fecal Incontinence: Prospective Analysis with a One-Year Follow-Up
1
Dept. of Urology and Transplantation, University Hospital of Caen, France; 2Dept. of Abdominal Surgery, University Hospital of Caen, France Introduction and Objectives: Few studies have estab-
lished that obesity promotes all types of urinary incontinence and disorders of the pelvic floor. The role of bariatric surgery on urinary incontinence remains poorly studied. We studied the effect of bariatric surgery on urinary incontinence, dysuria and fecal incontinence before and one year after bariatric surgery. Materials and Methods: This was an observational
cohort study of 140 patients who underwent bariatric surgery between September 2013 and September 2014. Patients prospectively completed four questionnaires: 2 urinary symptoms (USP and ICIQ) and 2 fecal incontinence questionnaires (Wexner score and FIQL). A total of 83 women and 33 men completed 4 questionnaires the day before surgery when arriving in the department, and one year after surgery. Preoperative questionnaires of the 140 patients were compared to the questionnaires completed by 40 obese patients followed in the nutrition department with no surgery scheduled. Results: A total of 116 of the 140 patients completely responded to the four questionnaires. The rate of urinary incontinence was 50.9% before surgery and 19% at 1-year follow-up (p<0.0001). Bariatric surgery improves the rate of stress urinary incontinence, which was 39.7% before surgery vs. 15.5% at 1 year (p<0.0001) after. There was an improvement of urinary urge incontinence of 36.8% vs. 7.9% (p<0.0001). The dysuria rate was 19.8% before surgery vs. 3.4% at 1 year (p<0.0001). Bariatric surgery improved the quality of life related to urinary symptoms (p<0.0001). One year after surgery there was no significant difference in terms of prevalence and severity of fecal incontinence. To eliminate a response bias related to the surgical treatment preparation and waiting time, we compared the patients operated on with a control population. The mean BMI was comparable between these groups: 43.6±6.9 kg/m2 for patients before surgery and 43.6±5.9 kg/m2 for the control patients (p=0.7). Regarding urinary level, there was no significant difference between the scores for stress urinary urge incontinence and dysuria between patients before surgery and the control group, however the ICIQ was higher in patients before surgery than the control population: 3.84±5.3 vs. 2.15± 4.4 (p=0.0428).
BMI>30
Quartiles
Overall
0.321
0.523
Wound infection
0.639
0.573
Wound dehiscence
0.019
0.142
UTI
0.018
0.009
Renal
0.149
0.353
Sepsis
0.348
0.787
loss following bariatric surgery improves stress urinary incontinence, urge incontinence, dysuria and quality of life. However, we did not find any positive effect on fecal incontinence.
Thromboembolic
0.019
0.142
MP-05.07
Pulmonary
0.785
0.406
Cardiac
0.355
0.299
The AUS Cycling Time Predictably Increases with Cuff Size
Reoperation
0.537
0.320
Cunningham K, Westney OL
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Conclusion: We confirmed with our study that weight
MD Anderson Cancer Center, Houston, United States
23
MODERATED ePOSTERS Introduction and Objective: The AMS 800™ Urinary
Control System is the gold standard for treatment of severe intrinsic sphincter deficiency. Cycling occurs with unidirectional flow to and from the PRB with use of valves and a refill delay resistor. The manufacturer’s manual describes a 1-11 minute cycle time. Increased length of cycling can equate clinically to post-void dribbling. The purpose of our study was to evaluate the cycling times for individual cuff sizes to allow for better post-operative patient counseling. Materials and Methods: We replicated device placement with an ex-vivo model using a Foley catheter as a surrogate urethra and measured cuff cycling times, 3.5 to 6.0 cm. Catheter size was adjusted directly with cuff size to produce a consistent spatial ratio between area of the cuff and the catheter. The AUS system was connected via a 3-way stopcock to an arterial line pressure transducer (Figure 1). A 61-70 cmH20 PRB was filed with 23 cc’s of normal saline. Cycle length was defined by full pump compression to system equilibration at 61 cm H2O (45 mmHg) as measured by the GE Dash 4000™ Vital Signs Monitor. Four run times were averaged to obtain a mean time for each cuff size. The post-equilibration cuff volume was measured to assess the change in volume between sizes.
Comparisons between cuff mean cycling times were performed using an unpaired t-test. Results: The average cycle time ranged from 3:06 min to 7:07 min with direct relation to cuff size. A comparison between cuff sizes and cycle time showed a significant difference between each cycle time when increasing by 0.5 cm (p<0.05, 95% confidence interval), except when comparing 4.5 cm to 5.0 cm cuff (Graph 1). The average fluid transfer rate was 0.01 cc/s. The end cycle cuff volumes increased by approximately 0.2 cc per 0.5 cm increase in cuff length. Conclusion: Increasing cycle time was related to cuff
size. Patients should be educated that complete closure may vary significantly depending on size of the cuff placed. Normal device operations should not be misconstrued as device malfunction.
MP-05.08 Increased AUS Reservoir Volumes Do Not Correlate with Increased Pressure Delivery Cunningham K, Westney OL MD Anderson Cancer Center, Houston, United States
MP-05.07, Figure 1. AUS Cycling Set Up
Introduction and Objective: The artificial urinary sphincter is the gold standard for the treatment of postprostatectomy incontinence. The 3-component AMS 800TM (American Medical Systems, Minnetonka, Minnesota) system includes a pressure regulating balloon (PRB), silicone urethral cuff and a control pump with associated kink-resistant tubing. The PRB, which is filled intra-operatively with 0.9% normal saline or an isotonic contrast mixture, delivers the occlusive force to the urethral cuff. Though the PRB has been available in a variety of 10 cm H2O pressure ranges from 41-100 cm H2O, the 61-70 cm H2O balloon is the most commonly utilized. The properties of the PRB (wall thickness, elasticity of the material (silicone elastomer) and the volume) are responsible for the resultant delivery pressure. According to the manufacturer’s device description, the pressure within the PRB is maintained within a certain range when a specific fluid volume is injected into the balloon. Anecdotally, urologists have increased the volume in the PRB in certain situations to accommodate the fluid requirements of a larger cuff or based on a hypothesis of augmenting the occlusive force. However, the effects of increasing volume in the PRB have not been objectively evaluated. The purpose of our study was to evaluate the pressure delivered by the AMS 800TM 61-70 cm H2O PRB at different volumes. Materials and Methods: We performed ex-vivo test-
ing of two 61-70 cmH20 pressure regulating balloons (PRB). The pressure transmitted by the PRB was measured at pre-designated volumetric intervals using a GE Dash 4000TM Vital Signs Monitor and an arterial line pressure transducer. After prepping the component in standard fashion, the PRB’s were sequentially filled with 20, 23, 25, 30 and 40 ccs of normal saline. Subsequently, we continued to test a single PRB from 50 cc to 100 cc of volume, recording the pressure at 10 cc increments. Results: Both 61-70 cmH2O PRB’s maintained stable pressures from 20-25 ccs. Recorded pressure transmission at 30-40 cc, while still in range, was reduced. Further PRB expansion resulted in the transduced pressure progressively dropping then going below the manufacturer’s specified range at volumes >60 cc (Figure 1). Conclusion: The pressure delivery characteristics of
the AMS 800 TM PRB allow for maintenance of the prescribed range up to a volume of 25 cc. Filling of the PRB in a compliant space above that volume results in a drop of transmitted pressure rather than an increase.
MP-05.07, Graph 1. Average Cycle Time (min) vs. AUS Cuff Size (cm)
MP-05.08, Figure 1. PRB Pressure vs. Volume
MP-05.09 Causes and Outcome of Re-Interventions After Placement of AMS 800 Artificial Urinary Sphincters on Males Haillot O CHU Tours, France; Francois Rabelais University, Tours, France Introduction and Objective: We reviewed the caus-
es and the results of every local re-intervention after AMS 800 artificial urinary sphincter (AUS) placement on males for urinary incontinence in a university department over a ten-year period. Materials and Methods: All cases of complete or partial explantation of AMS 800 AUS between January
24
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS 1, 2005 and December 31, 2015 were retrospectively reviewed. Causes of explantation were defined as erosion, infection and malfunction. Cases with both erosion and infection were classified as erosion. Intervals between implantation and re-intervention were defined as early (within 3 months), intermediate (3 months to 5 years) and late (after 5 years). In order to identify the factors of re-intervention, the statistical analysis compared only the explanted patients from our series versus non explanted ones. Results: Between 2005 and 2015, 36 patients have had a re-intervention, 27 coming from our series and 9 being referred. During this period of time, 107 patients have had a first implantation of an AMS 800 AUS in our department, and 17 of them were explanted giving a rate of 16%. In addition, 10 patients explanted during these 10 years were implanted before 2005. The global rate of explantation of our series was 22.5%, excluding patients having been referred. Among the 36 patients, causes of re-intervention were infection in 5 (early), 4 (intermediate) and 3 (late), erosion in 2, 8 and 4, and malfunction in 0, 3 and 7 respectively. A total of 19 patients have had a second implantation (7 of them during the same procedure) including 5 patients with only a part (balloon or cuff ) of the AUS reimplanted. Out of 19 men, 9 had a second explantation and one had a third implantation. In univariate analysis, previous radiotherapy, size of the cuff, experience of the surgeon and peno-scrotal route were significant risk factors. In multivariate analysis, only previous radiotherapy and peno-scrotal versus perineal route were significant. Conclusion: In this series, rate of re-intervention for
AMS 800 AUS seems to be higher than previously reported due to erosion, infection and late malfunction.
MP-05.10 The Staged Approach to Artificial Urinary Sphincter (AUS) Implantation in Complex Cases Bugeja S, Ivaz S, Frost A, Andrich DE, Mundy AR University College London Hospital, United Kingdom Introduction and Objectives: We have adopted a
staged approach for AUS implantation in selected complex cases in an attempt to reduce the risk of infection and erosion. We present our experience with this approach. Materials and Methods: Between January 2012 and December 2014, 32 of 150 (21.3%) AUS implantations were staged. The cuff was implanted and the tubing sealed off with a de-activation plug. The pump and reservoir were subsequently inserted, on average 6.1 months later, after excluding cuff erosion. Mean follow-up was 18.4 months (6.1-27 months). Results: Of 32 staged procedures, 13 were for bulbar and 19 for bladder neck (BN) devices. A total of 18 (56.3%) were non-primary procedures; 9 of 13 bulbar (69%) and 9 of 19 (47.4%) BN. Of the 18, 9 were having a 2nd device, 3 a 3rd, 5 a 4th and 1 a 5th. Nine of the bulbar cuffs (69%), including all the primary ones, had undergone previous urethral surgery (diverticulectomy n=2; BPA n=2; urorectal fistula repair n=1; urorectal fistula and redo-vesico-urethral anastomosis n=3, buccal graft bulbar urethroplasty n=1). All of the BN implants were in patients who had had
multiple abdominal procedures for previous BN AUS (4), cystectomy and neo-bladder or cystoplasty (6), pelvic fracture-related injuries (3), extrophy/epispadias reconstruction (3), female incontinence surgery (3). The explantation rate for the entire cohort was 9 of 32 (28%); 3 of 19 BN (15.8%) all for erosion at a mean of 87 days after implant; 6 of 13 bulbar (46%), 4 for erosion, 2 for infection, mean 208 days after surgery. In 3 patients, the cuff was explanted for early erosion before implantation of the rest of the device (surgical injury to the urethra). Two patients were dry with only the cuff. Conclusion: A staged approach allows implantation
of an AUS in complex situations in which this would otherwise not be possible. Explantation rates are still higher than for routine implants but are acceptable given the nature of the case mix. Advantages include the avoidance of spontaneous activation, shorter operative time, and fewer implanted components, all of which reduce the risk of infection and erosion in patients whose urethra is already heavily compromised.
MP-05.11 The New Aroyo® Artificial Urinary Sphincter Provides Adjustable/ Quantifiable Pressure for Personalized Continence Outcomes Zachval R1, Haillot O2, Thiruchelvam N3, Krhut J4, Chlosta P5, Paradysz A6, Lynch W7, Saussine C8, Moon D9, Chin P10, Gilling P11, Lenormand L12, Cornu J13, Hansen F14, Oelke M15 1
Thomayer Hospital; 1st and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; 2CHU Bretonneau; University Francois Rabelais, Tours, France; 3Dept. of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; 4 Dept. of Urology, Faculty Hospital, Ostrava, Czech Republic; 5Dept. of Urology, Collegium Medicum of the Jagiellonian University, Cracow, Poland; 6Dept. of Urology at SPSK no. 1, Zabrze, Poland; 7St. George Hospital, Kogarah, Australia; 8CHU StrasbourgHôpital Civil, Strasbourg, France; 9Royal Melbourne Hospital, Melbourne, Australia; 10The Wollongong Hospital, Wollongong, NSW, Australia; 11Tauranga Hospital, Tauranga, New Zealand; 12CHU de Nantes, Nantes, France; 13Dept. of Urology, Rouen University Hospital, Rouen, France; 14Herlev & Gentofte Hospital, Herlev, Denmark; 15Dept. of Urology, Hannover Medical School, Germany Introduction and Objectives: The Aroyo® Artificial Urinary Sphincter (AUS) was developed in response to deficiencies inherent to the AMS 800®, Zephyr® ZSI 375 and FlowSecure® AUS. Aroyo® AUS offers the following unique features:
• Pre-connected components eliminating tubing disconnections and reducing surgical time • ‘One-size-fits-all’ device with an adjustable urethral cuff for urethral circumferences of 3.5-6.0 cm • ‘One Touch’ open–close buttons designed to ease patient operation and simple use for nocturnal deactivation • Mechanism allowing ‘On Demand’ occlusive pressure increases to counter SUI
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
• Quantifiable, post-implant adjustment of the intra-device pressure for safe and effective personalized continence outcomes • This study presents the Aroyo® AUS design, implantation technique and relationship between intra-device pressure and 24-hour pad weight reduction. Materials and Methods: The Aroyo® AUS consists of a 3.5-6.0 cm urethral cuff, scrotal control mechanism and subcutaneous pressure compensator implantable via a single incision. Separate close-open buttons alternately occlude or open the urethra. Button geometry aids operation and encourages nocturnal deactivation. The pressure compensator may be manually compressed for temporary ’On Demand’ cuff pressure increases during stress events. A pressure optimization tool allows for post-operative percutaneous pressure measurement and adjustment for improved continence. RELIEF I study established a safe and effective intra-device pressure range of 80-130 cm H2O. RELIEF I (pre-market) and RELIEF II (post-market study in progress) are multi-center, prospective, single armed studies with change in 24-hour pad weight at 3-month follow-up primary endpoints. Secondary endpoints included change in 24-hour pad weight at 6 and 12 months. Pooled analysis of 16 RELIEF I/II patients at 6-month follow-up was performed. Results: At the 6-month follow-up, a 96 (± 20) cm H2O intra-device pressure provided an 81(± 27)% 24-hour pad weight reduction with no serious adverse events, supporting the hypothesis that intra-device pressures ≥80 cm H2O provide 24-hour pad weight reductions ≥80%. Additional data will be reported following RELIEF II completion. Conclusion: Pooled RELIEF I/II results indicate that
the Aroyo® AUS device pressures ≥80 cm H2O are predictive of 24-hour pad weight reductions ≥80%. The Aroyo® AUS provides a quantifiable method by which post-implant pressure adjustments may be used to predictably control continence and patient safety.
MP-05.12 Safety and Efficacy of the Adjustable Aroyo® Aus for Male Stress Urinary Incontinence: Preliminary 3 and 6-Month Relief II Results Zachval R1, Haillot O2, Thiruchelvam N3, Krhut J4, Chlosta P5, Paradysz A6, Lynch W7, Saussine C8, Moon D9, Chin P10, Gilling P11, Lenormand L12, Cornu J13, Hansen F14, Oelke M15 1 Thomayer Hospital; 1st and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; 2CHU Bretonneau; University Francois Rabelais, Tours, France; 3Dept. of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; 4 Dept. of Urology, Faculty Hospital, Ostrava, Czech Republic; 5Dept. of Urology, Collegium Medicum of the Jagiellonian University, Cracow, Poland; 6Dept. of Urology at SPSK no. 1, Zabrze, Poland; 7St George Medical Centre, Kogarah, Australia; 8CHU StrasbourgHôpital Civil, Strasbourg, France; 9Royal Melbourne Hospital, Melbourne, Australia; 10The Wollongong Hospital, Wollongong, Australia; 11Tauranga Hospital, Tauranga, New Zealand; 12CHU de Nantes, Nantes, France; 13Dept. of Urology, Rouen University Hospital, Rouen, France; 14Herlev & Gentofte Hospital, Herlev,
25
MODERATED ePOSTERS Denmark; 15Dept. of Urology, Hannover Medical School, Germany Introduction and Objectives: The Aroyo® AUS was developed in response to AMS 800™ deficiencies and offers the following features:
• Quantifiable, post-implant pressure adjustment for continence customization • Open and Close Buttons easing patient operation and encouraging nocturnal deactivation • Temporary pressure increases to counter stress urinary leakage • “One-size-fits-all” Cuff • Pre-connected components eliminating tubing disconnects and reducing surgical time • Single incision implantation • The RELIEF II study aims to evaluate Aroyo® AUS safety and efficacy for male SUI treatment. Preliminary 3 and 6-month results are reported here. Materials and Methods: RELIEF II is a prospective, single arm, international study. Perineal or peno-scrotal implantation. Irradiated patients included (<60% of population). Re-pressurization allowed any time post-activation. Primary endpoint: 3-month 24-hour PWT change. Secondary endpoints: 6 and 12-month 24-hour PWT change, 1-hour PWT change, average PPD, IQoL, ICIQ, ICIQ-MLUTS and IIEF scores. Primary safety endpoint: major device-related complications at month 3. A disposable pressure monitor provided for percutaneous pressure adjustments. A total of 80-130 cm H2O provides most favorable 24-hour PWT reductions. Results: A total of 48 men (SUI after RP or TURP) were enrolled at 14 centers (enrollment goal: 82). A 15 beyond 3-month and 12 beyond 6-month follow-up. Average 3 and 6-months intra-device pressures were 84 cm H2O (±17 cm H2O) and 112 cm H2O (±23 cm H2O) respectively. Intra-device pressure ≥80 cm H2O provides ≥80% improvement in 24-hour PWT reduction. Average 3 and 6-month 24-hour PWT reductions were 80% (±15%) and 84% (±18.3%) respectively. Average PPD reductions were -4.2 pads at 3 and 6-month follow-ups. A total of 7 SAE’s: 2x Control Mechanism re-positionings, 1x surgical damage to device, 1x scrotal fistula, 2x urethral erosion <30 day implant duration (1x previous urethroplasty), 1x infection, 15% SAE rate compares to 5% to 53% AMS AUS 800 rate. Conclusions: Early RELIEF II results demonstrate
that Aroyo® AUS has acceptable efficacy and low complication rates. Quantifiable pressure adjustment effectively customizes continence. Full results will be following RELIEF II completion. Preliminary results from this study confirm that the Aroyo® AUS is a promising alternative to current surgical management of male SUI.
MP-05.13 Burden of Refractory Overactive Bladder (OAB): Analysis of the United Kingdom Primary and Secondary Databases Sahai A1, Khalaf K2, Morton R3, Hamid R4
26
1 Guy’s Hospital, London, United Kingdom; 2Xcenda, Palm Harbor, United States; 3Allergan Plc, Marlow, United Kingdom; 4Wellington Hospital, London, United Kingdom
Introduction and Objective: Patients with OAB not responding to ≥2 antimuscarinics continue to cycle through oral medications in both primary and secondary care settings. This study estimated the clinical and economic burden of these refractory OAB (ROAB) patients. Materials and Methods: The Health Improvement Network Database (THIN) and Hospital Episode Statistic databases (HES) capture activity from a sample of primary care and secondary sources and are representative of the general UK population. Databases were queried for patients 18 and older with at least one OAB diagnosis, prescription codes for 3 distinct antimuscarinics, and with continuous data for 12 months before and after the index date (defined as date of third antimuscarinic prescribed). ROAB patients were then compared to a cohort of matched non-OAB patients (controls matched on age, gender, provider trust, duration of follow-up, and activity at case index) on a number of clinical outcomes (anxiety, depression, dementia, falls, fractures) and economic outcomes (inpatient and outpatient visits, prescriptions, costs). Results: A total of 2547 ROAB (66.6±15.4 years) patients and 7519 controls (66.9±15.3 years) were included in the analysis. ROAB patients were 78.7% female and 34.2% white. Control patients were 79.1% female and 14% white. ROAB patients were twice as likely to have anxiety compared to controls (Odds Ratio [OR] of 1.99, P<0.001). Likelihood of depression, dementia, falls, and fractures were also higher in the ROAB group; however, these results did not meet statistical significance. The likelihood of inpatient, outpatient, and ER visits were three to five fold higher in the ROAB group compared to controls (OR: 2.90, P<0.001; 4.53, P<0.001; and 4.84, P<0.001, respectively) and costs were 22% to 46% higher for outpatient costs and accident and emergency costs, respectively (Incidence Relative Ratio of 1.22 and 1.46, respectively; P≤0.001). Conclusion: ROAB patients who cycle beyond a second antimuscarinic, have a significantly higher clinical and economic burden compared to controls matched on age, gender, provider trust, duration of follow-up, and activity at case index.
MP-05.14 A Cadaver Model Describing a Novel Retrograde Approach for Percutaneous Placement of an Implantable Tibial Nerve Stimulation Lead Peters K, Sirls L Oakland University William Beaumont School of Medicine, Beaumont Health, Royal Oak, United States Introduction and Objective: To aid and clarify the approach for percutaneous lead placement for permanent implantation of tibial nerve stimulation lead electrode. We hypothesized that 1) ultrasound identification of the tibial artery, and 2) fluoroscopic imaging, would be independent tools that will augment bony landmarks and 3) retrograde percutaneous
approach may offer clinical advantage over the antegrade approach. Materials and Methods: A cadaver model was de-
veloped to guide delivery of permanently implanted tibial nerve leads. Quadrapolar electrode leads were placed percutaneously with the guidance of 1) bony landmarks 2) ultrasound and 3) fluoroscopic imaging in 4 below the knee cadaver legs. The tibial artery was identified proximally and a guide wire placed to help both ultrasound and fluoroscopic identification and serve as a point of reference in identifying the tibial nerve for lead placement. The tibial nerve leads were placed percutaneously with a standard lead introducer. Both antegrade (proximal to distal) and retrograde approaches (distal to proximal) were explored. Both approaches were evaluated real time with ultrasound (transverse and longitudinal) and fluoroscopy (lateral and anterior-posterior). Then the cadaver leg was dissected and the lead placement was evaluated with respect to depth and orientation to the nerve, whether it was crossing the nerve or lying more parallel to the nerve. Data from each leg dissection were used to guide the next lead placement to improve the accuracy of each subsequent percutaneous lead delivery. Results: Ultrasound easily identified the wire in the artery in both transverse and longitudinal planes, and the nerve posterior to that in all specimens. Flouroscopy, lateral and anterior-posterior, was effective in identifying the vector of lead placement, whether crossing the tibial nerve vs. placement more parallel to the nerve. The antegrade approach was modified by migrating more proximally from 5-7 cm above to the medial malleous to 9-10 cm above to try and get a more superficial, parallel vector for a more parallel lead placement. However, antegrade approaches were always crossing the tibial nerve and went deep to the nerve, with only 1-2 electrodes in close proximity to the nerve. The retrograde approach, starting at the level of the medial malleolus, about 1 finger breadth behind (in general about 1/3 the distance from the medial malleolus to Achilles tendon) was easy and effective in placing the lead parallel to the nerve with 3-4 electrodes in close proximity to the nerve. Conclusion: This cadaver model, below the knee leg
using a wire in the tibial artery, was an excellent tool for assessing percutaneous tibial nerve lead placement. The sequence of ultrasound and fluoroscopic guidance, then dissection of the lead with reference to the tibal nerve, provided appreciation of the trajectory and depth of the lead and improved subsequent lead placement. Antegrade approach, even with a more proximal start to achieve a more parallel trajectory, always resulted in more of a crossing lead with fewer electrodes in proximity to the nerve. The retrograde approach was 1) more reliably predicted using bony landmarks and 2) was easily observed with safety enhanced by using ultrasound and 3) resulted in consistently more parallel lead placement. We report a novel, safe retrograde method of percutaneous lead placement parallel to the tibial nerve, avoiding key vascular structures. The retrograde approach, starting posterior to the medial malleolus, was easier and reproducibly placed a more parallel lead that may optimize tibial nerve stimulation. Ultrasound, a common tool in many clinicians office, was effective in localizing the tibial artery to aid orientation and depth
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS of placement of the stimulation lead and maximize safety. We are optimistic that this minimally invasive retrograde percutaneous approach can be done in the physician’s office under local anesthesia.
1
MP-05.15
ter AdVance placement in ideally suited men with mild-moderate preoperative leakage.
Safety and Durability of Sacral Neuromodulation in the Geriatric Population: A SubAnalysis from the Insite Trial Liberman D1, Griebling T2, Siegel SW1 1
2
Metro Urology, Woodbury, United States; University of Kansas School of Medicine, Kansas City, United States Introduction and Objective: Overactive bladder
(OAB) symptoms are extremely prevalent in the geriatric population. Sacral neuromodulation (SNM) has been shown to be effective for the management of OAB symptoms, but there are very few reports of outcomes in the geriatric population. Therefore, the objective of the current analysis is to report therapeutic success rates, changes in quality of life (QoL) and safety in elderly patients with OAB receiving SNM. Materials and Methods: Data from subjects enrolled in the InSite trial who had successful test stimulation and received an InterStim implant were used in this retrospective analysis. Responder rates, (defined as >50% improvement in average leaks/day or voids/day or a return to normal voiding frequency (<8 voids/ day)), health-related quality of life (HR-QoL) and adverse events through 36 months were compared for geriatric subjects (age >65 years) and their younger counterparts (age <65 years). Results: Of 272 subjects who had an SNM implant for OAB, 80 were aged 65 or older (29.4%). Compared to younger OAB subjects, the geriatric subjects had a higher proportion of males (16% vs. 6%; p<0.01) and urinary urge incontinence (73% vs. 52%; p<0.01). There was no statistically significant difference in the 36-month OAB responder rate (see above)(81% vs. 84%; p=0.67) or the urinary frequency responder rate (74% vs. 69%; p=0.66) between older subjects and their younger counterparts. However, geriatric patients had a lower urinary incontinence responder rate (68% vs. 88%; p<0.01) and change from baseline HR-QoL at 36 months (median 30.3 vs. 38.8; p=0.04) than younger patients. Device-related adverse events, including loss of efficacy, undesirable change in stimulation and infection were no different between both age groups (all p>0.05). Moreover, geriatric subjects reported less implant site pain than younger subjects (5% vs. 16%; p=0.015).
Naval Medical Center San Diego, United States; Eastern Virginia Medical School, Norfolk, United States
2
Introduction and Objective: Extended follow up af-
Materials and Methods: Retrospective review of men who underwent AdVance sling placement for stress urinary incontinence. Men were excluded if their preoperative leakage was greater than two pads per day and if they had less than three years of postoperative follow-up. Results: Forty-eight men met our inclusion criteria. Mean age at the time of AdVance was 66.7 years, body mass index was 29.04 and 94% had a history of a radical prostatectomy. Prior radiotherapy was a confounding factor in 29% of men in the cohort and 25% had a prior treated bladder neck contracture. Mean (median) follow-up for the entire cohort was 4.6 (4.0) years. Following AdVance sling placement, the percentage of men cured at 6, 12, 18, 24 and 36 months was 79%, 79%, 75%, 71% and 67%, respectively. Ten patients underwent salvage incontinence procedures, including injection of a bulking agent in seven men and an AUS in three. Three patients underwent a tertiary procedure (AdVance in two, AUS in one). Complications were minimal. Short-term retention was seen in 12.5% of men and self limiting scrotal/perineal pain in 6.25%. Patient age at the time of AdVance was the only significant negative risk factor for cure (HR 0.92, p=0.035). Race approached significance with Caucasian men trending towards higher cure rates (p=0.068). Men without a history of XRT demonstrated a non-significant three-year cure rate of 75% compared with 50% in those with a history of XRT (p=0.11). Kaplan-Meier 50% incontinence free interval was not reached during the follow-up period (Figure 1). Conclusion: In the ideal candidate for a transobtura-
tor male sling with minimal SUI, reasonably high cure
rates can be expected to persist to at least three years of follow-up.
MP-05.17 AdVance Sling Use in the United States is Decreasing Relative to Artificial Urinary Sphincter Use Pusateri C, Zuckerman J Naval Medical Center San Diego, United States Introduction and Objective: The artificial urinary sphincter (AUS) and AdVance male sling are the two most commonly performed male incontinence procedures in the US. We aimed to evaluate the percent of AdVance male sling usage relative to AUS over a nineyear period since its introduction in order to assess trends across the United States. Materials and Methods: As a surrogate for procedures performed, we reviewed device purchase data of both the AdVance sling and AUS broken down by AUA section. ANOVA testing between years was used to determine purchasing trends with p-values of <0.05 considered statistically significant. Results: Relative to AUS, AdVance sling percentage significantly increased from 36% in 2007 to 48% in 2008 (p=0.032, see figure 1). Sling percentage then remained stable over the next three years from 20082011 with no significant percent change between years (p=NS). Compared with 2008-2011, AdVance usage decreased in 2012 to 29% (p=0.002) and remained stable at this decreased relative level through 2015 (p=NS, difference between years 2012-2015). The Mid-Atlantic AUA section utilized proportionally more AdVance slings relative to AUS at nearly every time point compared to the other sections. Comparing incontinence procedures across AUA sections, the Southeast section performed the highest percentage of male stress urinary incontinence procedures, including 27% of all AdVance slings and 25% of all artificial sphincters.
MP-05.16, Figure 1. Incontinence Free Interval After AdVance Male Sling
Conclusion: At 3 years, OAB treatment with SNM
has similar efficacy and safety for both geriatric and younger individuals. The impact of SNM on urinary incontinence and HR-QoL changes in a geriatric population warrants further study.
MP-05.16 Male Transobturator Sling Outcomes in the ‘Ideal’ Patient with at Least Three Years Follow-Up Zuckerman J1, Christman M1, McCammon K2, Virasoro R2, Tonkin J2
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
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MODERATED ePOSTERS
Percentage Advance Relative to AUS
MP-05.17, Figure 1. 60%
Mid Atlantic Section
55%
North Central Section
50%
North Eastern Section
45%
South Central Section South Eastern Section
40%
Western Section
35%
New England Section
30%
Total
25% 20% 2007
2008
2009
2010
2011
2012
2013
2014
2015
Year Conclusion: Proportion of Advance sling usage rela-
tive to AUS increased after its introduction through 2008. Usage remained stable at an increased level for the next three years. More recent years have found decreased AdVance usage and a resurgence of the artificial urinary sphincter. Reasons for these trends remain speculative.
MP-05.18 Photo-Thermal Er: YAG Laser Treatment of Stress Urinary Incontinence (3 Years Follow-Up) Gaspar A Dept. of Gynecology, Faculty of Medicine, University of Mendoza, Argentina Introduction and Objective: In the last decade, photo-thermal Er:YAG laser treatment has emerged as a promising non-surgical treatment option for stress urinary incontinence. Here we present a prospective controlled study with up to 3 years follow-up of the laser treated group. Materials and Methods: A total of 43 patients in the
laser group were treated with Er:YAG laser treatment (IncontiLase, Fotona). They received 3 laser therapy sessions, each 1-month apart. The control group included 29 patients who received perineometry sessions (2 per week during 3 months). In the first phase of the study, both groups were followed up to 18 months after the initial session. The control group then exited the study, while the active group received 3 additional sessions of laser treatment at 18, 24 and 30 months, and was followed up to 36 months after the study start. Stress urinary incontinence was assessed using the ICIQ questionnaire and 1-hour pad weight test.
28
Results: Average ICIQ score significantly improved from 11.0 at baseline to 3.4, 5.0 and 8.7 after 6, 12 and 18 months, respectively. After 3 maintenance sessions at 18, 24 and 30 months, the scores again dramatically improved to 4.6, 2.6 and 1.1 at 24, 30 and 36 month follow-ups, respectively. Results of the 1 hour pad weight test showed the same pattern; results significantly improved after the initial three laser sessions but started to show a slight diminishing trend after 18 months (from 9.1 g of leaked urine at baseline to 2.6 g, 2 g and 3.5 g after 6, 12 and 18 months respectively). The results were again dramatically improved after the 3 maintenance sessions (done 18, 24 and 30 months after the first treatment) to 2.3 g, 2.0 g and 1.1 g at 24, 30 and 36 month follow-ups, respectively. There was no significant improvement in the control group’s average ICIQ score or 1-hour pad weight up to 18 months after study start. Conclusion: Er:YAG photo-thermal laser therapy is
a highly efficient, minimally invasive non-surgical therapy for stress urinary incontinence. Excellent long-term results can be achieved with an optimized treatment schedule.
MP-05.19 Assessment of Pain During Administration of Botulinum Toxin Bladder Injections with and Without the Use of Intravesical Lidocaine Instillation Shin S1, Hadjipavlou M2, Sharma D2, Sabbagh S2, Sujenthiran A2 1
St George’s, University of London, United Kingdom; 2 St George’s University Hospitals NHS Foundation Trust, London, United Kingdom Introduction and Objective: Tolerability of intrade-
trusor botulinum toxin (BTX) injections can be vari-
able and pain may be a factor in discontinuation of treatment in patients with overactive bladder. We aim to assess the analgesic benefit of intravesical lidocaine instillation in patients undergoing BTX injections by comparing the pain experienced during and after the procedure for patients treated with and without intravesical anaesthesia. Materials and Methods: A retrospective standardized
questionnaire was used in a telephone survey conducted on patients with overactive bladder symptoms treated with BTX injections from May 2013 to March 2016. Patients used the numerical rating scale (NRS) to score the pain experienced from 0 (no pain) to 10 (worst pain imaginable). All patients received lidocaine-containing lubricant for the procedure. Results: A total of 78 consecutive cases (33 patients) were identified and divided into two groups; group A received lidocaine instillation (n=9) and group B did not receive instillation (n=69). A total of 19 males (57.6%) and 14 females (42.4%) were included. There was no significant difference in the NRS score of pain during the procedure between group A and group B (3.78 and 2.93 respectively; p = 0.38). We found no difference in pain score on the evening of the procedure between the two groups (0 and 0.88; p = 0.22). The mean NRS pain score on BTX injection for all 78 cases was 3.03 (95% CI 2.41-3.64). Conclusion: Overall, intradetrusor BTX injections are
well tolerated. Our study suggests that use of intravesical lidocaine instillation may not provide a significant analgesic effect. The lubrication and anaesthetic effect of a lidocaine-containing lubricant may be sufficient in most cases. Larger randomized controlled studies are required to establish the clinical significance of
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 6 Pediatric Urology Friday, October 21 1615–1745 MP-06.01 The Value of the Testicular Atrophy Index in Adolescent Boys with and Without a Varicocele De Baets K1, Daems F2, Aerts W2, van den Keybus T2, Vaganée D2, Dewaide R2, De Wachter S1,2, De Win G1,2 1
Dept. of Urology, Antwerp University Hospital, Edegem, Belgium; 2University of Antwerp, Belgium
Introduction and Objective: In patients with a varicocele, a testicular atrophy index (TAI) greater than 20% is used, among other measurements, to determine the necessity for surgical treatment. In this study, we compare the TAI in boys with and without a left-sided varicocele to demonstrate whether a varicocele significantly influences the TAI in adolescent boys. Materials and Methods: From April 2015 to April 2016, we included 321 boys aged 11 to 16 years old. The participant and parent were asked to fill in a questionnaire. Furthermore, a short physical examination and scrotal ultrasound were performed. Boys with a right-sided or bilateral varicocele, any scrotal pathology or history of scrotal surgery, were excluded. The testicular volume was measured by ultrasound using Lambert’s formula (LxWxHx0.71). TAI was calculated using the formula [(volume right-volume left)/ volume right] x100. A smaller left testis results in a positive TAI, a smaller right testis results in a negative TAI. Results: Of the 321 participants, 245 had no varicocele and 76 had a left-sided varicocele. The average TAI (absolute value) in the group without varicocele was 16.12% (SD: 15.30%) and 19.46% (SD: 14.21%) in the varicocele group. Independent t-test showed no significant difference (p=0.091) between these two groups. The varicocele group consisted of 54/76 (71%) boys with a positive TAI. In the group without a varicocele, 147/245 (60%) had a positive TAI. Chi-square analysis showed no significant (p= 0.082) association between the prevalence of left-sided varicoceles and positive TAI. A total of 28/76 (37%) patients had a TAI greater than 20%. In the group without a varicocele, 36/245 (15%) had a TAI greater than 20%. Chisquare analysis showed a significant (p=0.000) association between the prevalence of left-sided varicoceles and TAI greater than 20%.
MP-06.02 Laparoscopic Transcutaneous Extraperitoneal Repair of Hydrocele in Children by Using J Shaped Bended Spinal Needle: A Modified New Technique
formed for simultaneous repair of a potential contralateral patent processus vaginalis. Conclusion: During this procedure, other assistant
instruments or devices were not needed. This LTE technique is simple, fast, and safe, and a cosmetic procedure for pediatric hydrocele.
Jung W, Ha JY, Kim BH, Park CH, Kim CI
MP-06.03
Keimyung University, Daegu, South Korea
Is Renal Ultrasound Necessary in the Initial Assessment of Isolated Hypospadias?
Introduction and Objective: To introduce our expe-
rience of single port laparoscopic assisted extraperitoneal closure of patent processus vaginalis using J shaped bended spinal needle in hydrocele patients. Materials and Methods: From June 2014, 40 boys
underwent the LTE repair of hydrocele in our institution. During surgery, a 2.7 mm, 30 degree laparoscope was inserted through an umbilical incision. Patent processus vaginalis was closed extraperitoneally by using a J shaped bended 2 spinal needle (18 and 20 Gauge) with a 3-0 polyester suture and preperitoneal hydrodilation. As the needle passed over the spermatic cord, hydrodissection was made at the same time (Figure 1). A 3-0 polyester suture was threaded through a 18G spinal needle (Figure 2). The same 3-0 polyester suture was threaded through a 20G spinal needle from the tip (Figure 3). A 20G spinal needle traveled through the upper margin of internal ring, a 20G needle tip was pulled out of the initial 18G needle punctured opening (Figure 4). After all these procedures, the internal inguinal ring was completely encircled and tied extracorporeally (Figure 5). The knot was buried in the subcutaneous area (Figure 6). Results: During this procedure, only one umbilical incision was created. All patients were discharged on the same day after surgery without any complication. The mean operative time was 13.2 min and 19.3 min for unilateral and bilateral, respectively. During a mean follow-up period of 10 months (range 1-17 months), no recurrence was observed except in the first 2 cases. In total, 6 extra procedures were per-
Tobia Gonzalez S, Ceballos G, Abadie S, Etcheverry R Servicio de Urologia, Hospital de Niños, La Plata, Argentina Introduction and Objective: Renal ultrasonography
in patients with hypospadias is currently often requested by pediatricians. While necessary in hypospadias associated with other malformations, it does not seem to be useful in patients with isolated hypospadias. The objective was to define the usefulness of renal ultrasonography in the initial evaluation of isolated hypospadias. Materials and Methods: A prospective study was performed from 2000 to 2015 and included 454 patients with hypospadias. Patients with hypospadias associated with other malformations were excluded. The sample was divided into two groups, Group A: hypospadias isolated with renal ultrasonography at the beginning of the evaluation, Group B: isolated hypospadias without renal ultrasonography. The relationship between type of hypospadias and sonographic abnormalities was consigned. Statistical methods included diagnostic tests and chi-square analysis. Statistical significance was defined as P<0.05. Results: Of 454 patients with hypospadias, only 273 had isolated hypospadias. There were 174 patients in Group A (63.73%) and 99 in Group B (36.26%). All patients were less than 1 year old at the time of evaluation. Of the patients in Group A, 94.25% had normal
MP-06.02, Figures 1-6.
Conclusion: We report no significant association be-
tween a varicocele and the absolute TAI value. We also found no significant association between a left-sided varicocele and a smaller left testis. Finally, a significantly higher prevalence of TAI greater than 20% was observed in patients with a varicocele. We conclude that the TAI is a very ambiguous measurement and more data are needed to re-define the clinical use of this parameter.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
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MODERATED ePOSTERS ultrasounds, while in Group B, 4.02% had abnormalities (p=0.148). No statistical differences between the presence of ultrasound abnormalities and type of hypospadias was found.
Introduction and Objectives: Aseel’s operation offers
Conclusions: According to the results, we consider that it is not necessary to perform a renal ultrasound in the evaluation of a patient with isolated hypospadias.
Materials and Methods: A total of 53 children who had distal penile and glanular hypospadias were repaired using Aseel’s operation. First, a transverse ventral incision is done parallel to the circumcision incision 1 cm proximal to the urethral meatus. Then, proximal and distal skin dissection is done. A longitudinal incision across the urethra plate extending through the meatus is closed transversely that leads to urethral advancement, the distal skin edge is pulled downwards using 2 skin hooks to create a roof for the advanced urethra, followed by the closure of the skin incision. No catheter or stent is left. The operation is fully illustrated in details in the abstract book of the 35th SIU meeting.
MP-06.04 Meatal Mobilization and Glanoplasty: A Viable Option for Coronal and Glanular Hypospadias Repair Moradi M1, Kazemzadeh B1, Hood B2, Rezaee H1, Kaseb K1 1
Kermanshah University of Medical Sciences, Kemanshah, Iran; 2Wake Forest University, WinstonSalem, United States
a good alternative for hypospadias repair, and we are going to evaluate its advantages and disadvantages compared to other options.
Mobilization with Glanuplasty Inclusive (MMGPI) modification of MAGPI.
Results: A total of 44 children were available for follow-up. Seven patients had stitch loss, either partial in 3 or complete in the other 4, but no one developed fistula or meatal stenosis
Materials and Methods: A total of 120 patients with
Conclusion: Aseel’s operation has the advantages of
anterior hypospadias underwent MMGPI between September 2008 and October 2014 at Kermanshah University of Medical Sciences. A conical incision was made in the ventral glans between the meatus and glanular tip and the incision extended around the posterior aspect of the meatus. A triangular strip of glans was removed and the urethra completely mobilized. The meatus was then fixed to the glans with three golden sutures. For glanoplasty, the epithelium and skin in the sub-meatal region were removed and the glanular wings fixed to the urethra and each other, creating a slit-like meatus. Satisfactory outcome was defined as continuous strait urinary flow and catheterization of new meatus without difficulty. Cosmetic outcomes were considered acceptable if patients maintained a slit-like meatus at the glanular tip. Patients were examined at 1 week, and 1, 3, 6, 12 and 24 months.
being simple, easy to learn, taking only 15 minutes, having no stent or catheter left, and no incidence of fistula or meatal stenosis, and no glanular disfigurement. Being done with minimal tissue dissection when failed either redoing it or any other operation is facilitated not hindered by severe fibrosis due to the previous dissection. Its disadvantages include the higher incidence of stitch loss, but this was improved in the last few cases where skin dissection extended distally more into the glans, creating less tension on the stitch line. Aseel’s operation is worth being considered and introduced in our armentorium for the repair of distal penile and glanular hypospadias.
Introduction and Objective: To present the Meatal
Results: A total of 120 patients with anterior hypospadias underwent MMGPI. There were no hematoma, meatal necrosis or other early complications. In patients with glanular, there were no meatal regressions or stenosis, all voiding patterns were normal and all patients maintained a slit-like meatus at the glanular tip. Two patients with coronal hypospadias had meatal stenosis and two patients had meatal regression. Five patients with sub-coronal hypospadias had 2 mm meatal regression with downward sloping urinary stream and 2 patients had meatal stenosis. In all meatus remained distal to the preoperative meatus with no necrosis. Small sample size was the major limitation of this study. Conclusion: MMGPI represents a viable option for
glanular and coronal hypospadias repair.
MP-06.05 Aseels Operation as an Option for Distal Penile and Granular Hypospadias Repair: Advantage and Disadvantages Ismail M Theodore Bilharz Research Institute, Giza, Egypt
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MP-06.06 Adaptive Biofeedback for LUTD in Children: Early Results of Our Patients Ebiloglu T1, Kaya E2, Kopru B3, Yilmaz S2, Aydogmus Y1, Irkilata HC2, Kibar Y2 1
Dept. of Urology, Etimesgut Military Hospital, Ankara, Turkey; 2Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey; 3Konya Military Hospital, Turkey Introduction and Objective: In this study, we investigated the contraction and relaxation based BF results in children with lower urinary tract dysfunction (LUTD). Materials and Methods: Between 2007 and 2015, children diagnosed with LUTD and refractory to standard urotherapy modifications were randomly directed to BF using two different animations: animation A was relaxation based BF (RBF), and animation B was contraction based BF (CBF). Nonresponse, partial response, and full response were defined as a 0% to 49% decrease, 50% to 99% decrease, and 100% decrease in LUTDSS, respectively. Results of biofeedback using RBF or CBF were compared. Results: There were 100 and 70 children in the RBF and CBF group, respectively. Patients with abnormal voiding pattern (AbnormalVP) and positive EMG activity (Positive_EMG) had better resolution with RBF (p=0.001). Patients with AbnormalVP and negative
EMG activity (Negative_EMG) had better resolution with CBF (p=0.039). Despite being statistically insignificant, patients with normal voiding pattern (NormalVP) and Positive_EMG had better resolution with CBF (p=0.452). Patients with NormalVP and Negative_EMG had better resolution with RBF (p=0.083). Conclusions: In patients with AbnormalVP, EMG activity identifies the biofeedback nature: Positive_EMG have better results with RBF, Negative_EMG have better results with CBF. However, when the voiding pattern is normal, the outcome is controversial.
MP-06.07 Parental Expression About Biofeedback Success in Children with Lower Urinary Tract Dysfunction Kopru B1, Ergin G2, Ebiloglu T3, Kaya E4, Irkilata HC4, Kibar Y4 1
Dept. of Urology, Konya Military Hospital, Turkey; Dept. of Urology, Koru Ankara Hospital, Turkey; 3 Dept. of Urology, Etimesgut Military Hospital, Ankara, Turkey; 4Dept. of Urology, Gülhane Military Medical Academy, Ankara, Turkey 2
Introduction and Objective: We evaluated parental expression for biofeedback in children with lower urinary tract dysfunction (LUTD). Materials and Methods: We retrospectively analyzed
hospital records of 281 children with LUTD who were refractory to standard urotherapy and directed to biofeedback therapies between 2005 and 2015 with the consents of their parents. We evaluated parental expression with the life quality question in the lower urinary tract symptom score. Results: Forty-eight (17%) parents appraised that LUTD caused no effect in their child’s daily life, 104 (37%) expressed little effect, 89 (31%) moderate effect, and 41 (14%) expressed a serious effect. After biofeedback therapy, 120 (43%) parents expressed no effect, 98 (35%) little effect, 47 (17%) moderate effect, and 14 (5%) expressed a serious effect (p=0.001). Looking in detail, 12 (30%) of 41 parents expressing serious effect before biofeedback expressed no effect, another 12 (30%) expressed little effect, and 7 (17%) expressed moderate effect at the end of the treatments (p=0.03). Twenty-one (23%) of 89 patients expressing moderate effect before biofeedback expressed no effect, and 39 (44%) expressed little effect at the end of the treatments (p=0.001). Fifty-two (50%) of 104 patients expressing little effect before biofeedback expressed no effect at the end of the treatments (p=0.003). We also detected a linear correlation between parental expressions and pre biofeedback LUTDSS: a severe score caused more a serious parental expression (p=0.001). The median success of biofeedback in children was 70 (0-100)%, 50 (0-100)%, 37 (0-91)%, and 25 (12-76)% for parents expressing no, little, moderate, and serious effect, respectively. The correlation between patients’ success rates and post-biofeedback parental expression was also detected significant: parents of patients who had more success with biofeedback expressed less serious effects (p=0.001). Conclusion: According to parental expression for bio-
feedback in children with LUTD, biofeedback therapy significantly improved the quality of life of children.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-06.08 The Effect of Biofeedback Therapy on Uroflowmetry-Electromyography (EMG) Parameters in Children with Lower Urinary Tract Dysfunction Topuz B1, Köprü B2, Kaya E1, Uguz S1, Irkilata HC1, Kibar Y1 1
Gulhane Military Medical Academy, Ankara, Turkey; Konya Military Hospital, Turkey
2
Introduction and Objective: Lower urinary tract dysfunction (LUTD) is a situation that occurs in neurologically normal children during toilet training period and explaining as an incoordination between the external urethral sphincter and bladder. Actually, it occurs as a result of wrong acquired voiding habits. Voided volume, voiding time, average flow rate, voiding pattern during voiding, post-void residue (PVR) and pelvic floor activity can be measured by the Uroflowmetry-Electromyography (UF-EMG) test. Materials and Methods: Between 2013 and 2015, our study was designed on 130 children between the ages of 5-15 who were diagnosed with LUTD. Results: UF-EMG-PVR values of patients were compared before and after biofeedback treatment. Sixty two patients’ pre-treatment and post-treatment voiding pattern, EMG activity and PVR values were compared statistically (Table 1). Conclusion: Improvement was detected in UF-EMG-
PVR values by biofeedback treatment in children with LUTD. UF-EMG-PVR is an important test for evaluating the response of treatment in children with LUTD.
MP-06.09 A Novel Grading System for Bladder Trabeculation in Pediatric Patients with Neurogenic Bladders Selby B2, Wang P2, Khoury A2, Soltani T2, Wehbi E2, McAleer I2, McLorie G2, Hidus G2, Djahangirian O2 1
University of California, Irvine, United States; Children’s Hospital of Orange County, United States; 2 University of California, Irvine, United States; 3 University of California, Irvine, United States; Hadassah Medical Center, Israel
Introduction and Objective: Bladder trabeculation is a common finding in pediatric patients with neurogenic bladders. There is currently no standardized grading system used to describe the severity of bladder trabeculation. In this study, we developed and
determined the reliability of a grading system using cystograms. Materials and Methods: The grading system was developed and designed by an expert panel of pediatric urologists. The grading system is based on the appearance of the bladder on cystogram. There are 3 grades, with a grade 1 as normal and grade 3 being severely trabeculated. A previous pilot study (n=9) showed excellent intra and inter-rater reliability. In this study, we included 33 participants, including pediatric urologists, fellows, urology residents and nurse practitioners, to rate 30 cystogram images representing the 3 grades of bladder trabeculation. In order to calculate intra-rater reliability, 18 participants repeated this activity. Reliability was then calculated using Spearman’s rank correlation coefficient, Cohen’s Kappa and intraclass correlation coefficient. Results: All 33 participants were used to determine inter-rater reliability. This grading system showed a high degree of inter-rater reliability with an intraclass correlation coefficient of 0.998 (p<0.001). In addition, this was further confirmed with a Cohen’s Kappa ranging between 0.795-1.0 (p<0.001). The Spearman’s rank correlation coefficient ranged between 0.9101.0 (p<0.001), showing good intra-rater reliability. Conclusion: This novel grading system for bladder
trabeculation shows excellent inter and intra-rater reliability. This tool may potentially improve communication both clinically and within future research involving patients with neurogenic bladders. However, further validation studies are required.
MP-06.10 Surveillance Cystoscopy After Augmentation Cystoplasty Levy M1, Katorski J2, Elliott SP1 1
University of Minnesota, Minneapolis, United States; Gillette Lifetime Specialty Healthcare, St. Paul, United States
2
Introduction and Objectives: There is mixed data to
support the use of surveillance cystoscopy after augmentation cystoplasty (AC) for the purpose of early identification of bladder malignancy of enteric origin. There is also minimal data that specifically investigates adults with congenital anomalies. We sought to describe the incidence of bladder malignancy and secondary findings such as bladder stones in such patients on a surveillance cystoscopy protocol. Materials and Methods: A retrospective review from
2011 to 2015 was performed at Gillette Lifetime Spe-
MP-06.08, Table 1. UF-EMG-PVR values
Pre-treatment (n)
Post-treatment (n)
P* value
Voiding pattern
18 normal 6 tower 34 staccato 4 obstructive
52 normal 2 tower 8 staccato 0 obstructive
<0.001
EMG activity
58 activity (+) 4 activity (-)
23 activity (+) 39 activity (-)
<0.001
PVR values
46 high PVR 16 normal PVR
17 high PVR 45 normal PVR
<0.001
* McNemar's Test
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
cialty Healthcare, a multi-disciplinary transitional medicine clinic focused on spina bifida and cerebral palsy. Patients were included if they had neurogenic bladder and AC. All patients had a least 1 cystoscopy at 10 years or more following their original AC. Primary outcome was incidence of bladder tumor. Secondary outcomes include incidence of bladder stones. Results: A total of 50 patients met inclusion criteria. A total of 52% were men and 48% were women. A total of 82% had spina bifida, 10% had cerebral palsy, and 8% had spinal cord or traumatic brain injury. Ninety-two surveillance cystoscopies were performed. This compared to 123 possible cystoscopies had we performed yearly exams 10 years from the date of AC. Incidence of malignancy was 1/50 patients. This patient had an ileocecal augmentation and presented with recurrent bacterial cystitis. Pathology revealed colonic adenocarcinoma. The lesion was not seen on routine bladder ultrasound. Secondary cystoscopy findings included bladder stones in 6/50 patients (0.5 cm-4 cm in size). A total of 2/6 stones were also seen on ultrasound. A total of 4/6 patients were asymptomatic. A total of 3/6 patients were asymptomatic and had no evidence of stones on bladder ultrasound. Conclusions: The incidence of bladder malignancy was low. For patients who were asymptomatic, it was 0. This supports the literature recommending against surveillance cystoscopy for early tumor identification. We did find bladder stones in asymptomatic patients in our largely insensate population. However, there are alternatives for the detection of stones, and a better use of resources may include surveillance plain films.
MP-06.11 Peristeen Transanal Irrigation System in Treating Paediatric Patients with Bowel Dysfunction: KFSH-Dammam Experience, Saudi Arabia Almousa R, Alkawai F, Alabbad A, Aggamy M, Algahwari M, Albagshi S, Aldossary N King Fahad Specialist Hospital Dammam, Saudia Arabia Introduction and Objective: To evaluate the efficacy and safety of the Peristeen© Transanal Irrigation system in treating faecal incontinence/soiling or chronic constipation in children with neurogenic causes or due to chronic idiopathic constipation. Materials and Methods: This was a retrospective study of all paediatric patients with faecal incontinence/soiling or chronic constipation who were referred to our centre in incontinence and/or paediatric urology clinic and put on Peristeen© Transanal Irrigation system for management between January 2009 till December 2015. A validated faecal continence scoring system (Rintala and lindahl, 1995) was used to assess bowel function and social problems before and 6 months after treatment with Peristeen© (scoring system attached where 20 points are the highest). Patients included males and females. Only those who missed follow-up less than 6 months were excluded from the study. Length of follow-up in months, patients satisfaction (fully satisfied, partially satisfied or not satisfied), and complications related to the procedures were all assessed.
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MODERATED ePOSTERS Results: A total of 28 patients were included in the study. All patients were diagnosed with neurogenic bladder disorder, MMC with bowel dysfunction (soiling, constipation or both). There were 15 males (54%) and 13 were females (46%). The median age of the patients was 12years (range: 8-14). Four were fully satisfied (14%), 19 were partially satisfied (68%) and 5 were not satisfied (18%) (mainly due to discomfort to use the system and catheters, although some had good results). The median follow-up time using Peristeen© was 27.5 months (range from 9-52 months). The median score of the faecal continence improved from 5 (28) to 12.5 (4-18) out of 20 with (p-value<0.0001). No complications (bleeding, perforation or infection) were reported among all patients who used the system. The results show that satisfaction with the treatment is overall high with around 82% of patients. The improvement in symptoms according to the faecal continence score system was statistically significant comparing before and after treatment (p-value<0.0001). There were no complications recorded which support the safety of the system. The rate of satisfaction was affected negatively in some patients due to discomfort of using the system and not because of the efficacy of treatment. Conclusion: The study shows that Peristeen© Tran-
sanal Irrigation system is a safe and effective modality in treating faecal incontinence/soiling or chronic constipation in paediatric patients with neurogenic causes related to myelomeningocele and neurogenic bladder disorders.
MP-06.12 Effectiveness and Obstruction of Vantris® for Vesicoureteral Reflux Juaneda R, Carranza Bertarelli M, Belisle DF, Carrara S, Arismendi E, Compagnucci M, Colucci G, Sentagne A, Palacio M Sanatorio Allende, Córdoba, Argentina Introduction and Objective: To determine the effec-
tiveness of the endoscopic treatment of the Polyacrylate/Polyalcohol Copolymer (Vantris®) in children with Vesicoureteral Reflux (VUR) and the risk of ureteral obstruction. To determine loss of functioning tubular mass with DMSA (dimercaptosuccinic acid) in obstructed patients. Materials and Methods: Between February 2008
and June 2014, all children with Grades I to V VUR that were treated with Vantris® sub-ureteral injection in our institution were included. Pre and postoperative assessments included kidney, ureter and bladder ultrasounds, voiding cystourethrogram and renal scintigraphy with DMSA. Mean follow-up time was 29 months (range 5-80 months). Patients with VUR who were previously treated invasively were excluded. Results: Forty-eight children (78 reflux units) were included. Medium age was 3 years (range between 6 months and 14 years). Thirty-five patients were female and 13 were male. Of the 78 reflux units (RU), 51 were grades I to III VUR, and 27 were Grades IV to V. Reflux was repaired in 72/78 (92.3%) with a single injection. In follow up, 3 ureters were obstructed. Final success rate of the bulking agent was 88.46%. The global obstruction percentage was 3.84% (3/78). Obstruction was seen in 11% of high-grade reflux patients (2 with Grade V and 1 with Grade IV). These 3 patients were treated with ureteral reimplantation
32
afterwards. Ureteral obstruction of these three patients implied a minimum loss of functioning tubular mass when comparing pre and postoperative DMSA. This loss was 2, 1.6 and 4% respectively. Conclusion: The endoscopic treatment with this bulk-
ing agent is effective and a reliable option for the treatment of VUR in children. Our obstruction risk was low for reflux grades I to III and high for reflux grades IV and V, similar to literature reports. However, we found a small loss of tubular mass in our patients with ureteral obstruction.
MP-06.13 Endoscopic Treatment of HighGrade Vesicoureteral Reflux with Polydimethylsiloxane: Long-Term Results Tobia Gonzalez S, Gomez Y, Etcheverry R Servicio de Urologia, Hospital de Niños, La Plata, Argentina Introduction and Objective: Endoscopie treatment of vesico ureteral reflux (VUR) has become the first choice of surgical treatment. The materials used are diverse, and so are their results. The objective was to evaluate long-term endoscopic treatment of highgrade VUR results with polydimethylsiloxane. Materials and Methods: From 2004, a prospective study was initiated to evaluate the results of endoscopic treatment of VUR with polydimethylsiloxane, and thereafter at 30 days, 3 months and 1 year. VCUG was made prior to treatment and after treatment at 3 months and at 2 years. Renal scintigraphy with DMSA was performed before and after treatment. Immediate and late complications were recorded. The income cutoff date for this work was December 2008 in order to have long-term results. Statistical analysis was performed. Results: The results of endoscopic treatment of VUR in 40 renal units (UR) of 28 patients, 29 women and 6 men were evaluated. Of the total patients, 18 had bilateral VUR. O these, 6 had high-grade VUR on one side and contralateral VUR low grade, low grade UR these were dismissed for statistical study. A total of 10 patients had unilateral VUR, and all were high-grade. The UR evaluated that 22 were right and 18 left. VUR grades of UR right GIII were 5, 8 GIV and 9 GV; left UR were 5 GIII, 4 GIV and 9 GV. VCUG was performed in 19 of the 28 patients evaluated or 31 UR of 40. It was found at 2 years of follow-up that 87.09% of absence of VUR in UR evaluated and 12.90% residual VUR. Since 2008, we only perform VCUG to patients with clinical manifestations of VUR or poor outcome in monitoring. Clinical complications occurred in 6 patients (21%), 7.4% lower abdominal pain, fever IU 10.71%, 3.57% bladder instability with IU, of only 10.71% patients had residual RVU in VCUGs. Contralateral VUR was found in a post treatment in 1 (3.22%) unit without VUR. In the long-term ultrasound control, there were 5 (12.5%) cases of UR with ectasia (3 RU with GI and 2 UR with GII), 4 of these ectasia had prior to treatment, so only 1 UR (2.5%) presented post treatment. Conclusion: We consider endoscopic treatment of
high VUR with polydimethylsiloxane to be effective in the long-term, with a low rate of complications and residual RVU. It is necessary to conduct a study with more patients to get better conclusions.
MP-06.14 Assessing the Success Rate of Endoscopic Correction of Vesicoureteral Reflux Using Both the Presence of Postoperative Ultrasound Mounds and Intraoperative Mound Morphology Wang PZT1, Walia A1, Djahangirian O1, Wehbi E2, Khoury A2 1
University of California, Irvine, United States; University of California, Irvine, United States; Children’s Hospital of Orange County, Orange, United States
2
Introduction and Objective: Endoscopic correction
of vesicoureteral reflux (VUR) is a minimally invasive alternative to surgical reimplantation. The reported success rate varies between 68 and 92%, necessitating a need for a voiding cystourethrogram (VCUG) to confirm treatment success. Here we investigated the feasibility of combining appearance of postoperative ultrasound mounds (USM) and intraoperative mound morphology (IMM) as an alternative to postoperative VCUG. Materials and Methods: A retrospective review was performed on patients undergoing endoscopic correction of VUR between 2008 and 2014. A double HIT technique was used in all patients. Patients with secondary VUR, previous open surgery and anatomical anomalies were excluded. Patients received a postoperative renal ultrasound at 1 month and a VCUG at 3 months. IMM was graded by the surgeon. Postoperative USM was graded based on appearance. SPSS was used for statistical analysis with significance set at p < 0.05. Results: Fifty-eight patients (87 ureters) were included, of which 85% had a visible mound on US and 83% showed resolution of VUR. Sensitivity and positive predictive value (PPV) for presence of mound on ultrasound were 85% and 82%, respectively. Graded appearance of postoperative USM and IMM showed no significant difference in predictive value. Age, gender, presence of BBD, UO position, VUR grade, and UTI recurrence were not significantly different between cohorts. Conclusion: The presence of mound on postoperative
ultrasound showed good correlation with VCUG results. However, no improvement in correlation was observed when combining graded appearance of postoperative USM with IMM. A larger prospective study is needed for evaluation of other predictive factors.
MP-06.15 Long-Term Urinary Function and Sexual Health Follow-Up for Patients Who Underwent Hypospadias Repair During Childhood Rensing A1, Grossgold E1, Brandes S2, Vetter J1, Paradis A1 1
Washington University in St. Louis, United States; Columbia University College of Physicians and Surgeons, New York City, United States
2
Introduction and Objectives: Hypospadias is a com-
mon congenital disorder affecting 1 in 300 male newborns. Surgical repair for hypospadias typically occurs in early childhood. Current literature focuses
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS on the short-term postoperative outcomes. However, a number of complications related to the surgery emerge after puberty and continue into adulthood. Complications resulting from hypospadias repair can greatly affect urinary function and sexual health. There is a paucity of literature on long-term follow-up for these patients. Our study aims to assess the urinary and sexual health outcomes of patients who underwent hypospadias repair in childhood using an online questionnaire. Materials and Methods: The records of 672 men over the age of 16 who underwent hypospadias repair at St. Louis Children Hospital between 1988 and 2001 were examined. Patients were contacted by phone. They were then emailed a 27 question REDCap questionnaire that was a compilation of both validated and previously used surveys that assess urinary and sexual health (AUA symptom score, ICIQ-SF, PDQ, SHIM, Mulhall Hardness Score, SEAR questionnaire, and PPPS). Of those contacted, we obtained 38 completed surveys. Of those, 29 had complete data for their initial surgery. These patients were stratified by surgery type, presence of curvature prior to repair, age at repair, and location of meatus at time of surgery (distal vs. proximal). Using univariate analysis, responses were analyzed and compared for these four categories. Results: A total of 24% had a substitution procedure,
33% had MAGPI, and 43% of men were grouped as “other”, which consisted of circumcision, TIP, Mathieu, Thiersch-Duplay, and/or GAP. Overall, patients were generally satisfied with their urinary and sexual health outcomes. The MAGPI procedure was associated with a higher rate of leakage (p=0.022). Distal meatal location was associated with a higher push/strain response (p=0.011). Patients classified as “other” had statistically different responses for urgency (p=0.036), strain (p=0.022), nocturia (p=0.049), appearance (p=0.010), and erection hardness (p=0.049). There were no statistically significant differences in responses based on presence of curvature at time of repair. Conclusions: Hypospadias surgery in childhood has an impact on a patient’s wellbeing in adulthood. A long-term follow-up on patients is important for improving outcomes and satisfaction in adulthood. Most patients are satisfied with their outcomes as adults, regardless of meatal location or surgery type. More patients are needed to validate these findings. Our study will continue to recruit patients to better counsel patients and their families preoperatively.
MP-06.16 Efficacy and Outcomes of Percutaneous Nephrolithotomy in Preschool-Aged Children by Using Adult-Sized Instruments Iqbal N, Hasan A, Butt A, Yousuf A, Waqas M, Akhter S, Hussain I, Nawaz G, Khan A, Alam U PKI, Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: To review our experi-
ence of percutaneous nephrolithotomy (PCNL) in school-aged children, and determine its efficacy and safety in this age group. Materials and Methods: The records of children
aged 5 years or younger undergoing PCNL were re-
viewed retrospectively from December 2009 to March 2015. Data was collected by chart review on specified proforma. The patients were analyzed for variables such as size, location, number of stones, PCNL puncture site, clearance after PCNL alone and combined with ESWL, the rate of ancillary procedures, complication rate, and pre and post operative serum creatinine. Results: The study was a retrospective cohort comprised of total of 19 patients. A total of 8 out of 17 were boys (47%) and 9 girls (53%), mean age 3.4 ±1.1 years. Mean body weight was 22.1±3.6 (kg). Mean stone size was calculated to be 1.7 ± 049 Cm. The stone burden was calculated by adding the length of the longest axis of each stone. Mean number of stones was 2.7 ± 1.2. All PCNL were primary and with one puncture; access was through lower pole in 13/17 patients (76.47%), mid pole in 4/17 patients (23.52%). The mean operative time was 150.1± 38.7 minutes. The mean length of hospital stay was 3.17±1.42 days. The stone clearance with PCNL was 96.4±7.65 % as monotherapy, which increased to 100% by combining it with ESWL. A total of 3/17 (17.64%) patients required ESWL for residual stones and in 4/17 (23.52%), a DJ stent was placed. Conclusion: PCNL is safe and effective for treating
renal stones in very young children.
MP-06.17 Comparison of the Outcome of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Renal Stones in Preschool and School-Aged Children: A Single Center Study Iqbal N, Nadeem U, Pirzada A, Majeed M, Malik Y, Arshad Malik H, Khalid M, Akhter S, Hussain T, Hussain I Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: To retrospectively eval-
uate and compare the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones in preschool and school-aged children. Materials and Methods: From January 2007 to March
2015, ESWL was performed in 36 preschool (≤5 years) and 67 school-aged children (≥5 years). Modulith SL X lithotripter 4th generation Storz medical equipment was used for ESWL. The stone clearance rates, number of retreatment required, complication rates and ancillary procedures used were evaluated in a comparative manner. Results: A total of 103 patients; 36 (≤5 years) and 67 (≥5 years) were included. Mean age was 3.26±1.29 years and mean stone size was 0.97 cm±0.25 cm in preschool group ≤5 years of age. Stone-free rate was 34/36 (94.4%). Post ESWL complications included hematuria in 1 (2.8%), mild fever in 2 (5.6%), flank pain in 2 (5.6%), Steinstrasse in 2 (5.6%) requiring ureteroscopy and sepsis in 1 (2.8%) patient in the preschool group. In school-aged children (≥5 years of age), mean age was 10.31±3.01 years, mean stone size was 1.14 cm±0.68 cm, and stone-free rate was 57/67 (85%). Post ESWL complications included hematuria in 5/67 (7.5%), mild fever in 2/67 (2.98%), flank pain in 5/67 (7.46%), Steinstrasse in 1 (1.5%) requiring ureteroscopy and sepsis in 3 (4.5%) patients. The Chi
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
square test was applied regarding stone clearance in both groups, with a p-value of 0.158 that was not statistically significant. Conclusion: Our study showed that stone clearance
decreases with increasing stone size in both preschool and school-aged group. On the other hand, stone-free rate is much more dependent on stone size in the school going group (≥5 years).
MP-06.18 Predictive Value of Cortical Transit Time on Mercaptoacetyltriglycerine (MAG3) in Antenatally Detected Unilateral Hydronephrosis Due to Ureteropelvic Junction Stenosis Lee JN1, Chung JW1, Ha YS1, Choi SH1, Kwon SY2, Kim G3, Kim BS1, Kim HT1, Kim TH1, Yoo ES1, Kwon TG1, Chung SK1, Kim BW1 1
Kyungpook National University School of Medicine, Daegu, South Korea; 2Dongguk University College of Medicine, Seoul, South Korea; 3Gumi CHA Medical Center, CHA University, Bondang, South Korea Introduction and Objective: Unilateral ureteropelvic
junction (UPJ) stenosis is the most common prenatally detected disease leading to hydronephrosis. The aim of management is to preserve renal function by selecting the children who require early surgical intervention from those for whom watchful waiting may be appropriate because of spontaneous resolution without a significant loss of renal function. Some studies showed that cortical transit time (CTT) could successfully predict functional deterioration in children with UPJ stenosis. We assessed the impact of initial CTT on the need for surgery in children with antenatally detected unilateral hydronephrosis due to UPJ stenosis. Materials and Methods: We retrospectively reviewed
the medical records of 33 antenatally detected unilateral hydronephrosis (anteroposterior diameter (APD)>10mm) due to UPJ stenosis patients who managed at our institution between 2006 and 2014. Delayed CTT was defined by absence of activity in the subcortical structures within 3 minutes of tracer injection on Technetium-99m mercaptoacetyltriglycerine (MAG3) diuretic renogram. This study analyzed and compared the initial level of society of fetal urology (SFU) grade, APD, spilt renal function (SRF), drainage pattern on diuretic renogram, and CTT with the need for surgery. Results: Of the 33 children, 16 were classified as the delayed CTT group and 17 were placed in the normal CTT group. During follow-up period (31.8 months), the surgery was performed in 75.0% (12/16) of delayed CTT group and in 5.9% (1/17) of normal CTT group (p<0.001). Multivariate analysis showed that delayed CTT on initial MAG3 scan and APD on initial ultrasonography were independent predictive factors of the need for surgery. Conclusion: CTT on initial MAG3 scan was found
to be a predictive factor for the need for surgery in children with antenatally detected unilateral hydronephrosis due to UPJ stenosis. Our findings indicate that CTT should be considered a priority in the management of congenital unilateral hydronephrosis due to UPJ stenosis.
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MODERATED ePOSTERS
Moderated ePosters Session 7 Prostate Cancer— Various Topics Friday, October 21 1615–1745 MP-07.01 The Role of Heat Shock Protein 90 Interacting Genes in Prostate Cancer Prince T1, Williams H2 1
Weis Center for Research, Danville, United States; Geisinger Medical Center, Danville, United States
2
Introduction and Objective: Prostate cancer is a het-
erogeneous disease. Heat shock protein 90 (HSP90) and tumor specific kinases are involved in its pathogenesis and thus represent therapeutic targets. However, selective targeting of HSP90 or these kinases alone has been met with limited success. The purpose of this study is to determine the role of the HSP90 interactome and associated kinases in PCa. Materials and Methods: There are over 1300
known HSP90 interacting genes. We identified how many were either mutated or overexpressed (OE) at the mRNA level in the 498 PCa cases from the TCGA. Gene ontology analysis was performed on the top 100 OE genes. The clinical implications of these genes on clinicopathological presentation was assessed. The top 100 OE genes were also profiled for clinically actionable targets. Results: Over 500 HSP90 interacting genes were mutated or overexpressed in at least 5% of the PCa patients. The top 3 mutated genes were TTN, TP53 and CTNNB1 in 13%, 11% and 3% of the population respectively. The top 100 OE genes observed in 87% of cases included YWHAZ, RIPK2, RNF139, PTK2, HSF1, TIGD5, EIF3H, WWP1, NBN, and GATAD1. Increased alterations in the top 100 OE genes were associated with increased Gleason score (Student’s t test, p<0.01) and the need for hormonal therapy (Student’s t test, p<0.01). Gene ontology analysis highlighted the upregulation of nitrogen biosynthesis, response to DNA damage, and ubiquitin ligase activity pathways while down regulation of cellular death and activation of the innate immune response pathways in PCa. Interestingly, when the oncogenic kinases were specifically profiled, over 97% of patients overexpressed at least one HSP90 dependent kinase and over 45% of cases overexpressed at least 10 kinases. Of all the HSP90 dependent kinases combined, RIPK2, PTK2, CDK6, PRKDC, NEK11, LIMK1 and LYN were seen in 37% of the cases and represent targets for which drugs are currently available. Conclusion: All PCa cases involved a HSP90 interact-
ing protein kinase thereby suggesting a rationale for targeting both HSP90 and tumor specific kinases as part of a personalized treatment strategy.
MP-07.02 Tetherin and LRPPRC Relationship in Prostate Cancer and Its Clinical Value Huang H, Lai Y, Chen X, Guo Z, Du T, Chen T, Bai S
34
Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Introduction and Objective: Tetherin has been char-
acterized as a ligand of receptor ILT7 in tumor cells, and suppresses antiviral innate immune responses mediated by human plasmacytoid dentritic cells. Our previous results show that Tetherin interacts with autophagy/mitophagy suppressor LRPPRC and prevents LRPPRC from forming a ternary complex with Beclin-1 and Bcl-2 so that Beclin-1 is released to bind with PI3KCIII to activate autophagy initiation. Therefore, Tetherin may enhance autophagy and mitophagy to suppress tumorigenesis, enhance innate immune responses, or prevent T cell apoptosis and pyroptosis. So we detect Tetherin and LRPPRC expression in prostate cancer and evaluate its relationship with the prognosis in patients. Materials and Methods: Tetherin and LRPPRC
were detected in 112 cases of prostate cancer tissue and paracancer tissue. The combination of clinical parameters such as PSA expression level, Gleason score, TNM stage, metastasis and prognosis and tissue expression of PAP, psa, p504s, p501s, ar, p63 and 34βE12, were retrospectively analyzed. Results: Immunohistochemical results suggest that Tetherin expression in prostate cancer tissues was significantly lower than its adjacent tissues. About 66.1% of prostate cancer tissue showed Tetherin expression in a low state, otherwise paracancer tissue only 31.2% in low-expression state, the difference was statistically significant (P<0.01). LRPPRC in prostate cancer has a higher expression compared with the adjacent tissue, and there is a significant difference between the two groups. In prostate cancer, Tetherin expression level is associated with PSA levels, and is more prone to invasion and metastasis (P<0.05). A lower Tetherin expression level means longer survival time. In addition, Tetherin expression has no significant correlation (P>0.05) with patient age, AR et al. Tetherin expression levels were negatively correlated with LRPPRC. Conclusions: Tetherin in prostate cancer tissues has
prostate biopsies, especially in the “gray zone” (4.0 ng/ml-10.0 ng/ml) area. We introduce a new circulating-tumor-cell (CTC) biomarker for detection of prostate cancer in patients presented with PSA inside the “gray zone” area. Our goal was to clinically verify the potential to substantially decrease the number of unnecessary prostate biopsies. Materials and Methods: A total of 97 patients under-
went routine prostate screening including PSA testing and DRE. One tube of blood was drawn for each patient and sent for CTC analysis in a double-blinded study. Another subset of 23 patients with PSA in the 4.0 ng/ml-10.0 ng/ml range was selected with consent to undergo prostate biopsy for comparison with blinded CTC test results. The CTC test utilized a microfluidic platform with EpCAM as capture antibody. Suspected CTCs were eluted to a membrane chip and immunofluorescently stained with CK18, PSMA and CD45 antibody to confirm. Positive CTCs are defined as CK18+ or PSMA+ and CD45-. Results: Prostate cancer was confirmed by biopsy in 60 out of 97 patients. CTC assay reported 83% of the cancer cases, demonstrating prostate cancer detection ability of the assay. In the subset category of 23 patients (PSA in the 4.0 ng/ml-10.0 ng/ml range, and prostate biopsy), the CTC assay was able to detect cancer in 100% of the prostate cancer cases. Conclusion: This CTC-based blood test is a valuable
new tool in effective screening for prostate cancer. We have demonstrated that this new CTC biomarker is able to reduce unnecessary invasive prostate biopsies in the PSA “gray zone” level by over 60%, with the potential to reduce cost to the system and reduce complication rates due to prostate biopsies, thus improving patient outcomes.
MP-07.04 NK3 Homeobox 1 Is a Major Coactivator Inducing Agonistic Effects in Androgen Receptor-Androgen Receptor Antagonist Interaction Takeda K1, Nishiyama T1, Hara N1, Tasaki M1, Yaoita E2, Ishizaki F1, Tomita Y1
low expression and Tetherin expression levels has a correlation with PSA levels and metastasis, and a negative correlation with LRPPRC. Detection combined with Tetherin and LRPPRC may be a possible early diagnosis of prostate cancer progression, degree of malignancy and prognosis.
Div. of Urology, Niigata University Graduate School of Medical and Dental Sciences, Japan; 2Institute of Nephrology, Dept. of Signal Transduction Research, Niigata University Graduate School of Medical and Dental Sciences, Japan
MP-07.03
Introduction and Objective: Androgens and the an-
A Novel Biomarker for Prostate Cancer Detection with Abnormal PSA Level
drogen receptor (AR) are involved in the proliferation of prostate cancer cells. However, the function of cofactors with AR are less characterized.
Pang ST1, Chang YH1, Lin PH1, Chang YC2, Lin YS3, Hsieh B4, Liu CY1, Chuang CK1, Kamal R4, Mei R4, Weng WH5 1
Div. of Urology, Dept. of Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan; 2Academia Sinica Genomics Research Center, Taipei, Taiwan; 3CellMax Life, Taipei, Taiwan; 4CellMax Life, Sunnyvale, United States; 5Dept. of Chemical Engineering and Biotechnology, Graduate Institute of Biotechnology, National Taipei University of Technology, Taiwan Introduction and Objective: Prostate cancer screen-
ing with PSA is plagued by high rate of unnecessary
1
Materials and Methods: We used prostate cancer cell lines, LNCaP and VCaP cells. Hydroxyflutamide had antagonistic activity for VCaP cells and agonistic activity for LNCaP cells. As a screening, we analyzed changes in the levels of mRNA expression of various cofactors after treatment with hydroxyflutamide and dihydrotestosterone (DHT). Evaluation at the production level of the prostate-specific antigen (PSA) in the medium, assessment of the protein expressions by western blotting, and using small interfering RNA (siRNA) based silencing were performed for investigating the cofactors showing significant expressions. Cell proliferation was evaluated with MTT assay.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS Results: The expressions of mRNA of NK3 homeobox 1 (NKX3-1) in LNCaP cells were 4 times higher and the protein level was 2 times higher with hydroxyflutamide than those without hydroxyflutamide. This significant NKX3-1 expression was observed only in the presence of hydroxyflutamide in LNCaP cells. The expression and protein levels of NKX3-1 mRNA were reduced with siRNA, and the PSA production were reduced by 18% with siRNA. With MTT assay, cells with NKX3-1-silencing showed a lower proliferation activity compared with non-silencing control cells with DHT and hydroxyflutamide. In VCaP cells, no cofactors showed significant expressions.
along with a concomitant decrease in p-FoxO3a, not through the PI3K/Akt signaling pathway.
Conclusion: The function of NKX3-1 in prostate
Sanchis-Bonet A, Morales-Palacios N, SerranoUribe J
cancer has been reported as a corepressor in AR. However, the present study showed that it serves as a coactivator in LNCaP cells treated with hydroxyflutamide. The function of each cofactor in AR should be characterized in accordance with each of ligands, antagonists, and agonists. The functional alteration of NKX3-1 may explain the agonistic effect conversion of the AR antagonist.
MP-07.05 Matrine Inhibits PI3K/Akt and Upregulates the FoxO3a/P27/CDK2/CDK4 Pathway, Leading to Cell Cycle Arrest in CRPC Huang H, Chen T, Lai Y, Bai S Sun Yat-sen Memorial, Hospital Sun Yat-sen University, Guangzhou, China
Conclusions: Matrine reduced cell cycle progression by promoting a G1 phase block, probably not only through the PI3k/Akt pathway, but also through the FoxO3a pathway. It was accompanied by upregulated levels of P27Kip1 and downregulated levels of CDK4 and CDK2.
MP-07.06 Prostate Cancer Risk in Relation to Insulin-Like Growth Factor (IGF)1 and IGF-Binding Protein-3
University Hospital Principe de Asturias, Madrid, Spain Introduction and Objective: High levels of insu-
lin-growth factor (IGF)-1 are reported to be associated with increased risk of prostate cancer (PCa). In contrast, there is evidence that IGF-binding protein-3 (IGFBP-3) decreases the risk. However, not all studies show similar results. Our purpose is to investigate in a prospective study the role of serum IGF-1 and IGFBP-3 as possible risk factors for PCa in a cohort of 142 Spanish men, and to investigate the features of diagnosed tumors.
curring alkaloid extracted from the Chinese herb, Sophora flavescens. Our previous studies showed that matrine reduced the cell population at S phase and increased the cell population at sub-G1 phase. However, the mechanism of Matrine actions in prostate cancer remains poorly understood. Materials and Methods: Whole genome sequencing was used to detect the effect of Matrine about prostate cancer, and then select differentially expressed mRNA. qRT-PCR was used to valid the difference of mRNA. PI3K/Akt and FoxO3a pathway were selected as a research objective. CRPC cell lines PC-3 and DU145 were used and treated with Matrine and the PI3K inhibitor LY294002, respectively. MTT, Trans-well and Flow Cytometry were used to detect in each group. P27, CDK4, CDK2, p-Akt, Akt, p-FoxO3a, FoxO3a expression were detected by Western Blotting.
Results: A total of 59 patients (41%) were diagnosed with PCa. PCa patients and the control group demonstrated statistically significant differences for the means of age, glycaemia, body mass index (BMI), waist circumference, IGF-1 and IGFBP-3 (p=0.003, p=0.02, p<0.001, p<0.001, p=0.03 and p=0.02, respectively). When comparing the levels of IGF-1 and IGFBP-3 according to the age in patients with or without PC, differences were observed only in IGFBP-3 levels in the subgroup of patients 60 or less years-old (1.8[1.6-1.9] vs. 2.6[1.7-3.5]; p=0.001). Although
Results: Whole genome sequencing and qRT-PCR showed the PI3K/Akt and FoxO3a pathway had significant difference after the treatment of Matrine. Matrine resulted in the increase of arrest in the G0/G1 phase of the cell cycle, and combined with the PI3K inhibitor LY294002, also could increase the arrest of G0/G1 phase. The expression of CDK2 and CDK4 decreased in both cell lines after treated with Matrine. Activation of P27Kip1 was accompanied with a decrease in the expression of CDK2 and CDK4. This was particularly evident when compared with LY294002. The expression levels of p-Akt and Akt actually decreased in the Matrine and LY294002 group compared to the Matrine alone group, as well as the LY294002 alone group. Matrine treatment resulted in an increase in FoxO3a and a decrease in p-FoxO3a and PI3K. It was also demonstrated that LY294002 enhanced the effect of Matrine and increased FoxO3a
Conclusion: The measurement of serum levels of IGF-
1 and/or IGFBP-3 doesn›t improve the identification of men at high-risk of developing PC and an aggressive disease.
MP-07.07
Materials and Methods: Serum levels of IGF-1 and IGFBP-3 were determined in 142 men who subsequently received a first prostate biopsy between January 2015 and January 2016. The assessment of the predictive variables of PC and of its aggressiveness was done using the uni- and multivariate Logistic regression model; for this purpose IGF-1 levels were divided into“tertiles” to assess the odds-ratio (OR) and the 95% confidence interval (95% CI).
Introduction and Objective: Matrine is a naturally oc-
the levels of IGF-1 and IGFBP- 3 were lower in PCa patients with tPSA ≥10 ng/ml, pathological Gleason score ≥7, extracapsular disease and positive surgical margins, the differences were not statistically significant. Neither IGF-1 nor IGFBP-3 was able to independently predict the diagnosis of PCa (Table 1).
The Impact of Obesity on the Predictive Accuracy of ProstateSpecific Antigen in Spanish Men Undergoing a First Prostate Biopsy Sanchis-Bonet A, Morales-Palacios N, Ortiz-Vico F, Sanchez Chapado M University Hospital Principe de Asturias, Madrid, Spain Introduction and Objective: It is established that obesity results in lower PSA levels, and this may contribute to a lower ability for PSA to detect prostate cancer (PCa) in this population. Our purpose is to investigate PSA accuracy in detecting PCa according to body mass index (BMI) in Spanish European men with indication of a first prostate biopsy. Materials and Methods: We reviewed the clinical and
histopathological data of 1319 patients who underwent trans-rectal ultrasound guided prostate needle biopsy from 2007 to 2011 at a University Hospital in Spain. Men were categorized according to BMI as follows: < 25 kg/m2 (normal weight), 25-29.9 kg/ m2 (overweight) and ≥30 kg/m2 (obese). Receiver operator characteristics (ROC) curves were used to assess PSA accuracy for predicting PCa and biopsy Gleason sum overall, and then stratified according to digital rectal examination (DRE) findings using the area under the curve (AUC). Multivariate logistic regression analysis was used to examine the association between BMI and PC and between BMI and biopsy Gleason sum. A two-tailed p<0.05 was considered to indicate statistical significance. Results: A total of 661 (55%) men were in the normal weight group. A total of 517 cases of PCa were diagnosed and diagnosis of cancer was more common among the over-weight (45%) and the obese
MP-07.06, Table 1. UNIVARIATE
MULTIVARIATE
OR
CI95%
P
OR
CI95%
P
Age (years)
1.08
1.03-1.10
0.003
1.12
1.02-1.21
0.007
tPSA (ng/ml)
1.02
0.98-1.07
0.21
Digital rectal examination
3.2
1.58-6.70
0.001
2.7
1.1-6.3
0.01
Glycemia (m/dl)
1.01
1.001-1.03
0.03
1.01
0.99-1.03
0.2
BMI (kg/m2)
1.2
1.08-1.36
0.001
1.18
1.04-1.34
0.006
IGF-1 (ng/ml) ≥134 103-133 <103
1 2.04 2.45
0.8-4.9 1.04-5.7
0.04 0.1 0.03
0.1 0.8 1.2
0.4-2.7 0.8-3.5 0.3-1.1
0.4 0.5 0.2
IGFBP-3 (μg/ml)
0.4
0.2-0.8
0.01
0.6
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
0.1
35
MODERATED ePOSTERS MP-07.07, Table 1. AUC
CI 95%
p
PSA
0.56
0.56-0.62
0.02
DRE
0.57
0.53-0.60
0.01
PSA plus DRE
0.60
0.56-0.63
< 0.001
IMC
0.59
0.56-0.62
< 0.001
PSA plus DRE plus IMC
0.63
0.59-0.66
< 0.001
MP-07.07, Table 2.
AUC
CI 95%
p
PSA
0.57
0.52-0.63
0.01
DRE
0.57
0.50-0.63
0.03
PSA plus DRE
0.61
0.55-0.67
< 0.001
IMC
0.51
0.44-0.58
0.6
PSA plus DRE plus IMC
0.61
0.55-0.67
< 0.001
group (48%) than in the normal weight group (32%); p<0.001. No differences were observed in the PSA levels (6.6, 6.4 and 6.5 ng/ml respectively; p=0.7) and in the biopsy Gleason sum (≤7 vs >7; p=0.2) across the groups. The AUCs of serum PSA for predicting PCa on biopsy were 0.53, 0.58 and 0.62 for normal-weight, overweight and obese men, respectively. When stratified according DRE findings, the AUCs of PSA for predicting PCa among groups with non-suspicious PCa on DRE was 0.48, 0.57 and 0.63; p<0.001, while among those with a DRE suspicious for cancer, the corresponding AUCs were 0.58, 0.59 and 0.58; p=0.90. In the multivariate logistic regression analysis, BMI was one of the significant factors predicting PCa ([OR] 1.4, 95% CI 1.2-1.7, p<0.001), but BMI was not a significant factor predicting a biopsy Gleason sum > 7 ([OR] 1.03, 95% CI 0.97-1.1, p=0.3) after adjustments for age, PSA level, prostate volume, DRE. The incorporation of BMI in models predicting PCa improves the predictive accuracy of PSA from 0.56 to 0.63 (Table 1). The incorporation of BMI in models predicting a biopsy Gleason sum > 7 improves the predictive accuracy of PSA from 0.57 to 0.61 (Table 2). Conclusion: Obesity doesn’t negatively affect the ac-
curacy of PSA to detect cancer in our population. Moreover, the accuracy is better, and it is much better when DRE is normal. The inclusion of BMI in predicting models of PC diagnosis improves the diagnostic accuracy.
MP-07.08 Characteristics of Prostate Cancer in Korean Men with a Prostate-Specific Antigen Level of Less than 4.0 ng/ml Choi H1, Kim HJ2 1
Dept. of Urology, Korea University Ansan Hospital, Korea; 2Dept. of Urology, Dankook University College of Medicine, Cheonan, Korea
Introduction and Objective: We studied the preva-
lence of prostate cancer among Korean men with a PSA level of less than 4.0 ng/ml
36
Materials and Methods: A total of 1680 men with
PSA ≤4 ng/ml had a prostate biopsy after atypical findings on transrectal ultrasonography (TRUS), digital rectal examination (DRE), or other suspicious findings from January 2004 to December 2014. The differences in clinical factors were analyzed and their independent predictive implications were evaluated. Results: Among the 1680 men, prostate cancer was diagnosed in 331 (19.58%) and 99 of these 331 cancers (14.9%) had a Gleason score of 7 or higher. The prevalence of prostate cancer increased from 6.67% (≤0.5 ng/ml) to 20.36% (3.01-3.9 ng/ml) as the PSA level increased. There were significant differences between prostate cancer (+) patients and cancer (-) patients: age 65.7 vs. 62.1 years, prostate volume 33.4 vs. 38.2 g, PSAD (0.10 vs. 0.08 ng/ml/cc). On multivariate analysis, age and prostate volume were the best independent discriminative parameters. When comparing prostate cancer (+) patients with a Gleason score less than 6 to those with a 7 or higher, patients with a Gleason score less than 7 were older (67.2 vs. 64.8 years). Conclusion: Even when the PSA level is less than 4
ng/ml, prostate cancers, including high-grade cancers, were detected in a significant number of men. Patients with prostate cancer were older and had a smaller prostate volume. High-grade cancers were detected more frequently in older cancer patients.
MP-07.09 Clinical Performance of [-2] Pro-Prostate Specific Antigen and Prostate Health Index for the Prediction of Prostate Cancer in a Cohort of Spanish Men Sanchis-Bonet A, Morales-Palacios N, Barrionuevo Gonzalez M, Sanchez Chapado M University Hospital Principe de Asturias, Madrid, Spain Introduction and Objective: Prostate specific antigen
(PSA) and free prostate-specific antigen (fPSA) have limited specificity in detecting clinically significant prostate cancer (PCa), leading to unnecessary biopsy, and detection and/or overtreatment of some in-
dolent tumors. Recently there is some evidence that [-2] pro-prostate-specific antigen ([-2] proPSA) may improve specificity in detecting clinically significant PCa. The purpose of this study is to prospectively test the diagnostic accuracy of [-2] proPSA (p2PSA), percentage of p2PSA (%p2PSA) and prostate health index (PHI) in comparison to tPSA, free PSA (fPSA) and percentage of fPSA to tPSA (%fPSA) and to determine its role in discriminating between significant and insignificant PC. Materials and Methods: A total of 114 men scheduled for initial or repeat prostate biopsy. tPSA levels ranged between 2- 20 ng/ml. Beckman Colter Access immunoassay was used to study [-2] proPSA, and PHI. Multivariate logistic regression models were complemented by accuracy analysis in order to predict biopsy results. Results: Of 114 patients, PCa was diagnosed in 41(36%). A total of 20 (43%) Gleason score 7 or greater were identified at biopsy. Median tPSA (5.85 vs. 6.06 ng/ml); p=0.1) and median fPSA (0.69 vs. 0.68; p=0.7) did not differ between men with or without PCa. On the other hand, p2PSA (21.57 vs. 15.64 pg/ ml; p=0.008), %p2PSA (3.3 vs. 2.1; p<0.001), %fPSA (0.89 vs. 0.14; p<0.001) and PHI (89 vs. 49.2;p<0.001) differed significantly between men with or without PCa. The best AUC to predict PCa was for PHI (0.82[0.74-0.90]; p<0.001. In multivariate logistic regression model, p2PSA, %p2PSA and PHI significantly increased the accuracy of the base multivariate model by 7%, 4% and 8% respectively. A PHI cut-off of 33.27 has a sensitivity, specificity, positive predictive value and negative predictive value of 95%, 20%, 40% and 87% respectively, and a total of 16 biopsies (14%) could have been avoided, missing only 2 positive Gleason score 6 (3+3) biopsies and none Gleason ≥7. Conclusion: In patients with a tPSA range of 2-20 ng/
ml; p2PSA, %p2PSA and PHI are the strongest predictors of PCa, significantly improving the accuracy diagnosis of tPSA and fPSA.
MP-07.10 A Systematic Review and MetaAnalysis of the Diagnostic Accuracy of Prostate Health Index and Four-kallikrein Panel Score Russo GI, Regis F, Castelli T, Favilla V, Privitera S, Giardina R, Cimino S, Morgia G University of Catania, Italy Introduction and Objective: Markers for prostate cancer (PCa) have progressed over the last years and prostate health index (PHI) and four-kallikrein panel have been demonstrated to improve the diagnosis of PCa. In the last year, many studies have investigated their role for PCa detection. We aimed to review the diagnostic accuracy of PHI and four-kallikrein panel for PCa detection. Materials and Methods: We performed a systematic literature search of PubMed, EMBASE, Cochrane, and Academic One File databases until December 2015. We included diagnostic accuracy studies that used PHI or four-kallikrein panel for the diagnosis of PCa or high-grade PCa. Data were collected to create 2x2 contingency tables from all included studies
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS and to calculate test characteristics including sensitivity and specificity. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool by two independent reviewers. Results were pooled and plotted in a summary receiver operating characteristics plot. Results: Twenty-eight studies including 15,815 patients have been included for the analysis. The pooled data showed sensitivity of 0.91 (95% confidence interval (CI) 0.90-0.92) and 0.74 (95% CI 0.73-0.76) for PHI and four-kallikrein panel respectively for PCa detection and a pooled specificity for all studies of 0.29 (95% CI 0.28-0.31) and 0.60 (95% CI 0.590.61) for PHI and four-kallikrein panel respectively. The diagnostic odds ratio (DOR) was 4.26 (95% CI 3.40-5.35) and 4.62 (95% CI 3.52-6.05) for PHI and four-kallikrein panel respectively. For high-grade PCa detection, the pooled sensitivity was 0.93 (95% CI 0.90-0.95) and 0.87 (95% CI 0.85-0.89) for PHI and four-kallikrein panel respectively while the pooled specificity was 0.25 (95% CI 0.23-0.27) and 0.61 (95% CI 0.60-0.62) for PHI and four-kallikrein panel respectively. The DOR was 3.32 (95% CI 2.32-4.75) and 10.15 (95% CI 8.06-12.79) for PHI and four-kallikrein panel respectively. Conclusions: Both PHI and four-kallikrein panel provided good diagnostic accuracy in detecting PCa. However, for the detection of high-grade PCa, four-kallikrein panel seems to provide better capability. However, any recommendation on the threshold could not be made based on the heterogeneity of the studies.
MP-07.11 Does Selenium and Lycopene Supplementation Really Increase the Incidence of Prostate Cancer? A Post-Hoc Analysis from the Procomb Trial at 2 Years of Follow-Up Morgia G1, Voce S2, Palmieri F2, Gentile M3, Giannantoni A4, Blefari F5, Vespasiani G6, Carini M7, Santelli G8, Arnone S2, Pareo RM9, Russo GI1, Iapicca G2 1 University of Catania, Italy; 2Urology of Ravenna, Italy; 3Urology of Avellino, Italy; 4University of Perugia, Italy; 5Urology of Prato, Italy; 6University of Tor Vergata, Rome, Italy; 7University of Florence, Italy; 8 Urology of Lucca, Italy; 9Urology of Rome, Italy
Introduction and Objective: Prostate cancer (PCa) has always been considered as an ideal target for chemoprevention because of its long history and its natural high incidence. Over the past decade, many potential chemopreventive agents have been used in PCa. However, the use of selenium use has been dramatically refuted as a result of long-term results of the SELECT study. A recent study of Gontero et al. has shown that the administration of high doses of lycopene, catechins and selenium in patients with high grade PIN (HGPIN) and/or ASAP was associated with a greater incidence of PCa at re-biopsy and increased expression of microRNAs implicated in the progression of PCa. For this reason, we conducted the following study post hoc clinical Procomb trial (ISRCTN78639965) with the aim to evaluate the RR of developing prostate cancer in patients treated with Selenium + Lycopene.
Materials and Methods: From March 2011 to March 2012, 225 patients were enrolled in the study in relation to the following parameters: age between 55 and 80 years, DRE negative for PCa, PSA <4 ng / mL, ≥ 12 IPSS, prostate volume ≤ 60cc (assessed by suprapubic ultrasound), Qmax ≤ 15 ml / s, post-void residual <150 ml. Patients with PCa were excluded. Participants were randomized into three treatment arms for the treatment of LUTS, each consisting of 75 patients with enlistment 1: 1: 1: arm A (Ser 320 mg, Ly and Se (Profluss®) 1 tablet per day for 1 year), arm B (Tamsulosin 0.4 mg 1 tablet per day for 1 year), arm C (Ser 320 mg, Ly and Se (Profluss®) 1 tablet per day for 1 year + tamsulosin 0.4 mg 1 tablet per day for 1 year). The following post-hoc study was conducted at the end of the clinical trial from April 2012 to April 2014 and included patients who continued treatment given during the previous trial. Patients were repeated PSA total and the digital rectal exam annually. In the event of an increase in PSA above 4 ng/ml and/or suspected PCa a prostate biopsy was performed. Patients with incomplete data were excluded from statistical analysis. For statistical analysis, patients were divided into two groups: Group A (Ser, Ly and Se) and Group B (control). Each tablet of Profluss® consisted of 320 mg of lipid extract of Serenoa Repens which contains 85% sterols, selenium (50 g) and lycopene (5 mg) (Ayanda AS, Norway). The Cochran-Armitage trend test was used to describe the temporal changes of the PSA during follow-up. Results: After post-hoc analysis, 209 patients, 134 in group A and 75 in group B were included. During the 2 years of follow-up, 24 patients (11.5%) underwent prostate biopsy for high values of total PSA and of these, 9 (4.3%) received a diagnosis of PCA and 15 (7.2%) received a diagnosis of BPH. There were no significant differences regarding the mean changes of the PSA between the two treatment groups (p for trend = 0.33). The relative risk (RR) of having a diagnosis of PCa was 1.07 (95% CI [0.64-1.79]) and 0.89 (95% CI [0.41-1.95]) in group A and B, respectively (p = 0.95). In the multivariate Cox regression analysis, Group A treatment (OR 1.38 [95% CI: 0.32-5.90]; p = 0.67) was not associated with an increased incidence of PCa. Conclusion: Supplementary therapy with Selenium
and Lycopene does not increase the risk of prostate cancer in patients with LUTS secondary to BPH after 2 years of follow-up.
MP-07.12 Genetic Variants in the TelomereRelated Genes Are Associated with Prostate Cancer Risk and Recurrence Gu C, Qu Y, Zhu Y, Ye D Fudan University Shanghai Cancer Center, China Introduction and Objective: Telomere-related genes play an important role in carcinogenesis and progression of prostate cancer (PCa). It is not fully understood whether genetic variations in telomere-related genes are associated with development and progression in PCa patients. We designed a case-control study using a candidate-gene approach to test the hypothesis that potentially functional polymorphisms in three key telomere-related genes (TEP1, TNKS and TNKS2), which have previously been related to telo-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
mere length, are associated with PCa risk. The relationship between these SNPs and BCR were further tested among a subset of patients who received RP. Materials and Methods: Six potentially functional
single nucleotide polymorphisms (SNPs) of three key telomere-related genes were evaluated in 1015 PCa cases and 1052 cancer-free controls to test their associations with risk of PCa. Among 426 PCa patients who underwent radical prostatectomy (RP), the prognostic significance of the studied SNPs on biochemical recurrence (BCR) was also assessed using the Kaplan-Meier analysis and Cox proportional hazards regression model. The relative telomere lengths (RTL) were measured in peripheral blood leukocytes using real-time PCR in the RP patients. Results: TEP1 rs1760904 AG/AA genotypes were significantly associated with a decreased risk of PCa (odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.64-0.93, P = 0.005), compared with the GG genotype. By using median RTL as a cutoff level, RP patients with TEP1 rs1760904 AG/AA genotypes tended to have a longer RTL than those with the GG genotype (OR: 1.55, 95% CI: 1.04-2.30, P = 0.031). A significant interaction between TEP1 rs1713418 and age in modifying PCa risk was observed (P = 0.005). After adjustment for clinicopathologic risk factors, the presence of heterozygotes or rare homozygotes of TEP1 rs1760904 and TNKS2 rs1539042 were associated with BCR in the RP cohorts (hazard ratio [HR]: 0.53, 95% CI: 0.36-0.79, P = 0.002 and HR: 1.67, 95% CI: 1.07-2.48, P = 0.017). Conclusion: These data suggest that genetic variations
in the TEP1 gene may be biomarkers for the risk of PCa and biochemical recurrence after RP.
MP-07.13 Genetic Variants of the CYP1B1 Gene as Predictors of Biochemical Recurrence After Radical Prostatectomy in Localized Prostate Cancer Patients Gu C, Qin X, Zhu Y, Ye D Dept. of Urology, Fudan University Shanghai Cancer Center, China Introduction and Objective: Clinically localized pros-
tate cancer is curative. Nevertheless, many patients suffer from biochemical recurrence (BCR) after radical prostatectomy (RP). The CYP1B1 plays an important role in tumorigenesis and cancer progression via endogenous hormones and xenobiotics metabolism. We hypothesize that genetic variants of the CYP1B1 gene may influence clinical outcome in clinically localized prostate cancer patients. Materials and Methods: In this cohort study, we genotyped nine tagging single nucleotide polymorphisms (SNPs) from the CYP1B1 gene in 312 patients treated with RP. For replication, these SNPs were genotyped in an independent cohort of 426 patients. The expression level of CYP1B1 in the adjacent normal prostate tissues was quantified by reverse transcription and real-time polymerase chain reaction. Kaplan-Meier analysis and Cox proportional hazard models were utilized to identify SNPs that correlated with BCR. Results: After making adjustments for known clinicopathologic variables, CYP1B1 rs1056836 were found to be significantly associated with time to BCR in both
37
MODERATED ePOSTERS Study 1 and Study 2 (P = 0.028 and 0.035, respectively), and upon combined analysis (HR: 0.69, 95% CI: 0.40-0.89, P = 0.002). Compared with CG/CC genotype, rs1056836 CC genotype was significantly associated with higher expression levels of CYP1B1 mRNA (P = 0.025). Conclusion: Our findings suggest inherited genet-
ic variation in the CYP1B1 gene may contribute to variable clinical outcomes for patients with clinically localized prostate cancer.
MP-07.14 Detection of Prostate Cancer Recurrence Site After Primary or Salvage Radiotherapy Using C11 Choline PET/CT: Examination of PSA Characteristics in Positive Scans Davis BJ, Parker WP, Evans JD, Park SS, Stish BJ, Olivier KR, Quevedo JF, Lowe VJ, Nathan MA, Welch BT, Boorjian SA, Haloi R, Mahon ML, Karnes RJ, Mynderse LA, Kwon ED Mayo Clinic, Rochester, United States Introduction and Objective: C11 choline PET/CT
(CholPET) is useful for identifying site-specific recurrence among prostate cancer (CaP) patients experiencing biochemical failure following primary therapy at lower PSA levels in comparison to conventional imaging modalities. The objective of this study is to characterize differences in PSA levels in two cohorts with positive CholPET: salvage radiotherapy (sRT) versus primary radiotherapy (RT) patients. Materials and Methods: Between 2008 and 2015, a
total of 6 281 CholPET scans in 2 842 patients were performed. Of these, 632 received radiotherapy during their treatment course. Study inclusion criteria: 1) No ongoing androgen deprivation at CholPET, 2) no evidence of castrate resistant CaP, and 3) positive CholPET scan with biopsy confirmation and/or evidence of clinical progression/treatment response at recurrence site based on serial scans. Forty-one RT and 167 sRT patients satisfied these criteria. Scans were categorized by disease extent: 1) prostatic fossa or prostate/seminal vesicles only, 2) pelvis only, exclusive of osseous sites, and 3) extrapelvic sites inclusive of any osseous metastasis. PSA levels of the two cohorts as a function of recurrence site were evaluated using the Wilcoxon rank sum test. Results: Recurrence for sRT versus RT patients were: 1) local prostatic fossa vs. prostate/sv (2% vs. 46%), 2) pelvis only (inclusive of prostate fossa or prostate/sv) (61% vs. 62%), and 3) extrapelvic (38% vs. 39%) (p <0.01). Median PSA levels in ng/mL and their interquartile range (IQR) for sRT vs. RT patients were: 1) local: 3.1 (IQR: 3.1) vs. 5.1 (IQR: 3.5, 8.3), 2) pelvic: 2.5 (IQR: 1.9, 3.6) vs. 5.5 (IQR: 3.7, 8.3)(p <0.01), and 3) extrapelvic and/or osseous: 4.8 (IQR: 2.3, 10.5) vs. 7.7 (IQR: 4.6, 12.1) (p=0.17). The lowest PSA levels for recurrence detection in pelvic lymph nodes and extrapelvic sites were 0.1 and 1.2 ng/mL respectively.
Conclusion: Consistent with known patterns of biochemical failure, CholPET identifies recurrence at lower PSA levels in sRT versus RT patients in all categories of recurrence sites examined. The sensitivity of CholPET enables early identification of recurrences in
38
local, pelvic and extrapelvic locations that may impact strategies employing local salvage and/or systemic treatments.
MP-07.15 Validation of Stromogenic Carcinoma in an Intermediate Risk Cohort Miles B1, Gao Y1, Bu P2, Ding Y2, MacDonnell V1, Ayala G2 1
Houston Methodist, Houston, United States; University of Texas, Austin, United States
Conclusion: The risk category of Gleason 6 and
7 patients comprises the majority of PCa patients. In this group, current clinico pathologic parameters have limited performance. However, the majority of patients that die of PCa are in this intermediate risk group. This study confirms that the presence of stromogenic carcinoma provides additional information to current clinico-pathologic models and will help stratify care of the largest segment of PCa patients.
MP-07.16
2
Introduction and Objective: Reactive stroma grading
is a semiquantitaive method to incorporate the host response into current methods of prostate cancer (PCa) prediction. Grade 3, or stromogenic carcinoma is defined as reactive stroma comprising at least 50% of the PCa. This study will attempt to validate the prognostic value stromogenic carcinoma in a large cohort. Materials and Methods: This is a nested case-control
study designed to evaluate biomarkers for PCa recurrence. The full nested case-control study includes 524 recurrence cases and a sample of 524 controls identified among 4 860 PCa patients who underwent radical retropubic prostatectomy for clinically localized prostate cancer at Johns Hopkins in Baltimore, MD between 1993 and 2001, followed for outcome through 2004. Recurrence was defined as biochemical recurrence (serum PSA >0.2 ng/mL), local recurrence, systemic metastases, or death from prostate cancer. A total of 16 tissue microarrays were built. In specimens with multifocal tumors, only the dominant tumor (highest Gleason score) was sampled. We compared the probability of recurrence for stromogenic carcinoma by constructing Logistic regression model. Possible confounders and effect modifications were examined while developing a final multivariable model. Extra capsular extension, surgical margins, lymph node status, seminal vesicle invasion and age were adjusted for in the final multivariable model. Analyses were performed using SAS 9.3 at a statistical significance level of 0.05. Results: There were a total of 976 patients, of which 740 have a Gleason of 6 or 7. When compared to current clinico-pathologic parameters, the presence of stromogenic carcinoma was independently predictive of the presence of biochemical recurrence in the Gleason 6 and 7 intermediate risk category of patients (HR-1.7633 (1.0724, 2.8992); p=0.0254).
Effect of Gonadotrophin-Releasing Hormone Analogue-Induced FollicleStimulating Hormone Suppression on Prostate-Specific Antigen Response Keane T1, Damber JE2, Boccardo F3, Collette L4, Crawford ED5, Persson BE6 1
Medical University of South Carolina, Charleston, United States; 2University of Gothenburg, Sweden; 3 University of Genoa, Italy; 4EORTC Headquarters, Brussels, Belgium; 5University of Colorado, Aurora, United States; 6Läkarhuset and Uppsala University, Uppsala, Sweden Introduction and Objectives: Degarelix, a gonadotrophin-releasing hormone (GnRH) antagonist, is approved as a first-line treatment for androgen-dependent advanced prostate cancer. Here we present the association between age, baseline values of FSH, LH, and testosterone and ‘on treatment’ PSA suppression related to FSH suppression. This association is of interest because of the potential benefits of FSH suppression being unique for GnRH antagonists. Materials and Methods: Patients with histologically confirmed prostate cancer (all stages) were randomized to 1 of 3 dosing regimens for 13 months: (1) GnRH agonist leuprolide 7.5 mg/month (N=201); (2) Degarelix, starting dose 240 mg for 1 month followed by monthly maintenance doses of 80 mg (N=207); (3) Degarelix, 240 mg starting dose for 1 month and monthly maintenance doses of 160 mg (N=202). Antiandrogen flare protection was given in the leuprolide group. FSH, LH, testosterone and PSA levels were analyzed at baseline, month 1, 3, 6, 9, 12 and 13 (end of study). The correlation between FSH/PSA suppression of log transformed values was assessed. Statistical significance was declared at a 2-sided 0.05 level. Results: Demographic and baseline characteristics were similar across treatment groups. Median age was 73 years (range: 50-98 years) and 20.5% patients had
MP-07.16, Table 1. Suppression Levels Induced by the GnRH Antagonist Degarelix
Leuprolide
Sample period
N
Month 1
196
Month 3 Month 6 Month 9 Month 12 Month 13
Degarelix
Correlation FSH/PSA suppression of logtransformed values (SE)
Correlation FSH/PSA suppression of logtransformed values (SE)
p-value
N
p-value
0.06 (0.084)
0.457
403
0.13 (0.054)
0.016*
191
-0.11 (0.153)
0.480
387
0.29 (0.088)
0.001*
185
0.31 (0.208)
0.132
376
0.36 (0.116)
0.002*
181
0.43 (0.260)
0.097
358
0.27 (0.114)
0.093
172
-0.01 (0.113)
0.905
332
0.40 (0.147)
0.007*
171
-0.15 (0.339)
0.659
329
0.51 (0.162)
0.001*
*statistical significance p<0.05; FSH=follicle-stimulating hormone; PSA=prostate-specific antigen; SE=standard error
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS M1 stage disease. Baseline FSH and LH significantly increased (both p<0.0001) with age, while baseline testosterone was independent of age. Baseline testosterone significantly increased (p=0.015) with increasing baseline LH levels, while there was no such association between baseline testosterone and FSH. Patients in the degarelix group demonstrated a significant relation between ‘on treatment’ PSA suppression (% change from baseline) and FSH suppression levels at Month 1, 3, 6, 12 and 13 (p<0.05, Table 1). No such association was seen for the leuprolide group. Conclusion: The findings suggest a more pronounced PSA suppression at greater FSH suppression levels induced by the GnRH antagonist degarelix.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
39
MODERATED ePOSTERS
Moderated ePosters Session 8 BPO/LUTS Friday, October 21 1615–1745 MP-08.01 Is Bladder Ischemia a Cause of LUTS? Evaluation of Patients with Pelvic Arterial Hypoperfusion Costa D1, Antunes-Lopes T2, Coelho A3, Silva C2, Cruz F2 Hospital S. João, Porto, Portugal; 2Hospital S. João; Faculty of Medicine, University of Porto, Portugal; 3 Faculty of Medicine, University of Porto, Portugal
1
Introduction and Objective: Animal models of iliac
arterial occlusion (IAO) showed that chronic bladder ischemia can cause bladder dysfunction. However, the relationship between pelvic arterial hypoperfusion (PAH) and LUTS was never explored in clinical studies. We investigated LUTS and urinary neurotrophins in men with PAH in order to validate the experimental model of IAO. Materials and Methods: Twenty-seven men from the vascular surgery clinic were enrolled. Fourteen had PAH and were categorized according to severity: 9 had unilateral internal iliac occlusion (UIIO) and 5 had bilateral internal iliac occlusion (BIIO). The control group (n=13) included patients submitted to
carotid endarterectomy, without aortoiliac occlusive disease. Exclusion criteria included neurogenic bladder dysfunction, bladder or prostate cancer, pelvic radiotherapy or chronic treatment for LUTS. Patients were evaluated clinically (Rutherford classification) and anatomically (aortoiliac TASC II classification) for peripheral artery disease, using angio-CT or angiography. Urological evaluation included IPSS, uroflowmetry, postvoid residual (PVR) and prostate volume determination. Urine samples were collected to measure NGF and BDNF by ELISA. Results: Data are summarized in Table 1. Subjects with PAH had mild LUTS and although the mean IPSS was higher than in controls, the difference was not significant (p=0.26). Qmax and PVR were similar in both groups. There was a trend for patients with more severe PAH (BIIO) to have smaller prostate volumes (p=0.07). Patients with PAH had significant higher levels of NGF than controls (p=0.05). This did not occur for BDNF. Conclusion: Chronic PAH was not associated with se-
vere LUTS, suggesting that development of collateral irrigation of the bladder might delay or prevent significant bladder dysfunction. Low-grade inflammation associated with ischemia might explain the slight increase of urinary NGF. This study seems to limit human translation of the findings obtained in animal models of chronic bladder ischemia induced by IAO.
MP-08.02 Non-Alcoholic Fatty Liver Disease Is Associated with Greater Severity of Intraprostatic Inflammation in Patients with Benign Prostatic Hyperplasia Russo GI, Urzì D, Reale G, Motta F, Caltabiano R, Puzzo L, Vanella L, Sorrenti V, Cimino S, Morgia G University of Catania, Catania, Italy Introduction and Objectives: The association between metabolic syndrome (MetS), benign prostatic hyperplasia (BPH) and prostate inflammation has been previously demonstrated. We have recently shown that insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) were associated with greater severity of lower urinary tract symptoms (LUTS). In this study we aimed to investigate the association between IR, NAFLD and intraprostatic inflammation in patients undergoing transurethral resection of the prostate (TURP) for moderate-to-severe LUTS. Materials and Methods: Between January 2012 and June 2013, we enrolled 129 consecutive patients with IPSS ≥12, PSA <4 ng/ml or PSA ≥4 ng/ml but previous negative prostate biopsy, Qmax <15 mL/sec, prostate volume ≥30 ml and ≤80 ml. A condition of IR was defined in the presence of a value homeostasis model assessment (HOMA) greater than or equal to 3. The presence of NAFLD was defined in the presence of a value of Fatty Liver Index (FLI) greater than or equal to 40 (specificity 72%, sensitivity 82%, AUC 81%). The protocol was approved by the local ethics committee (ID: 578). During TURP procedure we collected tissue samples for the evaluation of the degree of
MP-08.01, Table 1.
Pelvic Arterial Hypoperfusion (vs. controls) Controls
N
13
Age
68.9±8.0
TASC II classification (grade C/D) (%; n)
8 (1)
Rutherford classification
0.5±1.1
IPSS
7.9±1.7
PVR (ml)
38.4±28.7
Qmax (ml/s)
16.9±8.0
Prostate volume (ml)
37.8±20.8
NGF/Creatinine (log)
2.93±0.72
UIIO (vs. controls)
BIIO (vs. controls)
P
9
5
72.2±9.2
>0.05
61.8±4.0
>0.05
25 (2)
>0.05
60 (3) *
<0.001
1.0±1.8
>0.05
3.8±1.1 *
<0.001
8.4±4.3
>0.05
31.6±29.1
>0.05
15.8±6.3
>0.05
22.8±10.1 *
0.07
9.8±4.6 (p>0.05) 10.8±3.0
>0.05 29.2±25.4
27.2±23.7
>0.05 14.5±4.6 (p>0.05)
13.7±3.5
>0.05 30.7±17.1 (p>0.05)
35.6±19.2
BDNF/Creatinine (log)
P
>0.05
3.59±0.73 (p=0.05) * 3.71±0.96
0.11
3.55±0.32
0.87
3.19±0.52
3.44±0.40
0.14
3.34±0.64 (p=0.66) 3.21±0.84
0.83
Data is expressed as the mean ± standard deviation TASC II classification – anatomical classification of aortoiliac disease C and D categories indicate more severe anatomical disease Rutherford classification – clinical classification of peripheral arterial disease Higher score indicates more severe symptomatic disease * p <0.05 is statistically significant
40
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS inflammatory infiltrate according to the classification used by Irani et al. The degree of inflammatory score (IS) was obtained by combining three different histological parameters (grade and aggressiveness), with a score ranging between 0 and 6. Results: The median HOMA -Index was 1.69 (IQR: 0.89-3.43), the median FLI was 44.83 (IQR: 26.9869.07) and the median IS was 3 (IQR: 2-4). Forty-two patients (31.8%) had IR, 75 (56.8%) had NAFLD, 75 (56.8%) had MetS and 36 (27.3%) had a IS ≥4. Patients with IS ≥4 showed higher levels of FLI (60.6 vs. 36.84; p< 0.05) and HOMA-index (2:41 vs. 1:56; p<0.05) than patients with IS<4. The logarithmic regression showed that for every increase of FLI was observed an increase of the IS 0.44% (p<0.01). No relationship was found, however, between Homa-index and IS. The multivariate logistic regression analysis, showed that the presence of NAFLD is an independent risk factor for IS ≥4 (OR: 2.84; p< 0.05). Conclusion: We have demonstrated that the FLI,
expression of NAFLD, is associated with a more severe inflammatory infiltrate prostate. In particular, for each increase of FLI it was observed an increase of 0.44 % of the severity of the inflammation. Finally, the presence of NAFLD increases the risk of having a severe inflammatory infiltrate (SI ≥4). These results may be useful in order to assess in detail the possible interaction between fatty liver and intra prostatic inflammation. The presence of IR was not found to play a key role for prostate inflammation.
MP-08.03 The Prevalence of Metabolic Syndrome and Its Association with Lower Urinary Tract Symptoms and Sexual Function: Geographic Differences in Its Occurrence Plata M1, Mariño Á1, Trujillo CG1, Caicedo JI1, Fernández N2, Gutiérrez A2, Godoy F2, Cabrera M2, Cataño JG2, Robledo D1 1
Universidad de los Andes, School of Medicine; Dept. of Urology, Fundación Santa Fe de Bogotá University Hospital, Bogotá DC, Colombia; 2Dept. of Urology, Fundación Santa Fe de Bogotá University Hospital, Bogotá DC, Colombia Introduction and Objective: To estimate the fre-
quency of metabolic syndrome in a general urology practice and determine its association with LUTS and erectile function. Materials and Methods: A retrospective cohort study
was conducted. All subjects who attended routine urological consult from 2010 to 2011 and had a full physical exam and laboratory tests were included. LUTS and sexual function were examined, and the prevalence of metabolic syndrome was determined. A bivariate model was used to determine possible associations, controlling for confounders and interaction factors. Results: A total of 616 patients were included. Meta-
bolic syndrome was observed in 43.8% (95% CI 39.648.3). The bivariate model showed an association between metabolic syndrome and LUTS (p<0.01). There was no statistically significant association between metabolic syndrome and the International Index of Erectile Function questionnaire in any of the categories. The logistic model showed an association
between metabolic syndrome and the International Prostate Symptom Score, while controlling for other variables. Patients exhibiting moderate symptoms had a greater chance to present metabolic syndrome than patients with a mild score (OR 1.83; 95% CI 1.14-2.94). After analyzing for individual components of metabolic syndrome, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24-7.1), and diabetes and ED (OR 2.57, 95% CI 1.12-5.8).
and International Prostate Symptom Score (IPSS) were also assessed in all participants. BPH/LUTS was defined as prostate volume ≥ 25gm, and IPSS ≥ 8.
Conclusions: This study was able to confirm an association between metabolic syndrome and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that metabolic syndrome is frequent among urological patients, it is advisable that urologists actively screen for it.
Results: Of 113 people, 58 were diagnosed with BPH/LUTS (Group I, Mean age: 58.7 ± 8.2) and 55 were in the healthy control group (Group II, Mean age: 50.1 ± 10.2). Mean number of ejaculations per month was 5.0 ± 2.4. Ejaculation frequency was inversely associated with age, but positively associated with degree of sexual satisfaction, history of sexually transmitted infection, and consumption of alcohol. After controlling for potential confounders, higher monthly ejaculation frequency was associated with a statistically significant decreased risk of BPH/LUTS (P=0.005). The hazard ratios (95% CI) comparing more than 6 ejaculations per month to less 6 ejaculations per month were 0.193 (0.075-0.497; P <0.0001); 0.307 (0.138-0.683; P=0.0003) at age 40-59.
MP-08.04
Conclusion: Our findings suggest that ejaculation
Does High Ejaculation Frequency Increase the Risk of BPH/LUTS in Asian Men?
frequency is related to increased risk of BPH/LUTS. These results support a role for ejaculation frequency in the etiology of BPH/LUTS.
Moon KH, Choi JY, Ko YH, Song PH, Jung HC
MP-08.05
Dept. of Urology, College of Medicine, Yeungnam University, Daegu, South Korea Introduction and Objective: Ejaculation frequency
including sexual intercourse, nocturnal emission, and masturbation has been hypothesized to play a role in the development of prostate disease, such as benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) and prostate cancer. However, epidemiological research is virtually limited to case-control studies, which may be prone to bias because recall among individuals with prostate disease could be distorted as a consequence of prostate disorder or its treatments. We prospectively evaluated the association between ejaculation frequency and risk of BPH/LUTS. Materials and Methods: Between May 2015 and Sep-
tember 2015, a total of 113 people (63 in our health examination center, 50 in our urology outpatient department) participated in this study. The monthly ejaculation frequency, overall sexual satisfaction, and other determinants of sexual function including alcohol, smoking, body mass index (BMI), and history of sexually transmitted infections were assessed using a self-administered questionnaire. Ejaculation frequency was assessed by asking participants to report the average number of ejaculations they had per month. Prostate specific antigen (PSA), prostate volume (PV)
Pressure Flow Outlet Obstruction Grade Is Related to Prostate Size Rosier P University Medical Center Utrecht, The Netherlands Introduction and Objective: LUTS are (very) imper-
fect for predicting the existence of bladder outlet obstruction. Confounding (and potentially co-existing) dysfunctions causing LUT symptoms include bladder storage dysfunction (detrusor overactivity, reduced compliance, small capacity), post-void residual urine and underactive detrusor contraction. Symptom score, uroflowmetry and post-void residual are important to objectively achieve a diagnosis, according to many Clinical Practice Guidelines. The EAU has revised the guideline in 2013 and added that “When considering medical treatment for male LUTS, imaging of the prostate (either by TRUS or transabdominal US) should be performed if it assists choice of the appropriate drug” (LoE3 GR B). It has also stated that “When considering surgical treatment, imaging of the prostate (either by TRUS or abdominal US) should be performed“ (LoE3 GR B). Materials and Methods: We compared transrectal
ultrasound prostate volume measurement with the result of pressure flow bladder outflow obstruction
MP-08.05, Table 1. Prostate Class Versus Obstruction Grade Count obstruction grade
Prostate Class grams
Total
0
1
2
3
4
5
6
Total
<25
53
31
21
11
10
3
0
129
26-39
63
40
41
32
17
1
3
197
40-55
25
28
44
32
26
6
3
164
55-80
9
6
7
12
12
2
0
48
>80
5
1
3
10
17
7
3
46
155
106
116
97
82
19
9
584
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
41
MODERATED ePOSTERS and with IPSS symptom score in 584 men aged greater than 50 referred with LUTS. Results: Prostate size is highly significantly related to BOO (Chi2 0.000 and Pearson r=0.2999 (p=0.000)). Total IPSS is slightly negatively associated with BOO (Pearson r =-0.055) without statistical significance (p=0.682). Conclusion: IPSS is necessary to evaluate the symp-
tom burden, however, it is less suitable for predicting the existence of BOO. Prostate size is imperfect but superior to symptom score.
MP-08.06 Correlations Between Androgen Hormones and Relevant Parameters (Prostate Volume, Prostatic Specific Antigen, IPSS) in Benign Prostatic Hyperplasia Patients Ene C1, Ene CD2, Geavlete B1, Nicolae I3, Geavlete P1 1
“St. John” Clinical Hospital of Emergency, Bucharest, Romania; 2“Carol Davila” Clinical Hospital of Nephrology, Bucharest, Romania; 3“Victor Babes” Clinical Hospital of Tropical and Infectious Diseases, Bucharest, Romania Introduction and Objective: Androgen hormones (testosterone, dihydrotestosterone (DHT), free testosterone) are involved in regulating the apoptotic processes of the prostate, their variation playing an essential role in the pathogenesis of benign prostatic hyperplasia (BPH). It was aimed to investigate the relation between testosterone, DHT, free testosterone and prostate volume, prostate-specific antigen (PSA) and International Prostate Symptom Score (IPSS) in BPH patients. Materials and Methods: The serologic evaluation of testosterone, DHT, free testosterone and PSA (ELISA) was performed in a group of 80 BPH patients (age=68.5±6.1 years, prostatic volume=46.3±11.5 cc, IPSS=20.9±11.6). The prostate volume was determined by transrectal ultrasound (TRUS). The exclusion criteria consisted of history of prostate cancer; recurrent urinary tract infections, previous BPH medical therapy and inflammatory conditions. Results: The prostate volume presented a significant negative correlation with testosterone and free testosterone (r=-0.42, p<0.05; r=0.31, p<0.05) and a positive correlation with DHT (r=0.46, p<0.05). Testosterone and free testosterone showed a significant negative correlation with PSA value (r=-0.30, p <0.05; r=-0.21, p<0.05), while DHT emphasized a significant positive correlation with PSA (r=0.43, p<0.05). Concerning the IPSS score, it was observed that testosterone displayed a significant negative correlation (r=-0.20, p<0.05), while DHT presented a significant positive correlation (r=0.25, p<0.05). Free testosterone did not show a significant correlation with the IPSS score (r=0.09, p>0.05). Conclusions: Based on serological determinations,
there can be observed a statistically significant relation between the androgens in general as an entity and some of the most important parameters in BPH patients (prostate volume, PSA value, IPSS score). Such correlations could represent a key point for a better prediction with regard to the evolution of benign prostatic hyperplasia cases.
42
MP-08.07
Materials and Methods: The present 12-week study
Does a Fully Automatic Voiding Diary Improve Patient Compliance and Accuracy? An Initial Feasibility Pilot Study
was a randomized parallel study of clinical outcomes in men aged ≥40 years with symptomatic BPH (IPSS ≥12), prostate volumes ≥30 ml, and testosterone levels less than 300 ng/dl. Eligible patients received a combination of tadalafil 5 mg once daily and placement of a transdermal gel containing 10 g T (n=44), or tadalafil alone (n=46). The primary outcomes were post-treatment IPSS, peak urinary flow rate, and post-void residual urine volume (PVR). Secondary outcomes were changes in IIEF-EF domain scores, Global Assessment Questionnaire (GAQ) scores, and Life Satisfaction Checklist (LSC) scores.
Christidis D, Lawrentschuk N Austin Hospital, Melbourne, Australia Introduction and Objectives: Voiding diary is an important diagnostic tool that assists physicians to better understand the type and severity of Lower Urinary Tract Symptoms (LUTS). Performing a voiding diary is an enormous burden to the patient. Inaccurate, incomplete and low compliance results in a negative experience to the patient and potential misdiagnosis. This study objective is to examine whether a fully automatic voiding diary (iUFlow) can overcome those limitations. Materials and Methods: The iUFlow is a device that
is placed over the toilet and connects to the patient’s smartphone, enabling automated and continues capture and recording of patient’s urinary flow and volumes at home. We asked patients with voiding dysfunctions to use the iUFlow at home. Participants were asked to perform a 2-day automated diary at home followed by a 2-day manual bladder diary. Diary data and patient satisfaction questionnaire were collected prospectively through online survey. Results: Twenty-five patients received the iUFlow device and used their over a 3 days study. All were able to use the device and complete the diary. Twenty-two patients reported preferred use and perceived higher accuracy of the automatic bladder diary. A total of 17 patients reported that the device was very easy to use, 4 reported that it was easy, three reported that it took an acceptable effort to use and one reported that it was inconvenient. Mean miss of urination event was 3 in three days and decreased over time of using the device. Conclusions: The iUFlow is an easy to use, fully automated method to monitor bladder events at home. Using the device by patients has resulted in high compliance and accuracy, which is a key to the diagnosis of LUTS. The iUFlow has the potential of improving patient compliance and quality of voiding diary data, as well as minimize the burden on patients who need to perform this test.
MP-08.08 Does Concomitant Testosterone Replacement Improve the Response to Daily 5 Mg Tadalafil in Men with Lower Urinary Tract Symptoms? Park NC, Park HJ Dept. of Urology, Pusan National University Hospital, Pusan National University School of Medicine, South Korea Introduction and Objectives: Recently, tadalafil was
found to be effective for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Testosterone (T) regulates nitric oxide synthase and is necessary to achieve an optimum response to PDE5 inhibitors. In the present study, we determined whether T replacement in men with low T levels receiving tadalafil to treat LUTS improved the response to tadalafil on LUTS.
Results: The extent of IPSS improvement from baseline to 12 weeks was the same in both groups (tadalafil+T –5.2 vs. tadalafil –5.0; p=0.634). Also, the changes in Q(max) and PVR from baseline were very similar in both groups. However, the tadalafil+T group showed a significantly greater change from baseline in the IPSS storage subscore, the IPSS-QoL score, and the IIEF-EF domain score. The tadalafil+T group showed significantly greater improvements in GAQ and LSC scores, as compared to the tadalafil-only group. The adverse event profiles of each group were similar to those of previous reports. Conclusions: Tadalafil plus testosterone was superior to tadalafil alone in improving LUTS in men with BPH/LUTS and low testosterone levels. Further study is needed with a greater number of patients and longer duration to support the findings of the present study.
MP-08.09 A Population-Based Case Control Study of Selective Alpha Blockade and Hip Fracture Among Men Wallner L1, Jacobsen S2, Shi J2, Loo R3, Adams A2 1
Dept. of Medicine and Epidemiology, University of Michigan, Ann Arbor, United States; 2Dept. of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, United States; 3Dept. of Urology, Kaiser Permanente of Southern California, Los Angeles, United States Introduction and Objective: One of the mainstays of treatment for lower urinary tract symptoms (LUTS) has been through alpha-adrenergic receptor blockade, especially since the introduction of compounds more selective for non-cardiovascular tissues, with the promise of fewer side effects related to hypotension. We performed a population-based case control study to determine if treatment with selective alpha-blockers was associated with a lower risk of hip fracture as compared to other pharmacologic treatments among men. Materials and Methods: Electronic health records
were used to identify all 12 333 men ages 45 years and up who were first diagnosed with hip fracture in Kaiser Permanente Southern California from January 1997 through December 2014. Men were matched to men of same age and race but without having had a hip fracture at the time of the incident fracture. Pharmacy dispensing records were used to assess treatments normally used for LUTS prior to the time of fracture for both index cases and their matched controls. Results: Among the 12 333 men with hip fracture, 840 (6.8%) had received a selective alpha-blocker as com-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-08.09, Table 1. Odds Ratio (95% CI) for Association Between LUTS Treatment and Hip Fracture No treatment (reference)
Selective alpha blocker
Non-selective alpha blocker
5-alpha reductase inhibitor
Crude
1.00
1.30 (1.17, 1.46)
1.04 (0.98, 1.10)
1.03 (0.92, 1.15)
Adjusted
1.00
1.16 (1.03, 1.31)
0.95 (0.89, 1.01)
0.97 (0.86, 1.10)
CI: Confidence interval
pared to 678 (5.5%) of matched controls (matched Odds ratio (mOR)= 1.30, 95% Confidence interval (CI)= 1.17, 1.46). Similarly, 3 875 (31.4%) of men with fracture received a non-selective alpha-blocker as compared to 3 861 (31.3%) of control subjects (mOR=1.04; 95% CI= 0.98, 1.10). With adjustment for Charlson Comorbidity Index, race/ethnicity, age and the recency of initiating use for alpha blockers (<=30 days, 30-182 days or >182 days), these associations were modestly attenuated (Table 1). Conclusion: These data suggest that hip fracture, as
a manifest side effect of treatment of LUTS with selective alpha-blockade, remains a concern and should be factored into risk: benefit considerations with their use.
MP-08.10 Subanalysis of the NEPTUNE Trial: Impact of Prostate Volume on Efficacy and Safety of Fixed-Dose Combination Solifenacin and Tamsulosin Oral Controlled Absorption System in Men with Lower Urinary Tract Symptoms Drake M1, Oelke M2, Klaver M3, Lenero E4, Bongaerts D3, Snijder R3, van Kerrebroeck P5 1
University of Bristol, Bristol, United Kingdom; Hannover Medical School, Hannover, Germany; 3 Astellas Pharma B.V., Leiden, The Netherlands; 4 Astellas Pharma Global Development, Northbrook, Illinois, United States; 5Maastricht University Medical Center, Maastricht, The Netherlands 2
Introduction and Objectives: The NEPTUNE trial (NCT01018511) demonstrated that men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) treated with once-daily fixed-dose combination (FDC) tablets containing solifenacin (soli) and tamsulosin OCAS (TOCAS) improved both voiding and storage LUTS and QoL compared with placebo. Furthermore, FDC was more effective than TOCAS alone in improving storage LUTS and QoL. Urinary retention and acute urinary retention (UR/AUR) are a concern when treating men with LUTS with antimuscarinics, specifically in men with large prostates. As 39% of men in NEPTUNE had prostate volumes >40mL, the objective of this post-hoc analysis was to evaluate the effects of FDC soli+ TOCAS by prostate volume. Materials and Methods: A total of 1334 men (≥45
yrs) with voiding and storage LUTS, post-void residual volume ≤150 mL, and prostate volume <75mL were randomized to receive placebo (n=341), TOCAS 0.4mg (n=327), FDC soli 6mg+ TOCAS 0.4mg (n=339), or FDC soli 9mg+ TOCAS 0.4mg (n=327) for 12 weeks. Efficacy measures included IPSS and Total Urgency Frequency Score (TUFS). Forest plots
by prostate volume (≤40mL, >40mL) were prepared post-hoc to assess changes from baseline to end of treatment for FDC soli 6mg+ TOCAS 0.4mg (registered dosage) compared with placebo. Differences of FDC versus TOCAS 0.4mg alone were also assessed; however, due to the smaller sample size in the subgroups, these comparisons were not sufficiently powered. Rate of UR/AUR by prostate volume were also assessed. Results: Median prostate volume across the NEPTUNE population was 36.0mL (range: 9–74mL; mean=38.1mL [SD: 14mL]) with 39% of subjects (n=513) having a prostate volume >40mL. Fixed-dose combination soli 6mg+ TOCAS 0.4mg demonstrated significant improvements from placebo on both primary endpoints (IPSS total score; TUFS) and in most secondary endpoints (eg, IPSS storage score, micturition frequency/24hrs, voided volume/24hrs) in both subgroups. UR/AUR rates associated with FDC soli 6mg+ TOCAS 0.4mg treatment were ≤1.5% in both subgroups; no subjects receiving placebo experienced UR/AUR.
White Healthcare, Temple, United States; 19Pinellas Urology, St Petersburg, United States; 20University of Texas Southwestern Medical Center, Dallas, United States Introduction and Objective: The PUL procedure is
a unique, minimally invasive, outpatient approach to the treatment of LUTS secondary to BPO. It offers rapid, durable improvement of patients’ symptoms with minimal adverse effects. We report on the 4-year outcomes after PUL as assessed through a large, multi-center, randomized, blinded study. Materials and Methods: A total of 206 men were
randomized to PUL (N=140) or sham control (N=66) at 19 centers in North America and Australia. Enrollment criteria included age ≥50 years, IPSS (International Prostate Symptom Score) ≥13, peak flow ≤12 ml/s, and prostate volume 30-80 cc. Small, permanent monofilament sutures, with metallic end implants, were transurethrally placed with cystoscopic guidance to retract the lateral lobes of the prostate and reduce obstruction. Through 3 months, subjects and assessors were blinded to treatment arm. Participants were assessed over 4 years via IPSS, quality of life (QOL), BPH Impact Index (BPH II), Qmax, Sexual Health Inventory for Men (SHIM), and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD).
TOCAS 0.4mg can provide substantial treatment benefits with low risk of UR/AUR in men with prostate volumes <75mL and PVR ≤150mL suffering from LUTS/BPH with storage and voiding symptoms.
Results: Average IPSS reduction was 44% by 1 month and 46% at 4 years (p-value < 0.0001). Adverse events were typically mild and transient. There were no reported de novo, sustained erectile or ejaculatory function adverse events. Sexual function assessments showed stable erectile function average scores and statistically improved average ejaculatory scores. For those subjects who reached their 4-year follow-up, 19 subjects underwent repeat PUL or other treatment procedure.
MP-08.11
Conclusion: These preliminary results from the larg-
Four-Year Results from the Largest, Prospective, Randomized Study of the Prostatic Urethral Lift (PUL)
est and longest study of the PUL procedure demonstrate that relief can be achieved rapidly and sustained to 4 years. In addition, the peri-operative risk profile is favorable and sexual function is preserved, both in terms of erectile and ejaculatory function. Durability will be assessed through 5 years as per protocol.
Conclusion: These data suggest that FDC soli 6mg+
Barkin J1, Rukstalis D2, Gange S3, Shore N4, Giddens J5, Bolton D6, Cowan B7, Cantwell A8, McVary K9, Chin P10, Te A11, Gholami S12, Rashid P13, Moseley W14, Tutrone R15, Freedman S16, Incze P17, Coffield KS18, Borges F19, Roehrborn C20 1
University of Toronto/Humber River Hospital, Toronto, Canada; 2Wake Forest University, WinstonSalem, United States; 3Western Urological Clinic, Salt Lake City, United States; 4Carolina Urologic Research Center, Myrtle Beach, United States; 5The Cosmetic Surgery Hospital, Woodbridge, Canada; 6Austin Hospital, Melbourne, Australia; 7Urology Associates of Denver, Denver, United States; 8Atlantic Urological Associates, Daytona Beach, United States; 9Southern Illinois University, Springfield, United States; 10Figtree Private Hospital, Figtree, New South Wales, Australia; 11 Weill Cornell Medical Center, New York, United States; 12Urology Associates of Silicon Valley, San Jose, United States; 13Port Macquarie Urology Centre, Port Macquarie, New South Wales, Australia; 14SD Uro-Research, San Diego, United States; 15Chesapeake Urology, Baltimore, United States; 16Freedman, MD, LTD, Las Vegas, United States; 17Oakville Trafalgar Memorial Hospital, Oakville, Canada; 18Scott and
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
MP-08.12 Assessment of Energy Density Usage During 180W Lithium Triborate Laser Photo-Selective Vaporization of the Prostate for Benign Prostatic Hyperplasia: Is There an Optimal Amount of KiloJoules per Gram of Prostate? Valdivieso R1, Meyer C2, Hueber PA1, Meskawi M1, Alenizi A1, Azizi M1, Trinh QD2, Misrai V3, Rutman M4, Te A5, Chughtai B5, Barber N6, Emara A6, Munver R7, Zorn K1 1 CHUM, Montreal, Canada; 2Brigham and Women’s Hospital, Harvard University, Boston, United States; 3 Clinique Pasteur, Toulouse, France; 4Columbia University, New York City, United States; 5Cornell University, Ithaca, United States; 6Frimley Park Hospital, Surrey, United Kingdom; 7Hackensack University Medical Center, United States
Introduction and Objective: The ideal amount of en-
ergy delivery during photo-selective vaporization of
43
MODERATED ePOSTERS Conclusion: Increased energy usage per cc of prostate
MP-08.11, Table 1. Change in Symptoms and Peak Flow Rate from Baseline Through 4 Years
2 Weeks
1 Month
3 Months
1 Year
4 Years
IPSS n (paired)
135
135
136
123
79
Baseline
22.3±5.5
22.3±5.5
22.3±5.5
22.1±5.6
21.4±5.9
Follow-Up
12.6±7.8
18.0±7.9
12.3±6.9
11.2±7.7
11.5±7.3
Change
-4.3
-9.99
-11.1
-10.6
-8.8
% Change
-18%
-44%
-50%
-47%
-41%
(95% CI)
(-23%, -12%)
(-49%, -39%)
(-55%, -44%)
(-53%, -42%)
(-49%, -33%)
p-value
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
n (paired)
136
135
136
123
79
Baseline
4.6±1.1
4.6±1.1
4.6±1.1
4.6±1.0
4.5±1.0
Follow-Up
3.6±1.7
2.6±1.7
2.4±1.7
2.3±1.6
2.1±1.4
QOL
Change
-1
-2
-2.2
-2.3
-2.4
-18%
-42%
-47%
-51%
-52%
(95% CI)
(-26%, -11%)
(-49%, -36%)
(-53%, -40%)
(-57%, -44%)
(-60%, -44%)
p-value
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
% Change
BPHII n (paired)
136
135
136
123
79
Baseline
6.9±2.8
6.9±2.8
6.9±2.8
6.8±2.8
6.3±2.7
Follow-Up
7.0±3.5
4.0±3.1
2.9±3.0
2.8±2.9
2.6±2.6
0.1
-2.9
-3.99
-4
-3.7
Change % Change
29%
-33%
-56%
-57%
-54%
(95% CI)
(8% – 50%)
(-46%, -20%)
(-64%, -48%)
(-66%, -49%)
(-65%, -43%)
p-value
0.0054
<0.0001
<0.0001
<0.0001
<0.0001
n (paired)
122
103
61
Baseline
8.0±2.4
8.0±2.4
8.4±2.4
Follow-Up
12.3±5.3
12.1±5.3
12.6±5.6
Change
4.3
4.1
4.2
% Change
64%
59%
62%
(50%, 79%)
(43%, 74%)
(38%, 86%)
<0.0001
<0.0001
<0.0001
Qmax (mL/sec)
(95% CI) p-value
the prostate (PVP) for optimal treatment of benign prostate hyperplasia (BPH) has not been established. The aim of this study is to assess the effect of energy density (kJ/cc) applied on adenoma during treatment on functional outcomes, PSA reduction and complications. Materials and Methods: A total of 440 patients that
underwent Greenlight laser XPS 180W LBO PVP for the treatment of BPH were retrospectively reviewed. Data was collected from seven different international centers (Canada, the United States, the United Kingdom and France). Patients were stratified into four energy density groups (kJ/cc) according to intraoperative energy delivered and prostate volume as determined by pre-operative trans-rectal ultrasound (TRUS): group 1: <3 kJ/cc, group 2: 3 to 5 kJ/cc, group 3: 5 to 7 kJ/cc and group 4: ≥7kJ/cc. Energy density
44
groups were chosen arbitrarily. PSA reduction and functional outcomes (IPSS, QoL, PVR, Qmax) were compared at 6, 12 and 24 months. Moreover, perioperative complications and retreatment rates were also compared between groups. Results: PSA reduction at 24 months post procedure was 51%, 61%, 79% and 83% for an energy density groups of <3, 3-5, 5-7 and ≥7 kJ/g respectively (p≤0.01). This held true after accounting for baseline confounders. Energy density was not associated with increased complication rates, including hematuria, stricture formation, incontinence, refractory urinary retention, urinary tract infection and conversion to TURP. Functional outcomes at 2 years of follow-up were equivalent between groups (p>0.05 for all) and comparable re-treatment rates were observed (p=0.36).
is associated with a more significant PSA reduction (>50%) at 6,12 and 24 months suggesting increased vaporization of adenoma tissue. However this did not translate into differences in functional outcomes at two years of follow-up.
MP-08.13 Postoperative Complications in 400 Patients Who Underwent Endoscopic Prostatic Surgery with Thullium Laser Carmignani L, Vizziello D, Ratti D, Finkelberg E, Motta G, Nazzani S, Marenghi C, Picozzi S, Stubinski R IRCCS Policlinico San Donato, University of Milan, Italy Introduction and Objectives: Laser prostatectomy has become popular due to its reduced peri- and post-operative morbidity compared with the TURP. This study reports short- and long-term complications in patients who underwent transurethral vapo-enucleation or vaporization of the prostate with Thulium laser (Thuvep/Thuvap). Materials and Methods: A total of 700 patients underwent Thuvep/Thuvap from January 2012 to June 2015 at our Center. Data of 400 patients were included in this study considering the “learning curve”. Follow-up was scheduled at 1, 6 and 12 months by examination and uroflowmetry. Urine-culture and urethrocystoscopy were used to assess UTI and urethral or bladder neck sclerosis, respectively. Complications such as Acute Urinary Retention (AUR), hematuria, UTI, transfusion and re-intervention, occurred during the first month after surgery. For this reason, the incidence rates of these complications were calculated considering the total population (400). On the contrary, urethral stenosis and bladder neck stenosis occurred as late complications and for this reason, only patients with one-year follow-up were considered (280). Results: Only 3 patients required a haemostatic TUR and in another 3 cases, a delayed morcellation was necessary. Five patients required a blood transfusion (1.25%), 3 of them were under anti-platelet therapy, 1 was under anti-coagulation therapy and 1 patient was taking both. A total of 15 patients (3.75%) had hematuria and were treated conservatively. Ten of them were under anti-platelet therapy. In 17 patients (4.25%), re-catheterization was performed after discharge for AUR. Bladder neck sclerosis occurred in 6 patients (2.1%) one year after surgery (among them, 2 had undergone Thuvap and 4 Thuvep). Moreover, no stress incontinence was reported. We reported only 3 cases of UTI (0.7%) and 2 cases of bulbar substenosis (0.6%). A total of 1.5% of all patients had an IPSS greater than 20 at 1 month and 2.1% of them at 1 year. Conclusions: Our study suggests that Thuvep/Thuvap results in less post-operative complications than TURP. However, the incidence of recatheterization is similar (4.7% vs. 4.2%). Compared to Holep, data show promising findings in terms of post-procedural requirement of blood transfusions (1.25% vs. 8%), re-intervention (1.5% vs. 4.3%), the occurrence of urethral stenosis (0.6% vs. 2.6%) and stress incontinence (0% vs. 1.5%).
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-08.12, Table 1. PSA Drop and Functional Outcomes After XPS180 LBO PVP for BPH at 6, 12 and 24 Months According to Energy Usage per cc of Prostate <3 kJ/cc
3 to 5 kJ/cc
5 to 7 kJ/cc
≥7 kJ/cc
p-value*
Median PSA drop (%)
49
54
72
81
<0.01
Median IPSS drop (%)
77
77
71
81
0.25
Variables at 6 months
IPSS was 19.3, 8.1 and 6.5 before, 3 and 6 months, respectively. QoL was 4.4, 1.9 and 1 before, 3 and 6 months, respectively. Qmax was 6.8, 16.7 and 16.2 before, 3 and 6 months, respectively. PVR was 169.5, 102.3 and 86.4 before, 3 and 6 months, respectively. No complications were reported during surgery. No blood transfusions were necessary. A total of 11 patients had acute urinary retention after surgery. 6 patients were discharged with a vesical catheter. Mean hospital stay was 3.3 days. At present, 4 patients have an indwelling catheter.
Median QoL change (%)
80
80
71
75
0.05
Median Qmax change (%)
233
200
215
171
0.74
Median PVR drop (%)
95
94
93
96
0.91
Median PSA drop (%)
50
50
64.3
79.1
<0.01
Conclusions: Our data show that in elder patients, in selected cases, thuvep/thuvap may reduce LUTS and improve IPSS score, also in patients with an indwelling catheter.
Median IPSS drop (%)
79.4
78.9
80.5
81.8
0.88
MP-08.15
Median QoL change (%)
83.3
80
80
80
0.04
Median Qmax change (%)
233.3
198.2
170
283.3
0.32
Median PVR drop (%)
96.7
96.5
95.8
90
0.2
180W LBO Laser Photo-Vaporization in Men with Large Prostates (Prostate Volume >100 cc): A Multicenter International Experience of 434 Patients
Variables at 12 months
Variables at 24 months
Hueber PA, Zorn KC
Median PSA drop (%)
51
61
78.8
83.1
0.002
CHUM University of Montreal, Canada
Median IPSS drop (%)
81.8
80.5
81.7
79.1
0.73
Introduction and Objectives: Prostate volume (PV) >100 cc remains challenging for endoscopic BPH management. Although PVP using the XPS-180 system is feasible for patients with a large PV, long-term outcome data supporting its use is still lacking. The aim was to evaluate the outcomes and durability at 4 years in a large, multi-center experience.
Median QoL change (%)
83.3
80
83
75
0.73
Median Qmax change (%)
309.1
233.3
300
425
0.48
Median PVR drop (%)
96.2
95.1
95.5
94
0.86
MP-08.14 BPH Surgery with Thulium Laser in Patients Older than 80 Years Vizziello D, Carmignani L, Ratti D, Finkelberg E, Motta G, Marenghi C, Picozzi S, Maruccia S IRCCS Policlinico San Donato, University of Milan, Italy
patients were taking antiplatelet medication, 1 patient was assuming anticoagulation therapy, 4 patients substituted anticoagulant oral therapy with low molecular weight heparin during the perioperative period.
Materials and Methods: This is a retrospective study
of 434 men with pre-operative TRUS PV >100 cc that were treated in 8 centers in North-America (Can-
MP-08.15, Figure 1.
Introduction and Objectives: Nowadays, more and more patients suffer from LUTS caused by BPO, due to the rise of life expectancy. Usually the symptoms of these patients are not controlled by medication, and surgery is often excluded for the old age, sometimes not even taking in consideration if there is any comorbidity. For this reason the only possibility for these patients is indwelling catheterization, worsening quality of life and exposing them to high risk of urinary tract infections. The aim of our study is to evaluate the outcome of patients older than 80 years treated with thulium laser vapoenucleation or vaporization of prostate. Materials and Methods: In this study we enrolled 57
patients older than 80 years treated by thuvep/thuvap at our center from February 2012 to November 2015. Bedfast patients or with cognitive impairment or neurogenic bladder were excluded. We studied the following criteria: age, ASA, catheterization pre and post surgery, antiplatelet and anticoagulation therapy, IPSS, QoL, Qmax and PVR before, 3 and 6 months after surgery. Complications during and after surgery were reported. Results: Mean age was 82.8, 20% of patients had an ASA score > 2. Mean prostate volume was 82.2 mL with 46 mL of adenoma. A total of 21 patients had an indwelling catheter before surgery. A total of 12
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
45
MODERATED ePOSTERS ada, USA) and in Europe (France) with the Greenlight-XPS laser using PVP for the treatment of LUTS associated with BPH. To assess efficacy, IPSS, Qmax, prostate volume (PV), postvoid residual (PVR) and PSA were measured at 6, 12, 36 and 48 months. Durability was evaluated using re-treatment rate at 24, 36 and 48 months. Results: Median prostate size and PSA were 121 cc (IQR 108-150) and 6.3 ng/mL respectively. A total of 42.3% of men had an indwelling catheter at the time of surgery. Median operative time and energy applied were 60 min (IQR: 40-74) and 424 kJ, respectively, with ≥2 fibers used in 40% of the cases. Median energy delivery was 3.4 kJ/cc per case. Median length of stay was 24 hours. IPSS, Qmax and PVR were significantly improved at all endpoints, including at 48 months (figure 1). Surgical BPH retreatment was 5.3% at 24 months, and rose to 11.9% at 36 months. Interestingly, characteristics of re-treated men included energy delivery that was 2.4 kJ (vs. 3.4 kJ) and PSA reduction at 12 months of 29% (vs. 46%). Conclusions: PVP treatment using Greenlight XPS180W can potentially provide durable improvements with regards to functional outcomes including IPSS at 4 years. However, re-treatment rate rising after 3 years is a concern. This data highlights the need of utilizing a standardized technique with an operative endpoint of an enucleation-like-defect (down to the surgical capsule). Other than encouraging the use of transrectal imaging preoperatively, benchmark perioperative parameters of energy use (KJ/cc), 12-month PSA reduction and rising PSA during follow-up may serve as surrogate markers for predicting durability.
Materials and Methods: A total of 956 men were
treated at 5 centers in Canada and the United States with GreenLight XPS laser therapy system for BPH between 2010 and 2014. Perioperative parameters, complications and outcomes at 6 months were retrospectively collected and compared. PVP was defined as a pure vaporization only while VIT was defined as incisions into the adenoma for tissue resection and removal. Propensity-score matching was performed to adjust for baseline differences between treatment groups. Subgroup stratified comparative analysis was performed according to preoperative prostate volume (PV) 80 cc or less vs. greater than 80 on TRUS. Results: One-to-one propensity-score matching resulted in 2 groups of 222 patients (185 with PV greater than 80 cc). PV and preoperative urinary retention rate were similar for both groups. While vapor-resection allowed greater overall energy delivery and energy density (kJ/cc) delivery in comparison to vaporization-only, operative time and laser time were longer with greater need for 2 Moxy fibers or more (all p <0.05). Improvements in 6-month outcomes including I-PSS, QOL, Qmax and PVR were significantly greater after VIT compared to baseline. PSA reduction (overall and in the greater than 80 cc group) was significantly greater after vapor-resection (all p <0.01). No differences in operative adverse outcomes were observed between both treatment groups. Conclusion: VIT using the GreenLight 180W-XPS
MP-08.16
is safe and efficacious, providing greater improvements in functional outcomes and PSA reduction at 6 months in comparison to PVP. Yet it is associated with
Comparison of Photoselective Vaporization of the Prostate (PVP) and Vapor-Resection (VaporIncision Technique (VIT)) Using the GreenLight 180W-XPS System: A Multicenter Experience
1
University of Montreal Hospital Centre, Canada; 2 Taibah University, Madina, Saudi Arabia; 3 Comprehensive Urology, Westland, United States; 4 Houston Metro Urology, United States; 5Urology of Virginia, Virginia Beach, United States; 6Georgia Urology, Roswell, United States Introduction and Objective: To compare periopera-
tive parameters, safety and short-term outcomes be-
MP-08.16, Table 1. 6-Month Median PSA Change (%) from Baseline Overall and by PV Subgroup
PVP
VIT
p-value
Overall (n=444)
-50.0
-63.0
0.01
PV 80 cc or less (n=259)
-50.0
PV greater than 80 cc (n=185)
-42.2
-60.0 -65.2
longer operative time and greater use of Moxy fibers. Long-term follow-up is needed to assess the durability of these outcomes particularly for patients with larger prostates.
MP-08.17 Predictors of Improvement in Storage Symptoms 3 Years After 120-W GreenLight High Performance System Laser for Benign Prostate Hyperplasia Jeon HJ1, Park J2, Cho SY2, Cho MC2, Son H2, You KH3, Chun SJ4, Lee JW5 1
Seoul National University Hospital, South Korea; SMG-SNU Boramae Medical Center, Seoul, South Korea; 3Gwangmyeong Seongae Hospital, Gyeonggi Province, South Korea; 4Gwangju Veterans Hospital, South Korea; 5Dept. of Urology, Dongguk University Ilsan Medical Center, Gyeonggi-Do, South Korea 2
Introduction and Objectives: Storage symptoms are
considered to be more bothersome to men than voiding symptoms. In men with BPH, storage symptoms can arise from maladaptive modification of bladder structure/function induced by bladder outlet obstruction (BOO) or independently of BOO. Recent literature suggested that postoperative storage symptoms after laser prostatectomy were generally more common than after transurethral prostatectomy (TURP). However, there has been a scarcity of studies on long-term (3-year) surgical outcomes of the 120-W GreenLight High Performance System photoselective vaporization of the prostate (HPS-PVP) for storage symptoms and on predictors of improvement in storage symptoms at long-term follow-up after HPS-PVP. The purpose of this study was to investigate the longterm outcomes of HPS-PVP for storage symptoms in men with BPH and to identify the predictors of
MP-08.17, Table 1. Baseline Characteristics
Azizi M1, Tholomier C1, Meskawi M1, Valdivieso R1, Hueber PA1, Alenizi AM2, Rajih E2, Hai MA3, Gonzalez RR4, Eure GR5, Kriteman LS6, Zorn KC1
46
tween GreenLight 180W-XPS photo-selective vaporization of the prostate (PVP) and vapor-resection (or vapor-incision technique (VIT)).
0.207 0.009
Variables
Mean ± SD or % Pts.
Age, year
66.8 ± 9.1
BMI, kg/m2
24.2 ± 3.0
PSA, ng/mL
4.45 ± 2.04
Total prostate volume, mL
52.2 ± 27.3
Transition zone volume, mL
31.8 ± 18.0
Subtotal voiding symptom score
11.1 ± 5.7
Subtotal storage symptom score
7.9 ± 3.7
Total IPSS
19.0 ± 8.6
QoL index
4.0 ± 1.3
Maximum flow rate, mL/s
10.2 ± 4.9
Post-void residual urine volume, mL
96.4 ± 137.7
Bladder voiding efficiency
0.72 ± 0.23
Bladder volume at first desire to void, mL
166.1 ± 80.7
Maximum cytometric capacity, mL
412.6 ± 87.3
Compliance (goo/poor)
61.9%/38.1%
Detrusor overactivity (yes/no)
29.5%/70.5%
Detrusor underactivity (yes/no)
77.5%/22.5%
Energy applied during PVP, kJ
129.3 ± 93.7
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS improvement in storage symptoms at long-term follow-up visit after HPS-PVP. Materials and Methods: A total of 228 men, who underwent HPS-PVP for BPH and for whom a complete 3 years of follow-up data were available, were included in this retrospective study. Baseline evaluation included history, physical examination, the IPSS, serum PSA, transrectal ultrasonography (TRUS) and multichannel video urodynamics. Surgical outcomes of HPS-PVP were evaluated at 1, 3, 6, 12, 24, and 36 months after surgery, using the IPSS, uroflowmetry with post-void residual urine volume, and serum PSA. Improvement of storage symptoms was defined as reduction by ≥50% of subtotal storage symptom score of the IPSS after surgery compared to baseline. Results: Table 1 shows the baseline characteristics.
Subtotal voiding symptoms score, subtotal storage symptoms score, total IPSS, QOL index, Maximum flow rate and PVR, significantly improved beginning from 1 month after surgery. Urgency score of the IPSS significantly improved starting from 3 months after surgery. The percentage of patients with postoperative improvement of storage symptoms at 1, 3, 6, 12, 24, and 36 months were 25.5%, 34.2%, 33.9%, 41.1%, 40.8% and 37.1%, respectively. The mean serum PSA at 3 years after HPS-PVP was decreased by 44.3% compared to baseline. On logistic regression analysis, higher urgency score of the IPSS (≥3 vs. ≤2), lower baseline maximum flow rate, higher BOO index (≥40 vs. <40) and the absence of detrusor underactivity on baseline urodynamics were significantly associated
with improvement of storage symptoms at 3 years after HPS-PVP. Multivariate analysis revealed that the higher urgency score and the absence of detrusor underactivity were the independent predictors of improvement of storage symptoms at long-term follow-up after HPS-PVP. Conclusion: Our data indicate that the improvement
of storage symptoms after HPS-PVP can be maintained at long-term follow-up. The present study suggests that the higher urgency score of the IPSS and the absence of detrusor underactivity on baseline urodynamics can be the independent predictors of improvement of storage symptoms at long-term follow-up after surgery.
MP-08.18 Efficacy and Safety of 120-W GreenLight High Performance System Photoselective Vaporization of the Prostate: 5-Year Results Song WH1, Park J2, Cho SY2, Cho MC2, Son H2, You KH3, Chun SJ4, Lee JW5 1
Seoul National University Hospital, South Korea; SMG-SNU Boramae Medical Center, Seoul, South Korea; 3Gwangmyeong Seongae Hospital, Gyeonggi Province, South Korea; 4Gwangju Veterans Hospital, South Korea; 5Dept. of Urology, Dongguk University Ilsan Medical Center, Gyeonggi-Do, South Korea 2
Introduction and Objectives: To investigate 5-year
postoperative results of photoselective vaporization of the prostate using the 120-W GreenLight High
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Performance System photoselective vaporization of the prostate (HPS-PVP) for treating benign prostate hyperplasia. Materials and Methods: A total of 208 men who un-
derwent HPS-PVP and were followed up for 5 years were analyzed retrospectively. Surgical outcomes were assessed by the ratio of the IPSS/QoL, the difference in Qmax/PVR and the difference of the prostate volume by transrectal ultrasonography before surgery and at 6, 12, 36 and 60 months postoperatively. The presence of postoperative complications was verified at every follow-up visit. Results: Preoperative parameters such as mean age, prostate volume, IPSS, QoL, Qmax and PVR, were 67.9 ± 8.2 years, 48.4 ± 26.3 mL, 20.4 ± 8.7, 4.0 ± 9.2 ± 3.5 mL/s, and 81.3 ± 92.0 mL, respectively. Perioperatively, mean operative time, lasing time, used energy, and postoperative urethral catheter indwelling time were 67.4 ± 45.9 minutes, 26.7 ± 29.3 minutes, 89.6 ± 82.5 kJ and 24.5 ± 11.0 hours, respectively. There were significant improvements in any outcome measures after 3, 12, and 36, 60 months. Forty-nine (23.6%) patients had immediate postoperative complications, which were managed successfully nonsurgical methods. There were no transfusion cases. A single case (1.5%) showed mild urethral stricture with voiding difficulty 12 months postoperatively and required urethral dilation using panendoscopy. Conclusion: HPS-PVP is an effective and safe proce-
dure for treating benign prostatic hyperplasia.
47
MODERATED ePOSTERS
Moderated ePosters Session 9 Kidney & Ureteral Cancer—Various Topics Saturday, October 22 1425–1555 MP-09.01 Prognostic Role of Vascular Endothelial Growth Factor in Patients with Clear Cell Renal Cell Carcinoma Veselaj F1, Kerliu-Manxhuka S2, Hyseni S1, Frangu B1, Neziri A1, Fetahu A1, Xharra S3, Sopi-Xharra K3, Selmani L1, Shahini L2 1
Riedmiller H10, Wagener N11, Huck N11, Zastrow S12, Wirth M12, Musquera M13, Surcel C14, Kalusova K15, May M16, Gilfrich C17, Hutterer G18, Zigeuner R18, Stief C19, Brookman-May S19 1
Instituto Nacional de Cancerologia (INCan), Dept. of Urology, Mexico City, Mexico; 2Carl-Thiem-Klinikum Cottbus, Dept. of Urology, Cottbus, Germany; 3 Instituto Nacional de Cancerologia (INCan), Dept. of Epidemiology, Mexico City, Mexico; 4Dept.
MP-09.02, Table 1. Variable
Introduction and Objective: Clear cell renal cell carci-
Histological subtype
Results: Expression of VEGF-A was higher in the ccRCCs than in the non-tumor kidney tissue, at a statistically significant level (VEGF-A: U’=720, P<0.0001). Expression of VEGF-A in ccRCC was positively correlated with DFS (r =0.335, P=0.034) and the degree of tumor necrosis (r=0.181, P=0.262). Expression of VEGF-A in ccRCC was negatively correlated with the tumor nuclear grade (r=-0.161, P=0.318), the pathological tumor stage (r=-0.07, P=0.018), the tumor size (r=-0.361, P=0.022), the degree of tumor hemorrhage (r=-0.235, P=0.143), PFS (r=-0.07, P=0.838) and CSS (r=-0.207, P=0.713).
0 >/=1 NA
Papillary Type 1 Papillary Type 2 Type 1 and 2 Unknown
MP-09.02 Impact of Gender on CancerSpecific Survival in Papillary Renal Cell Carcinoma: Results from an International Multicenter Study Scavuzzo A1, Wolff I2, Reynoso Noveron N3, Jimenez Rios MA1, Hoschke B2, Capitanio U4, Krabbe LM5, Herrmann E6, Klatte T7, Shariat S7, Haferkamp A8, Borgmann H8, Ecke T9, Lange C9, Vergho D10,
48
63 ± 11.8
62.6 ±11.6
64.2 ± 12.5
0.053
918 (39.48%) 549 (23.61%) 858 (36.9%)
715 (40.12%) 422 (23.68) 645 (36.20%)
203 (37.38%) 127 (23.38%) 213 (39.23%)
0.534
387 (16.6%) 414 (17.8%) 866 (37.2%) 658 (28.3%)
300 (16%) 338 (18%) 630 (35.3) 514 (28%)
87 (16%) 76 (13%) 236 (43%) 144 (26%)
0.003
1112 (47%) 493 (21%) 187 (8%) 90 (3.8%) 320 (13.7%) 79 (3.3%) 10 (0.4%) 34 (1.4%)
858 (48.1%) 371 (20.8%) 141 (7.9%) 74 (4.1%) 252 (14.1%) 51 (2.8%) 7 (0.3%) 28 (1.5%)
254 (46.7%) 122 (22.4%) 46 (8.4%) 16 (2.9%) 68 (12.5%) 28 (5.1%) 3 (0.5%) 6 (1.1%)
0.109
476 (20.4%) 87 (3.7%) 66 (2.8%) 1696 (72.9%)
352 (19.7%) 69 (3.8 %) 51 (2.8%) 1310 (73.5%)
124 (22.8%) 18 (3.3 %) 15 (2.7%) 386 (71%)
0.589
2169 (93.2%) 156 (6.7%)
1661 (93%) 121 (6.7%)
508 (93.3%) 35 (6.4%)
0.779
335 (14.4%) 1412 (60.7%) 384 (16.5%) 58 (2.4%) 136 (5.8%)
242 (13%) 1096 (61.5%) 295 (15.5%) 40 (2.2%) 109 (6.1%)
93 (17.1%) 316 (58.1%) 89 (16.3%) 18 (3.3%) 27 (4.9%)
0.12
33 (1.4%) 1613 (69.4%) 679 (29.2%)
22 (1.2%) 1240 (69.6%) 520 (29.2%)
11 (2%) 373 (68.7%) 159 (29.3%)
0.390
1127 (57.5%) 830 (42.4%)
828 (55.1%) 673 (44.8%)
299 (65.5%) 157 (34.4%)
<0.001
p Value
T Classification
T1 a T 1b T2 a T2 b T3a T3 b T3 c T4 N Classification
pN0 pN1 pN2 pNx M Classification
M0 M1 Grade
Conclusion: Higher VEGF-A expression is more of a
prognostic factor for low stage ccRCCs and not related to the pathological tumor stage. Decreasing levels of VEGF-A expression were associated with an increased risk of renal cancer death and recurrence in ccRCC patients.
Female
543 (23.3%)
Mean Age, ± SD, years
ECOG
Materials and Methods: Tumor samples taken from 40 patients with histopathology diagnosis of ccRCC and tissue samples taken from 20 normal kidneys as a control group were examined by immunohistochemical staining for VEGF-A.
Male
1782 (76.6%)
All n= 2325
Clinic Of Urology, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo; 2Dept. of Pathology, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo; 3Regional Hospital, Prizren, Republic of Kosovo noma (ccRCC) is the most predominant renal tumor with unpredictable tumor behavior. VEGF is a multifunctional cytokine that can increase microvascular permeability and stimulate endothelial cell growth and angiogenesis. Several factors can influence VEGF expression, including hypoxia. The aim of this study was to investigate the prognostic value of expression of vascular endothelial growth factor A (VEGF-A) in ccRCC.
of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; 5 Urology University of Muenster Medical Center, Germany; 6University of Muenster Medical Center Dept of Urology; 7Medical University of Vienna, Vienna, Austria; 8University Hospital Frankfurt, Dept. of Urology, Germany; 9Hospital Bad Saarow, Dept. of Urology, Germany; 10Dept. of Urology and Paediatric Urology, Julius-Maximilians-University Medical Centre of Würzburg, Würzburg, Germany;
G1 G2 G3 G4 NA Sarcomatoid
features Yes No Unknown Surgical method
RN NSS
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS 11
Dept. of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany; 12 Universitätsklinikum Carl Gustav Carus, Germany; 13 University of Barcelona, Barcelona, Spain; 14 Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania; 15Dept. of Urology, Faculty Hospital, Faculty of Medicine, Charles University, Pilsen, Czech Republic; 16Klinikum St. Elisabeth Straubing, Dept. of Urology, Straubing, Germany; 17Klinikum St. Elisabeth Straubing, Dept. of Urology, Straubing, Germany; 18 Medical University Graz, Dept. of Urology, Graz, Austria; 19Ludwig-Maximilians-University, Campus Grosshadern, Dept. of Urology, Munich, Germany Introduction and Objectives: Papillary renal cell carcinoma (papRCC) represents the second most common histologic RCC subtype accounting for 10-15% of all RCC cases. Although the incidence of pRCC is higher among males than females, until now gender-specific differences in clinico-pathological parameters and the impact of gender on prognosis in papRCC patients have not been reliably analyzed yet. Materials and Methods: The study comprised 2 325
papRCC patients diagnosed between 1992-2014 from seventeen international centers who underwent radical nephrectomy or nephron-sparing surgery. Age, sex, performance status, symptoms at presentation, TNM stage (2010), Fuhrman grade (FG), tumor size, and postsurgical follow-up were assessed. Impact of these parameters on cancer-specific survival (CSS) and overall survival (OS) were analyzed by univariate and multivariable Cox regression analysis. Results: A total of 1 782 (76.6%) of papRCC patients were male and 543 (23.3%) were female. When clinical and pathological tumor characteristics were compared, men and women, with regard to age, ECOG, TNM, grade, histological subtype, surgical treatment, no significant differences were observed. On multivariable analysis, gender didn’t have a significant independent impact on CSS and OS. In both genders pN, FG, vascular involvement and tumor size independently impacted CSS. Conclusion: In the present multicenter study, pa-
pRCC was significantly more frequently diagnosed in men than in women. Although there were differences in the distribution of clinical and pathological parameters between sexes, gender didn´t independently impact outcome with regard to CSS and OS.
naling on several types of malignancy has been studied, the impact of Notch signaling in clear cell renal cell carcinoma (ccRCC) is still unclear. This study was aimed at evaluating the expression of Notch signaling in ccRCC and to determine the relationship between the molecular marker and clinic-pathological manifestation.
1
Materials and Methods: The tumor tissue and
Materials and Methods: Retrospective analysis of
matched normal adjacent kidney tissue from 49 ccRCC were obtained. The expression of Notch1 and Jagged1 were analyzed using real-time PCR and Western blot. Tissue samples of 49 ccRCC were divided into several groups according to clinico-pathological features and the relative expression of Notch1 and Jagged1 were assessed.
patients with RCC diagnosed between 1997 and 2015 [N = 165, Male - 67%] (Mean Age = 63.8 years, range 27-87).
Results: The real time PCR showed increased expression level of Notch1 in tumor tissue compared with normal adjacent tissue. Based on pathological stage, a significant difference of Notch1 expression was shown between tumor and normal kidney tissue. The relative expression in tumor versus normal kidney tissue was more pronounced in high-stage cancer compared with low-stage cancer, and in large-sized compared with small-sized tumors. A significant linear correlation was found between the tumor size and the expression level of Notch1. The relative expression of Notch1 was significantly positively correlated with the maximal diameter of renal mass. High expression of Notch1 was associated with recurrence and disease specific death, though statistical significance was not shown. The expression level of Jagged1 did not show a significant correlation with any factors. Conclusion: Expression of Notch1 showed a positive
correlation with stage and size in ccRCC. Notch1 may have a significant role in the tumorigenesis and progression of ccRCC and could be a potential target for chemopreventive or adjuvant therapeutics for ccRCC.
MP-09.04 The Association of ABO Blood Groups and Renal Cell Carcinoma Bhuvanagiri A1, Kannan S1, Kelleher J1, Butu D1, Kowalski P1, Alexandrou K1, Ahiaku E1, Breeze J2, Hussain M2
Gwynedd Hospital, BCUHB, Bangor, United Kingdom; 2Bangor University, Bangor, United Kingdom
Introduction and Objectives: We studied Renal Cell Carcinoma (RCC) and its relation to ABO blood group, gender, tumour (T) stage, incidence and mortality rate.
Results: The distribution of ABO groups was: A (N = 62, 37%), B (N = 11, 7%), AB (N = 3, 2%), O (N = 89, 54%); and this had no effect on the survival outcome (p = 0.28). The effect of gender on the mortality rate was inconclusive (p = 0.38) [Male (N = 52, 47%), Female (N = 22, 40%)]. T stage distribution was as follows: T1 (N = 66, 40%), T2 (N = 40, 24%), T3 (N = 53, 32%), T4 (N = 6, 4%). We found a significant effect of T stage on the number of deaths (p = 0.02); [T1 (N = 25, 38%), T2 (N = 14, 35%), T3 (N = 30, 57%, p < 0.05), T4 (N = 5, 83%)]. Blood group (p = 0.44), gender (p = 0.68) and T stage (p = 0.52) were not significant contributing factors to the length of survival between diagnosis and death. Conclusion: In our study, ABO blood group had no
effect on the incidence of RCC. There was a significant effect of T stage on the number of deaths with blood group and gender having no impact.
MP-09.05 Overall Prevalence of Malignancy and the Differential Diagnosis of Bosniak III Renal Lesions Based on Lesion Size Lam C1, Kapoor A2 McMaster University, Hamilton, Canada; 2McMaster Institute of Urology, Hamilton, Canada 1
Introduction and Objectives: The aim of this study
was to evaluate the pathological results of renal masses in comparison with Bosniak III renal cystic lesions to determine the actual malignancy risk. Materials and Methods: A retrospective review of
all Bosniak III renal lesions identified by computed tomography (CT) or magnetic resonance imaging
MP-09.04, Figure 1.
MP-09.03 A High-Level of Notch1 Expression is Correlated with Tumor Stage and Tumor Size in Clear Cell Renal Cell Carcinoma Lee JN1, Chung JW1, Ha YS1, Choi SH1, Kwon SY2, Kim G3, Kim BS1, Kim HT1, Kim TH1, Yoo ES1, Kwon TG1, Chung SK1, Kim BW1 1
Kyungpook National University School of Medicine, Daegu, South Korea; 2Dongguk University College of Medicine, Seoul, Korea; 3Gumi CHA Medical Center, CHA University, Bundang, South Korea Introduction and Objective: Notch signaling is a
widely expressed signal pathway that mediates various cellular processes in normal development and tumorigenesis. Although the influence of Notch sig-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
49
MODERATED ePOSTERS (MRI) in our department were collected from all adult (>18 years of age) patients from August 1, 2013 to December 31, 2015 who underwent surgical excision. Surgical pathology including TMN stage, histology, and Fuhrman grade was collected along with maximum lesion size. Twenty-five patients were identified for this study and a two-tailed two-sample t-test was used to compare lesion size between malignant and benign lesions. Results: Of the 25 cases, 15/25 (60%) of Bosniak III lesions were determined to be malignant. All malignant lesions were classified as less aggressive malignancies as either Fuhrman grade 1 or 2 with no evidence of progression to Bosniak IV. On average, a larger lesion size trended towards pathological identification of benign complex cysts in comparison to a RCC (5.66 ± 2.53 cm vs. 4.09 ± 2.91 cm). Conclusions: The malignancy risk of Bosniak III renal is 60% in our study. Surgical excision should remain the recommended management option for patients who are good surgical candidates. Our study also identified that all identified Bosniak III lesions were of low Fuhrman grade with no evidence of progression, which suggests a better prognosis. No patient in this study developed metastatic disease within the 3-year follow-up period. Finally, lesion size data suggest that the larger the complex Boxniak III cyst, the more likely to be benign.
MP-09.06 The Creation and Development of LARCG (Latin American Renal Cancer Group) Zequi SdC1, Abreu D2, Nolazco A3, Decia R2, Yandian J2, Guimaraes GC1, da Cunha IW1, da Costa WH1, Ferreira DB1, Silva Neto DVC1, Gueglio G4, Rozaneck J5, Scoticartti C6, Ameri C7, Zuniga A8, Covarrubias FR9, Casttilejos Molina RA9, Gadu J10, Bengió R11, Rovegno A12, Secin FP12, Mingote P13, Montes de Oca L14, Carvalhal GF15, Lima Pompeo AC16, Tobias Machado M16, Glina S17, Nogueira L18, Reis LO19, Ferreira U20, Stopiglia RM20, Faria EF21, Varella M22, Muguruza D23, Clavijo J24, Clark O25, Langhenin R26, Montoya LM27, Vasquez JB28, Pazzos A28, Vidal I29, Cabanillas G30, Torrico M31, Palou J32, Gomez AMA33, Enguita CG33, Encinas MS34, de Miceu J35 1
AC Camargo Cancer Center, São Paulo, Brazil; 2 Hospital Pasteur, Montevideo, Uruguay; 3Hospital Britânico, Buenos Aires, Argentina; 4Hospital Italiano, Buenos Aires, Argentina; 5Hospital Austral, Buenos Aires, Argentina; 6Hospital de Clinicas, Buenos Aires, Argentina; 7Hospital Aleman, Buenos Aires, Argentina; 8 Universidade Catolica, Santiago, Chile; 9Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCNSZ), Mexico City, D.F., Mexico; 10 Hospital Militar, Mexico City, D.F., Mexico; 11Centro Urológico, Córdoba, Argentina; 12Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina; 13Policlinica Neuquen, Neuquén, Argentina; 14Centro de Urologia (CDU), Buenos Aires, Argentina; 15Pontificia Universidade Católica (PUC), Porto Alegre, Brazil; 16Faculdade de Medicina do ABC, Santo André, Brazil; 17Hospital Ipiranga and Faculdade de Medicina do ABC, Santo André, Brazil; 18Hospital das Clinicas HCUFMG, Belo Horizonte, Brazil; 19Pontifica Universidade Católica, Campinas, Brazil; 20Universidade Estadual de
50
Campinas (UNICAMP), Campinas, Brazil; 21Hospital do Cancer de Barretos, Barretos, Brazil; 22Hospital Militar, Montevideo, Ururguay; 23Hospital de Clínicas, Montevideo, Ururguay; 24Hospital de Clínicas, Montevideo, Uruguay; 25Hospital Militar, Montevideo, Uruguay; 26Coperativa Medica de Paysandu (COMEPA), Paysandu, Uruguay; 27Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru; 28 Hospital Militar, Lima, Peru; 29INDISA, Santiago, Chile; 30Hospital Nacional Almanzor Aguinaga Asenjo Essalud, Chiclayo, Peru; 31Clinica Los Olivos, Cochabamba, Bolivia; 32Fundacion Puigvert, Barcelo, Spain; 33Hospital Universitario Fundación Jiménez Díaz, Universidade Autonoma de Madrid, Spain; 34 Hospital Universitario Rey Juan Carlos, Universidade Autonoma de Madrid, Spain; 35Hospital Ramos Mejia, Buenos Aires, Argentina Introduction and Objectives: Data about renal cell
carcinoma (RCC) in Latin America (LA) are lacking. The composition of LA population is unique, and its oncological centers are heterogeneous and not skilled in participating in collaborative groups. To modify this scenario, the LARCG (Latin American Renal Cancer Group) was created. Materials and Methods: This is a detailed description
of LARCG’s foundation and current activities. Results: During the 2013 AUA (American Urological Association Meeting), Brazilian and Uruguayan colleagues created the LARCG, a non-profit collaborative study group. LARCG aims to develop the knowledge about RCC, to establish international scientific cooperation and to provide facilities to their members’ research. Twenty-four institutions joined (Brazil, Uruguay, Argentina, Chile, Mexico and Peru) and approved the LARCG’s Statute, Directory, Members Council, Ethical and Scientific committees. In each center, there is a leader Urologist, one Uropathologist (Path/Branch) and one medical oncologist (Oncol/ Branch). In January 2014, a data bank containing 149 demographic and clinico-pathological variables was sent to all centers, with a six months deadline to be filled and returned, resulting in information from 4 502 patients. Early epidemiological results and survival analysis were presented for the first time at the Confederacion Americana de Urologia Meeting, Punta del Este (2014). In 2015, LARCG structural aspects and clinical data were presented in the Spring SWOG Meeting in San Francisco, and in international meetings in São Paulo and Buenos Aires. During the second LARCG annual Assembly, held during the 2015 New Orleans AUA Meeting, (under AUA support) we received 20 new adhesions (Bolivia, Spain and US), totalizing 44 centers. The data bank was audited and corrected. Central pathologic review was finished in 1 800 Brazilian cases and is underway in Argentina. From each case, tissue samples have been removed for a tissue microarray confection. The LARCG Web page is on (www.larcg.org). There two international studies taking process. In 2016, nine new research projects (epidemiological, translational) have been submitted. Clinical trials are also in our scope.
countries. We hope that this initiative may grow, encompassing other urologic malignancies.
MP-09.07 National Trends in Diagnosis of Renal Tumours: Are We Listening? Christidis D1, Perera M1, Papa N1, Lawrentschuk N1,2 Austin Hospital, Melbourne, Australia; 2Peter MacCallum Cancer Centre, Melbourne, Australia
1
Introduction and Objectives: Small renal masses are
becoming increasingly more prevalent with the increased use of radiological imaging modalities. Traditionally, suspicious renal lesions warranted consideration for surgical resection. Over the past decade, an increasing body of literature is reporting the use of percutaneous renal biopsy (PRB) in the diagnostic assessment of small renal lesions. Despite reports of improving diagnostic yield and increased availability for PRB, uptake has been limited. We aim to assess the trends of PRB and assess state-based trends within Australia over the last 15 years. Materials and Methods: Medicare Australia databases were accessed and Medicare rebate codes pertaining to PRB were extracted per state and year between 2001 and 2015. State-based population data were extracted from the Australian Bureau of Statistics and PRB incidence data were collated. Mantel-Haenszel test for trend was utilized for yearly trends in incidence data. Results: Between 2001 and 2015, 13 097 PRBs were performed in Australia. During this time period, standardized rates of PRB doubled from 3.35 per 100 000 to 7.03 per 100 000 (p=0.001). Of the individual states, significant increasing trends were observed in New South Wales (p<0.001), Victoria (p=0.04) and Queensland (p=0.002). Western Australia demonstrated significant increases since 2007 (p=0.04). Conclusions: Increasing evidence supporting the use of PRB has coincided with increased Medicare billings in Australia over the past 15 years. While the overall incidence of PRB has increased significantly over the past 15 years, few states had limited increases during this same period.
MP-09.08 The Impact of Hospital Volume on Kidney Cancer Surgery Lundstam S1, Lindblad P2, Ljungberg B3 1
Dept. of Urology, Sahlgrenska University Hospital, Göteborg, Sweden; 2Dept. of Urology, Faculty of Medicine and Health, Örebro University, Sweden; 3 Dept. of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Sweden Introduction and Objective: The panorama of kid-
ney cancer surgery is changing due to the introduction of new techniques which may require structural changes i.e. concentration to fewer units performing operations. In the present study we analyzed data on practice pattern and mortality in high and low volume hospitals in Sweden.
Conclusion: LARCG was welcomed by the LA
Materials and Methods: Since 2005, 99% of all new-
uro-oncologic community, joining information and samples from thousands of RCC patients, and has been establishing scientific cooperation in developing
ly diagnosed renal cell carcinoma (RCC) have been included in the National Swedish Kidney Cancer Register (NSKCR). Data on histological verified RCC
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS patients that had a surgical procedure was obtained from the register for the period 2009 through 2014 and included 1942 patients from “low volume hospitals” performing less than 25 operations per year and 3251 patients from “high volume hospitals” performing 25 or more. The corresponding figures for the period from 2013 to 2014 was 589 in “low volume hospitals” and 1383 in “high volume hospitals”.
Clear cell was the most common histologic subtype (40.7%), followed by papillary (14.4%), multilocular cystic renal cell carcinoma (5.2%) and unclassified RCC (1.3%). With a mean and median follow-up of 68.4 and 62 months, respectively, one patient developed a local recurrence. No patients developed a metastatic disease. All patients were alive at the last follow-up.
Results: In 2013, 970 operations were performed in 46 hospitals and in 2014, 1002 operations were performed in 39 hospitals. Conventional and robotic assisted laparoscopy was performed in 17% and 12%, respectively, in low volume hospitals compared to 17% and 6% in high volume hospitals. Partial nephrectomy was performed in 25% of patients in low volume hospitals and in 30% of patients in high volume hospitals. Nephron sparing ablative treatments (RFA, Cryo) were performed in 3% of patients in low volume hospitals and in 8% of patients in high volume hospitals. Twenty-two percent of patients operated in low volume hospitals had T3-T4 tumors compared to 30% of patients in high volume hospitals. Thirty-day mortality for T1-T4 was 1.9% in low volume hospitals and 0.8% in high volume hospitals (p=0.058). During the period 2009 through 2014, 1942 patients (24% had T3-T4 tumors) were operated on in low volume hospitals, and 3251 (28% T3-T4) in high volume hospitals. Thirty-day mortality for all TNM stages was 1.5% in low volume hospitals and 0.8% in high volume hospitals (p=0.019).
Conclusion: In our series with moderate follow-up,
Conclusion: Low volume hospitals have surprisingly
utilized laparoscopy rapidly compared to high volume hospitals, but perform less nephron-sparing procedures, operate less advanced tumors and seem to have a higher operative mortality.
MP-09.09 Clinicopathologic Outcomes of Cystic Renal Cell Carcinoma Smaoui W, Touaiti T, Rebai N, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Academic Medical Center, Sfax, Tunisia Introduction and Objectives: The aim of this study
was to describe the clinicopathologic characteristics and oncologic outcomes of patients who underwent nephrectomy for cystic renal masses.
cystic RCCs appear to have a low potential for recurrence or progress regardless of size, histologic subtype or grade. These findings suggest that the malignant potential of cRCCs is significantly less than solid RCCs. Further investigation is required to determine if cRCCs should be classified and managed independently from solid RCCs.
Results: Seventy-six patients were identified who re-
ceived nephrectomy for a complex cystic lesion. Average age was 51.5 years. Forty-six (64%) patients were male. At the time of resection, 12 (15.7%), 4 (5.2%), 22 (29%), and 38 (50%) had a Bosniak category II, IIF, III, and IV cystic lesion, respectively. Sixteen (21%) patients were initially managed expectantly but underwent surgery because of progression of complexity on follow-up. Mean pathologic tumor size was 3.8 cm (range 0.8-13 cm). Forty-seven (61.8%) of the lesions were found to be malignant. Thirty-two (68%), 8 (17%), 3 (6.4%), 1 (2.1%), 2 (4.2%) and 1 (2.1%) were stage T1a, T1b, T2a, T2b, T3a and T4 respectively.
Conclusion: SCC of the upper urinary tract manifests
at an advanced clinical stage and seems to be more aggressive, compared to other histopathological types. New treatment modalities are urgently needed to improve the poor prognosis of advanced stage SCC of the upper urinary tract.
MP-09.11 Impact of Peri-Operative Blood Transfusion on Oncologic Outcomes of Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Carcinoma Suh YS, Choi T, Jeong BC, Lee SW, Jeon SS Samsung Medical Center, Sungkyunkwan University School of Medicine, Dept. of Urology, Seoul, Korea
MP-09.10 Squamous Cell Carcinoma of the Renal Pelvis: Incidence, Symptoms, Treatment and Outcome
Introduction and Objective: Recent studies have
shown unfavorable impacts of peri-operative blood transfusion (PBT) on oncologic outcomes in several cancers. Thus, we evaluated the association between PBT and oncological outcomes in patients undergoing nephroureterectomy for UTUC.
Fourati M, Hadj Slimen M, Mejdoub B, Kammoun O, Rebai N, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objective: Squamous cell carcino-
Materials and Methods: We reviewed 630 patients
idemiology and survival rates in patients with renal pelvis malignancies diagnosed from 1984 to 2015.
who underwent nephroureterectomy for UTUC between September 1994 and December 2013. Patients were classified into two groups; PBT and non-PBT group. Baseline characteristics and oncological outcomes were compared. Kaplan-Meir survival analysis and multivariate Cox regression models were used to analyze the effect of the PBT on intravesical recurrence, disease recurrence, cancer-specific mortality, and any cause mortality.
Results: Among a cohort of 92 patients presenting with renal pelvis malignancies, 14 patients had SCC. The average age was 57 years (36-84 years). Ten men and 4 women were affected. Chronic irritation, inflammation, and nephrolithiasis, especially staghorn calculi were the most common risk factors for SCC. Clinical features included flank or abdominal mass, weight loss and hematuria. The lumber approach was used in all cases. Adjuvant chemoradiotherapy was
Results: Baseline characteristics between the PBT group and non-PBT group were shown in table 1. PBT was done in 18.1% patients (n = 114). The PBT group was more likely to have high-grade tumors, nodal metastasis, and positive surgical margin (all p-values < 0.05). However, there was no difference between both groups regarding pathological tumor stage, lymphovascular invasion, and adjuvant chemotherapy administration (p > 0.05). Kaplan-Meier survival
mas (SCC) of the renal pelvis are rare diseases, accounting for only 1% of all urogenital malignancies. Previous reports suggest that SCC are associated with low survival rate. We present survival analysis in patients with upper urinary tract malignancies. Materials and Methods: We analyzed symptoms, ep-
MP-09.11, Table 1. Association of Administered PBT with Clinical and Pathological Characteristic of 630 Patients who Underwent Nephroureterectomy for UTUC
Materials and Methods: Using an institutional review
board-approved database, we retrospectively reviewed the clinical, pathologic, radiologic, and oncologic outcome data of patients who received nephrectomy for a complex cystic renal mass.
also performed but survival rate is still disappointing (8.42 months).
PBT (n=114)
No PBT (n=516)
Mean age, years
65.9±11.1
63.3±11.0
0.019
Gender, male, n (%)
61 (53.5)
404 (78.3)
<0.001
≤p T2
59 (52.7)
294 (56.8)
≥p T3
53 (47.3)
224 (43.2)
Pathological grade, III, n (%)
64 (57.1)
213 (41.1)
0.002
Surgical margin, positive, n (%)
10 (8.8)
21 (4.1)
0.036
Lymphovascular invasion, positive, n (%)
24 (21.1)
84 (16.3)
0.221
Carcinoma in situ, positive n (%)
13 (11.4)
50 (9.7)
0.581
Pathological nodal staging, positive, n (%)
16 (14.0)
40 (7.8)
0.033
Adjuvant chemotherapy, administered, n (%)
25 (21.9)
103 (20.0)
0.636
Intravesical recurrence, positive, n (%)
40 (35.7)
228 (44.0)
0.107
Pathological tumor stage, n (%)
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
P-Value
0.430
51
MODERATED ePOSTERS MP-09.11, Table 2. Multivariate Analyses to Predict Disease Recurrence, Cancer-Specific Mortality and Any-Cause Mortality Disease recurrence HR
95% CI
HR
Any-cause mortality
95% CI
P
HR
95% CI
P
Age
1.021
1.005-1.037
0.009
1.045
1.025-1.066
<0.001
1.045
1.027-1.063
<0.001
Male Gender
1.309
0.936-1.831
0.116
1.257
0.843-1.875
0.263
1.162
0.808-1.670
0.418
Administered PBT
1.467
1.012-2.125
0.043
1.683
1.101-2.572
0.016
1.577
1.074-2.316
0.020
High grade
1.809
1.269-2.580
0.001
1.390
0.928-2.081
0.110
1.409
0.986-2.013
0.060
T-stage (≤T2 vs ≥T3)
2.348
1.614-3.416
<0.001
3.308
2.117-5.169
<0.001
2.179
1.493-3.180
<0.001
pN+
2.223
1.488-3.321
<0.001
2.665
1.657-4.285
<0.001
2.621
1.677-4.096
<0.001 <0.001
Positive margin
2.321
1.322-4.074
0.003
3.072
1.603-5.889
0.001
2.891
1.595-5.242
LVI
2.072
1.461-2.938
<0.001
1.656
1.093-2.510
0.017
1.642
1.131-2.383
0.009
concomitant CIS
0.587
0.348-0.992
0.046
0.385
0.192-0.774
0.007
0.451
0.246-0.828
0.010
Adjuvant chemotherapy
0.821
0.574-1.174
0.280
0.989
0.644-1.517
0.958
0.926
0.263-1.376
0.704
analysis revealed that the PBT group was significantly associated with a higher risk of disease recurrence (p = 0.001), and lower cancer-specific survival (p < 0.001), any-cause survival (p < 0.001). Multivariate cox regression analysis also demonstrated that the PBT group was independent risk factor to predict disease recurrence (HR = 1.47, 95% CI = 1.01-2.12, p = 0.043), cancer-specific mortality (HR = 1.68, 95% CI = 1.10-2.57, p = 0.016), and any-cause mortality (HR = 1.58, 95% CI = 1.07-2.31, p = 0.020, table 2). In terms of intravesical recurrence, there was no difference between the two groups (p = 0.905). Conclusion: In patients who underwent nephro-
ureterectomy for UTUC, the PBT is associated with a greater risk of disease recurrence, cancer specific mortality, and any-cause mortality.
MP-09.12 Prognostic Impact of Tumor Diameter in Renal Cancer Stage pT3a Bengió RG, Arribillaga L, Orellana S, García Öntö H, Montedoro A, Epelde J, Cordero E, Bengió RH Centro Urológico Profesor Bengió, Córdoba, Argentina
52
Cancer-specific mortality P
Introduction and Objective: The TNM stratification system is highly accepted as the principal prognostic predictor in patients with renal cell carcinoma. However, there is limited evidence regarding prognostic equivalence between these two factors, as well as the difference between tumors that invade perirenal fat and localized neoplasia (pT1-2). We determined the prognostic impact that tumor size has in patients with pathological renal cancer stage pT3a. Materials and Methods: We have retrospectively evaluated 261 patients with pathological renal cancer stage pT1-3aN0M0; 166 (63.6%) were stage pT1a-b, 49 (18.8%) pT2 and 46 (17.6%) pT3a. In every group, we evaluated clinical and pathological characteristics. ROC curve was used in order to determine optimal cut-off points of the tumor size in relation to cancer-specific survival. Metastasis-free survival and cancer-specific survival were evaluated by Kaplan Meier method and Log-Rank Test evaluated differences between groups. This study group used the Cox proportional method for multivariate analysis searching for independent predictors of death by renal cancer.
Results: Patients with pT3a tumors had a higher proportion of radical surgeries (93.5% vs. 75.8%), symptomatic tumors (56.5% vs. 33.6%), tumor size (7.1 cm vs. 5.5 cm), Fuhrman grade 3-4 (52.2% vs. 19.1%), coagulative necrosis (62.8% vs. 28.8%), distance metastasis (39.1% vs. 14.9%) and death by cancer (23.9% vs. 8.9%) when compared with localized tumors (pT1-2). With the ROC curve, we demonstrated that a cut-off point of 7 cm is the ideal tumor size to determine renal cancer mortality. Metastasis-free survival at 5 years was 90% for tumors pT1a-b, 71% for pT2, 83% for pT3a <7 cm and 48% for pT3a >7 cm, with significant statistical differences (Log-rank test <0.001). In the multivariate analysis, only pT3a >7 cm stage is presented as an independent predictor of death by renal cancer. Conclusions: Although perirenal fat invasion and renal vein invasion (pT3a stage) are accepted as prognostic factors, to differentiate this category by tumor size could improve its predictive quality. Our data demonstrate that the tumor diameter (7 cm) should be applied to pT3a tumors in order to improve the accuracy of the TNM system.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 10 Prostate Cancer— Detection & Screening Saturday, October 22 1425–1555 MP-10.01 Prevention of Risk Factors for Complications After Prostate Needle Biopsy Sung LH, Cho IR Inje University Sanggye Paik Hospital, Seoul, Korea Introduction and Objective: Prostate biopsy for the
diagnosis of prostate cancer by transrectal ultrasonography (TRUS) is a common procedure used in daily urology practice with a low complication rate and easy applicability. However, acute prostatitis or sepsis are sometimes serious complications of the procedure. Recent studies showed that patients with urethral catheter, diabetes mellitus or those planned to undergo biopsy from more sites than the standard, should be closely monitored after the biopsy for more frequent complication rate. In this study, the precipitating factors for complications after prostate biopsy by TRUS in one center are examined. Materials and Methods: A total of 484 patients who
underwent prostate biopsy by TRUS were assessed retrospectively. Standard preparations, including enema and prophylactic oral antibiotics were given to most patients. The relationship of complications and age, serum total PSA level, prostate volume, number of cores, number of repeated biopsies, presence of urethral catheter and diabetes mellitus, and unprepared prostate biopsy was assessed. Data were analyzed using univariate and multivariate analysis. Results: Of the 484 patients, 24 (4.96%) developed complications, including acute prostatitis (18 patients, 3.72%), urinary retension (2 patients, 0.41%), persistent hematuria (1 patients, 0.21%), sepsis (3 patients, 0.62%) within a week after biopsy. Seven patients were hospitalized for high fever. On univariate analysis, unprepared prostate biopsy was the only parameter for complications (p=.0.037). There was no parameter for sepsis and significant relationship between complications and other parameters. Conclusion: Unprepared prostate biopsy was the only
risk factor for complications. General preparations (enema and prophylactic antibiotics) and aseptic procedure are believed to be more important for preventing complications, although many studies showed various risk factors for complications after prostate biopsy.
MP-10.02 Quantitative mpMRI Parameters and Derived Metrics to Assess Heterogeneity and Aggressiveness of Prostate Cancer, and Predict Targeted Biopsy Outcome Orczyk C1,2, Rusinek H3, Mikheev A3, Bazille C4, Villers A5, Valable S2
1 University College London, United Kingdom; 2UMR 6301 ISTCT, Caen, France; 3New York University, United States; 4University Hospital of Caen, France; 5 University Hospital of Lille, France
Introduction and Objective: Current interpretation of
prostate mpMRI in diagnosis setting is based on visual scoring, subject to interobserver variability. Quantitative parameters, like ADC for diffusion or Ktrans for perfusion imaging may offer objective data to assess prostate tissue before biopsy. Metrics as entropy are computed directly from histogram of a volume of interest (VOI) and aim to quantify its heterogeneity. We propose to investigate their ability to predict cancer and aggressiveness at diagnosis confronted to targeted biopsy. Materials and Methods: Under IRB approval, we reviewed the charts of 20 consecutive patients (median PSA 8.07 ng/ml) who underwent transrectal biopsy by a single urologist trained to cognitive targeted biopsy. All patients underwent mpMRI using identical protocol with T2 WI, DCE WI, DWI (b0-b1000) with ADC map at 1.5 T. Suspicious lesions were mapped and scored according PiRADS guidelines prior targeted biopsy. Using in house software which allows 4D image co-registration and processing, we built Ktrans map (Toft model). In the same registered space, VOI were then delineated over MRI leading to a map of targeted VOI and cancer location, based on pathology results. The software provided directly quantitative value for each map and entropy (E) metric. We compared mean, median and entropy for ADC and Ktrans between cancerous and non cancerous VOIs using two-sided T-test. The mean, median, entropy ADCs and Ktrans’ were determined from the wholeVOI histogram and correlated with the Gleason score by using the Spearman correlation coefficient (ρ). Results: A total of 33 VOI (median 0.65cc) of which 2, 19, 6, 6 scored respectively 2, 3, 4, 5 were biopsied. From 12 positive VOI for cancer, 8 were Gleason (G) 6, 3 G 7 and 1 G8. There was a significant difference between cancerous (k) and non-cancerous (nk) VOI for ADC E (p=0.04, mean E k: 5.21; mean E nk: 4.89). No significant difference was observed between mean or median ADC values. No significant difference was found in identical VOI for E, median and mean of Ktrans. There was a significant positive correlation of p=0.64 (p=0.023) and p=0.66 (p=0.019) between respectively E of ADC and E of Ktrans to Gleason Score. No such correlation was found respectively between mean, median ADC (p=-0.25, p=0.42; p=-0.25, p=0.42) and Ktrans (p=0.24, p=0.43; p=-0.042, p=0.89) values and Gleason score. Conclusion: In this cohort of targeted biopsy patients,
whole lesion entropy metric outperformed mean and median values of mpMRI quantitative parameters, especially at ADC for identification of cancer. As a first report, entropy of both Ktrans and ADC maps were correlated with aggressiveness of prostate cancer at diagnostic biopsy, suggesting a role of metric and quantitative mpMRI parameters for the diagnosis and stratification of cancer.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
MP-10.03 A New Registry of MRI in Prostate Cancer Diagnosis Using the REDCap Electronic Data Capture Program Pepdjonovic L1, Huang S1, Dat A1, Mann S1, Frydenberg M2, Moon D1, Hanegbi U1, Landau A1, Snow R1, Grummet J2 1
Australian Urology Associates, Melbourne, Australia; Australian Urology Associates, Melbourne, Australia; Monash University, Melbourne, Australia
2
Introduction and Objective: There is a burgeoning
literature on the utility of MRI in prostate cancer diagnosis. The rapid uptake of this diagnostic modality requires granular data capture for quality assurance of its purported diagnostic accuracy. We aimed to create a web-based registry enabling multi-center user-friendly real-time data entry for this purpose. Materials and Methods: The REDCap application was accessed through Monash University as a partner in the worldwide REDCap consortium. A registry was built for men undergoing MRI for suspicion of significant prostate cancer (either as a new diagnosis or on active surveillance for previously diagnosed low-risk disease). The registry was created using REDCap’s Online Designer. Results: Eighteen granular data collection instruments were created, including instruments for patient demographics, MRI findings, transperineal biopsy results, prostatectomy specimen pathology and repeated MRI and biopsy findings for active surveillance. Instruments included dropdown boxes and branching logic for ease of data entry. To date, the registry has been populated on 995 consecutive patients. Conclusion: The rapid uptake of MRI in prostate can-
cer diagnosis requires large volume multi-center data capture for quality assurance. REDCap appears to be a suitable application for this purpose. To our knowledge this is the first registry of prostate MRI using REDCap. This web-based program facilitates multi-center collaboration, real-time data entry and automatic export into common statistical packages.
MP-10.04 Combined ERSPC Risk Calculator and Multiparametric MRI for Risk Modeling of Prostate Cancer Hadaschik B1, Radtke J1, Kesch C1, Celik K1, Hohenfellner M1, Bonekamp D2, Schlemmer HP2 1
Dept. of Urology, Heidelberg University Hospital, Germany; 2Dept. of Radiology, German Cancer Research Center, Heidelberg, Germany
Introduction and Objective: PSA-screening for prostate cancer (PC) is controversial because the test lacks specificity. The use of multiparametric MRI (mpMRI) gains widespread acceptance in PC diagnosis and detects significant PC (sPC) accurately. Here, we add pre-biopsy mpMRI to an ERSPC risk calculator (RC) for development of a nomogram to provide individual sPC risk on biopsy. Materials and Methods: First, we retrospectively ana-
lyzed clinical parameters of 755 men who underwent mpMRI prior to transperineal MRI/TRUS-fusion-biopsy between 2012 and 2014 as training sample. sPC was defined according to NCCN criteria (GS=3+3
53
MODERATED ePOSTERS and PSA ≥10 ng/ml or GS≥3+4). We used a multivariate regression model to determine significant predictors of sPC in the training set and to develop a nomogram. The accuracy was compared to ERSPC RC and mpMRI alone (PI-RADS Likert score) by receiver operating characteristics (ROC) curve. Based on the difference in accuracy, a sample size calculation was performed for a validation set (n=404 men). Accuracy, discrimination and calibration of the nomogram were prospectively analyzed on this validation set. Results: Overall, PC occurred in 732 (63%) and sPC in 560 (48%) men. In the training set, 50% of men harbored PC and 78% of them sPC. In multivariate analysis, PSA, PSA-density, Likert score and ERSPC RC (each p<0.001) were significant predictors of sPC and used for the prediction model. In ROC analysis, area under the curve (AUC) was highest for the nomogram (0.82), compared to 0.74 for ERSPC RC and 0.76 for Likert score. Based on the 0.08 benefit of the nomogram, 404 men were prospectively enrolled as validation sample. In that subgroup, accuracy of the nomogram was best (0.79), compared to Likert score (0.78) and ERSPC RC (0.60). Calibration was analyzed using a calibration plot, demonstrating a good slope (0.94), but slight overestimation of the prediction model. Conclusion: The evaluated prediction model, incor-
porating both ERSPC RC and mpMRI data, provides reliable risk prediction of sPC, which is important to avoid unnecessary biopsies and reduce over-diagnosis and overtreatment. Compared to clinical and MRI parameters alone, the predictive model performed better in the initial training and the prospective validation sample.
MP-10.05 Personalized Medicine Within the Prostate Cancer Diagnosis Pathway: Pre-Biopsy MRI for All Malthouse T, Lam W, Van Riff S, Pindoria N, Challacombe B, Popert R Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom Introduction and Objective: Traditionally, patients with suspected localized prostate cancer (CaP) have a transrectal ultrasound (TRUS) prostate biopsy as the initial investigation. MRI was carried out as a staging tool after histological confirmation of CaP. With increasing different prostate biopsy techniques available, pre-biopsy MRI provides an opportunity to determine appropriate biopsy strategy to improve diagnostic accuracy. This study aimed to evaluate pre-biopsy MRI on the CaP diagnostic pathway in patients referred with suspected cancer. Materials and Methods: A retrospective analysis
was conducted at a single institution on patients referred with a suspicion of CaP between January and June 2015. All patients fit for curative treatment were included, and had pre-biopsy MRI using a 1.5 tesla biphasic protocol and reported using the PIRADs V1.0 scale. If prostate biopsy was deemed necessary, either a TRUS or transperineal (TP) approach was recommended, depending on the suspected tumour location on MRI and prostate volume. Targeting was carried out either by transperineal MRI fusion or cognitive technique, if small but obvious apical or anteri-
54
or lesion was identified on MRI. Patients with obvious posterior tumour on MRI or palpable disease were offered a limited targeted TRUS biopsy.
MCCL on MRI-targeted biopsies and mpMRI lesion volume to determine the validity of MCCL on targeted biopsies within risk stratification.
Results: Of the 428 patients referred with suspicion of CaP, 259 proceeded to MRI prior to biopsy. Overall, 202 patients had subsequent prostate biopsies, 133 (66%) were diagnosed with CaP. A total of 41 patients didn’t have biopsy following MRI because they were considered low-risk due to a combination of large prostate volume, low PSA density (PSAD) and a PiRAD score of 1 or 2. Sixteen patients declined biopsy and opted for watchful waiting. A total of 20 (10%) patients had limited TRUS biopsy (between 2 to 6 cores) due to presence of obvious tumour on MRI, 100% had pathologically confirmed clinically significant prostate cancer. Of the 75 patients in whom a primary TP biopsy was recommended, 59 (79%) had CaP, 40% of these had anterior lesions which may have been missed on a standard TRUS biopsy. Eighty patients had targeted biopsies guided by MRI images.
Materials and Methods: Treatment-naïve men with at least one lesion on mpMRI who underwent mpMRI visually-estimated targeted biopsy were included. MpMRI lesion volume and MCCL on biopsy were recorded for each lesion. Subgroups by mpMRI Likert score were evaluated. Pearson Correlation Coefficient [r>0.7][p<0.05] was used. Additionally, concordance between lesions with mpMRI volumes of ≥0.5 mL and ≥0.2 mL and histological UCL definitions 1 (MCCL ≥6 mm) and 2 (MCCL ≥4mm) respectively was evaluated. Results: A total of 181 treatment naïve men (09/201401/2016) with 243 visible lesions were included. A total of 27 scored Likert 3, 63 had Likert 4 and 90 scored Likert 5. Median mpMRI lesion volume was 1.0 mL [IQR 0.3-4.0]. A total of 180 lesions were biopsy positive. Median MCCL was 7 mm [IQR 3-11]. Correlations between MCCL and mpMRI volume were seen in all scenarios except Likert 3 lesions (Table 1a). A total of 118 and 154 lesions had mpMRI volumes of 0.5 mL and 0.2 mL, respectively. A total of 90 (76%) of ≥0.5mL lesions and 120 (78%) of ≥0.2 mL lesions also had an MCCL of ≥6 mm and ≥4 mm, respectively (Table 1b). However, MCCL alone detected UCL 1 and 2 disease in 24 and 36 cases.
Conclusion: In our series, pre-biopsy MRI enabled a
personalized approach to select appropriate prostate biopsy techniques. This allowed a high CaP detection rate, with some avoiding unnecessary biopsies.
MP-10.06 Is It Time to Assess Prostate Cancer Volume on Imaging Evaluating MultiParametric MRI Lesion Volume and Maximum Cancer Core Length
Conclusion: There
was concordance between MCCL on targeted biopsies and mpMRI lesion volume. MCCL on targeted biopsy can be an accurate surrogate marker of tumor volume on histology. Future risk stratification systems should incorporate both mpMRI and histological measurements in order to improve their predictive value.
Bass E1, Freeman A2, Jameson C2, Ramachandran N2, Punwani S2, Kirkham A2, Allen C2, Walkden M2, Moore C1, Emberton M1, Arya M1, Ahmed H1 1 University College London, United Kingdom; University College London Hospitals, United Kingdom; 2 University College London Hospitals, United Kingdom
Introduction and Objective: Current risk stratification systems rely on histological parameters such as maximum cancer core length (MCCL) as surrogates of cancer volume. Due to errors of TRUS-biopsy, they are inherently inaccurate. Multi-parametric MRI (mpMRI) is useful in detecting and localizing prostate cancer and might provide accurate assessments of cancer volume. We assessed the correlation between
MP-10.06, Table 1. TABLE 1A Likert Score
Lesions
3
4
5
Whole Group
27
63
90
180
r
0.27
0.29
0.49
0.49
p
0.17
0.02
< 0.00001
< 0.00001
MRI volume (mL)
0.4
0.4
3.1
1
3
6
9
7
Total
Parity
Non-parity
Lesions
MRI & MCCL
MRI alone
≥0.5 mL
118
90
28
≥0.2 mL
154
120
36
MCCL (mm)
TABLE 1B
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-10.07 The Role of Multi-Parametric Magnetic Resonance Imaging (mpMRI) Scans and mpMRI fusion targeted biopsies (MRF-Tb) in the Detection of Clinically Significant Prostate Cancer: A Single Center Prospective Experience Mevcha A, Deshpande A, Hedley N, Sherwood V, MacDonald D, Jefferson K University Hospital of Coventry and Warwickshire, Coventry, United Kingdom Introduction and Objective: There is increasing ev-
idence to use multi-parametric MRI (mpMRI) and mpMRI fusion targeted biopsies (MRF-Tb) to improve detection of clinically significant prostate cancer (PCa) while limiting over-detection of indolent disease. We evaluated our practice since we started MRF-Tb, comparing the results to our transperineal template biopsies (TTb) results as well as assessing the diagnostic accuracy of our mpMRI scans. Materials and Methods: We prospectively collected
data on all TTb and MRF-Tb performed at our institution from December 2014 to October 2015. All patients who had MRF-Tb also underwent TTb. TTb was performed using 5mm-interval templates with apical and basal cores. The 1.5T mpMRI T2, DWI/ ADC and post-contrast images were obtained and reported blind according to PI-RADS v2. Results: A total of 151 patients underwent TTb, of
which 60 (40%) also underwent MRF-Tb. Median age was 66 years (49-80) and median PSA of 9.2ng/mL (0.6-110). Median number of previous negative biopsies was 1 (1-5). A total of 65 (42%) had biopsies as part of active surveillance. A total of 95 (63%) patients had positive biopsies in total. Of these, 65 (68%) were only TTb positive. Of the 60 who underwent MRF-Tb, 30 (50%) were positive. A total of 60 (64%) of 94 TTb patients had Gleason > 7 PCa. 21 (70%) of the 30 MRF-Tb patients had Gleason > 7 PCa. Compared with TTb histology, 2 (7%) were upgraded while 10 (35%) were downgraded on MRF-Tb. A total of 142 patients had pre-biopsy mpMRI scans. 59 (41.5%) had a negative mpMRI. Of these, 30 (51%) had PCa on TTb. Of the 83 positive mpMRI scans, 59 (71%) had positive biopsies. This gives a sensitivity of 66%, specificity of 55%, positive predictive value of 71% and negative predictive value of 49% for mpMRI.
Nieuwenhuijzen J6, van Moorselaar J6, van Leeuwen T4, de la Rosette J2 1
AMC University Hospital, Amsterdam, The Netherlands; 2Dept. of Urology, Academic Medical Center, University of Amsterdam, The Netherlands; 3 Dept. of Pathology, VU University Medical Center, Free University, Amsterdam, The Netherlands; 4 Dept. of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, The Netherlands; 5Dept. of Instrumental Services, Academic Medical Center, University of Amsterdam, The Netherlands; 6Dept. of Urology, VU University Medical Center, Free University, Amsterdam, The Netherlands Introduction and Objective: Optical coherence to-
mography has the capability of creating a 3D optical biopsy with instant tissue visualization on μm scale. This study assesses the diagnostic accuracy of optical coherence tomography for instant and objective detection of prostate cancer. Materials and Methods: A total of 20 prostates were analyzed by OCT after radical prostatectomy using a customized tool for measurement and slicing of the prostate, enabling exact correlation with histopathology. OCT images were grouped per histologic category. Blind assessment of the OCT B-scans was performed by two independent reviewers. Cross tabulation rendered sensitivity and specificity. Quantitative analysis by automated attenuation coefficient and residue calculation was performed. A related-samples Wilcoxon signed rank test was used for attenuation coefficient and residue comparisons. Results: A precise correlation of OCT and histopathology was achieved in this study. Visual analysis of OCT scans showed a good identification for fat, cystous and regular atrophy and benign glands. The differentiation between benign stroma, inflammation
MP-10.08, Table 1. Results of Visual OCT B-Scan Scoring
Reviewer 1
Reviewer 2
Scores:
Benign glands
75%
50%
Cystous atrophy
77.8%
44.5%
Conclusion: Our early dataset suggests that even
Regular atrophy
72.7%
36.4%
though MRF-Tb compares favourably with TTb in the detection of clinically significant PCa, it cannot replace TTb due to a 50% false negative rate. Also, 24% of men with negative mpMRI would not have been diagnosed with PCa using NICE guidelines, had they not had TTb. Thus, patients with negative mpMRI cannot be assuredly diagnosed, and we therefore recommend that mpMRI be complemented with TTb.
Stroma
54.8%
35.5%
Gleason 3
60%
20%
Gleason 4
47.4%
36.8%
0%
20%
100%
100%
MP-10.08
Benign, cystous, regular
100%
83.3%
Optical Coherence Tomography in Prostate Cancer: Results in 20 Patients Validated with a Customized Pathology Matching Tool
Stroma, inflammation
51.2%
58.5%
75%
79.2%
Muller B1, van Kollenburg R2, Zwartkruis E3, de Bruin D4, Brandt M4, Swaan A4, van den Bos W2, Schreurs W5, Faber D4, Rozendaal R3, Vis A6,
Sensitivity
75%
79.2%
Specificity
87.2%
81.4%
Inflammation Fat Grouped scores:
Malignancy 3,4,5 Malignancy detection:
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
and malignancy Gleason 3 and 4 with OCT proved to be more challenging (table 1). The overall sensitivity and specificity of prostate cancer by visual analysis is 75% and 87.7% respectively. Quantitative analysis by means of the attenuation coefficient for differentiation between stroma and malignancy showed no significant difference with 0.493 mm-1 for stroma vs. 5.31 mm-1 for malignancy (related-samples Wilcoxon signed rank test p=0.209). A significantly lower residue was seen in malignant tissue (2393) than in benign prostate tissue (4317) (related-samples Wilcoxon signed rank test p=0.023). Conclusion: OCT has shown to be a technology in
which prostate cancer can be distinguished for benign prostate tissue with reasonable sensitivity and specificity. Residues are significantly different in benign and malignant prostate tissue. These results suggest that OCT is a promising technology for in-vivo visualization of prostate tissue on a microscopic level.
MP-10.09 Thinking Outside the Box: 3-Year Service Evaluation of a Nurse Practitioner-Led Clinic for Suspected Prostate Cancer Referrals Drudge-Coates L, Khati V, Ballesteros R, Brown C Dept. of Urology, King’s College Hospital NHS Foundation Trust, London, United Kingdom Introduction and Objective: Time to diagnosis and
treatment has been shown to impact survival in many cancers. In the UK, all urology departments are required to see new referrals for suspected prostate cancer within 2 weeks. Studies to date have focused on the appropriateness of the referrals, effective and consistent triage and the poor yield of confirmed cancer cases. The aim of this study was to evaluate a nurse practitioner-led approach for the assessment and management of men with suspected prostate cancer. Materials and Methods: A protocol driven nurse-led
assessment service was designed for new cases of possible prostate cancer. In June 2012 after initial training and supervision, all referrals underwent direct nurse vetting and assessment in nurse-led clinics. Assessment included a full medical history, digital rectal examination, bloods, lower urinary tract assessment and sexual health review. Subsequent diagnostic investigations were then requested based on clinical findings. Clinical outcomes were measured prospectively for all patients. A qualitative questionnaire was sent to the first 100 men. Results: From June 2012 to June 2015, 558 men were seen for assessment. The initial waiting time from GP referral to initial urology assessment was reduced from 8.4 to 4.4 days (52%). After initial assessment, 279 men (50%) were referred for further cancer diagnostic tests. A total of 223 (40%) patients were sent for biopsies, of whom 150 (67.3%) were diagnosed with cancer. A total of 25 (4.4%) men were diagnosed with metastases at presentation and commenced on hormone therapy without biopsy; 17 (3%) were clinically malignant and commenced on w/waiting, and 2 non metastatic patients with very high PSA levels but multiple co-morbidities were also commenced on hormones. A total of 12 (2.2%) men declined prostate biopsies. Of 100 questionnaires, 63 (63%) responded. Eighty-six percent were “very satisfied” with the
55
MODERATED ePOSTERS nurse-led service, 90% satisfied with seeing a nurse practitioner, with 95% of patients reporting a clear understanding of the diagnostic process. Conclusions: A nurse-led clinic can cut waiting times
for men with suspected prostate cancer, while delivering excellent levels of care and diagnostic performance. Patients appear very happy with the service they receive.
MP-10.10 Targeting Only Biopsies of the Prostate Based on MpMRI: Performance and Accuracy of the Transperineal Route Under Conscious Sedation Orczyk C1, Bass E1, Punwani S1, Freeman A2, Sidhu H1, Moore C1, Arya M2, Emberton M1, Ahmed HU1 1
University College London, United Kingdom; University College London Hospitals, United Kingdom
2
Introduction and Objective: MRI-targeted biopsies are increasingly common in prostate cancer detection and risk stratification. Whilst commonly transrectal, the risk of sepsis secondary to faecal contamination and multi-resistant bacteria is rising. Transperineal biopsies rarely cause sepsis. Hitherto, transperineal biopsies have been conducted under general anaesthesia making widespread use unfeasible. We report on the performance of transperineal MRI-targeted biopsies alone using local anaesthetic and conscious sedation. Materials and Methods: We retrospectively reviewed
consecutive treatment-naïve patients undergoing transperineal MR-targeted only biopsies under conscious sedation using visual/cognitive estimation (2014-2015). Local anaesthetic combined with intravenous propofol or intravenous midazolam was used.
MRI sequences included T2W, DWI with ADC map and long b-value and dynamic-contrast.
MDT. Primarily, patients returned for counseling within 7 days.
Results: A total of 89 patients with 166 mpMRI suspicious lesions were targeted (Table 1). All men were discharged the same day 1-2 hours after biopsy. There was no reported urinary infections or sepsis within 30 days of the procedure. The overall cancer detection rate was 72/89 (81%). A total of 60/72 (83.3%) harbored significant cancer (UCL definition 2: Gleason ³3+4=7 and/or maximal cancer core length >3 mm). Cancer detection rate for clinically significant disease was 34/34 (100%) for PIRADS score 5, 35/43 (81.3%) for score 4 and 25/89 (28%) for score 3 (Table 2).
Results: A total of 112 men attended the prostate one-stop clinic. A total of 111 (99.1%) underwent assessment by mpMRI. Median presenting PSA was 9.4ng/mL [IQR 5.6-21.0]. A total of 87 patients had a visible target on mpMRI. A total of 25 scored PIRADS 3/5 for radiological likelihood of disease, 26 4/5 and 36 5/5. A total of 57 (51%) patients subsequently received a local anaesthetic, cognitive mpMRI-targeted biopsy. Cancer was detected in 45 (79%), 43 (96%) of whom had UCL definition 2 disease or greater. A total of 30 (27%) patients did not undergo biopsy for clinical reasons or patient choice. The times to diagnosis and treatment were reduced to a median of 8 and 20 days respectively.
Conclusion: Patients and their physicians wishing to
virtually eliminate the risk of sepsis from a transrectal MRI-targeted biopsy should be aware that transperineal MRI-targeted prostate biopsy under local anaesthetic and conscious sedation is feasible, safe, and tolerable, and has a high diagnostic performance.
MP-10.11 The Prostate Cancer Diagnostic Pathway: Adoption of a One-Stop Service 1
2
2
2
2
Bass E , Coe J , Abu V , Farrow K , McCartan N , Dennett R2, Freeman A2, Jameson C2, Walkden M2, Allen C2, Kirkham A2, Ramachandran N2, Punwani S2, Pendse D2, Moore C1, Arya M1, Emberton M1, Ahmed H1 1
University College London; University College London Hospital, United Kingdom; 2University College London Hospital, United Kingdom Introduction and Objective: The standard prostate
PSA (ng/ml, median)
7.2
Age (years, median)
66
cancer diagnostic pathway with TRUS biopsy followed by MRI delays diagnosis and treatment. When added to its well described misclassification of disease, this leads to inappropriate staging, treatment, multiple hospital visits and inevitable patient burden. These issues may be mitigated by using multiparametric MRI (mpMRI) led diagnostic pathways that incorporate transperineal biopsy. We report a pilot study of a novel one-stop prostate cancer referral service to evaluate its feasibility, acceptability to patients and effectiveness in reducing times to diagnosis and treatment.
Number of targeted suspicious lesion (median)
2
Materials and Methods: Men referred under the
MP-10.10, Table 1. Population
Targeted biopsy maximum Gleason Score (n=72)
3+3
15
3+4
45
4+3
10
4+5
2
two-week wait rule with a raised PSA or abnormal digital rectal examination between January 2015 and March 2016 were investigated for prostate cancer. The patient was contacted on referral and a multiparametric MRI (mpMRI) was arranged. This was reported before the patient attended the clinic in the early afternoon of the same day. If required, a transperineal-targeted biopsy was offered. Results were available within 48 hours and were discussed at a specialist
MP-10.10, Table 2.
56
mpmRI lesion score (n=166)
No. suspicious lesions (%)
No. lesions with any cancer (%)
No. lesions with significant cancer (UCL definition 2) (%)
Score 5
34 (20)
34 (100)
34 (100)
Score 4
43 (25.9)
35 (81.3)
29 (67.1)
Score 3
89 (54)
41 (46)
25 (28)
166
110 (66)
88 (53)
Conclusion: This novel approach greatly reduced the
time to diagnosis and treatment. Attendance rates and pick-up rates of significant cancer are high. Similar services may be valuable to patients with a potential diagnosis of prostate cancer.
MP-10.12 Impact of the Different Recommendations for Early Detection of Prostate Cancer over a Regional Public Health Service in Brazil Rodrigues Junior AA, Cologna AJ, Tucci Jr. S, Molina CAF, dos Reis RB Ribeirao Preto School of Medicine, Sao Paulo University, Ribeirao Preto, Brazil Introduction and Objectives: We described our experience with prostate cancer (PCa) detection during the implementation of the Urology service at Américo Brasiliense State Hospital (HEAB), a regional hospital that encompasses twenty-four municipalities as the unique public reference center for medical specialties. The objectives were to describe the efficacy and safety rates for CaP detection in screened and nonscreened patients, and its respective costs. Materials and Methods: This was a retrospective analysis of 1412 patients who attended between December 2011 and December 2013. We followed the Urological Brazilian Society’s (SBU) orientation for screening. Men older than 40 years and younger than 75 years old, or with more than 10 years of life expectancy, were included in screened group. We excluded subjects with previous biopsy, surgery, radiation therapy, chronic prostatitis or urethral stenosis. Patients that underwent a prostatic biopsy, and were not included in the screened group, were included in the non-screened group. Simulations following the AUA, EUA and NCCN screening recommendations were performed for the same sample. Results: We included 1160 in the screened group 75% white, 19% brown and 6% black, following a self-denomination of skin color criteria. A total 302 biopsies were performed, and 115 cases of PCa were detected; respectively, 38, 38 and 35 with Gleason 6, 7 and ≥8. The AUA, EUA and NCCN simulations included 920, 1132 and 966 subjects respectively in the screened group, and detected 63, 95 and 93 cancers. The AUA detected only 16 undifferentiated cancers, instead of 26 from other simulations. In our sample, 61% of all undifferentiated cancers were found in men over
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS 70 years old. The total costs for screening and prostate cancer detection were between US$ 128,400.00 and US$ 198,800.00. The lowest costs were credited to AUA simulation. Conclusion: The AUA recommendation for prostate
cancer early detection would cause a lower financial impact in our service, however with a 41% impairment in detection rate of the undifferentiated cancers. The subjects’ age was the main factor for screening selection.
MP-10.13 Prostate Cancer Incidence and Severity in 375 Hypogonadal Men Treated with Testosterone Undecanoate Injections (TU) for up to 10 Years and 296 Untreated Hypogonadal Controls Haider A Private Urology Practice, Bremerhaven, Germany
nodes, distant metastases and surgical margin were negative (N0, M0, R0) in all 8 men. In CTRL, Gleason score was >6 in all 12 patients. Three men had a predominant Gleason score of 3, 8 had 4, and 1 had 5. Tumor grade was G2 in 5 (41.7%) and G3 in 7 (58.3%) patients, tumor stage T2b in 1 (8.3%), T2c in 1 (8.3%), T3b in 4 (33.3%) and T3c in 6 (50%) patients. Seven patients had positive lymph nodes and 7 patients had a positive surgical margin. Conclusions: Long-term treatment with TU in hypogonadal men undergoing regular monitoring according to EAU guidelines does not increase the incidence of PCa in comparison to an untreated hypogonadal CTRL group. PCa was more severe in the CTRL group.
MP-10.14 Development of a New Nomogram to Predict Insignificant Prostate Cancer in Patients Undergoing Radical Prostatectomy
Introduction and Objective: Testosterone therapy (TTh) in elderly men is still associated with concerns regarding prostate cancer (PCa). In this study, incidence of PCa in hypogonadal men on long-term treatment with TU in comparison to an untreated hypogonadal control group (CTRL) was assessed.
Dept. of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Materials and Methods: In an ongoing, cumulative
Introduction and Objective: To develop a nomogram
registry study, 375 men (age range: 33-70) with total testosterone ≤12.1 nmol/L in the presence of symptoms received TU 1000 mg every 12 weeks following an initial interval of 6 weeks for up to 8 years were studied. A total of 296 hypogonadal men (age range: 57-74) decided against TTh. Prostate volume (PV) and PSA were measured and digital rectal examination (DRE)/ transrectal ultrasound (TRUS) performed before treatment initiation and then regularly every 3-6 months. Biopsies were performed when indicated according to EAU guidelines.
to predict the probability of insignificant prostate cancer.
Results: In T-treated patients, 8 men (2.1%) were diagnosed with PCa. In the control group, 12 (4.1%) were diagnosed with PCa. The incidence per 10,000 years was 32 in the T-group and 64 in CTRL. The mean baseline age of PCa patients was 65 years in both groups. All patients underwent radical prostatectomy. In the T-group, all patients had a Gleason score ≤6 and a predominant Gleason score of 3. Tumor grade was G2 in all 8 (100%), tumor stage T2a in 6 (75%) and T2b in 2 (25%) patients. Regional lymph
Suh YS, Choi T, Jeong BC, Lee SW, Jeon SS
Materials and Methods: Between January 2005 and December 2014, 2 907 patients underwent radical prostatectomy (RP) at our institution. Exclusion criteria for the current study were as follows: patients who underwent a prostate biopsy at an outside institution, patients who had prior hormonal or radiation therapy, patients in whom <10 biopsy cores were obtained, and patients with incomplete clinicopathological data. Pathologically insignificant prostate cancer was defined as organ-confined disease with tumor volume less than 0.5 cm3 without Gleason patterns 4 or 5. The probability of insignificant prostate cancer was estimated based on the preoperative characteristics that were identified as predictors by multivariate logistic regression modeling with a stepwise selection procedure. We developed a nomogram to present the prediction rule for the probability of insignificant prostate cancer using preoperative data on patients who underwent radical prostatectomy
Results: The final study population consisted of 1 343 patients. Among these patients, insignificant prostate cancer was confirmed in 188 men (14.0%) at prostatectomy. All preoperative variables tested were significant predictors of insignificant prostate cancer on univariate logistic regression analysis, except total number of biopsy cores obtained. The multivariate model with the highest predictive accuracy had a bootstrap corrected AUC of 88.3%, using number of positive cores, maximal tumor involvement, biopsy Gleason sum, prostate volume, age, and PSA density. This model was used to construct our insignificant prostate cancer nomogram (Figure 1). Conclusion: The current nomogram derived proba-
bility of insignificant prostate cancer would provide more complete information for therapeutic clinical decisions.
MP-10.15 Improving Perineural Invasion Diameter Through PNI MechanismBased Biomarker Development Miles B1, Gao Y2, Bu P2, Ding Y2, Bryant E1, Ayala G2 1
Houston Methodist, Houston, United States; University of Texas, Austin, United States
2
Introduction and Objective: Perineural invasion
(PNI) is the most common mechanism of prostate cancer (PCa) spread. PCa cells in PNI have growth and survival advantage over cancer cells away from the nerve through an increase in proliferation and decrease in apoptosis. Perineural invasion diameter is a biomarker and an independently predictive of biochemical recurrence and PCa specific death. Biomarkers based on known mechanisms for PNI were tested to see if they could improve prediction. Materials and Methods: Over 1000 patients who
underwent radical prostatectomy at Baylor College of Medicine affiliated hospitals were enrolled for this study. Whole mount H&E slides were examined and areas of cancer away from the nerve and PNI were selected to build a tissue microarray (226 cases in a 2 mm array). The PNI array slides were immunostained with a large panel of 24 antibodies including NFκB, Cyclin-D1, Cyclin-E, GSK3, Pim2, FKHR, P-FKHR, P-AKT1, FRAT, p27, NCAM, C-MYC, β-catenin, androgen receptor, and Ki-67. Descriptive, correlative and survival analysis was performed for every marker individually. Cox modeling was used to identify the best combination of markers to predict PSA recur-
MP-10.14, Figure 1.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
57
MODERATED ePOSTERS rence. The predictive ability was quantified by Harrell’s concordance c-index. Results: Data was available in approximately 156 patients. NFκB, apoptotic rate, cyclin-D1, cyclin-E and GSK-3 were all associated with biochemical recurrence by univariate analysis. C-MYC and cyclin-E were independent predictors of biochemical recurrence on multivariate analysis. When the model includes only Pre-PSA level, surgical margin and Gleason score, the c-index is 0.885. Adding PNI diameter to model only improves the c-index to 0.887. When added PNI CMYC Nuclear to the model, the predictive ability of the model improves to 0.91, indicating a good model fit. A nomogram was built with the new model. Conclusions: PNI is a process that provides surviv-
al advantage for cancer cells through activation of numerous pathways. Both pro-proliferation and anti-apoptotic mechanisms seem to have significance. Some of the markers identified have potential prognostic significance and have been added to the PNI diameter in new models that significantly improve on our ability to predict.
MP-10.16 Briganti Nomogram Do Not Exhibit Greater Accuracy than Partin and Memorial Sloan Kettering Cancer Center (MSKCC) in Predicting Positive Lymph Node in Prostate Cancer: A Systematic Review and Meta-Analysis Russo GI, Reale G, Giardina R, Privitera S, Castelli T, Favilla V, Cimino S, Morgia G University of Catania, Italy Introduction and Objective: The individual risk of
finding positive lymph nodes can be estimated using preoperative nomograms. In this context, few models have been proposed to predict positive lymph nodes. The Briganti nomogram with the cutoff of 5%
58
as proposed in the EAU Prostate Cancer guidelines, showed the highest accuracy when compared with other similar prognostic tools. However, it is important that model’s accuracy should be compared using a meta-analysis methodology. The aim of this systematic review was to analyze the discriminative capabilities of Briganti, Partin and MSKCC nomograms in predicting lymph node metastasis by performing a meta-analysis of area under the curves (AUCs) of the models. Materials and Methods: An electronic search of the
Medline and Embase was undertaken until September 2015. The AUC values, total number of patients, number of lymph nodes removed, and number of positive lymph nodes were extracted from the included references. AUCs of the models were converted to odds ratios (ORs). A meta-analysis of the ROC curves was performed based on methods reported by Walter SD et al. For the meta-analysis, ln(OR) was used for data pooling. For each nomogram, the combined OR was transformed back to a converted AUC (cAUC). AUC values were compared using Mantel-Haenszel test. Results: After excluding redundant literature, a total of 21 studies were identified including 61004 patients. In total, the Briganti, Partin and MSKCC nomograms were validated in 6802, 44174 and 10028 patients respectively. In all of the included models, we did not observe any publication bias as assessed by Begg’s and Egger’s methods. The median number of lymph nodes removed was 15 in Briganti and Partin models, while 11 in MSKCC (p<0.05). The Mantel-Haenszel derived comparison of cAUC values revealed no better predictive capability of Briganti nomogram and Partin nomogram (0.794 vs. 0.778; p=0.23), between Briganti and MSKCC (0.794 vs. 0.780; p=0.47) and between Partin and MSKCC (0. 778 vs. 0.780; p=0.91). Conclusions: The accuracy of Briganti, Partin and
MSKCC models are statistically similar. We suggest
considering these results in a clinical decision making setting. Moreover, international guidelines could consider these findings by reporting similarities in the accuracy of these models.
MP-10.17 Treatment Outcome in Prostate Cancer Patients with Permanent Brachytherapy: A Single Center Experience Carl S, Andreas J Dept. of Urology, Emmendingen, Germany Introduction and Objective: To evaluate the outcome of patients with prostate cancer treated with permanent brachytherapy (iodine-125, I-125). Materials and Methods: Between 2006 and 2016, we
treated 637 patients with clinically localized prostate cancer with (I-125) brachytherapy at our institution. T-stage T1c was found in 56%, T2 in 41%, T3 in 3% of the patients. Gleason score was 3+3 =6 in 28% of the patients, 3+4 in 57% and 4+3 in 15% of the patients. No patient with Gleason score higher then 7 was treated with permanent brachytherapy alone. Initial median PSA-value prior to treatment was 9.3 (ng/ ml) (range 2.9 - 26.1). A total of 37 patients received hormonal therapy. Prescription dose for I-125 was 145 Gy. Survival functions were calculated using the Kaplan-Meier method. Results: Median follow-up was 73 months. The 6-year biochemical PSA free survival (PFS) in the low and intermediate risk group was for Gleason 6: 96%, Gleason 3+4 95 % and Gleason 4+3 83%. The PFS rate was significantly higher in the low and intermediate risk group compared to patients with Gleason 4+4. Surprisingly, there was no difference in PFS between lowrisk and intermediate-risk at median follow-up of six years. Conclusions: Permanent brachytherapy is a highly effective and safe therapy in low-risk and intermediate-risk groups for prostate cancer patients.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 11 Reconstruction and Trauma II
MP-11.02
Saturday, October 22 1425–1555
Introduction and Objective: Reconstruction of the
MP-11.01 Reconstruction of Bladder Defects with Amniotic Membrane: IDEAL Phase 0-1 Barski D1, Gerullis H2, Winter A2, Pintelon I3, Timmermans JP3, Ramon A4, Boros M5, Varga G5, Otto T6 1
Dept. of Urology, Lukas Hospital Neuss, Germany; School of Medicine and Health Sciences, Carl Von Ossietzky University, Dept. of Urology, Oldenburg, Germany; 3University of Antwerp, Laboratory of Cell Biology and Histology, Antwerp, Belgium; 4 International Tissue Engineering Research Association (ITERA), University of Antwerpen, Belgium; 5 University of Szeged, Institute of Experimental Surgery, Szeged, Hungary; 6Lukas Hospital Neuss and German Centre For Assessment and Evaluation of Innovative Techniques In Medicine, Germany 2
Introduction and Objective: New biological materi-
als and scaffolds are needed for the reconstruction of urinary tract defects. Amniotic membrane (AM) is assumed to have several unique characteristics like durability, hypoallergenic and anti-inflammatory features allowing its perfect ingrowth in the surrounding tissue. We aimed to prove these qualities in a xenograft model. Materials and Methods: Following the IDEAL rec-
ommendations, we first used multilayer cryopreserved dried AM from human caesarian section to repair defined bladder defects in Sprague male rats. The bladders of the control group were repaired with suture only. The animals (n=48) were sacrificed 7, 21 and 42 days after the implantation. Bladder volume capacity and leakage after grafting were measured. Perioperative complications were assessed. Histological and immunohistological analyses were performed to look for the degradation of AM, inflammatory reaction, graft rejection and the ingrowth of smooth muscle. Results: Two rats died due to sepsis in the treat-
ed group. No severe complications and no signs of leakage were observed. The bladder capacity did not change over time. The initial increase in inflammation in the AM group reduced significantly after time (p<0.05). No signs of AM degradation were observed after 42 days. The smooth muscle staining increased over time. A decent transient glomerulitis could be observed. Conclusion: AM seems to be a durable and hypoal-
lergenic graft for the reconstruction of urinary tract. Further standardized animal and human studies according to IDEAL are necessary to prove the possible indications.
Robotic-Assisted Laparoscopic Reconstructive Surgery in the Lower Urinary Tract: A Single Center Experience Tyagi V Sir Ganga Ram Hospital, New Delhi, India lower urinary tract (UUT) can be complex secondary to need for delicate tissue handling and precise suture placement to create tension free anastomosis in the area of difficult access that is pelvis. The improved dexterity, visualization, and ergonomics of robotic systems have applied naturally to reconstruction and have facilitated intracorporeal suturing compared with traditional laparoscopy. The prime limitation of the use of robots is cost. Thus, it is essential to define the judicious use of robotics. We will be sharing our experience of optimized use of robots in the reconstruction of the lower urinary tract. Materials and Methods: In Sir Ganga Ram Hospital,
25 patients underwent different types of lower urinary tract reconstructive procedures using robot assisted laparoscopic approach at our institute. The surgeries included 13 ureteric reimplanataions, 10 vesicovaginal fistulae and 3 augmentation cystoplasties. In all these robotic surgeries, we worked out the optimized use of robotic instruments in order to limit cost. Results: All the surgeries were uneventful with a smooth postoperative course. No complications have been encountered and all the patients are doing well. Conclusion: Our experience showed that robot-as-
sisted reconstructive urology surgery is feasible and can be safely used without compromising the generally accepted principles of open surgical procedures. The functional outcome was good and severe postoperative complications were rare. Robotic techniques are effective and minimize morbidity for all types of urinary reconstruction.
MP-11.03 Blunt Scrotal Trauma in Adults: A MultiInstitution Experience Evaluating the American Association for the Surgery of Trauma Organ Injury Grading Scale Sallami S1, Khouni H2, Kammoun O1, Bouzaidi K1, Ben Ali M1, Touinsi H1 1
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; FSI University Hospital, Tunis, Tunisia
2
Introduction and Objective: We evaluated the useful-
ness of the American Association for the Surgery of Trauma (AAST) testis injury scale based on preoperative scrotal ultrasonography (US) and physical examination compared to preoperative findings. Materials and Methods: A retrospective review was performed on 107 patients (mean age 29.2 ±5.8 years) with a testes blunt trauma treated between January 2005 and August 2015. Preoperative US was performed in all cases. Then all of them underwent surgical scrotal exploration. All testis injuries were scored retrospectively according to the AAST-OIS for testis injuries on preoperative US and preoperatively according to surgery reports. The two scores are then compared.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Results: The etiologies of the scrotal blunt traumas were dominated by assault (n=52). Other causes included sports accident (n=16), motor vehicle injury (n=15), fall (n=13), occupational accident (n=10) and unclear in one case.
Preoperatively, the US exploration revealed a normal testis (n=38), intra-scrotal hematoma (n=13), tunica albugina rupture (n=35), spermatic cord hematoma (n=6) and epididymal disruption (n=5). US had a sensitivity and specificity of 70.8 % and 71.2% respectively. The positive and negative predictive values of tunica albuginea rupture were 66.7% and 75% respectively. Of 48 grade I patients, 36 had a normal testis contour. Injuries were graded according to the AASTOIS preoperatively as grades III to V in respectively 33, 13 and 5 cases. Testis injury was identified postoperatively as grades III to V in 16, 25 and 7 cases, respectively. US under-diagnosis was seen in 30 patients (28.0%). There was a significant difference between US findings and the OIS finding in the surgery (p=0.003). Orchidectomy was performed in 12 cases, partial orchidectomy in 32 and tunica albuginea repair in 35 patients. The testicle salvage rate was 88.8%. Conclusions: Through this series, US was not a specific and sensitive exam to really precise the severity grade of testis trauma. Pre- and preoperative findings were significantly different. Thus, we continue to support history and clinical findings and we encourage surgical exploration when testis lesion is suspected.
MP-11.04 Challenges Associated with the Surgical Management of KetamineInduced Urinary Tract Disease Sihra N, Rajendran S, Ockrim J, Wood D University College London Hospital, United Kingdom Introduction and Objective: Regular use of recreational ketamine causes severe damage to the urinary tract. Patients present with a spectrum of debilitating symptoms including pain, urinary frequency, haematuria and renal failure. The aim of this study was to evaluate management strategies and outcomes in patients undergoing surgical intervention following damage to their urinary tract associated with ketamine use. Materials and Methods: A retrospective review of
prospectively collected data between 2007 and 2015 was performed. Evaluation included CT urogram, cystoscopic evaluation of bladder capacity +/- biopsy. Indications and outcomes for surgical intervention were assessed. Results: A total of 42 patients were identified. A total of 63% were male and mean age at presentation was 28.7 (range 23-55). All bladder biopsies confirmed an eosinophilic inflammatory infiltrate. A significant proportion of patients (83.3%) were found to have reduced cystoscopic and functional bladder capacity of <300 ml (mean 190 ml, range 70-550). A total of 29 patients were treated conservatively with a view to symptom resolution. Two patients underwent dilatation for urethral strictures. Four patients underwent repeated intra-detrusor onabotulinum toxin injection with minimal subjective symptom relief. Two of these patients proceeded to have major reconstruction. A total of 13 patients underwent reconstruction which
59
MODERATED ePOSTERS included simple cystectomy (5/13), substitution cystoplasty (6/13), augmentation cystoplasty (6/13), ileal conduit diversion (1/13), ureteric interposition using ileum (2/13) and appendix Mitrofanoff formation (6/13). Of these patients, 53.8% (7/13) had one or more complications requiring additional intervention. Complications included urine leak (1/7), anastomotic leak (2/7), adhesional small bowel obstruction (1/7), wound necrosis (1/7), ureteric stricture (3/7) and Mitrofanoff stenosis (1/7). One patient was lost to follow-up and there was 1 death from pneumonia 5 years following and unrelated to surgery. Conclusion: In a tertiary, high volume reconstructive
unit, we found ketamine patients seemed to be at particular risk of significant perioperative complications. There did not appear to be any other common factor apart from their use of ketamine, and the significant inflammatory change associated with this. We recommend meticulous preoperative evaluation and multidisciplinary consultation for all patients to determine optimal treatment strategies.
MP-11.05 Open Repair of Bladder Neck Contractures Following Radical Prostatectomy for Prostate Cancer with or Without Adjuvant Radiotherapy: Our Experience in 42 Patients Ivaz S, Frost A, Dragova M, Bugeja S, Andrich D, Mundy A UCLH, London, United Kingdom Introduction and Objectives: Bladder neck contrac-
tures (BNC) occur in 0.4-32% of patients after a radical prostatectomy (RP). The majority are managed endoscopically but a small number are refractory to treatment. This presentation describes our experience of open excision of the BNC and reconstruction of the vesico-urethral anastomosis (redo VUA) in this group of patients. Materials and Methods: A total of 42 patients, aged
49-76 (mean 63.5 years), presented with refractory BNC between March 2007 and March 2015. A total of 32 had had a RP alone. Ten had had a RP and adjuvant or radiotherapy. Patients with a history of radiotherapy were very carefully selected and only those with a bladder capacity of at least 200 ml and with relatively normal urodynamic parameters were selected for reconstruction. Redo VUA was performed through a transperineal approach as for a pelvic fracture-related urethral injury. An AUS was implanted 3-6 months later to correct sphincter weakness incontinence. Results: Of the 32 post-surgical patients 31 (97%) had a successful outcome. Of the 10 patients who had had radiotherapy as well as RP, 7 patients had a patent anastomosis and 6 (60%) of these were dry following implantation of an AUS. One other patient had 4 consecutive AUS all of which eroded. One patient developed a re-stenosis. Two had incomplete healing of their anastomosis and developed a urosymphyseal fistula requiring further major surgery in both. Conclusion: Patients with a recalcitrant BNC after a
RP with no history of radiotherapy can be treated as with any other traumatic posterior urethral stenosis, in this instance iatrogenic trauma, by revision of the VUA. The results are very satisfactory. With careful
60
selection, some patients who have also had adjuvant radiotherapy can be treated in the same way but they need a careful preoperative evaluation to avoid the very poor outcome in patients who fail such surgery. All patients must be counselled that this will almost certainly be a two-stage reconstruction, the first to dis-obstruct them by revision of the VUA and then secondly to implant an artificial sphincter for the almost inevitable sphincter weakness incontinence following dis-obstruction.
MP-11.06 Pelvic Fracture Injuries of the Female Urethra Ivaz S, Frost A, Dragova M, Bugeja S, Andrich D, Mundy A UCLH, London, United Kingdom Introduction and Objectives: Pelvic fracture-related
injuries are regarded as rare in female patients. We describe our experience with 20 patients, which we believe is the largest series presented so far. Materials and Methods: There were 20 female patients aged 7-51. A total of 18 injuries were due to road traffic accidents, and 2 were due to other types of trauma. All were treated initially elsewhere and came to us for further treatment. In 11 injuries, the urethra was ruptured longitudinally but was still in continuity. There were 9 urethral disruptions, 7 associated with vaginal disruption and 2 with disruption of the vagina and rectum. Those with urethral continuity suffered severe sphincter weakness incontinence and were treated by implantation of an artificial urinary sphincter. The 9 patients with urethral disruption presented with an indwelling suprapubic catheter. In 6 of the 9, the urethra was reconstructed by end-to-end anastomosis and in 3 a Mitrofanoff-type of supra-vesical urinary diversion was performed because the urethra was unsalvageable. Five patients had a simultaneous vaginoplasty and two underwent ano-rectal reconstruction. After urethral reconstruction, 4 patients in the urethral disruption group underwent implantation of an artificial urinary sphincter to restore continence. Results: Of the 15 patients treated by implantation
of an artificial urinary sphincter 4 patients (27%) developed erosion requiring explantation of the device within a year of the sphincter implant. Two further patients developed erosion 3-5 years later making 40% in all. The 2 other patients who had urethral reconstructions and the 3 patients with a Mitrofanoff procedure made an uncomplicated recovery. Conclusion: Urethral trauma in female patients is not
common but the incidence may be underestimated if the urethra had a longitudinal tear rather than a complete disruption. An artificial sphincter is required in most patients but only about 60% survive in the longer term, presumably because of relative ischemia of the damaged tissues.
MP-11.07 Buccal Mucosal Graft Augmentation Urethroplasty for Bulbomembranous Strictures After Radiation Therapy for Prostate Cancer Blakely S1, Spencer J2, Nikolavsky D2, Flynn B1
1 University of Colorado, Denver, United States; 2SUNY Upstate Medical University, Syracuse, United States
Introduction and Objective: Urethral stricture disease that develops as a result of radiation therapy for prostate cancer occurs in the bulbomembranous urethra. These strictures are difficult to treat due to ischemic changes in the local tissues. Anastomatic urethroplasty has been encouraged to avoid free grafting into an ischemia graft bed. We present our series of patients undergoing buccal mucosal graft urethroplasty for post-radiation bulbomembranous urethral strictures. Materials and Methods: We reviewed consecutive
patients undergoing buccal mucosal graft augmentation urethroplasty for bulbomembranous strictures after radiation therapy for prostate cancer at two institutions. Patient factors and recurrence rates are presented. Results: A total of 15 men, mean age 67 years, underwent urethroplasty. Eight men had previously received external beam radiation therapy while 2 were treated with brachytherapy alone and 5 received both. The median time between radiation therapy and urethroplasty was 8 years. All patients had bulbomembranous urethral involvement, and mean stricture length was 6.5 cm. All men had at least one prior intervention (urethrotomy: 10 patients, dilation: 5 patients). Six patients had ventral onlay urethroplasty, 8 patients had dorsal onlay and 1 patient had augmented anastomotic urethroplasty. At median follow-up of 27 months, three patients (23%) had stricture recurrence. Times to recurrence were 3, 5, and 8 months. Two patients were managed by urethrotomy, one by dilation. One patient reported new incontinence after urethroplasty while continence status was unchanged in the remaining patients (7 incontinent, 5 continent) Conclusion: Augmentation urethroplasty was suc-
cessful in greater than 75% of patients with radiation-induced bulbomembranous urethral stricture. Buccal mucosal grafting techniques should be considered in this setting. Larger studies are required to more accurately predict recurrence and incontinence rates.
MP-11.08 Prefabricated Composite GracilisBuccal Mucosa Flap for Reconstruction of Devastated Urethra: Outcomes from Two Institutions Nikolavsky D1, Blakely S1, Joshi P2, Kulkarni S2 1
SUNY Upstate Medical University, Syracuse, United States; 2Kulkarni School of Urethral Surgery, Pune, India Introduction and Objectives: In patients with devastated bulbous urethra (i.e. spongionecrosis, failed skin flap repairs, watering can perineum) repair options include buccal mucosa-dartos composite flap, radial forearm composite flap, enterourethroplasty, perineal urethrostomy or diversions. The outcomes of a novel technique to reconstruct a devastated bulbar urethra from two institutions are presented. This 2-stage technique involves the creation of two independently vascularized urethral hemi-plates lined with buccal mucosa (BMG). Materials and Methods: In stage-1, the affected urethra is dissected and removed or prepared for a dorsal
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS inlay augmentation. Two BMG segments are harvested. One graft is quilted on corpora cavernosa and urethra thus creating augmented perineal urethrostomy. The second BMG is quilted on the exposed distal gracilis muscle. Stage-2 is performed 6 to 8 weeks later, and gracilis-BMG composite is harvested. The muscle is passed into the perineal incision to create a ventral portion of urethral plate. The BMG edges on the flap are anastomosed the edges of the dorsal urethral plate. Preoperative and postoperative patient and stricture characteristics and functional outcomes were reviewed retrospectively. Results: Five patients with a mean age of 50 years old (46-56) underwent 2-stage repairs at 2 institutions. Stricture etiologies were traumatic in 4/5 patients and iatrogenic in 1/5 patients. Patients had a mean of 3.2 (1-9) prior open repairs with use of local skin flaps. Mean stricture length was 7.4 cm (6-9). Two patients had concurrent perineal urethrocutaneous fistulae on presentation. All patients preoperatively had suprapubic tubes. Time between stage-1 and stage-2 repairs was 6.4 weeks (1-10). At a mean follow up of 9.4 months (1-17) there were no complications or recurrences, mean uroflow was 27 cc/sec (12-48), and PVR was 38 cc (0-119). One of five patients was sexually active with SHIM of 21 and maintained the same function postoperatively on follow up at 17 months. Conclusion: We demonstrated feasibility of using
prefabricated gracilis-BMG composite flap for repair of devastated urethra in five patients. This technique avoids the use of hair-bearing skin, GI segments or distant free flaps. Gracilis provides vascular bed ventrally and reduces the risk of developing ventral diverticulum. Independently vascularized urethral hemi-plates require minimal dissection to achieve tension-free anastomosis.
presence of curvature prior to repair, age at repair, and original location of meatus. Results: Site of the original meatus was glanular/ coronal in 15, penile shaft in 10, and peno-scrotal in 4. Repairs were 11 substitution, 8 MAGPI, and 10 “ other”, which consisted of meatoplasty, TIP, Mathieu, Thiersch-Duplay, and/or GAP procedures. Mean age at surgery was 23.4 months, and mean age at follow-up was 18.8 years. Patients were satisfied or very satisfied with regards to penile appearance (80, 70, 75%), length of penile axis (87, 100, 100%), penile skin (87, 80, 100%), glans shape (87, 90, 75%), penile length (73, 90, 50%), shape/position of meatus (80, 90, 100%), confidence in erection (80, 80, 100%), and hardness of penetration (93.4, 100, 100%) for the three surgical repair groups, respectively. No statistical differences were noted for all three categories in function or aesthetics. Distal meatal location was associated with a higher AUA bother score (p=0.039). Patients classified as “other” had higher rates of urinary strain (p=0.020), nocturia (p=0.019), and worse appearance (p=0.032). Conclusions: Hypospadias repair performed in the modern era on children by dedicated pediatric urologists result in good to excellent patient reported outcomes. Most adult patients are satisfied with their sexual and voiding function, regardless of their initial meatal location or surgery type.
MP-11.10 Managing Difficult Urethral Catheterization after Urethroplasty Using the New Urethrotech™ Urethral Catheterisation Device (UCD) Bugeja S, Frost A, Ivaz S, Barker N, Dragova M, Mundy AR
MP-11.09
University College London Hospital, United Kingdom
Long-Term Urinary Function and Sexual Health Follow-Up for Patients Who Underwent Hypospadias Repair During Childhood
Introduction and Objective: It is not unusual to ex-
Grossgold E1, Rensing A1, Leopold Z1, Sartor L1, Vetter J1, Paradis A1, Brandes S2 1
Washington University School of Medicine, St. Louis, United States; 2Columbia University School of Medicine, New York, United States
Introduction and Objectives: Some complications related to hypospadias repair emerge after puberty and continue into adulthood, many affecting urinary and sexual function. There is a paucity of literature on long-term follow-up for patients treated within the last two decades utilizing modern techniques. Our study aims to assess the urinary and sexual health outcomes of adult patients who underwent childhood hypospadias repair. Materials and Methods: A total of 672 men, now
greater than 16 years old, underwent hypospadias repair at our institution between 1988 and 2001. Patients were contacted by phone and then emailed a questionnaire regarding urinary and sexual health selected from validated questionnaires: IPSS, ICIQSF, PDQ, SHIM, Mulhall Hardness Score, SEAR questionnaire, and the PPPS. Of the 672 contacted, 38 completed the surveys and 29 of those had complete data. Cases were stratified based on surgery type,
perience difficulty when introducing the urethral catheter at the end of bulbar and posterior urethroplasty. This is usually secondary to the catheter tip getting stuck in the proximal bulbar urethra due to the anterior curve created by the prostatic urethra, or getting caught between the anastomotic sutures. The new Urethrotech™ Urethral Catheterization Device (UCD) integrates a hydrophilic Nitinol guide wire into a 16F Silicone 3-way Foley catheter design to allow safe catheter passage over the guide wire in difficult urethral catheterization. This study evaluates the performance of the UCD in patients where difficulties were encountered passing a standard Foley catheter after urethroplasty. Materials and Methods: All patients undergoing bulbar and posterior urethroplasty over a 6 month period were enrolled (n=57): redo-vesico-urethral anastomosis (VUA) for post-prostatectomy bladder neck contracture (n=2); pelvic fracture-related bulbo-prostatic anastomotic urethroplasty (BPA) (n=17); non-transecting anastomotic urethroplasty (n=4); augmentation bulbar urethroplasty (ABU) with buccal graft (n=34). Difficulty introducing the catheter after the procedure and any problems using the UCD were recorded. Results: In 1 of 2 patients after redo-VUA, 2 of 17 patients after BPA and 6 of 34 patients after ABU, the
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
standard 2-way Foley urethral catheter would not pass into the bladder. In all these 9 patients (16%) the UCD was used without difficulty. The integrated UCDguide wire passed smoothly into the bladder without getting caught on the suture lines of the anastomosis and the UCD-catheter could be railroaded over it and into the bladder with ease. In one patient, the guide wire channel was used for post-operative bladder irrigation for 24 hours to prevent clot-retention. Conclusion: Difficulty passing a standard 2-way Fo-
ley catheter after bulbar or posterior urethroplasty is not uncommon; in this series it occurred in 16% of patients. The new Urethrotech™ UCD provides a safe and effective alternative in such cases. It also provides the additional possibility to start bladder irrigation if necessary. We now use the UCD routinely for all real or anticipated difficult urethral catheterizations under any circumstances.
MP-11.11 One-Side Dissection Dorsal Onlay Oral Mucosal Graft Urethroplasty for Panurethral Stricture: Experience from Two Centers of Reconstructive Urethral Surgery in Indonesia Satyagraha P1, Adi K2 1
Saiful Anwar General Hospital, Jawa Timur, Indonesia; 2Dept. of Urology, Faculty of Medicine, University of Brawijaya, Saiful Anwar General Hospital, Malang, East Java, Indonesia
Introduction and Objective: To investigate the feasibility and efficacy of using one-sided anterior urethroplasty (Kulkarni technique) for the repair of anterior urethral stricture to preserve vascular supply to the urethra and its entire muscular and neurogenic support. Materials and Methods: A cohort retrospective study from two centers was applied on this study. The data was collected from two centers of reconstructive urethral surgery in Hasan Sadikin Hospital, Bandung, West Java and Saiful Anwar Hospital, Malang, East Java from January 2012 until July 2015. We combined and compared these data to form group 1 from Malang with group 2 from Bandung. In all, 31 patients with mean (range) age 48 (29-72) years underwent one-sided anterior dorsal oral mucosal graft urethroplasty while preserving the lateral vascular supply to the urethra, the bulbospongiosum muscle and its perineal innervation. Of 31 patients, 16 patients from group 1 and 15 patients from group 2. The etiology for the stricture was idiopathic in 2 cases (7%), iatrogenic in four (13%), infection 12 cases (38%) and lichen sclerosus in 13 (42%). The mean stricture length was 11.5 cm. Of 31 patients, 5 patients had received previous treatments. Clinical outcome was evaluated with uroflowmetry and considered a failure when any post-operative instrumentation was needed, including dilatation. Results: The overall mean follow-up was 7.5 (6-12) months. Of the 31 patients, 26 (80%) had successful outcomes and 6 (20%) were failures. The percentage of successful outcomes from group 1 is 87.5% and 73.3% from group 2. Conclusion: In the short-term follow-up, one-sided
dissection urethroplasty using the Kulkarni tech-
61
MODERATED ePOSTERS nique achieved a significant, good result, showing promise and feasibility in two centers in Indonesia.
University College Hospital, London, United Kingdom
MP-11.12
ing complex urological reconstruction can achieve pregnancy within a normal life. This study aimed to evaluate antenatal and intrapartum management, and outcomes of pregnancy following urinary tract reconstruction.
Decision-Making for Bulbar Urethroplasty: BMG-Dorsal Versus Ventral Approach Kulkarni S, Joshi P, Surana S, Homouda A Kulkarni Center for Reconstructive Urology, Pune, India Introduction and Objective: Urethral strictures are most common in the bulbar urethra. Augmentation urethroplasty is the method of choice for non-traumatic and long bulbar strictures. Barbagli’s dorsal onlay and McAninch’s ventral onlay are the preferred techniques for bulbar urethroplasty. There are no clear guidelines for indicating which technique should be used in which scenario. We describe our simplified algorithm for bulbar urethroplasty. Materials and Methods: Patients were from a
high-volume tertiary referral center for urethral reconstruction. Detailed observations were made regarding body mass index (BMI), etiology, size of urethral plate, site, and width of corpora spongiosa. Whether to open the urethra ventrally or dorsally is based on multiple factors. A midline perineal incision is made and the bulbospongiosus muscle is exposed. The urethra is calibrated gently to mark the distal end of the stricture. If the stricture is above the upper border of bulbospongiosus muscle, the dorsal approach is preferred. If the stricture is below the border of the bulbospongiosus, the muscle ventral approach is preferred. In the proximal bulb, the urethra lies dorsally, has abundant spongiosa ventrally; hence overclosure of spongiosa is easy. The advantage of the dorsal approach is less bleeding and that the buccal graft lies flat on corpora. Distally, corpora spongiosa becomes narrower and has no support of the bulbospongiosus muscle. Overclosure of the sponge after ventral BMG patch may be difficult and may fold the BMG in the lumen. The risk of erectile dysfunction is smaller with ventral approach. In equivocal findings, the width of corpora spongiosa is assessed. Patients with a narrow spongiosa of less than 15 mm diameter underwent dorsal approach. In patients with obesity, it is easier to perform ventral onlay. Post TURP proximal bulbar stricture merit ventral onlay. In this approach, we incise only the mucosa and sphincter remains intact. Here the risk of urinary incontinence is less. Results: A total of 536 bulbar urethroplasties were performed between 1995 and 2015. A total of 332 dorsal onlay and 204 ventral onlay. Success rate of dorsal onlay was 80.30%, and ventral onlay was 82.10%. Conclusion: Ventral onlay is preferred for proximal
bulbar urethra. It is the method of choice in obesity, post TURP strictures, and sexually active young men. The dorsal approach is preferred for distal bulbar onwards strictures. The high and comparable success rates of different approaches were attributed to apt selection and individualized treatment for each case.
MP-11.13 Management of Pregnancy in Patients Following Complex Urological Reconstruction
Introduction and Objective: Many patients follow-
Materials and Methods: A retrospective review of
data collected prospectively between 2010 and 2015 identified 34 pregnancies in 29 patients (median age 31.2 years, range 17–46). Primary abnormality included exstrophy-epispadias (9/29), spinal dysraphism (4/29), sacral agenesis (2/29), Fowler’s syndrome (1/29), neuroblastoma (2/29), bladder cancer (1/29), congenital incontinence / small bladder / short urethra (8/29), congenital vesico-ureteric reflux (1/29) and urogenital sinus (1/29). Previous urological reconstruction included augmentation cystoplasty (15), ileal conduit (1), Mitrofanoff channel (15), ureteric reimplantation (4), colposuspension (2), artificial urinary sphincter (2) and antegrade continence enema channel (1). Five patients had a solitary kidney. Results: There were 35 (1 set of twins) live-births comprising 17 girls and 18 boys. Mean gestation at delivery was 36 weeks (33 - 38) and mean birthweight was 2.78 kg (1.79 – 3.50). The majority were delivered by elective Caesarean section (94.1%, 32/34) performed jointly by a urologist and obstetrician. Two women sustained bladder injury during surgery with no long-term complications. Another two women developed vesicocutaneous fistulas which resolved spontaneously (6.25%, 2/32). One woman required early (37 weeks) Caesarean section due to worsening hydronephrosis. Pregnancy-related urological complications included UTI requiring hospital admission (11.8%, 4/34) and upper tract obstruction requiring nephrostomy (20.6%, 7/34). Three women had difficulty with the Mitrofanoff, requiring indwelling catheters. No woman had significant deterioration in renal function. Conclusion: Pregnancy can be safely managed with
preservation of renal function in women with pre-
vious urinary tract reconstruction. These women are prone to complications and require shared care and careful monitoring throughout pregnancy to diagnose and manage complications proactively. Patients should be made aware of the impact of pregnancy and the high rate of pregnancy related complications. Although some of these women could potentially achieve a vaginal birth, we favour planned Caesarean section, jointly performed by an obstetrician and urologist, in patients with complex urinary tract reconstruction, in order to avoid the potential maternal and fetal risks of a complex emergency Caesarean section.
MP-11.14 The Impact of Age on Transecting Versus Non-Transecting Bulbar Urethroplasty Levy M1, Vanni AJ2, Stensland K2, Erickson B3, Myers JB4, Voelzke B5, Smith TG6, Breyer BN7, McClung C8, Alsikafi NF9, Elliott SP1 1
University of Minnesota, Minneapolis, United States; Lahey Clinic, Burlington, United States; 3University of Iowa, Iowa City, United States; 4University of Utah, Salt Lake City, United States; 5University of Washington, Seattle, United States; 6Baylor College of Medicine, Houston, United States; 7UCSF, San Francisco, United States; 8Central Ohio Urology Group, Columbus, United States; 9Loyola University, Maywood, United States 2
Introduction and Objectives: A successful transect-
ing bulbar urethroplasty by excision and primary anastomosis (EPA) depends on collateral blood flow. A successful non-transecting bulbar urethroplasty by ventral or dorsal buccal mucosa graft augmentation (BMG) likewise depends on neovascularization of the BMG. Older patients have increased incidence of comorbid conditions including peripheral vascular disease that are associated with reduced penile blood flow. We sought to determine the effect of age on bulbar urethroplasty success in general and, specifically, in transecting versus non-transecting.
MP-11.14, Table 1. Age <60 (n=258)
Age >60 (n=64)
P-value*
1.8 (1.0, 7.9)
1.8 (1.0, 7.3)
0.86
EPA
94.9
100.0
0.58
Buccal Mucosal Graft
71.7
84.0
0.21
Follow-up in years (median, range) Success based on cystoscopy at 3 months (%)
Success based on cystoscopy at 1 year (%)
EPA
92.4
85.0
0.38
Buccal Mucosal Graft
71.4
70.4
0.92
Repeat surgery at 1 year (%)
EPA
1.6
0
-
Buccal Mucosal Graft
13.2
8.6
0.46
EPA
7.8
6.9
0.88
Buccal Mucosal Graft
24.8
22.9
0.81
Repeat surgery during entire follow-up (%)
*P-value is from chi-square test that compares the percentages of the two groups.
Rajendran S, Sihra N, O’Brien P, Wood D
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36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS Materials and Methods: Bulbar urethroplasties were
retrospectively reviewed from 11 institutions that collaborate on a multi-institutional reconstructive urology database (TURNS). We limited patients to those with at least 12 months of follow-up after transecting EPA or non-transecting BMG. Our primary outcome was any procedure for re-stricture (dilation, urethrotomy or urethroplasty); our secondary outcome was anatomic success defined by urethral caliber greater than 17 F confirmed by cystoscopy. We compared results stratified by age. Results: N=322; 258 < 60 y/o, 64 > 60 y/o. Median
follow-up was 1.8 years, and there was no difference in follow-up time between the two groups. The following were not different between groups: stricture length, location of stricture, smoking status, number of previous dilations/urethrotomies, and type of urethroplasty. The following comorbidities were more common in the age >60 group: diabetes, hypertension, hyperlipidemia, coronary artery and peripheral vascular disease, chronic obstructive pulmonary disease, and cancer. There was no difference between age groups with regard to receipt of repeat procedures or anatomic recurrence, both overall and when stratified by urethroplasty type (Table 1). Conclusions: Both transecting and non-transecting
bulbar urethroplasty can be performed with high success rates regardless of age. This is despite a higher incidence of diabetes, cardiovascular and peripheral vascular disease in the elderly.
MP-11.15 Pathological Findings in Patients with Penile Fracture Nale D Urology Clinic, Belgrade, Serbia Introduction and Objectives: Penile fracture is defined as traumatic rupture of the tunica albuginea of the corpora cavernosa. It is not rare but it is remarkable. Prompt surgical exploration and corporal repair is the most efficacious therapy. The objective was to assess surgical characteristics of site and direction of rupture in the tunica albuginea and to estimate if there is a typical localization where rupture occurs. Materials and Methods: Prospectively, 23 surgically treated patients with penile fracture were evaluated. Mean age was 36 ± 8.34 years (range 23-52). Intraoperative localization of rupture, involvement of one and/or both corpora cavernosa, presence of urethral injury and direction of ruptured area in tunica albuginea were registered. The surgical approach in 17 patients was circumferential incision with denudation of penis and in 6 patients, it was anterior scrotal incision with aversion of the penis. Results: The most frequent and significant site of rup-
ture was registered in the proximal and mid penile body. Involvement of only one corpus cavernosum was registered in all 22 (95.53%) patients. A tunical tear of the right corpus cavernosum was detected in 17 (73.91%) patients. Concomitantly urethral injury was found in 3 (13.04%) patients. With respect to the longitudinal axis of the erectile penis, transversal direction of the ruptured area was registered in all observed cases.
Conclusions: With respect to the longitudinal axis of the erectile penis, direction of ruptured area is always transversal. This finding implicates that even though there is no typical localization of rupture, somehow, minor physiologic penile curvature might be a site of low resistance due to unstable structural integrity of the tunica albuginea.
MP-11.16 Routine Urethrography After Buccal Graft Bulbar Urethroplasty: The Impact of Initial Urethral Leak on Surgical Success 1
1
1
1
Grossgold E , Eswara J , Ho T , Strother M , Geminiani J1, Siegel C1, Vetter J1, Brandes S2 1 Washington University School of Medicine, St. Louis, United States; 2Columbia University School of Medicine, New York, United States
Introduction and Objectives: The long-term im-
pact of contrast extravasation noted at initial 3 week post-substitution bulbar urethroplasty is unknown. We present a novel classification system for post-urethroplasty extravasation and report the association of leak severity with surgical outcome. Materials and Methods: A total of 83 patients un-
derwent buccal mucosal graft (BMG) urethroplasties of the bulbar urethra from 2007 to 2014. Mean BMG length was 4.8 cm (1-11 cm), with 48 ventral and 35 dorsal. Median time to initial post-surgical urethrogram was 23 days (14-38 days). If leak was seen, catheterization was prolonged for a median 7 days (0-47 days), at 1-week intervals until leak resolution. All leaks were characterized by length and width. Optimal cutoffs for leak length and width were calculated using ROC curves. Each initial post-op RUG was graded 0-3 (0=no leak) with one point given for each: any leak, leak length ≥0.47 cm, and leak width ≥1.05 cm. All RUGs were graded by the same GU radiologist (CLS). Failure was defined as stricture recurrence on cystoscopy (<16 Fr). One-year failure rates were compared using Fisher’s test. Kaplan-Meier survival curves were also constructed to measure the impact of variables on stricture recurrence. Results: Mean age was 45.2 years. Of 83 urethro-
plasties, 29 had postoperative extravasation on initial imaging. Median RUG leak grade was 0 (0-3). With median follow-up of 13.9 months, 15 patients had stricture recurrence, 6 of whom had leak on initial urethrogram. There was no difference at 1-year for failures, as to any leak (p=0.209), leak length (p=1.000), or leak width (p=1.000). Grade 3 leaks were associated with higher failure rates compared to grade ≤2 leaks using Kaplan-Meier curves (p=0.036), with the curves significantly diverging around the 1-year mark. Conclusions: While there is no indication that leaks noted at 3 weeks post-BMG urethroplasty are associated with short term failure (<1 year), leak length and width at initial postoperative RUG appear to be a predictor of longer term stricture recurrence (>1 year).
MP-11.17 Management of Post TURP Strictures
Introduction and Objective: Urethral stricture is a
known complication of transurethral prostate surgeries. According to Hofmann, the incidence of post TURP stricture varies between 2.2% and 9.8%. Most cases present within 6 months. Presentation is likely with poor flow and recurrent urinary tract infection. The literature has focused on management in the form of dilatation, CIC (clean intermittent catheterization) and urethroplasty. We present our data of management of post TURP strictures. Materials and Methods: Patients were from a
high-volume tertiary referral center for urethral reconstruction. A retrospective study was undertaken from January 2000 to June 2014 for the management of post TURP stricture. A total of 69 referred patients with post TURP stricture were included in this study. Preoperatively, clinical examination, uroflow and RGU/MCU were performed. Site of stricture was accurately identified, and management was decided accordingly. Results: The series comprised men aged 51 to 74 years (mean age 66.94).The mean preoperative Qmax was 7.3 (range 2-15). The mean length of stricture was 2.9 cm (range 1 to 8) for bulbar and penile stricture, while average length for panurerthral stricture was 13.31 cm (11 to 15). Out of 69 patients, 28 had proximal bulbar, 25 had mid to distal bulbar, 9 had panurethral stricture, 5 had penobulbarjunction and 2 had penile stricture. Out of 69 patients, 27 underwent dorsal onlay buccal mucosa graft (BMG) urethroplasty, 23 ventral onlay BMG urethroplasty, 6 underwent double face, 5 augmented anastomotic urethroplasty and 9 panurethral stricture repair using one sided Kulkarni BMG urethroplasty. Eight patients underwent endoscopic management. Mean BMG length was 6.25 cm (4 to 8) and width was 1.5 cm (1.3 to 1.8). The post operative hospital stay was 48 hours. All patients were called after 4 weeks for catheter removal. Patients were followed up at 3, 6, and 12 month intervals with uroflow and urine culture. Overall success rate for all type of treatment modalities was 70%. Success rate improved to 76.9% for urethroplasties. Conclusion: Urethral stricture is a well-known com-
plication after transurethral surgeries. Post TURP stricture can occur at any part of the urethra. True strictures of membranous urethra occur rarely. Strictures very close to the sphincter may require dilatation/CIC. For other sites, BMG mucosa urethroplasty is the best option for these patients, and should be strongly considered over dilatation, urethrotomy VIU and CIC.
MP-11.18 A Decade of Urethroplasty Retrospective Analysis of 236 Patients: Experience of More than a Decade at Liaquat National Hospital and Liaquat University of Medical & Health Sciences Memon I Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
Kulkarni S, Surana S, Joshi P, Hamouda A
Introduction and Objective: To review the outcome of urethroplasty over the past 10 years.
Kulkarni Center for Reconstructive Urology, Pune, India
Materials and Methods: A total of 236 patients underwent urethroplasty for urethral stricture disease
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
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MODERATED ePOSTERS from January 2002 to December 2015. We reviewed 204 patients with a mean age of age 32 years (12-71 years), with the mean follow-up of 20 months. Stricture etiology was trauma in 78% (RTA 57%, instrumentation 11%) and infection (22%). Average stricture length was 2.5 cm. A total of 27 patients already underwent urethroplasty before presenting to our center. Patients with inadequate information, associated bladder neck injuries, neurogenic bladder and lost to follow were all excluded from the study (32 out of 236). Treatment was considered successful in patients with no obstructive symptoms, Qmax > 15 ml/sec; and those patients with obstructive symptoms with Qmax < 15 ml/sec which settled on single internal urethrotomy. Results: Of the 204 patients, 189 (92.6%) underwent successful procedures. A total of 117 (61.9%) were treated with end to end anastomotic urethroplasty, 41 (21.7%) with substitution urethroplasty, 27 (14.3%) underwent nontrasecting urethroplasty and 4 (2.1%) required an orandi procedure. Treatment failure was dealt with by redo; Urethroplasty (9 cases), internal urethrotomy (3 cases), and 3 cases of treatment failure were lost to follow-up. Aside from failure (8%), no other serious complication were observed.
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Conclusion: Urethroplasty has a success rate of 92.6%.
Most patients were satisfied with the surgical outcome. Results are comparable with multiple studies internationally.
MP-11.19 Analysis of Complications Following Urethroplasty in Stricture Urethra of Bulbar Region Shah SA, Shah U Bodyline Hospitals, Ahmedabad, India Introduction and Objective: We present a single
institutional experience of 5 years of intra and post operative as well as delayed complications following Urethroplasty of stricture involving bulbar urethra. We wanted to analyze the complications of stricture surgery and improve our surgical results. Materials and Methods: Retrospective review of charts from May-2010 to May-2015 in 60 consecutive Urethroplasty of bulbar region performed by a single surgeon. Mean follow up of 36 months. Initially we chose more of excision and anastomosis and augmentation and anastomosis. Later on we selected non transecting dorsal graft for mid bulbar and distal bulbar urethra and Ventral graft for proximal bulbar
urethra. For delayed complications, following this surgery we prepared a questioner and minor complications were also addressed. Results: Complications were charted as per type of urethroplasty. They were divide as per location of stricture and etiology of stricture. Early major complications such as infection leading to dehiscence of wound, occurred in two patients. Immediate bulbar necrosis (noted in x-ray) after 2 weeks occurred in two patients. Restricture occurred in 3 patients. Minor immediate complications like failure to void, foley’s catheter coming out, scrotal swelling, and urgency in immediate post operative period occurred in 10 out of 60 patients. Nine had delayed minor complications like Perineal Hyposthesia, Post Void Dribbling, Urinary Tract Infection, Erectile Dysfunction, Stream Splaying & Ejaculatory Dysfunction. In sum 31% (total 19 out of 60) had minor complications. Conclusion: Incidence of serious complications ap-
pear similar to those reported elsewhere but minor delayed complications are more than expected, in our series. Analysis of complications help us in improving results of surgery. Hence we decided not to transect urethra as far as possible.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 12 Basic Science Saturday, October 22 1615–1745 MP-12.01 ‘Peering Through the Fog’: An Updated Modeled Perspective of Laparoscopic Lens Fogging and Its Preventative Measures in Standard and Robotic Laparoscopes Manning T, Papa N, McGrath S, Khan M, Campbell N, Perera M, Lawrentschuk N Dept. of Urology, Austin Health, Melbourne, Australia Introduction and Objective: Laparoscopic lens fogging (LLF) during laparoscopic and robotic procedures hampers vision, impedes operative efficiency and increases risk of inadvertent patient injury. Attempts to reduce intra-operative LLF have led to the development of various anti-fogging fluids, warming devices and intra-operative techniques. Despite this growing body of potential solutions, comparative effectiveness has been poorly addressed in current literature. We aimed to construct a model peritoneum to simulate LLF and to compare the efficacy of various anti-fogging techniques for standard and robotic laparoscopes. Materials and Methods: A model peritoneum was
created using a plastic 80 liter container filled with water. Intraperitoneal space was formed using a suction bag with multiple ports and was suspended within the water. The model was then incompletely filled with heated sausages to simulate intraperitoneal viscera. The humidity and temperature was recorded and regulated at an ambient temperature of 40.1°C and humidity of 87-88%. Various anti-fogging products were assessed including FREDTM, ResoclearTM, chlorhexidine, betadine and heated water. These products were used on either a laparoscope at room temperature or applied to a scope after use with a disposable Matrix scope warmer. Visual acuity was evaluated by the same investigator for all testing and rated according to a standardized scale. Fogging of the laparoscope was assessed for each product 30 times and a mean vision rating was recorded. Results: FREDTM was statistically significantly better
than all other methods (p<0.001) and was improved further with the addition of the scope warmer. Chlorhexidine, Reso clearTM and the Scope warmer were equivalent and were superior to warming the scope using warmed water at 58°C. No further improvement was observed in acuity between warmed or nonwarmed scopes for Chlorhexidine or Reso clearTM. The environment that affected standard laparoscopes did not incite fogging in the robotic scope and thus it was statistically significantly superior to the standard laparoscope in our model. Conclusion: In standard laparoscopes, the most su-
perior preventative measure was FREDTM utilized on a pre-warmed scope. Despite improvements in LLF with other products FREDTM was statistically signifi-
cantly better than all other techniques. The robotic laparoscope performed superiorly regarding LLF compared to standard laparoscope.
MP-12.02 Correlation Between Androgen Receptor CAG Repeat Length Polymorphism and Metabolic Syndrome, Late Onset Hypogonadism in Korean Males Park JJ, Ahn ST, Chae JY, Kim JW, Oh MM, Park HS, Kim JJ, Moon DG Dept. of Urology, Korea University College of Medicine, Seoul, South Korea Introduction and Objectives: It is generally assumed
that there is a negative linear association between androgen receptor (AR) sensitivity and the CAG repeat length. However, the correlation between CAG repeat length and clinical factors of metabolic syndrome, late onset hypogonadism is unclear. In this study we explored the relationship between androgen receptor (AR) CAG repeat length polymorphism and MS, late onset hypogonadism (LOH) in a Korean male population. Materials and Methods: The association between AR
CAG repeat length polymorphism and MS was analyzed in 356 Korean men from 2013 to 2015. MS was diagnosed according to the NCEP criteria (any three or more of the following components were present: abdominal obesity (waist circumference (WC) > 102 cm), triglycerides > 150 mg/dl, HDL cholesterol < 40 mg/dl, fasting glucose > 110 mg/dl, or blood pressure of > 130/85 mmHg). LOH was diagnosed by serum testosterone level of <3.5 ng/ml and androgen deficiency in the aging male questionnaire positive. AR CAG repeat length polymorphism was determined by microsatellite fragment sizing and association with clinical factors and questionnaire related with LOH (patient health questionnaire-9 (PHQ), aging male symptom scale (AMS), and international index of erectile function (IIEF)) were analyzed. Results: Mean age of the patients was 58.8±11.0 years. Mean AR CAG repeat length and serum testosterone levels were 29.1±5.9 and 5.3±2.2ng/ml, respectively. A total of 69 men (19.4%) were diagnosed with MS and 35 men (9.8%) were diagnosed with LOH. Men with MS showed significant difference in AR CAG repeat length compared with men without MS (p=0.006). As CAG repeat length increased, NCEP criteria score increased significantly (r=0.088, p=0.022). Men with LOH showed no significant difference in AR CAG repeat length compared with men without LOH (p=0.598). AR CAG repeat length was not associated with HDL, LDL, (p=0.134, p=0.700), but showed significant association with triglyceride (r=0.098, p=0.011), HbA1c (r=0.088, p=0.022). As CAG repeat length was increased, AMS and PHQ scores were decreased and IIEF score was increased significantly (r=-0.150, r=-0.132, r=0.108)(p=0.001, p=0.006, p=0.021). Conclusion: In conclusion, AR CAG repeat length
seems to be associated with MS and clinical symptoms of LOH in Korean males.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
MP-12.03 Platelet-Rich Plasma Anchors Adipose Stem Cells Injected in the Urinary Sphincter in a Pudendal Nerve-Transected Rat Model of Stress Urinary Incontinence to Restore Sphincteric Function Villoldo G, Albite R, Jaunarena J, Pereyra-Bonnet F, Sordelli A, Loresi M, Dadamo M, Gonzales W, Lelpi M, Moldes J, Debadiola F, Giudice C Hospital Italiano de Buenos Aires, Argentina Introduction and Objectives: Adipose derived stem cells (ADSC) are non-immunogenic and have the ability to self-renew and to differentiate into multiple cell types. They have been used to restore urinary sphincter function in animal models. But there is not strong evidence regarding the role of the vehicle that must be used in combination with ADSC to improve effectiveness at the injection site. Our goal is to assess whether platelet-rich plasma (PRP) can anchor adipose stem cell (ADSC) to promote urethral sphincter restoration in a stress urinary incontinence (SUI) rat model. Materials and Methods: Thirty-five female inbred Wistar rats were used in our study. Animals were divided into seven groups (five animals per group): continent (C), sham (S), PNT (D), PNT+PBS injection (P), PNT+PBS+ADSC injection (PA), PNT+PRP injection (R) and PNT+PRP+ADSC injection (RA). Twenty-five female rats underwent bilateral pudendal nerve section (PNT) to induce SUI. ADSCs were purified from fat tissue of a 4-week-old inbred male Wistar rat, labeled CM-Dil and injected into the urinary sphincter in twelve o’clock position with 70 microlitres of PBS or PRP. Four weeks after injection, cystometry was undertaken in all animals and leak point pressure (LPP) measured to assess urethral resistance function. All groups were sacrificed after cystometry, urethra sections were submitted for histology, immunohistochemistry assessment. Results: LPP was increased significantly in R, RA and PA animals after implantation (P < 0.01), but was not different from group C and S. Histological and immunohistochemical examination demonstrated increased numbers of surviving ADSCs, increased muscle/collagen ratio, as well as increased microvessel density at the injection sites in RA compared to PA animals (CM-Dil +). Conclusions: PRP may potentially improve the action of transplanted ADSC to restore the histology and function of the urethral sphincter in a SUI rat model.
MP-12.04 Luteinizing-Hormone-Releasing Hormone (LHRH) Antagonist Degarelix Inhibits the Growth of Castration-Resistant Prostate Cancers: A Preclinical Report Rick FG1, Popovics P2, Cui T2, Vidaurre I3, Block NL2, Schally AV4 1
Miami VA Medical Center, United States; Florida International University, Miami, United States; 2 University of Miami, United States; 3Miami VA Medical Center, United States; 4Miami VA Medical Center, United States; University of Miami, United States
65
MODERATED ePOSTERS Introduction and Objective: Degarelix is a third gen-
eration antagonist of LHRH (also termed GnRH) for the treatment of advanced androgen-dependent prostate cancer. Degarelix binds pituitary receptors for LHRH, blocking the action of hypothalamic LHRH. Clinical trials demonstrate that treatment with degarelix results in improved disease control as compared with LHRH agonists in terms of superior PSA progression-free survival. Degarelix delays progression to castration-resistant prostate cancer (CRPC) and causes greater inhibition of serum alkaline phosphatase and follicle-stimulating hormone. Herein we investigated the effects of degarelix on the growth of human CRPC in vivo. Materials and Methods: Nude mice bearing human, androgen dependent, VCaP, and, castration-resistant, DU-145 and 22Rv1, prostate cancer cell lines were randomized into 5 groups (control, degarelix 2 mg/ kg, degarelix 10 mg/kg, LHRH agonist leuprolide 50 μg/day, and surgical castration). Treatment was continued for 8 weeks in the DU-145 and VCaP models and 4 weeks in the 22Rv1 model. Tumor volume was measured weekly. The presence of LHRH receptors was validated by Western blotting. Results: The receptors for LHRH were detected in all
three prostate cancer models. Degarelix at doses of 2 mg/kg and 10 mg/kg significantly suppressed growth of androgen-sensitive VCaP tumors compared to controls after 8 weeks of treatment (84% and 89% inhibition, respectively; p<0.001 for both). Leuprolide induced a less marked inhibition (63%) and surgical castration, an inhibition of 83% (p<0.001 for both). In the DU-145 model degarelix (10 mg/kg) inhibited growth by 50% (p<0.01) after 8 weeks. Leuprolide or surgical castration did not produce significant tumor growth inhibition. Because of rapid 22Rv1 tumor growth, we terminated the experiment after 4 weeks of treatment; degarelix at doses of 2 mg/kg and 10 mg/ kg induced significant growth inhibition of 22Rv1 tumors (65% and 71%, respectively; p<0.05 for both). Leuprolide and surgical castration had no effect. Conclusion: Degarelix induces inhibition of growth of
CRPC models. This could be caused by better inhibition of serum FSH levels than castration or leuprolide or by direct effects on prostate tumor. Various biochemical and histologic evaluations continue. Our preliminary findings suggest that selected groups of patients with CRPC could respond to degarelix.
MP-12.05 Histochemical Evaluation of Urethral Skeletal Muscle in Stress Urinary Incontinence Iatsyna O1, Vernygorodskyi S2, Yalovenko K3, Pirogov V1 1 Institute of Urology, Kiev, Ukraine; 2National Pirogov Memorial Medical University, Vinnytsya, Ukraine; 3 Week-end Clinic, Ukraine
Introduction and Objective: Stress urinary inconti-
nence (SUI) is a common problem that can have a serious impact on quality of life in people. Collagen and elastin are two main proteins composing the extracellular matrix (ECM) of connective tissue. The purpose of this study is to analyze the effects of electrical stimulation (ES) of the pelvic floor on the urethral skeletal muscle (USM), describe the morphological changes
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of the USM, evaluate the distribution of types I and III collagen and elastic fibers and its possible involvement in the pathogenesis of SUI.
topathological parameters (histological subtype, tumour stage, grade and lymph node status), HPV and cancer-specific survival.
Materials and Methods: Periurethral muscle biopsies were taken from sixty women (range 42-72 years old) during tension-free vaginal tape (TVT) procedure and gynecologic operations. All patients were divided into the following groups: 36 women with SUI that underwent the TVT procedure with ES (SUIES), 13 women with SUI and TVT but did not receive ES (SUI) and 11 were content women that underwent gynecologic operations (CV). The presence of collagen type I and III was determined by immunohistochemical technique. Morphometric evaluation was carried out with the help of image analysis software (Quick PHOTO MICRO 2.3) the slides were analyzed and photographed with a light microscope (Olympus BX41™).
Results: PIK3CA copy number gain was found in 84/199 (42%) of penile cancer cases. No correlation was found between PIK3CA copy number gain and high-risk HPV status (p=0.1172). Different penile cancer histological subtypes showed significant difference in PIK3CA copy number gain (p=0.0028), with higher prevalence of PIK3CA copy number gain found in basaloid 10/19 (53%) and the usual 60/127 (47%) than verrucous type 4/29 (14%). PIK3CA copy number gain correlated with tumour grade and stage (p<0.0001 and p=0.0397, respectively), but not with lymph node status (p=0.2902). PIK3CA copy number gain showed a tendency to associate with cancer-specific survival (HR=1.76, 95% CI; 0.94 to 3.3; p=0.0753). In multivariate analysis, PIK3CA copy number gain was found to have no prognostic value for cancer-specific survival (p=0.677). Only lymph node metastasis, high tumour grade and stage were found to be independent prognostic factors for cancer-specific survival.
Results: We revealed an irregular, fragmented distribution of the protein elastin in all patients with increasing age, irrespective, if they had SUI or not. In SUI and SUIES groups, we identified the lower ratio of type I over type III collagen around the urethra compared with that of CV. The percentage of muscle fibers was measured in all the groups. There was a significant difference only between SUIES and SUI without ES (p < 0.05). The SUIES group had greater skeletal muscle content and percentage in each muscle fascicle. On electromyography, patients with SUIES had significantly more fibrillation potentials, fewer motor unit action potentials, a higher percentage of polyphasia, and less maximum voluntary electrical activity than CV SUI and SUI without ES. Conclusion: Prolonged functional electric stimulation
of the pelvic floor induced an increase in periurethral muscle thickness in SUI women. We can recommend using the peripheral ES as a valid alternative in the treatment of female SUI before TVT procedure.
MP-12.06 The Prognostic Value of PIK3CA Copy Number Gain in Penile Cancer Adimonye A1, Sujenthiran A2, Stankiewicz E1, Kudahetti S1, Rajab R2, Corbishley C2, Lu YJ1, Berney D1, Watkin N2 1
Dept. of Molecular Oncology, Barts Cancer Institute, London, United Kingdom; 2Dept. of Urology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom Introduction and Objectives: The phosphatidyli-
nositol-4,5-bisphosphate 3- kinase, catalytic subunit alpha (PIK3CA) oncogene shows copy number gain and amplification in human papilloma virus (HPV) induced cancers leading to deregulation of the PI3K pathway, which is known to regulate cell proliferation, survival, motility and angiogenesis. We aimed to determine whether PIK3CA copy number gain in penile cancer has prognostic value and correlates with histopathological parameters, HPV and clinical outcome. Materials and Methods: PIK3CA copy number status was assessed with fluorescence in-situ hybridization in tissue microarrays generated from archival paraffin embedded blocks of 199 patients with primary penile cancer. HPV DNA was detected with INNO-LiPA assay. Follow-up data were available for 174 patients. PIK3CA copy number status was correlated with his-
Conclusion: PIK3CA copy number gain could be
used as a marker of high-risk disease as it correlates with more aggressive penile cancer histological subtypes and higher tumour grade and stage. However, it shows no significant association with lymph node metastasis or prognostic value for cancer-specific survival in penile cancer.
MP-12.07 Effects of Caffeine on Bladder Function and c-Fos and NGF Expression of the Central Micturition Areas in Rats Park CH1, Cho YS1, Joo KJ1, Kwon CH1, Park HJ1, Kim HJ2 1
Dept. of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Dept. of Urology, Dankook University College of Medicine, Yongin, Korea
Introduction and Objective: Caffeine has long been implicated as a source of irritation to the urinary bladder. It is known that caffeine may promote incontinence through its diuretic effect, especially among people with underlying detrusor overactivity. It also increases the velocity of muscle contractions in bladder smooth muscle. Few studies have been reported about the possible central mechanism of caffeine involved in the regulation of voiding behavior. Thus, the present study is to investigate the effects of caffeine on central micturition reflex by the degree of neuronal activation and nerve growth factor (NGF) expression in the central micturition areas. Materials and Methods: Nine-week-old adults female Sprague-Dawley rats (n=32) were used for experimental animals. The animals were randomly divided into four groups (n = 8 in each group): the control group, the 10 mg/kg caffeine-treated group, 50 mg/kg caffeine-treated group, and 100 mg/kg caffeine-treated group. The rats in the caffeine-treated groups orally received caffeine once a day for consecutive 14 days at the respective doses of the groups. Parameters of awake urodynamics were investigated after treatment in each group. Immunohistochemistry for c-Fos and NGF were performed for the detection of neuronal
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-12.07, Figure 1. Effects of Caffeine on c-Fos Expression in Neuronal Micturition Areas
is to evaluate the effect of melatonin and cladribine (adenosine-based purine, pyrimidine nucleoside analogue) on apoptosis and the changes in related proteins induced by ischemia/reperfusion injury in rat bladder. and Methods: One hundred male Sprague-Dawley rats were divided into 5 groups: control group (sham operation), I/R (ischemia/reperfusion) group, I/R plus melatonin treated (I/R+M) group, I/R plus cladribine treated (I/R+C) group and I/R plus melatonin and cladribine treated (I/R+M&C) group. Melatonin (10 mg/kg) and cladribine (10 μg/ kg) were injected intraperitoneally 3 times/week for 2 weeks after ischemic injury of bladder. On post operative day 14, tissue samples were obtained by cystectomy. TUNEL assay, mRNA and protein expressions associated with apoptosis and phosphorylation of some kinases were evaluated using RT-PCR and Western blot.
Materials
MP-12.07, Figure 2. Effects of Caffeine on NGF Expression in Neuronal Micturition Areas
Results: Cytokines related to apoptosis such as JNK1, p38 are decreased by melatonin, cladribine. Cytokines related to cell survival under stress conditions such as ERK1, Protein Kinase B1 (Akt1) are increased by melatonin and cladribine. The I/R+M&C group had more activated cytokine-related apoptosis pathways such as JNK1, p38, Akt1 and Sphingosine kinase 1 (Sphk1) than the I/R group on mRNA and protein expression. Also, the expression of Caspase 3 and Sphk1 showed similar patterns between the I/R+C and I/R+M&C groups. Synergy of combined therapy was not proven, but melatonin might directly suppress the expression of HIF-1α, whereas cladribine might increase expression of Sphk1 and consecutively SphK1 suppressed HIF-1α. In TUNEL assay, a section of the group I/R tissue exhibited a significant increase in the number of TUNEL positive cells compared to the control group. The I/R+M&C group showed significant decreased apoptosis compared to the other groups. Conclusions: In conclusion, these results show that melatonin is one of the most potent protectors against ischemia/ reperfusion injury of bladder and cladribine may have benefits in the treatment of ischemia/ reperfusion injury to the biochemical and histopathologic parameters. They deserve to be considered as therapeutic agents in clinical trials aimed at improving the outcome of patients with ischemia/reperfusion injury of the bladder.
MP-12.09 activity in the central micturition areas (medial medial preoptic area; MPA, ventrolateral periaqueductal gray; vlPAG, pontine micturition center; PMC). Results: The contraction pressure and contraction time in cystometry were increased by the injection of caffeine (P<0.05). The increasing effect of caffeine on contraction pressure and time appeared most potent with the lowest dose of 10 mg/kg (P<0.05). The c-Fos and NGF expression in all central micturition areas was significantly enhanced by the injection of caffeine (P<0.05), and the enhancing effect of caffeine on c-Fos and NGF expression appeared most potent with the lowest dose of 10 mg/kg (P<0.05). Conclusion: From the results of the present study,
we suggest that caffeine facilities bladder instability through enhanced neuronal activation and expression
of NGF in the neuronal micturition center. Indeed, neuronal activation in the brain micturition center has been shown to potentiate the bladder stimulation afforded by caffeine.
MP-12.08 The Effects of Melatonin and Cladribine on Apoptosis in Ischemia/ Reperfusion Injury in Rat Bladder Kim HW, Kim HJ, Chang YS Konyang University Hospital, Daejeon, Korea Introduction and Objective: Hypoxia and reoxygen-
ation are physiological phenomenons that occur in various situations. The reaction of the cell according to these condition is a critical physiological process for the survival of the cells. It is achieved through a number of signaling pathways. The aim of this study
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Neuregulin 1 Upregulates the Expression of Muscarinic Receptors in Rat Bladder with Partial Bladder Outlet Obstruction Yang S, Song KH, Na YG, Lim JS, Shin JH, Park JM Chungnam National University Hospital, Daejeon, Korea Introduction and Objective: The aim of this study is to evaluate the expression of muscarinic receptors and neuregulin 1 (NRG1) in the rat bladder and the changes of their proteins and mRNA induced by partial bladder outlet obstruction (PBOO). Materials and Methods: Male Sprague-Dawley rats (body weight 250 g-300 g) were used and subdivided into control (n=10) and PBOO groups (n=20). After PBOO was induced for 3 weeks, bladder weight and expression of protein and mRNA of muscarinic
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MODERATED ePOSTERS receptors, NRG1 and ErbB-2 were evaluated by using Western blotting and RT-PCR. A portion of the bladder was dissected into bladder urothelium and the smooth muscle layer before the molecular studies. Results: Bladder weight in the PBOO group was significantly increased compared to control. As revealed by H&E staining, the muscle layer of bladder was markedly thickened compared to control bladders. On RT-PCR and Western blotting, the expression of M2 and M3 receptors and NRG1 in urothelium and muscle layer was significantly increased in the PBOO group compared to the control group (p<0.05). The expression of ErbB-2 receptors was also increased in the PBOO group (p<0.05). Conclusion: There were significant changes in the
expression of muscarinic receptors and NRG1 induced by PBOO. Our results suggest that the changes in NRG1 and ErbB-2 expression in the urothelium and muscle layer may play a role in mediating the afferent sensory responses in the urinary bladder. NRG1 upregulates muscarinic receptors and may play a role in detrusor overactivity induced by PBOO.
MP-12.10 Altered Expression of Small Leucine Rich Proteoglycans (SLRPs) in Muscle Invasive Urothelial Carcinoma of Urinary Bladder Seth A1, Appunni S2, Anand V2, Khandelwal M2, Rao N1, Sharma A2 1
Dept. of Urology, All India Institute of Medical Sciences, New Delhi, India; 2Dept. of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
Introduction and Objective: Decorin (decorative protein of collagen type I) and Biglycan (protein containing two GAG chains) belong to the family of SLRPs that form important components of normal extra-cellular matrix. Decorin is capable of suppressing the growth of various tumor cell lines and has been shown to have anti-tumorigenic properties in murine models. It has a high-affinity interaction with VEGF receptor2, angiopoietin and platelet-derived growth factor. Biglycan has been reported to compete with decorin for the same binding site on collagen. The aim of this study was to find out if the levels of these SLRPs are altered in muscle invasive urothelial carcinoma of urinary bladder. Materials and Methods: After IRB clearance fifteen patients of biopsy proven muscle invasive carcinoma of urinary bladder undergoing radical cystectomy were enrolled in the study. After informed written consent their serum samples were obtained at the time of induction of general anesthesia. Serum samples of fifteen healthy volunteers were used as controls. Levels of Decorin and Biglycan were measured in both these groups of serum samples using highly sensitive sandwich ELISA kits. After surgery tumor and “normal” tissue samples were obtained from the excised urinary bladder and preserved in RNA later. RNA was extracted from these pairs of tissues and relative mRNA expression was assessed using Real Time-PCR (BioRad). Results: See Table 1 and Table 2. Conclusions: The circulatory levels of Decorin was significantly reduced (p<0.001) and that of Biglycan was significantly elevated (p=0.03) in patients as com-
MP-12.10, Table 1. ELISA Results SLRP
Serum Patients (n=15)
Serum Controls (n=15)
P value
Decorin
0.477 (0.111-1.122)
0.818 (0.209-1.382)
<0.001
Biglycan
0.963 (0.302-1.498)
0.688 (0.247-1.123)
0.03
Values in ng/ml median (range)
MP-12.10, Table 2. Real Time PCR Results SLRP
Tumor tissue (n=15)
“Normal” tissue (n=15)
P value
Decorin
1.25502 (0.064-13.53)
0.818 (0.209-1.382)
0.002
Biglycan
0.963 (0.302-1.498)
0.688 (0.247-1.123)
0.003
Relative mRNA expression (2-∆Ct Expression)
MP-12.11, Figure 1. Percentage Difference Between Cells Treated with Morphine (mM) and Control Cells (MMT Assay)
pared to controls. Relative mRNA expression from tissue specimen revealed significantly lower expression for Decorin (p=0.002) and higher for Biglycan (p=0.003) in tumor tissue as compared to “normal” tissue. These may be the initial steps or the final expressions.
MP-12.11 The Effect of Morphine and Its Inhibitors on RT112 Bladder Cancer Cell Growth Birch B1, Cooper A2, Lwaleed B3, Harper P4, Giatsidou I3 1
Dept. of Urology, University Hospital Southampton, United Kingdom; 2Dept. of Biomedical Sciences, Portsmouth University, United Kingdom; 3Faculty of Health Sciences, University of Southampton, United Kingdom; 4School of Medicine, University of Southampton, United Kingdom Introduction and Objective: Clinical studies suggest that opioid use may affect rates of metastasis in breast and prostate cancer. Through micro-opioid receptors, morphine may affect angiogenesis, migration and proliferation of neoplastic cells. However, little published work relates to bladder cancer. Here we aim to assess effects of morphine on a urothelial cell line proliferation in vitro and modulation of any such effect by the receptor blockers naloxone and naltrexone. Materials and Methods: Residual viable biomass (rvb) of adherent RT112 transitional cell carcinoma cells was measured on tetrazolium-based assay, following exposure over three days to serial dilutions of morphine, naloxone and naltrexone, and combinations including two-way titrations of drug and blocker to form a matrix of reagent proportions. Results: Morphine elicited a growth response, reducing rvb at high concentration (>125 μM), crossing into significant growth stimulation (P<0.001) at ~20 μM, stimulation becoming significant at ~4 μM. Titrating morphine four hours after treatment with blocker resulted in reduced rvb at lower concentrations. Some reversal of stimulated growth was also achieved when the treatment order was reversed. In two-way titrations, the greatest growth was seen where the ratio of morphine to blocker was highest. Conclusion: Morphine has a stimulatory effect on
the growth of RT112 cells in vitro, which can be at least partially reversed with naloxone and naltrexone. These phenomenological results invite further mechanistic studies and clinical audits in bladder cancer as is currently being done in breast cancer.
MP-12.12 Artemisinin Derivatives Inhibit Bladder Cancer Cell Proliferation and Human Umbilical Vein Endothelial Cell (HUVEC) Pseudo-Tubule Formation Birch B1, Cooper A2, Lwaleed B3, Humphreys C2 1 University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; 2Dept. of Biomedical Sciences, University of Portsmouth, United Kingdom; 3Faculty of Health Sciences, University of Southampton, United Kingdom
Introduction and Objectives: Semi-synthetic deriva-
tives of the drug artemisinin contain an atypical endoperoxide bridge, which is considered responsible
68
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS factor-α, interleukin [IL]-6, and IL-8) levels, anti-oxidant effects (superoxide dismutase) and histological findings were noted.
MP-12.12, Figure 1. Dihydroartemisinin
Results: The use of ciprofloxacin, WSY-1075, and WSY-1075 with ciprofloxacin showed statistically significant decreases in bacterial growth and improvements in the reduction of prostatic inflammation compared with the control group (P<0.05). The WSY1075 with ciprofloxacin group showed a statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the ciprofloxacin group (P<0.05). Conclusion: These results suggest that WSY-1075 may
for their anti-malarial activity. Recent work suggests that artemisinin derivatives may possess anti-cancer properties involving both anti-proliferative and anti-angiogenic activity. The proposed mechanism is that that ferrous iron reduces the endoperoxide bridge generating oxygen/carbon-centered radicals that create permeation pathways within cellular membranes. The objective here was to assess the influence of three artemisinins on bladder cell proliferation in vitro and on a HUVEC angiogenesis assay. Materials and Methods: Three artemisinin deriva-
tives, dihydroartemisinin (DHA), artesunate (ART) and artemether (ARTE), were tested for effects on the in vitro proliferation in RT112 bladder cancer cells using the MTT residual viable biomass assay and on angiogenesis using HUVEC pseudotubule formation in Matrigel. Preincubation with holotransferrin was included in the experimental protocols, as it might theoretically increase efficacy. Results: DHA, ART and ARTE all inhibit RT112 pro-
liferation. The effect was dose dependent, ARTE being the least effective, achieving only 60% of control biomass at highest concentration used (25 μg/ml). DHA (see Figure 1) and ART gave IC50s of approximately 6 μg/ml. DHA or ART at 10 μg/ml. Angiogenesis was inhibited in HUVECs subjected to. Preincubation with holotransferrin did not increase the effect of DHA. Conclusion: These results support the potential val-
ue of artemisinins in the treatment of cancer through either cytotoxic or anti-angiogenic actions. No augmentation of the activity was seen by the addition of holotransferrin, but such an effect cannot be discounted where receptor density is raised.
MP-12.13 In Vitro Study to Determine the Effect of Tadalafil on the Human Ureter Kumar S, MS S, Prabha R, Kekre N Christian Medical College, Vellore, India Introduction and Objectives: Basic science research
studies are commonly performed on animal models, which may not be directly applicable to human subjects. PDE 5 inhibitors are known to cause smooth muscle relaxation through cyclic GMP and cyclic AMP mediated pathways. The aim of our study is to assess the relaxant effect of tadalafil on human ureteric smooth muscles.
Materials and Methods: Eight human upper and middle ureteric specimens were studied in organ bath medium. After stimulation of ureter with KCl ureters were tested with various dose concentrations of tadalafil. Contractility of the ureter was assessed by the frequency, amplitude and area under contractile curve (AUCC). Results: All ureters were responsive to KCl. With a 20 micromole concentration there was significant reduction in mean amplitude, frequency and AUCC noted with p-values of 0.026, 0.008 and 0.008, respectively. Also, with 40 micromoles of tadalafil there was significant reduction in frequency, amplitude and AUCC (p-values were 0.008, 0.016 and 0.008, respectively). There was no significant excessive relaxation of ureter by increasing the concentration from 20 to 40 micromolar (p-values were 0.05, 0.172 and 0.115 respectively). Conclusion: Tadalafil causes relaxation of the human
ureter. Hence it can be used for medical expulsive therapy in ureteric calculi. There was no corresponding relaxation of ureter by increasing dose of tadalafil. Thus, increasing the dose may not provide additional benefit.
MP-12.14 The Anti-Inflammatory and AntiMicrobial Effects of WSY-1075 on a Chronic Bacterial Prostatitis Rat Model Bae WJ, Jeong HC, Choi SW, Kim KS, Bashraheel F, Kim SJ, Cho HJ, Ha US, Hong SH, Lee JY, Kim SW Dept. of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Introduction and Objective: The aim of this study was to investigate the anti-inflammatory and anti-microbial effects of a new herbal formula (WSY-1075) in a chronic bacterial prostatitis rat model. Materials and Methods: Thirty-two male Wistar
rats were used in the study. Experimental chronic bacterial prostatitis was induced by instillation of bacterial suspension (Escherichia coli 108 per ml) into the prostatic urethra. Animals were followed for 4 weeks. After the induction of prostatitis, the rats were randomly divided into one of four treatment groups: control (n=8), ciprofloxacin (n=8), WSY-1075 (400 mg/kg) (n=8), and WSY-1075 (400 mg/kg) + ciprofloxacin (n=8). After 4 weeks of treatment, the prostatic pro-inflammatory cytokine (tumor necrosis
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
have anti-inflammatory and antimicrobial effects, as well as a synergistic effect with ciprofloxacin. Therefore, we suggest that the combination of WSY-1075 and ciprofloxacin may be effective in treating chronic bacterial prostatitis to obtain a higher rate of treatment success.
MP-12.15 Serenoa Repens + Selenium + Lycopene Promote Apoptosis Through Decrease of Inhibitors of Apoptosis Proteins (IAPs) in Men with Benign Prostatic Hypertrophy/ Lower Urinary Tract Symptoms Morgia G1, Minutoli L2, Irrera N2, Micali A2, Rinaldi MG2, Privitera S2, Favilla V1, Castelli T1, Cimino S1, Russo GI1, Squadrito F2 1
University of Catania, Italy; 2University of Messina, Italy
Introduction and Objective: The apoptosis machinery is a promising system regarding the medical treatment of benign prostatic hypertrophy (BPH). As part of the apoptotic cascade, inhibitors of apoptosis proteins (IAPs) modulate apoptosis via the direct inhibition of caspase cascade. We have previously demonstrated that Serenoa Repens (SeR) combined with lycopene (Ly) and selenium (Se) significantly blunted prostate overweight and growth in rats with experimental testosterone-dependent BPH. Moreover, SeRSe-Ly association showed the highest efficacy in reawakening apoptosis by reducing levels of NAIP and survivin. The aim of this study was to evaluate the effectiveness of SeR-Se-Ly association on NAIP and survivin expression in men with BPH. Materials and Methods: We conducted a cross-sec-
tional analysis among men not eligible for the PROCOMB trial. Patients with LUTS due to bladder outlet obstruction (BOO) secondary to clinical BPH, assessed by urodynamic and pressure flow evaluation, refractory to medical treatment, with PSA between 4 ng/ml and 10 ng/ml were included in this post-hoc analysis. All patients underwent 12 cores prostatic biopsy with two more cores collected from transitional zone for the measurement of IAPs levels. In the current analysis, we included 90 patients negative for prostate cancer on the end-of-study and with histological diagnosis of BPH. Patients were off-site randomized into two groups with 1:1 ratio each consisting of 45 patients. During single-blind treatment, patient received SeR-Se-Ly for 3 months (Group A) or placebo for 3 months (Group B). Identical tablets were used to ensure that the blinded regimen was identical for all treatment groups. One tablet of SeR-Se-Ly (Profluss®) consisted of 320 mg of supercritical CO2
69
MODERATED ePOSTERS lipidic extract Serenoa Repens containing 85% of fatty acids sterols, selenium (50 mcg) and lycopene (5 mg) (Ayanda AS, Norway) and distributed by Konpharma Srl (Rome, Italy). After 3 months patients underwent transurethral resection of the prostate for their LUTS/ BPO. Surgical specimens (taken by at least three different randomly selected sites of the adenomatous tissue) were collected with sterile procedure and used for IAPs levels determination. Results: After 3 months, NAIP and survivin were significantly increased in prostate tissues from Group B when compared with Group A (p<0.05). The treatment SeR-Se-Ly combination was effective in decreasing NAIP expression respect to control group (p<0.05). We found that survivin was localized inside the cytoplasm, as diffuse spots, and likely in the mitochondria. The SeR-Se-Ly association induced the greatest inhibition on survivin fluorescence (p<0.05). We showed a full derangement of the prostate tissue and a profound hyperplasia in BPH patients while SeR-Se-Ly decreased the impaired histological pattern and the marked hyperplasia. Conclusion: Manipulation of the mechanism of apop-
tosis may represent an effective strategy for the control of BPH. In fact, the association SeR-Se-Ly proved to be effective in promoting apoptosis in men with BPH.
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36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 13 Kidney & Ureteral Cancer—Treatment Saturday, October 22 1615–1745 MP-13.01 The Role of the American Society of Anesthesiologists Classification (ASA) as a Prognostic Tool for Renal Cell Carcinoma: A Large Cohort from a Latin American Renal Cancer Group (LARCG) Beltrame D1, Clavijo D2, Guimarães G1, da Costa W1, Vieira da Silva D1, Werneck da Cunha I1, Nolazco A3, Zequi S1, Decia R2, Gueglio G2, Rozanec J4, Serra I4, Bengió R5, Mingote P5, Secin F6, Rovegno A6, Montes de Oca L7, Carvalhal G8, Pompeo AC9, Ferreira U10, Stopiglia R10, Glina S11, Nogueira L12, RodríguezCovarrubias F13, Castijeros Molina R13, Oliveira Reis L14, Faria E15, de Campos Zampoli H16, Gadu J17, Palou J18, Autran Goméz AM19, Enguita C19 1
A.C. Camargo Cancer Center, São Paulo, Brazil; 2 Hospital Pasteur, Montevideo, Uruguay; 3Hospital Británico, Buenos Aires, Argentina; 4Hospital Autral, Buenos Aires, Argentina; 5Centro Urológico Profesor Bengió, Córdoba, Argentina; 6Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina; 7Centro de Urologia (CDU), Buenos Aires, Argentina; 8PUC-RS, Porto Alegre, Brazil; 9 Faculdade de Medicina do ABC, Sao Paulo, Brazil; 10 Universidade Estadual de Campinas, Campinas, Brazil; 11Hospital Ipiranga, Sao Paulo, Brazil; 12 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 13Departamento de Urología Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudade de Mexico, Mexico; 14 Pontifícia Universidade Católica, Campinas, Brazil; 15 Hospital do Cancer de Barretos, Barretos, Brazil; 16 Instituto Arnaldo Vieira de Carvalho (IAVC), Sao Paulo, Brazil; 17Hospital Militar Central, Ciudad de Mexico, Mexico; 18Fundación Puigvert, Barcelona, Spain; 19Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain Introduction and Objectives: Renal Cell Carcinoma (RCC) accounts for 3% of malignant neoplasms in adults, and its incidence has increased over the past last 20 years. The impact of comorbidities in the evolution of many tumors has been demonstrated, however, the prognostic value in RCC patients is still poorly studied. This study evaluated the influence of comorbidities assessed by American Society Anesthesiologists Classification (ASA) on the survival rates of RCC patients who underwent surgical treatment. Materials and Methods: In this international collaborative study, the database of Latin America Renal Cancer Group (LARCG) was considered. In total, 2 580 RCC patients during the period 1980 to 2015 were assessed. All of the surgically treated patients had been previously evaluated by a team of anesthesiologists and classified as ASA 1, ASA 2, or ASA 3. Statistical analysis was performed using SPSS 21 package. The p<0.05 was considered statistically significant.
Results: Incidental tumors represented 31%, while 268 cases (10.7%) presented with metastases at diagnosis. Of the patients, 383 (15%) were classified as ASA 1, 1666 (65.1%) as ASAS 2, and 512 (20%) as ASA 3. An association between the ASA classification and the main clinicopathological variables of RCC was observed.. The mean age of patients ASA 1, ASA 2 and ASA 3 were 51.1, 59.2, and 64.5 years, respectively (p <0.001). The surgical time and length of stay of the ASA 3 patients were also higher when compared to ASA 1 and ASA 2 patients (p<0.001). Metastases at diagnosis occurred in 17.7% of the ASA 3 patients, versus 5.1% (19 of 369) the ASA 1 patients. ASA 3 patients had two times more metastases than ASA 1 or ASA 2 patients, respectively. The univariate analysis for overall survival (OS) and cancer specific survival (CSS) revealed significant differences in the survival curves according to the ASA classification (p<0.001). Presence of necrosis, high-grade neoplasms, pathologic stage, perirenal fat invasion, and metastasis at diagnosis remained as independent predictors of survival. Moreover, the multivariate analysis revealed a negative impact of the ASA classification on OS (p=0.003). Conclusion: This study confirmed in a large cohort
= 0.06). More patients with single kidneys and poor renal function were undertaken in group 4. Conclusion: We report the largest RPN series in the
UK. We demonstrate that despite taking on more complex cases, we have reduced length of stay, WIT and operative times. Most small renal masses can now be safely and effectively achieved robotically with reduced morbidity.
MP-13.03 Robotic Versus Laparoscopic Nephrectomy from a Single Center: Comparing Apples with Oranges? Akiboye D, Al-Khalidi F, Lam W, Dargan J, Blecher G, Catterwell R, Van Rij S, Challacombe B Guy’s and St Thomas’ Hospital, London, United Kingdom Introduction and Objective: Laparoscopic nephrectomy (LN) is currently the standard approach for localized renal tumours or simple nephrectomy. The role of robotic-assisted nephrectomy (RAN) has yet to be determined. We compared surgical outcomes of robotic nephrectomy with the conventional laparoscopic approach.
the value and impact of the ASA classification as an independent predictor of OS in RCC patients who underwent surgical treatment as previously described. Moreover, the ASA classification was associated with the main prognostic variables and might be able to predict worse outcomes in RCC.
Materials and Methods: Data were collected retro-
MP-13.02
Results: A total of 70% of LN & 84% of RAN were performed for malignancy. The RAN group had a significantly higher ASA grade (p<0.05) with a higher TNM stage and tumour size observed. A total of 44% of RAN tumours were stage ≥T2b (including 1 requiring caval thrombus resection, 2 IVC repairs, 2 splenectomies, 1 BMI >70 and 4 retroperitoneal lymphadenectomies) compared with 32% in the LN cohort. There was an increased length of stay, 4 vs. 3 days (p<0.05) in the RAN cohort, likely due to the higher ASA grades. One LN required open conversion (caval injury), with none in RAN cohort. No significant differences in preoperative and postoperative Hb, eGFR, operating time, estimated blood loss or Clavien-Dindo complications (2 vs. 3 grade III/IV) were identified between groups.
Extending Indications in Robotic Partial Nephrectomy: The Development of the Practice After 200 Cases Akiboye D, Al-Khalidi F, Lam W, Dargan J, Blecher G, Catterwell R, Van Rij S, Challacombe B Guy’s and St Thomas’ Hospital, London, United Kingdom Introduction and Objective: Robotic partial nephrectomy (RPN) is becoming the gold standard in the management of small renal masses. Here we assess the development of RPN within our center over the past 5 years to assess quality outcomes and changes in case complexity. Materials and Methods: A prospective database of >200 elective cases from Guy’s Hospital was chronologically split into 4 groups of 50 patients: peri-, intra- and post-operative outcomes of the groups were compared. We compared length of stay, tumour size, warm ischaemic time (WIT), operative time and PADUA score. Results: The mean age was 55.8 years, 181 cases were performed transperitoneally with 2 conversions to radical nephrectomy for tumour factors. There were no conversions to open surgery, 1 transfusion, 5 positive margins, and 3 Clavien IIIa/b complications. In comparing groups 1 and 4, mean PADUA score increased from 7.11 to 7.63 (p = 0.045), mean length of stay decreased from 3.76 to 2.6 days (p < 0.001), mean WIT decreased from 18.3 to 16.4 minutes (p = 0.0245), mean operative time decreased from 180 to 162 minutes (p = 0.012). We also found a non-significant mean increase in tumour size of 2.8 to 3.32cm (p
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
spectively in patients undergoing LN and RAN between 2011 and 2014 at a single center, including 116 patients who underwent nephrectomy; 56 (48%) RAN vs. 60 LN. Comparative analyses were performed using the Mann-Whitney-U test and Chi-squared test.
Conclusions: Surgical outcomes of RAN and LN are comparable despite more challenging tumours and co-morbid patients in the robotic group. RAN may provide the surgeon with greater ability to attempt more difficult cases and manage intra-operative complications that may otherwise lead to open conversion.
MP-13.04 Intra-Operative Ultrasound Control of Surgical Margins During Partial Nephrectomy Doerfler A, Alharbi F, Le Gal S, Guleryuz K, Chahwan C, Tillou X Dept. of Urology and Transplantation, Caen University Hospital, France Introduction and Objective: To evaluate a simple, fast and low-cost technique to ensure negative surgical margins on partial nephrectomies, while correlat-
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MODERATED ePOSTERS MP-13.02, Table 1.
Averages WIT
Padua score
Tumour size
Group 1
7.108695652
18.33333333
2.87755102
180.3571429
3.76
Group 2
8
17.67380952
2.912244898
180.6818182
3.085106383
Group 3
7.46875
18.72195122
3.244444444
170.0789474
2.945945946
Group 4
7.631578947
16.4
3.323404255
161.7045455
2.609756098
ing margin statuses with the final histopathological report. Materials and Methods: This study was conducted at our institution for patients undergoing partial nephrectomy (PN) with T1-T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and an ultrasound was performed to evaluate whether the tumor’s pseudocapsule was intact, and then compared to the final histopathological results. Results: A total of 177 PN(s) (147 open procedures
and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 42 patients and the mean warm ischemia time was 19+/- 6 minutes. The mean US examination time was 41+/7 seconds. The US analysis of surgical margins were negative in 172 cases, positive in 4 and in only one case it was not possible to conclude. The final histopathological results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53+/-1.43 cm and the mean surgical margin was 2.8+/-1.5 mm. Conclusion: The intraoperative ultrasound control
of resection margins in PN is a simple, efficient and cost-effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.
MP-13.05 Laparoscopic Nephron Sparing Surgery: Experience in 26 Clinical T1b and T2a Renal Tumors Vitagliano G, Guglielmi JM, Rios Pita H, Rico L, Blas L, Ameri C Hospital Alemán, Buenos Aires, Argentina Introduction and Objective: Partial nephrectomy (PN) has become the standard of care for T1a renal cell tumors. The nephron sparing technique has been expanded to include patients with renal cancer stage T1b and T2a with the same oncological outcomes as radical nephrectomy (RN). Currently, minimally invasive techniques have also been sought for these cases. Materials and Methods: We report the outcomes of
26 laparoscopic partial nephrectomies (LPN) for T1b and T2a renal tumors performed at the German Hospital of Buenos Aires.
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Operation Length
LOS
Results: CT average maximum tumor radius was 6 cm (4.3 to 10 cm). All procedures were performed laparoscopically, and average operating time was 118 minutes (70-150 min) with an average 23 minutes (17-35 min) of warm ischemia time. A total of 7 procedures were performed with a renal polar clamp. Average intraoperative bleeding was 137 ml (0 to 700 ml). Final pathological results were all T1b tumors with 5.25 cm average tumor size. All surgical margins were negative. Average creatinine rise in the postoperative day one was 18%. Mean hospital stay was 3.6 days (3 to 5 days). Complications were 1 degree I (large subcutaneous hematoma that evolved favorably), 3 Grade II (1 deep-vein thrombosis requiring anticoagulant, 1 presented with fever and required antibiotic, 1 perinephric hematoma that was self-limiting but required blood transfusion), and 3 grade IIIb complications (2 perirenal collections requiring percutaneous drainage under general anesthesia and postoperative incisional hernia that required surgical repair). Conclusion: In select T1b cases, LPN can be safely
performed. Results are comparable to those published for T1a.
MP-13.06 Nephron Sparing Surgery in Renal Masses over 6 Cm: Experience in 36 Cases Ameri C, Vitagliano G, Rico L, Rios Pita H, Lopez FM, Blas L Hospital Alemán, Buenos Aires, Argentina Introduction and Objective: Nephron sparing sur-
gery (NSS) has become an established surgical treatment for patients with renal occupying masses due to both oncological and functional results. The objective is to present our experience in NSS in renal occupying masses of 6 or more centimeters in maximum diameter, analyzing for surgical results. Materials and Methods: A total of 36 cases were op-
erated between 2006 and 2016 at our institution. Age, sex, mean size, topographic location, percentage of penetration into the parenchyma, use of ureteral catheter, pedicle clamping strategy, surgical approach, operative time, blood loss, histopathology (Fuhrman grade and stage UICC) and functional results were evaluated. Results: Of the 36 cases, 23 (64%) were male and 13 (36%) were female. Mean age was 58 years (30 to 67). Location was polar in 26 cases (72%) and mesorrenal in 10 (28%). Intraparenchimal penetration was less than 50% in 22 cases (61%), between 50 and 75% in 8 (22%) and more than 75% in 6 (17%). In 8 (22%) cases a ureteral stent was previously inserted. All
procedures were open, with a majority of cases being performed through a flank incision 34 (94.5%). Renal pedicle management was achieved by clamping artery and vein in 14 cases (39%), by segmental clamping in 3 (8%) and without clamping in 19 (53%). Mean surgery time was 130 minutes (75 to 190 minutes). Mean estimated blood loss was 250 ml (150 to 1500 ml). Average size was 6.8 cm (6 to 12 cm). Final pathological analysis showed malignancy in 29 cases (80.5%): clear cell carcinoma in 24 (66%) and chromophobe 5 (14%) T1b: 16 (55%); T2: 9 (31%); T3a: 4 (14%); Fuhrman 1: 8 (27%); 2: 17 (58%); 3: 4 (15%); oncocytomas 3 (8%), angiomyolipoma 3 (8%) and 1 (4%) inflammatory tumor. All cases showed normal excretion of contrast on CT or MRI 3 months after surgery. Conclusions: In well-selected cases, nephron sparing surgery is technically feasible in tumors larger than 6 cm, achieving acceptable functional results with a low rate of severe complications.
MP-13.07 Non-Clamping Partial Nephrectomy by Hydrodissection: A Comparison to Classic Open Partial Nephrectomy Zambon JV1, Aben K2, Heidenreich A3 1
Zuyderland Medical Centre, Heerlen, The Netherlands; 2I.K.N.L., Utrecht, The Netherlands; 3 Uniklinik Köln, Cologne, Germany
Introduction and Objective: For small renal masses partial nephrectomy is standard of care. Apart from oncological radicality, preservation of renal function is an important goal. Partial nephrectomy by hydrodissection with Erbejet (Erbe GmbH, Germany) offers the possibility of tissue selective preparation without the need of renal ischaemia, thus not jeopardizing renal function. In this international cohort study partial nephrectomy by hydrodissection is compared to classic partial nephrectomy. Materials and Methods: A group of 42 patients who
underwent an open partial nephrectomy by hydrodissection was compared to a group of 155 patients after classic open partial nephrectomy with respect to duration of surgery, hospital stay, blood loss, complication rate, radicality and renal function. The RENAL score was comparable in both groups; the median tumor size was larger in the classic group, 3.2 cm versus 2.5 cm (p=0.003). Results: In the hydrodissection group the median duration of surgery was shorter (90 versus 135 minutes, p=0.00) as was the median hospital stay (7 versus 8 days, p=0.00). The median blood loss in the hydrodissection group was 200 ml versus 150 ml in the classic group (n.s.). The postoperative kidney function and Clavien complication rate did not show a statistically significant difference between both groups. The percentage of positive surgical margins was considerably higher in the hydrodissection group (33% versus 3%, p=0.00), but the recurrence rate in this group was merely 3.3% after a median follow up of 43 months. In the classic group no recurrence has been found. Conclusion: Non-clamping partial nephrectomy by
hydrodissection offers the benefit of a relatively short hospital stay and relatively short duration of surgery. The hydrodissection technique did not show a statistically significant better preservation of renal function
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS in this study, when compared to the non-clamping classic procedures or the clamped classic procedures. Histologic examination is difficult after hydrodissection because of the precise dissection of the waterjet at the natural cleavage plane between tumor and renal parenchyma leading to a significant higher percentage of positive margins. This did not result in a high rate of tumor recurrence until now.
MP-13.09
MP-13.08
Introduction and Objectives: The primary objective
Benefits from a Modification of Kim’s Partial Nephrectomy Technique for Polar Kidney Tumors
was to compare the preoperative Charlson comorbidity index (CCI) with the presence of postoperative complications after partial or radical nephrectomy in patients over 70 years old. Secondary objectives were to compare CCI and the need for interdisciplinary evaluation, consults to the emergency department and/or need of readmission.
Ameri C, Lopez FM, Vitagliano G, Rios Pita H, Guglielmi JM Hospital Alemán, Buenos Aires, Argentina Introduction and Objective: In 1966, Dr. Kim de-
scribed a surgical technique for open partial nephrectomy designed to avoid vascular clamping. The technique passes two straight needles through the base of the tumor creating three pedicles that ligate the base and then proceed to the partial nephrectomy with minimum bleeding. Using the same principle, instead of ligating blindly through the tumor’s base, we perform a purse-string suture 7-10 mm proximal from the tumor with a depth of 5-10 mm, avoiding the risk of penetrating into the tumor. The objective is to evaluate the surgical outcomes of these techniques and compare them. Materials and Methods: A retrospective and descriptive analysis was performed reviewing medical records and prospective databases including all patients treated with both these partial nephrectomy techniques by one surgeon between 2005 and 2015. Surgical time (minutes performing the technique and the resection), tumor size, estimated blood loss (EBL), positive surgical margins (PSM), re-resection necessity, argon plasma coagulation (APC) use, calyceal treatment and complications related to technique were there considered variables. Results: A total of 55 patients fulfilled the criteria, 30 with Kim’s technique and 25 with modified technique. Mean surgical time for Kim’s was 21 minutes (range 15-42) and 18 (10-28) for modified. Mean tumor size for Kim’s was 5.3 cm (3-8) and 5.6 cm (4-9) for modified. Average EBL was 180 ml (50-700) and 120 ml (50-600), respectively. There were 6 cases of PSM requiring re-resection for Kim’s technique and 1 for modified. Re-resection with Kim’s techniques forced the need for new hemostasis control because of cut sutures. APC was used in 12 cases with modified and none in original technique, mainly to avoid liberating the pedicles. Calyceal opening and suture happened in 5 and 6 cases, respectively. There were no technique-related complications. Conclusion: From our experience, both techniques
showed adequate surgical results for off clamp partial nephrectomy in polar tumors. The modified technique showed less PSM and allowed an easier re-resection.
Rozzano, Milano, Italy; 4Dept. of Urology, Darent Vally Hospital, Dartford, United Kingdom; 5Dept. of Urology, Frimley Park Hospital, Camberley, United Kingdom; 6Dept. of Urology, Odense University Hospital, Denmark; 7Dept. of Urology, Bristol Urological Institute, Bristol, United Kingdom; 8Dept. of Urology, Ain Shams University, Cairo, Egypt; 9Dept. of Urology, Viborg Regional Hospital, Denmark
Association Between Charlson Comorbidity Index and Postoperative Complications in Elderly Patients After Partial or Radical Nephrectomy Becher E, García Marchiñena P, Jaunarena J, Santillan D, Perez L, Boietti B, Jurado A, Gueglio G Hospital Italiano de Buenos Aires, Argentina
Materials and Methods: This was a retrospective cohort study. The study population consisted of patients older than 70 years who underwent partial or radical nephrectomy at the Hospital Italiano de Buenos Aires between February 2012 and June 2014. CCI was categorized as low comorbidity (CCI=2), or high comorbidity (CCI=3 or more). Complications were assessed using the Dindo-Clavien (DC) classification. Performance of the CCI was evaluated by ROC curve. The association between CCI and complications was estimated by Chi2 test. Results: The study included 145 patients. Sixty-five percent were male. Median age was 75 years (IQR 25-75, 73-78). Area under ROC curve for the CCI was 0.61 (IC95% 0.52-0.69). Low comorbidity (group A) was found in 53.8% (78), the remaining had high comorbidity (group B). Group A presented 34.6% (27) of complications, and 50.7% (34) in B (p=0.05). Analyzing patients who presented complications, it was found that 70.4% (19) in group A vs. 58.8% in group B (p>0.05) had DC I-II, and that 29.6% (8) vs. 41.2% (14) (p>0.05) presented complications DC IIIa or more. Interdisciplinary evaluation was required for 16.6% (13) of patients in A vs. 55.2% (37) in B (p=0.00). Readmission was needed for 9% (7) in A vs. 19.4% (13) in B (p=0.06). Twenty-one percent in A consulted the emergency department vs. 29.8% in B (p=0.26). Conclusion: This study showed that patients with
high comorbidity have significantly more complications. A significant difference was also found for CCI in patients who required readmission and/or interdisciplinary evaluation. No significant difference was found for CCI in patients who consulted the emergency department.
MP-13.10 Complication Rates After Laparoscopic-Assisted Cryoablation for Small Renal Masses: A EuRECA Multi-Institutional Study 1
2
Dept. of Urology, Onze Lieve Vrouwe Gasthuis, The Netherlands; 2Dept. of Urology, Aarhus University Hospital, Denmark; 3Dept. of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital,
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: This retrospective study included 808 patients treated with LCA over a 10year period (2005-2015) with pooled data from eight European institutions. Complications were defined according to the Clavien-Dindo classification. Descriptive statistics were used for baseline analyses. Multivariate analyses were performed to test predictors of complications. Results: Median age was 67 years (IQR: 58-74). Median BMI was 26 kg/m2 (IQR 23.9-28.9) and the median ASA score was 2 (IQR 2-3). Tumour distribution between the right and left kidney was 54.6% vs. 45.4%, respectively. A solitary kidney was present in 95 patients (11.8%) Median tumour size was 25 mm (IQR: 19-30) and 589 patients (72.9%) had a biopsy-confirmed RCC. A transperitoneal laparoscopic approach was used in 77.7% of the patients and a retroperitoneal approach was used in 22.3% of the patients. Median postoperative hospital stay was two days. Median follow-up time for the RCC-cohort was 36 months (IQR: 14-56). A total of 19 patients (3.5%) were diagnosed with residual unablated tumour. A total of 134 postoperative complications (16.6%) were reported, with severe complications (grade ≥ 3) in 26 patients (3.2%). Multivariate logistic regression analyses showed that an ASA score of three was associated with a nearly three-fold increased risk of overall complications (OR: 2.85; 95%CI: 1.32-6.20; p=0.005). Conversely, a transperitoneal laparoscopic approach was associated with a decreased risk of overall complications (OR: 0.59; 95%CI: 0.38-0.91; p=0.02). None of the analyzed risk factors were found to be significantly associated with severe complications. Conclusion: This large series of LCA demonstrates
satisfactory complication rates. However, severe complications are rare. Furthermore, although LCA is considered a minimally invasive procedure, risk of severe complications should be considered when counseling patients.
MP-13.11 3
Lagerveld B , Kjaergaard Nielsen T , Lughezzani G , Sriprasad S4, Barber N5, Hansen L2,6, Buffi N3, Guazzoni G3, van der Zee J1, Ismail M7, Farrag K4, Emara A5,8, Lund L6,9, Ostraat O2, Borre M2, Keeley F7 1
Introduction and Objective: Laparoscopic-assisted cryoablation (LCA) is considered a minimal invasive alternative for patients with small renal masses (SRM) who are unfit for extirpative surgery. Currently, knowledge of complication rates is limited to single center series with small numbers and short follow-up. The aim of this study was to assess the complication rates associated with LCA in patients with T1a renal masses.
Effect of Perioperative Blood Transfusion on Oncologic Outcomes Following Curative Surgery for Renal Cell Carcinoma Hong SH1, Park YH1, Kim YJ2, Kang SH3, Kim HH4, Byun SS5, Lee JY1 1
Seoul St. Mary’s Hospital, South Korea; 2Chungbuk National University College of Medicine, Cheongju,
73
MODERATED ePOSTERS South Korea; 3Korea University School of Medicine, Seoul, South Korea; 4Seoul National University College of Medicine, South Korea; 5Seoul National University Bundang Hospital, South Korea Introduction and Objective: To elucidate the associ-
ation between perioperative blood transfusion (PBT) and prognosis of patients undergoing curative surgery for renal cell carcinoma (RCC), controlling for known clinicopathologic predictors. Materials and Methods: A total of 3 832 patients with RCC who had undergone curative surgery were included from multicenter database. PBT was defined as transfusion of packed red blood cells within 7 days before surgery, during surgery, or within the postoperative hospitalization. The association of PBT with oncologic outcomes was evaluated using univariate and multivariate Cox regression analysis, and regression adjustment with propensity score. Results: Overall, 11.7% (447/3 832) of patients received PBT. Patients receiving PBT were significantly older at diagnosis, with lower BMI, higher comorbidities, worse ECOG performance status, and more initial symptoms. Moreover, higher pathologic TNM stage, larger mass size, higher nuclear grade, more sarcomatoid differentiation, and more tumor necrosis were all unfavoured patients who received PBT. In univariate analysis, relapse-free survival, cancer-specific survival, and overall survival was worse in patients who received PBT, however, in the matched pairs, they became insignificant after propensity score matching. On multivariate Cox regression analysis and regression adjustment with propensity score, significant prognostic effect of PBT on disease relapse, cancer-specific mortality, and all-cause mortality was not observed. Conclusion: This KORCC cohort analysis demon-
strates no significant prognostic association between PBT and oncologic outcomes in patients with RCC.
MP-13.12 What Is the Effect of Cytoreductive Nephrectomy in Metastatic Renal Cancer Without Targeted Therapy or Immunotherapy? Scavuzzo A1, Reynoso Noveron N2, Santana Rios Z1, Meneses Garcia A3, Herrera Gomez A3, Jimenez Rios MA1 1
INCan-Instituto Nacional de Cancerologia, Dept. of Urology, Mexico City, Mexico; 2INCan-Instituto Nacional de Cancerologia, Dept. of Epidemiology, Mexico City, Mexico; 3INCan-Instituto Nacional de Cancerologia, Mexico City, Mexico Introduction and Objective: To investigate the effect
of cytoreductive nephrectomy (CN) on survival in patients with metastatic renal cell carcinoma (mRCC). Materials and Methods: We retrospectively reviewed
the records of patients who presented between 2007 and 2014 with mRCC. Of 146 patients, we compared two groups: 116 patients (79.5%) who underwent CN vs. 30 (20.5%) with no CN. No patients received targeted therapy or immunotherapy. The associations of the clinical and pathological features with cancer specific survival (CSS) were assessed using Cox proportional hazards regression models. Statistical tests were performed using the SPSS.
74
MP-13.12, Table 1. No. With CN
No. Without CN
p-value
55.51 (11.79%)
56.17 (13.67%)
0.811
Male (%) Female
77 (66.4%) 39 (33.6%)
19 (63.3%) 11 (36.7%)
0.830
BMI Underweight Normal weight Overweight Obesity
4 (4.5) 34 (38.2%) 37 (41.6%) 14 (15.1%)
2 (8.7) 13 (56.6%) 6 (26.1%) 3 (8.7%)
0.70
Symptoms for mts disease (yes) Hematuria Loin pain Palpable abdominal mass
28 (24.1%) 61 (52.6%) 49 (42.2%) 30 (25.9%)
22 (73.3%) 16 (53.3%) 21(70%) 15 (50%)
<0.001 0.072 0.011 0.012
More than 1 metastatic site
16 (16.2%)
8 (27.6%)
0.182
Tumor size <10 cm ≥10 cm
36 (42.86%) 48 (57.14%)
4 (21.5%) 15 (78.95)
0.078
Mean Age (+/-SD)
18.87 (P257.5-P7548.5)
13.5 (P253.5-P75 9.8)
<0.001
Nonclear cell pathology No Yes
11 (9.5%) 105 (90.5%)
3 (10%) 27 (90%)
0.581
Hemoglobin (g/dl) less than LLN
18 (24.7%)
8 (38.1%)
0.174
Serum corrected calcium (greater than 10 vs. 10 mg/dl or less)
10 (19.2%)
5 (27.8%)
0.325
LDH greater than 1.5 times ULN
14 (21.5%)
7 (33.3%)
0.209
42 (56%)
15 (71.4%)
0.154
Mean follow-up
Platelets greater than ULN
Results: There were no significant differences between the two groups, except in symptoms (Table 1). In the group with no CN, 9 cases were unresectable. The mean follow-up in the CN group was 18.87 months, and in the no CN group was 13.5 months. The median CSS time for all patients was P25 9.4- P50 30.5P75 109 months; CN group P25 3.3 - P50 11- P75 40 months vs. no CN group P25 13.4 - P50 36- P75 109 months. Death in the CN group was 25 (46%) vs. 8 in the no CN group (53.3%). In adjusted multivariate analyses, surgery (HR 0.44; p=0.040), hematuria (HR 0.49; p=0.009), obesity (HR 0.21; p=0.003), tumor size >10 cm (HR 2.1; p=0.02) and non-clear cell pathology (HR. 0.29; p=0.003) were prognostic factors to predict the probability of CSS. Conclusion: CN improve CSS independently to tar-
geted therapy or immunotherapy.
MP-13.13 Efficacy and Safety of Tyrosine Kinase Inhibitors as First-Line Therapy for Elderly Patients with Metastatic Renal Cell Carcinoma Harada K Kobe University Graduate School of Medicine, Japan Introduction and Objective: Although tyrosine ki-
nase inhibitors (TKIs) currently play central roles in the treatment of patients with metastatic renal cell carcinoma (mRCC), TKIs are frequently associated with adverse events (AEs), which could be an obstacle to maintain optimal dosing. Therefore, it is essential to assess the efficacy and safety of TKIs in elderly patients considering higher frequency of comorbidity
and concerns about toxicity and poor compliance. The objective of this study was to retrospectively analyze the clinical outcomes of TKIs as first-line therapy for Japanese elderly patients with mRCC. Materials and Methods: This study included a total of 427 patients with mRCC who received either sunitinib or sorafenib as a first-line agent at Kobe University and related hospitals. Clinical outcomes were compared between 163 patients aged >70 years (older group) and 264 aged <70 years (younger group). Results: There were no significant differences in major clinicopathological characteristics between younger and older groups. No significant difference in the distribution of best response to TKIs was noted between younger and older groups. The median overall survivals in younger and older groups were 26.4 and 34.3 months, respectively, and there was no significant difference in the OS between these two groups. Multiple analysis identified liver metastasis, presence of sarcomatoid feature, pretreatment CRP level, MSKCC risk criteria and Heng risk criteria, but not patient age, as independent predictor of OS. There were no significant differences in the incidences of major AEs, irrespective of their severities; however, the proportion of patients who required dose-interruption in older group was significantly higher than that in younger group. Conclusion: The outcomes described above showed
that the efficacy profile of TKIs appears comparable in younger and older patients with mRCC, with limited differences in the safety profiles. Collectively, these findings suggest that elderly patients with mRCC may receive significant benefit from treatment with TKIs;
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS therefore, elderly age alone should not be a deterrent to introducing TKIs in patients with mRCC.
MP-13.14 Poor Preoperative Glycemic Control Associated with Dismal Prognosis After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Korean Multicenter Study Yu HS1, Hwang EC1, Jung SI1, Kang TW1, Kwon DD2, Kim JS3, Noh JH3, Yu JH4, Kim MK4, Oh TH5, Seo IY5, Baik S6, Kim Cs6, Kang SG7, Kang SH7, Cheon J7 1 Dept. of Urology, Chonnam National University Medical School, Gwangju, Korea; 2Dept. of Urology, Chonnam National University Medical School; 3Dept. of Urology, Kwangju Christian Hospital, Gwangju, Korea; 4Dept. of Urology, Chonbuk National University Medical School, Jeonju, Korea; 5Dept. of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea; 6Dept. of Urology, Chosun University School of Medicine, Gwangju, Korea; 7Dept. of Urology, Korea University College of Medicine, Seoul, Korea
Introduction and Objective: Evidence suggests an
association of diabetes mellitus (DM) with increased incidence and mortality of various cancers. However, the studies on DM and preoperative glycemic control on oncologic outcomes in upper tract urothelial carcinoma (UTUC) were sparse. We evaluated the effect of DM and preoperative glycemic control on prognosis in Korean patients with UTUC who had undergone radical nephroureterectomy (RNU). Materials and Methods: A total of 566 patients who
underwent RNU at 6 institutions between 2004 and 2014 were retrospectively reviewed. Kaplan-Meier and Cox regression analysis assessed the association between DM, preoperative glycemic control and recurrence free, cancer-specific and overall survival.
Results: The median follow-up was 33.8 months (range: 0.6-249.5). A total of 135 (23.8%) patients had DM and 67 (11.8%) patients had poor preoperative glycemic control. The median recurrence free, cancer specific and overall survival were significantly shorter for patients with poor preoperative glycemic control than for patients with good and non-diabetics (all, p=0.001). By multivariable Cox regression analysis, DM with preoperative poor glycemic control was related to worse recurrence free (HR: 2.42, 95% CI: 1.72-3.39, p=0.001), cancer specific (HR: 2.99, 95%
CI: 1.76-5.10, p=0.001) and overall survival (HR: 2.13, 95% CI: 1.40-3.24, p=0.001). Conclusions: Diabetic UTUC patients with poor preoperative glycemic control have significantly dismal oncologic outcomes than diabetics with good preoperative glycemic control and non-diabetics. Further investigation would be needed to elucidate exact mechanisms underlying the impact of glycemic control on UTUC treatment outcome.
MP-13.14, Table 1. Univariable Cox Regression Analyses Predicting Recurrence, Cancer-Specific Survival and Overall Survival Variables
Recurrence free survival
Cancer specific survival
Overall survival
HR (95% CI)
p-value
HR (95% CI)
p-value
HR (95% CI)
p-value
Preoperative glycemic control
0.002
0.001
0.001
No DM
reference
reference
reference
DM, HgA1c < 7
0.94 (0.64-1.38)
0.755
0.71 (0.32-1.56)
0.4
0.53 (0.28-0.99)
0.049
DM, HgA1c ≥ 7
2.06 (1.49-2.84)
0.001
2.93 (1.79-4.78)
0.001
2.10 (1.41-3.12)
0.002
MP-13.14, Table 2. Multivariable Cox Regression Analyses Predicting Recurrence, Cancer-Specific Survival and Overall Survival Variables
Recurrence free survival
Cancer specific survival
Overall survival
HR (95% CI)
p-value
HR (95% CI)
p-value
HR (95% CI)
p-value
Preoperative glycemic control
0.001
0.001
0.001
No DM
reference
reference
reference
DM, HgA1c < 7
1.11 (0.74-1.65)
0.596
1.06 (0.47-2.37)
0.885
0.69 (0.36-1.30)
0.258
DM, HgA1c ≥ 7
2.42 (1.72-3.39)
0.001
2.99 (1.76-5.10)
0.001
2.13 (1.40-3.24)
0.004
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
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MODERATED ePOSTERS
Moderated ePosters Session 14 Prostate Cancer— Advanced & Localized Disease Saturday, October 22 1615–1745 MP-14.01 The Utility of C11 Choline PET/CT in PostProstatectomy Patients with Biochemical Recurrence: A Comparison to MpMRI McLaren R, Mynderse L, Davis B, Kwon E, Lowe V, Karnes RJ, Parker W Mayo Clinic, Rochester, United States Introduction and Objective: Historically the identification of locally recurrent prostate cancer (CaP) after radical prostatectomy (RP) has been challenging. Multi-parametric MRI (mpMRI) has been useful in localizing prostate bed recurrences and C11 choline PET/CT (CholPET) may aid in this effort. The objective of this study is to examine the recurrence patterns identified by CholPET as compared to mpMRI in patients experiencing biochemical recurrence after RP. Materials and Methods: Between 2008 and 2015
CholPET was performed in 2 842 patients. A subgroup analysis of 19 unique, post RRP patients between 2014 and 2015 who undertook mpMRI, CholPET and trans-rectal US (TRUS) biopsy was analyzed. This cohort was reviewed to access local recurrence patterns within seminal vesicle beds, vesico-urethral anastomoses, and bladder neck with correlation between imaging and biopsy results. Results: TRUS biopsy guided by CholPET and mpMRI confirmed prostate cancer in 68% (13/19) of patients. CholPET was equivocal in 10% (2/19), negative in 10% (2/19) and positive in 78% (15/19). mpMRI was equivocal in 15% (3/19) and positive in 84% (16/19). Seminal vesicle remnant/bed recurrences were the predominant recurrence site in the TRUS bx cohort 69% (9/13). Median PSA levels for the bx positive patients were 3.1 ng/ml. Conclusion: The use of CholPET coupled with mp-
MRI facilitated the detection of locally recurrent CaP following RP. When CholPET was positive, this was most predictive of a biopsy proven local recurrence. When both mpMRP and CholPET were negative or indeterminate in the seminal vesicle beds, vesico-urethral anastomoses, or bladder neck, 95% of patients had negative biopsies. mpMRI and CholPET are complimentary in restaging biochemically recurrent CaP. Such information may be useful in planning systemic and regional therapies for patients with biochemical recurrence after RP.
MP-14.02 Salvage Radical Prostatectomy: Who Is the Ideal Candidate? Martinez PF, Andrade C, Esquenazi G, Tobias I, Villamil W, Giudice CR Hospital Italiano de Buenos Aires, Argentina
76
Introduction and Objective: To analyze oncological
and functional outcomes of salvage radical prostatectomy (SRP) in patients with recurrent prostate cancer and to compare outcomes of patients within and outside the European Association of Urology (EAU) guideline criteria (organ-confined prostate cancer =T2b, Gleason score =7 and preoperative PSA level <10 ng/mL) for SRP. Materials and Methods: In all, 50 patients who underwent SRP, 37 conventional approach and 13 robotic, from August 2004 to March 2015 were retrospectively analyzed. Kaplan-Meier curves assessed cancer-specific survival. Cox regressions addressed factors influencing BCR. BCR was defined as a PSA level of >0.2 ng/mL and rising, continence as the use of 0 safety pad/day, mild incontinence 1pad, moderate-severe >1 pad, and potency as a five-item version of the International Index of Erectile Function score of 21 with or without PDE5 inhibitor. Results: The median follow-up was 32 months. After SRP, 42.0% of the patients experienced BCR, 8% developed metastasis, and 2% died from general disease. Patients fulfilling the EAU guideline criteria had significantly better BCR-free survival (2-year BCRfree survival 89% (IC 95% 75, 3-100) vs. 46% (IC 95% 26, 9-65) (Log Rank test p =0.002 HR 5.58 (IC 95% 1.61-19.34, p =0.007)). Global positive surgical margins (PSM) was 24%. Twenty-nine patients were pT3 (58%), and 18% of them were PSM. Continence rate at 1 year after SRP was 66%, mild incontinence was 28%, moderate to severe was 6%. Two patients (4%) had complications ≥III (Clavien grade). In all, 62% of the patients were potent before SRP. A total of 32% of these patients have recovered erectile function. Bilateral nerve sparing was performed in ten patients, while the remaining patients underwent non-nervesparing. In the multivariate analysis, Gleason score 9 was the only predictor of recurrence. Conclusion: SRP is a challenging but feasible surgery
with an acceptable rate of complications, offering a second option for cure in patients with biochemical recurrence after radiotherapy for prostate cancer. Patients that meet EAU eligibility criteria tend to have better oncological outcomes.
MP-14.03 A Randomized Phase II Clinical Trial of Personalized Peptide Vaccination with Metronomic Low-Dose Cyclophosphamide in Patients with Metastatic CastrationResistant Prostate Cancer Noguchi M, Moriya F, Koga N Kurume University School of Medicine, Japan Introduction and Objective: This study was designed to test how metronomic cyclophosphamide (CPA) in combination with personalized peptide vaccination (PPV) could affect regulatory T cells (Treg) and myeloid-derived suppressor cells (MDSC) and whether it could improve the antitumor effect of PPV. Materials and Methods: Seventy patients with metastatic castration-resistant prostate cancer were randomly assigned (1:1) to receive PPV plus oral lowdose CPA (50 mg/ day) or PPV alone. PPV treatment used a maximum of four peptides chosen from 31
pooled peptides according to human leukocyte antigen types and antigen-specific humoral immune responses before PPV, for 8 subcutaneous weekly injections. Peptide-specific cytotoxic T lymphocyte (CTL) and immunoglobulin G responses were measured before and after PPV. Results: The incidence of grade 3 or 4 hematologic adverse events was higher in the PPV plus CPA arm than in the PPV alone arm. Decrease of Treg and increase of MDSC were more prominent in PPV plus CPA than in the PPV alone (p = 0.036 and p = 0.048, respectively). There was no correlation among the changes of Treg or MDSC and CTL responses. There was no difference in positive immune responses between the two arms, although overall survival in patients with positive immune responses was longer than that with negative immune responses (p = 0.001). Significant differences in either progression-free survival or overall survival were not observed between the two arms. Conclusion: Low-dose CPA showed no change in the
antitumor effect of PPV, possibly because it decreased Treg but increased MDSC simultaneously, in patients under PPV.
MP-14.04 Quality of Life Data on a Long-Term Androgen Deprivation Therapy (ADT) with the LHRH Analog Leuprorelin Acetate in Microcapsules for Patients with Advanced and Metastatic Prostate Cancer: Data from a Non-Interventional Study Kunde J1, Hammerer P2, Wirth M3, Manka L2 1 Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany; 2Klinik für Urologie und Uroonkologie Klinikum, Braunschweig, Germany; 3Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus Dresden, Germany
Introduction and Objective: LHRH analogs (LHRHa)
are the gold standard in the treatment of patients with hormone-sensitive advanced and metastatic prostate cancer (PCa). In this study, we investigated the quality of life of patients under long-term treatment with leuprorelin acetate in microcapsules (1, 3, and 6 month depot formulation) for up to 19.8 years of treatment. Materials and Methods: Observational and retro-
spective analyses of data from 536 PCa patients treated with LHRHa and 116 patients of a control group (CG) (≥77 years of age, >5 years urological treatment, no cancer disease, no androgen deprivation therapy) were done. The data were collected in 30 German office based urological practices. For the data collection, we used the standardized EORTC questionnaires QLQ-C30 and QLQ-PR25. Results: Patients were treated for a mean of 8.6 years (range: 4.5-19.8). Mean age of PCa patients and control group (mean ± SD: 79.6 ± 6.3 vs. 80.5 ± 3.1 years), body height, weight, and BMI were comparable, as well as the Karnofsky-Index (88.0 ± 12.7 vs. 88.4 ± 12.0). The assessment of the overall health status (QLQ-C30) gave equal results for both groups (PCa patients vs. CG: 64.6 ± 20.5 vs. 66.8 ± 20.3; p=0.3117; 100 = well, 0 = poor). Marginal differences were observed regarding physical func-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS tion (73.2 ± 23.1 vs. 78.1 ± 21.0; p=0.0402) and role function (70.6 ± 30.4 vs. 74.4 ± 25.7; p=0.1648), the differences were statistically not significant. PCa patients rated the symptoms fatigue (33.6 ± 25.1 vs. 28.8 ± 23.3; p=0.0629), dyspnea (24.0 ± 28.5 vs. 19.6 ± 26.9; p=0.1307), insomnia (28.9 ± 32.6 vs. 23.7 ± 27.2; p=0.0751), slightly inferior compared to CG (100 = poor, 0 = well). Analyzing the prostate-specific module of QLQ-PR25, PCa patients had a worse status regarding sexual activity (88.0 ± 20.6 vs. 76.3 ± 25.7; p<0.0001) and sexual function (56.7 ± 25.8 vs. 44.1 ± 27; p=0.0067) compared to CG. PCa patients had less urinary symptoms (28.2 ± 19.8 vs. 31.2 ± 19.2; p=0.1472). Symptoms of androgen deprivation were more pronounced in PCa patients (21.4 ± 17.3 vs. 10.8 ± 13.2; p<0.0001) and they have a higher need of incontinence aids (29.6 ± 34.2 vs. 16.7 ± 20.5; p=0.0056). However, 136 of the 536 PCa patients had a prostatectomy. Conclusion: In our study, cohort PCa patients were
treated with LHRHa for up to 19.8 years, with the average treatment duration being 8.6 years. The overall physical status was comparable in PCa patients and the control group. As expected, sexual activity and sexual function were more affected in PCa patients with androgen deprivation therapy. Overall, the treatment with leuprorelin acetate in microcapsules is a well-tolerated long-term therapy for patients with hormone-sensitive advanced prostate cancer.
MP-14.05 Clinical Outcome of Docetaxel in Castration-Resistant Prostate Cancer with or Without Metastasis: A Retrospective, Multicenter Study Ito K, Kimura T, Onuma H, Yamazaki T, Mori K, Inaba H, Hata K, Miki J, Yamada H, Naruoka T, Egawa S Dept. of Urology, Jikei University School of Medicine, Tokyo, Japan Introduction and Objective: Guidelines recommend
that docetaxel is a therapeutic option for metastatic castration resistant prostate cancer (M1CRPC). Recently, phase 3 trials such as CHAARTED and STAMPEDE revealed that early introduction of docetaxel as an initial treatment for hormone-sensitive prostate cancer significantly improved overall survival (OS). However, the effect of early introduction of docetaxel for castration resistant prostate cancer without metastasis (M0CRPC) has not been elucidated. Public health insurance in Japan supports the use of docetaxel for not only M1CRPC but also M0CRPC. Thus, we retrospectively analyzed the clinical outcome of patients with CRPC induced docetaxel before developing metastasis comparing to those induced docetaxel after developing metastasis. Materials and Methods: A total of 94 patients with
CRPC who did not have metastasis at the time of induction of primary androgen deprivation therapy administrated with docetaxel from July to March 2016 in total eight Jikei University Hospital and its affiliated hospitals. Among them, 45 patients were administrated with docetaxel before developing metastasis (M0CRPC) and 53 patients were administrated after developing metastasis (M1CRPC). Clinical outcomes were retrospectively compared between both groups.
MP-14.05, Figure 1. Survival of CRPC-OS: Survival Proportions
Results: Both the characteristics of patients at the initial diagnosis and the development of CRPC were not significantly different. Median follow-up period from development of CRPC was 38 months (range 2 to 154 months). OS from the development of CRPC was significantly longer in the M0CRPC than in the M1CRPC (40 vs. 38 months; P=0.0212) (Figure 1). Conclusion: Early introduction of docetaxel to
M0CRPC was suggested to improve of OS from the development of CRPC.
MP-14.06 Potential Predictors for the Clinical Response of Abiraterone Acetate in Metastatic Castration-Resistant Prostate Cancer After Docetaxel Yang CR1,2, Li JR2, Wang SS2, Yang CK2, Chen CS2, Ho HC1,2, Chiu KY2, Cheng CL2, Ou YC2 1
Dept. of Urology, China Medical University Hospital, Taichung, Taiwan; 2Dept. of Urology and Surgery, Taichung Veterans General Hospital, Taiwan
Introduction and Objective: We performed a retrospective survey in our CRPC patients who received AA treatment after docetaxel and identified potential clinical markers for the treatment outcome prediction. Materials and Methods: Between 2012 and 2015, a total of 41 patients with CRPC who failed after docetaxel and followed by AA treatment were included in this chart-reviewed study. The general status, including previous local therapy, serum PSA level at each time-point, docetaxel treatment cycles, and AA treatment results were recorded. Patients were separated into PSA responder group and PSA non-responder group according to their treatment results. Analyses of variable differences between two groups were performed and calculated into regression analysis. Analyses about progression-free survival and overall survival were also performed. Results: Twenty-four patients were selected into the PSA responder group (20 patients had 50% PSA decrease). The median PSA progression free survival and overall survival in total 41 patients were 6.2 and 18.9 months respectively. The PSA responder group had a significant better median progression free survival and overall survival experience (19.6 vs. 1.87, p<0.0001; 20.8 vs. 7.7, p=0.002 respectively). Median time to maximum PSA response was 3.7 months.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Adverse events developed in 17 patients (41.5%) and most were grade 1/2. In univariate analysis for progression free survival, first line androgen deprivation therapy (ADT) duration, pre-AA PSA, PSA progression ratio, lowest PSA after AA treatment and PSA decline percentage reached statistical significance. In overall survival, pre-chemotherapy duration and PSA decline percentage were significant predictors (p=0.0317 and p=0.021 respectively). Conclusion: ADT therapy duration, pre-AA PSA, and
PSA progression ratio could act as clinical predictors for progression free survival before AA treatment. Pre-chemotherapy duration can predict the overall survival outcome before AA treatment. PSA decline percentage can be used as a post-treatment marker after AA treatment for both progression free survival and overall survival.
MP-14.07 Correlation of Biochemical Response with Quality of Life and Overall and Progression-Free Survival in Patients with Metastatic Castration Resistant Prostate Cancer (MCRPC) Treated with Cabazitaxel (Caba) in the QoL Time Trial Hammerer P1, Al-Batran SE2, WindemuthKieselbach C3, Hofheinz RD4 1
Dept. of Urology, Academic Hospital Braunschweig, Germany; 2Clinical Research Institute, Frankfurt am Main, Germany; 3Alcedis GmbH, Gießen, Germany; 4 University Hospital Mannheim, Germany
Introduction and Objectives: Caba combined with prednis(ol)one (P) is approved for second-line treatment of mCRPC after docetaxel. We sought to evaluate health-related quality of life (QoL) and determine the effect of biochemical response after 4 cycles of Caba on overall survival (OS) and progression-free survival (PFS) in men with mCRPC. Materials and Methods: Men with mCRPC receiv-
ing Caba (25 mg/m2 every 3 weeks) plus P in routine practice were included in the prospective non-interventional study. EORTC QLQ-C30 was completed at baseline and after each cycle of Caba. A Cox stepwise regression model was used to determine the effect of biochemical response (defined as PSA decrease ≥50%) on OS and PFS after cycle 4 of Caba. Results: Of the 527 evaluable patients, 348 had received 4 cycles or more of Caba and 266 had PSA
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MODERATED ePOSTERS MP-14.07, Table 1. Patient Characteristics, Time to Progression and Overall Survival Characteristics
N=527
Median age of study population, years (range)
72 (43-90)
ECOG 0 or 1
473 (90.0%)
Median PSA value before starting Caba, mg/L (range)
136.0 (0.04 to 735 493.0)
Progression Median time to progression, months (95% CI)
8.3 (6.2-11.7)
1-year event rate (Kaplan-Meier)
42.7%
PFS in PSA responders*, hazard ratio (95% CI)
0.31 (0.19-0.50)
Overall survival Median OS, months (95% CI)
16.8 (14.0-19.5)
1-year event rate (Kaplan-Meier)
65.4%
OS in PSA responders*, hazard ratio (95% CI)
0.40 (0.20-0.83)
*≥50% decrease in PSA (reference: <50% decrease)
measurements at baseline and cycle 4. After cycle 4, 92 (34.6%) patients had a PSA decrease ≥50%. Median time to progression was 8.3 months and OS 16.8 months (Table 1). Both PFS and OS were significantly improved in PSA responders (P<0.0001 and P=0.014, respectively) (Table 1). No significant change in global health status was observed between baseline and cycle 4, irrespective of PSA response (51.3, 95% CI 48.5-54.1 vs. 48.4, 95% CI 45.8-51.0; P=0.62). PSA responders had a significantly improved pain control and a stable physical functioning at cycle 4. Conclusion: This is the largest prospective analysis of
QoL and survival in men receiving Caba for mCRPC. Caba was associated with a good PSA response after cycle 4. Good PSA response was associated with significant improvements in pain, PFS and OS, stable health status and physical function.
MP-14.08 Trans Perineal Stereotactic Biopsy MRI-TRUS Guided and Watson® Fusion Processed: Our Experience Blefari F1, Di Loro F1, Macchiarella A1, Mencarini M1, Del Grasso A1, Spurio M1, Russo GI2, Morgia G2, Dattilo C1, Rubino F1 1
Dept. of Urology, S. Stefano Hospital, Prato, Italy; University of Catania, Italy
2
Introduction and Objectives: TRUS has a poor sen-
sitivity and specificity for identifying prostatic cancer while multiparametric MRI has proved extremely effective. Combining MRI images with real time TRUS guided improves detection rate of biopsy. Materials and Methods: In a year, 15 patients un-
derwent prostate stereotactic transperineal biopsy (median age 60.4 years, range 46-74, PSA 7.6, range 4.2-11.7, prostate volume 71 ml, range 40-110 ml). All patients had a previous TRUS guided negative mapping. A multiparametric MRI 1.5T with T2-weighted imaging, diffusion and with contrast medium was performed. We processed images with Watson® software to identify suspicious areas and superimposed those upon the real time TRUS vision in order to reach the bioptic target. With the patient in the lithotomic position and spinal anesthesia, we used a template grid to point trans-perineal prostatic samplings
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by 18 g needles (an average of 24.1 samples, range 2433) under live TRUS guidance. Results: All patients had a positive MRI for suspected lesion. Eleven biopsies were positive (73.3%). A total of 85% of the samples taken in suspect areas were positive. Gleason score was 4+4 in 3 cases, 4+3 in 4, 3+4 in 2 and 3+3 in 2. Three patients (20%) had urinary retention resolved with short catheterization. Five patients (30%) had hematuria for 2 days. No UTI or hematoma. All patients reported hemospermia. This technique has proved superior in the detection of prostate cancer (73.3% positive) than biopsy mapping performed with ultrasound alone (440 positive mapping have been carried out in 1 275 since 2008 with a cancer detection rate of 34.5%). Conclusion: The method has proven effective in the
diagnosis of prostatic adenocarcinoma in patients with suspected MRI. This platform can also be used for active surveillance, for repeating biopsy and, in the future, for focal treatments of prostate cancer.
MP-14.09 Disease-Free Survival After LowDose Brachytherapy: Post Implant Dosimetry as an Early Prognostic Factor of Biochemical Relapse Alekseev B, Apolikhin O, Sivkov A, Roshin D, Koryakin A Research Institute of Urology, Moscow, Russia Introduction and Objective: The most widely used efficacy criteria for prostate brachytherapy is post implant PSA level, however it has limitations. Post implant dosimetric analysis (PDA) is advised by professional societies for the quality control of seed implantation. PDA is usually performed on the basis of computed tomography on day 30 after brachytherapy. We analyzed the 5-year disease-free survival, depending on the calculated post implant dose in a single center with more than 10 years of experience. Materials and Methods: We performed retrospective
analysis of 117 patients who met the following criteria: disease stage T1-T2c, low- or intermediate-risk of disease progression (D’Amico criteria), with follow-up of 5 years or more, who had PDA after implan-
tation. Patient age at the time of the seed implantation varied from 52 to 76 years. Radioactive sources used were 125I, with the summary dose of 120-160 Gray. According to the results of PDA, patients were divided into two comparable groups, the first group with prostate D90>140 Gy, and the second <140 Gy. The mean preoperative PSA level was 7.3 ng/ml ± 2.6 and 7.9 ng/ ml ± 2.4 for the first and second groups, respectively. In 30 (50.8%) patients in the first group and in 27 (46.1%) patients in the second group, the tumor site was not determined (stage T1c). Stage T2 was diagnosed in 29 (49.2%) patients of the first group and 31 (53.4%) in the second group. Results: A 5-year biochemical disease-free survival (bDFS) in the first group was achieved in 96.6% with cT1, and with cT2, 82.7%. In the second group, it was 85.2% and 71.0% respectively. Disease-free survival in patients who received a radiation dose of D90>140 Gy was significantly higher than in the group of patients with a dose of <140 Gy (89.8% and 77.6%, respectively). The evaluation of complications of radiation treatment showed that in the early period, the most significant symptom that bothered patients was dysuria, which was registered in 34 (58.6%) patients in group 1 and in 25 (42.4%) in group 2. 125 I sources is an effective radical treatment of localized prostate cancer in low- and intermediate-risk patients, with good results of disease-free survival and biochemical control and a small number of complications. PDA plays a great role in the prognosis of treatment results, under-dosed patients could be offered reimplantation of “cold spots” or undergo a more thorough follow-up. Biochemical control is better in patients with higher D90, although the frequency of dysuria in these patients is also higher.
Conclusion: Brachytherapy with
MP-14.10 Relationship Between Biochemical Recurrence and Two Year PSA Nadir in Prostate Cancer Patients Treated with Iodine-125 Brachytherapy Martinez PF, Andrade C, Hernandez Henao YM, Tobia I, Villamil W, Giudice CR Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: To evaluate the relation-
ship between two year PSA nadir (PSAn) and biochemical recurrence rates in prostate cancer patients after iodine-125 brachytherapy. Materials and Methods: We retrospectively ana-
lyzed 196 patients with prostate cancer treated with iodine-125 brachytherapy alone in the period from December 1999 to March 2011. Biochemical recurrence was defined as a PSAn + 2 ng/ml. Inclusion criteria was a minimum follow-up of 60 months. In the present study, patients were divided according to PSAn in two groups <0.5 ng/ml or ≥0.5 ng/ml as a cut-off value at 2 years and correlated with the probability of biochemical failure. Mean and median values were calculated for results analysis. The following statistical methods were utilized: chi square test for categorical variables. The adopted significance level was 5% probability (p≤0.05), with a confidence interval of 95% (CI95%).
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS Results: Of all 196 patients, 31 were excluded from the study, 9 died from general disease before the 60-month follow-up, 22 were lost to follow-up. Analyses were done on a total of 165 patients. Biochemical control was observed in 131 patients (79.3%), and biochemical recurrence in 34 (20.6%). The mean follow-up was 111 months. The patients were divided into two groups: group 1, with two year PSAn <0.5 ng/ml after brachytherapy (89 patients; 53.9%), and group 2, with two year PSAn ≥0.5 ng/ml after brachytherapy (76 patients; 46%). Group 1 presented biochemical recurrence in 13 patients (14.6%), and group 2, in 21 patients (27.6%) (p=0.039) Conclusion: The levels of two year PSAn ≥0.5 ng/ml
after brachytherapy are correlated with a poor prognosis. This may help to identify patients at risk for disease recurrence.
MP-14.11 Changes in Lower Urinary Tract Symptoms After Iodine-125 Brachytherapy for Localized Prostate Cancer Onishi K1, Miyake M1, Tanaka N1, Hori S1, Morizawa Y1, Nakai Y1, Asakawa I2, Hasegawa M2, Konishi N3, Fujimoto K1 1
Dept. of Urology, Nara Medical University, Japan; Dept. of Radiation Oncology, Nara Medical University, Japan; 3Dept. of Pathology, Nara Medical University, Japan 2
Introduction and Objective: We investigated chrono-
logical changes in lower urinary tract symptoms (LUTS) after iodine-125 brachytherapy (BT) of the prostate. Materials and Methods: A total of 706 patients who
underwent BT in our hospital were included in this study. Of 706 patients, 265 (38%) were treated with the combination of BT and external beam radiation therapy (EBRT). International Prostate Symptom Score (IPSS), QOL score, and overactive bladder symptom score (OABSS) were recorded before BT (baseline, BL) and 1, 3, 6, 12, 24, 36, 48 and 60 months after BT. The sum of frequency (2), urgency (4) and nocturia (7) in IPSS questions was defined as the storage symptom score. Results: Total IPSS score significantly increased at 3 months following BT compared to BL (mean: 17.1 vs. 7.99), and returned to BL by 36 months. The storage symptom score did not return to BL 36 months after BT. Total OABSS score significantly increased 3 months after BT compared to BL (average score: 6.51 vs. 3.45), and returned 48 months after BT. QOL score at 3 months after BT showed the highest score (mean: 2.5 vs. 3.9) and returned to BL 48 months after BT. QOL score at 60 months was lower than BL (mean: 2.01 vs. 2.46). Patients treated with the combination of BT and EBRT experienced the transient storage symptoms at 24 and 36 months after BT, while the patients treated with BT alone did not. However, the storage symptom score of the patients treated with the combination had been improving by 48 months after BT and eventually showed no significant difference compared to the patients treated with BT alone.
Conclusion: Three months after BT, LUTS, includ-
ing the storage symptoms, deteriorated the most and improved with time in the group of brachytherapy combined with EBRT. Knowledge of changes in LUTS associated with BT may influence treatment recommendations and enable patients to make better-informed decisions.
MP-14.12 Updated Clinical Results of Active Surveillance with Very LowRisk Prostate Cancer in Korean Men: A 7-Year Follow-Up Jung W, Ha JY, Kim BH, Park CH, Kim CI Keimyung University, Daegu, South Korea Introduction and Objective: This report represents an
update and reanalysis of our experience of active surveillance (AS) for prostate cancer in Korea. Materials and Methods: A prospective, single-arm, cohort study was initiated January 2008. Patient selection; Gleason sum ≤6 with single positive core, clinical stage ≤T1c, PSA ≤10 ng/ml, negative for magnetic resonance imaging (MRI). Follow-up; PSA was measured every 6 months. Prostate biopsies were performed at 1 year and then every 3 years. The MRI was included in a follow-up study. MRI was performed prior to biopsy. Patients were reclassified after performing of prostate biopsy earlier if below: PSA doubling time (DT) of less than 3 year, suspicious clinical progression. Criteria for intervention; Gleason score progression (≥7), increase in the number of positive biopsy cores (≥2 or more than one lobe). Results: A total of 70 patients were treated with AS. Median follow-up was 41 months (6 to 89 months). Of them, 32 patients (45.7%) remain on the AS. During the entire period, 21 patients (30.0%) discontinued AS for various reasons (4; RP, 3; Hormone therapy, 11; WW, 3; Follow-up loss). Overall, 14 patients (20.0%) have been progressed (10; radical prostatectomy (RP), 3; transfer to another hospital, 1; watchful waiting (WW)). The probability of progression was 13.0% and 44.4% at 1 and 3 years, respectively. Overall survival was 97.1%. Prostate cancer specific survival was 100%. There were no incurable progression or no recurrence after definitive treatment. There were 6 detectable positive lesions at follow-up magnetic resonance image (MRI). Of them, 4 patients (66.7%) had actual progressed disease. Conclusion: MRI has benefit for the detection of
unilateral prostate cancer (PCa) relapse after radiation therapy (RT). Materials and Methods: We treated 38 patients with unilateral post RT recurrent PCa performing a hemi ablation technique with a Sonablate 500 device (SonaCare Medical, Charlotte, NC USA) in an outpatient surgical setting. All patients were staged with a multi-parametric MRI (mpMRI) and a saturation biopsy scheme. Follow-up included PSA every 3 months and mpMRI plus a control biopsy at 6 months. The age was 66.9 (56-80) years, PSA 7.96 (1.5-25) ng/ml and Gleason Score 7.3 (6-9). Results: Mean follow-up was 28 months (6-72). Twenty-one (55.3%) patients remain free of disease, 10 (26.3%) had biochemical recurrence and 6 (15.8%) developed metastasis. The PSA nadir post treatment was 3.1 (60.8%) ng/ml. The mean PSA in patients free of disease was of 0.73 and in those who progressed 6.2 ng/ml, which represents a drop of 89.9% and 21.5% respectively (p < 0.001). A total of 10/38 (26.3%) patients had a positive biopsy, 8 in the 6th month control and 2 in the follow-up. The latter were re-treated with HIFU and remain free of disease. Of the 8 patients, 6 were re-treated. Three (37.5%) are free of disease, 1 had a low volume tumor and is under active surveillance, and 4 showed disease progression. The rate of negative biopsies was 86.8% (33/38), and the rate of re-HIFU was 21% (8/38). According to the risk group, the freedom of disease is 7/8 (87.5%) for the low, 4/11 (36.4%) for the intermediate and 10/19 (52.6%) for the high risk group. Complications were observed: 4 needed a TURP, 2 urethral dilatations, 1 laparoscopic correction of a rectal fistula and 1 spontaneously-resolved mixed urinary incontinence. Conclusions: Focal HIFU hemi-ablation after EBRT failure is a feasible treatment with a good short-term results and acceptable safety. A study with a longer follow-up and a larger patient population is needed to establish its role in the management of these patients.
MP-14.14 Use of Administrative Data to Develop and Validate an Indicator for Intermediate Treatment-Related Interventions Following Radical Prostatectomy Sujenthiran A, Charman S, Parry M, Nossiter J, van der Meulen J, Cathcart P Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom
Centro de Urologia, Buenos Aires, Argentina
Introduction and Objective: Radical prostatectomy (RP) is a common treatment for localized prostate cancer. Although cancer-specific survival following RP is favorable, the impact of treatment-related morbidity remains an important factor in patient-centered decision-making. Data on the incidence of unplanned intermediate treatment-related interventions are lacking. In this study, data linkage was performed between English national administrative data (Hospital Episode Statistics) and National Cancer registry data. An indicator was then developed and validated to capture unplanned lower urinary tract (LUT) interventions following RP.
Introduction and Objective: We report our initial experience with a hemi ablation technique using High Intensity Focused Ultrasound (HIFU) in patients with
Materials and Methods: Men who underwent RP between 2008 and 2012 were identified in Hospital Episodes Statistics database if their record contained a
progression. Nevertheless, regular biopsies should be performed. It is difficult to explain and maintain AS in Korean men. However, AS is a feasible treatment option for low-risk prostate cancer.
MP-14.13 Hifu Hemi Ablation in Local Recurrence After Radiation Failure for Prostate Cancer Borghi M, Rios Pita H, Chernobilsky V, Montes de Oca L, Becher EF
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
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MODERATED ePOSTERS “M61” OPCS-4 code. Hospital readmissions post-RP were interrogated for procedure codes related to urinary complications. A transparent coding framework using procedural codes was proposed and evaluated to develop an indicator for the assessment of complications following RP. Kaplan-Meier survival analysis was performed for the development of the study indicator (at least one LUT intervention) in a 2-year period post-RP. Multivariate logistic regression modeling was used to determine the effect on the study indicator by adjusting for patient characteristics and operative information.
outcomes and positive surgical margins were nearly similar in all operative techniques.
Results: A total of 17 299 men underwent RP over the
Sasaki Y1, Miyake T1, Yura K1, Izumi K1, Kishimoto T1, Yamanaka M1, Kawanishi Y1, Fukawa T2, Kanayama H2
study period and underwent a total of 3 609 LUT interventions within a 2-year period. The mean number of LUT interventions per man was 1.5 (range 1-5). A total of 15.6% of men underwent at least one urological intervention within 2 years. Median time to first intervention was 102 days. Lower socio-economic status (OR 1.45 (95%CI: 1.26-1.67), p<0.01), length of stay for RP >3 days (OR 1.54 (95%CI: 1.40-1.69), p<0.01) and open approach (1.47 (95%CI: 1.30-1.67, p<0.01) significantly increased the likelihood of undergoing a urological intervention. Conclusion: Approximately 1 in 6 men required an
unplanned urological intervention within two years of RP. These data could be used to counsel patients regarding treatment-related complications while an adjusted indicator could be used to assess variation in care between providers of prostate cancer surgery.
MP-14.15 Comparison of Open and Laparoscopic Radical Prostatectomy for the Treatment of Prostate Cancer Wu Z, Gao P, Wang L, Seng Z, Ding Q Dept. of Urology, Huashan Hospital, Fudan University, Shanghai, China Introduction and Objective: To compare outcomes of open (O) and laparoscopic (L) radical prostatectomy (RP) for the treatment of prostate cancer performed by the same surgeon. Materials and Methods: From May 2009 to February 2016, 106 RPs were performed by a single surgeon. Patient data including age, body-mass index, serum prostate specific antigen (PSA) level, Gleason score of prostate biopsy and prostatectomy specimen, preoperative prostate and specimen volumes, clinical and pathologic stages, operation time, estimated blood loss (EBL), catheterization time, blood transfusion rate were recorded. Prospectively collected data was evaluated retrospectively by statistical analyses. Results: Of 106 radical prostatectomies, ORP (46)
and LRP (60) done by the same surgeon were included in this study. Mean ages were 65.3 and 67.7 years for ORP and LRP respectively. Operation times for ORP and LRP were 152 and 177 minutes. EBL and hospitalization time were 615 and 202 ml, and 13.6 and 6.3 days for ORP and LRP respectively. While a significant advantage was found for EBL, hospitalization time and complication rates in LRP, significant disadvantages were found in terms of catheterization time, hospitalization time, decrease in hemoglobin and blood transfusion in ORP. However, preoperative prostate volume and serum PSA level, oncologic
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Conclusion: Minimally invasive techniques such as
LRP are promising techniques with comparable outcomes with ORP. Shorter hospitalization time and catheterization time, less blood loss and fewer complication rates can be provided by LRP.
MP-14.16 Impact of Dorsal Vein Complex Stump Length on Pathological and Functional Results in Radical Prostatectomy
1
Takamatsu Red Cross Hospital, Takamatsu, Japan; Tokushima University, Tokushima, Japan
2
Introduction and Objective: As both pathological and
functional results are dependent on proper apical dissection of the prostate during radical prostatectomy (RP), more objective data regarding apical surgical margins and postoperative continence are necessary to better understanding this crucial step. We studied this issue by measuring dorsal vein complex (DVC) stump length remaining after RP. This study is a sub-analysis of studies conducted with permission from the ethical committee at our hospital (H10-020). Materials and Methods: Subjects were 47 patients
with post-RP erectile dysfunction. Age distribution was 51 to 79 years with a median value of 66. We used 3D-CT pelvic venography data that had been performed for further examination of erectile dysfunction. DVC stump length was measured as the distance from cavernous vein origin to the DVC stump on sagittal plane images. The patient group with continence was defined as zero pads or a liner used for security reasons only. Resection margins were evaluated by 3 pathologists. Results: Mean DVC stump length was 13.8±4.8mm (mean ± SD). Regarding apical resection margins, there was no statistically significant difference for length of DVC stump remaining. Stump length for negative and positive margins were 13.6±4.7mm and 14.6±5.5mm, respectively (P=0.607). In contrast, regarding urinary continence, there was a difference of 3.7mm between continent and incontinent patients (continent patients: 14.8±5.0mm vs. incontinent patients: 11.1±3.2mm, P=0.0284). Conclusion: DVC stump length was related to urinary
continence, however, it was not related to apical surgical margin. That is, if the point of dissection differs by 3.7mm, the rate of urinary continence varies, but apical surgical margin does not. Post-RP urinary continence is correlated to DVC stump length. We believe that oncological and functional results will become compatible with each other due to instrument improvement and the progress of anatomical knowledge.
MP-14.17 Erectile Function and Sexual Activity 12 Months After Robot Assisted Laparoscopic Radical Prostatectomy (RALP) Berge V1, My Diep L2, Berntsen M3, Karlsen S3, Eri LM3
1
Dept. of Urology, Oslo University Hospital, Norway; Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo University, Norway; 3Oslo University Hospital, Norway 2
Introduction and Objectives: Erectile dysfunction occurs in 20-100% of men undergoing radical prostatectomy. This study aims to assess by self-administered EPIC Expanded Prostate Cancer Index Composite (EPIC) questionnaires, how erectile function (EF) influences the sexual activity in patients 12 months after RALP. Materials and Methods: EPIC sexual function (SF) is assessed by 9 questions, and the scores range from 0 to 100, higher scores representing better sexual function. During the study period, 748 patients were operated with RALP. EPIC-question 28 “How was your ability to have an erection during last 4 weeks” was dichotomized into None/Poor (Impotent) and Fair/ Good/Very good (Potent). EPIC question 33 “During the last 4 weeks, how often did you have any sexual activity?” were dichotomized into Not at all and Less than once a week/ About once a week/Several times a week/Daily (Sexually active). Dichotomized answers were assessed pre- and postoperatively with cross tabulation. Results: Mean age of patients was 62.6 (±6.0) years. A total of 675 (90.2%) and 589 (78.7%) patients returned questionnaires pre- and postoperatively respectively. Questions 28 and 33 were answered both pre- and postoperatively by 566 (75.7%) and 576 (77.0%) patients respectively. Mean EPIC-SF score pre- and postoperatively was 56.9 (± 22.2) and 21.5 (±19.1) respectively (p < 0.001). A total of 428 (75.6%) patients were potent preoperatively. A total of 62 (14.5%) of these were potent postoperatively (p < 0.001). A total of 483 (83.9%) patients were sexual active preoperatively. A total of 332 (68.5%) of these were sexual active postoperatively (p < 0.001). Conclusion: Even though there is a severe reduction
in EF 12 months postoperatively, the reduction in sexual activity is not so pronounced. This is important preoperative information to communicate to patients.
MP-14.18 Bladder Neck Contracture: Lessons Learned from a Large Single Institution Radical Prostatectomy Registry Mynderse L, McLaren R, Viers B, Sharma V, Karnes RJ Mayo Clinic, Rochester, United States Introduction and Objective: Vesico-urethral stenosis
and bladder neck contracture (BNC) are common complications of radical prostatectomy (RP) with significant morbidity and quality of life implications. Herein we identify unique clinical associations of this entity and quantify temporal trends in a large prostatectomy registry. Materials and Methods: A prospectively maintained single institution RP registry was queried over a 26year period from 1987 -2013 for BNC. Descriptive statistics were used to identify predictors of BNC as well as quantify oncologic and function outcomes. Those with previous radiotherapy or pelvic surgery/TURP were excluded.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS Results: A total of 858 (4.8%) out of 17 954 men with a mean follow-up of 10 years following RP developed BNC. BNC contracture rates have decreased to a mean of 2.5% since 2000 and are temporally associated with the initiation of robotic assisted surgery. Incidence of BNC was significantly associated (odds ratio) with type of anastomosis (4.2), transfusion (1.1), urine leak (3.2) and early UTI (2.8). BNC was not associated with adverse 20-year oncologic outcomes, but was associated with greater risk of one or more incontinence pads/day after RP (OR 1.755). Conclusion: The incidence of BNC after RP has de-
clined over the time of this study. Overall, about 5% of patients will develop a BNC. Risk factors of BNC include early UTI, need for transfusion, lack of nerve sparing technique and advanced pT stage. BNC is independently associated with a 75% increased risk in urinary incontinence at 1 year following RP.
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MODERATED ePOSTERS
Moderated ePosters Session 15 Infections & Inflammatory Diseases Sunday, October 23 1425–1555 MP-15.01 Emphysematous Pyelonephritis: Outcome of Conservative Management Smaoui W, Touaiti T, Rebai N, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Academic Medical Center, Sfax, Tunisia Introduction and Objectives: To identify the prog-
nostic factors, assess the outcome of conservative management, and modify the existing radiologic classification of emphysematous pyelonephritis. Materials and Methods: Forty-five consecutive pa-
patients subjected to flexible cystoscopy divided into three groups (Group 1: 60 patients with prophylaxis of 500 mg of ciprofloxacin, Group 2: 62 patients with prophylaxis of 3 g of phosphomycin, and Group 3: 62 without antibiotic prophylaxis). Prior to inclusion in the study, absence of infection was checked by means of a urine culture obtained 7 days before the procedure. An analysis was made of the cystoscopy indications and its results, the presence of comorbidities, urine culture at 7 days after the procedure, and the urinary symptoms during the following 7 days. The statistical analysis was performed using SPSS 20.0 and with a statistical significance of P≤0.5. Results: The mean age of the patients in Group 1 was
65.3 (SD: 12.5) years, 66.7 (10.8) years in Group 2, and 66.9 (10.8) years in Group 3 (P=0.7). Bacteriuria was present in 15% of the patients in Group 1, compared to 22.6% in Group 2, and 12.9% in Group 3, with the differences not being significant. In the multivariate analysis, it was observed that there was no association with the appearance of bacteriuria between the groups for age, diabetes, smoking, lower urinary tract symptoms, and immunosuppression.
tients diagnosed with emphysematous pyelonephritis between January 2001 and December 2015 were studied retrospectively. On the basis of computerized tomographic scan, they were grouped into four classes (1 to 4). The management was conservative with antibiotics alone or with a combination of percutaneous or endourological drainage and antibiotics.
Conclusion: The use of ciprofloxacin or phosphomy-
Results: Forty (88.8%) of a total of 45 patients were diabetic. Escherichia coli (in 93.3%) was the predominant pathogen identified in pus culture. With antibiotics alone, treatment was successful in 42.8%, and with a combination of percutaneous or endourological drainage and antibiotics, the success rate was 79%. No patients underwent nephrectomy as a primary procedure. The risk factors for mortality were thrombocytopenia, shock, altered sensorium, and hemodialysis. In the absence of risk factors, the success rate with conservative management was 100%. The mortality rate was 25%, 75%, and 100% in the presence of one, two, and three risk factors, respectively. The mortality rate in class 1, 2, 3, and 4 was 8.3%, 12.5%, 50%, and 33.3% respectively. The overall success rate was 77.7%.
Leal W1, Cruz Moreno EK1, Baldino L2, Pinto Barbosa LR1
Conclusions: A combination of urinary drainage with antibiotics offers an effective therapy for emphysematous pyelonephritis.
MP-15.02 Prophylaxis with Ciprofloxacin or Phosphomycin in Flexible Cystoscopy: Is It Indicated? Cano-García MdC1, Arrabal-Polo MA2, ArrabalMartín M2, Merino-Salas S3, López-Carmona Pintado F2 1 Institute IBS Granada, Spain; 2Granada University Hospital, Spain; 3Poniente Hospital, Almeria, Spain
Introduction and Objective: The aim of this study is to determine whether antibiotic prophylaxis is required in this outpatient procedure. Materials and Methods: This was a non-randomized, prospective observational study that included 184
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cin in prophylaxis does not appear to be indicated in flexible cystoscopy in our health area.
MP-15.03 The Use of Intravesical Hyaluronic Acid in the Treatment of Radiation-Induced Cystitis
1
University of the State of Amazonas, Amazonas, Brazil; 2Foundation Center of Oncology Control of the State of Amazonas, Amazonas, Brazil Introduction and Objective: Cystitis induced by radiation is a histopathological change caused by the exposition of the bladder to radiation due to the treatment of cancerous pelvic structures. The objectives of this study were to evaluate the use of hyaluronic acid in patients who developed actinic cystitis during and after the treatment of pelvic malignancies, evaluating its effectiveness in treating this disease and determining the time required for clinical improvement in these patients. Materials and Methods: Between August 2014 and July 2015, a total of 13 patients with actinic cystitis underwent treatment in the Urology sector at the Foundation Center of Oncology Control of the State of Amazonas. The research is a clinical trial that studied the therapeutic response of patients suffering from cystitis actinic. Urine and cystoscopy tests were performed to confirm the diagnosis. From the beginning of treatment with hyaluronic acid, the patients received an instillation of 50 ml of sodium hyaluronate weekly into the bladder, in total of twelve applications. Results: The study showed that 8 patients (61.5%) had already completed treatment for pelvic cancer and developed actinic cystitis after completion of treatment, and 5 (38.5%) patients started presenting the urinary symptoms of actinic cystitis during radiotherapy treatment, the main symptoms reported by patients were pelvic pain (92.3%) and urinary urgency (76.9%). Patients who received treatment with hyaluronic acid
during radiation therapy showed improvement attenuating symptoms by the second (60%) and third application (40%), while patients who started the treatment after the radiation therapy responded to treatment by the fourth application (37.5%) and fifth instillation with hyaluronic acid (62.5%). Considering all the patients in the study, 23.1% had absence of symptoms in the ninth application, while 15.5% in the tenth, 23.1% in the eleventh and 38.4% in the twelfth. After the treatment with hyaluronic acid, all patients were asymptomatic. Conclusion: This research has shown that intravesical
instillation of hyaluronic acid resulted in clinical improvement of patients, providing better quality of life and satisfactory therapeutic response in the treatment of radiation-induced cystitis.
MP-15.04 Efficacy and Role of GeneXpert MTB/ RIF PCR Assay in the Diagnosis of Urinary Tuberculosis Kumar S, Samuel B, Michael J, Berry C, Devasia A, Kekre N Christian Medical College, Vellore, India Introduction and Objectives: To study the accuracy of X-pert MTB/RIF PCR assay in reference to a composite gold standard including urine culture, imaging, and biopsy for diagnosis of urinary tuberculosis. To compare the sensitivity and specificity of Xpert test with that of smear microscopy. Materials and Methods: This prospective study of
accuracy of a diagnostic test conducted at a tertiary care, teaching institution from March 2014 to February 2015 included all adult patients suspected to have tuberculosis of the urinary tract. Three urine samples were collected from each patient. The first early morning, first void sample was subjected to analysis by Xpert MTB/RIF assay, quantitative AFB microscopy, and liquid media (Bactec MGIT 960). The second first void urine and one spot sample were subjected to microscopy only. Imaging, endoscopy and tissue biopsy were performed as clinically indicated. Results: The Xpert Mtb/Rif PCR test was found to have a high specificity (100%) but moderate sensitivity (64.1%) with reference to the composite reference standard. The sensitivity with respect to the microbiological gold standard liquid AFB culture MGIT 960 is 90% with 100% specificity. Xpert PCR assay is far superior as an initial test for urinary tuberculosis (sensitivity of 64.1% vs. 33.1%) compared to the best current available LED fluorescent smear microscopy on serial specimens. Conclusion: Xpert PCR assay on an early morning
first void urine specimen should replace smear microscopy as the initial diagnostic test for urinary tuberculosis.
MP-15.05 Histopathological Classification Criteria of Rat Models for Chronic Prostatitis/ Chronic Pelvic Pain Syndrome Shen Z, Zhong S, Wang X, Zhang M Huashan Hospital Fudan University, Shanghai, China
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS Introduction and Objective: A variety of murine
models for experimental prostatitis that mimic the phenotype of human chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have been developed. However, there is still a lack of explicit diagnosis criteria about these animal models. Our study aims to establish histopathological classification criteria, which will be useful in evaluating these animal models.
MP-15.06, Figure 1.
viously we reported that IC/BPS patients with small bladder capacity had an up-regulation of pro-inflammatory and a down-regulation of urothelial barrier transcripts. Following the same direction, this study aims to correlate bladder capacity (BC) with LUTS, non-urological syndromes, cystoscopic and pathological findings in the search for a relevant biological marker for IC/BPS patients.
Materials and Methods: We established a rat model
Materials and Methods: This is a prospective analysis
of experimental autoimmune prostatitis that is considered a valid model for CP/CPPS. For modeling, male Sprague-Dawley rats were immunized with autologous prostate tissue homogenate supernatant emulsified with complete Freund’s adjuvant by subcutaneous injection into abdominal flank and simultaneously immunized with pertussis-diphtheria-tetanus vaccine by intraperitoneal injection. Three immunizations were administered semi-monthly. On the 45th day, animals were killed and prostate tissue morphology was examined.
of retrospective single institution data, which included women diagnosed with IC/BPS according to AUA Guidelines. BC was estimated during bladder hydrodistension under general anesthesia. Patients were categorized into three groups: Group 1 (BC <400 ml); Group 2 (BC 400-800 ml); Group 3 (BC >800 ml). All subjects underwent assessment that included a detailed history and physical examination, O’Leary/Sant Voiding & Pain Indices (ICPI/ICSI), and the Pelvic Pain Urgency and Frequency Questionnaire (PUF). Bladder biopsies were collected along with hydrodistension for pathological analysis.
Results: Histologically, the prostate tissues were characterized by lymphoproliferation, atrophy of acini, and chronic inflammatory cells infiltration in the stromal connective tissue around the acini or ducts. Finally, we built histopathological classification criteria incorporating inflammation locations (mesenchyme, glands, periglandular tissues), ranges (focal, multifocal, diffuse), and grades (grade I-IV). To verify the effectiveness and practicability of the histopathological classification criteria, we conducted the treatment study with the alpha blocker, tamsulosin.
MP-15.06, Figure 2.
Results: This study included 145 women; 16 in Group 1, 54 in Group 2, and 75 in Group 3. The average age across all 3 groups was 44 years. There was an inverse correlation between BC and age (p=0.013), urinary frequency (p=0.003), ICPI/ICSI (p=0.006), and PUF (p=0.033) score. The prevalence of non-urological syndromes (fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome) was >20% in the three groups, reaching as high as 50% in some cases (e.g. fibromyalgia in Group 2; IBS in Group 3 [p=0.03]). All women had dyspareunia and poor sexual activity. Lower bladder capacity was associated with more severe glomerulations and chronic inflammation.
Conclusion: The histopathological classification crite-
ria of rat model of CP/CPPS will serve as a basis for further research on the pathogenesis and treatment strategies of the disease.
MP-15.06 Mast Cell Subtypes: Implications for the Pathogenesis of Interstitial Cystitis Birch B1, Cooper A2, Lwaleed B3, Malik S3 1
University Hospital Southampton, United Kingdom; 2 Dept. of Biomedical Sciences. Portsmouth University, United Kingdom; 3Faculty of Health Sciences, University of Southampton, United Kingdom Introduction and Objectives: Painful bladder syn-
in PBS/IC tissue (p<0.05). It was also shown that PBS/ IC tissue contains a higher number of MCs compared to controls (figure 1), with the largest difference in density between the two groups found in the lamina propria layer. There is also a significant difference in the density of MC subtype (figure 2, p<0.05).
drome/interstitial cystitis (PBS/IC) is a chronic inflammatory disorder of the urinary bladder. Although its pathogenesis is largely unknown, there is evidence that it is related to mast cell (MC) proliferation and activation in a subset of patients. The objective of this study was to compare the difference in MC subtype, density, and distribution, between normal and PBS/ IC bladder tissue.
Conclusions: These findings suggest that MC numbers are significantly increased in PBS/IC bladder tissue, with a significant difference in subtype, and density within the layers of the bladder. This may provide new insight into the role of MCs in PBS/IC, further our understanding of the pathogenesis of the disease, and develop treatment strategies.
Materials and Methods: Full-thickness bladder tis-
Interstitial Cystitis/Bladder Pain Syndrome: Correlation between Bladder Capacity, LUTS, NonUrological Syndromes, Cystoscopic Findings & Histopathology
sue was collected from patients with PBS/IC (n=14), and from patients with normal histological findings. Samples were paraffin-embedded, and sectioned for immunohistochemistry. Mast cell subtypes were identified using anti-mast cell tryptase antibody (AA1), and anti-mast cell chymase antibody (CC1). Slides were photographed at a standard magnification, and positively stained mast cells were quantified using ImageJ software Results: Results showed a significant difference in the
density of MCs between each layer of the bladder wall
MP-15.07
Zambon JP, Walker S, Badlani G, Langeafeld C, Colaco M, Eschenroeder A, Zhao S, Evans R Wake Forest University, Winston Salem, United States Introduction and Objective: IC/BPS is a clinical diagnosis of exclusion for which there is no specific symptom, cystoscopic or pathological marker. Pre-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Conclusions: The prevalence of non-urological syndromes was high across the three groups, women with the lowest BC (BC <400ml; Group 1) had more urinary symptoms and higher ICPI/ICSI and PUF scores than those with BC >400ml. Cystoscopic and pathological findings suggested more severe disease in this group.
MP-15.08 Modulating the Inflammatory Response to Bladder Catheterization: The Effect of Two Different Catheter Regimens Birch B1, Cooper A2, Lwaleed B3, Xiaoying X3, Fader M3 1
Dept. of Urology, University Hospital Southampton, United Kingdom; 2Dept. of Biomedical Sciences, Portsmouth University, United Kingdom; 3Faculty of Health Sciences, University of Southampton, United Kingdom Introduction and Objective: Indwelling urinary cath-
eters are commonly encountered in both hospitals and community medicine. In this study we examine whether cyclical stretching and relaxation of the bladder is important in maintaining its health and functional integrity. Materials and Methods: Inflammatory markers in urine and blood from non-catheterized healthy volunteers (G1) and catheterized patients on cyclical (G2) and free drainage (G3) regimens were compared using enzyme-linked immunosorbent assays. Plasma and urinary levels of IL-4, IL-6, IL-8, IL-10, IL-1β,
83
MODERATED ePOSTERS MP-15.08, Figure 1. Urinary IL-1`/Creatinine Ration in Non-Catheterized Volunteers and Catheterized Patients on Cyclical and Free-Drainage Regimens
MP-15.10 Risk Factors for Severe Infection in Patients with Urosepsis Caused by Urinary Stones Nakano Y, Shigemura K, Hinata N, Yamada Y, Fujisawa M Kobe University Graduate School of Medicine, Japan Introduction and Objectives: Obstructive pyelonephritis, which is secondary to urinary stones, can easily cause sepsis and concomitant disseminated intravascular coagulation (DIC). In those patients, the severity of sepsis depends mostly upon the host response. We therefore examined the incidence rate, microbiological outcome, and antimicrobial resistance in patients with urosepsis caused by urinary stones, to identify risk factors for severe sepsis. Materials and Methods: We reviewed clinical data
between January 2010 and December 2013 in our institution. Using the computer database, the age, gender, microbiological outcome, antimicrobial resistance, and comorbidities (diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, and cerebrovascular disease) were obtained from all patients. Multivariate logistic regression analyses were applied to identify risk factors associated with severe sepsis.
Box and Whisker Plots Indicate Medians, Quartiles and Ranges
IFN-γ, TNF-α, TGF-β1, and tissue factor (TF) were measured. Urine microcopy and cultures were performed on all subjects. Patients’ general medical condition and performance were also recorded.
mast cells, and increased levels of tryptase, a marker of mast cell activity, have been reported. The present study was conducted to elucidate the role of mast cells in the pathophysiology of IC.
Results: Urinary IL-6, IL-8 and IL-1β (see figure 1), as well as plasma TNF-α were significantly reduced in G2 compared to G3 (p=0.015, 0.011, 0.005 and 0.047, respectively). There was no significant difference between G1 and G2. Although the Barthel Index showed significant differences between the 3 groups (p=0.001), there was no significant relationship between this and the levels of inflammatory markers measured. In addition, the frequency of asymptomatic UTIs did not differ significantly within the 3 groups.
Materials and Methods: The mast cell-deficient
Conclusions: These results suggest that alterations in inflammatory markers can be detected and these can be linked to the system of managing urinary catheters. Levels of some mediators were significantly reduced and others trended downwards in subjects managed with bladder cycling compared to those on free drainage. Maintaining cyclical stretching and relaxation of the bladder may be important in limiting inflammatory responses in patients with long-term indwelling catheters.
WBB6F1-W/W v mice (W/W v) (n = 10) and control WBB6F1+/+ mice (+/+) (n=10) were obtained from Japan SLC. Voiding frequency and voided volume (VV) were determined in these mice housed in metabolic cages. The changes in voiding behaviour 4 hours after intraperitoneal administration of 300 mg/kg cyclophosphamide (CYP) were assessed by measurements of VV. In addition, we examined the presence or absence of mast cells by toluidine blue staining, observed histological changes by hematoxylin and eosin staining, and quantified the degree of edema in the lamina propria of the cystic mucosa. Results: The changes in mean VV following CYP
Clinical Research Support Center, Asahikawa Medical University Hospital, Japan; 2Dept. of Pathology, Asahikawa Medical University, Japan
administration were 48.3 (17.4-65.7) μL and 70.8 (15.7-86.5) μL in W/W v and +/+, respectively. The rate of changes in VV was significantly higher in W/W v (32.0%) than in +/+ (19.2%). Histologically, the degree of edema in the lamina propria was more prominent in +/+ as compared with W/W v, and the relative thickness of the lamina propria to the entire cystic wall was 32.3% and 42.5% in W/W v and +/+, respectively. There were differences in the changes in VV and histology following CYP between W/W v and +/+, suggesting that mast cells might be involved in the pathogenesis of IC.
Introduction and Objective: Interstitial cystitis (IC)
Conclusion: Our study shows that the presence of
is a group of disorders associated with reduced quality of life, and is difficult to treat. In IC, an elevated number of mast cells in the bladder tissue and increased urinary levels of histamine metabolites from
mast cells may be an aggravating factor of inflammatory changes in IC, although further studies concerning the detailed pathophysiological roles of mast cells are needed.
MP-15.09 The Role of Mast Cells in Mice with Cyclophosphamide-Induced Cystitis Matsumoto S1, Nishikawa Y2 1
84
Results: We identified 87 patients with obstructive pyelonephritis caused by urinary stones during the study period. Twenty-five and 62 patients were male (29%) and female (71%), respectively. The mean age of the patients was 68 years (range, 17 to 95 years). Forty-one patients (47%) had cases involving Gram-negative organisms. The most common Gram-negative organism was E. coli (twenty-nine of 41 Gram-negative organisms) followed by Krebisiella pneumoniae. Sixteen Gram-positive organisms were isolated from patients with obstructive pyelonephritis. Among them, fifteen patients developed the acute DIC, received emergent drainage of urinary tract and anti-DIC treatment, as well as administration of antibiotics and adequate volume infusion. According to our multivariate analysis, significant risk factors for severe sepsis were being female, and having a greater number of comorbidities. Conclusion: Obstructive pyelonephritis is a urologic
emergency as it can result in sepsis and even death. A greater number of comorbidities was an independent risk factor for severe sepsis in acute obstructive pyelonephritis caused by urinary stones.
MP-15.11 Diluted Honey Inhibits Biofilm Formation: Its Potential Role in the Management of Indwelling Bladder Catheters Birch B1, Cooper A2, Lwaleed B3, Emineke S2, Fouch S2 1
Dept. of Urology, University Hospital Southampton, United Kingdom; 2Dept. of Biomedical Sciences, Portsmouth University, United Kingdom; 3Faculty of Health Sciences, University of Southampton, United Kingdom Introduction and Objectives: Mature biofilms form readily on moist surfaces and exhibit a complex structure of microcolonies in an extracellular polysaccha-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS ride and eDNA matrix. Indwelling medical devices harbor biofilms which can act as reservoirs for pathogens and lead to disseminated infections. Strategies for minimizing biofilm occurrence underpin an active research area in biomedicine. Urinary catheters are often in place for considerable periods of time and are susceptible to both encrustation and biofilm formation. Manuka honey has, inter alia, well established antibacterial properties. This study aims to assess the influence of honey on early biofilm formation in an established in vitro model. Materials and Methods: An established model of
early biofilm formation using static bacterial cultures in vinyl 96-well plates was used to grow Escherichia coli and Proteus mirabilis, as co-cultures. Planktonic cells were eliminated and the residual biofilm stained with crystal violet, which was subsequently eluted and quantified spectrophotometrically. Manuka “UMF15+” honey, diluted with bacterial growth medium, was added with the bacteria or up to 3 days after. Results: Biofilms in this model developed optimal-
ly over three days Growth stalled thereafter; mixed cultures grew slower than monocultures. In (1:1 by numbers) mixed cultures honey gave a dose-dependent reduction in biofilm formation (between 3.3 and 16.7% w/v). At 3 days all concentrations inhibited maximally. Application of honey to cultures after one and two days also reduced adherent bacterial biomass with 48-hour (figure 1) and 72-hour (figure 2) biofilms stained, eluted and read spectrophotometrically. Means ± S.E.M are shown (16 replicates) (*p<0.05 vs. control). Conclusion: Manuka honey at dilutions as low as
3.3% w/v (which is not prohibitively viscous) inhibits bacterial attachment to a vinyl substrate and reduces further early biofilm development.
MP-15.11, Figure 1.
MP-15.12 The Prevalence of Causative Organisms of Community-acquired Urethritis: Focus on High Risk Age Group of Sexually Transmitted Infections Kim HJ, Kim MK, Jeong YB, Park JK, Shin YS Chonbuk National University Hospital, Jeonju, South Korea Introduction and Objective: We investigate causative organisms of community-acquired urethritis in young male to provide more information for urethritis treatment. Materials and Methods: Between June 2012 and
January 2015, the patients with urethritis symptoms occurred by sexual contact were participated in the study. All patients were evaluated urine analysis, and screened for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Herpes simplex virus (HSV) type II, Trichomonas vaginalis (TV) by multiplex polymerase chain reaction (mPCR) assay for detect of sexually transmitted pathogens (STP). Results: A total of 436 male patients aged from 18 to 28 older were included for the study. Mean age was 22.6 years. The prevalence of STP were as follows: NG in 19.0%, CT in 36.6%, UU in 24.0%, MG in 21.5%, MH in 6.1%, HSV type II in 1.6%, TV in 0.2% and indeterminate pathogens in 9.4%. The prevalence of co-infection of NG with non-NG STP were detected in total 5.7% and STP as follows: with CT in 3.4%, with UU in 2.7%, with MG in 0.2% and with MH in 0.2%. Conclusion: Co-infections of NG with CT, appear less
frequently. And mPCR method is rapid and accurate to identification of STP. The mPCR should be conducted in advance and it will be good to give suitable antibiotics for STP in patient with urethritis rather than give experimental combination antibiotics for NG with CT.
MP-15.13 The Role of 99 m-TechnetiumDimercaptosuccinic Acid Scan in the Evaluation of First Episode Febrile Urinary Tract Infection in Children in Ismailia Governorate Abdelkader O1, Elbakry A1, Abdullah A2 1
Suez Canal University Hospital, Ismailia, Egypt; Ismailia Health Insurance Hospital, Egypt
2
resolution, and a follow-up DMSA was performed 4 months later. Results: The initial DMSA scan results were normal in 53.3% of children. A total of 16.7% had positive initial DMSA findings of right side, 20% had positive initial DMSA findings of left side, and 10% had bilateral initial positive. A total of 80% of children had no reflux with normal VCUG findings. A total of 10% had grade II reflux, 6.7% had grade III reflux, while 3.3% had grade V reflux. Renal scarring was noted in 30% of children who underwent repeated DMSA 4 months later. Conclusion: Acute-phase DMSA scan is important
in the assessment of febrile UTI in children with or without VUR and modify the further strategy such as indication for VCUG.
MP-15.14 Diagnostic Challenges and Variable Presentations of Granulomatous Epididymo-Orchitis Lakovleva G1, Lakovlev V2 1
Markham Stouffville Hospital, University of Toronto, Canada; 2St. Michael’s Hospital, University of Toronto, Canada
Introduction and Objective: Granulomatous epididymo-orchitis can present a diagnostic challenge clinically and pathologically. It can mimic a neoplasm, can have variable presentations and etiologies. BCG introduction for the treatment of bladder cancer expanded this differential diagnosis. Materials and Methods: Cases of pathological di-
agnosis of granulomatous epididymo-orchitis were studied retrospectively at St. Michael’s Hospital (Toronto, Canada) and the data were analyzed together with published literature. Results: A total of 8 cases were identified, with the 4 most representative cases summarized in Table 1. Conclusion: The presented cases and current litera-
ture indicate that granulomatous epididymo-orchitis can present in a variety of non-tuberculous clinical scenarios, including those mimicking primary or metastatic malignancy. Previous BCG treatment should be considered as an etiology. Although attenuated, Bacille Calmette-Guerin (BCG) can lead to an extensive necrotizing granulomatous process, even in an immunocompetent host. The bacilli can be reliably detected in histological sections while molecular test can be false negative as PCR testing is optimized for Mycobacterium Tuberculosis, not BCG.
Introduction and Objective: To evaluate the useful-
MP-15.11, Figure 2.
ness of DMSA performed during the acute phase of first episode febrile UTI in children for detection and Identification of children at risk of events like vesico-ureteric reflux, recurrent UTI or renal scarring that may lead to development of progressive renal damage. Materials and Methods: Between April 2014 and May 2015, 30 children (aged 2 months to12 years) presented to Suez Canal University Hospital with a first episode of febrile UTI. A prospective descriptive study was carried out by an ultrasound and an initial DMSA scan within 5-7 days after diagnosis. Voiding cystourethrography was performed one month later after
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
85
MODERATED ePOSTERS MP-15.14, Table 1.
86
Presentation and procedure
History of intravesical BCG
History of urothelial carcinoma
Immune status
Epididymitis, orchiectomy
No
No
77
Testicular pain, bilateral orchiectomy
No
3
67
Testicular mass, orchiectomy
4
80
Epididymitis with draining sinus, debridement
#
Age
1
59
2
Pathological findings
Acid fast bacilli detected
Unknown
Acute & granulomatous epididymitis, Gram+ bacteria
No
No
Competent
Granulomatous epididymitis, necrotizing vasculitis, polyarteritis nodosa?
No
Yes
Yes
Competent
Granulomatous epididymitis and orchitis, BCG related
Yes, easily
Yes
Yes
Competent
Granulomatous epididymitis, fistula tract, BCG related
Yes, easily
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Sunday, October 23 1425–1555
Introduction and Objectives: We have previously reported that elevated pre-cystectomy serum levels of epithelial tumor markers predict worse oncological outcome in patients with invasive urothelial bladder cancer (UBC). Herein, we evaluated the effect of neoadjuvant chemotherapy (NAChT) on elevated tumor marker levels and their association with oncological outcomes.
MP-16.01
Materials and Methods: Under IRB approval, serum
Moderated ePosters Session 16 Bladder Cancer
Development and External Validation of a Novel 12-Gene Signature on Muscle Invasive Bladder Cancer for Prediction of Overall Survival: Linkage to Data from the Cancer Genome Atlas Shen YJ, Xie HY, Wan FN, Wang BH, Ye DW Dept. of Urology, Fudan University Shanghai Cancer Center, China Introduction and Objective: We aimed to develop
and validate a novel gene signature from published data and improve the prediction of survival in muscle invasive bladder cancer (MIBC). Materials and Methods: We searched the published
gene signatures of MIBC on overall survival (OS) and complied all the 237 genes to develop a novel gene signature. Statistics were conducted with R (version 3.2.1, The R Foundation for statistical computing). RNAseq data of TCGA bladder cohort was downloaded from website “https://genome-cancer.ucsc. edu/proj/site/hgHeatmap/TCGA_BLCA_exp_HiSeqV2-2015-02-24”. All genes were enrolled in the univariate Cox hazard ratio model. We used a reduced multivariate Cox regression model, only genes fulfilled P<0.10 in univariate model were enlisted. A consecutive cohort with 172 patients in Fudan University Shanghai Cancer Center was treated as external validation set. Results: Only with intact clinical and follow up data
were enrolled and finally a total of 327 patients in TCGA cohort were enrolled. We identified 236 genes, from 9 published paper on OS of MIBC. Using the TCGA Database we identified a total of 12 genes that correlated with OS (P<0.05 in univariate and multivariate analysis both). By integrating these genes with the RT-qPCR data in our validation data set we confirmed its prediction of OS (C-index=0.82, P=0.038). The prediction of our novel gene signature is higher than former published data sets. Conclusion: Applying published gene signatures and
levels of Carbohydrate Antigen 125 (CA-125), Carbohydrate Antigen 19-9 (CA 19-9) and Carcinoembryonic Antigen (CEA) were prospectively measured in 368 patients with invasive UBC from August 2011 through August 2015. In the subgroup undergoing NAChT, markers were measured prior to the first and after the last cycle of chemotherapy (before cystectomy). Results: A total of 93 (25%) patients underwent NAChT, of whom 51 had a complete tumor marker profile before and after therapy and 24 (47%) of them had one or more elevated pre-NAChT tumor markers (3 missing post NAChT markers). The mean age was 67 years (range: 33-82), with 12 (57%) males. After completion of chemotherapy, 9/21 (43%) patients normalized their tumor markers, while 12/21 (57%) had one or more persistently elevated markers (p=0.004). There was no difference in pathological stage between groups (p=0.16). Median serum level of CA19-9 was significantly different before and after NAChT (137 vs. 19.3 respectively; p=0.03), while CA125 and CEA were not (Figure 1). Further analysis showed that tumor marker response is strongly correlated with disease recurrence/progression (45% in responders vs. 91% in non-responders at a median time 111 vs. 71 days respectively; p=0.01). Two patients that died in the normalized tumor marker group had tumor marker relapse at recurrence prior to their death. Conclusions: To our knowledge, this is the first pilot study showing tumor marker response to NAChT. The results of this cohort suggest that patients with persistently elevated markers following NAChT have a very poor prognosis following cystectomy. There may be a promising role for these markers in identifying patients whose tumor is resistant to chemotherapy. A larger, controlled study with longer follow-up is needed to determine their role in predicting survival.
MP-16.03
TCGA data, we successfully built and externally validated a novel 12-gene signature for OS of MIBC. The improved prediction for those at high-risk of disease progression or survival will be helpful to doctor-patient consultation and finally, will benefit our patients.
Role of Steroid Hormone Receptors in Formation and Progression of Bladder Carcinoma: A Case-Control Study
MP-16.02
1
Prognostic Role of Epithelial Tumor Marker: Effect of Biomarker Response to Neoadjuvant Chemotherapy on Oncological Outcomes in Urothelial Bladder Cancer Bazargani S1, Clifford T1, Djaladat H1, Schuckman A1, Sadeghi S2, Dorff T1, Quinn D1, Daneshmand S1 1
USC Institute of Urology, Los Angeles, United States; USC Institute of Oncology, Los Angeles, United States
2
Pourmand G1, Mashhadi R1, Kosari F2, Mehrsai A1, Salem S1, Alatab S1, Khonsari M1 Urology Research Center, Tehran University of Medical Sciences, Iran; 2Dept. of Pathology, Sina Hospital, Tehran University of Medical Science, Iran Introduction and Objective: To compare the expres-
sion rate of sex steroid hormone receptors of estrogen (ER), progesterone (PR) and androgen (AR) in normal urothelium and urothelial bladder cancer (UBC) and to evaluate the possible associations of these receptors expression with cancer progression and patient’s survival.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: We evaluated the clinical data and tumor specimens of 120 patients with pathologically confirmed primary UBC with 132 normal healthy controls. Both patients and controls selected from list of subjects who have been referred to Sina Urology clinic, and had a minimum of one-year follow-up duration. Data collected from medical cords. For evaluation of expression, immunohistochemistry was performed on paraffin-embedded tissue sections using a monoclonal antibody for androgen, estrogen and progesterone receptors. Presence of at least 10% positive cells defined as positive expression. Results: None of the control subjects showed AR expression, while 22% of the patients were AR-positive. ER/PR expressions were observed in 4.2% and 2.5% of the cases and in 2.3% and 1.5% of the controls, respectively. A statistically significant correlation was found between AR expression and tumor stage and grade (P<0.001). AR-positive patients showed a significantly poorer prognosis than AR-negative cases (log-rank test, P=0.02, hazard ratio=2.12; 95% confidence interval: 1.36-4.65). Conclusion: AR expression was significantly associat-
ed with higher grade and poorly differentiated tumors with unfavorable outcome. AR expression test might be useful as a diagnostic tool for determining the malignancy and outcome of UBC patients.
MP-16.04 Androgen-Dependent Genetic Signatures of Luminal TCGA Subtype Bladder Cancer Morales E, Jinesh GG, Williams S, McConkey DJ, Kamat AM, Su X The University of Texas M.D. Anderson Cancer Center, Houston, United States Introduction and Objective: In 2014, the Cancer Ge-
nome Atlas (TCGA) Research Network performed a comprehensive analysis of 131 different tumors and delineated 4 subtypes. Recent retrospective evidence as well the existing profound gender discrepancy in the incidence of urothelial carcinoma worldwide suggests that UC may be affected by the androgen hormonal axis. We sought to investigate these effects by comparing androgen (particularly dihydrotestosterone) gene signatures with genetic expression profiles from TCGA. Materials and Methods: The bladder TCGA is a
widely recognized and comprehensive multicenter effort to characterize 131 non-variant muscle-invasive bladder tumors. Gene signatures were obtained from the Broad Institute by searching for the keyword “androgen.” A total of 37 gene sets were found published on the website. Using genome expression profiling analysis, the bladder TCGA was searched for those androgen-dependent signatures. Pathway analysis looking for known gene sets was then performed on the results above. Results: A total of 109 different androgen-dependent genes were found with a greater than 3-fold increase in expression in luminal TCGA tumors when compared to basal. Several of the genes with the highest-fold increases are known biochemical markers for androgen-dependent prostatic carcinoma, including KRT5, FGFBP1, PI3, and CXCL10. The highest-fold increases in relative expression were KRT6A (44.28x,
87
MODERATED ePOSTERS MP-16.02, Figure 1. Median Serum Marker Levels Trend Before And After Neoadjuvant Chemotherapy (NAChT)
preNAChT
PostNAChT
P value
CA125
26.7
14
0.29
CA19-9
137
19.3
0.03
CEA
4.2
2.8
0.52
Descriptive Data of Patients with Complete Tumor Marker Profiles*
1
Pre Neoadjuvant
Post Neoadjuvant (30 d)
Pathologic Stage
CA 125
CA 19-9
CEA
CA 125
CA 19-9
CEA
Biomarker Response
Survival Status**
OS Months
Recurrence Status***
RFS Months
T4aN2M1
4
203
5
2
185
6
N
Alive
2
Progression
2
2
T3aN0M0
9
108
6
14
15
6
N
Alive
8
NED
7
3
T3bN2M0
11
28
4
11
18
5
N
Alive
1
NED
1
4
T3bN1M1
24
32
4
64
33
10
N
Alive
3
Progression
3
Alive
7
Progression (unresectable)
5
5
T4bNXM0
334
267
3
103
19
2
N
6
T0N0M0
8
65
6
9
58
5
N
Alive
11
Recurrence
2
7
T4bN0M0
27
208
6
15
161
4
N
DOD**
4
Progression
2
8
T3bN2M1
28
51
3
67
26
4
N
DOD
4
Progression
2
88
N
Dead (intraop)
0
Progression
0
41
178
5
45
1510
9
T4aN2M0
10
T2aN2M0
12
369
2
13
39
2
N
Alive
4
Recurrence
4
11
T4aN2M0
746
4235
31
4523
29410
958
N
DOD
10
Progression
5
12
T4bN2M1
NA
<0.6
12
12
<0.6
28
N
DOD
24
Progression
3
13
T2aN0M0
4
309
3
4
11
2
Y
Alive
2
NED
2
14
T0N0M0
162
291
3
12
11
3
Y
Alive
4
NED
4
15
T3aN2M0
135
1
9
22
1
1
Y
Alive
5
NED
5
16
T0N0M0
13
9
16
5
4
3
Y
Alive
4
NED
4
17
T0N0M0
82
196
3
10
11
1
Y
DOD
15
Recurrence
4
18
TabNXM1
106
1238
7
18
28
1
Y
DOD
5
Progression
2
19
T3bN2M1
8
89
1
5
17
1
Y
Alive
4
Recurrence
2
20
TisN0M0
11
137
2
18
35
3
Y
Alive
23
NED
23
21
T4aN2M1
85
<0.6
2
16
<0.6
1
Y
Alive
15
Progression
5
*Normal values are as follows: CEA<37 u/mL, CA 125<35 u/mL, CEA>3.8 u/mL **DOD: Dead of Disease ***NED: No Evidence of Disease
p-value=5.6e-30), PI3 (25.28x, p-value=1.29e-20) and KRT6B (20.73x, p-value=1.27e-30). The M7600 pathway, a gene set that is involved in androgen-stimulated proliferation of estrogen and progesterone receptor negative (ER-/PR-) breast cancer, was found to be significantly upregulated in luminal versus basal tumors. Conclusion: The luminal TCGA subtype of bladder
cancer shares 109 different known androgen-dependent genes with prostatic adenocarcinoma. Androgen-mediated genes may be directly involved in the carcinogenesis of luminal urothelial tumors. In addition, a known androgen stimulated proliferative
88
pathway in (ER-/PR-) breast cancer cells was found. Further research in this area may hope to demonstrate targeted therapies for luminal subtype bladder cancer involving androgen-depletion or androgen-axis manipulation.
MP-16.05 The Effects of Therapy Applied for Superficial Bladder Carcinoma on Certain Interleukins and Neopterin Temeltas G, Kosova F, Ucer O, Yuksel MB, Muezzinoglu T, Ari Z Celal Bayar University, Manisa, Turkey
Introduction and Objective: In superficial bladder
cancers, intravesical chemo-immunotherapies are applied after surgery in order to minimize the rate of progression and recurrences. So far, immunotherapy with BCG is known to be the best adjuvant therapy, which triggers an intense immunologic reaction via increased production of cytokines. These molecules are known to play important roles in the pathogenesis of bladder cancer developing in inflammatory process. The aim of this study is to investigate the blood levels of certain cytokine markers, i. e. IL-6, IL-1, IL-8 and neopterin, before and after the therapy, in order to obtain clues that may illuminate the underlying
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS mechanism of tumorigenesis, and to assess whether these molecules can be used in diagnosing and monitoring of superficial bladder cancer. Materials and Methods: Thirty patients with superfi-
cial bladder carcinoma were included in the study as the study group, while 30 healthy voluntaries serving as the control group. After analyzing the blood levels of IL-6, IL-1, IL-8 and neopterin with ELISA test in both groups before the operation (group 1), at day 15 post-operatively (group 2) and after the termination of intravesical BCG therapy (group 3), calculated levels in three groups of the study group were compared statistically with the control group and with each other. Results: Calculated IL-6, IL-1, IL-8 and neopterin values were found significantly higher (p<0.05) when comparing groups 1 and 2 with the control group, while there was no statistical difference between the control group and group 3. Comparing group 1 and 2 yielded statistically significant higher results in group 1 in terms of IL-6, IL-1 and IL-8 values, while neopterin levels in both group were quite similar. All parameters were found to be significantly lower in group 3 when compared with both group 1 and group 2 (p<0.05). Conclusion: The data obtained in this study displayed
that blood levels of IL-1, IL-6, IL-8 and neopterin were significantly higher in bladder cancer patients before therapy and declined to the values of the control group after therapy. Although these findings point out that blood levels of these cytokines may be useful in the diagnosis and long-term follow-up of superficial bladder cancer, utilizing these tests in routine practice, in our opinion, needs longer-term studies with larger patient groups.
MP-16.06 Effectiveness of Bladder Tumour Antigen Quantitative Test in Diagnosis of Bladder Carcinoma in Schistosoma Endemic Area Muhammad AS1, Mungadi IA1, Kalayi GD2 1
Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; College of Health Sciences, Usmanu Danfodiyo University Sokoto, Nigeria; 2Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; Faculty of Medical Sciences Gombe State University, Gombe, Nigeria Introduction and Objective: Bladder carcinoma is
the most common malignancy in men in Sokoto, North-Western Nigeria due to endemicity of schistosomiasis and most patients present with advanced disease. We determined the effectiveness of bladder tumour antigen quantitative test (BTA TRAK) as non-invasive marker of bladder cancer in a schistosoma endemic area. Materials and Methods: This was a 12-month pro-
spective study of patients with features of bladder carcinoma as study group, and patients with haematuria from other urologic conditions, benign urologic conditions and healthy volunteers as the control group. Bladder tumour antigen was assayed using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using SPSS version 20.0 for windows. Results: A total number of 88 patients participated in the study, 52 patients in the study group and 36 pa-
tients in the control group. The mean ages of patients in the study and control groups were 47.17 ± 17.00 and 44.19 ± 18.89 years respectively (p=0.412). The male to female ratio was 12:1. Thirty-one (60%) of the patients were farmers and 44 patients (85%) had history childhood haematuria, which was suggestive of schistosomiasis. The histopathological types of bladder carcinoma were squamous, urothelial and adenocarcinoma in 60%, 38%, and 2% respectively. The sensitivity of urine cytology and BTA TRAK in the study was 29.1% and 98.8% respectively. The specificity of urine cytology and BTA TRAK was 95.5% and 13.6% respectively (p=0.05). The positive predictive values of urine cytology and BTA TRAK in the study were 96.2% and 81.7% respectively, while their negative predictive values were 25.0% and 75.0% respectively. There was positive correlation of mean BTA concentration with stage of the bladder carcinoma (p=0.03). The marker was 100% false positive in patients with haematuria from other urologic conditions, benign urologic conditions and cancer of the prostate. Conclusion: Bladder tumour antigen is highly sensi-
tive (98.9%) but poorly specific (13.6%) for bladder cell carcinoma in a schistosomiasis endemic area. The marker correlates positively with the stage of the bladder carcinoma.
MP-16.07 Impact of Smoking Status and Timing of Smoking Cessation on Outcomes in Non-Muscle Invasive Bladder Cancer Treated by BCG Immunotherapy: About 550 Patients Sallami S1, Stambouli N2, El Ourhani S1, Ben Ammar Elgaaied A2 1
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; Laboratory of Genetics, Immunology and Human Pathology, Faculty of Sciences, Tunis, Tunisia
2
Introduction and Objective: The causal association
between cigarette smoking and urothelial bladder cancer has been well established. However, the prognostic effect of cigarette smoking on disease recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC) treated with endoscopic resection and BCG-therapy is still poorly investigated. We analyzed the effects of smoking status, cumulative exposure, and time from smoking cessation on the prognosis of patients with primary NMIBC. Materials and Methods: We collected data from 550
patients with primary NMIBC treated with transurethral resection of the bladder tumor followed by BCG immunotherapy. Smoking history was obtained in all patients from the medical records. Smoking variables included smoking status, average number of cigarettes smoked per day (CPD), duration in years, and time since smoking cessation. Clinical data concerning diagnosis, treatment, and disease course were collected retrospectively. The minimum follow-up duration in this study was 60 months. Results: The study population comprised 72 never smokers (13.1%), 66 former smokers (12%), and 412 current smokers (74.9%) at the time of diagnosis. Univariate Cox regression analysis didn’t reveal statistically significant difference or trend in risk of recurrence or progression across the 3 smoking status categories was found. Using the Weka statistical tool,
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
we found two class association rules: 1) Non-smoking cessation is significantly associated with 5-year recurrences, 2) Being a heavy smoker (>30 CPD) with an initial tumor multifocality is highly associated with recurrences at 3 and 15 months. The specificity and sensitivity of these two. The class association rules were 0.8405 (CI: 0.9108-0.9608) and 0.7947 (CI: 0.7317-0.8461) respectively. Conclusion: Based on the present unicentric study,
heavy smokers or high cumulative smoking exposure seem to be at the greatest risk for recurrence of MNIBC treated by BCG immunotherapy. Smoking cessation may limit these effects thereby improving prognosis. Patients’ smoking history may be very useful for the guidance of management decisions especially follow-up rhythm. Continued efforts should be made to raise awareness of bladder cancer in smokers and to advocate further for smoking cessation.
MP-16.08 Initial Experience and Recurrence of Transurethral Resection of Bladder Tumor in Narrow-Band Imaging: Prospective, Randomized Comparison with White-Light Cystoscopy Kim S1, Kim J1, Lee J1, Cheon J1, Kang S1, Park H2, Moon D2, Oh M2, Kim J2, Bae J3, Park J3, Kang S1 1 Korea Anam Hospital, Seoul, Korea; 2Korea Kuro Hospital, Seoul, Korea; 3Korea Ansan Hospital, Korea
Introduction and Objective: We expect NBI (narrow-band imaging) cystoscopy to heighten the detection rate of bladder tumors in transurethral resection of bladder tumor because NBI cystoscopy is clearly indicated in bladder tumors that have a lot of blood vessels, which may be detected via narrow-band light. Materials and Methods: We included patients who underwent transurethral resection of bladder tumor from December 2013 to present in our hospital. We divided patients into the NBI cystoscopy group and the WLC (white light cystoscopy) only group through randomization, and investigated the number of tumors that were diagnosed with cancer or found during surgery in both groups. We compared the recurrence rate for 3 and 6 months in both groups. We excluded patients who underwent previous surgery, or cystectomy after surgery, no cancer, or was diagnosed with T2 or greater. Results: A total of 94 patients were divided into the WLC group and NBI group, consisting of 48 and 46 patients, respectively. In the WLC group, 43 patients had been diagnosed with bladder cancer where 64 bladder tumors out of a total 82 bladder tumors were diagnosed with bladder cancer. In the NBI group, 39 patients had been diagnosed with bladder cancer where 86 bladder tumors out of a total of 101 bladder tumors were diagnosed with bladder cancer. Additional tumors that had been detected in the NBI group were 20 patients amongst where 4 patients had been diagnosed with cancer. The number of additional tumors was 41, 3 tumors were diagnosed with CIS, and 2 tumors were diagnosed with Ta. In the NBI group, 5 additional cancers were found in 4 patients in which up-staging was done in one case. Threemonth postoperative follow-up results for the WLC and NBI groups where each group consisted of 9 and 18 patients, showed recurrence of 0 and 1 patient, re-
89
MODERATED ePOSTERS spectively. Six-month postoperative follow-up results for the WLC and NBI group which consisted of 7 and 12 patients was a recurrence of 2 and 0 patients, respectively. Conclusion: The number of patients diagnosed with
bladder cancer who had been additionally detected via NBI was four. Also, the grade of the tumor in one patient was elevated. Although the follow-up results showed no significant difference in recurrence rates between the two groups, taking into consideration that this study was based on a small population of patients, it can be anticipated that a significant difference may exist when long-term observation is carried out.
MP-16.09 Transurethral Resection and Degeneration of Bladder Tumor (TURD-Bt) to Treat Bladder Cancer: A 10-Year Review Li A, Fang W, Li W, Lu H, Liu S, Wang H, Zhang B Dept. of Urology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
a better treatment option to preserve bladder integrity and improve living status.
MP-16.10 Prostate-Sparing Cystectomy Versus Nerve Sparing Cystoprostatectomy: A Retrospective Study of Long-Term Functional and Oncological Outcomes Saad M, Sanchez-Salas R, Barret E, Galiano M, Rozet F, Macek P, Cathala N, Mombet A, Prapotnich D, Cathelineau X Dept. of Urology, Institut Mutualiste Montsouris, Paris, France Introduction and Objective: Prostate sparing cystectomy (PSC) is arguably a valid option for the management of patients with bladder cancer provided that strict selection criteria are met. We aimed to evaluate our long-term results of PSC and compare them to patients who received nerve-sparing cystoprostatectomy (NSCP) after matching for clinical and pathological characteristics.
the surgical outcome of transurethral resection and degeneration of bladder tumor (TURD-Bt) to treat bladder cancer.
Materials and Methods: Between 2001 and 2011, 60 patients were treated with laparoscopic or robotic PSC for bladder cancer while 47 patients received laparoscopic or robotic NSCP and orthotopic bladder substitution.
Materials and Methods: Between September 2005
Results: Mean patient age was 60.35 and 62.12 for
and February 2015, 117 patients with bladder tumor were treated by TURD-Bt in the last 10 years. Among them, 36 patients had muscle invasive bladder cancer (MIBC) in stage T2, who were unsuitable for, or who refused, the radical cystectomy. The other 81 patients had non-muscle invasive bladder cancer (NMIBC). The surgical outcomes were reviewed and evaluated.
PSC and NSCP respectively. Median follow up was 69.5 months and 51 months for PSC and NSCP respectively. Forty percent of PSC had ≤pT1N0, 30% pT2N0, 22% pT3N0 while 8% had N+ disease; compared to NSCP patients whom 38% had ≤pT1N0, 19% pT2N0, 23% ≥pT3N0 and 19% N+ (p=0.74). Prostatic adenocarcinoma was found on final pathology in 2 (3%) of PSC patients and in 21 (45%) of NSCP patients. One patient in the PSC group had TCC of prostatic acini. The overall 3- and 5-year cancer specific survivals were 92% and 90% in the PSC group, and 82% and 79% in the NSCP group respectively. The local recurrence rates were 11.7% and 21.3% for the PSC and the NSCP groups respectively, and the respective distant recurrence rate was 17% and 28%. CIS in the final bladder pathology was significantly associated with recurrence in the PSC group but not in the NSCP group. Regarding continence, 97% and 70% of PSC group were leak-free for day and night respectively, compared to 70% and 37% in NSCP group. On long-term follow-up, 18% of PSC required TURP. Sexual intercourse was achievable without any treatment in 68% of PSC compared to 37% in NSCP (p≤0.001). In both surgeries, high BMI was associated with a poor functional recovery.
Introduction and Objectives: To review and evaluate
Results: Median follow-up time was 50.69 ± 33.63
months. Bladder tumor recurrence was 13 (11.11%), other cancers were 8 (6.84%), cancer death was 6 (5.13%), and non-cancer death was 13 (16.05%). In 36 patients with MIBC, bladder tumor recurrence was 9 (25.00%), other cancers were 4 (11.11%), cancer death was 4 (11.11%), and non-cancer death was 3 (8.33%). In 81 patients with NMIBC, bladder tumor recurrence was 4 (4.94%, P < 0.01), other developed cancers were 4 (4.94%), cancer death was 2 (2.47%) and non-cancer death was 10 (12.35%). Among 45 patients over 5 years postoperatively, 5-year overall survival was 37 (82.22%), bladder tumor recurrence was 7 (15.56%), other cancers were 5 (11.11%) and cancer death was 4 (8.89%). In 16 patients with MIBC, 5-year overall survival was 12 (75.00%), bladder tumor recurrence was 4 (25.00%), other cancers were 2 (12.50%) and cancer death was 2 (12.50%). In 29 patients with NMIBC, 5-year overall survival was 25 (86.21%), bladder tumor recurrence was 3 (10.34%), other cancers were 3 (10.34%) and cancer death was 2 (6.90%). The differences were not significant between the two groups. Conclusions: Complete removal of bladder tumor can be expected by TURD-Bt. Residual tumor and tumor recurrence are significantly decreased by degenerating deeper tissue. For NMIBC, TURD-Bt could be performed to replace transurethral resection of bladder tumor (TURBt) to remove residual tumor, decrease tumor concurrence and improve surgical outcome. For MIBC in stage T2, TURD-Bt could be
90
Conclusion: Based on our experience, prostate-spar-
Introduction and Objective: Radical cystectomy cou-
pled with pelvic lymphadenectomy is the mainstay of curative surgical management of patient’s with muscle invasive non-metastatic bladder cancer. In patients with a history of pelvic radiation, radical cystectomy is considered a challenging and morbid procedure. Literature is unavailable for reports comparing open surgical radical cystectomy and of robotic assisted techniques in patients with previous pelvic radiation. In this study, we compared the outcomes of robotic assisted (RAPRC) and open post radiation cystectomy (OPRC) in patients with a history of pelvic radiation. Materials and Methods: We identified all patients
with previous pelvic radiation followed by open or robotic radical cystectomy at our institution since 1998. Patient’s demographic, pathological results and complication rates were compared for 35 robotic assisted and 31 open salvage cystectomies using the Chi-square and Wilcoxon signed-rank test. Results: At 90 days, grade 2-5 complications were observed in 40% and 55% of RAPRC and OPRC patients, respectively. The RAPRC group had lower mean intraoperative blood loss (p =0.0002) and shorter length of stay (p =0.03) than the ORC group. Limitations include retrospective design. Conclusions: RAPRC has achieved surgical outcomes comparable to open radical cystectomy in the salvage setting in experienced hands, while offering a lower intraoperative blood loss and shorter length of stay.
MP-16.12 The Clinical Outcomes in Patients Undergoing Radical Cystectomies Who Are over the Age of 80 Robinson S Frimley Health Foundation Trust, Surrey, United Kingdom Introduction and Objective: Offering major radical
surgery has often been felt to be inappropriate in an elderly population, even if they are otherwise fit and well. We offer supporting evidence that in fit octogenarians, radical cystectomy does not result in greater mortality. The proportion of elderly people in the general population is increasing. The increase in lifespan is associated with an increase in the incidence of some tumors, including bladder cancer. Among people in the eighth decade, bladder cancer is the fifth leading cause of cancer death. Radical cystectomy is the treatment of choice for patients with invasive bladder cancer. Co-morbidity and unique physiological changes present a surgical challenge in the elderly patient Materials and Methods: A retrospective review of
ing cystectomy is functionally superior to nerve sparing cystoprostatectomy. On an oncologic basis, prostate-sparing cystectomy is not inferior to nerve sparing cystoprostatectomy as long as rigorous selection criteria are met.
all patients 80 years or older who underwent radical cystectomy with urinary diversion during the last 10 years was done. Of 257 cystectomies performed in this period, 36 patients (14%) were identified. Age ranged from 80 to 90 years (mean 83 years). There were 26 males and 10 female patients.
MP-16.11
Results: See Tables 1 and 2.
Robotic Versus Open Salvage Cystectomy: Early Outcomes
Conclusion: The number of octogenarians in the total
Omar M, Kaouk J, Haber G, Stein R, Caputo P, Fergany A Cleveland Clinic, United States
population is rising and many will be diagnosed with invasive bladder cancer. Advances in anesthesia, intensive care and surgery, the mortality and morbidity rates of patients undergoing radical cystectomy have
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-16.12, Table 1. Comparison of Octogenarians and Non-Octogenarians Octogenarians (36)
Non-octogenarians (221)
Age
83
67
Male
72%
80%
Tumour volume
15cc
15cc
Localised T1/T2
42%
62%
Locally advanced
58%
38%
Nodal involvement
22%
20%
CIS
42%
45%
PSM
14%
10%
Incidental prostate cancer
63%
43%
Transitional cell cancer
27
187
Squamous cell cancer
4
11
Metastatic cancer
3
3
Neuroendocrine
1
9
Sarcomatoid
1
11
MP-16.12, Table 2. Logistic Regression and Significant Predictors of Mortality coefficient
P
Odds ratio
All cause mortality
Neobladder
-0.8
0.0154
0.42
Private patient
-1.4
0.0013
0.24
T3
1.007
0.0008
2.7
T4
1.97
<0.0001
7.18
0.77
0.021
2.17
Disease specific mortality
Additional treatment Complication
0.73
0.013
2.08
Neobladder
-0.95
0.015
0.38
Node density
2.26
0.014
9.67
Private patient
-1.08
0.035
0.33
Additional treatment
0.74
0.029
2.11
Private patient
-1.92
0.002
0.14
T2
1.18
0.010
3.28
T3
1.99
<0.0001
7.3
T4
1.89
0.0001
6.6
Progression
dramatically decreased over the last 20 years. Radical cystectomy and ileal conduit can be performed with an acceptable morbidity and mortality in individuals 80 years of age or older with no statistically significant difference with respect to age. Age should not exclude the elderly from a curative procedure.
MP-16.13 Frailty as a Predictor of Complications in Older Patients Undergoing Radical Cystectomy Clifford T, Bazargani S, Cai J, Schuckman A, Djaladat H, Daneshmand S USC Institute of Urology, Los Angeles, United States
ing (weight loss of ≥10 pounds within the past year), exhaustion, and low physical activity. The patients were also prospectively scored using the Clinical Epidemiological Survey for Depression, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists scoring system (ASA), Katz Activities of Daily Living, Karnofsky performance status (KPS), and Eastern Cooperative Oncology Group (ECOG) performance status. The 30-day and 90-day postoperative data was recorded. Chi-square and multivariable logistic regression were performed for analysis. Results: A total of 62 patients were identified between February 2014 and June 2015 with an average age of 75 years. A total of 42 (67.7%) and 49 (79.0%) patients had at least one postoperative complication within 30 and 90-days, respectively. A total of 61.3% of patients underwent open radical cystectomy, with no difference in complication rates between open and robotic approach (p=0.75). On univariate analysis, shrinking was significantly associated with 30-day complications (p<0.03). Median number of 30 and 90-day complications was 2 (range 0-5) in those with shrinking compared to 1 (range 0-5) in those without (p<0.004, p<0.02). On multivariable analysis, frail grip strength was associated with increased number of complications after controlling for pathologic stage and albumin (OR 5.4, CI 1.4-21.0, p<0.01). Other frailty measures (such as walking speed and activity level) and other assessment tools (such as ECOG, CCI, and KPS) were not associated with postoperative complications (p>0.05). Conclusions: Preliminary results of this prospective study suggest that grip strength and shrinking may be useful frailty measures predictive of postoperative complications in older patients undergoing radical cystectomy. These measures may be useful for identifying patients at high risk for perioperative complications.
MP-16.14 Underutilization of Radical Cystectomy Among Elderly Patients Diagnosed With Muscle-Invasive Bladder Cancer Ghaffary C1, Huo J2, Chamie K3, Hu JC4, Giordano S5, Dinney C6, Kamat A6, Tina Shih YC2, Williams SB7 1
scribed as a medical syndrome characterized by decreased physiologic reserve causing vulnerability to adverse outcomes. There is a paucity of prospective studies on frailty in urological patients. Our goal was to determine whether established measures of frailty can identify high-risk patients undergoing radical cystectomy and predict their surgical outcomes and complication rates.
Div. of Urology, University of Texas Medical Branch, Galveston, United States; 2Dept. of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, United States; 3Dept. of Urology, David Geffen School of Medicine at UCLA, Los Angeles, United States; 4Dept. of Urology, WeillCornell Medical College, New York City, United States; 5 The Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 6Dept. of Urology, University of Texas MD Anderson Cancer Center, Houston, United States; 7Div. of Urology, University of Texas Medical Branch, Galveston, United States; Dept. of Urology, University of Texas MD Anderson Cancer Center, Houston, United States
Materials and Methods: Under IRB approval, we identified patients over the age of 65 undergoing radical cystectomy. We prospectively measured frailty preoperatively using surrogates including hand dynamometry (grip strength), walking speed, shrink-
Introduction and Objective: Survival outcomes among patients diagnosed with muscle-invasive bladder cancer remain unchanged over the last 3 decades. Radical cystectomy is the standard surgical treatment for muscle-invasive bladder cancer. We examined de-
Introduction and Objective: Frailty has been de-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
91
MODERATED ePOSTERS terminants associated with utilization of radical cystectomy. We sought to identify population-based factors predicting the use of radical cystectomy, as well as pelvic lymph node dissection. Materials and Methods: A total of 3 922 patients aged 66 years or older diagnosed with stage II muscle-invasive bladder cancer from January 1, 2002 to December 31, 2011 using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. We used univariate and multivariable regression analyses to identify factors predicting the use of radical cystectomy. Cox proportional hazards models were used to analyze survival outcomes. Results: A total of 740 (18.9%) patients with muscle-invasive bladder cancer underwent radical cystectomy. Older age at diagnosis (>80 vs. 65-69 years old, odds ratio [OR] = 0.15, 95% confidence interval [CI] = 0.11 to 0.19, p<0.001) and higher comorbidity (Charlson comorbidity index 3+ vs 0, OR = 0.41, 95% CI = 0.29-0.57, p<0.001) were associated with a decreased use of radical cystectomy. Moreover, non-Hispanic black versus white patients were less likely to undergo radical cystectomy (OR = 0.62, 95% CI = 0.40-0.96, p=0.032) as well as pelvic lymph node dissection (OR = 0.65, 95% CI = 0.42-1.02, p=0.058). Overall survival was improved for patients who underwent radical cystectomy alone (hazard ratio [HR] = 0.70, 95% CI = 0.56-0.88, p=0.002) and with lymph node dissection (HR = 0.45, 95% CI = 0.40-0.51, p<0.001) compared with those who did not undergo radical cystectomy. Conclusion: Despite improved overall and can-
cer-specific survival, there is significant underutilization of radical cystectomy in patients diagnosed with muscle-invasive bladder cancer. Moreover, older patients with significant comorbidities and non-Hispanic black patients were less likely to receive potentially curative surgery.
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36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 17 Sexual Function & Dysfunction Sunday, October 23 1425–1555 MP-17.01 Effect of the BKCa Channel Opener, LDD175, on Erectile Function of Diabetic Rats Lee SW1, Choi TS1, Jeon SS1, Jeong BC1, Park JK2 1
Dept. of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Dept. of Urology, Medical School and Institute for Medical Sciences, Chonbuk National University, South Korea
Introduction and Objective: Phosphodiesterase type
5 inhibitor (PED5I) is the first-line treatment for patients with erectile dysfunction (ED). However, the response rate is lower in certain subpopulations, such as those with diabetes. Thus, the development of novel therapeutic options is imperative for patients who are unresponsive to PDE5I. LDD175 is the potent BKCa channel opener and is known for its relaxation effect of in vitro cavernosal smooth muscle strip of rabbit and in vivo normal rat model. The aim of the current study is to investigate the effect of the LDD175 on erectile function using in vivo diabetic rat models. Materials and Methods: Male Sprague-Dawley rats were assigned to 6 groups: normal control group (n=5) and 5 diabetic groups: (1) diabetic control group (n=8), (2) sildenafil group (1 mg/kg, n=6), (3) LDD175 group (5 mg/kg, n=7), (4) combination of LDD175 (5 mg/kg) and Sildenafil group (1 mg/kg, n=4) and (5) LDD175 (10 mg/kg) with tetraethylammonium group (TEA, n=6), with streptozotocin intraperitoneal injection (60 mg/kg), diabetic rats were induced at 16 weeks. We compared intracavernosal pressures (ICP), mean arterial pressure (MAP) and area under curve (AUC) of ICP/MAP of 6 groups using in vivo pelvic nerve stimulation (1, 2.5 and 5 V with 2 Hz, 5 ms a duration of 60 seconds). Results: Diabetic rats had a significantly lower ICP/ MAP ratio than normal controls (p<0.05). Intravenous 5 mg/kg LDD175 alone restored the erectile function of diabetic rats to a level similar to that of 1 mg/kg sildenafil alone. These improvements were completely blocked by TEA. There was no difference between 5 mg/kg LDD175 alone and 1 mg/kg sildenafil regarding maximal ICP, ICP/MAP ratio, and the AUC of the ICP/MAP ratio (p>0.05). Combination group of 5 mg/kg LDD175 and sildenafil 1 mg/ kg showed significantly more improvement of erectile function than 1 mg/kg sildenafil alone (p<0.05). Conclusion: The current study showed that the BKca
channel opener LDD175 improved erectile function of in vivo diabetic rat models. Furthermore, combination therapy of LDD175 and sildenafil has an additive effect on the improvement of erectile function in diabetic rats. We therefore suggest that LDD175 could be a new candidate treatment for ED.
MP-17.02 Effects of Eupatilin on the Contractility of Corpus Cavernosal Smooth Muscle Through Nitric Oxide Independent Pathways Lee SW1, Choi TS1, Jeon SS1, Choo SH2, Park JK3, Lee SW4 1 Dept. of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Dept. of Urology, Ajou University School of Medicine, Suwon, South Korea; 3Dept. of Urology, Medical School and Institute for Medical Sciences, Chonbuk National University, South Korea; 4Dept. of Urology, Gyeongsang National University Hospital, Jinju, Korea
Introduction and Objective: Eupatilin (5,7-dihy-
droxy-3,4,6-trimethoxyflavone) is an important single lignan of the herb Artemisia asiatica Nakai. Eupatilin has been known to possess relaxation effects on vascular contraction regardless of endothelial function. We have evaluated the relaxant effects of eupatilin on rabbit corpus cavernosum (CC) and the mechanism of action of eupatilin on corporal smooth muscle cells. Materials and Methods: Isolated rabbit CC strips
were mounted in an organ-bath system and the relaxation effect of eupatilin was evaluated by cumulative addition (10-5 M, 3x10-5 M, 10-4 M and 3x10-4 M) to CC strips pre-contracted with 10-5 M phenylephrine. A conventional whole-cell patch-clamp technique was used to measure activation of calcium-sensitive K+ channels currents in human corporal smooth muscle cells. Western blot analysis for myosin phosphatase targeting subunit (MYPT) was performed to evaluate the effect of eupatilin on RhoA/Rho-kinase pathway with CC strips pre-contracted with 5x10-7 M Endothelin-1. Results: Eupatilin effectively relaxed phenylephrine-induced tone in rabbit CC in a dose dependent manner (n=8, p<0.05). Iberiotoxin and tetraethylammonium significantly reduced the relaxation effect (n=8, p<0.001 and p=0.003). Removal of the endothelium or the presence of the NO-synthase (NOS) inhibitor, L-NAME, did not affect the relaxation effect of eupatilin. The extracellular application of eupatilin 100 μM significantly increased outward currents, and this effect was significantly attenuated by treatment with 100nM Iberiotoxin (n=13, p<0.05). Eupatilin reduced phosphorylation of MYPT at Thr850. Conclusion: Eupatilin showed relaxation effects on
rabbit corpus cavernosum through NO independent pathways. Activation of calcium-sensitive K+ channels and inhibition of RhoA/Rho-kinase would contribute to the relaxation effect of eupatilin.
MP-17.03 Inhibition of Jun N-Terminal Kinase Restores Erectile Function by Suppression of Corporal Apoptosis in a Rat Model of Cavernous Nerve Injury Song WH1, Kim JK1, Park J2, Lee JW3, Cho SY2, Chun SJ4, You KH5, Cho MC2, Park K1, Son H2, Jeong H2, Kim SW1, Paick JS1 1
Seoul National University Hospital, South Korea; Seoul Metropolitan Government, Seoul National
2
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
University (SMG-SNU) Boramae Medical Centre, South Korea; 3Dongguk University Ilsan Hospital, Seoul, South Korea; 4Gwangju Veterans Hospital, South Korea; 5Gwangmyeong Seongae Hospital, South Korea Introduction and Objective: The aim of this study was to determine which one of two mitogen-activated-protein-kinases (MAPKs) (p38 or JNK) contributed to corporal apoptosis after cavernous nerve injury (CNI) and to evaluate whether specific inhibition of the relevant MAPK could improve erectile function by suppressing corporal apoptosis in a rat model of CNI. Materials and Methods: In the preliminary experiment to identify which one of the two MAPKs (p38 or JNK) contributed to corporal apoptosis after CN crush injury (CNCI), twenty 10-week-old male rats were divided equally into two groups: sham-surgery (S) and CNCI (I). At 2-weeks postoperatively, we assessed erectile response and performed TUNEL, western-blot (WB) and double-immunofluorescence (dIF) with antibody to alpha-smooth-muscle-actin (ASMA) and phosphorylated p38 or JNK. I group showed the significantly increased apoptotic cells, SM cells positive for phosphorylated-JNK, increased JNK-phosphorylation and decreased erectile response, compare to S group. However, there was no significant difference in SM cells positive for phosphorylated-p38 between the two groups. Thus, we identified that JNK contributed to SM apoptosis after CNCI, while p38 did not. In the main experiment, fifty-six 10-week-old rats were distributed equally into four groups: sham-surgery (S), CNCI (I), and CNCI treated with low-dose (L) and high-dose (H) JNK-inhibitor. L and H groups were treated with daily intraperitoneal injection of JNK-inhibitor (1.0 and 10.0 mg/kg, respectively) for 2-weeks from the day after surgery. At 2-weeks after surgery, erectile response was assessed using electrostimulation. Immunohistochemical staining to ASMA, WB, dIF with ASMA and phosphorylated-JNK, and dIF with TUNEL and antibody to phosphorylated-JNK were performed. Results: In I group, significantly lower erectile responses were observed compared to S group. Also, I group showed decreased immunohistochemical staining of ASMA, increased apoptotic SM cells positive for phosphorylated-JNK, decreased Bcl2/Bax ratio and increased JNK-phosphorylation, compared to S group. JNK inhibition in H group alleviated erectile response and histological/molecular dysregulation, but their improvement were not observed in the L group. Conclusion: Our data indicate that the inhibition of
JNK can restore erectile function by suppression of corporal apoptosis via normalizing the JNK pathway. Thus, an early therapeutic strategy targeting the JNK pathway may be helpful to prevent corporal apoptosis after CNI.
MP-17.04 Castration Impairs Erectile Organ Structure and Function by Inhibiting Autophagy and Promoting Apoptosis of Corpus Cavernosum Smooth Muscle Cells in Rats Shen Z, Zhong S, Zhang M, Wang X, Chen S
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MODERATED ePOSTERS Huashan Hospital Fudan University, Shanghai, China Introduction and Objective: The aim of this study was
to determine the changes and underlying mechanisms of erectile organ structure and function in castrated rats. In addition, the regulatory effects of an androgen on autophagy and apoptosis in corpus cavernosum smooth muscle cells (CSMCs), especially the regulatory effect of androgen on the BECN 1–Bcl-2 interaction, were investigated. Materials and Methods: Male Sprague-Dawley rats were divided into three groups (30/group): control group, castration group, and castration with testosterone supplementation group. The erectile function was examined both in vivo and in vitro, by electric stimulation of the cavernous nerve, and corpus cavernosum strip bath test, respectively. Transmission electron microscopy, TUNEL assay, Masson’s trichrome staining, immunohistochemistry, and western blotting were performed to determine the levels of autophagy and apoptosis, and the structural changes in corpus cavernosum. Results: Compared with the control group, the castration group showed (1) lower erectile function: lower intracavernosal pressure/mean arterial pressure ratio, lower systolic and diastolic capability of corporal strips, and reduced expressions of eNOS and nNOS; (2) greater fibrosis: decreased smooth muscle/collagen ratio, lower expression of α-SMA, and higher expression of TGF-β1; (3) inhibited autophagy: decreased autophagosomes, lower expressions of BECN 1 and LC3-II; (4) enhanced apoptosis: higher apoptotic index, and decreased Bcl-2/Bax ratio. Testosterone supplementation partially improved the effects of castration. Conclusions: Castration attenuates erectile function and induces corporeal fibrosis by inhibiting autophagy and promoting apoptosis of CCSMCs in rats. Therefore, our study highlights the important role of androgens in maintaining the integrity of the structure and function of corpus cavernosum in rats through counter-regulation of autophagy and apoptosis, mainly by regulating BECN 1–Bcl-2 interaction.
MP-17.05 Effect of LDD175, a Novel Benzofuroindole Compound, on Seminal Vesicle Contractility and Ejaculation Lee SW1, Choi TS1, Park JK2, Jeon SSJ1, Jeong BC1 1 Dept. of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Dept. of Urology, Medical School and Institute for Medical Sciences, Chonbuk National University, Jeonju, Korea
Introduction and Objectives: Premature ejaculation
(PE) is one of the most prevalent male sexual disorders but there are very limited effective medications for treatment of PE. Ejaculation is a complex process involving coordinated contraction of the seminal vesicle (SV), and ductus deferens smooth muscle causing the sequential release of fluid from the sexual accessory glands and expulsion of sperm. The rhythmic contraction of the smooth muscle of the SV is vital to the facilitation of seminal fluid discharge. Therefore, decreasing SV contraction and SV pressure can be one of methods to treat PE. The BKCa channel is
94
expressed in SV and plays an important role in the modulation of SV contraction. LDD175 is a newly synthesized activator of the BKCa channel and recently, we have reported that LDD17 induces relaxation of erectile tissue, primarily through the opening of BKCa channels. In this study, we investigated the effect of LDD175 on SV contractility and SV pressure. Materials and Methods: Human SV tissues were obtained from patients undergoing radical prostatectomy under permission of IRB. Using the organ bath technique, the effects of LDD 175 on contraction of SVs induced by norepinephrine (NE, 3x10-6-1x10-4) was studied in vitro. To evaluate the effect of LDD 175 on SV pressure, the pressure changes of SV were recorded after electrical stimulation (ES) of the hypogastric nerve in rats. Results: NE produced concentration-dependent contractions of SV tissues. The oscillatory contraction induced by NE was significantly inhibited after pre-treatment with LDD175. LDD175 caused a significant decrease in the basal resting tone (0.3±0.02 g vs. 0.5±0.14 g), the peak amplitude (0.9±0.13 g vs. 1.4±0.22 g), and the frequency of contraction (0.1±0.04/sec vs. 0.2±0.05/sec) (n=12, P<0.05). In in vivo studies, intravenous LDD175 repressed markedly the ES-induced SV pressure increase without significant alteration of systemic blood pressures. Area under the curve (AUC) and the maximal SV pressure were decreased by LDD175. The mean values of maximal SV pressure and AUC were 20.1±2.75 mmHg vs. 35.1±2.84 mmHg, 336±85.2 mmHg·sec vs. 546±97.8 mmHg·sec, respectively (n=12, P <0.05). Conclusion: LDD175 induces relaxation of human
SV tissues and reduce the seminal vesicle pressure in rats. These in vitro and in vivo experimental results provide evidence for the peripheral role of LDD175 in the regulation of contractile responses of the SV. The results suggest that LDD175, a novel Benzofuroindole compound, might be a new candidate for premature ejaculation treatment depending upon further studies.
MP-17.06 Sexual Dysfunction in Women with Various Types of Urinary Incontinence Nale D Urology Clinic, Belgrade, Serbia Introduction and Objective: Sexual dysfunction in
women is a problem that is not well studied or discussed. The objective of our cross-sectional study was to evaluate the influence of urinary incontinence on sexual function in women with various types of urinary incontinence using validated and reliable Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in premenopausal and postmenopausal women. Materials and Methods: A total of 43 consecutive,
sexually active incontinent women, who attended our urology department, were enrolled in this study provided that they were eligible. A total of 27 healthy, sexually active continent volunteers served as controls. All patients underwent clinical evaluation including medical history, physical examination, urine analysis, urine culture and cystoscopy with stress test. Incontinent women were given prospective 3-day
voiding diary. We used the International Consultation of Incontinence Questionnaire-Short Form-ICIQ-SF to evaluate frequency and severity of incontinence. We assessed sexual functions in patients with various types of urinary incontinence and compared with healthy continent subjects by means of short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). All subjects were asked to complete a PISQ-12 questionnaire. The mean scores were compared between the groups. Results: Mean age of subjects with stress urinary incontinence (SUI), urgency urinary incontinence (UUI), mixed urinary incontinence (MUI) and controls were: 50.47±9.11, 58.73±10.31, 58.71±2.69 and 49.56±7.10 years, respectively. Age was significantly lower in patients with SUI and control group (p=0.003). Total score of PISQ-12 of women without and with various type of incontinence were: controls: 10.00±5.69; SUI: 15.38±6.98; UUI: 15.00±5.15; MUI: 18.58±8.68. Total score of PISQ-12 was significantly higher in incontinent women (p=0.002). Among the incontinence types, no significant difference was determined in total score of PISQ-12. Frequency of incontinence episodes and severity of incontinence obtained from ICIQ-SF questionnaire significantly influenced total score of the PISQ-12 (p=0.036 and p=0.005, respectively). Conclusions: Urinary incontinence significantly reduces sexual function in sexually active women. The frequency and severity of incontinence have a significant influence on sexual function among women with urinary incontinence.
MP-17.07 Canadian Consensus Guidelines for Sexual Rehabilitation Following Prostate Cancer Treatment Petrella A1, Van Asseldonk B1, Jamnicky L1, Brock G2, Elliot S3, Finelli A1, Gajewski J4, Jarvi K5, Robinson J6, Ellis J7, Lauren W6, Curtis A1, Matthew A1 1
University Health Network, Toronto, Canada; 2St Joseph’s Health Care, London, Canada; 3University of British Columbia, Vancouver, Canada; 4Dalhousie University, Halifax, Canada; 5Mount Sinai Hospital, Toronto, Canada; 6University of Calgary, Canada; 7 Sunnybrook Health Sciences Center, Toronto, Canada Introduction and Objective: Treatment options for
prostate cancer (PC) vary widely and depend on a number of factors. The prevalence of erectile dysfunction (ED) following radical prostatectomy (RP) is high (40-75%), and severely impacts patients’ sexual function and quality of life. The present descriptive analysis carried out by a Pan-Canadian panel of medical experts summarizes best practices for PC survivorship, with an overall aim of using these results to establish an online sexual health and rehabilitation clinic (SHARe-c) where patients can independently access medical guidance and care. Materials and Methods: Men’s health experts convened for the True NTH Sexual Health and Rehabilitation Initiative Consensus Meeting to address concerns about ED therapy and management following treatment for PC. The day-long meeting brought together experts from across Canada for discussion of current practices, latest literature and patient interviews.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS MP-17.07, Figure 1. Baseline Treatment Algorithm
Results: A baseline algorithm is presented in Figure 1, incorporating surgical RP and degree of nerve sparing or radiation based therapy, and level of invasiveness. This algorithm provides an initial treatment approach from both a biomedical and psychosocial focus that can be more specifically tailored to different patient groups. Regular sexual activity is recommended, and there is further consideration for partner sexual dysfunction, libido concerns, climacturia and dysorgasmia. Primary goals of long-term penile health, shortterm erectile function and psychosocial aspects are addressed with specific therapies at key milestones. Conclusion: With ED affecting such a large portion
of men post PC therapy, establishing best practices for sexual rehabilitation is critical. The guidelines proposed by the expert consensus have taken into account important factors such as patient input, type of treatment and timeline post-therapy, with the goal of becoming a nationwide standard, and independently accessible online as SHARe-c.
A multidisciplinary RAND consensus group of UK
MP-17.09
andrologists defined the item-specific PROM. The
Erectile Function Improves Under LongTerm Treatment with Testosterone but Worsens in Untreated Hypogonadal Men: Real-Life Data from a Registry in 656 Patients in a Urological Office
final construct domains were penile curvature (PC), erectile function (EF), sexual relationships and generic quality of life measure (GQoL). The draft PROM was piloted until a final version was agreed for this
1
patients being considered for PD surgery were offered
2
the PROM in one specialist center. Internal consistency was assessed using Cronbach alpha test to understand if construct domains reliably measured the same latent variable. Variability and bias was assessed using a Bland Altman plot. Results: The baseline PROM was self-completed
pre-operatively in a test-retest fashion by 46 men. All questions had response rates >85%. Cronbach’s alpha for the penile curvature construct was 0.78 ranging
MP-17.08
from 0.68 to 0.8 with any single item removed. Wil-
Validation Study: Patient Reported Outcome Measure (PROM) for Penile Curvature Surgery
coxon Signed Rank test for the penile curvature con-
Coscione A, Campbell A, Akiboye R, Mukhtar S, Yap T, Watkin N, Jackson M
consistent as average PC scores increase. Average dif-
Dept. of Urology, St George’s Hospital NHS Trust, London, United Kingdom
surements should lie between the limits of agreement
Introduction and Objective: The subjective measures
of successful penile curvature surgery are poorly defined. This study describes a PROM for baseline and post-operative assessment of patients with Peyronie’s disease (PD). Materials and Methods: Questions were selected following semi-structured interviews with PD patients.
Haider A1, Haider KS1, Doros G2, Traish A3
validation study. Over a 3-year period, all consecutive
struct indicated no significant difference between the test and re-test scores (P<0.62). Variability remains ferences between scores (bias) is small so future mea(+8 to -8) 95% CI. Conclusions: The PC questions were answered con-
sistently well and demonstrated content validity and reliability. To establish responsiveness, validity and generalizability of a PROM containing the most robust items from this analysis, deployment is required pre and post-operatively across healthcare providers.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Private Urology Practice, Bremerhaven, Germany; Dept. of Epidemiology and Statistics, Boston University School of Public Health, United States; 3 Dept. of Biochemistry and Dept. of Urology, Boston University School of Medicine, United States
Introduction and Objective: Effects of long-term testosterone therapy (TTh) on erectile function in hypogonadal men published so far are from observational studies without a control group. We present registry data including an untreated hypogonadal control group. Materials and Methods: The registry study included 656 hypogonadal men from a single urology office. Hypogonadal men were given the choice to receive TTh. A total of 360 opted for TTh (T-group), while 296 opted against it (CTRL). Patients were not randomized to either group, resulting in baseline differences. Mean changes over time between groups were compared by a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction. Changes were adjusted for age, weight, waist circumference, blood pressure, fasting glucose, lipids and AMS to account for baseline differences between the two groups. Results: Mean age was 60.72±7.15 years, mean follow-up time was 6.43± 2.01 (minimum: 1; maximum: 10) years, and median follow-up time was 7 years. In the T-group, T levels rose from 9.84±1.27 nmol/L to trough levels (measured prior to the following
95
MODERATED ePOSTERS injection) between 16 and 18 nmol/L (p<0.0001). In CTRL, T levels dropped slightly but significantly from 9.62±1.22 to 9.03±1.4 nmol/L (p<0.05). The estimated adjusted difference between groups at 8 years was 7.02 nmol/L (p<0.0001). In the T-group, IIEF-EF (maximum score: 30) increased from 19.51±4.99 to 25.94±3.01 with a change from baseline of 6.02 points. The improvement was statistically significant for the first four years and remained statistically significant versus baseline throughout the observation time, and stable compared to previous years. In CTRL, IIEF-EF decreased from 20.47±3.13 to 11.7±1.64 after 8 years by 9.52 points, adjusted difference between groups 14.07 (p<0.0001 for all). Weight decreased progressively from 104.85±16.46 to 86.91±8.89 kg in the T-group (p<0.0001) and increased from 91.76±10.58 to 92.38±9.01 kg in CTRL (p<0.0005), adjusted difference 18.85 kg (p<0.0001). Waist circumference decreased from 106.17±8.12 to 99.85±7.93 cm in the T-group and increased from 106.65±7.52 to 107.87±6.43 cm in CTRL, adjusted difference 11.06 cm (p<0.0001 for all). Conclusions: Erectile function is improved and preserved for a prolonged period of time by TTh in hypogonadal men and deteriorates in untreated hypogonadal men.
MP-17.10 Patient Perception of Ejaculatory Volume Reduction After Holmium Laser Enucleation of the Prostate (HoLEP) Kim JK, Kim BS, Ryu HY, Song WH, Lee SH, Ku JH, Oh SJ, Paick JS Dept. of Urology, Seoul National University Hospital, Korea Introduction and Objective: Retrograde ejaculation is a major complication following Holmium Laser Enucleation of the Prostate (HoLEP). We aimed to investigate patient perception of ejaculatory volume reduction after HoLEP. Materials and Methods: A total of 192 patients were
included in the analysis. All patients completed six self-developed, non-validated questionnaires. The questionnaires were composed of questions involving overall satisfaction, voiding symptom change, current experience of sexual intercourse, ejaculatory volume change, change of orgasmic intensity on ejaculation, and the patient’s perception of postoperative ejaculatory volume reduction. Results: Among 192 patients, 91 patients had had sexual intercourse within the past 6 months. Ejaculatory volume changes after HoLEP were as follows: ‘total loss’ (76.9%), ‘decreased’ (18.7%), and ‘no change’ (4.4%). Among the 87 patients who reported ejaculatory volume reduction, their perceptions of this issue were as follows: ‘feels better’ (2.3%), ‘not a problem’ (16.1%), ‘disappointed, but tolerable, due to improvement of voiding symptoms’ (73.6%), and ‘dissatisfied and want to reverse the situation’ (8.0%). Decreased orgasmic intensity was present in 48 patients, whereas 43 patients reported no change or increased orgasmic intensity. There were significantly more patients who reported decreased orgasmic intensity among those who wanted to reverse the situation compared with the others (p=0.027).
96
Conclusions: Our study showed that a majority of patients reported ejaculatory volume reduction and more than half of patients reported decreased orgasmic intensity after HoLEP. Decreased orgasmic intensity on ejaculation was closely related to the unfavorable perception of ejaculatory volume reduction.
MP-17.11
MP-17.12 Testosterone and Chronic Prostatitis/ Chronic Pelvic Pain Syndrome: A Propensity Score-Matched Analysis Lee JH National Police Hospital, Seoul, Korea
Erectile Dysfunction: Prevalence and Risk Factor Analysis in Men Referred for Suspected Prostate Cancer
Introduction and Objective: We evaluated the relationship between low total testosterone (TT) and chronic prostatitis/chronic pelvic pain syndrome CP/ CPPS.
Drudge-Coates L, Khati V, Ballesteros R, Brown C, Muir G
Materials and Methods: We conducted a propensi-
Dept. of Urology, King’s College Hospital NHS Foundation Trust, London, United Kingdom Introduction and Objective: Hypertension, hyperlipidaemia and diabetes are established cardiovascular risks for erectile dysfunction (ED). In addition, ED is well documented as a side effect of prostate cancer diagnostic tests and treatment. To date, no studies have quantified ED in men referred with suspected prostate cancer with known risk factors, having instead concentrated on the post cancer treatment effect on ED. The aim of this study was to describe the prevalence of ED, along with independent risk factors, in a cohort of potential prostate cancer patients seen in a protocol-led nurse practitioner clinic. Materials and Methods: The study used data from a
prospectively collected database over a 3-year period. Erectile function was assessed using the IIEF-5 Index of Erectile Function questionnaire, and data were collected in related to current prescribed medication for known ED risk factors: hypertension, hyperlipidaemia and diabetes. In addition, information was collected on positive prostate cancer diagnosis and ethnicity. Results: Questionnaires from 463 patients were completed, median age 74 (range 39-90), of which 84 patients (18.1%) were not sexually active. A total of 379 responses were therefore analyzed. Of the 379 responses analyzed, 306 (81%) of patients reported symptoms of, or were being treated for, ED. Of these, 148/306 patients (48%) were noted to have at least one ED risk factor (P<0.001). The strongest treatment risk for ED was hypertension (0.321), and Caucasian men represented the highest proportional group. Men over 60 years old represented the largest number affected by ED at 64% (P<0.001), with 38.5% seen within 61-70 year olds. A total of 151/379 (39.8%) men who completed the IIEF form, were subsequently diagnosed with prostate cancer. The mean pre treatment ED rates in those men diagnosed with prostate cancer was 84.8% (69.1-90.9). Conclusions: Men referred with suspected prostate
cancer to our nurse-led clinic had a risk of ED of over 80%, with 67% having never been offered treatment. ED is a significant disorder and both impacts and is affected by the diagnosis and treatment of prostate cancer. It is also significantly associated with cardiovascular morbidity. Baseline assessment of ED is therefore essential prior to treatment for prostate cancer, in order to offer appropriate advise on the likelihood of ED preservation post treatment and to help avoid patient dissatisfaction with treatment.
ty-matched study by identifying men with TT <3.5 ng/mL among a total of 8 336 men in their 40’s and 50’s who had participated in a health examination. A control group of men with T ≥3.5 ng/mL matched for age, metabolic syndrome, and body mass index at 5:1 ratio was selected for comparison. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was administered. The symptoms were considered mild pain if respondents reported perineal or ejaculatory pain and the pain score was ≥4 but <8, and the symptoms were considered moderate to severe pain if the pain score was ≥8. Lower urinary tract symptoms (LUTS) were evaluated using international prostate symptoms score, uroflowmetry, and post void residual urine volume. A chi-squared test, a t-test and logistic regression analyses were used to evaluate the relationship between TT and prostatitis-like symptoms. Results: The ratio of mild and moderate to severe prostatitis-like symptoms was higher in the case group (TT <3.5 ng/mL) than in the control group (24.0% vs. 27.4%, P=0.001). The ratio of moderate to severe prostatitis-like symptoms was also higher in the case group (TT <3.5 ng/mL) than in the control group (6.2% vs. 9.2%, P=0.028). The pain domain of NIH-CPSI, the QoL and the total NIH-CPSI was also higher in the case group (TT <3.5 ng/mL). The ratio of severe LUTS (12.6% vs. 15.1%, P=0.044), the maximal flow rate ≤10 mL/sec (3.8% vs. 5.3%, P=0.044), and the post-void residual urine volume ≥100 mL (4.0% vs. 5.6%, P=0.035), which suggests high pressure in the prostate urethra, were higher in the case group (TT <3.5 ng/mL). After adjusting for voided volume during uroflowmetry and total prostate volume, the relationship of TT <3.5 ng/mL with the maximal flow rate ≤10 mL/sec (odds ratio: 1.402, 95% confidence interval: 1.017-1.934, P=0.039), and the post void residual urine volume ≥100 mL (odds ratio: 1.410, 95% confidence interval: 1.031-1.927, P=0.031) was maintained. Conclusion: Low TT (<3.5 ng/mL) significantly cor-
related with the presence of prostatitis-like symptoms in our study.
MP-17.13 Comparative Evaluation of Physical Characteristics of Different Inflatable Penile Prostheses Malaeb B1, Barboglio Romo P1, Chikkatur H2, Beldona S2, Yi Y1, Bruns T2 1
Dept. of Urology, University of Michigan, Ann Arbour, United States; 2Dept. of Biomedical Engineering, University of Michigan, Ann Arbour, United States
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS Introduction and Objectives: Despite the well-known
MP-17.13, Table 1. Single Cylinder
Length
Girth
Internal Pressure
18 cm Titan @ 22 ml
18.0 cm
17.4 mm
1018 cmH2O
18 cm AMS LGX @ 22 ml
18.9 cm
15.6 mm
1074 cm H2O
18 cm AMS CX @ 22 ml
18.2 cm
16.3 mm
996 cm H2O
14 AMS CXR @ 12 ml
14.4 cm
12.0 mm
1188 cm H2O
14 cmTitan Narrow @ 12 ml
14.3 cm
12.0 mm
1098 cm H2O
Introduction and Objective: We sought out to evaluate and compare the existing inflatable penile prostheses (IPP) in an independent setting. Materials and Methods: New IPP were obtained
from the two manufacturers: American Medical Systems and Coloplast. The AMS 700 LGX, CX, CXR and Coloplast Titan Touch and Narrow were interrogated. Fluid displacement by the pump operated manually was evaluated. We measured internal pressure, length and width (girth) of the cylinders at 2 ml increments. A urodynamic transducer connected to an analog amplifier and recording system was utilized to measure pressure. An Instron system was utilized to assess for buckling and 50% girth compression by applying a negative load while measuring the negative extension between the superior and inferior plate. Results: Regular size IPP (Titan, LGX, CX) were inflated up to 22 ml and narrow ones (Titan Narrow, CXR) up to 12 ml per cylinder. Both pumps displace on average 2 ml per squeeze. Measurement parameters are described in Table 1. AMS 700 LGX 18 cm cylinder increased in length to 18.9 cm at 22 ml inflation compared to 18 cm for the Titan. The Titan however, was the widest at 17.4 mm compared to 15.6 cm for the LGX at 22 ml. Of the regular sized prosthesis inflated to the same volume, Titan Touch exhibited the most rigidity when compared to AMS 700 LGX and CX. It required a higher load to reduce the diameter by 50% (p<0.001). AMS 700 CXR was more rigid compared to Titan Narrow. Buckling as measured by applying a longitudinal force did not show significant differences among prostheses. Conclusion: Ex vivo data suggests that the tested
prostheses have significant differences in their behavior. This is not an attempt to find the best prosthesis, but rather to understand and quantify the main variations among different devices.
MP-17.14 The Efficacy and Safety of Tadalafil 5mg Once Daily for the Treatment of Erectile Dysfunction Related to Vascular Causes After Robot-Assisted Radical Prostatectomy: 2-Year Follow-Up Sung GT1, Kim S1, Bae YK2 1
Dong-A University Hospital, Busan, South Korea; 2Jeil Hospital, Seoul, South Korea Introduction and Objective: To evaluate the efficacy and safety of tadalafil 5 mg once daily use in the treatment of erectile dysfunction (ED) related to vascular causes after robot-assisted radical prostatectomy (RARP).
Materials and Methods: The study retrospective-
ly evaluated 92 patients who underwent RARP and had a penile rehabilitation by tadalafil 5mg once daily use at our medical center. The patients were surveyed based on the abridged five-item version of the International Index of Erectile Function (IIEF-5) Questionnaire, which was self-administered before the surgery, and at 6 months, 1 year and 2 years after the surgery. The 92 patients were classified into the tadalafil group (n=47) and the non-tadalafil group (n=45). Each group was then classified depending on the nerve-sparing (NS) procedure: bilateral NS and unilateral NS. Additionally, patients who underwent a penile color-duplex U/S study to evaluate the cause of erectile dysfunction were also analysed. Results: At 6 months, 1 year, and 2 years, the total IIEF score of the tadalafil group and that of the non-tadalafil group were 10.0±3.4 vs. 7.0±4.0, 13.2±5.6 vs. 7.7±4.8, and 13.8±4.7 vs. 8.1±4.2, respectively. Statistically significant improvements (P<0.05) were observed in the tadalafil group for all 5 domains of IIEF-5 score, while in the non-tadalafil group there was no significant improvement in any of the domains at 1 and 2 years. Fifty-three patients had a penile color-duplex U/S study. Arteriogenic and venogenic ED was seen in 31 patients (58.5%) and 7 patients (13.2%). Fifteen patients (28.3%) showed unremarkable findings. Venogenic ED patients had little response compared to arteriogeinc ED patients by tadalafil 5 mg once daily use (0% vs. 22.5%). The overall side effects were hot flushing in 8.5%, headache in 4.3%, and dizziness in 2.1%. Conclusions: In ED patients after NS RALP, a once
daily dosage of tadalafil 5 mg was well tolerated and significantly improved EF compared with the non-tadalafil group until two years. However, in the venogenic ED patients, response to a once daily dosage of tadalafil 5 mg was relatively limited compared to the arteriogenic ED patients.
MP-17.15 Impact of Metabolic Syndrome on the Occurrence of Premature Ejaculation Jeh SU1, Yoon S1, Lee SW1, Choi SM1, Hwa JS1, Seo DH2, Kam SC2, Lee C2, Chung KH2, Hyun JS3 1
Dept. of Urology and Urological Science Institute, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea; 2Dept. of Urology, Gyeongsang National University Changwon Hospital, Jingu, Republic of Korea; 3Dept. of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jingu, Republic of Korea
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
association between erectile dysfunction (ED) and metabolic syndrome, few data are available that describe the relationship between premature ejaculation (PE) and metabolic syndrome (MetS). The aim of this study was to investigate the effect of MetS in pathogenesis of ejaculatory symptoms, particularly PE. In addition, we evaluate the other risk factors associated with PE. Materials and Methods: Between January 2010 and July 2014, we analyzed the medical records of men who had visited our Urology clinic for screening of male health. To evaluate the risk factors including MetS for PE, patients were assessed by self-reported intravaginal ejaculation latency time (IELT), International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), the Male Sexual Health Questionnaire (MSHQ-EjD) for Ejaculatory Dysfunction, NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and Androgen Deficiency in the Aging Male (ADAM) scales. Premature ejaculation defined as self reported IELT <1 minute, and metabolic syndrome diagnosed by modified National Cholesterol Education Program’s Third Adult Treatment Panel (NCEP ATP III) criteria. Results: Among the total of 1 029 men, 74 patients (7.2%) were considered to have PE (ejaculation within 1 min) and 111 patients (10.8%) were considered to have MetS. The multivariate logistic regression analysis showed that IIEF OS score (OR 0.670, P <0.001), NIH-CPSI pain score (OR 1.070, P = 0.048), NIH-CPSI voiding score (OR 1.167, P = 0.040), and metabolic syndrome (OR 2.187, P = 0.023) were significantly related to the prevalence of PE. Conclusions: MetS may be an important predisposing factor for the development of PE, and consequently its effective prevention and treatment could also be important for the prevention of PE.
MP-17.16 Daily Use of 5-Phosphodiesterase Inhibitors in Patients with Sexual Dysfunction Secondary to 5-ARI Cho DY, Yu JH, Sung LH, Chung JY Inje University, Dept. of Urology, Sanggye Paik Hospital, Seoul, South Korea Introduction and Objectives: 5-ARI drugs can cause erectile dysfunction, ejaculatory disorders and reduction of sexual desire. This study was conducted to evaluate the role of tadalafil (a PDE-5 inhibitor) in patients with sexual dysfunction secondary to 5-ARI during BPH treatment. Materials and Methods: In total, 125 men who complained of sexual dysfunction after 5-ARI treatment of BPH were elected. The group I (n=64) completed a 12-week daily use of tadalafil 5mg with 5-ARI and tamsulosin and the group II (n=61) had no additional tadalafil treatment. Erectile dysfunction, ejaculated dysfunction and sexual desire were assessed including IIEF-5 and IPSS at 1 month and 3 months. Results: Baseline IIEF-5 was 13.5±2.9 (group I) and 14.3±3.1 (group II) respectively. At the end of the 1 month, IIEF-5 score 20.2±3.5 in the group I and 14.1±3.9 in the control group (p<0.05). At 3 months, IIEF-5 score 23.4±3.2 in the group I and 13.2±3.5 in
97
MODERATED ePOSTERS the control group (P<0.05). Ejaculatory dysfunction was not changed in both groups but sexual desire was improved in group I. Conclusions: The PDE-5 inhibitor improves erectile dysfunction and decreased sexual desire secondary to 5-ARI in patients with BPH.
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36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS
Moderated ePosters Session 18 Stones II Sunday, October 23 1425–1555 MP-18.01 Impact of Irrigation Fluid Pressure on the Risk of Systemic Inflammatory Response Syndrome After Conventional Percutaneous Nephrolithotomy: A Randomized Clinical Trial Omar M, Noble M, Sivalingam S, Monga M Cleveland Clinic, United States Introduction and Objective: To evaluate the impact of irrigation fluid pressure on intra-operative variables and postoperative outcomes during conventional PCNL Materials and Methods: Between January 2014 to
March 2015, 90 patients with renal calculi scheduled for conventional PCNL (30 Fr. Sheath) were randomized to high-pressure irrigation (200 mmHg, n=46) or low-pressure irrigation (80 mmHg, n=44) groups. Patient demographics, perioperative outcomes, and systemic inflammatory response (SIRS) incidence rates were compared utilizing the Chi-square and Wilcoxon signed-rank test.
formed using fixed and random-effects models with tests for publication bias and heterogeneity. Results: Significant worsening was detected in sperm concentration (mean difference -17.23, 95% confidence interval -22.53 to -11.93, p<0.00001) and motility (mean difference -10.82, 95% confidence interval -18.56 to -3.07, p=0.006) after ESWL in the case group. Rates of microscopic and macroscopic hematospermia were significantly higher after ESWL (microscopic: RR 40.00, 95% confidence interval 10.11 to 158.30, p<0.00001; macroscopic: RR 14.33, 95% confidence interval 2.82 to 72.90, p=0.001). All parameters recovered after three months. Conclusion: This study showed that sperm concentra-
tion, motility and rate of hematospermia (microscopic and macroscopic) were affected by ESWL, which was used for the treatment of lower ureteral stones. Long-term studies with a focus on male fertility (ie, pregnancy rates) after ESWL are warranted.
MP-18.03 F-URS or Miniperc: Which Is More Effective for 1-2 cm Renal Stones? Ergin G1, Ebiloglu T2, Kirac M1, Kopru B3, Unsal A4, Biri H1 1
Dept. of Urology, Koru Hospital, Ankara, Turkey; Dept. of Urology, Etimesgut Military Hospital, Ankara, Turkey; 3Dept. of Urology, Konya Military Hospital, Turkey; 4Dept. of Urology, Gazi University, Ankara, Turkey 2
Results: The mean patient age, sex, BMI, and other preoperative outcomes were similar in both arms. High-pressure irrigation was associated with a higher SIRS incidence (46%) compared to low pressure irrigation (11%, p=0.0002). Hospital stay was statistically insignificant (p=0.7), as was ICU admission (p=0.9), in both groups.
Introduction and Objectives: To compare the post-
Conclusions: High-pressure irrigation fluid has a
Materials and Methods: Between January 2013 and December 2015, 60 patients were operated for the treatment of renal stone of 1-2 cm in size. Patients were randomly directed to the two different operations: F-URS and miniperc. After the operations, a 1000 mg paracethamol IV infusion was applied to all patients within 2 hours. A visual analogue scale (VAS) classifying the pain out of a score of ten, by 10 cm horizontal lines, was used to assess the severity of pain. VAS scores were filled at 2, 4 and 6 postoperative hours and at 1 postoperative day. The stone free rates, hgb drop, fluoroscopy time (FT), OT, HT, BNLT, and complications were noted.
potential role in the incidence of postoperative SIRS following PCNL.
MP-18.02 The Effect of Extracorporeal Shock Wave Lithotripsy on Semen Parameters: A Systematic Review and MetaAnalysis of Current Available Studies Radfar MH, Shemshaki HR Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction and Objective: Extracorporeal shock
wave lithotripsy (ESWL) is an important tool for the management of urolithiasis. The effect of shockwave on tissues is established. The aim of this meta-analysis is to evaluate the microscopic semen characteristics of young men before and after ESWL treatment for lower ureteral calculi. Materials and Methods: Literature searches were
performed following the PRISMA guidelines. We conducted a systematic review and meta-analysis that included 6 trials investigated the effects of ESWL on semen parameters including sperm concentration, motility and hematospermia. Meta-analysis was per-
operative results of flexible ureterorenoscopy (F-URS) and minipercutaneus nephrolithtotomy (miniperc) for 1-2 cm renal stones in terms of pain after operations, stone free status, complications, operation time (OT), hospitalization time (HT), and back-to-normal-life time (BNLT).
Results: There were 20 (66%) males and 10 (33%) females in the F-URS group, and 17 (56%) males and 13 (44%) females in the miniperc group. The VAS scores for postoperative 2, 4, and 6 hours and 1 day were 1.83 (1-4), 1.86 (0-3), 1.1 (0-2) and 0.56 (0-2) in the F-URS group, and 6.30 (1-10), 5 (1-10), 4.13 (0-8) and 2.5 (0-5) in the miniperc group, respectively. Comparing the VAS scores, there was significantly higher pain in the miniperc group at 2, 4, and 6 hours and at 1 day (p=0.001, 0.001, 0.001, 0.001). Stone-free status and complication rates were not significantly different in both groups (p=0.453, 0.054), but hgb drop, FT, OT, HT and BNLT were detected to be higher in miniperc group (p=0.023, 0.002, 0.004, 0.001, 0.001).
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Conclusions: For 1-2 cm renal stones, F-URS is superior to miniperc, with similar stone free rates, less pain, a smaller drop in hgb, and a shorter HT and BNLT.
MP-18.04 The Effect of Intercostal Nerve Block and Local Anesthetic Infiltration to Nephrostomy Tract on Postoperative Pain Control After Percutaneous Nephrolithotomy: A Prospective, Randomized, Case-Controlled Trial Lee KW1, Jang H2, Ha US1, Hong SH1, Lee JY1, Kim SW1, Cho HJ1 1
Dept. of Urology, College of Medicine, The Catholic University of Korea, Seoul St Mary’s Hospital, Korea; 2 Dept. of Urology, College of Medicine, The Catholic University of Korea, Daejeon St Mary’s Hospital, Korea
Introduction and Objective: To evaluate the efficacy of intercostal nerve block and nephrostomy tract infiltration with ropivacaine in patients treated by tubeless percutaneous nephrolithotomy (TPCNL). Materials and Methods: From February 2015 to
March 2016, a total 67 patients undergoing TPCNL were enrolled. Patients were randomized into three groups: group I (n=22), control group; group II (n=20), intercostal blockade with 12 ml of 0.5% ropivacaine with epinephrine; group III (n=25), infiltration of 0.25% ropivacaine with epinephrine 20 ml to nephrostomy tract. Pain status was assessed at postoperative 2, 8, 24 hours and discharge by visual analogue scale (VAS) score at rest and on deep breathing. Results: Patient demographics and perioperative data between groups were comparable. Resting VAS score at postoperative 2 hours and discharge in group II and III was significantly lower than group I (each P<0.05). VAS score on deep breathing was also significantly lower in group II and III during follow-up periods (each P<0.05). There was no significant difference in VAS scores between group II and III, and in analgesic requirement of each group. No complication was attributable to the intercostal nerve block and nephrostomy tract infiltration. Conclusion: Intercostal nerve block and nephrostomy
tract infiltration were effective in alleviating postoperative pain in patients treated by TPCNL.
MP-18.05 Management of Steinstrasse After Extracorporeal Shock Wave Lithotripsy for Renal and Ureteral Calculi: About 193 Patients Sallami S1, Ben Rhouma S2, Kammoun O1, Chtourou M3 1
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; Rabta University Hospital, Tunis, Tunisia; 3Habib Thameur University Hospital, Tunis, Tunisia 2
Introduction and Objective: Steinstrasse (SS) is a seri-
ous complication that may have a considerable patient impact in terms of renal function and need a fast and efficient management. We evaluate different therapeutic options for the management of SS after ESWL and suggest therapeutic recommendations.
99
MODERATED ePOSTERS tion of the caliceal arborescence. A second puncture is performed with an 18-gauge needle targeting the posteroinferior calix. We use the Moroccan technique shown by the glove model or Chinese shadows game.
MP-18.04, Table 1. Postoperative Pain Assessment p-value Variables
Group I (Control, N=22)
Group II (ICNB, N=20)
Group III (NTI, N=25)
Group I (Control) vs. Group II (ICNB)
Group I (Control) vs. Group III (NTI)
Group II (ICNB) vs. Group III (NTI)
requiring the ultrasound guidance. For all the other patients the technique was efficient and safe.
2 hrs
4.3
3.6 2.4
3.0
0.662
0.268
0.804
8 hrs
4.5
2.6
2.3
0.039
0.025
0.957
24 hrs
2.5
1.2
1.3
0.077
0.097
0.972
Conclusions: Our technique gives the opportunity to our residents to learn the renal puncture necessary in PCNL without complications or a simulation device. This technique is a precious tool to learn the first step of percutaneous renal access.
Discharge
1.2
0.1
0.1
0.028
0.022
0.997
MP-18.07
VAS score at rest
VAS score on deep breathing
2 hrs
6.6
4.6
3.8
0.078
0.005
0.620
8 hrs
7.0
3.6
3.2
0.001
<0.001
0.918
24 hrs
4.3
1.8
1.8
0.004
0.002
0.998
Discharge
1.8
0.2
0.2
0.002
0.002
0.992
1. Rescue analgesic consumption [MED, (mg)]
1.8
0.5
1.3
0.467
0.947
0.521
2. Total PCA consumption [MED, (mg)]
29.1
Total consumption of analgesia (1+2)[MED, (mg)]
30.9
Effectiveness and Safety of Minimally Invasive Percutaneous Nephrolithotomy in the Management of Lower Pole Renal Stones 2 cm or Less: A Comparison with Flexible Ureterorenoscopy and Shockwave Lithotripsy Abdel Wahed M, Shouman A, Mosharafa A, Morsy A, Shoukry AI, Ghoneima W Cairo University, Egypt
33.9 34.4
18.8 20.1
0.880 0.957
0.156 0.158
0.138 0.184
ICNB=intercostal nerve block; NTI=nephrostomy tract infiltration; VAS=visual analogue scale; MED=morphine equivalent dose; PCA=patient-controlled analgesia
Materials and Methods: From January 1999 to De-
cember 2014, 193 adult patients who underwent ESWL for the treatment of renal or ureteral stones developed SS. The overall incidence of SS after ESWL was 5.1%. They were 107 men and 86 women with a median age of 56.4 years (22-74). The stones treated by ESWL were renal (n=168) and lumbar ureteral (n=35). The parameters studied were initial stone size, location, side of SS, location of SS, length of the SS column, type of SS according to Coptcoat classification and size of the leading stone of the SS. Medical treatment (NSAIDs) was administrated to all patients for 1 month and endo-urological procedure was proposed after failure of medical treatment. Results: SS was in the pelvic ureter in 82.4% of cases, in the iliac ureter in 12.4% and in the lumbar ureter in 5.2%. SS column length varied from 1 to 8.4 cm and it was classified as type 1 (n=104), type 2 (n=50) and type 3 (n=39). Medical expulsive therapy was efficient in 73 patients. Repeated ESWL was used as a primary procedure in 7 patients. Ureteroscopy with lithotripsy was performed as a primary procedure in 113 patients (12 with type 1, 74 with type 2 and 27 patients with type 3 SS). The overall success rate was 93%. Medical treatment was significantly successful for distal SS (p=0.02), type 1 SS (p=0.03) and when the leading stone size was inferior to 6 mm (p=0.01). Type 2 or 3 SS and leading stone of SS superior to 6 mm need an endo-urological treatment initially. ESWL may be indicated when the leading stone >10 mm. Conclusions: SS is a serious complication after ESWL. Medical expulsive treatment is effective for distal, type 1 SS and when the leading stone is inferior to 6 mm
100
Results: The blind puncture failed in nine patients
in size. For other cases, ureteroscopy with lithotripsy is indicated.
MP-18.06 Percutaneous Nephrostomy in Supine Position Under Fluoroscopic Guidance Alone: A Precious Tool to Learn PCNL El Anzaoui J, Ghoundale O, Ncir H, Elharrech Y, Moufid K, Touiti D Dept. of Urology, Military Hospital, Marrakech, Morocco Introduction and Objective: The emergency nephrostomy is still performed in the prone position by many hospital centers and the nephrostomy in supine position has shown safety and feasibility. Its main interest is the protection from colon injuries. In our center, the PCNL and nephrostomy are performed in the same position (supine position to 40 degrees). The nephrostomy under fluoroscopic guidance is a valuable tool to learn the first steps of PCNL and renal puncture. We present our experience of 40 percutaneous nephrostomies in the supine position under fluoroscopic guidance alone, performed by junior residents (see video). Materials and Methods: This was a prospective study
that concerned 40 patients. The patient flank is rotated to 40 degrees from the plan of the table. The position is maintained by pillows under the ipsilateral shoulder and gluteus. The first puncture is done blindly with a 22-gauge needle. The preoperative radiologic evaluation gives information about localization and dysrotation of the kidney. The puncture must be parallel to the plan of the able and oriented cranially. Then, a contrast product is injected, permitting the visualiza-
Introduction and Objective: The best management
of lower calyceal stones remains controversial. This study aims to assess the efficacy and complications of minimally invasive percutaneous nephrolithotomy (miniPNL) in lower calyceal stones, and to compare the results with outcomes of flexible ureterorenoscopy and shockwave lithotripsy (SWL) in matched patients. Materials and Methods: Patients with lower calyceal radiopaque unilateral stones ≤2 cm were prospectively enrolled, and underwent miniPNL between February 2014-2016 using a semirigid ureteroscope through a 16 or 20 Fr sheath and holmium laser or pneumatic lithotripsy. Patients were considered stone-free when no stones or residuals <3 mm were found on non-contrast CT. Stone-free rates (SFR) and complications were compared to two matched cohorts of patients who underwent ureterorenoscopy or SWL at the same institution. Results: Thirty patients with mean age (range) 39.8 (22-63) underwent miniPNL for lower calyceal stones ranging in size from 10-20 mm (mean ±SD 16.1±1.8). A single tract was used (16 Fr in 24 patients and 20 Fr in 6). Eight (26.7%) patients had a percutaneous tube placed at the end of the procedure (tubeless in the remaining 22 patients), and mean ±SD hospital stay was 2 ±0.15 days. Post-operative pain scores included “no pain” in 3 (10%) and “mild pain” score 1-3 in 21 (70%) patients. Minor complications occurred in 6 (20%) patients in the form of postoperative fever or significant pain. Stone-free rate was 93.3% at 1 month and 96.7% at 3 months, with 2 patients requiring an auxiliary procedure (SWL) for residual fragments. In matched cohorts, patients undergoing flexible ureterorenoscopy had a similar SFR of 96.7%, while patients undergoing SWL had a SFR of 56.7% (p<0.001). Auxiliary procedures were required in one patient in the ureterorenoscopy group vs. 11 patients in the SWL group (p=0.001). Conclusion: MiniPNL is a safe and effective treatment
option for lower calyceal stones of 2 cm or less, with a
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS high SFR that is comparable to ureterorenoscopy and that is significantly better than SWL.
MP-18.08, Table 1. Comparison of Clinical and Laboratory Variables by Serum NGAL
MP-18.08 The Clinical Significance of Neutrophil Gelatinase-Associated Lipocalin in Patients with Ureteral Obstruction Due to Urinary Stones Jung W, Ha JY, Kim BH, Park CH, Kim CI Keimyung University, Daegu, South Korea Introduction and Objective: This study was per-
formed to investigate the significance of serum neutrophil gelatinase-associated lipocalin (NGAL) as a predictive factor for severe clinical conditions in patients with ureteral obstruction due to urinary stones. Materials and Methods: In this retrospective study,
Normal NGAL (n=81)
24 (29.6)
8 (44.4)
Female
57 (70.4)
10 (55.6)
Age (yr)
48.9
62.7
< 0.001
DM (%)
6 (7.4)
3 (16.7)
0.358
Pain duration (min)
498.1
1149.6
0.015
Stone laterality (%)
MP-18.09 Comparison Between Extracorporeal Shock Wave Lithotripsy (ESWL) and Rigid Ureteroscopic Stone Removal (URS) for Treatment of Large (>10 mm) Upper Ureteral Stones Sung LH, Noh CH, Cho IR Inje University Sanggye Paik Hospital, Seoul, South Korea Introduction and Objective: The management of large (>10 mm) upper ureteral calculi presents a challenge for urologists to select an optimal treatment because ESWL is the least invasive treatment but has variable success rates, and URS is more invasive technique. These calculi are frequently associated with obstructive uropathy and deteriorated renal function. However, the application of advanced ureteroscopy, lithotriptor and techniques has increased the success rate and lesser complication rate of treating proximal ureteral stones. The aim of this study is to compare the efficacy, safety and compliance of the rigid ureteroscopic stone removal (URS) with the extracorporeal shock wave lithotripsy (ESWL) for large (>10 mm) proximal ureteral stones.
0.440
Right
41 (50.6)
7 (38.9)
Left
40 (49.4)
11 (61.1)
Upper
41 (50.6)
11 (61.1)
Middle
5 (6.2)
2 (11.1)
Lower
35 (43.2)
5 (27.8)
4.2
8.9
Results: Mean age was 48.9 and 62.7 years, respective-
vere clinical conditions such as fever, PCN, admission and operation events.
0.269
Male
Stone location (%)
Conclusion: Elevated NGAL was associated with se-
p-value
Gender (%)
we analyzed 99 patients who visited the emergency department with ureteral obstruction caused by urinary stones between April 2014 and July 2015. All patients were divided into two groups depending on serum NGAL level. Pain duration, past history, stone laterality, stone location, stone size, serum C-reactive protein (CRP), intervention, admission events and body temperature were measured after the visit to our emergency department according to serum NGAL level. ly. Stone laterality, stone location, and percentage of male patients were similar. The mean stone size was 4.2 mm vs. 8.9 mm (p=0.001), CRP level was 0.66 vs. 6.54, respectively (p<0.01). The operation events were 19.8% vs. 55.6% (p=0.003). Admission events were 25.9% vs. 72.2% (p=0.001). PCN events were 13.6% vs. 66.7%, respectively (p<0.01). No patients in the normal NGAL group and six patients (33.3%) in the abnormal NGAL group had fever and reached statistical significance (p<0.001).
Abnormal NGAL (n=18)
0.431
Stone size (mm) CRP
0.001
0.66
6.54
0.001
Operation events (%)
16 (19.8)
10 (55.6)
0.003
Admission events (%)
21 (25.9)
13 (72.2)
< 0.001
PCN events (%)
11 (13.6)
12 (66.7)
< 0.001
0 (0)
6 (33.3)
< 0.001
Fever (%)
NGAL, serum neutrophil gelatinase-associated lipocalin; DM; diabetes mellitus; CRP, serum C-reactive protein; PCN, percutaneous nephrostomy
MP-18.08, Table 2. Logistic Regression Analysis That Were Performed to Find the Factor That Predict of Severe Clinical Conditions Univariate analysis
Age
Multivariate analysis
Odds ratio (95% Cl)
p-value
Odds ratio (95% Cl)
p-value
1.020 (0.988-1.053)
0.208
0.994 (0.954-1.035)
0.772
DM
1.457 (0.337-6.301)
0.615
1.243 (0.211-7.312)
0.810
Pain duration
1.001 (1.000-1.001)
0.027
1.000 (0.999-1.001)
0.934
Stone size
1.404 (1.181-1.669)
< 0.001
1.359 (1.133-1.718)
0.002
Serum NGAL
1.002 (1.000-1.005)
0.080
1.000 (0.998-1.003)
0.827
CRP
1.009 (0.991-1.219)
0.075
0.959 (0.819-1.124)
0.607
Fever
6.455 (1.107-37.647)
0.038
2.754 (0.288-26.314)
0.379
DM, diabetes mellitus; NGAL, serum neutrophil gelatinase-associated lipocalin; CRP, serum C-reactive protein
Materials and Methods: We reviewed 123 patients
who have been treated for upper ureteral stones (>10 mm). A total of 51 patients were treated with URS and 72 patients were treated with ESWL. We analyzed the success rates of stone removal, reasons for failure, and complication rates of each procedure. Results: The overall success rate of URS was 90.2%. With the ESWL treatments, overall success rates after the first, second, third, and more sessions were 47.2%, 61.1%, 76.4% and 81.9%, retrospectively. Notably, the stone-free rate of URS group was better than that of the 1st, 2nd, and 3rd session ESWL group (p<0.05). The complication rate of URS was 24.0% and that of ESWL was 22.2%, these parameters had no significantly statistical difference (p<0.05).
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Conclusions: In this study, URS achieved excellent stone free rate, visual pain scale and similar complication rate for treating large (>10 mm) upper ureteral calculi. Thus, this procedure should be considered as a first line therapy for large (>10 mm) upper ureteral stones. In addition, for the proper selection of patients for ESWL and URS, analysis of cost effectiveness and recurrence rates of two groups should be done hereafter.
MP-18.10 The Role of Flexible UreteroRenoscopy in the Management of Renal Calculi in Kidneys with Anomalies of Rotation, Form, Lie or Fusion Singh A, Sabnis R, Ganpule A, Shah D, Jairath A, Desai M
101
MODERATED ePOSTERS Mulgibhai Patel Urological Hospital, Nadiad, Gujarat, India Introduction and Objective: Flexible uretero-renos-
copy (FURS) is an accepted modality for the management of renal calculi in orthotopically placed kidney. Though it has been used in the management of calculi in anomalous kidneys, the literature scarce. Materials and Methods: We performed a retrospec-
tive analysis of all the patients with anomalous kidneys, who primarily underwent FURS from January 2010 to December 2015 at our institute. A total of 25 patients with renal calculi in anomalous kidneys were evaluated. Indications for FURS included a stone size less than or equal to 2 cm, contra-indication to PCNL, patients who refused ESWL and PCNL. Complete clearance of stone was defined as no residual fragment greater than 2 mm after 1 month. The parameters studied included patient demographics, type of renal anomaly, stone size, location, laterality, patient’s presentation, need for pre operative stenting, operative time, hospital stay, analgesic requirement, need for post operative DJ stent placement, number of stages or auxiliary procedures required for stone clearance and success rate. Results: Twenty-five patients with calculus disease in kidneys with anomalies of lie, rotation, fusion or form were managed with flexible uretero-renoscopy. These 25 patients had a total of 37 stones. Out of 25 patients, 14 had ectopic kidneys with 19 stones, 5 had malrotated kidneys with 6 stones, 5 had horseshoe kidneys with 11 stones and one had a left to right crossed fused ectopia with a single stone. Average age of presentation was 38.28 ± 12.59 years. The majority of patients had the stone located in the pelvis (11) or in the lower calyx (11). Eight stones were in the middle calyx, five in the upper calyx and two in the upper ureter. Fifteen patients had a single stone and 10 of them 2 or more stones. Average stone size was 14.71± 7.11 mm, with an average density of 1210.8 ± 237.7 Hounsfield units. Five patients had a preplaced DJ (double J) stent. Average operative time was 74±21.2 minutes and patients had an average hospital stay of 59.48±17.8 hours. DJ stent was placed posto-peratively in 21 patients and the rest were managed with a ureteric catheter. Complete clearance was achieved in 22 (88%) patients, 3 patients required 2 stages and one required 3rd stage. Three patients (12%) could not be managed by FRUS alone and required percutaneous stone clearance. Conclusion: FRUS is an effective and less invasive
modality for the management of renal calculus of less than 2 cm in kidneys with anomalies of lie, fusion and rotation. It can offset the low clearance rate and high complication rate of ESWL and PCNL respectively.
MP-18.11 Comparison of the Outcome of Ureteroscopic Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy for the Management of Proximal Ureteric Stones: A Single Center Experience Iqbal N1, Khan MA2, Ikram Y2, Hasan A2, Masood A2, Butt A2, Malik Y2, Haider A2, Hussain T1, Akhter S2
102
1
Shifa International Hospital, Islamabad, Pakistan; Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan
2
Introduction and Objective: To compare the outcome of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy in managing proximal ureteric stones in terms of stone-free rates and complications. Materials and Methods: We included 62 patients in
group 1 who underwent extracorporeal shock wave lithotripsy (ESWL) and 63 patients in group 2 who underwent ureteroscopic intervention. We used Modulith SL X lithotripter 4th generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in ureteroscopy group. Stonefree status was defined as stone fragments of less than 4 mm on follow-up X Ray KUB (Kidney ureter and bladder) after 3 weeks of procedure. SPSS version 16 was used for statistical analysis. Results: Mean age was 39.21±13.36 years for the ESWL group and 46.03 ±13.65 years for the ureteroscopy group. Mean stone size was 10.47±3.7 mm for the ESWL and 14.89±4.71 mm for the ureteroscopy group, while mean operative time was 60 minutes and 80.26 ± 31.01 minutes for respective groups. Stonefree rate after single procedure was 42% for the ESWL and 88% for the ureteroscopy group. Stone-free rates reached 70% and 88% after second and third sessions of ESWL while 100% stone-free rate was achieved for the ureteroscopy group after the second procedure. Complications included post procedure sepsis in 1 patient from the ESWL group, and in 2 patients from the ureteroscopy group. Stone fragment retropulsion into the kidney was seen in 4 patients of the ureteroscopy group. Steinstrasse was seen in one patient of the ESWL group. Pain was seen in 3 patients in the ureteroscopy group and in 7 patients in the ESWL group. Conclusion: The outcome of ureteroscopic manage-
ment for proximal ureteric stones was more successful as compared to ESWL in terms of early and higher stone-free rate. Complications were similar in the two groups.
MP-18.12 Clinical Experience and Management of Encrusted Ureteral Stents Sung LH, Noh CH, Cho IR Inje University Sanggye Paik Hospital, Seoul, South Korea Introduction and Objective: The ureteral stent (US)
is a fundamental part of many urological procedures. The severe encrustation may cause obstructions and threaten the renal unit. Endourological and certain additional procedures could be needed to manage them. We tried to provide our clinical experiences and management of encrusted US. Materials and Methods: A retrospective analysis was performed on all patients with stents in our department. A total of 975 patients had stents inserted for the treatment of urinary calculi, malignant ureteral obstruction, after percutaneous nephrolithotomy, pyeloplasty, or injury to the ureter and kidney etc. The stents were encrusted in 34 (3.5%) patients: 28 men and 6 women. The stents were inserted in 29 patients due to stone disease and in 5 patients for the
malignant obstruction. The US used in this series was made of polyurethane manufactured by Cook®. Anatomical abnormality, presence of encrustation on the stent and associated stone burden were evaluated using plain radiography and intravenous pyelography. Treatment decisions were made based on the clinical presentation and image findings of each patient. Results: The average duration of stent placement was as follows: stone disease 8.5±1.7 months (1.2511 months) versus malignant obstruction 13.7±2.4 months (4-16 months). In 29 patients, cystoscopic stent removal failed and additional procedures were needed. A total of 42 sessions of additional procedures were required to render patient stent-free. Most patients (25 patients, 85.3%) were made stent-free in single additional session, the others required more than one session. Additional procedures were as follows: SWL (23, 54.7%), ureteroscopy (URS) with forceps retrieval (7, 16.6%), URS with intracorporeal lithotripsy (10, 23.8%) and open surgical removal (2, 4.9%). All patients were eventually rendered stentfree and stone-free. Conclusions: Most forgotten stents are expected to have severe encrustation. Patients with stone disease developed encrustation on the stent in a shorter period than those with other diseases. To prevent the forgotten stent, we are planning to provide detailed patient education and develop a computerized tracking system.
MP-18.13 A Novel Approach to Reduce Irrigation Fluid Extravasation in Multi-Tract Percutaneous Nephrolithotomy of Staghorn Stones by Placing a Drainage Tube During the Procedure Maghsoudi R1, Etemadian M1, Kashi AH1, Mehravaran K1, Habib Akhyari H1, Shadpour P1, Soleimani AH2 1
Hasheminejad Kidney Center, Tehran, Iran; 2Tehran University of Medical Sciences, Iran
Introduction and Objective: Extrarenal fluid extravasation is a serious complication during multi-tract percutaneous nephrolithotomy (PCNL) for staghorn stones because of longer operative time and larger volume of irrigation fluid. We introduce a new technique by placing a drainage tube during the procedure to reduce this event. Materials and Methods: Patients with staghorn
stones underwent multi-tract PCNL from January to September 2014. After completion of lithotripsy through the first access tract, a drainage tube was inserted and PCNL was continued through next access tracts. The tube was removed after the end of operation. All patients were evaluated by ultrasonography for free extravasated fluid in the first postoperative day. KUB and renal ultrasonography were requested 2 weeks after the operation. Stone free percent was calculated by dividing the surface of residual stones to the surface of original stone. Results: A total of 12 complete and 8 partial staghorn stones were treated. The mean±SD of stone size was 65.2±21.4 mm. Mean number of tracts was 2.6 (range: 2-4). Mean operation duration was 144.2 minutes (range: 90-240). Mean volume of irrigant flu-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
MODERATED ePOSTERS id was 39.7±10.5 L (range: 25-70). Ultrasonography revealed perirenal fluid collection in 9 patients with the mean±SD volume of 3.4±4.5 mL (range 0-15). Fever (>48 hours) was the most common complication, occurring in 6 patients. The mean±SD of stone free percent 2 weeks after the operation was 88.3±4.6.
and 2 patients from group 2. There was no significant difference in terms of intraoperative or postoperative complications, mean stone-free rate, mean hospital stay and use of analgesics doses between the two groups.
Conclusion: During multi-tract PCNL of staghorn
PCNL are almost similar in terms of safety and stonefree rate when an intraoperative decision about placing nephrostomy tube is made judiciously.
stones, placing a drainage tube in the first access tract can effectively reduce irrigation fluid extravasation and may increase stone clearance by washing away stone fragments through the drainage tube.
MP-18.14 Comparison of the Outcome of Tubed Versus Tubeless Percutaneous Nephrolithotomy (PCNL) in Children: A Single Center Study Iqbal N1,2, Khan MA1,2, Khan F3, Mahnoor N1,2, Naqvi SA1,2, Mustaqeem R1, Mahmud US1,2, Siddiqui FS1,2, Sheikh AAE1,2, Akhter S1,2 1
Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan; 3 Khyber Medical College, Khyber Medical University, Peshawar, Pakistan 2
Introduction and Objective: To evaluate and compare
the effectiveness of tubed versus tubeless PCNL in the treatment of renal stones in children. Materials and Methods: From January 2010 to April 2015, PCNL was performed in 35 children out of which tubed PCNL was done in 18 patients (group 1) and tubeless PCNL in 17 patients (group 2). We used an adult-sized 27 French nephroscope for PCNL by standard technique. The nephrostomy tube used in tubed PCNL group was a 12 Fr size. The stone-free rate, mean operative time, mean hospital stay, mean drop of hemoglobin level, use of analgesics doses and pain control, complication rates and ancillary procedures used were evaluated in a comparative manner. Results: The mean age in this study was 9±5.2 years and 7.5±5.94 years in group 1 and 2 respectively, mean stone size was 1.67±0.61 cm and 1.94±0.72 cm in group 1 and 2 respectively. The mean operative time was 156±38.7 minutes and 160±41.1 minutes in the two respective groups. The mean drop in hemoglobin level was 0.76 g/dl and 1.37 g/dl in these groups. The mean analgesic dose required was 8.8±2.8 doses in group 1 and 7.3±3.9 doses in group 2.The mean hospital stay was 2.88±1.31 days and 3.17±1.50 days in group 1 and 2 respectively. The mean stone-free rate was 93% and 96% in the two groups. Postoperative blood transfusion was done in 1 patient from group 1
Conclusion: The results of tubed PCNL and tubeless
MP-18.15 Percutaneous Nephrolithotomy: A Comparison of the Tubeless Versus the Standard Technique Ahmad M1, Ali Shahiman M2, Malik M1, Sarfraz S2
of the nephrostomy tube may help in keeping the patient comfortable after the surgery and reduction in the length of hospital stay. It may also expedite the process of recovery and the patient is able to resume daily life routine earlier. The procedure does not carry any significant risk of complications.
MP-18.16 Flexible Cystoscopy for Preventing Malpositioning of Double-J Stents Following Laparoscopic Ureterolithotomy Kim JY, Shim JS, Pyun JH, Cho S, Kang SH, Cheon J, Lee JG, Kim JJ, Kang SG, Park HS Dept. of Urology, Korea University College of Medicine, Seoul, Republic of Korea
1
Rawalpindi Medical College, Pakistan; 2Benazir Bhutto Hospital, Rawalpindi Medical College, Pakistan
Introduction and Objective: The purpose of this
study is to assess the efficacy, safety and advantages of tubeless PCNL over the standard tubed PCNL. Materials and Methods: This study includes 52 PCNL procedures on 50 patients. Patients aged 10 to 70 (mean 36.8) years, with 30 males and 20 females. Patients were divided into group A (n=26) with standard PCNL having postoperative 16 FR nephrostomy tube and group B (n=26) with tubeless PCNL. The surgical outcome and postoperative course were evaluated and compared for the two groups. Results: A total of 52 cases of PCNL from November 2015 to March 2016 were reviewed and compared. There was no significant difference between the two groups regarding sex distribution, stone side, mean stone size, the mean operative time and stone free status. No major complication was recorded in either group. The mean hospital stay was 4.5 days (range 3 to 6) for group A and 3.2 days (range 2 to 4) for group B. According to the visual analogue scale for pain assessment, mean reading was 6.1 (range 5 to 7) for group A and 3.6 (range 2 to 4) for group B. Mild soakage of wound dressing was observed in the early postoperative period in 5 of 26 (19.2%) cases of group A, while early postoperative dressings were absolutely dry in all the 26 cases of group B. Hence, the levels of pain recorded, analgesic requirements, urinary leakage from the wound, comfort level of patients without nephrostomy tube, duration of inpatient stay and convalescence time were all significantly reduced in the tubeless PCNL group. Conclusion: Tubeless PCNL is a safe and effective
modification of the conventional procedure. Absence
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Introduction and Objective: Upward malpositioning
of intracorporeal double-J stents following laparoscopic ureterolithotomy can cause patients to require further treatment by ureteroscopy for stent removal, which causes pain and discomfort. The aim of this study was to evaluate the effects of flexible cystoscopy for preventing malpositioning of ureteral stents. Materials and Methods: From April 2009 to June
2015, 97 patients with large stones of the upper ureter more than about 1.5 cm in size underwent intracorporeal double-J stenting of the ureter following laparoscopic ureterolithotomy by four surgeons. In the recent 27 consecutive patients that underwent ureterolithotomy, flexible cystoscopy was performed to confirm the position of the double-J stent. Patient demographic data and perioperative outcome were reviewed retrospectively. A logistic regression analysis using penalized logistic regression was used to evaluate the effects of flexible cystoscopy. Results: Upward malpositioning of the ureteral stent was found in 13 (18.6%) of the 70 patients that underwent surgery without using flexible cystoscopy of 97 enrolled patients. Among the 27 most recent patients that underwent surgery using flexible cystoscopy, upward malpositioning was observed in 5 (18.5%) patients and the position of the double-J stent was successfully corrected intracorporeally under flexible cystoscopy. Preventing factors for upward malpositioning of the double-J catheter in multivariate analysis were the surgeon (p=0.039) and the use of flexible cystoscopy (p=0.008). Conclusion: Flexible cystoscopy has proven to be a
simple but safe, quick, and effective method to identify and correct malpositioning of double-J stents.
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Unmoderated Videos Thursday, October 20 Saturday, October 22 0800-1800 Sunday, October 23 0800-1600 VID.01 Laparoscopic Excision of Inter Aorto-Caval Paraganglioma Shukla A, Agarwal T, Kumar R All India Institute of Medical Sciences, New Delhi, India Introduction and Objective: Extra-adrenal pheochromocytomas are termed paragangliomas and can be located in the inter aorto-caval region close to the organ of Zuckerkandl. Although a minimally invasive approach is ideal for pheochromocytomas, extra-adrenal tumors often have variable blood supply and desmoplasia, making laparoscopy challenging. Through this video, we demonstrate the steps involved in laparoscopic excision of an inter aorto-caval paraganglioma. Materials and Methods: A 24-year-old man present-
ed with features of catecholamine excess and poorly controlled hypertension. His urinary normetanephrine levels were elevated and CT scan revealed a 5x4 cm tumor in the inter aorto-caval region which showed uptake on an MIBG scan. After pre-operative stabilization with adrenergic blockade and hydration, he was planned for a transperitoneal laparoscopic resection. In the left lateral decubitus position, 5 ports were placed and the right colon was mobilized to expose the tumor. The duodenum was extensively mobilized off the tumor to expose the venacava and aorta. The tumor was separated from the large vessels, clipping a large number of feeders and draining vessels. The dissection site had to be changed repeatedly as bleeding was encountered until a plane could be found between the venacava and aorta that was relatively blood-less. Results: The procedure was successfully completed in 150 minutes with 250mL of blood loss. The patient was discharged after 2 days with no complications and without any anti-hypertensive medication. Conclusions: Paragangliomas in the inter aorto-caval
region are technically challenging for minimally invasive surgery. A slow meticulous dissection with ligation of all vessels is essential to ensure a successful outcome.
VID.02 Laparoscopic Adrenalectomy for Large Pheochromocytomas: Tips for Success Kumar R, Prakash P, Desai P All India Institute of Medical Sciences, New Delhi, India Introduction and Objective: Laparoscopic surgery is
a standard option for management of pheochromocytomas. However, large tumors pose a surgical challenge. We demonstrate the surgical steps involved in these difficult cases and highlight tips for a safe surgery through a representative video.
Materials and Methods: A 57-year-old man present-
Conclusion: Retroperitoneal access for kidney sur-
ed with a 5-year history of palpitations and sweating. He was diabetic and hypertensive. A CT scan revealed a 12 cm right adrenal tumor with central necrosis. The tumor showed activity on MIBG scan and his urinary metanephrine and nor-metanephrine levels were elevated. A right adrenal pheochromocytoma was diagnosed. After stabilization, transperitoneal laparoscopic adrenalectomy was performed with the patient in the left lateral decubitus position. Four ports were placed and the peritoneum over the tumor was incised on the lower and medial borders. Unlike smaller tumors, the dissection for large tumors begins at the inferior pole since accessing the upper pole under the liver may be difficult. Further, large tumors often distort the renal hilar anatomy and identification and preservation of the renal vessels is important to avoid inadvertent ligation. The duodenum was identified and mobilized medially, exposing the inferior venacava followed by preservation of the renal vessels. Thereafter, an additional 5mm port was inserted and gentle traction was applied under the tumor to retract it laterally, giving space to separate it from the venacava while ligating draining veins. The direction of the traction was then changed infero-laterally to expose the attachments to the undersurface of the liver. The superior vein was ligated and the tumor was separated from the liver, avoiding injury to the parenchyma.
gery is feasible. Operative time, ischemia time and EBL are acceptable.
Results: The procedure was successfully completed
laparoscopically with an operative time of 150 minutes and blood loss of 100 ml. The patient required dextrose infusion post-operatively for profound hypoglycemia but was discharged on the second day with normal sugar and blood pressure with no drugs. Conclusions: Large adrenal pheochromocytomas can
be successfully treated laparoscopically. The surgical steps differ from those for smaller tumors. Careful dissection allows the surgery to be performed safely.
VID.03
VID.04 Off-Clamp Laparoscopic Partial Nephrectomy for T1A Renal Tumor Lopez Fontana G, Lopez Fontana R, Lopez Laur JD Clinica Andina de Urologia, Mendoza, Argentina Introduction and Objective: Laparoscopic partial
nephrectomy has been gaining place for renal tumor management due to minimal invasive surgical advantages; however, almost every procedure need to be performed under hiliar clamping and renal ischemia, representing an injury to renal parenchyma. In selective cases, hiliar renal clamping may be avoided; therefore, the aim is to report an off-clamping partial nephrectomy for exophytic renal mass. Materials and Methods: This video shows a 56-yearold woman who underwent an off-clamp laparoscopic partial nephrectomy for T1a exophytic renal tumor. Standard ports position for laparoscopic radical nephrectomy was used. Once inside abdominal cavity, the Gerotas fascia was opened to identify the renal tumor. Cold incision was performed with safety oncological surgical margins and renal hemostasis was successfully done using sliding clip technique. Results: Surgical time was 60 minutes with an estimated blood loss 50 ml. No perioperative complications were reported and hospital stay was 48 hours. Final histopathological finding was a clear renal cell carcinoma Fuhrman 1 with negative surgical margins. Conclusion: In selective renal masses such as T1a and
exophytic tumors off-clamp laparoscopic partial nephrectomy may be an effective and oncological safety procedure with all minimal invasive advantages; however, more cases are required.
VID.05
Retroperitoneal Approach for Robotic Kidney Surgery: Technique Description
Hand Assisted Laparoscopic Radical Cystectomy (HALC) and Studer Neobladder with Lymph Node Dissection
García Marchiñena P, Costabel J, Jurado A, Gueglio G, Villamil W, Andrade C
1
Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: To describe, step by step, retroperitoneal approach for robotic kidney surgery. Materials and Methods: We present a 76-year-old patient with a 3 cm right incidental renal mass. His medical history recorded heavy smoking, obesity and Pulmonary obstructive chronic disease. Preoperative estimated glomerular filtration rate was 58 ml/min Retroperitoneal access was decided due to the tumor location and the small amount of fat in the retroperitoneal space. We present a video with the description of the access and the surgery step by step. Results: Operative time was 163 minutes. Estimated blood loss was 80 cc. Warm ischemia time was 12 minutes. After a favorable postoperative course, patient was discharged on postoperative day 3. No complications were recorded. Final pathology revealed Chromophobe type renal cell carcinoma, nuclear grade II. Negative margins were assessed.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Choi H1, Kim HJ2, Bae JH1, Park JY1 Dept. of Urology, Korea University Ansan Hospital, South Korea; 2Dept, of Urology, Dankook University College of Medicine, Cheonan, South Korea
Introduction and Objective: Minimal invasive operation has recently appeared as an effort to reduce morbidity and rapid recovery. Nonetheless, hand assisted surgery for radical cystectomy is not established. Here we define the new trial of HALC and orthotopic neobladder and report its feasibility and safety. Materials and Methods: Patient was 63 years old male with muscle invasive bladder cancer in previous tans urethral bladder resection. A midline 8 cm incision from umbilicus to pubis was made. The incision was used for hand port placement through the skin and fascia into the abdominal cavity. An 11 mm trocar was inserted through site of 4 cm lateral to umbilicus. And then the abdomen was insufflated with CO2 gas. With the camera placed through the 11 mm port, and the secondary 10 mm trocar was placed to latero-inferior side of 1st trocar. At first, we made retzius space for the dropping bladder. We identified right vas and
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UNMODERATED VIDEOS ligated and divided. The ureter is identified where it crosses the common iliac bifurcation, dissected free for 3 to 4 cm, divided, and its distal end ligated. The lower margin of the ureter was then transected and transported to the department of Pathology. Result of frozen biopsy was negative. The arterial divisions were ligated and divided near the bladder margin respectively. Following the manual traction of the bladder medially, an incision was made in the peritoneum directly into the deepest aspect of the rectovesical cul-de-sac. Then the endopelvic fascia was incised anteriorly. The lateral aspect of the prostate was mobilized from the surrounding tissue and then the major vascular pedicle to the bladder neck and prostate was isolated. With careful dissection, the prostatic urethra was resected and then the bladder including the prostate, seminal vesicles were removed from the operative field successfully. Some bleeding was noticed at the dorsal vein complex and the resected urethral margin consequently which were controlled by gauze packing. After adequate hemostasis, we made approximately 60 cm of distal ileum segment from 20 cm from ileocecal valve and divided following incision in the mesentery. A standard bowel anastomosis is performed and the mesenteric trap is closed. The bowel is opened on the antimesenteric border except for 5- to 7-cm chimmey to make Studer flap. An ileal plate is formed by sewing together the cut edges of the antimesenteric borders using 4-0 vicryl neeedles and the flap was folded for twice for the spheric neobladder formation. Uretero-neovesical anastomosis was done. For urethro-vesical anastomosis, we left 5 to 6 meters on the antimesenteric border without suture to make more ease manipulation of anastomosis. Under intermittent gentle traction of the ileal plate by transurethral catheter is manipulated down to the urethral remnant, we performed bidirectional anastomosis by 3-0 V-lock sutures. After filling of neobladder, there was no leakage from the operative sites. Results: The whole procedure was completed with-
out any complication and there was no injury to adjacent tissues. The operative time was 470 minutes and blood loss was 450 ml. Pathologic report was bellows: infiltrating urothelial carcinoma, high grade, residual, right posterolateral wall, with tumor size: 0.7x0.6 cm depth of invasion; involvement of perivesical fat. Ureteral and urethral resection margins were free of tumor. No involvement of prostate, seminal vesicles, and vas deferentia, but metastasis in one out of 11 pelvic lymph node. Foley removal was done in 21 days after confirmation of no leak of pouch on cystography. Patient was discharged 23 days after the operation without further problem. Conclusion: HALC and Studer neobladder with
lymph node dissection is technically feasible operation with comparable outcome to those of conventional minimal invasive procedures. Further advances and more cases are necessary to improve operative efficiency and reduce surgical difficulties.
VID.06 A Novel Technique of Ureteroileal Anastomosis: “Tube in Tube Technique” Singh A, Rawal S, Chatterjee S, Bansal P RGCI&RC, Rohini, Delhi, India
106
Introduction and Objective: Presenting a video of new technique of ureteroileal anastomosis “Tube in Tube technique”. Materials and Methods: We started doing this technique from October 2015 onwards after getting permission from ethical committee. Between October 2015 and March 2016, a total of 33 patients underwent radical cystectomy or anterior exenteration with urinary diversion. The mean age of patient was 61.12 years, and mean male and female patient age were 29 and 4 respectively. Ileal conduit and orthotopic ileal neobladder were made in 18 and 15 patients respectively and data was collected from prospectively maintained computerized database. Results: Mean operative time for only ureteroileal anastomosis during extracorporeal and intracorporeal urinary diversion was 22.6 and 46.6 min respectively. Two patients developed acute pyelonephritis and both had history of diabetes mellitus. Three patients developed hydroureteronephrosis during follow up but on diuretic renogram they had non-obstructive drainage with preserved renal function. Only 1 patient had urine leak in immediate postoperative period, which was managed conservatively. Conclusion: Though we have results of short term
follow up, “Tube in Tube” technique is a feasible technique to do ureteroileal anastomosis.
VID.07 Comparison of Flexible Blue Light Cystoscopy and Rigid Blue Light Cystoscopy in Bladder Cancer: A Video Case Demonstration Zare R Dept. of Urology, Bærum Hospital VV HF, Oslo, Norway Introduction and Objectives: Non-muscle-invasive bladder cancer (NMIBC) is labour intensive and costly to manage. Owing to long-term survival rates and life-long monitoring and treatment (particularly recurrences and complications), it is the most expensive cancer to manage in per-patient terms. Fluorescence-guided cystoscopy, using hexaminolevulinate (HAL), improves the detection of bladder tumours, particularly carcinoma in situ, compared with standard white-light (WL) cystoscopy. In 2010, a European expert panel reviewed the evidence for HAL-guided blue-light (BL) flexible cystoscopy in the outpatient (OP) setting. Although studies had shown that flexible BL cystoscopy was feasible and was superior to rigid WL cystoscopy. The 2010 European expert consensus panel did not recommend BL flexible cystoscopy in the OP setting due image quality. However, they believed that the outcomes would improve as the quality flexible cystoscopy equipment gets upgraded. In 2014 the European expert panel consensus panel indicated that BL flexible cystoscopy may have a role in the management of NMIBC. Improved BL flexible cystoscopy equipment has since been developed that allow the rinsing of the bladder to secure optimal vision. The objective of the video case example is to demonstrate the equipment and procedure and the differences observed with BL rigid cystoscopy compared with BL flexible cystoscopy.
Materials and Methods: A case example of a patient is presented coming for a regular follow-up at Bærum Hospital Centre in VestreViken, Oslo, Norway. Fifty ml of HAL was instilled into the bladder and a KARL STORZ PDD SPIES Videocystoscope was used to examine the bladder. The bladder was first inspected under WL, and then changed to BL to identify tumours and suspicious areas not seen in WL. We discovered multiple papillary tumours in the bladder and the patient was referred to surgery TURB. One hour prior to the TURB, the patient had 50 ml HAL installed into bladder and Olympus Exera II PDD videocystoscope was used to examine the bladder. The bladder was first inspected with WL and then with BL. We discovered multiple papillary tumors. TURB was done following the inspection. Results: The HAL-guided BL flexible cystoscopy procedure resulted in high quality images that improve the visibility of tumours, especially tumours that were smaller compared with WL alone. HAL-guided BL flexible cystoscopy was superior to rigid BL cystoscopy specially by using SPIES CLARA and SPIES CHROMA. Conclusion: Improvements in the equipment have
provided high image quality and superior sensitivity of the BL flexible cystoscope with no loss of fluorescence intensity or diagnostic information compared to rigid cystoscopy, addressing the previous issues identified. Motion ability and suction by flexible PDD videocystoscope is essential advantages for flexible BL compare to rigid BL. The image quality is even better with the use of SPIES CLARA and CHROMA. BL flexible cystoscopy offers a new tool in the management of NMIBC that may increase detection of lesions otherwise not seen under WL examination.
VID.08 Transurethral Resection of the Prostate without Postoperative Irrigation Lezrek M1,2, Bazine K1, Ammani A1, Tazi H2, Kasmaoui EH1, Qarro A1, Alami M1, Beddouch A1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco Introduction and Objective: We present a video of our experience of transurethral resection of the prostate (TURP), possibly without postoperative irrigation. Two techniques were used for hemostasis: injection of adrenaline in the para-prostatic space, to produce vasoconstriction of the prostatic vessels, and extensive coagulation at the end of the procedure. Materials and Methods: A total of 43 consecutive patients had a TURP with a try to perform Perfect Hemostasis. The patients had a mean age of 68 years, and presented with benign hyperplasia of the prostate unresponsive to medical treatment, with or without urinary retention. The average prostate size was 40 to 150 g. Operative technique: Under spinal anesthesia and lithotomy position, an injection of 10 ml of 2 % lidocaine adrenaline solution is performed, in each para-prostatic space via a supra-pubic route. Then a monopolar transurethral resection of the prostate is performed with a slow progression of the cutting loop, throughout the entire procedure. At the end of the resection, the entire surface of resection was systematically coagulated with a barrel-shaped coagulat-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED VIDEOS ing-electrode. Patients were hydrated intravenously, with the help of intra venous 20 mg of furosemide, if needed, in order to have a good diuresis immediately when the 3-way catheter is inserted. If the urine is clear or pink, postoperative irrigation is not installed. Results: The average time of the procedure was 70 min. The intraoperative bleeding was minimal, and no complications were noted. Postoperative Irrigation was performed only in 6 patients. For the other 37 patients, no irrigation was needed in the theater room or after. No patient presented late hemorrhage or clotting. The catheter was removed the third postoperative day. The patients were reviewed at one month and no complications were reported, especially late hemorrhagic complications that we were concerned about after extensive coagulation.
VID.10 HOLEP vs. THULEP: Comparison of Techniques in the Same Patients Blefari F1, Di Loro F1, Macchiarella A1, Mencarini M1, Del Grasso A1, Spurio M1, Russo GI2, Morgia G2, Dattilo C1, Rubino F1 1
Dept. of Urology, S. Stefano Hospital, Prato, Italy; University of Catania, Italy
2
Introduction and Objective: For many years, the la-
ser has been introduced for the therapy of BPH. In our center we use the HoLEP since 2009 as the only surgical treatment for BPH. The video shows the comparison of tissue effects using Holmium laser and Thulium laser for the enucleation of prostate in the same Patients.
Conclusion: Postoperative bleeding is not a normal
Materials and Methods: From 2009 to date we have
fate after TURP. Hemostasis almost perfect is possible. Mostly, a single postoperative drainage, without irrigation, can be enough. We think that the injection of adrenaline in para-prostatic space seems to provide a better homeostasis and good vision during TURP. Only a comparative study, with or without adrenaline, can tell.
performed over 1200 HoLEP with excellent results in terms of functionality and very low incidence of postoperative complications. Recently we carried out the same operation using the Thulium laser that has characteristics similar but not identical. We performed 15 adenomectomy enucleating out the right lobe of the prostate with the Holmium laser (100W Lumenis) and the left lobe with Thulium laser (100W Quanta System).
VID.09 HOLEP “En Bloc”: Alternative Technique for Enucleation of Prostate Adenoma Blefari F1, Di Loro F1, Macchiarella A1, Mencarini M1, Del Grasso A1, Spurio M1, Russo GI2, Morgia G2, Dattilo C1, Rubino F1 1
Dept. of Urology, S. Stefano Hospital, Prato, Italy; University of Catania, Italy
2
Introduction and Objectives: The HoLEP technique has been described by P. Gilling in 1998. The video shows we can improve the technique modifying the original steps performing an “en bloc” enucleation of prostatic adenoma. Materials and Methods: A single longitudinal incision of the prostate at 5 or 7 starting from the bladder neck to the veru montanum that reaches the posterior prostatic capsule is performed. The apex of the adenoma at the side of the incision and ipsilateral lobe are isolated. Dissected the bridge of tissue above the veru montanum we elevate the middle lobe and the contralateral lobe of the prostate. The entire adenoma is isolated anteriorly combining the two cleavage planes. The bladder neck is opened laterally leaving an anterior small bridge as a support. The anterior mucosa of the prostatic apex is sectioned away from the external urethral sphincter and, after cutting the bridge of bladder neck we left before, the prostate “en bloc” can be pushed into the bladder. Results: We used this technique in 180 consecutive cases with clinical results comparable to previous series of 345 with an improvement (14 pts. 7.7% versus 51 pts. 14.7%) in post-operative temporary SUI (=/>1 pad/ day). Surgical time was reduced (-15% approximately). The technique seems easier to learn because the surgeon has to achieve the cleavage plane only once. Conclusions: The modification of the original HoLEP technique we propose is safer thanks to lower use of laser energy near the external urethral sphincter and easier to perform. Furthermore it can reduce the learning curve and surgical time.
Results: In this video it is noted that the execution of the enucleation is similar. The thulium laser has a greater ability of coagulation, which allows better control of bleeding but it makes it difficult to locate and follow the cleavage plane of the adenoma. This forces the operator to use more mechanical work with endoscopic sheath in order to detach the cleavage plane between adenoma and prostatic capsula. Furthermore, the pulsed emission of the Holmium laser (Thulium is continuous) with the characteristic of impulse action in front of the laser fiber, in our experience, allows an easier and faster dissection of the adenoma. The 15 patients did not present postoperative complications and functional results are similar to those obtained with Holmium laser alone. Conclusion: Both techniques have proven successful
to carry out the enucleation of prostatic adenoma. However for ease of enucleation due to the characteristics of the laser, we prefer HoLEP technique. Furthermore, we believe that the learning curve for the enucleation of prostate is shorter with the use of Holmium instead to lase with Tullium.
VID.11 Intravesical Mesh Removal Zambon JP, Hood B, Hughes A, Priddy B, Walls J, Badlani G Wake Forest University, Winston Salem, United States Introduction and Objective: Synthetic mesh material
has been used for surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) repair since 1990. Since then, the development of non-absorbable biocompatible materials, minimal invasiveness and availability of easy-kits resulted in an exponential increase in the number of mesh surgical procedures performed by both urologists and gynecologists. According to FDA, in 2010 approximately 300,000 women underwent surgical procedures in the United States to repair POP and approximately
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
260,000 underwent surgical procedures to repair SUI. From 560,000 surgeries, in one out of three was used mesh, and three out of four was performed transvaginally. The rationale of using synthetic mesh for POP repair is the high-recurrence rates when native tissue is used for reconstruction. The incorporation of mesh into POP repair has improved the long-term outcomes and lower recurrence rates. However, vaginal mesh placement is associated with potential risks for the patients such as vaginal mesh erosion, infection, dyspareunia, and chronic pelvic pain. The objective of this video is to present a case of a mesh perforation into the bladder after prolapse repair, which was successfully removed endoscopically. Materials and Methods: This is a case of a 44 years
old woman who underwent vaginal hysterectomy, cystocele repair, and mid-urethral synthetic sling. Three months later she developed suprapubic pain and overactive bladder symptoms. Ultrasound and flexible cystoscopy was performed at the office and demonstrated an intravesical calcified mesh. On the next day patient underwent endoscopic surgical procedure to remove the mesh. Results: This video contains a short literature review about mesh-related complications in pelvic reconstructive procedures and the endoscopic procedure to remove the mesh. First, calcification over the mesh was removed with laser lithotripsy. Then the mesh was split and removed completely with the resectoscope. Conclusion: This video shows an alternative and min-
imally invasive approach to remove intravesical mesh in a patient with mesh perforation after pelvic reconstructive procedure.
VID.12 Prostatic Utricle Cyst: Laparoscopic Excision Juaneda Castell B1,2, Crego Tapias M1, Garriga Farriol V1, Puig Duran P1, Segura Forcada J1, Jimenez Corro R1, Cortadellas Angel L1, Serrano Vidal A1 1
Hospital General de Granollers, Barcelona, Spain; 2Universitat Internacional de Catalunya, Barcelona, Spain
Introduction and Objective: Cystic lesions at the midline of the prostate are uncommon and they are considered congenital disorders. We report the case of 45-year-old patient with history of treatment with testosterone for hipognadism and karyotype 46XY consulting for acute prostatitis repeat. Materials and Methods: Exploration: Micropenis and atrophic testis seen in scrotal sacs. Abdominal ultrasound was performed, with the finding of a retrovesical, midline cystic mass (6 x 2.3 cm). The study was completed by an abdominal TC, cystourethrography and cystoscopy. Transperitoneal laparoscopic excision of cystic formation was performed. Results: The operating time was 125 minutes. The hospital stay was 3 days and no postoperative complications. The pathology reported a prostatic utricle cyst and marked acute and chronic inflammation. One year after surgery, the patient has had a satisfactory outcome, without further episodes of prostatitis. Conclusion: The differential diagnosis is difficult and
indication for surgery depends on presenting symp-
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UNMODERATED VIDEOS toms, size and complications. Laparoscopy can be another minimal invasive option when the large cystic size makes the endoscopic approach impossible.
VID.13 A Huge Renal Hydatid Cyst: Is Renal Preservation Possible? Lezrek M1,2, Tazi H2, El Majdoub A2, Bazine K1, Ammani A1, Kasmaoui EH1, Qarro A1, Alami M1, Beddouch A1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco Introduction and Objectives: In this era of renal preservation even in renal cancer, is it possible to preserve the kidney in huge hydatid cysts? We present a video of our experience of a minimally invasive management of a huge hydatid cyst of the left kidney, with complete renal compression. Materials and Methods: A 36-year-old female patient presented a left renal hydatid cyst with positive serology. The left kidney is flattened in the upper internal aspect of the cyst. Serum creatinine and blood urea nitrogen tests have a normal value. Renal scintigraphy (Radionuclide study) was not performed. These are the only CT-scan images available. The patient had Albendazole therapy for 3 months preoperatively. This patient was managed using an endoscopic percutaneous approach. The patient was placed in the split leg modified lateral position. In Retrograde opacification, the kidney is stretched in the upper medial aspect of the cyst. There is an opacification of the cyst, thus there is a fistulae between the cyst and the calyceal system. A hypertonic saline solution is instilled through the ureteral catheter, as scolicidal agent; with a waiting time of 10 minutes. The cyst is punctured percutaneously and once again injection of a hypertonic saline solution, with a waiting time of 5 minutes. Insertion of a guidewire and dilation of the tract with one step dilation and insertion of a 30 F Amplatz sheath. The hydatid material is evacuated using aspirathin through the nephroscope. A Foley catheter is inserted in the cavity. Results: The minimally invasive management of the hydatid cyst was possible. After opacification showed the sealing of the fistula, the cystic cavity was sclerosed using povidone-iodine during 5 days. The patient had uneventful discharge and continued Albendazole therapy for 3 months postoperatively. 6 months postoperative CT-scan showed that the left kidney has returned to almost normal shape with a residual cavity. Conclusion: After management of the hydatid cyst,
the left kidney has returned to almost normal shape; though, it was completely compressed by the cyst. In this benign pathology, mostly, the kidney is stretched and compressed but not destructed; and a renal preservation has to be tried.
VID.14 A Rare Case of Epitheloid Angio-MyoLipoma with Cavo-Atrial Thrombus Seth A, Tiwari D, Nayyar R, Saxena R, Chowdhary S All India Institute of Medical Sciences, New Delhi, India
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Introduction and Objective: Epitheloid variant of angio-myolipoma has been estimated to have an incidence of 4% among angio-myo-lipomas. Five percent of these have been reported to be metastatic. Progression in the form of cavo-atrial thrombus is rare with only four cases reported. Materials and Methods: A 55-year-old lady was
referred to our department as a case of left renal angio-myolipoma with cavo-atrial extension. She complained of persistent ache in left flank. CT and MRI scans showed a 15x12 cm fat containing lesion replacing left kidney with extension till right atrium. Co-morbidities included moderate restrictive lung disease. She was planned for nephrectomy+thrombectomy under partial minimal access cardio-pulmonary bypass. Aim was to avoid thoracotomy. Video shows laparotomy using a chevron incision. Left kidney was mobilized leaving left renal vein hanging on IVC. Video shows cannulation of SVC per-cutaneously through neck. Thoracic aorta was cannulated using minimum access technique through the exposed abdominal aorta. The IVC was cannulated in the exposed infra-hilar part using open technique. Patient was put on cardio-pulmonary bypass and cooled to a temperature of 30C. Portal structures and right renal artery were cross-clamped and IVC opened. Thrombus was gently peeled-off from IVC wall and pulled. The whole thrombus seemingly got delivered. Kidney was pulled from left to right underneath mesentry of left colon. Whole specimen was delivered. Vena-cavotomy was closed. Blood flows were restored. But trans-esophageal-echocardiography showed a residual lesion in right atrium. Limited lower sternotomy was carried out. Patient was cooled to 18C. Blood flow reduced to 100ml/minute. Video shows right atriotomy, complete removal of thrombus, right atriotomy closure, reversal of cardio-pulmonary bypass, chest/ abdominal closure, specimen and histo-pathology. Results: The patient was taken off ventilator support
after 14 hours, started on oral liquids after 36 hours, drains removed after 36 hours. She was fit to go home by day 7. Conclusions: Teaching points 1) demonstration of a rare occurrence of cavo-atrial extension of angio-myo-lipoma 2) use of partial minimal access cardio-pulmonary bypass in an attempt to avoid thoracotomy 3) importance of trans-esophageal-echocardiography in demonstrating residual lesion.
was demonstrated. Surgical technique: The patient was placed in a modified flank position. A four-port transperitoneal technique was used. The colon was reflected. Left gonadal vein, lumbar vein, left ureter and renal pedicle were dissected. The kidney was fully mobilized. The renal arteries and renal, gonadal and lumbar veins were secured with polymer clips. Right segmental artery branch was respected to preserve the function of the isthmus. Adrenal Gland was controlled with a 45 mm Stapler. The tumor excision was made through the ischemia line at the isthmus. The renal medulla and cortex were repaired with a polydioxanone suture. The specimen was extracted intact in a plastic bag through an inguinal incision. A drainage was fixed. Results: The operative time was 240 minutes, and the estimated blood loss was 200 ml. There were no immediate or delayed complications. The patient resumed oral intake on postoperative day 1 and was discharged on postoperative day 3. Pathologic examination of the specimen confirmed a clear cell carcinoma, with sarcomatoid differentiation, with negative surgical margins. Grade IV. Stage: pT1b cN0 cM0. The patient is cancer free and with normal kidney function at 12 months of follow-up. Conclusion: Laparoscopic radical nephrectomy in the
horseshoe kidney is challenging due to the associated vascular anomalies and the need to resect and reconstruct the contralateral renal parenchyma.
VID.16 Laparoscopic Partial Nephrectomy, Excision of Adrenal Nodule and Interaortocaval Lymph Node Kumar S, Pandian R, Kekre N Christian Medical College, Vellore, India Introduction and Objectives: Laparoscopic partial
nephrectomy is being increasing used for T1a and select T1b tumors with similar oncologic outcomes. Presence of adrenal nodule and interaortocaval lymph node could influence the surgical approach. We present a video demonstrating laparoscopic partial nephrectomy, excision of adrenal nodule and interaortocaval lymph node.
Introduction and Objective: We describe technical details of a pure laparoscopic radical nephrectomy in a patient with horseshoe kidney.
Materials and Methods: A 41-year-old lady was incidentally detected to have right renal lower pole mass. She had no known co morbid illness. Her preoperative evaluation was within normal limits. CECT showed 4x3x3 cm, exophytic, well-defined, enhancing right renal lower pole mass; 2x2cm, homogenous, hypodense, right adrenal nodule and 1.5x1cm interaortocaval lymph node. She underwent an uneventful laparoscopic partial nephrectomy, excision of right adrenal nodule and interaortocaval lymph node. Following application of vascular clamps across the renal hilum, tumor was excised with a margin and hemostatic sutures were taken. Excision of adrenal adenoma and interaortocaval lymph node was done.
Materials and Methods: Case Report: A 56-year-old man, smoker, is evaluated with an incidental renal mass. CT Scan of the abdomen revealed a 66x63 mm renal mass arising from the left upper pole moiety of an incidentally discovered horseshoe kidney. The left renal artery shows three branches, with a right segmental branch feeding the isthmus. No metastasis
Results: The duration of operation was 1 hour 30 minutes with a warm ischemia time of 18 minutes. She had an uneventful post-operative recovery. There was no blood transfusion. Histopathology report showed renal cell carcinoma (clear cell), Fuhrman type 1-2, with negative margins; adrenal adenoma and reactive change in the interaortocaval lymph node.
VID.15 Pure Laparoscopic Radical Nephrectomy in a Horseshoe Kidney Daruich M, Garcia Marchiñena P, Jaunarena J, Gueglio G, Jurado A Hospital Italiano de Buenos Aires, Argentina
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED VIDEOS Conclusions: Small renal masses with adrenal nodule and enlarged interaortocaval lymph node can be safely managed laparoscopically.
VID.17 Video Case Series of RobotAssisted Surgical Treatment of Renal Epithelioid Angiomyolipoma: ‘The Wolf in Sheep’s Clothing’ Akiboye D, Malthouse T, Lam W, Chakravorty M, Challacombe B Guy’s & St Thomas’ Hospital, London, United Kingdom Introduction and Objective: Epithelioid Angiomyo-
lipoma (E-AML) is a rare variant of renal AML that unlike classical AML exhibits malignant properties. This presents a diagnostic challenge, being difficult to differentiate from AML both radiologically and intra-operatively, and is therefore usually made histologically. We present with videos a 4-patient case series of E-AMLs who undertook robotic resection, the first of its kind in the UK. Materials and Methods: Four patients with an
E-AML were incidentally identified on histopathology review following robot-assisted excision of renal mass diagnosed radiologically. Three underwent robotic partial nephrectomy (RPN), & 1 underwent robotic assisted radical nephrectomy, all completed by a single surgeon. Peri-operative data was collected prospectively from September 2013 to May 2015. Results: Mean age of patients was 38 years. All ASA 1. Mean tumour size was 3.23 cm; mean operation time was 150 minutes; mean warm ischaemia time was 14.3 min; and mean estimated blood loss was 117 ml. No peri-operative complications were identified. None of these tumours were identified as an AML/E-AML pre-operatively, due to all having a fat poor appearance. Only 1 tumour exhibited atypical mitosis, with 2 revealing necrosis. One patient had a positive surgical margin and required a ‘re-do’ RPN which showed no tumour growth and negative margins. Conclusion: Renal neoplasms with certain unusual
features such as fat poor AML should provoke consideration of E-AML. E-AML should be managed as a malignant tumour, even when identified on post-operative histological analysis. This can safely be managed by a ‘re-do’ RPN if indicated.
discovered incidentally in all the patients. Thirteen tumors were localized in the right kidney and 8 in the left kidney. Preoperative renal function was normal in all the cases. The average tumor size was 5.66 cm (3-9.4). The tumor was in the upper, middle, and lower pole in 8, 6 and 7 patients. Fifteen were peripheral and 6 were central tumors. Through a flank incision, nephrolysis is performed. The renal vessels are isolated, but not clamped. One curved vascular or gastrointestinal clamp is positioned around the tumor with a 5 mm parenchyma margin, and sometimes 2 clamps are necessary. In the first 14 cases, the tumorectomy is performed with electrocautery and then the small vessels and the calyceal system are oversewn with figure-of-8-sutures. Renal reconstruction is performed over fat bolsters or Surgicel. Lastly, the tumorectomy is performed with progressive blunt dissection, and clamping of vascular and calyceal structures; then, they are sharply cut and ligated. Renal reconstruction is performed with only figure-of-8-sutures. For central tumors, the renal artery was clamped only during tumorectomy. Parenchymal clamping is performed for renal reconstruction. Results: The average parenchymal clamping time was 35 min. For central tumors, the renal artery was clamped for 5 minutes in 5 patients and 20 minutes in 1. The average operative bleeding was 150 ml. The mean hospital stay was 5 days. All the tumors have negative margins. Seventeen tumors were RCC and 4 were oncocytoma. With a follow-up of 2-76 months, there is no evidence of recurrence in 19 patients. One patient presented with pulmonary metastasis after 36-months. Another patient had a left nephrectomy for local recurrence after 40-months.
VID.20
safe, and effective technique in the conservative surgery of the kidney. It might allow teaching and learning nephron-sparing surgery without the anxiety of warm ischemia time. In our small experience even in central tumors, where parenchymal clamping is not possible during tumorectomy, it had helped to reduce the time of arterial clamping for hemostasis and renal reconstruction.
Sister Mary Joseph Nodule?
VID.19 Zero Ischaemia Minimal Invasive Partial Nephrectomy for T1b Renal Tumor Lim BTY1, Sim A2 Changi General Hospital, Singapore; 2Singapore General Hospital, Singapore
Parenchymal Clamping Open Partial Nephrectomy 1,2
2
2
Introduction and Objective: Partial nephrectomy has 1
Lezrek M , Tazi H , Badraoui M , Bazine K , Qarro A1, Alami M1, Beddouch A1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco
Introduction and Objectives: We present a video of open partial nephrectomy, for renal tumors, with parenchymal clamping, without the limiting time of pedicle clamping. Materials and Methods: Between May 2003 and Feb-
ruary 2014, 21 patients (10 men and 11 women) were treated with this technique. The patients had an average age of 56 years old (35 to 78). The tumors were
Conclusions: Minimal invasive zero ischaemia partial nephrectomy for pT1b renal tumours is safe and feasible. Oncologic outcomes and functional results are excellent with acceptable safety profiles and minimal peri-operative complications.
Conclusion: Parenchymal clamping is an attractive,
1
VID.18
Results: Mean patient age was 62 ± 11 years, mean tumor size was 4.9 ± 0.6 (4.1 - 6.5) cm. Mean R.E.N.A.L nephrometry score was 8 ± 1 (5-10). Five patients underwent off clamp partial nephrectomy, 4 performed laparoscopically, one was robot assisted. The remaining 16 involved hilar clamping; 7 performed laparoscopically, and 9 were robot assisted. The mean warm ischaemia time in the clamped group is 26 ± 5.3 minutes. Mean tumour size (4.6 vs. 5.0 cm, p=0.254) and R.E.N.A.L nephrometry score (8.6 vs. 7.9, p=0.238) is similar in the zero-ischaemia vs. the clamped group respectively. Mean operating time is shorter in the zero-ischemia group (208 vs. 236 minute, p=0.386). Mean drop in hemoglobin (2.5 vs. 2.6 g/dl, p=0.706) were similar in both groups. The mean estimated blood loss was lower in the zero ischaemia group (390 vs. 461 ml), but it was not statistically significant (p= 0.783). However, three patients in the clamped group required intra-operative blood transfusion, none in the zero-ischaemia group (p=0.046). Two patients in the clamped group underwent conversion to open, none were observed in the zero ischaemia group (p=0.406). Mean duration of hospital stay is similar in both groups (4.8 vs. 4.3 days, p=0.539). Mean follow up duration is 16 ± 15 months. One patient in the clamped group has positive surgical margins, the remaining has negative margins (p = 0.567). None of the patients developed new onset chronic kidney disease post operatively.
been favoured over radical nephrectomy in T1b renal tumors whenever feasible. There is only limited data regarding performing minimally invasive partial nephrectomy for T1b renal tumors. We aim to compare the peri-operative outcomes of minimal invasive partial nephrectomy for T1b renal tumors. Materials and Methods: We retrospectively reviewed
the records of 21 patients who underwent minimally invasive partial nephrectomy from May 2010 till Dec 2015 in our institution. All patients have pre-operative computed tomography scan. Preoperative characteristics and outcomes were analysed. Post-operative complications were graded according to modified Clavien classifications.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Russo A1, Sanchez-Salas R2, Di Trapani E1, Castiglione F1, Weber N3, Validire P3, Fregeville A4, Barret E2, Rozet F2, Galiano M2, Salonia A1, Briganti A1, Montorsi F1, Cathelineau X2 1 Div. of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; 2 Dept. of Urology, Institute Mutualiste Monsouris, Paris, France; 3Dept. of Pathology, Institute Mutualiste Monsouris, Paris, France; 4Dept. of Radiology, Institute Mutualiste Monsouris, Paris, France
Introduction and Objective: Umbilical tumors are relatively rare. The term Sister Mary Joseph nodule (SMJN) is used to describe a malignant umbilical tumor usually associated with advanced metastasizing intra-abdominal cancer. Gastrointestinal and gynecologic malignancies account for the majority of the underlying sources. A 70-year-old woman presented with a history of fatigue, loss of appetite and mild lower gastrointestinal discomfort over the previous 4 months. Blood tests showed an elevation of CA125 and CA15.3 markers. Imaging (CT and MRI) revealed an intra-abdominal tissue formation behind the left rectus muscle, without any other sign of malignancies. In the setting of an isolated abdominal mass harboring high CA125 and CA15.3 markers, an initial hypothesis was a SMJN. Differential diagnosis for such a lesion was a primary urachal carcinoma, urachus benign cyst or infected urachal remnants. Surgical resection was decided and performed.
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UNMODERATED VIDEOS Materials and Methods: Under general anesthesia the patient was placed in Trendelemburg position. A 10mm Hasson trocar was placed on the right hemi-abdomen, at the lateral border of the rectus muscle. Two ports were placed on the epigastrium and the line joining the umbilicus with the right anterior iliac spine, respectively. After identification of mass the parietal peritoneum was opened and dissection throughout its entire length was performed cranially to the umbilical cicatrix. Caudally the dissection was carried out until the bladder was identified. A partial cystectomy was performed and the en-bloc piece was removed. Eventually a cystorrhaphy was performed. Results: The pathology report showed an 82gr
specimen (115x95x50mm) with a neoplastic lesion measuring 85mm of diameter and negative surgical margins. The histology of the lesion is a primary adenocarcinoma of the urachus CK7+, WT1+, CA125+, CK20-. Further diagnostic tests did not reveal any gynecologic or gastrointestinal cancers. Patient evolved uneventfully. CA125 levels became normal two months after the procedure. Conclusion: We present the assessment and surgical
treatment of a primary adenocarcinoma of the urachus, initially suspected as a SMJN on the setting of a female patient with high levels of CA125.
VID.21 Emptying the Bladder Organized Hematoma Using Morcellator
VID.22 Robot Assisted Laparoscopic Transmesocolic Pyeloplasty in Pediatric Patient Kibar Y, Yilmaz S, Kaya E Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey Introduction and Objective: Ureteropelvic junction (UPJ) obstruction is classically treated with the method, which is defined by Anderson Hynes in 1949. Robotic surgical techniques play a major role in urologic surgery and continue to grow today. In this case, we aimed to share our robot assisted laparoscopic trans-mesocolic left pyeloplasty experience in 7-yearold male patient. Materials and Methods: A 7-year-old male patient
has admitted our clinic with the left hydronephrosis that diagnosed in antenatal period. In his ultrasonography, left grade 3-4 hyronephrosis was determined. In his mercaptoacetyltriglycine (MAG-3) scintigraphy, 43% left kidney function that not allows the pharmaceutical transition is determined. Robot assisted laparoscopic trans-mesocolic left pyeloplasty was planned as a treatment procedure. The surgery was performed with no complication and it was observed that the renal function returned to normal. Results: Still open surgical procedures are considered to be the gold standard treatment for UPJ stenosis. Release of the colon during this surgery raises the risk of postoperative gastrointestinal complications. With trans-mesocolic approach this risk is minimized. Conclusion: In the pediatric age group, trans-meso-
Gulhane Military Medical Academy, Ankara, Turkey
colic robot-assisted laparoscopic pyeloplasty seems to be the preferable surgical procedure. Prospective studies should be planned for more information.
Introduction and Objective: Urinary system bleed-
VID.23
ing can be organized in the bladder and it can be treated difficult. We have described a novel endoscopic treatment method for organized hematoma in the bladder.
How to Insert a Foley Catheter Just after Transurethral Resection of the Prostate
Bedir S, Zor M, Kaya E, Topuz B, Tomruk H, Uguz S
Materials and Methods: A 76-year-old male patient
had transvesical prostatectomy surgery. It failed to check the patient’s post-operative hematuria and organized hematoma filling the entire lumen of the bladder was occurred. Two weeks later cystoscopy was performed with the resectoscope, but showed no active bleeding and least a portion of hematoma could be drained. One week after surgery morcellator was inserted with 26 fr nephroscope in the bladder and organize the hematoma was drained successfully in 30 minutes. No complications were observed. Results: Organized hematoma primarily treated with endoscopic methods and in case of failure open surgical methods are available. Role of resection is limited for hematoma fills all the lumen. Morcellator is used most frequently in the HoLEP due to BPH surgery. In a manner not previously described in the literature we used morcellator in organized bladder clots and hematoma. Conclusion: Use of morcellator in bladder organized
hematoma treatment is fast, effective and safe.
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Shin YS1, Park JK1, You JH1, Lee SW2 1
Chonbuk National University Hospital, Jeonju, South Korea; 2Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Introduction and Objective: Transurethral resection of the prostate (TURP) is a standard surgery to treat the cumbersome moderate to severe LUTS secondary to benign prostatic hyperplasia (BPH) within the conventional range of 30-100 ml. Just after a deep resection of the prostate, especially the posterior portion, the insertion of a Foley catheter could be very difficult or impossible even while the stylet is used. We demonstrate a new technique to more easily insert a Foley catheter just after performing a TURP. Materials and Methods: Among 180 men who underwent TURP by bipolar surgical unit (BSP), we found that 36 men experienced the Foley catheter getting stuck while being inserted in the conventional way. The reason was because portion of the prostate just underneath the bladder neck was excessively resected. In those 36 men, we then inserted a 20 Fr sized Foley catheter through an anterior- and upward-movement of posterior prostatic capsule by pressing the rectal wall using a finger or a urethral catheter that was a newly invented has the flexible portion by traction of thread which was anchored at the 1 cm distal from
the tip instead of a stylet. The thread passes through inside hole from the tip and comes out at the end of the catheter. We filmed the inside view of prostatic fossa by using a cystoscope through the opened bladder just after the suprapubic open prostatectomy and transurethral coagulation and adjustment with BPS continuously. Results: For all case of the 36 men concerned, by adopting this novel technique, the Foley catheter was completely inserted just after the TURP without any complication. Conclusion: The two techniques to insert a Foley
catheter just after the TURP can be performed safely within the set time limit without having to use any other medical device such as the stylet.
VID.24 A Magic Trick To Straighten a J-Tip Guidewire Lezrek M1,2, Tazi H2, El Majdoub A2, El Bagouli M2, Beddouch A1, Ammani A1, Qarro A1, Alami M1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco Introduction and Objectives: The introduction of
a J-tip guidewire, through the puncture needle or a catheter, can be tricky. Normally, both hands are needed. The J-straightener or introducer does not simplify the technique much. Also, both hands are needed; otherwise, the guidewire have to be placed in the J-straightener before beginning the procedure or by the help during the procedure. The guidewire might slip from the J-straightener or the introducer might fall complicating more this simple procedure. We present our experience of a simple trick to facilitate the introduction of a J-tip guidewire without using the J-straightener. Materials and Methods: We present a straightening technique that can be performed single handedly. A J-tip Tefon guidewire is firmly held between index and thumb, a few centimeters below the tip. Simultaneously, the other fingers of the same hand do traction on the body of the guidwire against the palm of the hand. Thus, the tip is straightened. Results: The technique is possible single handedly, and allows the introduction of the guidewire without letting-go of the puncture-needle. It is much quicker and sure than using a J-straightener. A guidewire is composed of wire wounded around a steel core. Traction on the body of the guidewire, while firmly holding the guidewire near the tip, will lead to a tightening of the wounded wire in the tip, which will lead to the straightening of the J-tip. However, this technique is possible only with a Teflon guidewire and not with a hydrophilic guidewire. Conclusion: The straightening of a J-tip Teflon guide-
wire is possible single handedly, and without the use of a J-straightener. This technique simplifies and facilitates the introduction of a J-tip guidewire.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED VIDEOS VID.25 Thoracoscopy with the Nephroscope to Remove a Stone That Migrated During Percutaneous Nephrolithotomy Lezrek M1,2, Tazi H2, Slimani A1, Bazine K1, Qarro A1, Ammani A1, Kasmaoui EH1, Beddouch A1, Alami M1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco
Introduction and Objectives: We present a video of our experience of a thoracoscopy using the nephroscope to manage an uncommon complication of percutaneous nephrolithotomy (PCNL) with the migration of a renal stone in the thoracic cavity. Materials and Methods: A 17-year-old girl had open
surgery for a complex stone of the right kidney, 1 year ago. She had 3 residual stones of about 7-9 mm, so PCNL was decided. The kidney was fixed in a higher position. Needle renal caudal displacement failed. Thus, an intercostal, between the 11th and 10th rib, upper pole calyx percutaneous access was performed and a 24 Fr working sheath was placed. Two stones were removed by the rigid nephroscope without fragmentation. The third stone was found by the flexible nephroscope, and was grasped with a Nitinol basket. After an abrupt pull, the Amplatz sheath, nephroscope and the stone were in the retroperitoneal tract and the stone was lost. Fluoroscopy showed the stone in the thorax. The rigid nephroscope and a 30 Fr Amplatz sheath are inserted through the pleural injury and thoracoscopy was performed. The vacuum technique with aspiration through the nephroscope-operating channel helped to have a good vision and to locate the stone. The stone was removed with a forceps. A 24 Fr chest-tube was inserted through the percutaneous tract. A double-J-stent was inserted in the kidney, and no nephrostomy tube was placed. Results: The chest-tube was removed the second
postoperative day, after a normal chest X-ray. The patient had an uneventful discharge on the fourth postoperative day. Conclusions: The endoscopic exploration of the percutaneous tract with the nephroscope allowed the sighting of the pleural cavity opening. Thus, thoracoscopy was possible using the rigid nephroscope through the same percutaneous tract, and the stone was removed. The pleural effusion was easily managed with the chest tube, and the postoperative period was uneventful. Gentle maneuvers are necessary during PCNL to avoid complications.
VID.26 Robotic Assisted Partial Right Nephrectomy with Ipsilateral Adrenalectomy Kamkoum H, Al-Ansari A
fined hypo echoic mass in the upper pole of the right kidney measuring 24*13mm Doppler scan demonstrates peripheral and central vascular flow and a well demarcated hyper echoic mass involving the right suprarenal gland measuring 32*21mm”. Follow-up renal ultrasonography performed 3 weeks after discharge showed the same findings. Computer Tomography with IV contrast: Ill-defined heterogeneous enhancing hypodense focal lesion measuring 28*30mm arising from the upper pole of the right kidney it arise from the cortex with capsular bulge, Well defined right adrenal gland lesion with homogenous fatty contents without calcifications or cysts highly suggestive of myolipoma. MRI: Right upper pole partially enhancing parenchymal renal mass suggests a solid cortical renal neoplasm likely papillary RCC Stage II (T3aN0M0) and right adrenal adenoma. Blood workup negative. Hormonal workup for the suprarenal adenoma negative. Urine culture: No Growth. Materials and Methods:
1. Radical Nephrectomy (en-bloc resection of the right kidney and the right suprarenal gland) 2. Partial nephrectomy and ipsilateral adrenalectomy (en-block single specimen) • Approach: • Transperitoneal • Retroperitoneal • Open • Laparoscopic • Robotic Assisted Results: Robotic Assisted partial right nephrectomy with ipsilateral adrenalectomy single specimen performed with smooth postoperative recovery, Foleys removed at Day 3 post-op drain removed and patient discharged at day 4 post-op. Histopathology report showed Xanthogranulomatous Pyelonephritis. Conclusion: Robotic Assisted partial right nephrecto-
my with ipsilateral adrenalectomy single specimen is a feasible and safe procedure for adrenal tumors involving the upper pole of the ipsilateral kidney.
VID.27 Robotic Assisted “Davinci” Bladder Diverticulectomy Kamkoum H, Al-Ansari A Hamad General Hospital, Doha, Qatar Introduction and Objective: We reviewed a clinical case of bladder diverticulum with recurrent UTIs. Materials and Methods: A 23-year-old gentleman was followed in the Urology outpatient clinic (Hamad General Hospital) since June 2014 up-to-date, he was complaining of LUTS (Obstructive) associated with recurrent UTIs for the last 3 months prior to his 1st visit. He was investigated by:
Hamad General Hospital, Doha, Qatar
• Urine RM: WBC=64 RBC=3
Introduction and Objective: We reviewed a clinical case of right renal mass associated with right suprarenal adenoma.
• Urine Culture: E.Coli (Treated)
Materials and Methods: A 41-year-old gentleman
• Flexible Cystoscopy: Presence of huge bladder diverticulum at the left lateral wall, near to the left ureteric orifice, with wide diverticular neck and high bladder neck.
was admitted under medicine with right pyelonephritis for which he received full course appropriate antibiotics. Renal ultrasonography showed “focal ill-de-
• Urine Cytology: Negative for malignancy • Flowmetry: Abdominal straining, (Q-Max = 22)
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
• CT with IV contrast: Delay film showed bladder diverticulum at the left lateral wall adjacent to the left ureter Materials and Methods: Available options: A. Inser-
tion of left JJ stent and endoscopic resection of the diverticular neck; B. Insertion of left JJ stent and open diverticulectomy; C. Insertion of left JJ stent and laparoscopic diverticulectomy; D. Insertion of left JJ stent and Robotic assisted (Davinci) diverticulectomy. Results: Patient had smooth postoperative course, discharged with Foley’s catheter on the second postoperative day, Foleys’s removed an fifth postoperative day, flowmetry showed Q-Max of 26 and PVR 40 ml, VCUG showed no extravasation and no filling defects, no episodes of UTIs since the surgery. Conclusion: Robotic assisted (Davinci) diverticulec-
tomy is a safe procedure for big bladder diverticulum with wide neck very near to the ureteric orifice, and the insertion of JJ stent facilitates the surgery.
VID.28 Retrograde Endopyeloplasty Using the Ureteroscope: A Feasibility Study Lezrek M1,2, Tazi H2, Slimani A1, Bazine K1, Kasmaoui EH1, Beddouch A1, Alami M1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco
Introduction and Objectives: Percutaneous endopyeloplasty is a horizontal suturing of the longitudinal endopyelotomy incision, via a single percutaneous tract. Generally, one suture is enough. Can this suture be performed in a retrograde fashion? We present a video of a preclinical feasibility study of an endoscopic suturing technique using a rigid ureteroscope. Materials and Methods: A 4/0 suture with a conventional curved 13-mm needle is used. The needle is straightened and the thread is folded over the needle, and it is tied in the middle of the needle using another 6/0 suture. When the first suture is attracted through tissue, the needle will become horizontal and the suture will be anchored. A 3-Fr basket is retrieved in its sheath until a 13-mm of the sheath is empty, and the straightened needle is inserted. The suture is left outside the sheath. This modified basket is used through the ureteroscope. A longitudinal incision is performed. The distal extremity of the basket is applied a few millimeters below the incision lower apex. The basket is opened so the straightened needle and then the sheath pass through tissue. The needle is completely pushed outside. The basket is retrieved. The suture is attracted anchoring the needle. Similarly, another suture is anchored in the upper incision apex. The 2 sutures are inserted in a ureteral catheter and traction on the 2 sutures will close the incision; approximating the incision distal and proximal apex. The longitudinal incision will become transversal in a Heineke-Mikulicz plasty. Results: The endoscopic suturing technique was achieved easily and quickly. It was feasible directly in a glove model. Moreover, it was possible through the rigid ureteroscope in the glove model, a sheep vena cava model, and a left nephroureterectomy specimen.
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UNMODERATED VIDEOS Conclusions: This suturing technique is possible through the ureteroscope, which suggest the possibility of retrograde endopyeloplasty. Additionally, retrograde Heineke-Mikulicz plasty might be used for caliceal diverticulum neck, infundibulum stenosis, Fraley’s syndrome, ureteral stricture… More studies are necessary to confirm the feasibility of retrograde endopyeloplasty, and further development of the suturing technique is needed, like to have an absorbable “needle” or anchor.
VID.29 Robot Assisted Laparoscopic Bladder Diverticulectomy Yilmaz S, Yildirim I, Alp BF, Uguz S Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey Introduction and Objective: Bladder diverticula may
be congenital or acquired. Acquired ones are most commonly secondary to bladder outlet obstruction, resulting in an increased intravesical pressure, causing a herniation of mucosa through the muscle layer of the bladder. In this report, we present the robot assisted laparoscopic bladder diverticulectomy in a patient with huge bladder diverticula. Materials and Methods: A 72-year-old male patient applied our hospital with the stomachache. After a clinical evaluation with abdominal ultrasonography and computerized tomography huge bladder diverticula was determined. Robot assisted laparoscopic bladder diverticulectomy was planned to the patient. Results: Surgery was performed with no intra/postoperative complication and discharged postoperative second day. In his routine controls there was no late complication.
and left ureteral duplication is determined. Robot assisted laparoscopic extravesical ureteral re-implantation is planned. Results: Surgery is performed without any intra/postoperative complication and patient discharged postoperative third day. Conclusion: Robot assisted laparoscopic extravesical
ureteral re-implantation in a patient with ureteral duplication is an effective and safe option for primary vesicoureteral reflux requiring surgery.
VID.31 Laparoscopic Treatment for Local Recurrence of Renal Cell Carcinoma Juaneda R, Belisle DF, Carrara S, Carranza Bertarelli M, Arismendi E, Compagnucci M, Bertran M, Juaneda RA, Lopez Seoane M Sanatorio Allende, Córdoba, Argentina Introduction and Objective: To present a video de-
scribing the surgical technique of a laparoscopic resection of a renal cell carcinoma local recurrence. Materials and Methods: We present the case of a
54 years old female patient with a renal cell carcinoma recurrence. She was operated of a right open radical nephrectomy for an 8.5 cm renal tumor in 2010. The pathology results showed a Fuhrman grade 2 renal cell carcinoma, pT2a, R0. After 3.5 years follow up, a computed tomography showed an isolated local recurrence of 3.5 cm in the right renal fossa. A transperitoneal laparoscopic right resection of a renal cell carcinoma recurrence was planned.
Robot Assisted Laparoscopic Ureteral Re-implantation in a Patient with Ureter Duplication
Results: After lysis of peritoneal adhesions, the retroperitoneum was opened and the mass was identified. Using mainly the Ligasure energy source, the 3.5 cm renal recurrence was dissected and mobilized. It was extracted in a bag and a drain was left in place. Operating time was 60 minutes and bleeding was 50 cc. The patient was discharged on postoperative day 2 with no complications. Pathology results informed renal cell carcinoma Fuhrman grade 2 in the resection mass; surgical margins were negative (R0). Two years after the recurrence resection, there are no signs of local or metastatic relapse and the patient has a good renal function (creatinine 0.8 mg/dl; MDRD 74 ml/ min/1.73 m2).
Yilmaz S, Kibar Y, Kaya E, Tomruk H
Conclusion: Laparoscopic treatment of renal cell car-
Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey
cinoma local recurrence is a feasible option for selected patients.
Introduction and Objective: Vesicoureteral reflux
VID.32
(VUR) gives symptoms as a recurrent urinary tract infection. In pediatric population, treatment of VUR is important to prevent the kidney parenchyma. Various types of treatment procedures have demonstrated according to technologic developments however, robot assisted procedure is the most famous and effective one. VUR and ureteral duplication is rare. In this case, we aim to present the robot assisted laparosopic extravesical ureteral re-implantation in a pediatric patient with ureter duplication.
Less Conventional Indications for Retroperitoneal Laparoscopy
Conclusion: Robot assisted laparoscopic diverticulec-
tomy seems safe with a low risk of intraoperative or postoperative complications. Randomized controlled trials that compare open, laparoscopic and robot assisted laparoscopic surgeries to identify the differences of both procedures must be planned.
VID.30
Materials and Methods: A 5-year-old female patient has admitted to our clinic with the history of recurrent urinary tract infection. After clinical evaluation, in her voiding cystourethrography left grade-3 VUR
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Lu J, Chen WK, Consigliere D, Tiong HY National University Hospital, Singapore Introduction and Objectives: Retroperitoneal laparoscopic procedures have been considered a safe and reliable urological approach to the kidney and adrenal gland. In this video, we present less conventional surgical indications using this approach: 1) solitary kidney biopsy, 2) excision of ganglioneuroma and 3) para-aortic lymph node biopsy. Materials and Methods: A standard technique for
achieving laparoscopic access to the retroperitoneal
space was utilized for all 3 patients. Using the tip of the 12th rib as the landmark, the retroperitoneal space was dissected using balloon expansion. Two additional working ports were placed. Patient 1: a 28-year-old female with a solitary native kidney who was referred for open renal biopsy to investigate the cause of chronic kidney disease and proteinuria. Patient 2: a 43-year-old male with a 10cm ganglioneuroma proven on core biopsy that was in close relation to the left adrenal gland medially and renal hilum caudally. Patient 3: a 53-year-old female for consideration of kidney re-transplant with enlarged para-aortic lymph nodes for biopsy to rule out malignancy. The videos highlight key technical points to approaching target retroperitoneal structures without injury to the renal hilum, main vessels and peritoneal structures. Results: All the procedures were performed successfully without major complications. Estimated blood loss was less than 50ml for all patients with an operating time of 203, 91 and 126 minutes respectively. All patients resumed normal diet on first post-operative day. Length of stay was 3, 2 and 7 days respectively. Core biopsies of the solitary kidney showed focal segmental glomerulosclerosis while histological examination of the excised para-aortic lymph node revealed diffuse large B-cell lymphoma. No recurrence was seen on interval-computed tomography imaging of the patient with the excised ganglioneuroma at 19 months. Conclusion: Familiarity with the retroperitoneoscop-
ic approach facilitates access to other retroperitoneal structures without the need to disturb intraperitoneal organs, with potentially less postoperative ileus and quick recovery.
VID.33 A Watertight Rubber Seal for the Flexible Nephroscope and Ureteroscope Lezrek M1,2, Tazi H2, Bazine K1, Slimani A1, Ammani A1, Qarro A1, Beddouch A1, Alami M1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco Introduction and Objectives: When using the flexible
nephroscope, there is a large outflow or backflow with the standard rubber cap. Especially, when using a basket, guidewire or laser fiber. In this case, the ureteroscope-seal is efficient to prevent irrigant backflow and secure devices inserted through the working channel. However, if the fibroscope-seal is not available, is there another option? The injection port of a serum bag can be used. Materials and Methods: In the beginning of the en-
dourologic procedure, the sterile empty 500 ml serum bag is kept on the operating table. The injection port is harvested from the serum-bag. The whole length can be used or it can be shortened. Then, the injection port is adapted to the working channel of the flexible nephroscope, cystoscope or uretero-renoscope. To insert a device (basket, guidewire, etc.), the puncture needle is inserted from inside-out in the injection port, then the basket is inserted into the needle and it is attracted through the port. Results: The injection port fit perfectly to the working channel of flexible scope, thus, there is no longer any
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED VIDEOS backflow. Moreover, there is no backflow with any instrument inserted in the working channel guidewire, basket, or laser fiber, even with large movements of the instrument. Limitations: However, the spontaneous insertion of a device, guidewire, basket or laser fiber, is almost impossible. It necessitates the use of the puncture needle or an introducer. Moreover, since the rubber of the injection port is so tight, the progression of the basket or guidewire is difficult. However, this limitation can be used to reduce the movements and to secure the inserted device: baskets, guidewire, or laser fiber.
Conclusions: Robotic hydrodissection is a novel technique, which is effective in facilitating NVB preservation by lifting and hydrodissecting the NVB away from the prostate and minimizing bleeding from small blood vessels, thus improving visualization of the anatomic planes during the NVB dissection.
Conclusion: The injection port can be adapted per-
Apollo BGS Hospitals, Mysore, India
fectly to the working channel of the flexible scope and it is watertight without any irrigant outflow. It is a good cost-free alternative to the ureteroscope-seal.
VID.34 Local Anaesthetic Hydrodissection of the Neurovascular Bundle during Robotic Radical Prostatectomy Thanigasalam R1, Lau H2, Arianayagam M3, Raz O4 Concord Hospital, Sydney, Australia; 2Westmead Hospital, Sydney, Australia; 3Nepean Hospital, Penrith, Australia; 4Macquarie University Hospital, Sydney, Australia
1
Introduction and Objectives: We present a point of technique video to demonstrate the use of local anaesthetic (LA) hydrodissection of the neurovascular bundle (NVB) during robotic-assisted radical prostactectomy (RARP) (bilateral intra-fascial nerve) sparing, from our experience of more than 200 cases of LA hydrodissection of NVB during RARP. Materials and Methods: A 64-year-old man with a PSA 4.12 and normal DRE had a GS 7 (3+4) tumour diagnosed on TRUS guided prostate biopsy (10 out of 35 cores involved; each core <5%). Following negative staging he underwent a Robotic assisted radical prostatectomy with bilateral intra-fascial nerve sparing (shown in this video presentation). A short orange 25 gauge 16mm (5/8 inch) needle attached via intravenous cannula tubing to a 20ml syringe is introduced via the 12mm assistant port using a laparoscopic needle holder; 10mls of 0.5% Marcaine/adrenaline were mixed with 10mls of normal saline (half strength). The console surgeon injected ~3ml aliquots at the base, mid zone and apex of the prostate bilaterally above the NVB (6 point injection) to elevate and hydrodissect the NVB away from the prostate prior to the division of the anterior bladder neck. NVB preservation was then performed following completion of the dissection of the seminal vesicles/vas deferens and posterior plane. Results: The blood loss for the procedure was 97mls, there were no haemodynamic changes noted during or following the injection of LA for NVB hydrodissection. There were no intra-operative or post-operative complications, and no delayed/secondary bleed following the injection. The IDC was successfully removed on day 7 following a cystogram and the surgical margins were negative. The patient was using 1 security pad a day at 6 weeks post op, and had noticed minor tumescence of the penis with PDE5-inhibitor at 6 weeks (though not firm enough for intercourse).
VID.35 Laparoscopic Pyeloplasty in Horseshoe Kidney: Is It Any Different? Raghavendran M, Shivathirthan N
Introduction and Objectives: Horseshoe kidney is the
most common of all fusion anomalies. The incidence is around 1 in 666 individuals. Generally, the isthmus is bulky and parenchymatous, but occasionally can be flimsy. The ureter usually lies laterally and the upper ureter is usually angulated with the lower ureter normal in position. Uretero-Pelvic Junction (UPJ) dilatation is in 20% patients, but significant obstruction is in only 20% of these. Pyeloplasty is the treatment of choice. Recent series suggest Laparoscopic pyeloplasty as alternative, but there are only around 30 cases reported. The procedure also has not been clearly described or documented. Materials and Methods: We present a case of PUJO in HSK and discuss the course of the patient with emphasis on the surgical treatment. Results: A 30-year-old gentlemen presented with left flank pain. His renal functions were normal. Ultra sonogram revealed HSK with hydronephrosis in the left moiety. CT was performed with contrast and revealed hydronephrosis most probably due to UPJ obstruction in the left moiety. The isthmus was bulky on the right side and flimsy on the left side. The patient was subjected to left Retrograde Pyelography, which confirmed Jet effect with gross ballooning of Pelvi calyceal system. A Double J stent was placed initially and patient was subjected to Laparoscopic pyeloplasty. The procedure was uneventful. No drain was placed. The blood loss was minimal and the operative time was around 90 minutes. Post-operative pain was insignificant and the patient was discharged on the first post-operative day. Excised specimen sent for histopathology confirmed muscular disarray at UPJ site. Conclusions: UPJ obstruction in HSK patients is similar to that occuring in normal kidneys. Preoperative retrograde pyelography confirms diagnosis. Preoperative retrograde stenting makes intraoperative identification and dissection easier. Laparoscopic pyeloplasty in Horseshoe kidney patients is similar to pyeloplasty being done for normal UPJ obstruction patients. The ease of procedure, lack of complications and limited hospital stay with early return to work makes us conclude that Laparoscopic Pyeloplasty is the treatment of choice for UPJ obstruction in this subset of patients.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
VID.36 Robot Assisted Radical Cystoprostatectomy: Our Nerve Sparing Technique Villamil W, Andrade C, Martinez PF, Jurado A, Gonzalez M, Tejerizo J, Favre G Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: Robot-assisted proce-
dures are increasingly being performed as minimally invasive surgical approaches. Robotic assisted radical cystectoprostatectomy has the benefits of minimally invasive procedures as decreased blood loss, and low use of analgesic drugs; another important advantage of this technique is the possibility of neurovascular bundle preservation in selected patients. Our objective is to demonstrate our technique of neurovascular bundle preservation in robotic assisted radical cystoprostatectomy. Materials and Methods: We performed a robot-as-
sisted radical cystoprostatectomy on a 50-year-old male with history of muscle invasive bladder cancer (T2); a trans-peritoneal technique was performed with 6 ports with a 4 arm Da Vinci Si platform. Results: 1. Bilateral lymph node dissection; 2. Circumferential mobilization of each ureter from pelvic brim down to the distal portion of the ureter and section of the ureters between clips; 3. Retrovesical dissection: posterior peritoneotomy across the culde-sac, mobilization of bilateral vas and seminal vesicles, and incision of Denonvilliers’ fascia to enter the pre-rectal fat plane with blunt dissection; 4. Lateral dissection: lateral peritoneotomy up to the endopelvic fascia; 5. Transection of lateral pedicles: we perform a combined approach for nerve sparing with cold scissors and clips, anterograde dissection on the bladder and retrograde dissection on prostate; 6. Anterior dissection: anterior inverted-U shaped peritoneotomy, dissection of the space of Retzius, division of dorsal venous complex (DVC) and membranous urethra; 7. Neobladder through a small midline incision. Conclusion: Robotic assisted radical cystoprostatec-
tomy is a feasible technique, offering the advantages of mini-invasive surgery for meticulous nerve sparing dissection. More cases will be needed to validate its application.
VID.37 Knotless Laparoscopic Partial Nephrectomy: Turning Easy a Challenging Procedure Torres-Anguiano JR, Moreno-Palacios J, TorresMercado LO, Leon-Mar R, Lopez-Samano VA, Montoya-Martinez G, Serrano-Brambila EA Instituto Mexicano del Seguro Social, Hospital de Espacialidades Centro Medico Nacional Siglo XXI, Mexico City, Mexico Introduction and Objectives: Partial nephrectomy represents the standard of care for T1 renal masses, providing oncologic outcomes equivalent to radical nephrectomy. Laparoscopic partial nephrectomy (LPN) remains a demanding technique due to the large time-consuming steps required specially for knot-tying. Our work aims to make a step-by-step description of a knotless technique.
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UNMODERATED VIDEOS Materials and Methods: Using the protocol preparation for LPN, we achieve pneumo-peritoneum, then five ports are placed (shown in video). The laparoscope is inserted and we divide the renal silhouette to identify the ureter exposing the inferior renal pole and the renal vessels. Afterwards we identify the tumor and a segment of a Nelaton catheter is introduced with the vascular loop, the renal artery is surrounded and we lock the loop tails with a hem-o-lok, starting ischemia time. Cold cuts around the tumor are made, achieving a complete excision within the first five minutes. We change the laparoscope to port #3, using #2 and #4 as working ports. The renal sinus is closed using V-Lock suture, finishing the suture line with a hem-o-lok. The parenchyma is closed by setting three suture stitches across the width of each parenchymal edge, a loose loop of suture is left and the sutures are tighten with hem-o-loks in every stitch. A hemostatic pad is placed under the suture loops and the stitches are crossed over, ischemia is released. After passing the parenchyma the sutures are locked with a second hem-o-lok anchored to the renal surface counterpart. Results: Our patient was discharged at the third postoperative day. No perioperative complications were identified. The surgical margins were negative. Conclusion: Our technique defines a novel approach,
solving important disadvantages of LPN, with a safe and easy reproducibility. This study sets the background for further reports required to elucidate the performance outcomes of our surgery in different settings.
VID.38 Customized Tool for Validation of Optical Coherence Tomography in Differentiation of Prostate Cancer Muller B1, Swaan A2, de Bruin D2, van den Bos W1, Schreurs W3, Faber D2, Zwartkruis E4, Rozendaal R4, Vis A5, Nieuwenhuijzen J5, van Moorselaar J5, van Leeuwen T2, de la Rosette J1 1
Dept. of Urology, Academic Medical Center, University of Amsterdam, The Netherlands; 2Dept. of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, The Netherlands; 3Dept. of Instrumental Services, Academic Medical Center, University of Amsterdam, The Netherlands; 4Dept. of Pathology, VU University Medical Center, Free University, Amsterdam, The Netherlands; 5Dept. of Urology, VU University Medical Center, Free University, Amsterdam, The Netherlands Introduction and Objective: To design and demonstrate a customized tool to generate histologic sections of the prostate that directly correlate to needle-based Optical Coherent Tomography (OCT) pull-back measurements. Materials and Methods: A customized tool was created to hold the prostatectomy specimens during OCT- measurements and formalin fixation. Using the tool, the prostate could be sliced into slices of 4 mm thickness, through the OCT-measurement trajectory. In this way, whole mount pathology slides were produced in exactly the same location as the OCT measurements were performed. Full 3D OCT pullbacks were fused with the histopathology slides using the 3D imaging software AMIRAtm and images were compared.
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Results: A radical prostatectomy was performed in a patient (age: 68y, PSA: 6.0 ng/mL) with Gleason score 3+4=7 in 2/5 biopsy cores on the left side (15%) and Gl 3+4=7 in 1/5 biopsy cores on the right side (5%). Histopathology after radical prostatectomy showed an anterior located pT2cNx adenocarcinoma Gl 3+4=7. Histopathological prostate slides were produced using the customized tool for OCT measurements, fixation and slicing of the prostate specimens. These slides correlated exactly to the OCT images. Various structures e.g. Gleason 3+4 prostate cancer, stroma, healthy glands and cystic atrophy with septae, could be identified both on OCT and the histopathological prostate slides. Conclusion: We successfully designed and applied
a customized tool to process radical prostatectomy specimens to improve the co-registration of whole mount histology sections to fresh tissue OCT pullback measurements. This technique will be crucial in validating the results of OCT imaging studies with histology and can easily be applied in other solid tissues as well e.g.: lung, kidney, breast and liver. This will help to improve the efficacy of OCT in cancer detection and staging in solid organs.
VID.39 Transurethral Ventral Buccal Mucosa Graft Inlay Urethroplasty for Distal Urethral Strictures Nikolavsky D, Abouelleil M, Daneshvar M SUNY Upstate Medical University, Syracuse, United States Introduction and Objective: Distal urethral stricture
repair usually involves penile skin incision to gain access to urethra for various forms of external urethrotomy and subsequent repair with flaps or grafts. These incisions place the repair at risk for fistula formation, dehiscence and suboptimal cosmetic outcomes. We introduce a novel technique for reconstruction of distal urethral strictures without a need for skin incision. Our approach, a modified Naude technique, employs a ventral internal urethrotomy and precise transurethral delivery and fixation of BMG to the surface of the urethrotomy. Materials and Methods: Technique: A ventral ure-
throtomy is performed transurethrally and a wedge of the obstructive tissue is removed to access a proximal patent lumen. Appropriate size BMG is harvested and prepared for delivery. Both arms of a double-arm 6-0 polydioxanone suture are passed through the proximal apex of the graft then through the urethra at the proximal apex of the urethrotomy and externalized through the skin. The arms of the suture are pulled to deliver the graft precisely into its place in the urethra. Additional 6-0 double-armed sutures are used to quilt the graft at its mid-portion and their knots tied externally. The distal edge of the graft is sutured to the edge of the meatotomy with absorbable sutures. A retrospective chart review was conducted of all the patients after a distal urethral stricture repair by a single surgeon (DN) since March 2014. Surgical and functional outcomes, complications were reviewed. Uroflow and SHIM scores were evaluated pre- and post-operatively. Results: Eight male patients underwent this procedure. Mean age was 48 years (26-69), mean stric-
ture length 1.8 cm (1-4). At a mean follow up of 10.3 month (3-24), there were no recurrences, fistula, penile chordee or adverse effects on sexual function. Mean uroflow pre-op was 4.6 cc/sec (0-9), post-op 19.5cc/sec (10-32). SHIM scores pre-op 17 (5-25), post-op 19 (19-25). Conclusion: We demonstrated the feasibility of inci-
sionless distal urethral stricture repair with ventral inlay BMG. This single stage technique allows avoiding skin incision or urethral mobilization. It prevents glans dehiscence or fistula formation. It avoids the use of genital skin flaps in patients affected with LS.
VID.40 Posterior Sagittal Ano-Rectal Pull Through for a Persistent Post Traumatic Recto-Urethral Fistula in an Adult Seth A, Agrawala S, Nayyar R, Dogra P, Shukla A All India Institute of Medical Sciences, New Delhi, India Introduction and Objective: Children born with high ano-rectal malformations may have a proximally placed rectal pouch with the anal sphincter at the normal position. Posterior sagittal approach to mobilize the rectum to pull it through the normally positioned anal sphincter leads to a minimal disturbance of the anteriorly placed uro-genital structures. We utilized this approach for an adult male who had a persistent recto-urethral fistula after a trans-pubic repair of a post-traumatic urethral distraction defect with a recto-urethral fistula. Materials and Methods: A 24-year-old male, victim of a road-traffic-accident, status transverse colostomy and supra-pubic cystostomy had a trans-pubic repair of his urethral distraction defect with a recto-urethral fistula. Urethral alignment and patency was established but a fistula persisted between the posterior apex of prostate and rectum just above anal sphincter. Video shows the steps of repair utilizing this approach. Patient positioned in jack-knife position. Vertical midline incision from tip of coccyx to anal verge. Exact midline incision of anal sphincter posteriorly and posterior proctotomy. Pairs of stitches marking anal sphincter and ano-rectal junction. Extension of incision through exact midline of anal sphincter anteriorly carefully preventing any injury to previously repaired urethra. Detachment of rectum from fistula and its proximal mobilization. Detachment of anal sphincter from fistula and its sideways mobilization. Double layered repair of the fistula. Suturing back the anterior component of anal sphincter. Suturing of mobilized rectal tube to anal sphincter. Suturing back of posterior component of anal sphincter. Soft tissue and skin closure. Results: Patient had an un-eventful recovery. He was maintained on regular anal dilations for six months after which he had colostomy closure and is well at seven months after colostomy closure. Conclusions: Posterior sagittal approach provides a wide exposure for repair of recto-urethral fistula with minimal disturbance of anteriorly placed uro-genital structures.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED VIDEOS VID.41 Surgical Management of Adult Acquired Buried Penis: Escutcheonectomy, Scrotectomy, and Penile Split Thickness Skin Graft Fuller T, Theisen K, Rusilko P University of Pittsburgh Medical Center, United States Introduction and Objectives: Adult acquired buried penis as a result of obesity is a morbid condition with increasing incidence. Affected patients can have poor or absent sexual function, urine dribbling and skin breakdown, mood disturbance, and overall poor quality of life (QoL). Often lichen sclerosis develops and can lead to stricture disease. Medical management with weight loss after chronic skin changes and chronic suprapubic fat pad lymphadema (termed the escutcheon) is often ineffective. Previous surgical efforts have described limited repairs including isolated resection of the escutcheon, which unfortunately often leads to reburying and progressive urethral disease. We present a more extensive surgical repair including escutcheonectomy, partial scrotectomy, and penile degloving with split-thickness skin graft as an approach to provide definitive repair and halt the progression of the disease process. Materials and Methods: A retrospective chart re-
view was conducted of patients managed surgically for adult acquired buried penis by a single surgeon in 2015. Ten patients were identified that underwent escutcheonectomy, partial scrotectomy, penile degloving and split-thickness skin graft (STSG) repair. All
VID.41, Table 1.
patients had morbid obesity as a sole etiology or significant contributing factor. Outcomes evaluated were surgical complications, reburying of the penis, graft take rate, and urinary symptoms. A representative surgical video of the procedure is presented. Results: Ten patients underwent repair of adult acquired buried penis. All patients in the series had good cosmetic results and durable unburying at intermediate term follow-up. Etiology of buried penis was due to morbid obesity in all cases. One patient had an adult circumcision with post-surgical scarring contributing. Mean patient body mass index (BMI) was 45.4 ± 3.7. Sixty percent of the patients in the series were diabetics and 50% had hypertension and hyperlipidemia (Table 1). Mean operative time, length of stay (LOS), and estimated blood loss (EBL) were 305 ± 21 min, 5.6 ± 1.1 days, and 321 ± 147 cc respectively. STSG take rate was 80-100% (mean 91%). There was one partial wound dehiscence that required surgical debridement and wound vac therapy that had a good ultimate outcome (Table 2). Conclusions: Adult acquired buried penis is a chal-
lenging disease to treat. Limited surgical repairs can lead to reburying of the penis, need for further procedures, and the progression of urethral disease with voiding dysfunction. Escutcheonectomy, Scrotectomy, and STSG as presented in series and surgical video has encouraging intermediate term outcomes with durable unburying of the penis, and good STSG take rates. Further follow-up in larger series is needed but results are thus far encouraging.
VID.42 Technique of Perineal Urethrostomy Shah SA
Demographics (n=10)
Bodyline Hospitals, Ahmedabad, India
Age
45.4 ± 13.8
Weight (Kg)
143.0 ± 14.0
BMI
45.4 ± 3.7
Comorbidities:
Diabetes
6/10 (60%)
Hypertension
5/10 (50%)
Hyperlipidemia
5/10 (40%)
Lichen Sclerosus Depression
10/10 (100%) 2/10 (20%)
Introduction and Objective: We wish to highlight
the finer aspects of the technique of perineal urethrostomy, which we do when finance is a problem besides the case being a complicated one. Materials and Methods: A total of 104 patients underwent Blandy perineal urethrostomy. The technique is shown in this video. Right selection of patient, a good flap and preservation of blood supply are the key factors. Results: Out of 102, 18 (17.6%) patients required dilatation, multiple interventions or revision in case of lichen sclerosis. Conclusion: In this video, technique of perineal ure-
VID.41, Table 2.
throstomy is depicted with tips to reduce complications.
Surgical Details and Outcomes (n-10)
Mean Follow-Up (mo) Wound Dehisence STSG Take Rate Readmission
VID.43
3.5 1 80-100% (mean 91%) 3
Modified One-Stage Dorsal Inlay Buccal Mucosa Graft Technique for Ventral Urethral and Penile Skin Laceration Van Putte L1, De Baets K2, De Win G1,2 1
EBL (ml)
321 ± 147
University of Antwerp, Belgium; 2Dept. of Urology, Antwerp University Hospital, Edegem, Belgium
Operative Time (min)
305 ± 21
Introduction and Objective: We demonstrate the use
LOS (days)
5.6 ± 1.1
of a modified one-stage dorsal inlay buccal mucosa graft technique for the repair of a ventral urethral and penile skin laceration.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: A 44 year old male with known paraplegia, neurogenic bladder dysfunction and chronic sacral decubitus, presented in November 2015 with a large mid-penile erosion of the ventral penile shaft and urethra, which was caused by chronic transurethral indwelling catheterization while being hospitalized in an intensive care unit. The reconstruction involved a one-stage dorsal inlay buccal mucosa graft urethroplasty (Asopa) in addition to the second stage of a two-stage repair. The urethroplasty as well as the buccal mucosa graft harvest was performed by a single team. Results: The modified one-stage urethroplasty procedure had a duration of 2h38min with a post-operative hospitalization of three days. At three months follow up, the lesion had fully healed and the patient was back on clean intermittent self-catheterization with Solifenacin 10 mg daily. No complications, e.g. fistula formation, occurred postoperatively. Conclusion: The modified one-stage buccal mucosa
graft inlay technique shows to be a viable method for repairing ventral urethral laceration with involvement of penile skin.
VID.44 Treatment of Forgotten Double J Stent Using Laser Ureterorenoscopy Topuz B, Bedir S, Tomruk H, Kaya E, Zor M, Coguplugil E Gulhane Military Medical Academy, Ankara, Turkey Introduction and Objective: With the endoscopic
treatments, usage of ureteral stents has become common in Urology practice. Ureteral stents may cause several complications when remain long time in the body. We will present a patient treated using laser with ureterorenoscopy has an encrusted Double J in a short period endoscopic stone treatment history. Materials and Methods: Twenty-year-old male pa-
tient was admitted to our clinic with left flank pain and dysuria. In his medical examination learned that he had URS to treat left ureteral stone one year ago. Pyuria and hematuria was found in urine analysis. Double J stent was observed in the left ureter in radiography and learned that after the operation he had no control. In CT scan especially the distal and the proximal section of Double J stent was found petrified. Three times ESWL was applied to the upper ureteral segment but no fragmentation was observed. Under fluoroscopic image using Holmium laser with semi-rigid URS encrusted Double J stent section was lithotripted and Double J stent was released. Double J stent was taken out intact. After checking residual fragmentation under fluoroscopy, 6f 28 cm double J ureteral stent was placed to the left ureter. There were no intraoperative or postoperative complications. The urethral catheter was removed postoperative day 1 and the patient was discharged on the 2nd day. Results: Double J stent is placed to provide drainage in the kidney after the open or endoscopic surgery. With advances in endoscopic surgeries the use of Double J stent has increased. Double J stents varies according to the surgical procedure, generally can stay in the body a few weeks to several months. If prolonged period complications such as infection, calcification, break up, migration and ureteral obstruction
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UNMODERATED VIDEOS can be observed. Therefore, patients implanted with a Double J stent should be monitored after surgery and surely it must be told to the patients. Although varies in size and localization for the treatment of encrusted Double J stents ESWL, URS and the use of laser, percutaneous nephrolithotomy and open surgical procedures are available. In our case we preferred URS and Holmium laser lithotripsy due to the location and stone burden. Conclusion: Double J stents used during surgery pa-
tients need to be informed about the presence of the stent, removing time and the complications. As soon as possible the stent should be removed. Otherwise, they can lead to various complications, especially calcification.
VID.45 Mini-ECIRS in Multiple Renal Stones Cepeda M, Amón JH Hospital Universitario Río Hortega, Valladolid, Spain Introduction and Objective: Multiple renal stones
can be treated by retrograde intrarenal surgery (RIRS). However, when the stone burden is large, several procedures will be required. In such cases, a combination of mini-percutaneous nephrolithotomy (mini-PNL) and RIRS allows the surgeon to achieve free stone kidneys in one single procedure, maintaining a minimally invasive approach. Materials and Methods: A 31-year-old female patient with multiple stones in the right kidney presented renal colic due to the stones descending into the ureter, which called for the usual admittance and endourological manipulations. The CT scan shows multiple stones in the renal pelvis and different calyxes, which altogether reach a stone burden up to 7 cm. A mini-endoscopic combined intrarenal surgery is the procedure of choice. The patient is placed in a combined approach position. The flexible ureteroscope is introduced to explore the renal cavities thoroughly and prepare the surgical strategy. The lower calyxes host multiple stones with a large load, so a mini-PNL sheath is placed accordingly. Puncture, dilation and sheath placement are monitored with the flexible ureteroscope. All the accessible stones in the lower calyxes and renal pelvis are solved through this access. The unreachable stones in the lower calyxes are then displaced to the sheath with the flexible ureteroscope, in a “pass the ball” technique, to be treated with the mini-nephroscope. The small stones in the upper calyx are removed with the flexible ureteroscope through the sheath in the lower calyx. The stone located in the middle calix is treated with micro-percutaneous (microperc) surgery. An exploration of the renal cavities with the flexible ureteroscope is then carried out. The procedure is finished tubeless as far as the mini and microperc accesses. Results: Surgical time was 120 min. No complications were reported. The patient was discharged 48h later totally stone free. Three months after surgery the patient is asymptomatic and stone free. Conclusion: The treatment of large load multiple
stones is complex. The combination of mini-percutaneous surgery and flexible ureteroscope allows us to perform minimal accesses to the renal cavities and achieve stone free rates with a single procedure.
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VID.46 Flexible Microperc: Initial Experience Cepeda M, Amón JH Hospital Universitario Río Hortega, Valladolid, Spain Introduction and Objective: Micro-percutaneous
nephrolithotomy (Microperc) has become popular during the last few years. However, it presents two clear disadvantages: one, maneuvering inside the kidney is limited and, two, the probability of fragment migration is high. Flexible Microperc, on the other hand, solves these drawbacks. The aim of the video is to show the Flexible Microperc technique performed at our hospital. Materials and Methods: A 57-year-old female patient with a history of open pyelolithectomy due to multiple stones, presented a 12mm symptomatic stone in the upper calix of the left kidney. A Flexible Microperc is performed in the upper calix: an 8 Fr disposable flexible nephroscope is introduced through a 10Fr. metallic sheath, which allows for a 180º deflection, with a 10,000 megapixel resolution and a 120º angle of sight. The optics offers an appropriate vision to perform the surgery. The renal pelvis and different calyxes can be reached. The stone is located in the upper calyx. The lithotripsy is carried out with a 20 W Holmium laser and a 200 micron fiber. The 10 Fr sheath allows us to remove fragments up to 3 mm. The largest fragments are displaced to the renal pelvis to finish their lithotripsy without deflection. We verify that there are no significant residues left. The procedure is finished tubeless. Results: Surgical time was 70 minutes. There were no
complications, neither during nor after procedure. The patient was discharged 24 hours later totally stone free. Conclusion: In our opinion, the flexible technique
helps to solve the drawbacks of rigid Microperc. Nevertheless, prospective studies are needed to confirm this technique as an alternative for the treatment of renal stones.
VID.47 A Tri-Prong Forceps Grasping a Stone Impacted in the Amplatz Sheath Lezrek M1,2, Tazi H2, Ammani A1, Qarro A1, Beddouch A1, Alami M1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco Introduction and Objectives: A stone and tri-prong
forceps are impacted in the Amplatz sheath, during percutaneous renal surgery. We present a video of how to overcome this complication. Materials and Methods: During a percutaneous re-
nal surgery with a 24 Amplatz sheath access, the triprong forceps grasps a large stone with the hope that it will pass whole through the Amplatz sheath. With a forced pull, the stone passes through the first centimeters of the Amplatz sheath, and then it is jammed. It is impossible to retrieve the forceps, or to push the stone backward. Since there is a safety guidewire, the Amplatz sheath and the stone could have been extracted. However, there is a risk of stone fragments migrating in the retro-peritoneum. The tri-prong forcep is dismantled by opening the U-spring handle,
and removing the metallic sheath. The forceps insert is still stuck in the Amplatz sheath. The 2 mm (6 Fr) ballistic probe can pass alongside the forceps insert through the working channel of the nephroscope. The stone is fragmented, and the forceps is liberated. The stone is still stuck into the sheath, the ballistic probe is reaching only the lower part of the stone and it is just shaving the stone, there is no effective fragmentation. The Amplatz sheath is turned 180°. Consequently, the stone is turned down in the area reached by the probe. Therefore, the stone is fragmented and extracted. Results: Dismantling the tri-prong forceps was convenient and had allowed to free the forceps from the stone and Amplatz sheath. The rotation of the Amplatz sheath had allowed the good orientation of the stone for effective ballistic stone fragmentation into the sheath. Conclusion: Both those tricks, although very simple,
had allowed to overcome the impaction of the stone in the Amplatz sheath.
VID.48 How to Remove the Amplatz Sheath and Keep the Nephrostomy Foley Catheter Valve Lezrek M1,2, Bazine K1, Ammani A1, Qarro A1, Beddouch A1, Alami M1, Tazi H2 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco Introduction and Objectives: At the end of the per-
cutaneous renal surgery procedure, if the placed nephrostomy tube is a Foley catheter, the Amplatz sheath cannot be removed without cutting the Amplatz sheath or the Foley catheter, especially the valve. We present a video of our technique, for preservation of both, the Amplatz sheath and the valve of the Foley catheter. Materials and Methods: At the end of the percutaneous renal surgery procedure, a Foley catheter is placed as a nephrostomy tube and the Amplatz sheath is removed from the percutaneous tract. The Amplatz sheath remains trapped by the valve extremity of the Foley catheter. To avoid cutting the Amplatz sheath and/or the Foley catheter, a trick is used. After cutaneous fixation of the Foley catheter, the urine drainage port is reduced about 1-cm, to be just short of the valve. Thus, it will not be superposing with the valve during the passage into the sheath. The Foley catheter is firmly held at it cutaneous entry, to avoid its dislodgement. The Amplatz sheath is progressively attracted, thus the catheter is stretched and the proximal end will become thinner and pass throughout the sheath. The Amplatz sheath attraction has to be progressive and smooth, to avoid abrupt release and backlash of the catheter; thus, to avoid spray of blood and fluid. Sometimes, the rubber sleeve of the valve is removed with the sheath. Sometimes, even the rubber valve is removed. For catheters with a hard plastic valve, mostly, the valve cannot pass through the 24 Fr sheath, so it has to be removed before. However, both soft and hard valves can be replaced in the catheter, after sheath removal. Results: This trick is effective and quick and both Sheath and Foley valve are preserved. It is used for all percutaneous renal surgeries in our department since
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED VIDEOS 2006, no complication was noted. Especially, there was no nephrostomy tube dislodgement. Conclusion: This trick had allowed the preservation
It had allowed to show whether the puncture needle was in the correct position, and accordingly, to take the correct course of action.
of both Amplatz sheath and Foley catheter valve.
VID.50
VID.49
MIDLINE Extraperitoneal Approach Retroperitoneal Lymph Node Dissection: The USC Experience
Diagnostic Micro-PCNL: ViaNeedle Endoscopy to Ensure That It Is the Calyx with Stones Using a Disposable Fibroscope Fiber-Optic Lezrek M1,2, Mawfik H3, Errai A3, Basfaou B3, Iraqui EO3, Tazi H2, Bazine K1, Slimani A1, Kasmaoui EH1, Alami M1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco; 3Dept. of Urology, El Massira Private Hospital, Casablanca, Morocco Introduction and Objectives: Sometimes, in percutaneous renal surgery, after successful calyx puncture, it is not certain that it is the correct calyx that was accessed, and that the stone is in this accessed calyx. In this case, we used the rigid ureteroscope after dilation to 10 or 12 Fr. However, can this exploration be performed with less tract diameter? We present a video of our experience of diagnostic via the needle nephroscopy to ensure that the punctured calyx is one containing stones. The needle endoscopy is performed using the visualization source fiber-optic of a disposable fibroscope. Materials and Methods: We used the 3 Fr VueOptic
that is the visualization source fiber of the disposable flexible ureteroscope Flexor® Vue™, (Cook Medical) and its 3-ways adapter. The injection port is harvested from a serum bag. The handle of 16-gauge-25-cm prostate biopsy needle is removed. The needle is inserted into the injection port, through the rubber cap, from inside to outside. The 3-way adapter is tightly inserted in the opening of the injection port. Thus, the irrigation can be adapted to the 16-gauge needle in a watertight fashion. The 3-way adapter allows the adaptation of irrigation and introduction of the visualization fiber-optic and the laser fiber. After calyx puncture with 18-gauge needle a Teflon guidewire is inserted. Then, the 16-gauge needle is advanced into the calyx over the guidewire. The injection port and 3-way adapter are adapted to the needle. Then the visualization optic fiber is advance into the calyx, and exploration is performed. If the stone is in the calyx, the guidewire is replaced. After dilation and insertion of a 24 Fr Amplatz sheath, the stone is removed with the standard nephroscope. Results: This technique was performed in 3 cases. In one case, Micro-PCNL exploration showed that the stones were in the accessed calyx. Since the stones were complex and could not be managed with Micro-PCNL alone, conventional dilation and PCNL was performed for stone extraction. In 2 cases, after puncture and a clear fluid is recuperated through the needle, the guidewire was not coiling in the pelvi-calyceal system. Diagnostic Micro-PCNL was performed, and found that the needle had moved from the calyx in the peri-renal fat; and puncture was repeated. Conclusion: Diagnostic Micro-PCNL via the needle
endoscopy using the visualization source fiber-optic of a disposable fibroscope was feasible and successful.
Bazargani S, Syan S, Hugen C, Clifford T, Djaladat H, Schuckman A, Daneshmand S USC Institute of Urology, Los Angeles, United States Introduction and Objectives: Retroperitoneal lymph
node dissection (RPLND), an important modality in the treatment of non-seminomatous germ cell testicular tumor (NSGCT), can be technically challenging and associated with significant morbidity, particularly in the post-chemotherapy setting. We adopted a midline extraperitoneal approach, which has the potential to decrease perioperative complications, particularly gastrointestinal morbidity. We present our experience performing a midline extraperitoneal (EP) RPLND in patients with NSGCT. Materials and Methods: From 2004 to 2014, 154 pa-
tients have undergone RPLND for germ cell tumors by a single surgeon (130 post-chemotherapy, 24 primary). Starting in 2010 we adopted a midline extraperitoneal approach to RPLND. All patients were considered for EP-RPLND except for ones undergoing resection of massive tumors and major vessels (13), retrocrural dissection (7), mesenteric lymphadenectomy (1) or concomitant liver resection (3) that were excluded from the cohort. Fifty-five patients underwent EP-RPLND using a midline incision (between 2010-2014). All patients underwent bilateral template dissection in the post-chemotherapy setting and extended right and left templates for primary RPLND’s. Results: Midline extraperitoneal RPLND of two different cases is shown in the video step by step. These steps start from 1) Midline incision: Xiphoid to below umbilicus; 2) Dissection of plane between transversalis fascia and peritoneum, ipsilateral to the desired site of surgery; 3) Medial Sweep of peritoneal contents (Avoiding inadvertent peritoneal opening, primary repair in case); 4) Development of plane between gerota’s fascia and peritoneum; 5) RPLND with desired template; 6) Retraction of peritoneum and closure. Images of a completed surgery are provided (see Figure 1). Conclusion: Extraperitoneal RPLND can be per-
formed safely without prolonging operative times, compromising exposure, or ability to perform com-
VID.50, Figure 1.
Completed nerve-sparing Post-chemotherapy RPLND using midline extraperitoneal approach
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
plete node dissection, even in most post-chemotherapy settings. This approach is associated with less EBL and transfusions, as well as shorter hospital stay, which may be attributed to a decreased incidence of postoperative ileus and faster return of bowel function.
VID.51 Smartphone Torch-App “ShadowsPlay” for Learning of Calyx Puncture without Radiation Exposure Lezrek M1,2, Bentani N3, Moudouni S3, Sarf I2, Tazi H2, El Khadim R1, Bazine K1, Slimani A1, Alami M1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco; 3Dept. of Urology, Hospital Errazi, University Hospital Center Mohammed VI, Marrakesh, Morocco Introduction and Objectives: We present a video of a latex glove model using the principle of shadows, for initial learning of percutaneous calyx puncture, without radiation exposure. The smartphone torch Application is used as the source of light. Materials and Methods: A Foam box is used. A latex glove is inflated with air, and it is inserted in the slit in the box’s side, thus, the fingers are horizontal. The Torch application of a smart-phone is lighted. The phone is inserted below the glove. The box is covered with a paper. The shadows of the fingers and the puncture needle are projected on the paper. The puncture needle is used through the lateral side opposite the glove. The beam of light is perpendicular to the tract, so it gives orientation in the frontal plan. The needle is aligned with the glove’s tip in the frontal plan, then it is moved from down to up in the transversal plan, with little thrusting movements, until the finger moves. The fingers’ tips are used as calyxes; puncture is to push the finger’s tip in the middle until it is invaginated. The gloves’ fingers can be shortened using ligation in the middle, and then the glove is inversed inside out. Thus, the shape will be similar to the shape of a hydronephrotic kidney. Results: The torch-app-model is simple and rapid to set up. It is economical, by using very cheap and widely available material. It can be used in classrooms and workshops without the risks of radiation exposure, and there is no limit of training time. It allows beginners the initial use of the puncture needle and its orientation in the space. However, dilation and Amplatz sheath insertion are impossible. There is a limitation in terms of “tissue feeling” and for anatomic relations. Ultrasound-imaging guidance cannot be used. Conclusions: The smartphone-torch-app. model allows beginners the initial use of the puncture needle and its orientation in the space. It can be used in classrooms and workshops without the risks of radiation exposure, and there is no limit of training time. However, further studies are needed for validation.
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UNMODERATED VIDEOS VID.52 Percutaneous Micro-Nephroscopy Training in a Glove Model Lezrek M1,2, Mawfik H3, Errai A3, Tazi H2, Bazine K1, Slimani A1, Qarro A1, Ammani A1, Beddouch A1, Alami M1 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco; 3Dept. of Urology, El Massira Private Hospital, Casablanca, Morocco
Introduction and Objectives: We present a video of a model using a latex glove for learning and training of Through-the-needle percutaneous nephroscopy. Materials and Methods: Stone fragments are inserted
into a latex surgical glove. Different stones sizes can be used. The glove opening is closed around a 24 Fr Amplatz sheath, using a few ligations. To avoid the use of irrigation, the glove is filled with saline and the Amplatz sheath is placed upright propped by a 3 L serum bag. For Micro-PCNL, the 3 Fr visualization source fiber VueOptic™ and the three-ways adapter of the disposable flexible ureteroscope Flexor® Vue™, Cook Medical, are used. The handle of 16-gauge-25cm prostate biopsy needle is removed. The injection port of a 500 ml serum bag is harvested. The needle is inserted into the injection port, through the rubber cap, from inside to outside. The 3-way adapter is tightly inserted in the opening of the injection port. The 3-way adapter allows the adaptation of irrigation and
118
introduction of the visualization fiber-optic and the laser fiber. A 273 micron laser fiber is used for fragmentation. Urologist with no micro-PCNL skills and residents were taught micro-nephroscopy, and laser stone fragmentation. Results: The glove model is simple to set up, with a preparation time of about a few minutes. It is economical, by using widely available material. The glove model closely simulates percutaneous micro-nephroscopy. The endoscopic exploration of the glove’s fingers is similar to intra-renal exploration. In addition, it had allowed training in stone laser lithotripsy. Since it is a non-biological model, there is no risk of biologic contamination, nor any hygiene or sterilization issue. Thus, it can be performed in the operating room. However, there is a limitation in terms of “tissue feeling” and for anatomic relations. Evaluations submitted by training session participants revealed a high degree of satisfaction with model effectiveness in the application of percutaneous micro-nephroscopy techniques. Conclusions: The glove model closely simulates percutaneous micro-nephroscopy, exploration and stone fragmentation. However, further technical experience and comparative studies with biologic and virtual reality simulators are necessary to evaluate this technique.
VID.53 Studying the Suitability of Distal Ureterectomy and Boari Flap for Distal Ureteric Transitional Cell Cancer Robinson S, Parnham A, Motiwala H, Havrenek E, Bhardwa J Frimley Health Foundation Trust, Surrey, United Kingdom Introduction and Objective: To study the suitability of distal ureterectomy and Boari flap for distal ureteric transitional cell cancer. Materials and Methods: This was a retrospective study from 2004 to 2015. It involved one surgeon, and a series of 20 patients (see Table 1). Kaplan-Meier curve was used to examine progression of disease and all cause mortality. Results: See Tables 2 and 3. Both disease specific deaths were high grade and muscle invasive and both had high anaesthetic risk grading. There were no disease specific deaths in those with low and intermediate grade non-muscle invasive disease. Patient number 2 went on to have radical nephroureterectomy after ipsilateral recurrence. Patient 18 went on to have radical cystectomy after bladder recurrences. Both ureteric recurrences were upgraded from an initial grade 1 to grade 2 (patients 2 and 19). Conclusion: In select cases, distal ureterectomy and
Boari flap can be considered.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED VIDEOS VID.53, Table 1. Patient Demographics Male/female
13/7
Age
Mean 71 (sd+/-11) Median 72
Side left/right
14 left/ 6 right
Length of ureter
Mean 83 mm (sd+/- 30)
Creatinine pre op
Mean 101 uM (sd+/- 58)
eGFR
Mean 70 ml/min/ 1.73 m2 (sd+/-20)
Presentation Haematuria
11
Surveillance
5
Incidental
4
VID.53, Table 2. Patient number
ASA
Biopsy
Final histology
Recurrence
All cause mortality
Disease specific mortality
1
1
G1pTa
G2pTa
No
No
2
2
G1pTa
G2pTa ureter
Yes
No
3
3
G1pTa
G1pTa
Yes
No
4
1
G2pTa
No
No
5
2
G1pTa
G1pTa
G1pTa bladder
No
No
6
2
Malignant?
G1pTa
No
No
7
2
G2pTa
G2pTa
No
No
8
2
G1pTa
G2pTa
No
No
9
2
G1pTa
G2pTa
Yes
No
10
2
G1pTa
G1pTa
No
No
11
3
G2pT1
G2pT1
Yes
No
12
2
G2pTa
G2pTa bladder
No
No
13
2
G2pTa
G2pTa
Yes
No
14
1
G2pTa
G2pTa
G2pTa bladder
No
No
15
2
G2pTa
Yes
No
16
3
G2pTa
No
No
17
3
G3pT2
G3pT1 bladder
Yes
Yes
18
1
G3pT1
G3pT2
G3pT1 bladder
No
No
19
1
G1pTa
G2pTa ureter
No
No
20
3
Inflammation
G3pT2
Pelvic
Yes
Yes
VID.53, Table 3. Survival Figures
Time to progression
Number of patients
5 year %
8 (5 bladder, 2 ureteric, 1 pelvic)
60% (no progression)
Disease specific mortality
2
95%
All cause mortality
8
85%
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
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Residents’ Forum
at his life and training and how these influenced his surgical practice.
Saturday, October 22 1425–1745
Results: We demonstrate how Frere Jacques’ novel
RF-01.01 Prostatic Memokaths: A LongTerm Follow-Up of 35 Cases Mosli-Lynch C, Forster L, Tanabalan C, Chari N, Patki P St Bartholomew’s Hospital, London, United Kingdom Introduction and Objectives: To examine the long-term efficacy of an expanding metallic stent (Memokath) placed in patients with obstruction of the prostatic urethra, who were unfit or unsuitable for surgical intervention, in order to determine a population of patients in whom a prostatic Memokath would be a suitable treatment. Materials and Methods: We followed up 35 patients who had a prostatic Memokath placed in a single unit, between 2005 and 2009, to assess their long-term functional outcome. Aside from demographic factors and reason for insertion, we looked at migration rate, replacement rate and survival times. Results: The mean age at insertion was 78. A total of 13 patients are still alive with the Memokath in situ (mean time 86.3 months). Nine patients died with the Memokath in situ, and mean survival time was 29.3 months (range 1-69). In eleven patients, the Memokath either migrated (5) or was removed (6) with a mean time of 3.7 months (range 5 days-11 months). Two patients were lost to follow-up. Conclusions: Memokaths are useful in patients who
are unable to tolerate either a GA or a LASER resection of the prostate, and who have a reasonable life expectancy. Though a proportion either migrated or necessitated removal, the majority were well-tolerated.
RF-01.02 Frère Jacques, Frère Jacques, Dormez-Vous? (Itinerant Lithotomists of the 17th Century) Mosli-Lynch C1, Davies C2 1
St Bartholomew’s Hospital, London, United Kingdom; Imperial College, London, United Kingdom
2
Introduction and Objective: The popular French children’s song ‘Frère Jacques’ roughly translates as ‘Brother Jacques, where have you gone?’ This was an important question that was frequently asked in various European cities in the 17th century. Brother Jacques Beaulieu was a well known travelling lithotomist, practicing his personal operation to remove bladder stones with a mortality rate of around 40%. This made it necessary for him to leave towns at short notice, sometimes to escape an angry mob. He refined this technique and improved this mortality significantly, eventually performing over 5000 operations and gaining significant fame. Materials and Methods: This paper examines historical records and cadaveric dissections to determine how Frere Jacques developed and improved his lithotomy technique (The Lateral Operation), from operations that were being performed at the time. It looks
operation, though considered barbaric today, conveyed a significant advantage upon previous techniques which, when refined led to a significant improvement in mortality. Conclusions: This paper shows how over the proceeding centuries, the Lateral Operation and the tools designed to perform it, helped influence the development of scientific, evidenced-based urological surgery.
RF-01.03 Comparison of Mean Stone Size, as Measured on Bone Window Versus Standard Soft Tissue Window, on Axial Planes on Multidetector Computed Tomography Soomro HU, Ather H Aga Khan University Hospital, Karachi, Pakistan Introduction and Objective: Acute flank pain from urinary tract calculi is a common problem. Non-contrast CT scan has become the standard in the evaluation of suspected acute renal colic. The stone size is routinely measured on soft tissue window on the CT scan. We aim to compare the mean difference of stone size, as measured on bone window settings (axial planes) versus standard soft tissue window settings (axial planes) on a multidetector computed tomography (MDCT) in patients with solitary ureteric stone. Materials and Methods: A total of 60 patients pre-
senting to Emergency and Outpatient department of Aga Khan University Hospital, Karachi from May 2015 to October 2015, fulfilling the inclusion criteria were included in the study. A 64-slice Multi detector Computerized Tomography was used to assess the locations and size of the ureteral stones. A consultant radiologist independently analyzed CT Scans of all those patients. The mean difference in stone size was calculated between both window settings in axial planes. Results: The mean age of the patients was 37.13 ±
11.9 years. Males constituted about 68% of the cohort while 32% were females. A total of 85% of the patients had left ureteric stones, while 15% had right ureteric stones. The mean stone size, as measured on soft tissue window settings was 6.68 ± 2.01 mm, and on the bone window settings mean stone size was 4.8 ± 1.9 mm. Mean difference of stone size between the two window settings was found to be 1.85 ± 0.55 mm. The two means were compared using Student T-test, and the difference was found to be statistically significant (P value < 0.05). The data were stratified according to age, gender and location of stone in the ureter, and the mean difference was compared using Student T-test, and the difference was not found to be significant (P value > 0.05). Conclusion: The stone size measured on soft tissue
window on a multidetector CT scan is significantly different from the measurement done on bone window setting.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
RF-01.04 Retrograde Pyelography Under Local Anesthetic Is Safe, Feasible, and Cost-Effective Manwaring J SUNY Upstate Medical University, Syracuse, United States Introduction and Objectives: Retrograde pyelogra-
phy to evaluate upper tracts is commonly performed under sedation. However, this procedure has been described using only local anesthetic and many patients under our care have undergone this procedure. We sought to examine the success rate, complications, and duration of retrograde pyelography under local anesthetic. Materials and Methods: Retrospective chart review revealed 133 consecutive retrograde pyelogram studies in 123 patients with multiple providers between January 2009 and January 2014 at our institution. Departmental surgical logs were reviewed focusing on outcomes, procedural findings, adverse events, and duration of procedure. Results: Success rate was 81%. Most common reasons for failure included poor visualization (e.g. blood, stones, enlarged prostate) or difficulty cannulating ureteral orifice. Inability to tolerate the procedure accounted for only 2 failures. Reported times varied from 6 to 26 minutes with an average of 13 minutes. No complications or adverse events were reported. Conclusions: We found that retrograde pyelography under local anesthetic is generally well tolerated, rapid, and represents a feasible alternative to the same procedure under anesthesia. This has positive cost-saving implications as the procedure can be performed in a short amount of time and no anesthesiologist or anesthetist need be present.
RF-01.05 The Influence of the Menstrual Cycle and Infectious-Inflammatory Processes in the Genitals on the Incidence of Acute Uncomplicated Pyelonephritis in Reproductive-Aged Women Samchuk P, Pasiechnikov S Bohomolets National Medical University, Kiev, Ukraine Introduction and Objective: The objective of the study was to determine the role of the menstrual cycle (MC), infectious-inflammatory diseases and infection of the genital tract by pathogens of sexually transmitted diseases (STD), in the occurrence of acute uncomplicated pyelonephritis (AUP) in reproductive-aged women. Materials and Methods: Between 2007 and 2011, 232
reproductive-aged women with AUP were examined and treated. A total of 173 (group I) of them had infectious-inflammatory diseases related to the genital tract, infectious pathogens or a STD. Group II consisted of 59 patients with AUP without concomitant infectious diseases and reproductive tract infection pathogens of STD. Results: In 71.6% of reproductive-aged women, AUP occurs during the 20th to the 5th day of the MC. In
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RESIDENTS’ FORUM patients of group II, AUP was more likely to occur during the 20th to the 5th day of the MC as compared to the 6th to the 19th day (81.4 ± 5.1% against 18.6 ± 5.1 %, p <0.001). From the 6th to the 19th day of the MC, AUP occurs more significantly (p <0.001) in patients in group I (31.8 ± 3.5%) than in patients in group II (18.6 ± 5.1%).
Results: All surgical procedures were successfully completed. The mean total operating time was 135 minutes (range, 60-185). The mean blood loss was less than 20 ml. No serious intra- or perioperative complications were encountered. All patients were satisfied with the cosmetic result.
Conclusion: These results suggest that the factors of
generative grafts after the laparoscopic resection of infected urachal remnant and umbilicus offers a satisfactory cosmetic outcome.
humoral regulation of the menstrual cycle play an important role in the pathogenesis of acute pyelonephritis. It is in this connection during the 20th to the 5th day of the MC that AUP risk in reproductive age women is at a maximum. The presence of associated infectious-inflammatory diseases and infection by STD pathogens of the genital tract significantly increases the risk of disease in this category of women in any period of the MC.
RF-01.06 Laparoscopic Urachal Resection and Novel Umbilicoplasty Using Dermal Regenerative Grafts for Urachal Abscesses Atsuta M1, Sasaki H1, Kimura S1, Shimada H1, Ishida K2, Egawa S1 1
Dept. of Urology, Jikei University School of Medicine, Tokyo, Japan; 2Dept. of Plastic Surgery, Jikei University School of Medicine, Tokyo, Japan
Introduction and Objectives: Omphalitis secondary to infected urachal remnants often necessitates simultaneous resection of umbilicus. This may cause a concern in cosmesis especially in younger patients. We report a simple reconstruction method using dermal regenerative grafts at the time of resection of urachal abscesses. Materials and Methods: Between March 2014 and September 2015, 22 patients were referred to us with the complaints of infected urachal remnants. Laparoscopic urachal resection was conducted. One upper (5 mm) trocar and one lower (12 mm) trocar were placed in the right abdominal wall. Another 5 mm trocar was inserted alongside the umbilicus as a camera port. Five mm flexible scope was inserted through the 5 mm port. A 5 mm port 3 cm above the umbilicus was placed for the camera in the event of urachal abscess instead of the one at the umbilicus. After dissecting peritoneum and both lateral umbilical ligaments, a layer involving median umbilical ligament was developed. Dissection proceeded until a portion of the muscular wall of the urinary bladder could be verified. The distal end was secured with Hem-o-clips and cut. Detachment was continued to skeletonize the umbilicus and urachus. At this point, the skin and the fascia of umbilicus were incised so that the urachus was extracted. After closure of the fascia, a 1 cm square of dermal regeneration sheet (Terudermis, Olympus) was suture-retained between the fascia and the umbilical skin. Dermal regenerative graft consists of two layers, the bottom layer made of a low antigenic atelocollagen produced from a calf dermal collagen, and the silicone top layer that prevents the wound from infection and controls permeability of water. The scar formation over the skin under this sheet helps regaining natural outlook of umbilicus with excellent cosmesis.
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Conclusions: Novel umbilicoplasty using dermal re-
RF-01.07 Emphysematous Pyelonephritis: 10 Years of Experience at a Tertiary Care Hospital Soomro HU, Ather H Aga Khan University Hospital, Karachi, Pakistan Introduction and Objective: Emphysematous pyelo-
nephritis is an acute fulminant, necrotising urinary tract infection associated with gas within the kidney and/or perinephric space. It is a life-threatening condition usually affecting diabetics, and if left untreated, the condition is uniformly fatal. We aimed to study the clinical presentation, management and outcome of emphysematous pyelonephritis. Materials and Methods: This was a retrospective case
series of 21 patients, treated for emphysematous pyelonephritis, from January 2003 till December 2012, at the Aga Khan University Hospital, Karachi. Their clinical presentation, diagnostic workup, mode of treatment and outcomes were studied. Results: The median age of the patients was 63 (SD 10.5), with slight preponderance of females. The most common presentation was that with flank pain, tenderness and fever. A total of 19% had altered sensorium and 14% had shock on presentation. A total of 81% also had renal stones, 71% were diabetic and 43% had existing renal dysfunction. Left kidney was involved in 11 patients, and right kidney in 9, while 1 had bilateral EPN. E. Coli was the most common organism isolated on urine cultures. A total of 71% had leukocytosis and 14% had thrombocytopenia. CT Scan was the diagnostic modality in most of the patients. A total of 57% of the cases had Class 1 EPN, 28% had Class 2 EPN, while Class 3a, 3b and 4 comprised of 5% patients in each group, based on Huang and Tseng CT Classification. A total of 81% were treated conservatively, while 19% had nephrectomy. Both mortalities were in the nephrectomy group. Conclusion: Emphysematous pyelonephritis is a
life-threatening condition, presenting symptoms similar to pyelonephritis. CT Scan was the investigation of choice, showing air in the urinary tract. Most of the cases were of Class 1 & 2 EPN. Most were managed conservatively. If conservative treatment fails, surgery should be considered without delay.
RF-01.08 A Meta-Analysis of Trials of Transurethral Needle Ablation of the Prostate for Treating Chronic Pelvic Pain Syndrome (Chronic Non-Bacterial Prostatitis) Mosli-Lynch C, Chinegwundoh F St Bartholomew’s Hospital, London, United Kingdom
Introduction and Objectives: To investigate the efficacy of Transurethral Needle Ablation of the Prostate (TUNA), in the treatment of Chronic Pelvic Pain Syndrome (Category III Non-bacterial Prostatitis) via a meta-analysis of all relevant studies. Materials and Methods: We examined the only four published clinical trials on the use of TUNA in patients with severe Chronic Prostatitis. These included two Randomized Controlled Trials and two Single-Arm Trials, encapsulating a total of 120 patients. The outcomes measured were the post-operative percentage improvement in Symptom Score (PSSI/CPSS/ DAN PSSI), Quality of Life Score (IPSS-8), Analgesia Use and Leucocyte Count in Expressed Prostatic Fluid (EPF) three months after treatment. Results: All four studies had similar inclusion criteria and similar patient demographics. Mean symptom scores decreased significantly in all studies, with an average decrease of 49% when weighted for individual study size (range 36.5-58.4). In the two studies that measured Quality of Life Score (via IPSS-8) this increased on average by 60.1%. Leucocyte Count in EPF decreased by 73.9% in two studies. Daily analgesia use also fell by 35.4%. Conclusion: This meta-analysis shows that TUNA is
an effective treatment for the debilitating symptoms of Chronic Prostatitis. It has been shown consistently to improve painful symptoms, analgesia use and quality of life. The vast majority of patients show overall satisfaction with their treatment. More randomized trials are needed to demonstrate the efficacy of this minimally-invasive treatment when compared to more invasive techniques such as Thermo and LASER therapies, as well as to observe the long-term improvement in symptom control.
RF-02.01 The Role of Long Non-Coding RNA Expression Profiles in Advanced Renal Carcinoma Su H, Ye D Dept. of Urology, Fudan University Shanghai Cancer Centre, China Introduction and Objective: Renal cell carcino-
ma (RCC) is the third most common genitourinary cancer, of which the clear cell carcinoma (ccRCC) is the most common subtype of RCC. While the resection of small RCC is usually curative, the prognosis of advanced ccRCC is poor. Long non-coding RNA (lncRNA) is a novel class of non-protein-coding transcripts that have been implicated in cancer biogenesis and prognosis. In order to decipher the molecular biology of this tumor and to identify potential prognostic biomarkers and therapeutic targets, we re-evaluated published lncRNA expression profiling data. Materials and Methods: By repurposing microarray
probes on Affymetrix HG-U133 Plus 2.0 Array, we herein analysed the lncRNA expression profiles in ccRCC microarray dataset GSE47352. In addition, an independent cohort of 85 clinical samples was analysed to confirm the selected lncRNAs by quantitative real-time PCR (qRT-PCR) of which the difference were most statistically significant. Furthermore, we investigated the association between the most statis-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
RESIDENTS’ FORUM tically significant lncRNAs and ccRCC patients’ clinicopathological features and prognosis. Results: An expression profile of 49 lncRNAs allowed discrimination of localized and advanced ccRCC. The PCR results in a cohort of 60 localized ccRCC and 25 advanced ccRCC tissues was used to confirm the selected 6 lncRNAs which was the most statistically significant and the result indicated that NR_024420 and CRNDE were overexpressed in advanced ccRCC and the expression of these two lncRNA was significantly associated with poor overall survival of this disease. H19 was decreased in ccRCC and was also significantly associated with poor overall survival of ccRCC. Conclusion: lncRNAs are involved in renal carcino-
genesis and lncRNAs NR_024420, CRNDE and H19 may be useful for the prediction of ccRCCs patient-outcomes following nephrectomy.
RF-02.02 Renal Cell Carcinoma with Inferior Vena Cava (IVC) Thrombus: Single Center Experience with Long-Term Follow-Up Seth A1, Chowdhary S2, Pal S3, Kumar A1, Dogra PN1, Kumar R1, Nayyar R1 1 Dept. of Urology, All India Institute of Medical Sciences, New Delhi, India; 2Dept. of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India; 3Dept. of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
Introduction and Objective: Renal tumors have the
propensity to grow into the renal vein, IVC till right atrium in approximately 4-10% of cases. The aim of the present study was to evaluate the perioperative and long-term outcome in these patients. Materials and Methods: Data of patients who under-
went radical nephrectomy (RN) and IVC thrombectomy in the absence of metastatic disease at our institution from January 2006 to June 2015 were included. Follow-up data were retrieved where available. Remaining patients were telephoned and asked to come for a follow-up. Out of a total of 63, long-term follow-up was available in 44. Mean age 53.5 years (1488), M:F 33:11, R:L 37:7, mean tumor size 9.6 (5.4-14). Level of thrombus was renal vein 2, infra-hepatic in 12, retro-hepatic in 11, and right atrial in 19. Patients were divided into two groups, group I operated without bypass (25), group II with bypass (19). A total of 17/19 were operated using our technique of mild hypothermia with partial circulatory arrest, and two with deep hypothermic circulatory arrest. Results: Mean operative time was 283 (135-540) minutes, mean blood loss was 910 (200-4500) ml, and mean blood transfusion (in units) was 3.02 (010). Histology showed clear cell in 30, papillary in 6, PNET in 6, and unclassified in 2. Furhman nuclear grading was not helpful. There was peri-operative mortality in group 1 (sudden intra-op pulmonary embolism) and group 2 three (uncontrolled bleeding diathesis two, post-operative renal failure one). Additionally, there were three complications in group I (Clavien-Dindo I/II) prolonged ileus 2, hydro-pneumothorax 1. In group II, additional complications (6) included wound infection in 3, pleural effusion needing inter-costal drainage in 2 and acute psychosis in
1 (all Clavien-Dindo I/II). Mean follow-up was 37.9 (6-73) months. Five-year overall survival in group 1 is 80% and in group 2 is 60%. Median survival in group I is 70 months and group II is 64 months. Conclusion: Aggressive surgical management in pa-
tients with renal tumor with IVC thrombus provides good long-term prognosis with acceptable mortality and morbidity.
RF-02.03 Effect of SMS Reminders on Adherence to Follow-up of National DRE Campaign Participants: A Randomized Controlled Pilot Study Firaza PN, Lorenzo EI, Quanico U Jose R. Reyes Memorial Medical Center, Manila, Philippines Introduction and Objective: National annual pros-
tatic digital rectal exam (DRE) campaign advocated by the Philippine Urological Association (PUA) started 2 decades ago in over 60 urological centers in the country. It is being used as a tool to educate Filipinos regarding benign and malignant prostate diseases. However, after each campaign, most patients were lost to follow-up leading to delay in diagnosis and low adherence to medications. We evaluated the effect of short message service (SMS) in the adherence to follow-up of participants after a campaign. Materials and Methods: We enrolled 126 participants
aged 40 years old and above with significant LUTS and/or a prostate cancer suspect, in a two-arm, parallel, randomized controlled pilot study at the Jose R. Reyes Memorial Medical Center, Manila, Philippines (center with the most number of participants annually). Participants received daily SMS text messages for 3 days (n = 63) or usual care (n = 63). The primary outcome was follow-up at the outpatient clinic within 1 month after the campaign. We used Epi Info version 7 to analyze the data. Results: Among participants receiving SMS, 21/63 (33.3%) returned, compared to 5/63 (7.94%) in the control group. The relative risk [RR] = 4.2, odds ratio = 5.8 and uncorrected Chi-Square (X2) = 12.4, at 95% confidence interval; p = 0.000429). Conclusion: This pilot study illustrated the feasibility
of using SMS reminder among Filipino national prostatic DRE participants to improve adherence to follow-up. However, further research needs to be done to investigate the impact on adherence to medications and delay in diagnosis.
RF-02.04 Adult-Type Granulosa Cell Tumor of the Testis: Report of a Case and Review of the Literature Al-Alao O, Gul T, Al-Ani A, Bozom IA, Al-Jalham K Hamad Medical Corporation, Doha, Qatar Introduction and Objective: We report a 48-year-old
Filipino man with a left testicular adult type granulosa cell tumor, a very rare tumor with only 46 cases reported until the end of 2015. This patient underwent radical orchiectomy with unremarkable postoperative surveillance for 1 year. The previously reported AGCTTs were reviewed thoroughly.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: A fully and detailed review of the previous 46 cases, which were reported on PubMed from between 1952 and 2015, was done. Results: The initial treatment for all reported cases was radical or inguinal orchiectomy. There is no evidence to support additional therapy in patients with a disease clinically confined to the testicle. Dissection of the retroperitoneal lymph nodes should be considered with pathology suggestive of malignant features or if small-volume metastatic disease is present. If performed, it should be immediately after the orchiectomy. A very poor prognosis is expected for patients with unresectable metastatic, widespread disease. There is no consensus about the treatment for metastatic disease, which may include chemotherapy and/or radiation therapy. The angiogenesis inhibitor ‘pazopanib’, after initially resisting cytotoxic chemotherapy in an advanced AGCTT, showed 3 years overall survival in one case. We suggested that hemorrhage, a necrosis size of >7.0 cm, and presence of lymphovascular invasion, might be indicative of malignancy because these characteristics were present in the malignant cases we identified. US of the abdomen and testis, coupled with clinical examination, may be sufficient in cases thought to have low malignant potential. More extensive follow-up may be warranted with larger tumors or tumors deemed to be aggressive. A follow-up protocol suggested is an abdominal and testicular US along with chest X-ray, with a CT of the abdomen and pelvis every 6 months. The duration of follow-up is not well defined; however, long-term follow-up is mandatory because metastasis has been found after 10 years of treatment. Conclusion: Reporting every case of AGCTT, to allow
thorough analysis, is necessary to identify factors that can reliably predict tumor behavior and to optimize methods of diagnosis and treatment together with classic means of follow-up.
RF-02.05 Surgical Management of Large NonInvasive Intra-Abdominal Testicular Tumors: A Series of Cases Ibarra J1, Lorenzo EI1,2, Bardelosa JG1,3,4, Reyes E1,5,6,7, Patron N1,4,8 1 Jose R. Reyes Memorial Medical Center, Manila, Philippines; 2The Medical City, Pasig, Philippines; 3 Veterans Memorial Medical Center, Quezon City, Philippines; 4National Kidney and Transplant Institute, Quezon City, Philippines; 5Far Eastern University Hospital, Quezon City, Philippines; 6United Doctors Medical Center, Quezon City, Philippines; 7Philippine Orthopedic Center, Quezon City, Philippines; 8Capitol Medical Center, Quezon City, Philippines
Introduction and Objectives: The most common pre-
sentation of testicular tumors is a painless, unilateral testicular scrotal mass. However some would present as a large intra-abdominal mass due to a malignancy transformed intra-abdominal testis. Patients will either be asymptomatic or have symptoms of obstruction, severe abdominal pain, vomiting and nutritional deficiency. Diagnostic evaluation would include clinical examination, imaging of the scrotum and abdomen, and serum tumor markers. Treatment options depend on the type of testicular tumor, and the staging and extent of spread of the disease. Due to the bulk of the tumor, some would opt to subject the patient to
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RESIDENTS’ FORUM chemotherapy or radiation prior to the surgical procedure. This paper describes 3 distinct cases that were managed initially by surgical resection of tumor with the aim of relieving the patient of symptoms, getting accurate histopathologic diagnosis and nutritional improvement. We present the feasibility of doing exploratory laparotomy, tumor resection on patients with large testicular tumors located intra-abdominally. Materials and Methods: A retrospective review of pa-
tients presenting with intra-abdominal tumor of testicular origin who underwent exploratory laparotomy with resection by a single surgeon was done. Data gathered included patient demographics, imaging studies, tumor makers, perioperative outcomes and complications. This paper has IRB approval. Results: We present 3 cases of intra-abdominal testic-
ular tumor managed with tumor resection. The cases are presented in Table 1. Patients were followed up and there was note of improvement of symptoms and nutritional status. However two cases had a delay in chemotherapy due to financial constraints and both cases presented tumor recurrence. Conclusion: In patients with large non-invasive intra-abdominal testicular tumors, surgical management is a viable option in optimizing treatment strategy for patients. Such a procedure is feasible, safe, improves prognostication and nutritional status and provides immediate relief of symptoms. However, immediate chemotherapy is recommended to complete treatment.
RF-02.06 Active Surveillance of Stage I Testicular Seminoma (TS) and Non-Seminoma Testicular Cancer (NSTC) in a Community Hospital Rico L, Lopez FM, Vitagliano G, Contreras PN, Guglielmi JM, Ameri C Hospital Alemán, Buenos Aires, Argentina Introduction and Objective: Active surveillance for
stage I TS and NSTC is an increasingly used treat-
ment option as long as the patient is committed to the follow-up protocol. Active surveillance avoids treatment for 60-75% of these patients and is the most frequently used treatment in the USA. Reported specific survival rate for TS is 97-100% and 85-100% for NSTC. Relapse rate decreases in time, being 12% for the second year, 6% for the third and dropping to less than 1% since the fourth one. The objective is to evaluate the outcomes and role of active surveillance as a management strategy in a community hospital. Materials and Methods: A retrospective and descriptive analysis was performed reviewing medical records and databases from testicular cancer patients treated in Aleman Hospital and managed with active surveillance between 2005 and 2015. Age, presentation, ultrasonography diagnose, tumor markers, CT stage, frozen section and definitive pathology were considered initial stage variables. Follow-up adherence, relapse rate, overall survival and recurrence-free survival were accounted as follow-up variables. Results: A total of 44 patients fulfilled the search criteria and were included in the analysis. A total of 37 TSs, 6 NSTCs and one papillary serous carcinoma were identified. Average age was 38.5 years (14-72 years) and self-examination was the most common presentation (43.2%). Stage Ia was the most frequent (86.3%) followed by 5 patients in stage Ib. Average follow-up time was 46.28 months (1-120 months) with a median of 34 months. Follow-up protocol consisted of physical examination and tumor markers every three months the first two years, and biannually afterwards; CT biannually the first two years and then every 12 months. Follow-up adherence was complete for the first two years, 86% for the third and 62% on the fourth year. Relapse rate was 4.5% with an overall survival of 100%. Conclusion: Active surveillance for stage I TS and
NSTC was feasible in our patient series with adequate follow-up adherence and favourable oncological outcomes comparable to previous reports.
RF-02.05, Table 1. Parameters
Case 1
Case 2
Case 3
Age (Years)
45
35
24
Laterality
Left
Left
Right
Tumor Size
15x8x5 cm
12x9x8 cm
17x13x11 cm
AFP
2.0 ng/ml 1 ng/ml
2.83 ng/ml 2.84 ng/ml
23.845 IU/ml 1000 IU/ml
BHCG
70 mIU/ml 2 mIU/ml
80.63 mIU/ml 0.10 mIU/ml
17.84 mlU/ml 2.10 mIU/ml
LDH
400 U/L 300 U/L
2200 IU/L 238 U/L
820.03 U/L 275 U/L
Operative Time
6 hours
3 hours and 30 minutes
3 hours
Blood Loss
300 cc
1 liter
2.2 liters
Length of Hospital Stay
6 days
4 days
3 days
Seminoma
Seminoma
Yolk sac tumor
Tumor Markers
RF-02.07 Liposarcoma of the Spermatic Cord: A Case Series Report Cuny D, Silva E, Blanco F, Caradonti M, Tosolini E Hospital Aeronáutico Central, Buenos Aires, Argentina Introduction and Objective: Liposarcomas are malignant tumors of mesenchymal origin of the adipose tissue. They represent 7-10% of total intrascrotal peritesticular masses and are responsible for 90% of malignant tumors of the spermatic cord. We present 5 clinical cases of this disease diagnosed in our institution. Materials and Methods: We performed a review of
medical records, and histological and immunohistochemical studies in five cases of tumors of the spermatic cord. Results: Five clinical cases are presented, with a broad age range of 35 to 76 years old, and all of whom attended the consultation for spermatic cord masses. The histhopatological studies showed two cases of undifferentiated tumors, one case of a well-differentiated tumor, one case of a mixoid tumor and one case of fusiform cells with epididimary leiomyosarcoma. All cases were treated by surgical excision. Conclusion: With the emergence of a spermatic cord
mass, it is important to make differential diagnosis with testicular primary tumors or extrascrotal injury, and take early surgical conduct. Radical orchiectomy is advised, followed by subsequent periodic monitoring and control.
RF-02.08 Novel Surgical Forceps for Open Surgery Gaspar S, Oliveira P, Oliveira , Dias JS, Lopes T Hospital Santa Maria, Lisbon, Portugal Introduction and Objective: Thumb forceps, some-
times referred as tweezers, are used to grasp, hold and move small objects or tissue with easily variable pressure. They are used when applying sutures, to gently grab tissues out of the way during exploratory surgery and to move dressings or draping without using the hands or fingers. They are held between the thumb and two or three fingers of one hand, with the top end resting on the first dorsal interosseous muscle at the level of the base of the thumb and index finger. Spring tension at one end holds the grasping ends apart until pressure is applied. There are several arrangements for the tip endings: serrated tips, common called “mouse’s teeth” (two teeth on one side meshing with a single tooth on the other), and smooth tips and crosshatched tips. Serrated forceps are used on vessels and tissue; puncture wound from teeth is less damaging to tissues than a crushing smooth surface and one can grasp with less overall pressure. Materials and Methods: This particular clamp falls in
Histopathologic Findings
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the serrated forceps category, with a 1x2 arrangement - one tooth in one side vs. two teeth in the other. Additionally, close to the tip ending, it has an elevated rugged surface on both clamp endings, close to the tip. Results: It holds two functions simultaneously. One, it allows the user to grasp tissue through its serrated tip, has one would normally use it; two, it allows the needle to be held in place through its rugged surface,
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
RESIDENTS’ FORUM in order to set it immediately in the needle-holder, allowing a natural and intuitive gesture. Conclusions: By combining two functions in a single instrument, this novel clamp enables the surgical movement associated with closing surgical planes to be shorter, economic, and faster.
RF-03.01 Intravesical Foreign Body: A Tertiary Care Center Experience from Pakistan Soomro HU, Khan I, Faruqui N Aga Khan University Hospital, Karachi, Pakistan Introduction and Objective: Intravesical foreign body
is an uncommon but significant cause of urologic consultation. A great variety of foreign bodies have been removed and reported from the lower urinary tract and male urethra. The aim of study was to evaluate the presentation, mode of insertion, diagnosis, complications and management of intravesical foreign bodies in patients treated at our institute. Materials and Methods: Records of patients treated for intravesical foreign bodies from 1989 to 2013 were retrieved retrospectively. Results: A total of eleven patients were identified with complete record. Median age was 51 ± 20 years (range 19-77 years). Ten were male (91%) and one (9%) was female. The most common presentation was with lower urinary tract symptoms in eight cases (73%). One patient developed colovasical fistula, and a second had urine leak from the suprapubic wound while only one was asymptomatic. Iatrogenic insertion was the most common mode seen in five (45%) patients, out of which only one patient had a history of psychiatric illness, followed by self-insertion in four patients (36%), migration from adjacent viscera and bomb blast injury in one patient each. Recurrent UTI, hematuria, bladder stone formation and rectovesical fistula were complication noted in our series. Intravesical foreign bodies had been removed endoscopic ally in all patients. Foreign bodies retrieved includes, piece of Foley’s catheter in three patients, electric wire in two, piece of ureteric stent, plastic material, DJ pusher, endo GI staples, Broom Stick and bomb shrapnel in one patient each respectively. Conclusion: Intravesical foreign bodies could be con-
sidered as the differential diagnosis of refractory lower urinary tract symptoms. Size, shape, nature of foreign body, available expertise and equipment guides the suitable removable method. Most intravesical foreign bodies can be retrieved with minimally invasive techniques (endoscopy).
RF-03.02 A Rare Case of a Sequestrated Disc in a 14-Year-Old Patient: A Case Report Umurangwa Ngarambe F University of Rwanda, Kigali, Rwanda Introduction and Objective: Cauda Equina Syndrome (CES) results from an injury to two or more spinal nerve roots below the conus medullaris within the lumbosacral neural canal causing a variable combination of the bladder, bowel, and lower extremity sensorimotor deficits. CES is most frequently due to lumbar disk herniation, which leads to CES 16% of
the time. MRI is the diagnostic modality of choice and surgical decompression is generally the treatment of choice for CES, although the timing of this intervention remains in question. Materials and Methods: We are reporting a case of
a 14-year-old who presented to urology service for urinary incontinence and saddle anesthesia without lower limbs motor dysfunction. Her lumbosacral MRI showed a centrally herniated lumbar disc at L5/S1 level. She underwent surgical decompression with L5/S1 unilateral right laminotomy and microdiscectomy 10 days after the onset of the symptoms. Results: The postoperative course was marked by full recovery of bladder function and saddle sensation and complicated with lumbar CSF leak, which was successfully treated with surgical repair. The current report focuses on atypical age presentation, and the challenges in making the diagnosis of CES, which resulted in a delayed surgical decompression. Eventually, this was followed by a full neurological recovery. Conclusion: The low specificity of clinical features of
Cauda Equina syndrome resulted in a significant delay definitive treatment. This case serves as an example of a possible neurologic function recovery of CES after a delayed surgical decompression.
RF-03.03 Tunneled Buccal Mucosa Tube Grafts for Treatment of Hypospadias Kim SW, Lee YS, Han SW Dept. of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Introduction and Objective: Buccal mucosa has been used as an inlay, onlay or tube graft in 1 or 2 stages with moderate success rate in treatment of hypospadias. We report our experience of tunneled buccal mucosa tube grafts in treatment of hypospadias. Materials and Methods: We retrospectively reviewed
the charts of all 61 patients 7 months to 48 years old who underwent urethroplasty using buccal mucosal grafts between January 2005 and March 2015 at our institution. Of these, 3 patients were excluded because of loss to follow-up, and 8 patients who had urethroplasty with Braka’s technique or onlay method were also excluded. A total of 47 patients who were followed at least 12 months postoperatively (median 32 months) were included. Results: Of 47 patients, buccal mucosa grafts urethroplasty was performed in 16 patients for the treatment of primary 2 stage urethroplasty, in 15 for the correction of recurred chordee after initial urethroplasty, and in 16 patients for the previous failed-hypospadias. Initial hypospadias location was in the perineum in 16, in the scrotum in 13, in the penis in 10, and 2 patients had chordee without hypospadias. Thirty-two patients (68%) underwent visual internal urethrotomy due to urethral stricture and 29 (61%) had open surgeries including fistulectomy or diverticulectomy. The mean number of visual internal urethrotomy and open surgery for the treatment of complication was 1.21±1.31 and 0.87±0.92, respectively. During follow-up, only 7 patients (15%) were complication-free. The number of visual internal urethrotomy required after urethroplasty was associated with the number of previous surgery before buccal mucosa graft urethro-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
plasty (R=0.394, p=0.006). On the last follow-up visit, 43 patients (91%) were problem-free for at least 6 months with low residual urine volume 13.0±17.0 ml. The mean duration required to achieve problem free after urethroplasty was 10.8±11.9 months. Conclusions: Although several procedures for complications were required, the majority of patients were ultimately free of long-term problems within a year after urethroplasty using tunneled buccal mucosa tube grafts.
RF-03.04 Possibilities of Lesional Vas Deferens Repair in an Experiment Štichhauer R1, Kaška M2, Ryška A3, Koudelka J1 1 Dept. of Pediatric Surgery, Faculty Hospital and Academic Dept. of Surgery, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic; 2Academic Dept. of Surgery, Faculty of Medicine, Charles University and Surgical Dept., Faculty Hospital, Hradec Králové, Czech Republic; 3 The Fingerland Dept. of Pathology, Medical Faculty, Charles University and Faculty Hospital, Hradec Králové, Czech Republic
Introduction and Objective: Damage to the vas deferens during inguinal hernia surgery represents one of the most frequent iatrogenic injuries in paediatric surgery. The main aim of the experimental study is finding a useful algorithm for vas deferens repair under conditions of standard paediatric surgery departments with a help of magnifying glasses only. Materials and Methods: A pilot prospective experimental study was conducted on male rats. A total of 48 animals were enrolled and divided into six subgroups according to type of injury and method of its reparation. The subgroups of animals: 1/ contusion of vas deferens with pressing by a pean, transection and anastomosis with use: 2/ single stitches made by absorbable sewing material, 3/ joining with absorbable sewing material as an intra-luminal “leader”, 4/ = 3 + non-absorbable sewing material as a “leader”, 5/ anastomosis combined with absorbable “leader”, and 6/ = 5 + fiber of non-absorbable “leader”. Flow rate of methylene blue solution (μL/min) through the lesional part of the vas deferens was examined 120 days after the operation and histological examination of this tissue was performed. The intact contra-lateral vas deferens was used as a control. Results: The average liquid flow rate through contused vas deferens was 17.885 μL/min, in contra-lateral vas deferens 17.950 μL/min. Minimal histological changes were found in this subgroup. The significantly best flow rate (p=0.004) and small histological changes after transection and reconstruction of vas deferens were found in subgroup 3 (injured - 13.173 μL/min. versus intact - 16.313 μL/min.) and No.5 (injured - 10.402 μL/min versus intact - 17.901 μL/min). Conclusions: A contusion of the vas deferens did not lead to substantial changes of the vas deferens. The best results of vas deferens reparation after its transection and a consequent reconstruction were found in the animals with the method using the absorbable sewing material situated intraluminally only.
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RESIDENTS’ FORUM RF-03.05 Transcutaneous Posterior Tibial Nerve Stimulation in Paediatric Overactive Bladder: A Prospective Randomized Study Yadav P, Sekhon V, Ansari M Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India Introduction and Objective: Various methods of
neuromodulation have been reported to treat refractory lower urinary tract dysfunction. Most of these techniques are invasive, and hence less applicable in children. We evaluated the effectiveness of transcutaneous posterior tibial nerve stimulation (PTNS) to treat overactive bladder (OAB) in paediatric population. We designed a prospective randomized trial with sham control for this evaluation. Materials and Methods: All the children enrolled
easily accepted the PTNS in both the groups. This study was a single-blinded, prospective, sham controlled randomized trial. A total of 50 children with non-neurogenic OAB refractory to behavioural and anticholinergic therapy were randomized either to the test group or the sham group. A total of 12 sessions, of 30 minutes each were performed weekly. The OAB symptoms, severity of incontinence, number of voids daily (NV), average voided volume (AVV) and maximum voided volume (MVV) were evaluated before and after the treatment. Statistical analysis was done using SPSS version 22.0. Results: On assessment of subjective improvement
of OAB symptoms, 64.0% of patients reported cure and 26.0% of patients reported significant improvement of symptoms in the test group whereas in the sham group only 10.0% of patients reported significant improvement. In the test group, 72.0% of patients reported complete improvement in incontinence and 24.0% of patients reported mild incontinence only, whereas in the sham group only 12.0% of patients reported complete improvement. The AVV, MVV and NV improved significantly in the test group (p<0.001) as compared to the sham group. Conclusion: Transcutaneous PTNS is easily accept-
able and effective in children with OAB refractory to behavioural and anticholinergic therapy.
RF-03.06 The Urologist’s Role in the Multidisciplinary Management of Placenta Accreta Renteria L, Jaunarena J Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: Placenta accreta occurs when the placenta abnormally adheres to underlying myometrium, often where there is an absence of decidua basalis. Depending on the depth of invasion, it can be placenta accreta, placenta increta, or placenta percreta. Placental adhesive disorders usually require resolution through postcesarean hysterectomy, which implies a high risk of genitourinary injury. Our aim is to describe how placental adhesives disorders can compromise the urinary tract, detailing possible complications and expose the surgical strategy in the multidisciplinary management.
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Materials and Methods: Between January 2002 and December 2015, 137 patients underwent cesarean section for suspected placental adhesive disorder. In elective procedures, cystoscopy and ureteral catheter placement were carried out before the surgery, as well as bilateral placement of an angiographic catheter on the uterine arteries. After cesarean section and hysterectomy, urological assessment was done, and reconstruction of the bladder or ureters was performed when necessary. In emergency procedures, no ureteral catheters were placed. The obstetrics department kept a prospective database for all patients. Results: Ureteral catheters were successfully placed in 123 patients. Bladder perforation was detected in 46 cases. Ureter re-implantation was necessary in 1 case. Vesico vaginal fistula occurred in 1 case, but there weren’t any other long-term urological complications. Conclusion: Multidisciplinary management is critical
7 (completed primary school). The average level of knowledge for all patients was 46%, with the highest score for Question 2 (80%) relating to the definition of a urethral stricture. The lowest score was achieved for Question 8 (28%) relating to self-catheterization frequency. There was no linear correlation between knowledge and age, or patient knowledge and level of education. Conclusion: This study demonstrates that the level of
knowledge of one’s own disease is unacceptably poor across the whole patient profile. Interventions to improve patient knowledge regarding urethral stricture disease are indicated.
RF-03.08 Identifying Risk Severity Using Wuhan Chart in Deceased Donor Kidney Transplantation
for minimizing complications during cesarean section for placental adhesive disorders. Urologists play an important role in preventing ureter damage with ureteral catheters, and repairing eventual bladder or ureteral injuries.
Kunwar KJ, Zhendi W, Guosong J, Guo C, Li H, Fuqing Z
RF-03.07
Introduction and Objective: To find etiological risk
Patient Knowledge of Urethral Stricture Disease in a State Sector South African Academic Hospital
Materials and Methods: From January 2009 to De-
Barnard M, Van Der Merwe A Stellenbosch University, Stellenbosch, South Africa Introduction and Objective: The knowledge that urethral stricture patients in a developing country Specialist Clinic have regarding their own disease remains uncertain. The objective was to measure patients’ knowledge of their disease at the Tygerberg Urethral Stricture clinic in Cape Town, South Africa. Materials and Methods: A total of 81 patients were
assessed from May 2015 to August 2015, and presented with a questionnaire containing questions on demographics, ten knowledge questions and qualitative comments. Subgroups were created for patients less than and greater than 50 years of age, and education level up to grade 10 and above grade 10. Means were compared using the Student t-test, correlations were assessed using Pearson’s correlation coefficient and the significance was assumed at an alpha level of 0.05. Results: The average age of patients attending the clinic was 55, and the average level of education Grade
Wuhan Union Hospital, Tongji Medical College of Huanzhong University of Science & Technology, Wuhan, China factors for deceased donor kidney transplantation. cember 2015, a total of 130 individuals underwent deceased donor (DBD-48, DCD-82) kidney transplantation. Any complication post transplantation within one year was re-studied to determine the probable identifiable risk factors. When reevaluating the donor from the data center, certain factors like: age of donor, body temperature during retrieval, cause of donor death, drugs received (catecholamine, vasopressin), creatinine level, duration of anuria, duration of low BB, WIT, and TIT were the major focus for evaluation. Results: Out of 130 cases, 56 cases reported complications like DGF, ureterocele, hydronephrosis, urinary leakage, hematoma, embolization, chest infection, sepsis even death. Upon reevaluating the recipient and donor, we found that the common risk factors for post transplantation complications in deceased donors: age > 60 is indeed a risk factor, death related to CVS was associated with complications. Serum creatinine > 3mg/dl & drugs administered prior to retrieval (prolog morbidity) to the donor is a definite risk for DGF, anuria and SBP (<80 mmhg) for more than 24
RF-03.08, Figure 1. Wuhan Chart (Risk Severity Scale) DEMOGRAPHIC FEATURES
REMARKS
Age (<60 / >60)
0/1
Cause of Death (CVD / Others)
1/0
Drugs (Catecholamine/Vasopressin) (Yes / No)
1/0
S Creatinine at organ Retrieval (<3.0 mg/dl / >3.0 mg/dl)
0/2
Body Temperature at Retrieval (<38o c / >38o c)
0/1
Duration of Anuria (<24 hr / >24 hr)
0/2
Duration of Low SBP (<24 hr / >24 hr)
0/2
Warm Ischemia Time (<20 mns / >20 mns)
0/2
Total Ischemia Time (<24 hr / >24 hr)
0/2
SCORE
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
RESIDENTS’ FORUM hours increases chances of delay in early graft function. Warm ischemia time (WIT) of >20 mns along with higher total ischemic time (TIT) increases risk for the delay graft function (DGF)/ Non-functioning of graft (PNG). We propose a chart (Wuhan Chart, see Figure 1) to evaluate the risk severity scale, greater than 7(half or more than half) will always have an increased risk severity than with less than 7.
with a mean follow-up of 32 months (3-61 months). The length of hospital stay was shorter although not statistically significant in the laparoscopic group. No abdominal injury from trocars or need of conversion to the open technique was registered. The number of living donors has increased from 10 in 2010 to 34 in 2015 at our institution.
stones, this is the first report of ESWL being used for treating a gallstone ileus.
Conclusions: Renal functional results in recipients
Conclusion: In the future, deceased donor transplan-
and surgical complications were similar between both groups. Although it was not statistically significant, the hand assisted laparoscopic approach decreased the length of hospital stay and is nowadays the procedure of choice in our hospital.
Pre-Operative Urinary Tract Infections and Complications at Time of Ureteropyeloscopy for Urolithiasis: Experience from a High-Volume Center
tation will serve as a major organ pool. Identifying risk factors and taking extra precaution will definitely help to minimize complications. Identification of possible risk factors will help to minimize complications and make transplant successful by prolonging graft and patient survival, therefore we propose a simple, easy chart to major risk severity scale. Thus, The Wuhan Chart (Risk Severity Scale) will help to identify common risk factors.
RF-03.09 Our Experience in Living Donor Nephrectomy: From Open to HandAssisted Laparoscopic Approach Santillan D, Martinez PF, Becher E, Tirapegui F, Gonzalez MI, Garcia Marchiñena PA Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: The aim of this study was
to compare donor morbidity and recipient outcomes in patients undergoing hand-assisted laparoscopic nephrectomy versus open surgery in a high volume hospital. Materials and Methods: Reviewing a prospective-
ly collected database of renal living donor-recipient pairs, 50 open donor nephrectomies were compared with 88 hand assisted laparoscopic nephrectomies. All of these surgeries were performed from March 2010 to February 2016 in Hospital Italiano de Buenos Aires. Data collected on donor characteristics included demographics (age, sex, weight, and height), renal vascular anatomical features, surgical information (number of blood transfusions, ischemia and anastomosis time and renal injury), complications, and length of hospital stay. Recipients’ data also included renal function information (serum creatinine level on postoperative days 7 and 30, 90 and 365; need of hemodialysis in the first postoperative week) and urological complications. Results: Patient characteristics were not significantly different between the open donor nephrectomy and hand assisted laparoscopic groups. Only 2 right kidney laparoscopic nephrectomies were done because of the shortness of the right renal vein. The postoperative vascular and urological complications and the creatinine clearance values at one week, one month, three months and one year of both groups were similar. Graft survival was 100% in both groups
RF-03.10 Extracorporeal Shock Wave Lithotripsy (ESWL) of a Massive 5 cm Gallstone Obstructing the Sigmoid Colon Carminatti T, Sole M, Hosman R, Jaunarena JH, Cristallo C, Gonzalez MS, Daels PF Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: Gallstone ileus is an extremely rare cause of colonic obstruction. We report the case of a 5 cm stone impacted in the sigmoid colon, treated with extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: Case description and litera-
ture review were made. Results: We present the case of an 83-year-old Caucasian male who presented to the Emergency Room complaining of abdominal pain. The patient had had pain in the left lower quadrant for 7 days. No other symptoms were referred. Relevant clinical history included a biliary duct stent because of a Mirizzi’s syndrome in 2013. The last colonoscopy in 2004 had shown hemorrhoids and diverticular disease. Blood work-up showed leukocytosis. The CT scan revealed an impacted stone in the sigmoid colon and pneumobilia consistent with gallstone ileus. The patient underwent a colonoscopy in which a stone was seen, 35 cm from the anal margin. The efforts of fragmentation and mobilization were unsuccessful. As a last resort before surgery, ESWL was proposed. The procedure was done without general anesthesia according to the usual protocol. The patient was placed in prone position. A Siemens Lithostar ESWL system was used. X-rays showed a large stone, 2 cm above the symphysis pubis. The stone was focused, and treatment was started at 10 kV, with progressive increase up to 17.2 kV, completing 4000 pulses. The procedure was uneventful. After one day, the patient was able to pass the stone fragments and eliminated them in the stool. The patient was discharged 2 days after the procedure. The patient had no complications related to the procedure, and continued his treatment with the surgery department. Even though ESWL has been used for biliary
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Conclusion: This novel approach for gallstone ileus
through ESWL allowed stone expulsion without requiring open surgery.
RF-03.11
Okullo A, Al-Bermani O Westmead Hospital, Sydney, Australia Introduction and Objectives: Longer duration of ureteral stents when managing urinary obstruction places the patient at increased risk of stent encrustation, urosepsis and other possible complications. Urosepsis from manipulation of the urinary tract during stone surgery can be catastrophic despite sterile pre-operative urine and prophylactic antibiotic use. The aim of this study was to evaluate the rates of pre-operative urinary tract infections (UTIs), sepsis and complications at the time of uretero/pyeloscopy in pre-stented patients. Materials and Methods: Consecutive patients from July 2012 to October 2015 at Blacktown Hospital undergoing uretero/pyeloscopy for urolithiasis were included. All patients were stented pre-operatively. Demographic and clinic-pathologic data were collected retrospectively. Analysis between groups was performed by Chi-square analysis for categorical and Mann-Whitney U Test for continuous variables. Significance was taken as p<0.05. Results: A total 129 patients with a median age of 49 years were included. The duration (weeks) of pre-operative stent presence prior to uretero/pyeloscopy was associated with the presence of preoperative UTI (p=0.004). All pre-operative UTIs were treated with antibiotics prior to uretero/pyeloscopy. There was no association between preoperative UTI and post-operative sepsis. Only 3 (2.33%) patients had post-operative sepsis. Operative time was also associated with the position of the calculus being treated with significant difference (p=0.005) between ureteric and renal calculi (47.0 and 53.4 minutes respectively). Pre-operative stent duration, pre-operative UTI and calculus location were not associated with post-operative complication rates. Females had a significantly higher likelihood of post-operative complications (p=0.044). Conclusions: Pre-operative UTI is associated with length of pre-operative stent duration. Stent duration should be minimized pre-operatively to reduce the risk of UTI. Risk of post-operative sepsis is low and unrelated to the presence of pre-operative UTI if it is treated pre-operatively.
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UNMODERATED EPOSTERS
Unmoderated ePosters Thursday, October 20 Saturday, October 22 0800-1800 Sunday, October 23 0800-1600 UP.001 Interest of Stone Density and Patient Corpulence in Predicting the Efficiency of Lithotripsy Extracorporeal: Results in a North African Ethnic Group of 267 Patients Abbar M Dept. of Urology, Military Hospital, Rabat, Morocco Introduction and Objective: The extracorporeal lithotripsy is one of the most used in the treatment of upper urinary tract stones methods. Its effectiveness depends on a number of factors including the density, size, shape, and location of the calculation. The objective was to determine the role of the density of urinary stones and the distance between calculation and skin of the patient determined from an abdominopelvic CT in predicting the success of extracorporeal lithotripsy. Materials and Methods: A total of 267 patients re-
ceiving extracorporeal lithotripsy for kidney stones or ureter lumbar measuring between 5 and 20mm were followed over a 50-month period. The average density calculations in Hounsfield units (HU) and the average distance calculation-skin in mm were determined from an abdominopelvic CT not injected. The efficiency was effective when residual fragments were ≤ 3mm. Results: Extracorporeal lithotripsy was effective in
63.5% of cases; the average density calculation was 513 ± 163 UH in the group that made the extracorporeal lithotripsy successfully and 795 ± 101 HU in the group with failed procedure, and this is statistically significant (p < 0.001, student’s t-test). The average DCP was 112 ± 18 mm in the group that had the extracorporeal lithotripsy successfully and 124 ± 22mm in the group without, and this was not statistically significant. Conclusion: This study shows that the density calcu-
lations can help predict the success of the extracorporeal lithotripsy. It shows that the efficiency is more likely to hit for stones less than 500 UH and more susceptible to failure for calculi more than 800UH. This should be taken into account in the indications of treatment.
compressed by the inferior vena cava. An open ureteroureterostomy has been the gold standard for many years for completely correcting this disease. However, in the last decade, with the intensive growth of minimally invasive surgery, laparoscopic procedures have almost replaced open surgery. Materials and Methods: We present a case of retrocaval ureter treated by laparoscopy. Results: It was a 45-year-old man with right flank pain from 6 months. Explorations by a Computerized tomography and MR imaging have shown a retrocaval ureter with moderate hydronephrosis and dilatation of the upper third of the right ureter. The laparoscopic procedure was performed using 4-port transperitoneal approach and it consisted in excision of the reverse cave portion of the ureter with ureteral anastomosis end to end using two V-Loc suture in 3/0, protected by a double J catheter inserted through the under ribs port. The postoperative follow-up was uneventful, with the first get up at the first day postoperative and the removal of the urinary catheter on the third day, the patient left the hospital in 5 days. The double J stent was removed uneventfully at 6 weeks with a good clinic evolution. Conclusion: Laparoscopic ureteroureterostomy is an
effective and minimally invasive surgical alternative for the management of retrocaval ureter.
UP.003 Laparoscopic Adrenalectomy for Adrenal Gland Tumors: 6 Years of Experience Pinto U, Martinez O Dr. Carlos Arvelo Military Hospital, Caracas, Venezuela Introduction and Objective: Adrenal lesions cover a
broad spectrum from benign to neoplastic entities. Laparoscopic surgery has revolution in the surgical treatment of these tumors. This is a retrospective investigation of laparoscopic adrenalectomy cases for tumors of the adrenal gland. Materials and Methods: Between February 2009 and
February 2016, a total of 9 patients underwent laparoscopic transperitoneal adrenalectomy at Dr. Carlos Arvelo Military Hospital. Mean patient age was 47 years (range 31 to 63), with predominance of males 5 (55.5%). A database was kept prospectively for all patients.
Results: Mean operative time was 192 minutes (range 180-240) and average surgical bleeding was 300 ml (range 250-500 cc). In 5 cases (55.5%), the tumor was in the right gland. A total of 3 patients (33.3%) had a complication, which was intraoperative (hemorrhage) in 2 (22.2%) and postoperative (surgical site infection) in 1 (11.1%). Transfusion rate was 14%. Two cases required conversion to open surgery. Mean hospital stay was 2.4 days. Mean tumor size was 4.9 cm (range 3-7 cm). The histology diagnosis of adrenal gland tumor was adenoma in 6 (66.6%) cases, phaeochromocitoma in 2 (22.2%) cases and myelolipoma in 1 (11.1%) case. Conclusion: Laparoscopic transperitoneal adrenalec-
tomy has a low potential for complications and can be performed in many of our hospitals. It is able to heal the patient in most cases, with reduced costs and morbidity. It is imperative to invest time in the learning curve for this surgical technique.
UP.004 Analysis of Adult Nephrectomies in the Komfo Anokye Teaching Hospital Appiah KAA1, Gyasi-Sarpong CK2, Amoah G1, Azorliade R1, Opoku Manu PM1, Otu Boateng K1, Aboah K1, Opoku Antwi I1, Togbe S1 1
Komfo Anokye Teaching Hospital, Kumasi, Ghana; Dept. of Surgery, School of Medical Sciences, College of Health Sciences, KNUST, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana
2
Introduction and Objective: Nephrectomy forms an important part of the workload of the urologist. It may be indicated for renal trauma, benign and malignant diseases of the kidney. The indications for nephrectomy vary from place to place, as does the surgical technique employed. Complications following nephrectomy are not uncommon and may differ based on indications and technique. The objectives of this study are to describe the clinico-pathological features, indications and complications of patients presenting for adult nephrectomy at the Komfo Anokye Teaching Hospital (Kath), Kumasi, Ghana. Materials and Methods: Between October 2012 and March 2016, a total of 26 open adult nephrectomies were carried out in the Urology unit of Kath. A database, which included patients’ age, gender, clinical presentation, laterality, indications, histopathology results and complications was kept prospectively for all the 26 patients. Data were entered into SPSS 19.0 for statistical analysis.
UP.002, Table 1. Outcome of Laparoscopic Adrenalectomy
PATIENTS (n)
GROUP-(I)
GROUP-(II)
50
50
40.6
39.06
2.5 cm (0.5-5)
4.2 cm (1-8)
94± 28
87.1±21
P VALUE
UP.002
AGE (mean)
The Laparoscopic Treatment of Retrocaval Ureter
SIZE
Mejdoub B, Mseddi MA, Bouassida M, Rebai N, Bouhlel A, Hadj Slimen M, Mhiri MN
BLOOD LOSS
48.8±31
43 ±24
p<0.01
Dept. of Urology, Habib Bourguiba Hospital, Sfax, Tunisia
ORAL-INTAKE
1.1±0.30
1.08±0.27
p<0.05
ANELGESICS
3.32±0.59
3.16±0.5
p<0.05
AMBULATION
1.54±0.54
1.1±0.30
p<0.05
8.3±2.8
4.6±1.04
p<0.01
Introduction and Objective: Retrocaval ureter, also
known as circumcaval ureteris, is a rare congenital anomaly in which the ureter passes behind, and is
OPERATION TIME
HOSPITAL STAY
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
p<0.01
129
UNMODERATED ePOSTERS Results: During the study period, a total of 26 adult nephrectomies were performed. Fourteen (53.8%) of the patients were males and 12 (46.2%) were females. Male to female ratio was 1.2:1. The age range was from 16 to 80 years with the modal age group being 31-40 (26.9%). The main clinical presentations were flank pains 20 (76.9%), flank mass 14 (58.3%), hematuria 6 (23.1%) and 1 (3.8%) was an incidental finding. Renal malignancies accounted for the majority 18 (69.2%) of nephrectomies with a 1:1 male to female ratio followed by benign renal diseases 7 (26.9%), and trauma 1 (3.9%). There was no significant difference in terms of laterality of renal tumours removed, but there were much more left nephrectomies (6) done for neglected UPJ obstruction than the right (1). Complications of adult nephrectomies included torn renal artery (1) and vena caval injury (1) with massive hemorrhage, retroperitoneal abscess (1) and wound infection (3). The predominant histologic type of the malignancies was renal cell carcinoma 13 (72.2%) followed by transitional cell carcinoma 3 (16.7%) and nephroblastoma 2 (11.1%).
stricture 65 (15%) and bladder cancer 36 (8.3%). On the other hand the three most common findings in women were trigonitis (48/274 17.5%), urinary incontinence (25/274 9.1%) and non-specific chronic cystitis (19/274 6.9%). The cystoscopic appearance was entirely normal in 98 (22.6%) males and 60 (21.8%) females. Cystoscopy was well tolerated and there were no complications noticed.
Conclusion: From this study, the major indication for nephrectomy in our center is malignant renal disease followed by neglected UPJ obstruction.
Daelen D
UP.005 The Role of Outpatient Cystoscopy in the Evaluation of Lower Urinary Tract Symptoms and Lower Urinary Tract Disorders Salazar I1, Castro C2, Salazar A2, Jacob O2, Fuentealba C2, Orellana S2 1
Faculty of Medicine, University of Los Andes, Chile; Dept. of Urology, Carabineros Hospital, Ñuñoa, Región Metropolitana, Chile
2
Introduction and Objective: In urology, the key to
accurate diagnosis is the clinical history, the physical examination and the clinical investigations, being endoscopy a cornerstone given the number of useful applications. One important endoscopic tool is the cystoscopy, which allows us to make an accurate diagnosis showing the real appearance of the lower urinary tract. We wanted to know the most frequent indications and cystoscopic findings in males and females. Materials and Methods: This was a retrospective study. We reviewed the medical records of patients who underwent flexible or rigid cystoscopy for LUTS and lower urinary tract disorders between January 2013 and December 2015. Data collected included pre and post-cystoscopy diagnosis. Results: A total of 707 patients underwent flexible or rigid diagnostic cystoscopy, of which 433 (61.2%) were men and 274 (38.8%) were women. The average age of these patients was 66±12 (18-95) years for men, and 60±12 (23-89) years for women. The majority of cystoscopies were performed in men for the evaluation of bladder cancer (109/433 25.1%), bladder outlet obstruction (106/433 24.4%), and hematuria (63/433 14.5%). In women, the majority were for bladder cancer (35/274 12.8%), hematuria (42/274 15.3%) and urinary incontinence (68/274 24.8%). Cystoscopic evaluation revealed the following abnormalities: The three most common findings in men were benign prostatic hyperplasia 128 (29.5%), urethral
130
Conclusion: Cystoscopy is an effective, well-tolerated
and easy way for detecting lower urinary tract pathologies among outpatients. Both flexible and rigid cystoscopy are used for multiple procedures, such as finding urethral strictures, removing vesical calculus, and for the surveillance and follow-up of transitional cell bladder tumor. This makes it an essential routine diagnostic tool, which should therefore be considered as an essential part of the investigation of LUTS and lower urinary tract disorders.
UP.006 The Effects of Non-Ketamine Drug Abuse on Bladder Function Changi General Hospital, Simei, Singapore Introduction and Objective: The relationship be-
tween ketamine abuse and bladder dysfunction has been extensively studied and reported. Statistics from the Central Narcotics Bureau of Singapore state that Methamphetamine abusers made up slightly more than half (53% or 889) of all abusers arrested, followed by heroin users (40% or 672). The aforementioned drugs are much more commonly abused in Singapore than ketamine, yet the literature on the effects of such drugs on urinary function is lacking. We present a case series of patients with a known history of drug abuse (excluding ketamine) seen in the CGH urology department from 2008 to 2015 for lower urinary tract complaints. Materials and Methods: Data from 10 patients who presented to Changi General Hospital in Singapore with urinary symptoms following drug abuse with drugs excluding ketamine were analyzed. Results: All ten patients were males (mean age 46.4 years, range 35-59 at first presentation) (follow-up 6-72 months) with a history of drug abuse excluding ketamine. All presented with symptoms of lower urinary tract symptoms (LUTS), commonly hesitancy, frequency, weak stream and incomplete emptying. Flexible cystoscopy done on 3 of the patients was normal and CT-IVP was done on 4 patients, all of whom had normal-sized prostates. Urodynamic studies (5) showed detrusor overactivity for 2 and underactive bladder for the 2. Two patients had delayed sensations, 1 had early sensation with a weak bladder and 1 of them had to percuss his supra-pubic region for 5 minutes before he developed the desire to void. There was no obstruction demonstrated during the voiding phase for all the patients. All 10 patients were treated pharmacologically. Two patients were discharged from follow-up due to improvement of symptoms with medications, 8 are on long-term medications with variable success in control of symptoms. Conclusion: The side effects of illicit drugs (other
than ketamine) on the urinary system are not well known and not commonly considered when manag-
ing patients with lower urinary tract symptoms. Presenting symptoms are varied, and no effective treatment strategies/guidelines are available to tackle this complicated issue as of yet. A multi-center response is needed to improve our understanding of this entity.
UP.007 Register of Urogynecological Implants: The Development of an Online Platform for Registration and Outcome Measurement According to the IDEAL Long-Term Stage of Surgical Innovation Barski D1, Gerullis H2, Ecke T3, Joukhadar R4, Kranz J5, Tahbaz R6, Queissert F7, Schneidewind L8, Mühlstädt S9, Grabbert M10, Huppertz N11, Pelzer AE12, Klinge U13, Boros M14, Bader W15, Naumann G16, Puppe F17, Otto T1 1
Dept. of Urology, Lukas Hospital Neuss, Germany; University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany; 3Dept. of Urology, HELIOS Hospital, Bad Saarow, Germany; 4 Dept. of Gynecology, University Hospital Würzburg, Germany; 5Dept. of Urology, St.-Antonius Hospital Eschweiler, Germany; 6Dept. of Urology, University Hospital Hamburg Eppendorf, Germany; 7Dept. of Urology, University Hospital Münster, Germany; 8 Dept. of Urology, University Hospital Greifswald, Germany; 9Dept. of Urology, University Hospital Halle (Saale), Germany; 10Dept. of Urology, LMU University Hospital Munich, Germany; 11Dept. of Neuro-Urology, University Hospital Bonn, Germany; 12Dept. of Urology, Ingolstadt, Germany; 13Surgical Department, University Hospital of the RWTH Aachen, Germany; 14 Institute of Experimental Surgery, University of Szeged, Hungary; 15Dept. of Gynecology, Klinikum Bielefeld, Germany; 16Dept. of Gynecology, HELIOS Erfurt, Germany; 17Institute for Mathematics and Computer Science, University of Würzburg, Germany 2
Introduction and Objective: Most aspects of implants for reconstruction of the pelvic floor are still under debate or poorly studied. Different tools and definitions of success make the comparability of studies and meta-analyses in this field of surgery difficult. The aim of the present study was to prove the feasibility of a register to analyze the outcome after implant application. Materials and Methods: The available literature on the application of implants for pelvic organ prolapse (POP) and female and male stress urinary incontinence (SUI) repair was reviewed according to IDEAL stages of surgical innovation. A working group was formed to create an online platform for registration and outcome measurement of implant-assisted operations for POP and SUI repair. To date, 20 patients from a previous published study on modified mesh materials were evaluated over 23 months follow-up in the register. For validation, a previously published modified “satisfaction, anatomy, continence, safety (S.(A.)C.S) score” was used. Results: A review of the literature revealed missing data, especially on male continence surgery and longterm trials. A register was established with consensus on clear definitions and classifications of patient variables, surgical procedures and mesh materials used, as well as outcome parameters. According to the S.(A.)
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS C.S. scoring system, only 14 patients (70 %) reached the maximum score of cure.
UP.011, Table 1.
Conclusion: An online platform for registration and
n= 2009
outcome measurement of implant-assisted POP and SUI repair with clear definitions and classifications is offered to the surgical community.
Qmax
29.4 (41.7) ml/s
30.7 (58.6) ml/s
0.557
Pdet,max
79.0 (37.1) cmH2O
43.6 (30.3) cmH2O
0.000
UP.008
Wmax
12.8 (10.0) W/m2
10.9 (15.0) W/m2
0.002
Inhibition of ICAM-1 Could Effectively Reduce Bladder Inflammation with Related Cytokines or Receptors in a Rat Model of Non-Bacterial Cystitis Resembling Interstitial Cystitis Shen Z, Zhang X, Zhong S Huashan Hospital Fudan University, Shanghai, China Introduction and Objective: To examine the inhibi-
tion of intercellular adhesion molecule 1 (ICAM-1) on bladder inflammation in a rat model of non-bacterial cystitis resembling interstitial cystitis (IC). Materials and Methods: Female SD rats were divid-
ed into 5 groups: seven in the normal control group; nine in the pure non-bacterial cystitis model group constructed by intraperitoneal cyclophosphamide with intravesical protamine/lipopolysaccharide; remaining 3 groups consisted of 10 cystitis model rats in each with intervention of celecoxib, aprepitant or anti-ICAM-1 antibody (AIA), respectively. Bladder tissue evaluation included histological inflammation grade, mast cell counts and measurements of P2X3/ P2Y2, PGE2, EP1/EP2, TNF-, ICAM-1 and neurokinin-1 receptor (NK1R). Results: A significant increase in bladder inflammation grade and mast cell counts with higher expression of all related cytokines and receptors were observed in cystitis model. AIA significantly decreased inflammation grade and mast cell counts. Compared with celecoxib, AIA could reduce the expression of PGE2 (P=0.014), EP1/EP2 receptor (P=0.003, P=0.01), TNF-α (P=0.006) and ICAM-1 (P<0.001) more seriously. Moreover, the effect of AIA on attenuating the increase of P2X3 (P=0.017), P2Y2 (P=0.019) and EP2 (P=0.046) in the cystitis model was significantly better than aprepitant. Conclusion: Inhibition of ICAM-1 could effectively
reduce bladder inflammation, accompanied by reduction of related cytokines and receptors in a rat model of non-bacterial cystitis representing IC. ICAM-1 may play a critical role in the pathogenesis of IC and should be further investigated as a novel therapeutic target.
UP.009 Does Fesoterodine Have a Role in the Treatment of Japanese Elderly Patients with Overactive Bladders? Takeda H Tosei General Hospital, Seto, Japan Introduction and Objective: Persistence with longterm medication in chronic diseases is typically low, and for overactive bladder medication, is even lower than average. Sub-optimal persistence is a major challenge for the successful management of overactive bladders. We evaluated the efficacy, safety and per-
Men mean, sd.
sistence of fesoterodine in medically complex vulnerable elderly subjects with OAB. Materials and Methods: Our hospital data from a longitudinal patient database were analyzed retrospectively to assess persistence with fesoterodine in elderly Japanese patients. Data were collected on patients who started treatment between January 2014 and December 2015, to allow each patient a full 12-month potential treatment period. Failure of persistence was declared after a gap of at least 1.5 times the length of the period of the most recent prescription. Additional assessments included the Vulnerable Elders Survey-13 (VES-13), IPSS, OABSS and HUS. Results: A total of 103 patients were included (mean age 76.3 years, 100% of patients aged 65 years or greater). Subjects had high rates of comorbidities, polypharmacy and functional impairment. At 3 months, the VES-13 >3 group and VES-13<4 had greater improvements in OABSS and IPSS. Adverse effects were generally similar to those of populations including risk of urinary retention. At 3 months, the proportion of patients still on their original treatment was: all fesoterodine 70.1%. At 12 months, the proportion of patients still on their original treatment was: all fesoterodine 48.5%. In a sub-analysis stratified by age and VES-13, patients aged ≥75 years (38.5%) with VES-13>3 (37.4%) were no more likely to persist with prescribed therapy over the 12-month period than the other group (N.S.). Conclusions: Twelve months after the initial prescription, persistence rates with pharmacotherapy in the context of OAB are generally low. Fesoterodine was associated with comparatively high levels of persistence in vulnerable elderly patients with OAB.
UP.010 Non-Invasive Measurement of Bladder Pressure in Patients for Photoselective Vaporization of Prostate Kim KS1, Bae WJ1, Kim SJ2, Cho HJ2, Hong SH2, Lee JY2, Kim SW2 1
Dept. of Urology, College of Medicine, The Catholic University of Korea, Incheon St Mary’s Hospital, Incheon, Korea; 2Dept. of Urology, College of Medicine, The Catholic University of Korea, Seoul St Mary’s Hospital, Seoul, Korea
Introduction and Objective: The purpose of this
study was to compare penile cuff test with conventional urodynamic study (UDS) in the preoperative assessment of patients who scheduled photoselective vaporization of prostate (PVP) for benign prostate hyperplasia (BPH). Materials and Methods: A total of 45 patients with LUTS performed simultaneous penile cuff test and conventional UDS before undergoing PVP for treatment of BPH. Newcastle non-invasive nomograms
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Women
P diff
were used to confirm bladder outlet obstruction (BOO) after measuring maximum urinary flow rate and highest pressure at flow interruption. Results by penile cuff test and conventional UDS compared with the outcome predicted by the nomogram. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: A total of 25 patients were diagnosed as obstruction and 20 patients as non-obstruction on Newcastle non-invasive nomogram at penile cuff test. All patients diagnosed as obstruction at penile cuff test were confirmed at the following UDS. Regarding the 20 patients non-obstruction at penile cuff test, all of them were verified not to be obstructed on UDS, with 6 patients revealed obstruction. Penile cuff test showed a sensitivity of 80.6% and a specificity of 100%. The positive predictive value was 100% and the negative predictive value was 70%. Conclusion: Our data suggest that penile cuff test
can give greater diagnostic information about BOO before performing PVP by high sensitivity and specificity. Although our study enrolled a small number of patients, our results are comparable with studies on invasive UDS.
UP.011 Epidemiology of Aging and Detrusor Voiding Contraction Activity for Men and Women Rosier P University Medical Center Utrecht, The Netherlands Introduction and Objective: Detrusor voiding contraction is believed to decline as a consequence of ageing. Clinical epidemiological data is however scarce and the ageing effect could be gender related because of concurrent prostate growth in men. Materials and Methods: We have evaluated 2015 consecutive pressure/flows that were representative according to the patient. No patient had undergone relevant surgery or had a UTI or relevant neurological abnormalities. Results: The table shows that men had higher voiding pressures (Pdet.max) and not statistically significant lower maximum flow rates (Qmax) (see Table 1). In patients aged greater than 50 years referred with LUTS, the data (grouped according to age) shows an average decline of maximum detrusor contraction of ± 3.3 W/m2 (women) or ± 1.2 W/m2 (men) can be observed in a period of ± 30 years. Longitudinally interpreted, this shows that men ‘lose’ ±15% of their maximum detrusor contraction power over a 30-year period and women lose ±35%. Voiding against outflow obstruction (on men) may act as a ‘power’ training for the detrusor muscle.
131
UNMODERATED ePOSTERS Conclusion: This large sample study of a large age
Conclusion: Based on our results, the placement of a round posterior stent for the management of BNC is an easy, safe and minimally invasive procedure, and is suitable for patients who do not accept surgery.
range cohort quantifies the gender-related and age-related decline of detrusor maximum work during a subjectively representative voiding. The difference in maximum detrusor work in elderly women with symptoms of lower urinary tract dysfunction versus the somewhat younger women is larger than the difference over the similar age range in men.
UP.013 The Beneficial Effect on Nocturia in Patients Treated with C-PAP for Obstructive Sleep Apnea Syndrome
UP.012
Rahnama’i MS1, Degaillier S2, Ewoldt T3, Marcelissen T1, Gronenschild M4, de Vries P4
Management of Bladder Neck Contracture with a Minimally Invasive Method: RoundPosterior Bladder Neck Stent
1
Maastricht University Medical Centre, The Netherlands; 2Zuyderland Medical Centre, Geleen, The Netherlands; 3Maastricht University, The Netherlands; 4 Zuyderland Medical Centre, Heerlen, The Netherlands
Culha MM, Simsek E, Teke K, Yuksekkaya M, Uslubas AK, Yilmaz H
Introduction and Objective: Continuous Positive
Kocaeli University, Turkey
Airway Pressure (C-PAP) is a well-established therapy of Obstructive Sleep Apnea Syndrome (OSAS). In this study, we aimed to assess the incidence of nocturia in patients with OSAS who received C-PAP treatment. Moreover, we analyzed the effect of C-PAP treatment on nocturia episodes.
Introduction and Objective: Several surgical methods
have been described for the management of bladder neck contracture (BNC) up until now. This is the first study that presents stent usage for the treatment of this morbidity. Materials and Methods: A total of 37 patients between 51 and 77 years old, with highly recurrent BNC and multiple prior attempts of endoscopic treatment, underwent round-posterior stent Allium placement between 2010 and 2015. Round posterior stent is a fully covered metal stent specially designed for the treatment of bladder neck contracture. It is a temporary stent. The indwelling time was planned 12 months for the stents. Four stents were replaced since early migration not more than two months period. The success criteria after stent removal consisted of no evidence of structure on uretrogram or endoscopy, urinary peak flow greater than 15 ml/sn and no recurrent urinary tract infection. Median follow-up was 23 months after stent removal.
Materials and Methods: All patients who received a C-PAP mask for OSAS in 2015 at the pulmonology department of our hospital (N= 358) were interviewed and invited to take part in our study. After informed consent, all patients were asked by one of our two interviewers to answer the same set of standardized questions about their nocturia episodes prior and after C-PAP treatment. Results: A total of 256 patients (206 male and 50 female) gave consent and took part in the study. The mean age of the patients was 60 years (range 28-92 years). The prevalence of nocturia (N≥1 voids per night) was 69 % (176 patients). All patients with nocturia were stratified in groups with nocturia episodes. Treatment with C-PAP reduces nocturia in 65% with one or more episodes per night. There were no patients in our study who reported an increase in nocturia episodes after C-PAP treatment. All results are summarized in table 1.
Results: Etiology was radical prostatectomy in 23 (62%) and transurethral prostatectomy in 14 (38%) patients. None of the patients reported discomfort at the stent site. All stents were removed very easily, without any complications 7 to 15 months (mean 8.9 months) after implantation. Eleven stents removed early (before 12 months) because of obstruction due to recurrent urinary infection. Nine patients complained of mild urinary incontinence, which was resolved after stent explantation. Clinical success was achieved in 22 patients (59%).
Conclusion: The prevalence of nocturia with (N≥1
voids per night) among patients with OSAS is 69%. Treatment with C-PAP reduces nocturia in 65% of patients with 1 or more voiding episodes per night and in patients with OSAS. This study is the first large study to show a clear relationship between OSAS
UP.013, Table 1. Nocturia episodes before C-PAP
No pts. N= 256 (50 female & 206 male)
0 1
132
reduction to 0
reduction to 1
reduction to 2
reduction to 3
reduction to 4
80 (31%)
-
-
-
-
-
55 (21%)
17 (31%)
-
-
-
-
2
77 (30%)
32 (42%)
22 (29%)
-
-
-
3
19 (7%)
16 (84%)
2 (10%)
-
-
-
4
17 (7%)
7 (41%)
-
1 (6%)
2 (11%)
-
5
6 (2%)
-
2 (33%)
2 (33%)
-
1 (17%)
7
2 (1%)
-
1 (50%)
1 (50%)
-
treatment and the reduction of nocturia episodes, stratified by the number of voiding episodes per night.
UP.014 Size Matters! The Prostate as the Indicator for Lower Urinary Tract Dysfunction Rosier P University Medical Center Utrecht, The Netherlands Introduction and Objectives: Elderly males referred with bothersome lower urinary tract symptoms may (LUTS) have bladder outflow obstruction (BOO). The golden standard for this diagnosis is pressure flow analysis (resulting in bladder outflow obstruction index; BOOI or bladder contraction index; BCI, and bladder working function (maximum) Wmax. Symptoms (IPSS), maximum flow (Qmax) and PVR are considered indicators of BOO. Materials and Methods: We tested the correlation of
prostate size (TRUS (g) with BOOI and other parameters in 584 men. Results: Table 1 shows the prostate size cohorts and the average values of the column parameters with Pearson r (and significance) on last row. Conclusion: If elderly male patients are ‘grouped’
according to prostate size, the correlation with IPSS and PVR is weak and insignificant. The correlations of prostate volume with age, Qmax, bladder outflow obstruction and also detrusor contractility are highly significant.
UP.015 Automatic Diagnosis and Monitoring of Lower Urinary Tract Activity by a Novel Device Implemented on a Smartphone Platform: In-Vitro Pilot Study Hidas G1, Hidas G2, Hidas Y2 1
Dept. of Pediatric Urology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel; 2Kesem Health, Melbourne, Australia Introduction and Objective: Voiding diary is an important diagnostic tool assisting physicians to better understand the type and severity of Lower Urinary Tract Symptoms (LUTS). Performing a voiding diary is an enormous burden to the patient. In many cases, voiding diaries are inaccurate, incomplete and low in compliance. These can result in a negative experience for the patient and potential misdiagnosis. The iUFlow is a device that is placed over the toilet bowl and connects to the patient’s smartphone, enabling automated and continues capturing and recording of patient’s urinary flow, frequency and volumes at home. The smartphone software is configured for processing sensor(s) signals to determine the total volume voided by the subject as well as total intake, max volume, median leakage, median urgency, first morning urination, night frequency and total night volume. This is done by an arrangement of sensors under a urine container producing acoustics signals that can be recorded, processed and analyzed via the mobile device microphone. Additionally, the iUFlow utilizes a HIPPA complaint cloud service for the storage and retrieval of clinical data.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.016
UP.014, Table 1. Prostate (g)
<25
26-39
40-55
55-80
Age
IPSS
Qmax
PVR
P/q Qmax
P/q pdetQmax
BOOI
Wmax
BCI
N
129
70
93
80
129
129
129
129
129
Mean
60.3
17.2
14.1
59.8
11.1
26.9
68.4
12.16
104.9
Sd.
12.7
6.4
8.8
94.9
6.2
32.0
34.0
6.7
31.7
N
197
99
157
131
197
197
197
195
197
Mean
63.1
16.1
12.7
103.1
10.6
35.7
76.3
11.8
109.8
>80
Sd.
10.5
6.1
8.1
147.2
6.3
30.6
33.0
5.5
36.3
163
91
130
108
164
164
164
162
164
Mean
67.2
19.1
10.8
80.7
9.4
48.2
90.0
14.2
113.7
Sd.
9.7
7.0
5.9
143.7
5.1
32.8
36.4
8.8
34.2
47
24
38
35
48
48
48
47
48
Mean
70.9
19.8
9.6
96.8
9.5
57.3
96.0
17.2
123.6
Sd.
9.6
7.2
5.0
184.7
4.5
29.9
37.3
12.9
30.8
N Mean
Total
Park CH, Cho YS, Joo KJ, Kwon CH, Park HJ
N
N
46
23
36
31
46
46
46
46
46
71.4
17.2
10.0
139.7
7.7
76.1
112.4
15.6
130.1
Sd.
8.1
7.6
6.3
159.9
4.2
37.5
34.5
6.1
27.9
N
582
307
454
385
584
584
584
579
584
Mean
64.9
17.6
12.0
90.2
10.0
42.3
82.9
13.3
112.6
Sd.
11.2
6.7
7.5
143.0
5.7
34.8
36.8
7.8
34.3
0.298 0.000
0.058 0.314
-0.171 0.000
0.113 0.027
-0.139 0.001
0.372 0.000
0.314 0.000
0.184 0.000
0.214 0.000
Pearson Significance
Materials and Methods: An independent 3rd par-
ty company (Mettler Toledo) was asked to test the repeatability and accuracy of the iUFlow device. A calibrated balance was placed under the outlet of the iUFlow, an empty collecting beaker was sat on top of the measuring pan and the balance was tared. Purified water was delivered into the iUFlow device. The water passed through the iUFlow and was collected in the collecting beaker. An attached iPhone displayed the
unrounded total volume. This volume was recorded along with the mass indicated on the balance. Results: Volumes of 49 ml, 102 ml, 254 ml and 514 ml were repeated three times. Mean volumes reported of the iUFlow device were 56 ml, 114 ml, 263 ml and 518ml. Mean difference between the mass of water and iUFlow reported volumes was 8.5 ml with a standard deviation of ±2.8 ml. Conclusion: The iUFlow device demonstrated strong
UP.015, Figure 1. iUFlow (Indicated Volume) Repeatability and Accuracy Testing Mass of water (g)
Indicated volume (mis)
Deviation (g/mis)
49
56
7
49
56
7
49
56
7
102
114
12
102
113
11
102
114
12
254
264
10
253
263
10
253
263
10
514
518
4
514
519
5
514
518
4
The Correlation of Insulin Resistance, Prostate Volume and Serum PSA
repeatability and accuracy with clinically insignificant deviation. Further studies should be conducted using urine, as well as clinical studies in order to validate the importance and usability of the iUFlow device in the management of LUTS patients.
UP.015, Figure 2. iUFlow Fully Automated Voiding Diary Digital Health Solution
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Dept. of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Introduction and Objective: Benign prostatic hyperplasia (BPH) is a prevalent disease in older men, and is characterized by augmented cell proliferation and contractility of the prostate gland. Several reports proposed the critical role of obesity and insulin-resistance (IR) associated complications in the pathogenesis of BPH. We investigated the relationship between IR and prostate volume and serum prostate specific antigen (PSA) in Korean men. Materials and Methods: A total of 4 039 men visited health care center were enrolled from January 2014 to December 2015. We excluded 347 men who had abnormal serum PSA level (≥4 ng/ml), history of prostate surgery or who were taking prostate related medication. Prostate volume by transrectal ultrasonography of the prostate, serum PSA, digital rectal examination, urinalysis, and metabolic syndrome parameters were investigated. The homeostasis model assessment of insulin resistance (HOMA-IR) index was calculated using the HOMA algorithm, glucose in mg/dl × insulin in μU/ml/405. The IR cutoff was defined as 2.0 based on a study of Korean Men. Results: The mean age, serum PSA and prostate volume were 45.24±7.78 years, 0.98±0.57 ng/mL, 21.63±6.18 cc, respectively. Prostate volume was significantly larger in the IR-group (22.66±7.31 cc) than in the non-IR group (21.68±6.28 cc). In univariate analysis, serum PSA was correlated with age and IR. Prostate volume was correlated with age, IR, waist circumference (WC), triglyceride, high-density lipoprotein cholesterol, and diastolic blood pressure (Table 1). In multivariate analysis, serum PSA was negatively correlated with IR compared to positive correlation of age and serum PSA. However, IR was not correlated with prostate volume in multivariate analysis and age. WC were the only factors that positively correlated with prostate volume (Table 2). Conclusion: These results suggest that the serum
PSA level is significantly influenced by age and IR. Although IR was not a risk factor of prostate volume enlargement, normal range of serum PSA should be considered in association with IR and prostate volume as well as age.
UP.017 Insulin Resistance and Prostatic Growth in Healthy Korean Men: A 4-Year Longitudinal Study Park CH, Cho YS, Joo KJ, Kwon CH, Park HJ Dept. of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Introduction and Objective: Benign prostatic hyperplasia (BPH) is a highly prevalent disease in aged men. Many reports indicate the correlation between metabolic syndrome (MS) and BPH. Insulin resistance (IR) was recognized as a key factor in MS. We
133
UNMODERATED ePOSTERS Conclusion: In this longitudinal study of healthy Ko-
UP.016, Table 1. Comparison of Prostate Volume and Serum PSA According to Metabolic Parameters and Insulin Resistance Variables
Age (years) WC (cm) FBS (mg/dl) TG (mg/dl) HDL-C (mg/dl) SBP (mmHg) DBP (mmHg) HOMA-JR
n
PV (cc)
< 50
2659
20.51=5.03
≥ 50
1033
25.28=8.24
< 90
2857
21.26=5.96
≥ 90
835
23.86=7.91
< 100
2647
21.95=6.21
≥ 100
1045
21.58=7.05
< 150
2562
21.58=6.23
≥ 150
1130
22.45=6.92
≥ 40
3218
21.66=6.34
< 40
474
23.14=7.09
< 110
794
21.60=5.39
≥ 110
2898
21.63=6.38
< 85
3247
21.67=6.31
≥ 85
445
23.13=7.35
<2
3101
21.68=6.28
≥2
591
22.68=7.51
p=value
<0.001
<0.001
0.11
<0.001
<0.001
0.89
<0.001
0.002
PSA (ng/mL)
p-value
0.96=0.55
<0.001
1.04=0.62
UP.018
0.99=0.57
0.20
0.96=0.57 0.99=0.57
0.33
0.97=0.58 0.99=0.57 0.96=0.57 0.98=0.57 0.95=0.57 1.00=0.60
Almousa R, Almatar A, Alfadagh A, Aggamy M, Algahwari M, Albagshi S
0.29
King Fahad Specialist Hospital Dammam, Saudi Arabia
0.38
0.98=0.56 0.98=0.57
0.55
1.00=0.59 1.00=0.58
<0.001
0.89=0.53
UP.016, Table 2. Multiple Logistic Regression Models to Determine Independent Predictors Associated with PV and PSA Odds ratio
95% CI
p-value
Age (≥50 years)
2.624
2.233-3.083
<0.001
Abnormal WC
1.904
1.587-2.285
<0.001
Abnormal TG
1.091
0.929-1.287
0.289
Abnormal HDL-C
1.209
0.971-1.506
0.090
Abnomal DBP
1.237
0.996-1.536
0.055
IR
0.910
0.739-1.120
0.372
Age (≥50 years)
1.404
1.149-1.714
0.001
IR
0.587
0.433-0.781
<0.001
PV
PSA
PV: prostate volume, WC: waist circumference, TG: triclyceride, HDL-C: high density lipoprotein cholesterol, DBP: diatolic blood pressure, IR: insulin resistance, PSA: prostate-specific antigen, CI: confidence interval.
investigated the relationship between IR and annual prostatic growth rates in healthy Korean men.
a study of Korean Men. Annual total PV growth rates were calculated.
Materials and Methods: A total of 144 men who visited the health care center for a routine health checkup were included in this prospective study from June 2010 to June 2015. We excluded men who had abnormal serum PSA level (≥4ng/ml), history of prostate surgery or who were taking prostate-related medication. Men were divided into two groups according to IR. Total prostate volume (PV) was measured using transrectal ultrasonogrphy of prostate (TRUS) by one examiner. The homeostasis model assessment of insulin resistance (HOMA-IR) index was calculated using the HOMA algorithm, glucose in mg/dl × insulin in μU/ml/405. The IR cutoff was defined as 2.0 based on
Results: The mean age, serum PSA and PV were 47.04±5.62 years, 1.11±0.64 ng/mL, 23.25±6.56 cc, respectively. There were no significant differences in baseline characteristics including age, underlying disease, serum PSA, PV between the two groups. There was no difference in serum PSA changes between the two groups during follow-up periods. However, the mean annual PV growth rate (1.91±1.36 cc/year) in the IR group (n=32) was significantly higher than the non-IR group (n=112, 1.04±3.25 cc/year) (p<0.05). The mean annual PV growth rate was significantly higher in the IR group, so IR could be influencing PV growth and it could be the key factor in pathogenesis of BPH and MS (Table 1).
134
Peristeen Transanal Irrigation System in Treating Adult Patients with Bowel Dysfunction: KFSH-Dammam Experience in Saudi Arabia
0.18
WC: waist circumference, FBS: fasting blood sugar, TG: triglyceride, HDL-C: high density lipoprotein cholesterol, SBP: systolic blood pressure, DBP: diastotic blood pressure, Home-IR: homeostatic model assessment-insulin resistance, PV: prostate volume, PSA: prostate-specific antigen
Variables
rean men, the IR group showed a further increase in prostate growth compared to the non-IR group. This study demonstrated that IR could be a risk factor for BPH and a common key pathogenesis in BPH and MS. Future studies are needed to confirm our results and to explain underlying mechanisms.
Introduction and Objective: To evaluate the efficacy and safety of the Peristeen© Transanal Irrigation system in treating faecal incontinence/soiling or chronic constipation in adults with neurogenic causes or due to chronic idiopathic constipation. Materials and Methods: This was a retrospective study of all adult patients with faecal incontinence/ soiling, or chronic constipation who were referred to our center in incontinence clinic and put on Peristeen© Transanal Irrigation system for management from January 2009 till December 2015. A validated faecal continence scoring system (Rintala and lindahl, 1995) was used to assess bowel function and social problems before and 6 months after treatment with Peristeen© (scoring system attached where 20 points are the highest). Patients included males and females. Only those who missed follow-up less than 6 months were excluded from the study. Length of follow-up in months, patient satisfaction (fully satisfied, partially satisfied or not satisfied) and complications related to the procedures were all assessed. Results: A total of 20 patients were included in the study. All patients were diagnosed with neurogenic bladder disorder with bowel dysfunction (soiling, constipation or both) due to MMC or SCI due RTA. A total of 16 males (80%) and 4 females (20%) were included. The median age was 21 (range 15-61). No patient was fully satisfied (0%), 16 were partially satisfied (80%) and 4 were not satisfied (20%) (all due to discomfort with the system and also no change in symptoms). The median follow-up time was 22.5 months (4-42). The median score of faecal continence improved from 5.5 (3-13) to 14 (5-17) out of 20 (p<0.0001). No complications (bleeding, perforation or infection) were reported among all patients who used the system. One patient died during follow-up due to other cause (sickle cell crises). The results show that satisfaction with the treatment is overall high with around 80% of patients. The improvement in symptoms according to the faecal continence score system was statistically significant comparing before and after treatment (p<0.0001). There were no complications recorded, which supports the safety of the system. Conclusion: The study shows that Peristeen© Transanal Irrigation system is a safe and effective modality in treating faecal incontinence/soiling or chronic constipation in patients with neurogenic causes and/
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.017, Table 1. Baseline Characteristics and Prostate Volume & Serum PSA Changes of Study Population According to IR
gen-deprived male rats were significantly enhanced, and germ cell apoptosis were reduced after treatment. Conclusion: We investigated the effect of KH-204 as
IR (n=32)
No IR (n=112)
p-value
Age (years)
46.09±5.03
47.31±5.78
0.06
DM
9.37% (n=3)
4.46% (n=5)
0.26
HTM
9.37% (n=3)
6.25% (n=7)
0.53
HOMA-IR
2.51±0.54
1.05±0.40
<0.001
PSA (ng/mL)
1.17±0.64
1.09±0.64
0.53
PV (cc)
23.13±6.23
23.28±6.68
0.90
PSAV (ng/mL/yr)
0.01±0.18
0.00±0.43
0.70
PV change (cc/yr)
1.91±1.36
1.04±3.25
0.02
DM: diabetes mellitus, HTM: hypertension, HOMA-IR: homeostatic model assessment-insulin resistance, PSA: prostate specific antigen, PV: prostate volume, PSAV: PSA velocity. *The p-value determined by Mann-Whitney U test.
or spinal cord injuries, with good overall patient satisfaction.
UP.019 Solifenacin Versus Trospium Chloride for the Relief of Stent-Related Symptoms Following Ureteroscopic Lithotripsy: A Comparative Study Mohamed Haytham M1, Zayed A2, Ghoneima W1, El Sheemy M1 1 Kasr El Aini Hospital, Faculty of Medicine, Cairo University, Egypt; 2Theodore Bilharz Research Institute, Cairo, Egypt
Introduction and Objective: The objective of this
study was to compare the effect of solifenacin versus trospium chloride on double-j (DJ) stent-related symptoms following uncomplicated ureteroscopic lithotripsy (URSL). Materials and Methods: A total of 166 adult patients
of both sexes aged 18-70 years, who underwent URSL with DJ ureteric insertion, were included in this simple randomized comparative study. Patients were randomly allocated to 2 groups. Group A was comprised of 99 patients who received solifenacin and group B had 67 patients receiving trospium chloride. The primary outcome measure was evaluation of postDJ irritative manifestations. All subjects were asked to complete a brief form ureteral symptom score questionnaire to assess the lower urinary symptoms, stent-related body pain and hematuria two weeks after operation. The secondary outcomes included drug-related adverse effects during the study period. Patient demographics, significant operative details, and stone characteristics were reported. Results: The study participants showed statistical-
ly significant difference in mean age of both groups (p=0.001), with 36 ± 8.9 vs. 41 ± 11.63 years in group A and group B, respectively. There was no significant difference between both groups for the stent size, distal and proximal coil, operative time, and stone size. Based on the total score of lower urinary tract symptoms, urgency (0.35 ± 1.72), flank pain (0.85 ± 1.63) and abdominal pain scores (0.38 ± 0.87) were significantly correlated with significantly lower in solifenacin group compared to group B (0.35 ± 1.72 vs. 1.76 ± 1.84, p<0.001, 0.85 ± 1.63 vs. 1.52± 1.72,
p=0.012, 0.38 ± 0.87 vs. 0.62 ± 0.78, p=0.071), respectively. Concerning urethral pain and hematuria, there was no significant difference between mean scores of both groups. Drug-related side effects constituting dry mouth, constipation, and headache were higher in group B than group A, with reported frequencies of 14, 11 and 6 in patients receiving trospium chloride. Conclusion: For patients undergoing URSL and
double-j stent fixation, the postoperative use of solifenacin is more effective and well tolerated for the treatment of lower urinary symptoms, which mainly include urgency and body pains, especially flank and abdominal pains, than the use of trospium chloride.
UP.020 The Herbal Formulation, KH-204 Protects Oxidative Stress via ERK and Akt Pathways in Vitro and in an Androgen-Deprived Rat Model Bae WJ, Jeong HC, Choi SW, Lee KW, Kim KS, Bashraheel F, Kim SJ, Cho HJ, Ha US, Hong SH, Lee JY, Kimi SW Dept. of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Introduction and Objective: A Korean herbal formulation, Ojayeonjonghwan, is used to treat late-onset hypogonadism (LOH) symptoms including erectile dysfunction (ED). A previous study demonstrated that a modified Ojayeonjonghwan (KH-204) could be developed as a therapeutic alternative medicine to improve ED. We examined the pharmacological effects of KH204 in vitro and in an androgen-deprived rat model. Materials and Methods: The survival rate of TM3
Leydig cells treated with KH-204 was measured based on oxidative stress. Androgen-deprivation was induced by s.c. injection of leuprorelin. After daily intake of KH-204 for 4 weeks, the testes and epididymides from the rats in all groups were removed, weighed and subjected to histopathological examination. In addition, serum testosterone level, oxidative stress, and apoptosis were measured. Results: The results showed that KH-204 protected TM3 cells from oxidative stress via activation of the ERK and Akt pathways. The levels of serum testosterone and activation of spermatogenesis in andro-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
an alternative treatment to reverse testicular dysfunction in LOH. The therapeutic effects are likely, at least in part, attributable to reduced oxidative stress via ERK and Akt-dependent signaling pathways.
UP.021 Androgen Deprivation Therapy with Degarelix Compared to Leuprolide Increases Survival in a Cardiovascular Disease Model of Ins2+/Akita: apoE-/- Mice Duivenvoorden W1, Werstuck G2, Hopmans S3, Pinthus J4 1
St. Joseph’s Healthcare, Hamilton, Canada; McMaster University, Dept. of Surgery, Hamilton, Canada; 2 TaARI, Hamilton, Canada; McMaster University, Hamilton, Canada; 3St. Joseph’s Healthcare, Hamilton, Canada; 4McMaster University, Hamilton, Canada Introduction and Objectives: Cardiovascular disease (CVD) is one of the most common causes of mortality in prostate cancer patients. In prostate cancer treatment, androgen deprivation therapy (ADT) is associated with weight gain and the development of metabolic syndrome. However, different modes of ADT can achieve castration. A post-hoc analysis of phase III trials suggests that GnRH-antagonists are associated with less cardiac events in men with pre-existing CVD during the first year of ADT. We investigated the effects of GnRH-agonist and GnRH-antagonist on the development of CVD in two mouse models of atherosclerosis, Ins2+/Akita: apoE-/- mice who succumb to CVD and LDLR-/- mice Materials and Methods: Ins2+/Akita: apoE-/- and LDLR-/- mice (n=10/group) were used to compare the effects of GnRH-antagonist (degarelix) and GnRH-agonist (leuprolide). Longitudinal weight gain (4 months), visceral fat accumulation (CT measurements), fasting glucose and glucose tolerance, blood pressure, and testosterone levels were studied along with characteristics of aortic atherosclerotic plaques in LDLR-/- mice. Survival was determined in Ins2+/Akita: apoE-/- mice using the Kaplan-Meier method. Logrank test was used to compare survival between GnRH agonist and antagonist. Results: Leuprolide-treated LDLR-/- mice gained significantly more weight and visceral fat compared to mice treated with degarelix. Significantly better glucose tolerance was recorded in mice treated with degarelix. The aortic atherosclerotic plaque area in leuprolide-treated mice was significantly larger than in control mice, but not significantly different from control after degarelix-treatment. The necrotic plaque area in degarelix-treated mice was significantly smaller than in leuprolide-treated mice (0.26 ± 0.07% vs. 1.34 ± 0.38% of total aortic area, p=0.011, t-test). Kaplan-Meier plots show that degarelix-treatment of Ins2+/Akita: apoE-/- mice led to significantly longer median survival compared with leuprolide-treatment (39.7 vs. 31.1 weeks, p=0.022, log-rank test). Conclusions: In preclinical mouse models, the use of GnRH-antagonist attenuates the development of ath-
135
UNMODERATED ePOSTERS erosclerosis and the metabolic syndrome and is associated with increased survival.
UP.023 Integrative Genitourology Neu E1, Michailov M1, Senn T1, Lütge C1,2, Bauer HW1,3, Ernst G1,4, Härlin U1, Martin D1, Hofstetter A1,5, Weissenbacher ER1,6, Welscher U1, Schratz M1,7, Weber G1,8 1
Inst. Umweltmedizin c/o ICSD/Int.Acad.Sci. e.V., POB 340316, 80100 Muenchen, Germany; 2 Techn. Univ. Muenchen, Dir. Inst. Ethics, Germany; 3 Univ. Muenchen, Free Univ. Berlin, Med. Fac. (Urology), Germany; 4Univ. Muenchen, Med. Fac. (Urology), Germany; 5Univ. Muenchen (Urology), Dir.a.D., Klinikum Grosshadern, Germany; 6 Univ. Muenchen, Dir.a.D., Dept. Gynecology, Germany; 7Univ. Innsbruck, School of Education (Dean), Austria; 8Univ. Luxembourg&Vienna, Fac. Psychology (Dean), Austria Introduction and Objective: Ultraspecialization in medicine lead to mono-/oligodimensional considering of patients. Future needs creation of an integrative genitourology (GU) including multidimensional and holistic treatment helping for higher effectivity and reduction of enormous therapeutic financy. Proposal for discussion is given by example with systematic theoretical, clinical, and experimental approaches. Materials and Methods: Theoretical-clinical-experimental approaches (see A-F). Results: Recent/earlier. Conclusions: Similar systematic long-term interdis-
ciplinary investigations (A-F) in context of an integrative genito-urology could open new dimension for vesical electro-pharmacotherapies. Amongst others a new hypothesis of bladder function: After the active collecting (sympathetic) phase (max.-stretch) probably are activated trigonal-pacemaker mechanisms (STC) leading to expulsion (parasympathetic-phase) (reflex or conscious-micturition). Detrusor excitation is probably induced by transformation by spikes into burst-plateau activity, i.e. by stretch-channels Ca++-activated K+). Further investigation could help for development of a direct vesical electrostimulator (neurogenic and/or myogenic) related to pharmacotherapy (inhibition-sensitization). Further investigations could support UNO-Agenda21 for better health, education and economy on global level. A. Problems of moral philosophy - normativemetaethics (deonotology/axiology), also relativismabsolutisms (e.g. utilitarisms/non-cognitivism). - in GU are very complex: It is necessary foundation of
philosophical departments to hospitals/clinics incl. existing social&psychological units. Psychosomatics: Adjuvant therapy for genito-urological patients incl. respiratory/music/physical-exercises, evaluated by psychic-items (“polar-attitude-list”) relaxed/open/ clear-etc. and parameters induce strong positive changes upto 50% correlated with decrease of respiratory cardiac frequency/blood pressure (n=50, p<0.01). B.
Psychology-psychosomatics:
C. Clinical genito-urology: Analysis of radio-oncological
patients with radiocystitis incl. bladder-hypertonia/ reduced volume/incontinency (cystotonometry, n=133)
136
demonstrate possibility for more effective treatment by combined psycho-/phyto-pharmacological/radiochemo-therapy. D. Experimental genito-urology: New approaches to pathogenesis-therapy conc. functional disturbances of pyelonephritis/nephrolithiasis, incontinence/overactive-bladder, abortus/partus-praematurus are given by discovery of periodic slow tonic motor-oscillations in urinary-bladder (rat/guinea-pig) in-vivo et in-situ/ in-vitro et in-toto (isovolumetric cystotonometry). These slow tonic contractions appear also in isolated preparations of trigonum (STC: 0.28±0.15/min, n=94) after stretch (3 to 80 mN) independent from spontaneous phasic contractions of vesical detrusor (SPC: 4.04±0.75/min, n=420). E. Detrusor myocytes (intracellular rec., n=120). Mechanosensitive ionic channels are evident also electro-physiologically: After stretch 3-80 mN ap-
pear spkie transformation (63.29±4.96/min) into burst-plateaus (1.45±1.18/min), augmentation rate of spike-rise (RR: 0.41±0.19/3.27±0.76 V/s) and spikefall (RF: 0.43±0.28/2.32±0.58 V/s resp.). F. Human relevance of animal experiments: Replacement of many animal-experiments could be realized by application of human urogenital-preparations (surgical-tissue): Comparative investigations demonstrate strong physiological/morphological (ultrastructure) differences, e.g. human/guinea-pig detrusor/ureter/ vas-deferens (n≥300).
UP.024 Renal Arterial Infusion of Adipose Tissue-Derived Stromal Vascular Fraction Protects the Renal Function Against Acute Kidney Injury Induced by Ischemia-Reperfusion Injury Lee C1, You D1, Jang MJ2, Kim BH1, Jeong IG1, Hong B1, Kim CS1, Park SH3 1
Dept. of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; 2 Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; 3Dept. of Urology, Haeundae Paik Hospital College of Medicine, Inje University, Busan, South Korea Introduction and Objectives: Acute kidney injury
(AKI) induced by ischemia-reperfusion injury (IRI) is a major challenge in critical care medicine, with high rates of in-hospital morbidity and mortality. Preclinical studies suggested that administered cultured stem cells protected kidney function against AKI induced by IRI. Due to several concerns regarding the implantation of cultured stem cells into humans, however, recent clinical studies have focused on the use of stromal vascular fraction (SVF) in treating various diseases. The purpose of this study was to determine the therapeutic effects of adipose tissue-derived SVF and the optimal route for SVF delivery in a rat model of AKI induced by IRI. Materials and Methods: Fifty male Sprague-Dawley
rats were randomly divided into 5 groups (10 animals per group): sham, nephrectomy control, IRI control, intra-renal arterial SVF infusion, and subcapsular SVF injection. To induce AKI induced by IRI, the left renal artery was clamped with a non-traumatic vas-
cular clamp for 40 minutes, and the right kidney was removed. Serum creatinine and glomerular filtration rate (GFR) were evaluated 1 day prior to IRI, and 2, 4, 7, 14 days after IRI. For histomorphometric studies, the kidney was removed 2 weeks after IRI. Results: Intra-renal arterial infusion and subcapsular injection of SVF significantly reduced the increase in serum creatinine compared with the IRI control group 2 days after IRI. The GFR of intra-renal arterial SVF infusion group was maintained at a level similar to those of the sham and nephrectomy control groups 14 days after IRI. Masson’s trichrome stain for the degree of fibrosis showed that intra-renal arterial infusion of SVF was significantly less fibrosis than that observed in the IRI control group (P < 0.001). Staining for alpha-smooth muscle actin showed that the number of small vessels was noticeably higher in the intra-renal arterial SVF infusion and subcapsular SVF injection groups than in the IRI control group (P < 0.001). The number of terminal transferase-mediated dUTP nickend labeling-positive cells increased after IRI, suggesting apoptosis or necrosis had occurred. Terminal transferase-mediated dUTP nick-end labeling assay showed significantly decreased apoptosis in both the intra-renal arterial SVF infusion and subcapsular SVF injection groups than compared to the IRI control group (P < 0.001). A greater increase in glutathione reductase and glutathione peroxidase was observed in both the intra-renal arterial SVF infusion and subcapsular SVF injection groups than in the IRI control group (P < 0.001). These findings further suggest that anti-oxidative responses were elicited by IRI and SVF treatment contributed to further anti-inflammatory and anti-oxidative effects after IRI in this study. Conclusion: Our study showed that renal function is
effectively rescued from AKI induced by IRI through administration of SVF in rat models and intra-renal arterial infusion of SVF was more effective than subcapsular injection.
UP.025 Radical Cystectomy in the Elderly Population: Is This a Safe Treatment Option? Young M, Elmussareh M, Dooldeniya M, Weston P Mid-Yorkshire Hospitals, Wakefield, England Introduction and Objective: Radical cystectomy is often not offered to ‘elderly’ patients with bladder cancer because of supposed increased risks of complications. We aim to determine if significant differences exist in the peri-operative outcomes of patients over 75 years treated with radical cystectomy compared to younger patients. Materials and Methods: Retrospective analysis of
prospectively collected data; 81 consecutive radical cystectomies between May 2013 and June 2015. Patients were divided into 2 groups: <75years (n=51) and ≥75years (n=30). Co-morbidities, peri-operative complications were compared. Fisher’s exact test was used for statistical analysis. Results: A total of 68 out of 81 cases were performed laparoscopically. Mean age was 70.7 years (36–85). A total of 37 subjects had muscle invasive disease, while 42 had non-muscle invasive disease. Median hospital stay was not significantly different between the
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.025, Figure 1. Charlson Score for the 2 Cohorts of Patients, Including Fisher Exact p Values Charlson Score
<75 years old (n=51)
>75 years old (n=30)
Fisher Exact p value
0
34 (67%)
14 (47%)
0.10
1
10 (20%)
9 (30%)
0.29
2
5 (10%)
4 (13%)
0.72
3
1 (2%)
3 (10%)
0.14
≥4
1 (2%)
0
1
UP.025, Figure 2. Clavien-Dindo Score Divided into Minor and Major for the 2 Cohorts of Patients, Including Fisher Exact p Values Clavien-Dindo Score
<75 years old (n=51)
>75 years old (n=30)
Fisher Exact p value
Nil
22 (43%)
10 (33%)
0.48
Minor (1-2)
26 (51%)
15 (50%)
0.99
Major (3-5)
3 (6%)
5 (17%)
0.14
two groups (10 vs. 11 days). There was no significant difference in the pre-operative Charlson co-morbidity index (Figure 1). Thirty-day mortality rate was 4% for <75years and 6.6% for ≥75years, with overall peri-operative complication rates of 57% vs. 67%, respectively. The majority of complications were minor (Clavien-Dindo I-II) and no statistical significance was demonstrated between the 2 cohorts (Figure 2). No statistical difference was found in blood transfusion rates (p=0.83). Conclusion: Radical cystectomy in those ≥75 years
has similar peri-operative morbidity compared with younger patients and can be offered in selected elderly patients. Age should not be an absolute contraindication for radical cystectomy.
UP.026 Comparative Study on the Efficacy of Holmium Laser with Local Anesthesia and Transurethral Resection of the Bladder Tumor (TURBT) in Patients with Non-Muscle Invasive Bladder Cancer (NMIBC) Razaghi M, Javanmard B, Yavar M, Qashqai H Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction and Objective: Transurethral resection
of the bladder tumor (TURBT) remains the gold standard for non-muscle invasive bladder cancer (NMIBC). Laser techniques have been widely used in urology. This study studied the safety and efficacy of holmium laser resection of the bladder tumor (HoLRBT) versus TURBT. Materials and Methods: Data from 76 patients with
primary non-muscle invasive bladder cancer were collected. The patients were divided into two groups, those treated by holmium laser resection (HoLRBT group), and those with transurethral electroresection (TURBT). The patient demographic data and tumor characteristics were compared between the two groups before surgery. The intraoperative complications and postoperative characteristics of the HoL-
RBT and TURBT groups were compared. The data of operation time, obturator nerve reflex rate, bladder perforation, bladder irrigation, catheterization time, hospital stay, and 1, 3, 6, 12, 18 months recurrence free survivals were compared between the two groups. Results: There was no significant difference in operative duration between the two groups. Compared with the TURBT group, the HoLRBT group had less intraoperative and postoperative complications, including obturator nerve reflex, bladder perforation, as well as bleeding and postoperative bladder irritation. There were no significant differences between the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoLRBT group had less catheterization and hospitalization time in comparison to those in the TURBT group, and there were no significant differences in the overall recurrence rate between the TURBT and HoLRBT groups (P > 0.05). Conclusion: HoLRBT is a safe and efficient method
that showed several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in patients with non-muscle invasive bladder cancer.
UP.027 A Comparison of Squamous Cell Carcinoma (SCC) of the Bladder with Transitional Cell Cancer (TCC) Treated by Radical Cystectomy Robinson S, Motiwala H, Bhardwa J Frimley Health Foundation Trust, Surrey, United Kingdom Introduction and Objective: Worldwide, SCC is relat-
ed to schistosomiasis. Most series show male predominance. Grading has not been formalized. Treatment is surgical, with radiotherapy and chemotherapy being evaluated. There is a low 5-year survival of 7-50%. Materials and Methods: The study population was 258 patients who underwent radical cystectomy. A total of 230 had transitional cell cancer and 17 had squamous cell cancer on final histology. Patients were
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
followed up over 9 years and procedures were performed by a single surgeon. Results: See Table 1.Our series showed a predominance of women. The grade of squamous cell tumours is significantly lower than TCC yet have a far worse prognosis. Related to the larger tumour volume and greater proportion of locally advanced cases with positive surgical margins. Interestingly, we do not see any greater lymph node involvement. There was no difference in neo or adjuvant treatments. We see an earlier tendency to progression (local recurrence or metastasis), a lower disease specific mortality and a far lower all cause mortality with SCC. Conclusions: We see the worse prognosis appears to be due to very large, low and intermediate grade tumours that are locally advanced tending to positive surgical margins.
UP.028 Low-Power Setting Plasmakinetic Bipolar Versus Monopolar Transurethral Resection of Non-Invasive Bladder Cancer Dalva I1, Akan H1, Yildiz O1, Albayrak AL2 1
Dept. of Urology, Bayindir Hospital, Ankara, Turkey; Dept. of Pathology, Bayindir Hospital, Ankara, Turkey
2
Introduction and Objectives: To compare the safety, efficacy and morbidity of low-power setting plasmakinetic bipolar versus conventional monopolar power in the transurethral resection of non-invasive bladder cancer. Materials and Methods: In our retrospective study, 96 patients underwent monopolar transurethral resection (group I) and 75 patients underwent low-power setting (30 W cutting 40 W coagulation) plasmakinetic bipolar transurethral resection (group II) of bladder tumors between 2008 and 2016 at the Bayindir Hospital Urology Department. Resected tissue was examined by a pathologist who recorded the number of tumors, tumor size, tumor shape, location, grade, invasion of muscularis propria, and presence of muscularis invasion and cautery artifact. The operating time, hospital stay, blood loss and intraoperative and postoperative complications were recorded. Results: The median age of patients was 59 years, and 45 patients had multiple tumors. The mean tumor size was 2.4 cm and 2.1 cm respectively. The mean operative time was 25 min for bipolar plasmakinetic transurethral resection of the bladder tumor and 38 min for monopolar transurethral resection (p<0.05). No significant differences in the mean change of hemoglobin were observed. Mean catheterization time was 1.5 days for bipolar plasmakinetic energy and 3.4 days for monopolar transurethral resection of bladder tumors respectively (p<0.05). The mean hospital stay was shorter in the bipolar plasmakinetic transurethral resection of bladder tumors (2.2 vs. 3.4 days respectively). Bladder perforation was reported in three cases for the monopolar transurethral resection and obturator nerve reflex occurred in four cases for monopolar transurethral resection. No bladder perforation and obturator jerk were seen for low-power setting plasmakinetic bipolar transurethral resection. A significantly lower incidence of tissue distortion from thermal artifact was seen in the low-setting power plasmakinetic bipolar group (12% vs. 45% p<0.05).
137
UNMODERATED ePOSTERS
6/11
185/45
0.03
Age
67
68
0.58
Neobladder
2
51
0.37
Grade High
9
213
0.0001
Intermediate
6
17
0.0021
Low
2
0
0.0045
progression in group 1 was 18 months (range 3-45) and in group 2 was 15 months range (3-45), Side effect of intravesical instillation distributed in both groups approximately in the same level, in group I; 42 patients (31%) with post instillation symptoms in the form of lower urinary tract symptoms (LUTS) in 28 patients (21%), 4 patients (3%) epididymitis, 4 patients (3%) by hematuria and 6 patients (4%) presented by fever, chills and flu-like symptoms, in group II 36 patients (30%) presented by post instillation symptoms in the form of (LUTS) in 24 patients (20%), 2 patients (1.7%) epididymitis, 4 patients (3.3%) by hematuria and 6 patients (5%) presented by fever, chills and flu-like symptoms.
UP.027, Table 1. 17 Squamous cell
230 Transition cell
P value fishers and t
3
32
0.7
Private Male/female
Tumour volume cc
101
14
0.019
Conclusion: The efficacy of chemo immunothera-
Positive surgical margins
6/17 (35%)
21/230 (9%)
0.0052
Localised/locally advanced
3/14 (17%)
140/90 (61%)
0.0006
CIS
6
105
0.45
py in superficial cancer bladder TCC is evident over immunotherapy alone. Side effects do not appear to increase, but a multicenter trial is indicated to consolidate these results.
Node positive patients
4
51
1.0
UP.030
Number of nodes positive (total number of nodes)
13
128
Liver Dysfunction After Open Radical Cystectomy and Relationship to Commonly Administered Treatments
Node harvest
214
2299
Node density
0.06
0.055
2
22
2/13 = 0.15
22/128 = 0.17
1.0
Prostate cancer
2/6 =0.33
83/185 = 0.45
0.69
Complications
4
59
1.0
Additional treatment
2
44
0.76
Progression free survival at 5 years
0.625
0.76
0.046
Disease specific survival at 5 years
0.5
0.71
0.0037
All cause survival at 5 years
0.187
0.61
0.0001
Number of disease specific deaths
8 (47%)
80 (35%)
0.31
Number of all cause deaths
14 (82%)
113 (49%)
0.010
Extracapsular extension Proportion of ECE
Conclusion: Low-power setting plasmakinetic bipo-
lar transurethral resection of bladder tumour represents a safe, effective and low-morbidity procedure in the management of non-invasive bladder cancer. Low-power plasmakinetic bipolar resection appears to cause less tissue distortion and has the potential to facilitate staging and grading of bladder tumors.
UP.029 Immediate MitomycinC Instillation Followed by Usual BCG Course Versus Usual BCG Alone for Superficial Transitional Cell Carcinoma of the Bladder Abdelkader O1, Mokhtar N2, Mohy El Den K3 1
Suez Canal University Hospital, Ismailia, Egypt; Cairo University Hospital, Egypt; 3Fayoum University Hospital, Egypt 2
Introduction and Objective: We present our expe-
rience with combination of chemo immunotherapy [mitomycin (MMC) + Bacillus Callmette Guerin (BCG)] in comparison to single agent BCG immunotherapy in regards to efficacy and side effects for superficial cancer bladder transitional cell carcinoma TCC with at least 6 months follow-up.
138
0.75
Bass E, Parr N Wirral University Trust Hospitals, United Kingdom
Materials and Methods: Between July 2004 and June 2014, 256 patients (172 men and 84 women) with histologically proven bladder TCC and a mean age of 54 years were included into this prospective study. The definitive stage was Ta in 10 patients and T1 in 246 patients, while the grade was grade I in 36, grade II in 172 patients and grade Ill in 48 patients. All patients underwent transurethral resection of the bladder tumor (TURBT) and were then randomly divided into two groups. Group one included 136 patients who received immediate 40 mg mitomycinC (MMC) followed by BCG weekly for 6 weeks 3 weeks post TURBT. Group two included 120 patients who underwent BCG instillation weekly for 6 weeks post TURBT by 3 weeks with follow-up cystoscopy. Results: Follow-up ranged from 6-45 months, with a mean of 26 months. Out of the group 1, 86 patients (63%) were free at last follow up, 34 (25%) showed recurrence and 16 (12%) showed muscle invasive progression and in group 2; 54 patients (45%) were free at last follow up, 40 (33%) showed recurrence and 26 (22%) showed muscle invasive progression. The mean interval to recurrence was 15 months range (3-45) in group 1 and 13 months range (3-45) in group 2 and the mean interval to
Introduction and Objectives: Complications are common following open radical cystectomy (ORC) and their causes are multifactorial, but of importance is the risk of a prolonged stress response, for which the liver is the metabolic epicentre. Liver dysfunction (LD) occurs after major surgery, sometimes due to hepatic ischaemia, but other agents administered in the perioperative period are also known to cause LD even in the absence of surgery. This study observed LD post ORC and its relationship with antibiotic use, low molecular weight heparins (LMWHs), blood transfusion (BT) and statins. Materials and Methods: A single centre retrospective study of 39 consecutive ORCs between 2013 and 2014. Aspartate transaminase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), bilirubin and platelet (PLT) levels were measured daily postoperatively for up to day 21. Differences were analyzed using Student’s T-test. Patients were separated into groups based on use of statins, antibiotics, LMWHs and BT. Differences in liver function tests (LFTs) were analyzed by linear regression analysis and ANOVA. Results: Mean pre and postoperative LFTs are shown in Table 1, with significance compared to preoperative levels. Lower levels of ALP and GGT were seen in patients using statins (p<0.0001), higher levels in those receiving postoperative antibiotics (p<0.0001). Dose-dependent increases in postoperative ALP and GGT were seen in those receiving LMWHs (treatment > reduced> standard doses, p<0.0001). BT of 3-5 units packed RBCs was associated with higher levels of ALP and GGT (p<0.0001). One patient developed profound hepatitis, although none jaundice. Conclusion: Postoperative LD is a common sequela
following ORC, and is associated with administration of antibiotics, LMWHs and BT. Statins may be protective of this effect, possibly in keeping with studies demonstrating decreased mortality/morbidity in patients undergoing major vascular surgery and suggesting the need for further studies in urological patients.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS significantly associated with RFS (G-CSF; HR=7.78, P=0.002, GM-CSF; HR=5.07, P=0.005).
UP.030, Table 1. AST
ALP
GGT
Bilirubin
Platelets
Conclusion: High G-CSF and low GM-CSF expres-
Normal values
5-45 U/L
25-110 U/L
<65 U/L
1-20 μmol/L
150-400 x 109L
Preop
20
88
45
2
287
sion in tumor cells were significantly associated with an increased risk of recurrence in MIBC.
Day 2
35*
61***
38
10***
205****
Day 7
42**
129**
123***
7
343****
Day 21
33*
158***
145***
5
507****
UP.033 Trans-Urethral Resection of Bladder Tumor: Is Length of Stay Increased by Antiplatelet Therapy? Prader R1, De Broca B2, Durand M1, Tibi B1, Treacy PJ1, Parassol-Girard N1
* = P<0.05 ** = P<0.01 *** = P<0.001 **** = P<0.0001
1
CHU Pasteur II, Nice, France; 2CHU Amiens, France
Introduction and Objective: Trans-urethral resection
UP.031 Neoadjuvant Chemotherapy in Patients with Muscle-Invasive Bladder Cancer: Impact on Radical Cystectomy Morbidity Nguyen TT1, Huillard O2, Barry Delongchamps N3, Sibony M2, Saighi D3, Zerbib M3, Peyromaure M3, Xylinas E3 1 University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; Dept. of Urology and Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France; 2Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, France; 3Dept. of Urology and Oncology, Cochin Hospital, Assistance PubliqueHôpitaux de Paris, Paris Descartes University, France
and acute renal insufficiency (7.5%). In the group of late complication, minor and major complications were 20% and 80%, respectively. After cystectomy, mortality was 5%. Conclusions: The NAC had a significant toxicity, but most of patients having side effects had mild symptoms (grade ≤2). The use of NAC was not associated with higher perioperative morbidity and mortality.
UP.032 CD204, G-CSF, GM-CSF and PD-L1 Expression in Muscle Invasive Bladder Cancer Morizawa Y, Miyake M, Oonishi K, Hori S, Tatsumi Y, Nakai Y, Anai S, Tanaka N, Fujimoto K
Introduction and Objective: The efficiency of neo-
Dept. of Urology, Nara Medical University, Japan
adjuvant chemotheraypy (NAC) with methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) for muscle-invasive bladder cancer (MIBC) has been prospectively demonstrated within Level I evidence studies. However, NAC with gemcitabine and cisplatin (GC) or other regimens are widely used in the clinical neoadjuvant setting. The purpose of this study was to investigate the impact of neoadjuvant chemotherapy on perioperative morbidity according to the chemotherapy regimens in bladder cancer patients undergoing radical cystectomy.
Introduction and Objective: Immune cell expression
Materials and Methods: Data were collected retro-
in tumors and in tumor-infiltrating immune cells has been widely reported as an influential factor in the tumor microenvironment for urothelial carcinoma. We evaluated CD204, granulocyte colony stimulating factor (G-CSF), granulocyte macrophage colony stimulating factor (GM-CSF) and programmed cell death ligand 1 (PD-L1) expression in the tumor microenvironment for muscle invasive bladder cancer (MIBC) to determine their clinicopathological features and cancer prognosis. Materials and Methods: We included the data from
spectively on 40 patients with urothelial carcinoma of the bladder who received at least two cycles of NAC, followed by radical cystectomy (RC), between 2010 and 2015 at Cochin hospital. The primary outcomes were toxicities of NAC, perioperative complications, morbidity and mortality.
a total of 58 patients who underwent radical cystectomy (RC) for MIBC. Tumor specimens from initial TURBT before RC were calculated. CD204, G-CSF, GM-CSF and PD-L1 expression were evaluated by immunohistochemistry.
Results: Among these cases, 23 patients (57.5%) re-
Results: CD204 expression in tumor infiltrating cells
ceived MVAC, 4 patients (10%) received GC, and 13 patients (32.5%) received other regimens. In this study, 85% of patients had at least one of side effects of NAC, grade ≥3 was 20% and 20% of patients had an incomplete chemotherapy because of toxicity. The gastrointestinal effects were the most common toxicity of this series (47.5%). This study showed that 35% of patients had at least one early complication (30 days or less) after cystectomy followed by late complication (31 to 90 days) in 12.5% of the cohort. Overall minor (grade 1-2) and major (grade 3-5) complications were 66.7% and 33.3%, respectively. In the group of early complication, minor and major complications were 78.9% and 21.1%, respectively. The most common early comorbidity included urinary infection (25%)
was low in 34 patients (59%) and high in 24 patients (41%). G-CSF expression in tumor cells was low in 32 patients (55%) and high in 26 patients (45%). GMCSF expression in tumor cells was low in 28 patients (48%) and high in 30 patients (52%). PD-L1 expression in tumor cells was low in 33 patients (57%) and high in 25 patients (43%). Low GM-CSF in tumor cells was significantly associated with pathological T stage (P=0.035). In univariate analyses, high CD204, high G-CSF, low GM-CSF and high PD-L1 expression were associated with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). In multivariate analyses, pathological T stage was significantly associated with RFS, CSS and OS. High G-CSF and low GM-CSF expression were
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
of bladder tumor (TURBT) is considered to present a moderate or high risk of bleeding during the surgical procedure. The number of patients on antiplatelet drugs has been increasing, and we wanted to assess their impact on the outcome of patients undergoing scheduled TURBT. Materials and Methods: Retrospective assessment of non-inferiority on 450 consecutive procedures performed between April 2013 and June 2015 was done. Patients were divided in two groups: naive or antiplatelet drug user. The primary endpoint was the average length of stay (ALOS). Non-inferiority was set at 1 day. A subgroup analysis comparing acetylsalicylic acid (ASA) and clopidogrel to naive was performed. Multivariate analysis was performed to find the determinants of longer ALOS. Results: A total of 325 TURBT were included, 117 on antiplatelet drugs (85 ASA and 32 clopidogrel) and 208 naive (of which 117 consecutive were analyzed). ALOS were 2.5 days (naive) vs. 2.9 days (antiplatelet). The subgroup analysis found an ALOS of 2.6 days (ASA) vs. 3.7 days (clopidogrel). Clopidogrel therapy OR = 4.1 (1.7 to 9.6), duration and depth of resection, emerged as a determinant of longer ALOS in multivariate analysis. Perioperative management of antiplatelet therapies was achieved according to recommended practices. Conclusion: ALOS of patients under antiplatelet was
not clinically different from naive patients. This result was identical for patients with ASA. However, clopidogrel increased the length of stay and questioned on its perioperative management.
UP.034 Short-Term Outcome Analysis of a New Technique of Ureteroileal Anastomosis “Tube in Tube Technique” Rawal S, Singh A, Basal P, Chatterjee S, Shah S, Shukla H Rajiv Gandhi Cancer Research Institute & Research Center, New Delhi, India Introduction and Objective: Prospective analysis of short-term outcome of a new technique of ureteroileal anastomosis was analysed at our centre. Materials and Methods: We started this study from October 2015 onwards after getting permission from an ethical committee. Between October 2015 and March 2016, a total of 33 patients underwent radical cystectomy or anterior exenteration with urinary diversion. Mean patient age was 61.12 years, and the
139
UNMODERATED ePOSTERS number of males and females included were 29 and 4 respectively. Ileal conduit and orthotopic ileal neobladder were made in 18 and 15 patients respectively and data were collected from prospectively maintained computerized database. Results: Mean operative time for only ureteroileal anastomosis during extracorporeal and intracorporeal urinary diversion was 22.6 and 46.6 min respectively. Mean preoperative creatinine was 1.16 mg/dl with standard deviation of 0.317. Mean creatinine on post-operative day 3, 12, and on 6th weak were 1.02, 1.09, and 1.22 with standard deviation of 0.37, 0.19, and 0.24 respectively. Statistical analysis to determine any change in preoperative and postoperative creatinine during follow up was done with SPSS 21 version. On repeated measure ANNOVA test, the p-value was 0.101. Two patients developed acute pyelonephritis and both had history of diabetes mellitus. Three patients developed hydroureteronephrosis during follow-up but on diuretic renogram they had non-obstructive drainage with preserved renal function. Only 1 patient had urine leak in the immediate postoperative period, and this was managed conservatively.
UP.035, Table 1. Detection Rate of Different Bladder Lesions Using White and Blue Light Cystoscopy Detection rate (sensitivity)
Any malignancy
Any papillary
Low Grade papillary
High Grade papillary
CIS
White light only
73%
87%
83%
87%
52%
Blue light only
91%
90%
82%
92%
95%
Either white or blue light
98%
99%
98%
99%
98%
UP.035, Figure 1. Detection Rate of BLC after BCG Therapy and at Margins of Prior Resection
Conclusion: Though we have results of short-term
follow-up, the “Tube in Tube technique” is better in terms of decreased urinary leak, shorter operative time, and decreased rate of upper tract change in comparison to historical control. None of our patients developed anastomotic stricture during follow-up.
UP.035 Blue Light Cystoscopy for Diagnosis of Urothelial Bladder Cancer in Controversial Situations: Results from a Prospective Multicenter Registry Bazargani S1, Clifford T1, Djaladat H1, Daneshmand S1, Schuckman AK1, Willard B2, Konety B3 1
USC Institute of Urology, Los Angeles, United States; Carolina Urology Partners, Lexington, United States; 3 University of Minnesota, Minneapolis, United States 2
Introduction and Objectives: Blue Light Cystoscopy (BLC) using hexaminolevulinate (Cysview) improves the detection of non-muscle invasive bladder cancer (NMIBC). We report on our experience from the prospective Blue Light Cystoscopy with Cysview Registry and its utility in these scenarios. Materials and Methods: Under IRB approval, we prospectively enrolled consecutive patients undergoing transurethral resection of bladder lesions into the registry at three different centers. Patients who refused catheter insertion (3), had pure upper tract or prostatic urethral lesions (5) or were lost to follow up (7) were excluded from the study. Results: A total of 548 separate lesions were identi-
fied from 220 BLC procedures on 175 patients at three different centers between April 2014 and Oct 2015 (40 patients underwent repeat use). The sensitivity of WL, BL and the combination for any malignant lesion was 73%, 91% and 98% respectively. The addition of BL to standard WL cystoscopy increased the detection rate by 12% in any papillary lesions and 46% for CIS (Table 1). BL resulted in upgrading or upstaging of tumors in 18 (10%) patients of the whole cohort. Overall false-positive (FP) proportion was 21% for WL and
140
25% in BL (p=0.96). 60 (34%) patients received BCG at least 6 weeks prior to BLC, with a positive predictive value (PPV) of 67% for malignancy (FP=25%) (Figure 1). A total of 46 biopsies were taken from margins of a previous resection site (with more than 6 weeks’ interval), wherein the PPV of BLC was 54% (FP=28%). There were 8 (4.5%) minor complications after Cysview instillation (all mild irritative urinary symptoms), but no hypersensitivity reaction. A total of 22 patients eventually underwent cystectomy, 2 (1.2%) of whom exclusively because of lesions detected by BLC. Conclusions: Our experience with a prospective
registry confirms that BLC significantly increases detection rates of CIS and papillary lesions over WL cystoscopy alone. Prior BCG therapy appears to have no effect on BLC accuracy. Bluelight is very useful in detecting residual or recurrent malignancy at margins of prior resection and can result in upgrading or upstaging in a significant fraction of patients. Repeat use of Cysview for bluelight cystoscopy appears to be safe.
UP.036 Paclitaxel and Gemcitabine Chemotherapy for Advanced Urothelial Cancer Resistant to Prior Cisplatin-Based Chemotherapy Kuratsukuri K, Nishihara C, Matsuda H, Iguchi T, Tanaka T, Uchida J, Nakatani T, Tamada S Dept. of Urology, Osaka City University Graduate School of Medicine, Japan
Materials and Methods: This study was approved by the Institutional Review Board of Osaka City University and 22 patients with advanced or metastatic urothelial cancer after the failure of cisplatin-based chemotherapy were enrolled in this study between from January 2002 to December 2014. Patients administrated paclitaxel (200 mg/m2; day 1) and gemcitabine (1000 mg/m2; day 1, 8, 15) and repeated every 4 weeks. Patients were evaluated after every cycle of the therapy by CT or MRI imaging. Results: The patients received 1-4 cycles of paclitaxel and gemcitabine treatment (a median: 2 cycles). Overall response rate was 36%, including two patients who had complete response, and disease control rate was 59%. Median overall survival was 14 months, and median progression-free survival was 4 months. In patients who received gemcitabine/cisplatin as 1st line chemotherapy, the overall response rate of paclitaxel and gemcitabin treatment were 40% respectively. For adverse effects, grade 3/4 neutropenia in 12 patients (55%), grade 3/4 thrombopenia in 3 patients (14%), grade 3 anemia in 1 patient (5%) were observed, but there were no severe infections and no transfusion. Conclusion: Paclitaxel and gemcitabine chemothera-
py are a favorable and tolerable regimen as a 2nd line treatment for patients with advanced or metastatic urothelial cancer after the failure of prior cisplatin-based chemotherapy.
Introduction and Objective: The objective of this
study is to evaluate the efficacy and toxicity of combination chemotherapy with paclitaxel and gemcitabine as a 2nd line regimen for patients with advanced or metastatic urothelial cancer after the failure of prior cisplatin-based chemotherapy.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.037
UP.038
UP.039
Incidence, Characteristics, and Implications of Thromboembolic Events in Patients with MuscleInvasive Bladder Cancer Undergoing Neo-Adjuvant Chemotherapy
BK Polyoma Virus and Urothelial Carcinoma: A Study of Association in the Immunocompetent Setting
A Non-Suspect Cystoscopy After an Initially Complete TUR B and Six Intravesical Instillations of BCG in HighRisk Ta-T1 Bladder Cancer Is a Good Predictor for (the Absence of) Recurrence
Duivenvoorden W1, Daneshmand S2, Canter D3, Lotan Y4, Black P5, Abdi H5, van Rhijn B6, Fransen van de Putte E6, Zareba P7, Koskinen I8, Kassouf W9, Traboulsi S9, Kukreja J10, Boström P11, Shayegan B7, Pinthus J7 1
St. Joseph’s Healthcare, Hamilton, Canada; McMaster University, Hamilton, Canada; 2USC/Norris Comprehensive Cancer Center, Los Angeles, United States; 3Fox Chase Cancer Center, Philadelphia, United States; 4University of Texas Southwestern Medical Center, Dallas, United States; 5Vancouver Prostate Centre, Canada; 6The Netherlands Cancer Institute, Amsterdam, The Netherlands; 7McMaster University, Hamilton, Canada; 8University of Helsinki, Finland; 9 McGill University, Montreal, Canada; 10University of Rochester, Rochester, United States; 11University of Turku, Finland Introduction and Objectives: Neoadjuvant chemotherapy (NAC) and pelvic surgery are significant risk factors for thromboembolic events (TEE). The study objectives were to investigate the timing, incidence and characteristics of TEE during and after NAC and subsequent radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC). Materials and Methods: A multi-institutional ret-
rospective analysis of 676 patients undergoing NAC and RC for MIBC from 2002 to 2014 at ten different tertiary centers across North America and Europe was performed. The median follow-up time from MIBC diagnosis was 21.4 months (range 3-272). Patient characteristics included incidence and timing of TEE (before/after RC) and Khorana score. Multivariable analysis was performed on 676 patients. Survival was calculated using Kaplan-Meier method. Log-rank tests and multivariable Cox proportional hazards regression were used to compare survival between patients with or without TEE. Results: Khorana score indicated intermediate TEE risk in 88% of patients. The overall incidence of TEE in patients undergoing NAC was 14% with a wide variation between institutions (5%-32%). Patients with TEE were older (67.6 vs. 64.6 years, p=0.02) and had longer NAC courses (10.9 vs. 9.7 weeks, p=0.01) compared to non-TEE patients. The majority of TEEs (58%) occurred pre-operatively; 72% were symptomatic. Mean progression-free survival of patients with TEE was 21.5 (95% CI 16.6-26.4) vs. 70.1 (63.9-76.4) months for non-TEE patients (p<0.001). TEE was an independent predictor of progression-free survival after adjusting for age, Khorana score and pathologic stage (adjusted HR 1.57, 95% CI 1.08-2.29, p=0.02). Conclusions: This multi-centered retrospective study shows that TEEs are very common in MIBC patients undergoing NAC both before and after RC and is associated with poorer progression-free survival. Further investigation with a prospective prevention trial is warranted.
Seth A1, Singh G2, Pradeep I2, Kakkar A2, Nayak B1 1
Dept. of Urology, All India Institute of Medical Sciences, New Delhi, India; 2Dept. of Pathology, All India Institute of Medical Sciences, New Delhi, India
Berendsen C, van der Heij B Zuyderland Medical Centre, Heerlen, The Netherlands
Introduction and Objective: BK polyoma virus is a
ubiquitous virus that lays dormant in the urothelial tract with known pathogenic effects in the renal transplant setting where it results in a tubulointerstitial nephritis (polyoma virus nephropathy). Due to its location, its role in oncogenesis in urothelial carcinoma has been investigated. Numerous case reports now document its role in the development of urothelial carcinoma in the immunodeficient setting post renal transplant. In the immunocompetent setting, the role of the virus in oncogenesis remains controversial. This study was designed to look at immunocompetent patients with urothelial carcinoma and investigate the role of BK polyoma virus in oncogenesis. Materials and Methods: After IRB approval and informed written consent from patients, tissue samples were obtained from tumor tissue and non-malignant urinary bladder mucosa. These samples were obtained during TUR-BT in 24 and on specimen delivery in 14 patients undergoing radical cystectomy. Histo-pathological confirmation of urothelial carcinoma and non-malignant mucosal tissue was carried out. The presence of BK polyoma virus in these pairs of tissues was investigated by immunohistochemistry for SV40T antigen and chromogenic in situ hybridization (CISH) using a BKV specific probe. Results: In the 38 cases tested, which included both high-grade and low-grade urothelial carcinomas, there was no evidence of BK polyoma virus infection in tumor or surrounding mucosa by immunohistochemistry. Similarly, all 10 cases, which were also tested by CISH, were found to be negative. Conclusions: This study suggests that BK polyoma virus infection is not associated with urothelial carcinoma in the immunocompetent setting. Further investigation of the role of BKV in the pathogenesis of urothelial carcinoma in the immunocompetent setting is not worthwhile.
Introduction and Objective: A restaging resection after initial TUR B in patients with high-risk bladder cancer lesions is advocated because of the risk of residual tumour. Persistent disease after resection of T1-Ta G3 tumours has been observed in 33-55% of patients with bladder cancer. The risk of under staging detected by second resection of initially T1 tumour ranges from 4-25%, and it increases to 45% if there was no muscle in the initial resection. Adjuvant intravesical therapy with Bacillus Calmette-Gurin (BCG) is used to prevent recurrences and/or delay progression to muscle invasive disease. We determined whether a non-suspect cystoscopy is a good predictor for the outcome of a restaging resection after an initially complete TURB followed by adjuvant intravesical BCG. Materials and Methods: We retrospectively analysed
data on 153 patients treated between 1994 and 2013 at our institution for Ta-1G3 bladder carcinoma with or without CIS. After a macroscopically complete initial TUR B patients were treated with 6 intravesical instillations with BCG followed by a restaging resection. Results: Restaging resection was performed in all 153 patients. A total of 102 patients (67%) had a non-suspect cystoscopy. The histology showed bladder carcinoma in 3 patients. Two had CIS and one TaG2 low grade. Urinary cytology before the restaging resection was malignant in two of these three patients. A total of 51 patients (33%) had a suspect cystoscopy. Histology showed recurrent/residual bladder carcinoma in 38 patients (20%). In 5 patients (3%), muscle invasive disease was present. Conclusion: A non-suspect cystoscopy after an ini-
tially complete TUR B and six intravesical instillations of BCG in high-risk Ta-T1 bladder cancer is a good predictor for (the absence of) recurrence. The risk of missing residual/recurrent bladder carcinoma is low in this group of patients when a restaging resection is not performed.
UP.039, Table 1. Bladder carcinoma present
Bladder carcinoma not present
Suspect UCS
38
13
51
PPV: 75% (38/51)
Non-suspect UCS
3
99
102
NPV: 97% (99/102)
41
112
153
Sensitivity: 93% (38/41)
Specificity: 88% (99/112)
Total
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Total
141
UNMODERATED ePOSTERS UP.040
Introduction and Objective: To present our expe-
Association between ABO Blood Groups and Bladder Cancer
rience with the ‘Vescica Ileale Padovana’ (VIP) neobladder technique for the treatment of muscle-invasive bladder cancer.
Bhuvanagiri A1, Kannan S1, Kelleher J1, Butu D1, Kowalski P1, Alexandrou K1, Ahiaku E1, Breeze J2, Hussain M2 1 Gwynedd Hospital, BCUHB, Bangor, United Kingdom; 2Bangor University, United Kingdom
Introduction and Objective: We conducted a study to investigate the association between ABO blood groups and Transitional Cell Carcinoma of the bladder (TCC). Incidence, recurrence rate and mortality were examined. Materials and Methods: This was a retrospective analysis of patients newly diagnosed with bladder cancer between January 2003 and December 2015, presenting to our hospital in North Wales. Out of the total of 652 patients (75% male), 628 patients were diagnosed with TCC. The mean age at time of diagnosis was 71.9 years (range 20-99). Results: Blood group incidence in this study showed
group O (N = 303, 48%), A (N = 244, 39%), B (N = 60, 10%), and AB (N = 21, 3%) [UK distribution O = 47%, A = 38%, B = 11%, AB = 4%]. Out of 628 patients, 208 had recurrences at follow-up (33%; p=0.12). The recurrence rates across ABO groups was not significant (p = 0.27); O (N = 90, 30%), A (N = 92, 38%), B (N = 19, 32%), and AB (N = 7, 33%) blood groups. Of the total number of patients diagnosed with TCC, 254 died (40%, p = 0.13). ABO group and mortality figures showed similar survival rates across ABO groups (A = 59%, B = 60%, AB = 43%, O = 61%, p = 0.43). Conclusion: In our study, we could not demonstrate a
relationship between blood group and bladder cancer incidence, recurrence or mortality rate.
UP.041 Radical Cystectomy and Intestinal Urinary Diversion with ‘Vescica Ileale Padovana’ 1
2
1
Veselaj F , Kerliu-Manxhuka S , Hyseni S , Frangu B1, Smani L1, Neziri A1, Yusuf T1, Kryeziu D1, Osmani N1 1
Clinic of Urology, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo; 2Dept. of Pathology, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo
UP.040, Figure 1.
Materials and Methods: In a retrospective study, we analyzed the data of a consecutive series of 137 patients (age range 34 to 78 years, median 64.2) with muscle-invasive transitional cell carcinoma of the bladder treated by radical cystectomy (RC) between 2005 and 2014 at our institution. Results: Of the 137 patients, 61 (44.5%) had undergone radical cystectomy (RC) with orthotopic diversion. A total of 48 (35%) had undergone ileal conduit diversion and 28 (20.5%) had undergone cutaneous continent diversion. Of the 61 patients, 11 (18%) with orthotopic diversion VIP have been clinically, radiologically and urodynamically evaluated with a follow-up ranging from 8 to 90 months (mean 36 months). The complication ratio was low. There was one case with ureteroileal stenosis and two cases with urethroileal strictures. Daytime continence was perfect in 91% (10 of 11 patients). Nighttime continence was very good (dry sleep for 5-7 hrs) in 82% (9 of 11 patients). The reservoir features were: high capacity (400-650 ml); absence of neovesico ureteralis reflux; complete voiding by abdominal straining, and perineal relaxation. In our series RC and VIP, only 3 (27%) of 11 men were potent after surgery. These 3 potent patients had undergone nerve-sparing RC and were <60 years. Conclusion: RC and VIP reconstruction contributed
to reducing peri and postoperative morbidity. It provides a good capacity, low pressure and non-refluxing reservoir employing and satisfactory continence without compromising cure rates. The late complications ratio is very low and offers a high quality of life to patients undergoing RC.
UP.042 Importance of Presence (or Absence) of Detrusor Muscle in TURB Specimen in Intermediate and High-Risk NonMuscle Invasive Bladder Cancer: Is It Undoubtedly Essential? Tomaskin R, Jonas M, Sulgan J, Elias B, Kliment J Dept. of Urology, Jessenius School of Medicine, University Hospital, Martin, Slovakia
Introduction and Objective: Textbook TURB requires presence of detrusor muscle in TURB specimen to ensure correct staging, furthermore current guidelines state, that absence of detrusor results in higher risk of residual disease and early recurrence, understaging with incorrect treatment; hence reTUR is strongly recommended. Our own daily clinical practice experience led us to evaluate our extensive data to define real risk and, if appropriate, to challenge such strict recommendation to avoid unnecessary second resection in at least subgroup of patients. Materials and Methods: Our study includes patients
with primary intermediate and high-risk bladder cancer (according to EAU Guidelines definition) managed in single tertiary care center. Recorded clinical and pathological data were statistically analyzed for differences (Chi-square test, Mann-Whitney U-test) and ORs were calculated to examine the effect of muscle absence on probability of reTUR residual tumour, early recurrence (3-month cystoscopy), recurrence and progression. Results: All 488 patients complying inclusion criteria were divided in subgroups (no muscle, 204 pTx patients, separately analysed as 105 pTx/1 pts with and 73 pTx/a pts without submucosa invasion, 26 pTx/x no submucosa in specimen; 228 pT1 and 56 pTa patients with present muscle served as control groups). All compared subgroups were well balanced for known clinicopathological risk factors. ReTUR was performed in 233 cases, pT2 residual tumour was found in 7 cases only (3%, 6 in pTx/1 and 1 in pT1 group). Comparing pTx/a vs. pTa and pTx/1 vs. pT1 subgroups we found no differences (Chi-square, p=NS) in incidence of reTUR residual tumour (26.1 vs. 29.2%; 56.6 vs. 45.1%), early recurrence (5.5 vs. 5.6%; 9.4 vs. 11.2%), recurrence (44.8 vs. 44.2%; 51.1 vs. 58.1%) and progression (4.9 vs. 3.8%; 19.5 vs. 22.7%). Corresponding ORs didn’t reach significance. There was no difference in median time to first recurrence in both subgroups (12 vs. 14; 10 vs. 12 months) and progression in pTx/a vs pTa (50 vs. 53 months), with the only significant difference in pTx/1 vs. pT1 progression time (42.5 vs. 59 months, p=0.007). Conclusion: Considering our intermediate and high-
risk bladder cancer dataset, when the submucosa was well defined in specimen and was invasion-free, the absence of muscle didn’t increase the risk of understaging and unfavourable prognosis, thus routine reTUR is questionable. When the submucosa was invaded, the absence of muscle increased the risk of understaging, but in general prognosis wasn’t deteriorated.
UP.043 Long-Term Survival of Non-Muscle Invasive Bladder Cancer According to the Histological Risk in Madrid, Spain Morales Pinto SF, Huertas Peña J, Fernandez Puertas B, Alvarez Diaz P Hospital Universitario de Mostoles, Madrid, Spain Introduction and Objective: The survival rate of non-muscle invasive bladder tumors is variable, and it has been reported that the 5-year survival rates reach up to 98%. It is known that poor or moderately differentiated tumors (G2, G3) as well as tumors in situ (Tis) have a worse prognosis than well-differentiated
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36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS (G1) and superficial papillary (Ta) tumors. The objective of this study is to determine the 60-month survival curves based on the histological risk. Materials and Methods: A total of 174 patients di-
agnosed with non-muscle invasive bladder neoplasms were included in a retrospective, descriptive study done at the University General Hospital of Mostoles, between January 1, 2005 and December 31, 2008. The follow-up of the patients was maintained until December 31, 2013. Results: The mean age of the 174 patients was 65 ± 11.1 years (30.7-89.1), 153 (87.9%) were male and 21 (12.1%) female. According to the TNM classification (2009), 132 patients (75.9%) were T1, 31 (17.8%) Ta, 9 (5.2%) Tis (in situ) and 2 (1.1%) TX. Based on the degree of histological differentiation (WHO 1973), 41 patients (23.6%) had well-differentiated tumors (G1), 79 (45.4%) had moderately differentiated tumors (G2) and 45 (25.9%) had poorly differentiated tumors (G3). The median follow-up was 77.3 months (IC 25-75%: 53-89). The overall survival rate was 75.9% (132) and the cancer-specific survival reached 88.5% (154). After analyzing the survival rate according to the histological risk, the following data were found: there was an overall survival rate of 90% (4 of 40) for low histological risk tumors (Ta, G1) versus a 71.6% (38 of 134) for high histological risk tumors (Tis, G3, G2) (p=0.020 log-rank), and there was a cancer-specific survival rate of 97.5% (1 of 40 cases) for low histological risk tumors versus 85.8% (19 134) for high histological risk tumors (p=0.040 log-rank). Conclusion: The overall survival and the 5-year can-
cer-specific survival rates for non-muscle invasive bladder neoplasms are different when low histological risk tumors (Ta, G1) are compared with high histological risk tumors (G3, Tis).
UP.044 Transurethral Resection Versus Open Prostatectomy for Prostates Larger than 150 Grams and Patients over 75 Years: A Single Institution Retrospective Study Panackal A Kims Hospital, Muscat, Oman Introduction and Objective: BPH is now one of the most common diseases in the elderly. According to histological studies, more than 50% of men will face this diagnosis by the age of 60 (90% by the age of 85). Open prostatectomy (OP), either retropubic or transvesical, is the oldest and most invasive management for BPH. It has been replaced by transurethral resection (TURP) in many countries, and currently represents ≈3% of all prostatectomies in the USA, and 12–32% in Europe, reaching up to 40% in some developed countries, where laser technology is not available. A better understanding of the clinical characteristics of patients over 75 years old with prostate size more than 150 g is important for preventing complications and improving clinical outcomes. In this study, we aimed to determine the complications (both clinical and urological) of standard surgical treatments (TURP Versus OP) among patients over 75 years with prostate size 150g and above. Materials and Methods: We performed a retrospective analysis of 40 patients with lower urinary symp-
toms secondary to BPH with an enlarged prostate (>150 cc) who underwent TURP or OP (transvesical). There were 20 patients in each group. All patients were assessed preoperatively using the International Prostate Symptom Score (IPSS), Quality of Life Score (QOL), and complete urodynamic evaluation. Perioperative parameters such as blood loss, catheter removal, and hospital stay were assessed. Secondary endpoints included international prostate symptom score, residual urine volume, surgical complications, and patients’ quality of life. Patients were followed up for 6 to 12 months after the operation. Results: Median age was 79 years. The median International Prostatic Symptom Score was 20, the median prostate volume was 175g, 51% were using an indwelling bladder catheter, and the median prostate-specific antigen level was 5.0 ng/ml. There was no significant difference between the TURP and OP groups in terms of age, preoperative IPSS, QOL, peak urinary flow rate, post-voiding residual volume (PVR), prostate volume, or weight of resected tissue TURP: 101.5g (range 80.3 -120.1 g) OP: 175 g (range 155.2-220.7 g). There were significant differences in mean hemoglobin loss (TURP: 1.4 g/dl vs. OP: 2.4 g/dl), median catheter time (TURP: 3 days vs. OP: 6 days), median hospital stay (TURP: 4 days vs. OP: 7 days), and mean operative time (TURP: 151 minutes vs. OP: 91 minutes). Both TURP and OP resulted in postoperative improvements in IPSS (TURP: 8.5 vs. OP: 8.4), QOL (TURP: 1.6 vs. OP: 2.2), peak urinary flow rate (TURP: 14.6 ml/s vs. OP: 18.5 ml/s), and PVR (TURP: 24.9 ml vs. OP: 19.7 ml). Blood transfusions were required in 1 TURP patient vs. 6 OP patients. Re-operation due to residual prostate lobe and urinary retention was performed in 8 patients in TURP group versus no patient in OP group. Late complications bladder neck contracture and stricture was seen in 2 patients in TURP and 1 patient in OP group. Conclusions: There is no doubt that TURP is best sur-
gical treatment for BPH. But our study showed that patients with 75yrs and above and with large prostate (>150g), OP is the best acceptable operation in good hands, characterized by good surgical efficiency, significantly reduced complications, shorter convalescence, higher peak flow rate improvement, less need to re-operation, and its ease of learning make open prostatectomy a suitable option to be discussed in patients parallel to TURP.
UP.045 Prostate Disease Correlation on Demographics and Clinical Findings among National Annual Prostatic Digital Rectal Exam Campaign Participants Firaza PN Jose R. Reyes Memorial Medical Center, Manila, Philippines Introduction and Objective: National digital rec-
tal examination (DRE) of the prostate advocated by the Philippine Urological Association (PUA) started 2 decades ago in the advent of PSA screening. It is an effective campaign in promoting prostate health awareness among Filipinos. The aim of this research was to describe and correlate the demographics, clinical profile and prostatic physical findings examined by urologists in over 60 centers in the country.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: This study was an analytical cross-sectional study involving the participants of the 2013-2015 National DRE campaign. The data were retrieved from the PUA secretariat using a convenience-sampling method on completed forms. The data were correlated using a non-parametric measure of statistical dependence between two variables. Results: The total number of participants were continuously rising [n=978 (2013), n=2052 (2014) and n=2792 (2015)] having 60-70% newly diagnosed cases annually. The mean age of participants were on their 6th decade of life, mostly employed, married and an educational attainment of secondary level. Most of the patients have no family history of cancer and have no current medical condition. Most of the previous prostate examinations were done at government hospitals. The most predominant symptom was nocturia followed by frequency, incomplete emptying and weak stream. The mean IPSS and quality of life were similar across the years [2013 = 10.65 (SD=9.08) and 4.68 (SD=1.98); 2014 = 10.11 (SD=8.6) and 2.78 (SD=2.2); 2015 = 9.19 (SD=8.23) and 1.85 (SD=1.78)]. The predominant prostate size was between 21-30 grams mostly with doughy consistency, nodular and tender. The family history of cancer correlated well with the clinical diagnosis of prostate cancer. The mean age of having clinically benign prostate enlargement was noted to be consistent at the age of 61 and while that of a prostate cancer suspect range from 63-69 years old. Conclusion: Filipinos have similar predominant signs
and symptoms of prostate disease as compared to Malays, Chinese and Indians. Clinical findings of prostate cancer correlated well with age, symptom score, prostate size and consistency.
UP.046 Correlations Between the Zinc Serum Levels, Prostate Volume and Prostate Specific Antigen Values in Cases of Benign Prostatic Hyperplasia Ene C1, Geavlete B1, Ene CD2, Nicolae I3, Geavlete P1 1
“Saint John” Emergency Clinical Hospital, Bucharest, Romania; 2“Carol Davila” Clinical Hospital of Nephrology, Bucharest, Romania; 3“Victor Babes” Clinical Hospital of Tropical and Infectious Diseases, Bucharest, Romania Introduction and Objectives: Zinc is one of the most
important metal-enzymes, presenting high concentrations in the prostatic tissue. Its’ role in benign prostatic hyperplasia (BPH) cases still remains unclear. The present trial was aimed to analyze the correlation between zinc serum levels, prostate volume and prostate specific antigen (PSA) in BPH patients. Materials and Methods: The serologic evaluation of zinc (using the photometric method) and PSA (by the ELISA method) was performed in a series of 65 BPH patients (age = 68.2 ± 6.4 years; prostate volume = 45.8 ± 11.3 cc; PSA = 1.5 ± 1.3 ng/mL). The prostate volume was determined by transrectal ultrasound (TRUS). The exclusion criteria consisted of history of prostate cancer, recurrent urinary tract infections, previous BPH medical therapy and inflammatory conditions.
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UNMODERATED ePOSTERS Results: For patients with a prostate volume of 30-50 cm3, the mean zinc level was 73.94 ± 6.35 μg/dl. With regard to a prostate volume of 50-70 cm3, the mean zinc level was 66.87 ± 11.10 μg/dl (p < 0.05), while for patients with a prostate volume higher than 70 cm3, the respective value of zinc level was 67.42 ± 7.80 μg/ dl (p > 0.05). Concerning patients with a PSA value of 0-1.5 ng/ml, the level of zinc was 76.37 ± 6.56 μg/ dl. For a PSA value of 1.5-4 ng/ml, the zinc level was 76.53 ± 10.48 μg/dl (p > 0.05). In cases of a PSA value higher than 4 ng/ml, the mean amount of zinc was 70.46 ± 9.61 μg/dl (p < 0.05). The prostate volume and PSA score presented a significant negative correlation with the serum zinc level (r = -0.62, p < 0.05; r = -0.52, p < 0.05). Conclusions: Based on serological determinations, a statistically significant correlation was observed between the serum zinc mean level relevant parameters in BPH patients (prostate volume and PSA value). Such correlations may provide useful data with regard to the mechanisms involved in the evolution of benign prostatic hyperplasia.
UP.047 Smoking and Oxidants/ Antioxidants Balance in Benign Prostatic Hyperplasia Patients 1
2
3
1
Ene C , Nicolae I , Ene CD , Geavlete P , Geavlete B1, Georgescu S2 1
“St. John” Clinical Hospital of Emergency, Bucharest, Romania; 2“Victor Babes” Clinical Hospital of Tropical and Infectious Diseases, Bucharest, Romania; 3 “Carol Davila” Clinical Hospital of Nephrology, Bucharest, Romania Introduction and Objective: The oxidative stress, ev-
idenced by the overproduction of pro-oxidant factors and antioxidant deficiency, plays a crucial role in the pathogenesis of prostate diseases. A number of epidemiological studies showed that smoking has negative effects over all the organs and systems of the human body. The aim of the trial was to determine whether smoking would influence the pathogenesis of BPH by affecting the oxidative stress factors (total antioxidant status (TAS), malondyaldehide (MDA) and protein carbonyls (PCO)). Materials and Methods: This prospective study included 65 patients diagnosed with BPH (no medical or surgical treatment, normal weight and adequate nutritional status). There were quantified the serum levels of oxidant and antioxidant markers. The BPH cases were divided into two homogeneous groups: 35 non-smokers (age=58.8±3.2 years; prostate volume=38.3±9.3 g; PSA=1.7±0.2 ng/mL) and 30 smokers (age=60.1±2.4 years; prostate volume=40.4±7.1 g; PSA =1.5±0.4 ng/mL). The determinations of TAS, MDA and PCO were performed using enzyme-immunoassay or spectrophotometric techniques. Results: Serum MDA values (mmol/L) were significantly altered in smokers when compared to nonsmokers (3.37±0.25 versus 3.06±0.31, p<0.05). PCO serum values (mmol/mg protein) showed minimal variations between smokers and nonsmokers, which were statistically insignificant (2.14±0.22 versus 2.02±0.16, p>0.05). Serum TAS levels (mmol/L) were significantly lower in smokers (1.39±0.09 versus 1.08±0.12, p<0.05). In the non-smoking group, there
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was no statistical significant correlation between MDA, PCO, TAS and the prostate volume and PSA (r=0.20, p>0.05). In smoking patients, there was a significant positive correlation between MDA and PCO and prostate volume (r=0.23, p<0.05 and r=0.35, p<0.05, respectively). There was no statistically significant correlation between TAS and prostate volume, respectively between MDA, PCO, TAS and PSA value. There was not found a statistically significant difference (p>0.05) between the age, prostate volume and PSA level with regard to the smoking and respectively non-smoking study arm.
was defined by the absence of recatheterization within the following two days. Chi2 and Student test analysis with the Stat view software were performed to identify risk factors of a catheter removal failure (p=0.05).
Conclusions: These outcomes support the hypothesis that smoking might participate in the development of BPH by stimulating lipoperoxidation, thus consequently reducing the level of antioxidants in the body.
Results: A total of 98 patients were eligible, 11 were excluded for non-compliance with the protocol (Table 1). Average time before catheter removal was 240 minutes with 82% rate of success. Mean follow-up was 104 days (45-388) with 2.5% of re-hospitalization for Clavien 1 and 2 complications. Median age was 67 years old (41-87) with 17% older than 75, with a mean BHP volume of 50 cc before surgery. Mean operative time was 50 minutes including 24 minutes of laser time. In the univariate analysis, patients older than 75 were significantly at risk of failure (47% vs. 13%, p=0.05).
UP.048
Conclusion: Urinary catheter might be removed 240
minutes with 82% of success rate. Patients older than 75 could be at higher risk of failure.
Photoselective Vaporization of the Prostate Using GreenLight Laser Can Reduce the Postoperative Urinary Catheter Duration
UP.049 Effects of Silodosin in Improving Sleep Disturbance and Nocturia Associated with Lower Urinary Tract Symptoms/ Benign Prostatic Hyperplasia
Colomb F1, Loeffler J1, Tibi B2, Daniel C2, Jean A2, Michel C2, Matthieu D2 1 Centre Hospitalier de Grasse, France; 2Centre Hospitalier de Nice, France
Kim HJ, Seo YM
Introduction and Objectives: Time optimization be-
fore removal of the urinary catheter after a photoselective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BHP) has been poorly evaluated. We investigated what was the minimal catheter length of time removal at Day-0. Materials and Methods: All consecutive consenting patients from 2013 to 2015 with BHP underwent PVP at a single center by two experienced surgeons with early removal of urinary catheter at Day-0 in case of neither gross haematuria nor prostatitis. Average time of catheterization was the main criteria. Clinical data and success rate of removal of urinary catheter and of recatheterization were collected. Success of removal
Dept. of Urology, Dankook University College of Medicine, Yongin, South Korea Introduction and Objective: This study aimed to
evaluate the effects of silodosin in improving nocturia and sleep disturbance in patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia. Materials and Methods: A total of 20 patients with lower urinary tract symptoms/Benign Prostatic Hyperplasia with nocturia (above 2 times per night) were enrolled prospectively, but 18 patients were evaluated completely. All patients were evaluated for PSA, prostate volume, IPSS, voiding diary for three days, uroflowmetry (Qmax) and post-voided residual (PVR) before and after administration of an 8 mg dose of
UP.048, Table 1. Demographic and Clinical Characteristics of the Cohort (n=81) Prior to PVP
Mean Age (yo)
Overall (n=87)
Success (n=71)
Failure (n=16)
p
67
66
70
ns
Age> 75 yo (%)
17
11
44
p<0.01
Diabetes (%)
11
11
13
ns
High-blood pressure >14 (%)
46
48
44
ns
Long-term urinary catheter (%)
20
20
21
ns
Neurological disorders (%)
8
7
13
ns
ASA score >2 (%)
7
6
13
ns
Aspirirn/Coumarin (%)
24
24
25
ns
Prostate volume > 50 ml (%)
39
23
24
ns
Q max (ml/s) PVR (ml)
7
7
6
ns
157
154
176
ns
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.049, Table 1. Improvement of Nocturia After Administration of Silodosin
nocturia
visit 1 (4 week)
visit 2 (8 week)
3.4±0.9
2.0±0.7
p-value vs. visit 1
0.001
UP.049, Table 2. Improvement of the Hours of Undisturbed Sleep (HUS) After
HUS (min) p-value vs. visit 1
visit 1 (4 week)
visit 2 (8 week)
176.7±41.6
243.1±42.1 0.001
silodosin for 8 weeks. Quality of sleep was also evaluated using the Pittsburgh sleep quality index (PSQI), the hours of undisturbed sleep (HUS), the interval between the time of sleeping and the first instance of nocturnal voiding, and the Epworth sleeping scale. Results: Qmax, total IPSS, QoL of IPSS, voiding and storage symptoms of IPSS were improved, but PVR was not, after silodosin was administered for 8 weeks. Nocturia was improved significantly (from 3.4 times to 2 times per night, p<0.05). Total mean score of PSQI in response group was not improved significantly after administration of silodosin (from 18.12 to 16.29, p>0.05). Sleeping scale was not improved significantly, but HUS was improved significantly (from 176.7 min to 243.1 min, p<0.05) (see Tables 1 and 2). Conclusion: These results suggest that silodosin ad-
ministration improved nocturia and LUTS. However, silodosin does not improve sleep disturbance, even though nocturia is improved. This means that sleep disturbance may be caused by things other than LUTS/BPH.
UP.050 Post-Transurethral Resection of the Prostate Inflation of PressureControlled Endorectal Balloon Impact on Postoperative Bleeding: A Preliminary Experimental Pilot Study Mohyelden K1, Ibrahim H1, Abdelkader O2, Sherief M2, El-Nashar A2, Shaker H1, Elkoushy M2 1
Fayoum University Hospital, Faiyum, Egypt; Suez Canal University Hospital, Ismailia, Egypt
2
Introduction and Objective: To evaluate the impact of rectal balloon (RB) inflation on post-transurethral resection of the prostate (TURP) bleeding in patients with symptomatic benign prostatic hyperplasia. Materials and Methods: After institutional review
board approval, patients who were eligible for TURP were randomized into two equal groups, depending on whether they received postoperative endorectal balloon (RB) (GII) or not (GI). The tip of three-way Foley catheter was fixed to a balloon by a blaster strip to prepare air-tight RB. Post-operatively, the RB was inflated for 15 minutes by a pressure-controlled sphygmomanometer. Perioperative data were com-
pared between both groups, including hemoglobin (Hb) deficit 24-hour postoperatively and at time of discharge. Functional outcomes, anorectal complaints, and adverse events were assessed perioperatively and after 1 and 3 months. Results: Fifty patients were enrolled, including 13 (26%) patients who presented with indwelling urethral catheters. Baseline data and mean resected tissue weight were comparable between both groups, including preoperative Hb (p=0.17). Immediate postoperative Hb deficit was, comparable between GI and GII patients (0.58-0.18 vs. 0.60-0.2, p=0.56) before RB inflation, respectively. However, compared to GI patients, mean Hb deficit significantly decreased in GII patients 24-hour postoperatively (0.2-0.2 g vs. 0.7-0.3 g, p=0.002) and at time of discharge (0.8-0.2 g vs. 1.3-0.4 g, p=0.003). GII patients needed significantly less postoperative irrigation (2.1-1.6 L vs. 8.3-1.8L, p<0.001), shorter catheterization time (2.3-0.8 days vs. 3.8-1.3 days, p<0.001), and shorter hospital stay (2.6-0.5 days vs. 4.3-1.0 days, p<0.001). Both groups were comparable in all functional outcomes at the most recent follow-up. Blood transfusion was needed in only one patient (4%) in GI. No patient needed recystoscopy for hematuria or clot retention in either group, while there were no anorectal complaints reported by GII patients. Conclusion: Post-TURP endorectal balloon inflation
seems to be simple, safe, and an efficient procedure to reduce postoperative bleeding and irrigation volume. It is significantly associated with shorter catheterization time and hospital stay.
UP.051 Transurethral Incision Versus Transurethral Resection of the Prostate in Small Prostatic Adenoma: Long-Term Follow-Up Abdelkader O1, Mohy El Den K2, El-Nashar A1, Hussein A1, Yehya E1 1
Suez Canal University Hospital, Ismailia, Egypt; Fayoum University Hospital, Faiyum, Egypt
2
Introduction and Objective: To evaluate the efficacy of transurethral incision of the prostate (TUIP) compared to transurethral resection of the prostate (TURP) in patients with small benign prostate adenoma, based on long-term follow-up. Materials and Methods: We prospectively random-
ized 86 men with bladder outlet obstruction symptoms caused by a prostate less than 30 g to undergo TUIP or TURP. The following preoperative parameters were evaluated: prostate weight, international prostate symptom score (IPSS), voided volume, maximum flow rate (Qmax) and post-void residual volume (PVR). Postoperatively the patients were followed up for 48 months and the following data were collected: morbidity, operative time, catheterization period, hospital stay, Qmax, IPSS, voided volume, PVR and reoperation rate. Results: A total of 80 of the 86 patients completed the study, and there were 40 patients in each group. The mean age of patients in group I (TURP) and group II (TUIP) was 63.6 and 66.2 years, respectively. Preoperative parameters in both groups showed no statistically significant differences with regard to uroflow parame-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
ters and prostate weight. At 48 months follow-up, the mean voided volume increased from 161 ml to 356 ml in group I and from 161 ml to 341 ml in group II, while Q-max increased from 8.4 to 18.4 in group I and 8.4 to 16.6 in group II, the IPSS decreased from 19 to 5.8 in group I and from 19 to 6.3 in group II and PVR decreased from 107 ml to 20 ml in Group I and from 109ml to 21 ml in Group II (all differences statistically significant). When comparing groups I and II, there were statistically significant differences with regard to mean operative time (60.0 versus 20.6 min), duration of catheterization (3.2 versus 2.2 days), hospital stay (3.7 versus 2.6 days), the incidence of postoperative retrograde ejaculation (52.5% versus 22.5%) and erectile dysfunction (20% versus 7.5%). Conclusion: TUIP and TURP for small prostat-
ic adenoma of less than 30 g are equally effective in providing symptomatic improvement. TUIP is more advantageous with regards to side effects, operative time, hospital stay and the duration of catheterization.
UP.052 Pharmacological Treatment of Benign Prostatic Hyperplasia After Cystolitholapaxy: Is It a Valid Option? Abdelkader O, Metwally A, El Nashar A Suez Canal University Hospital, Ismailia, Egypt Introduction and Objective: To assess the clinical
outcomes of medical treatment for BPH after transurethral cystolitholapaxy. Materials and Methods: Through a 6-year period, from December 2008 to December 2014, 60 patients with bladder outlet obstructive symptoms caused by benign prostatomegally with bladder calculi underwent transurethral bladder stone removal at Suez Canal University Hospital, Ismailia, Egypt, then received medical treatment for BPH (preoperative evaluation (prostatic volume, IPSS, Qmax and post voiding residual urine volume (PVR))). The follow-up was scheduled on outpatient basis for 2 years by (IPSS, Qmax, PVR) every three months. Failure of medical treatment was considered if patients developed recurrent vesical lithiasis or if lower urinary tract symptoms (LUTS) became worse, indicating the need for surgical treatment of the prostate. Results: Out of 60 patients, 56 patients completed the study. The mean age of patients was 60.36 ± 6.25 years. Mean prostatic volume was 53.34±16.8 cc, mean diameter of largest stone was 23.92±8.61 mm, and mean number of stones was 2.15 ± 1.59. In the first year follow-up period, there was statistically significant improvement for IPSS, Qmax, and PVR in 100% of patients without record of any failure. In the second year of follow-up, failure was reported in four (7.1%) patients by bladder lithiasis recurrence in three patients after 18 months and increase in IPSS in the fourth case after 2 years, which was treated by TURP with cystolitholapaxy and TURP, respectively. Conclusion: Medical management of BPH after stone
bladder clearance seems to be a valid option, resulting in significant symptomatic improvement in selected patients.
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UNMODERATED ePOSTERS UP.053 Thulium Ejaculation Sparing: Impact on Sexual Outcomes Carmignani L, Vizziello D, Claudia S, Ratti D, Finkelberg E, Motta G, Marenghi C, Maruccia S, Casellato S IRCCS Policlinico San Donato, University of Milan, Italy Introduction and Objectives: Ejaculation may be permanently compromised by surgical treatment of BPH. Even if there are new surgical procedures available to treat successfully BPH, it has been poorly studied on their effects on erectile function and ejaculation. The aim of this study is to determine the impact of thulium laser prostate vapoenucleation/vaporization (thuvep/thuvap) on sexual function and retrograde ejaculation in patients with LUTS caused by BPH. Materials and Methods: Our current study included 167 patients who underwent thuvep/thuvap using ejaculation sparing technique. This procedure consists in preserving 1 cm of tissue proximal to the verum montanum, performing an inverted U-shaped incision using a very low power setting (40 watts). Considering the U as a landmark, complete resection of the middle lobe and then of the lateral lobes is performed with a power setting of 110 watts with particular care in order to avoid any paracollicular digging. Five validated questionaries were used to evaluate changes in erection and ejaculation, as well as the effects of LUTS on QoL: the ICIQ-MLUTSsex, MSHQ-EjD, IIEF5, IPSS and QoL index of the intraclass correlation coefficients. Patients were evaluated by questionnaires and flowmetry before, 3 and 6 months after surgery. Results: The mean age of patients was 69 years old and the mean prostate volume was 78.3 ml. All patients were dis-chargeable in 48 hours after surgery and only two of them were discharged with urinary catheter. No statistically significant differences in erectile function were observed before and after surgery while an improvement in postoperative urinary symptoms was found. A total of 94 patients maintained ejaculation after surgery. Comparing other techniques described in literature, the percentage of ejaculating patients raised to 56.3% after Thuvep/Thuvap. A significant improvement in IPPS was reported at 3 months (mean IPSS: 8) and this was maintained through to 6 months (mean IPSS: 5.2). Conclusions: TES (Ejaculation sparing Thuvep/Thuvap) reduces LUTS and improves QoL of patients as determined by questionnaire scores, with no erection impairments and good ejaculation preservation.
UP.055 Holmium Laser Enucleation Versus Transurethral Resection for Surgical Management of Intermediate-Sized Benign Prostatic Hyperplasia in Patients with Detrusor Underactivity Lee JN1, Chung JW1, Ha YS1, Choi SH1, Kwon SY2, Kim G3, Kim BS1, Kim HT1, Kim TH1, Yoo ES1, Kwon TG1, Chung SK1, Kim BW1 1
Kyungpook National University School of Medicine, Daegu, South Korea; 2Dongguk University College of
146
Medicine, Seoul, South Korea; 3Gumi CHA Medical Center, CHA University, Bundang, South Korea Introduction and Objectives: Recent studies have revealed that surgical management of BPH in patients with detrusor underactivity (DU) can be effective in improving voiding symptoms. In this study, we compared the short-term outcomes of Holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) for the management of intermediate-sized (30-80 cc) BPH in patients with DU. Materials and Methods: From January 2010 to May
2015, 49 patients who had an intermediate-sized prostate ranging from 30 to 80 cc and had DU were enrolled (HoLEP; 17, TURP; 32). Surgical outcomes and postoperative voiding symptom improvements were compared retrospectively between the two groups. All patients took alpha-adrenoreceptor blockers and 5 alpha reductase inhibitors before the surgery and DU was defined as detrusor pressure at maximal flow (PdetQmax) under 40 cmH2O measured by pressure flow study. Results: The mean prostate volume of the HoLEP and TURP group were 50.2±11.8 and 50.0±15.7 cc (p=0.953). The PdetQmax of each group was 34.7±5.7 cmH2O and 33.1±10.0 cmH2O (p=0.483), mean operation time and resected volume of prostate were 86.2±13.9 and 78.8±24.0 minutes (p=0.246), 29.6±11.1 and 25.0±7.9 g (p=0.099), respectively. There were no significant differences in preoperative international prostate symptom score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) between the two groups. Uroflowmetry (UFM) measured three months after the operations showed that the Qmax for HoLEP and TURP group was 16.1±6.0 ml/s and 10.4±7.0 ml/s (p=0.006). HoLEP group showed lesser post-operative PVR than TURP group (11.2±36.0 cc vs. 52.5±80.0 cc, p=0.017). Post-operative IPSS checked at 3 months after surgery was not significantly different between both groups (12.1±5.9 vs. 12.9±7.0, p=0.684). Only 17.7% in Ho-
LEP group continued BPH medications after surgery, meanwhile 65.6% in TURP group kept medications (p=0.001). Conclusion: This study showed that both HoLEP and
TURP can be safely and effectively performed in patients with intermediate-sized BPH and DU. However, HoLEP can be more helpful for improving voiding symptoms compared to TURP in patients with intermediate-sized BPH and DU.
UP.056 Shortened Urinary Catheter Length of Time at 3 Hours After Photoselective Vaporization of the Prostate with the GreenLight 180W Laser May Be an Option Haider R1, Roustan FR1, Regnier P1, Treacy PJ1, Marsaud A1, Tibi B1, Loeffler Mc Neill J2, Chevallier D1, Amiel J1, Durand M1 1 Dept. of Urology, Hôpital Pasteur 2, CHU Nice, University of Nice-Sophia-Antipolis, France; 2Dept. of Urology, Centre Hospitalier Général de Grasse Clavary, Grasse, France
Introduction and Objective: The duration of urinary
catheterization after surgical treatment for benign prostate hyperplasia (BPH) has decreased significantly since the use of photoselective vaporization of the prostate (PVP) using the Green Light laser. We sought to define the incidence of AUR related to a specific duration of postoperative catheterization (3 hours) and the risk factors associated with the failure of early catheter removal. Materials and Methods: We defined a specific anesthetic protocol with morphine-sparing. Between 2014 and 2015, we prospectively included patients with the following criteria: age 45-85, prostate volume 30-100 cc, IPSS ≥ 15, PSA ≤ 4 ng/ml or negative biopsy within 6 months. All urinary catheters were removed at 3 hours post-procedure. Success was defined as the ability to void with no significant post void residual (PVR). Failure was defined by a urinary catheter removal contraindication at 3 hours (fever > 38.5°C or
UP.056, Table 1. Characteristics of the Population and Success and Failure Groups Population n = 16
Success n = 11
Failure n=5
p
years
68.2
67
70.6
0.55
Average Age
g
51.6
53.2
48
0.56
score
18.9
18.4
20.6
0.76
Operative time
min
47.3
43
56
0.26
Laser time
min
21.5
21.8
21
0.83
Amount of energy
kJ
152.6
164.7
131
0.10
Prostate volume Pre-op IPSS
UP.056, Table 2. Outcomes of PVP at 1-Month Follow-Up Pre-op
1-month follow-up
p
Q max (ml/s)
10.6
17.15
0.15
IPSS
18.9
9.54
0.004
Post-void residual urine (ml)
146.3
20.4
0.13
9.7
9
0.11
IIEF 5
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS gross hematuria) or AUR with recatheterization within 24 hours. Pre-, peri- and postoperative data were collected and analyzed with the Student’s t-test. Results: In total, 51 patients underwent PVP, 21 were included, and 5 were excluded for anesthetic non-compliance. AUR with a post-void residual urine > 500 ml occurred in 31% (n=5). No patient had a urinary catheter removal contraindication at 3 hours. There were no significant differences between the success and failure groups’ preoperative variables (Table 1), peri- and postoperative variables are presented in Table 2. In the univariate analysis, we noted a longer operative time (56 vs. 43 min) and higher amount of energy delivered (131 vs. 164.7 kJ) in the failure group but these variations did not reach significance (p=0.26, p=0.10). Conclusion: The incidence of AUR at 3-hour catheter
length of time after PVP was 31% (5/16). None of the risk factors have been identified. A longer cohort is needed.
UP.057 Effects on Urinary Function in Hypogonadal Men Treated for up to 8 Years with Testosterone Undecanoate Injections (TU) vs. Untreated Controls: Real-Life Data from a Registry Study in a Urological Office Haider A1, Haider KS1, Doros G2, Traish A3 1
Private Urology Practice, Bremerhaven, Germany; Dept. of Epidemiology and Statistics, Boston University School of Public Health, United States; 3 Dept. of Biochemistry and Dept. of Urology, Boston University School of Medicine, United States 2
Introduction and Objective: Effects of long-term testosterone therapy (TTh) on urinary function in hypogonadal men published so far are from observational studies without a control group. We present registry data including an untreated hypogonadal control group. Materials and Methods: The registry study included 656 men (mean age: 60.72 ± 7.15 years) with total testosterone (T) levels ≤12.1 nmol/L and symptoms of hypogonadism. A total of 360 men received parenteral TU 1000 mg/12 weeks following an initial 6-week interval for up to 10 years (T-group). A total of 296 men had opted against TTh and served as controls (CTRL). Median follow-up in both groups was 7 years. Measurements were taken at least twice a year, and 8-year data were analyzed. Mean changes over time between the two groups were compared by means of a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction. Changes were adjusted for with regards to age, weight, waist circumference, blood pressure, fasting glucose, lipids and AMS to account for baseline differences between the two groups. Results: Mean age was 60.72±7.15 years, mean follow-up time 6.43± 2.01 (minimum: 1; maximum: 10) years, median follow-up time 7 years. Prostate volume increased from 29.2±10.4 to 31.1±11.5 ml (p<0.05) in the T-group and decreased from 34.5±5.9 to 33.5±12.0 ml (p<0.0001) in CTRL. The model-adjusted estimated difference between groups at 8 years was 2.3 ml (p<0.01). Post-voiding residual volume de-
creased in the T-group from 47.3±22.8 to 13.7±4.6 ml and increased in CTRL from 48.3±16.3 to 64.5±22.2 ml, difference between groups 52.8 ml (p<0.0001 for all). IPSS decreased in the T-group from 6.4±4.0 to 2.0±1.0 and increased in CTRL from 4.5±2.0 to 6.5±2.6, difference between groups -4.8 (p<0.0001 for all). There were two deaths in the T group and 21 deaths in the control group. No patients dropped out. Conclusion: Long-term TTh with TU in an unselect-
ed cohort of hypogonadal men resulted in improvements in urinary function, whereas untreated controls experienced a worsening which was independent of prostate size. Long-term TU was well tolerated and excellent adherence suggested a high level of patient satisfaction.
UP.058 Comparison and Prediction of Perioperative and Postoperative Results on Benign Prostate Hyperplasia Patients Who Underwent HoLEP by Catheterless Urodynamic Study Using Penile Cuff Han C1, Bae S1, Park B1, Lee Y1, Kang S1, Cho Y2 1
Catholic University of Korea, Uijeongbu St.Mary’s Hospital, Gyeonggido, South Korea; 2Catholic University of Korea, Yeouido St.Mary’s Hospital, Seoul, Korea Introduction and Objectives: Conventional urodynamic study was commonly performed for evaluating bladder function before TUR-P or HoLEP. However, conventional urodynamic study required catheter insertion, and caused pain or discomfort to patients, required a long time for examination, had a relatively high cost, and required short-term antibiotics. The objectives of this study were to identify the perioperative results after prostate surgery using catheterless UDS using penile cuff. Materials and Methods: From October 2013 to June 2015, 22 patients agreed to examination and underwent HoLEP for BPH were included in this study. All patients were performed both catheterless UDS using penile cuff and conventional UDS. Uroflowmetry were checked in postoperative 2 weeks, 1 month, and 3 months. The results of pressure flow study and ICS nomogram were compared to the results of cuff test and Newcastle nomogram. The visualized analogue pain scale (VAS) was used in all patients to measure pain after both tests. Results: Mean patient age was 69.8 years old. Mean PSA was 9.93 nd/dL and mean prostate volume was 72.40 cc. Nineteen patients were diagnosed with BPH and 3 were diagnosed with prostate cancer. Fourteen patients were represented same pattern both ICS nomogram and Newcastle nomogram. In the different results, 3 patients were failed to voiding after pressure flow study and low pressure low flow in cuff test. Only 2 patients were opposite result in both tests. Detailed analysis showed a correlation between maximal detrusor pressure/maximal intravesical pressure in UDS and maximal cuff pressure in cuff test (R=0.263/0.235, P=0.237/0.293). In VAS, all patients had a higher pain score in conventional UDS (4.77 vs. 1.81, p<0.001). The patients who were represented ‘low pressure low flow’ in cuff test were failed to voiding after pressure flow study in conventional UDS and maximal cuff pressure were less than 100 mmHg. Patients who had
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
success in voiding after PFS and less than 100 mmHg in cuff test were checked less than 10 ml/sec in uroflowmetry in postoperative 2 weeks, 1 month, and 3 months. Conclusions: Penile cuff test has some advantage such as less pain during examination, no antibiotic use, and short examination time compared to conventional UDS for evaluation of preoperative bladder function. Low maximum cuff pressure might be predicted fail to voiding or low Qmax in uroflowmetry after operation.
UP.059 Large Prostatic Calculi May Worsen Erectile Dysfunction and Lower Urinary Tract Symptoms in Middle-Aged Men Cho Y, Sohn D, Kim S Yeoeuido St. Mary’s Hospital, Seoul, Korea Introduction and Objectives: The clinical signifi-
cance of prostatic calculi remains unclear, although they were commonly found when we performed transrectal prostate ultrasound (TRUS). There are only a handful of papers on the relationship they have with lower urinary tract symptoms (LUTS) but no papers of their effect on erectile dysfunction (ED). The aim of this study was to investigate the effects on ED and LUTS of large prostatic calculi. Materials and Methods: A total of 346 men who voluntarily underwent TRUS for a routine check-up prostate and who were aged 40 years or older were enrolled, and the prostatic calcification grading and prostate volume were checked by TRUS. The men were divided in two groups, in accordance with the type of prostatic calculi (group A: no or small (<3mm), single or group B: large (≥3 mm), multiple and eccentric with coarse echoes). Additional evaluation included medical records like as International Prostatic Symptoms Score (IPSS), International Index of Erectile Function (IIEF)-5 and Prostate Specific Antigen (PSA) etc. The variables were compared between the two groups using univariate and multivariate regression analysis. Results: There were 267 (77.1%) men in group A and 79 (22.9%) men in group B. The overall IPSS score and IIEF-5 score of the former group were 6.8±8.2 and 22.3±3.5, while those of the latter group were 9.1±8.8 and 18±4.5, respectively. Therefore, both scores in group B were much worse than those in group A (<0.05). The presence of large prostatic calculi, old age (≥61.3 years) and prostate volume (≥23.8 ml) were significant factors for moderate to severe LUTS (IPSS≥8) in the both univariate and multivariate analysis, but obesity (BMI>25kg/m2) was not a significant factor in multivariate analysis. Meanwhile, the presence of large prostatic calculi, old age and obesity were closely related to predisposing factors of ED in the both analyses. However, prostate volume, comorbidity and PSA etc. were not significant (<0.001). Common predisposing factors for both LUTS and ED were only large prostatic calculi and old age. The likelihood of both LUTS and ED was related to group B with a 2.846-fold and 2.126-fold respective increase in risk over group A.
147
UNMODERATED ePOSTERS Conclusion: These data demonstrate that large pros-
tatic calculi and old age may worsen ED and moderate to severe LUTS at the same time in middle-aged men.
UP.060 Usefulness of Flexible Cystoscopic Classification of the Prostate in Benign Prostate Hyperplasia 1
2
2
2
2
Choi SM , Yoon S , Lee SW , Jeh SU , Hwa JS , Seo DH3, Lee C2, Kam SC2, Chung KH2, Hyun JS2 1 Dept. of Urology, Gyeongsang National University Hospital, Jinju, Korea; 2Gyeongsang National University Hospital, Jinju, Korea; 3Gyeongsang National University Changwon Hospital, Korea
Introduction and Objective: To classify and evaluate the prostate by flexible cystoscopy in patients with benign prostate hyperplasia (BPH). Materials and Methods: From January 2008 to May 2015, EMR data and images were collected retrospectively from the patients who underwent flexible cystoscopy for BPH. Flexible cystoscopic prostate classification is combination of six urethral views (no enlargement: N, median lobe enlargement: M, unilateral lobe enlargement: U, bilateral lobe enlargement: B, M and U: MU, M and B: MB) and two bladder neck views (no protrusion: NP, protrusion: P). Age, body mass index (BMI), prostate volume (PV), international prostate symptom score (IPSS), voided volume (VV), maximal flow rate (MFR) and residual urine (RU) were compared among classified groups. ANOVA and Pearson correlation coefficient (r) were used. Results: A total of 374 patients were enrolled in this
study. The mean age of the patients was 71.04 years. The prostates were classified into 10 groups (N-NP, M-NP, M-P, U-NP, U-P, B-NP, B-P, MU-NP, MU-P, MB-P). Age was not significantly different among classified groups (p = 0.073). However, BMI, PSA, PV, IPSS, MFR, RU were significantly different among them (p < 0.05). In simple correlation analysis, age, BMI, PV, IPSS and RU had a significant linear correlation with the classified group (p < 0.05), and had a positive linear correlation (r = 0.180, 0.311, 0.534, 0.692, 0.244, respectively). VV and MFR had a significant linear correlation with the classified group (p < 0.05), and had a negative linear correlation (r = -0.316, -0.553). Conclusion: We think that flexible cystoscopic clas-
sification is correlated with patient symptoms and many BPH parameters, so this classification could be useful in patient BPH work up.
UP.061 High Temperatures or a Sharp Drop in Temperature May Result in a Urological Emergency Visit for Renal Colic or Acute Urine Retention: A 3-Year MeteorologyDisease Survey with 2874 Cases Mao S, Liu R, Jiang H Huashan Hospital, Fudan University, Shanghai, China Introduction and Objective: A high ambient tem-
perature is a risk factor for renal colic, and a previous study suggested seasonality in the incidence of acute urine retention (AUR) among benign prostate hyperplasia (BPH) patients. Yet a correlation between the
148
daily ambient temperature and the incidence of renal colic /AUR remains to be determined. Materials and Methods: This was a retrospective
analysis of the meteorological effect on renal colic and AUR episodes between 2008 and 2010 at the emergency department of Huashan Hospital (a TOP 10 tertiary medical center in China). A total of 2418 episodes of renal colic and 456 episodes of AUR were retrieved from the database at Huashan Hospital over a study period of 1096 days (1 January 2008 to 31 December 2010). Meteorological data (including temperature and humidity) were obtained from the National Oceanic and Atmospheric Administration. The correlation of temperature, temperature change, humidity and so on were calculated. Results: The Spearman’s correlation coefficient test revealed that the number of admissions for renal colic per day and mean daily temperature showed a significant correlation (r=0.236, p<0.01). The number of admissions for AUR did not increase in cold weather. Linear regression analysis showed a significant positive correlation between weekly temperature change and rate of AUR episode (incidences/days: r2=0.251, p=0.015). Humidity did not affect the incidence of admission for AUR and renal colic. Seasonal distributions of renal colic and AUR episodes were not influenced by age and sex. Conclusion: Ambient temperature had a positive in-
fluence on the number of daily admissions for renal colic at the emergency department. AUR incidence did not increase in cold weather; however, a sharp drop in temperature had a positive influence on the number of admissions for AUR. Urologists should pay more attention to BPH patients on days when temperatures dramatically decrease.
UP.062 180W-LBO Greenlight XPS Laser Vaporization for Benign Prostatic Hyperplasia: Evaluation of a Single Surgeon Learning Curve to Attain Surgical Proficiency for Durable and Reproducible Outcomes Zhou J1, Tholomier C1, Hueber PA1, Valdivieso R1, Trudeau V1, Misrai V2, Bienz MN1, Lavigueur-Blouin H1, Zorn KC1, Zanaty M1 1 Dept. of Surgery, University of Montreal Hospital Center (CHUM), Canada; 2Dept. of Urology, Clinique Pasteur, Toulouse, France
Introduction and Objectives: Although the learning
curve to safely perform Greenlight photoselective vaporization of the prostate (PVP) is considered short, the case volume needed to ensure durable outcomes with the 180W XPS for men with benign prostatic hyperplasia has not been well addressed. This study aims at evaluating our learning curve of reaching technical proficiency and the impact of acquired experience on intraoperative and clinical outcomes. Materials and Methods: A retrospective analysis was
conducted on a prospectively gathered database of 328 consecutive patients who underwent PVP performed by a single experienced laser surgeon. The population was divided into chronologically consecutive equal groups of patients to assess the perioperative and postoperative outcomes up to 12 months.
Logarithmic regression was used to evaluate the case number to attain benchmark criteria for durable treatment. We also compared these outcomes before and after technical proficiency was attained, defined as use of 3-4 kJ per mL of TRUS prostate volume and PSA reduction of 50% at 6 months post-operatively. Results: Energy delivered per prostate volume increased significantly with XPS experience. The benchmark values of 3 kJ/mL, 4 kJ/mL and 6-month PSA drop of 50% were attained after 33, 190 and 136 cases, respectively. There were no significant differences between groups in intraoperative complications or postoperative functional outcomes (IPSS, Qmax, PVR); however, the number of Clavien-Dindo category I adverse events significantly decreased with increased experience. Sub-analysis looking at small (≤80 g) and large (>80 g) prostates yielded comparable good clinical outcomes before and after technical proficiency. Conclusions: The case volume required to achieve reference values related to durable clinical outcomes and surgical proficiency was >100 cases. However, desirable clinical outcomes were attained before reaching benchmark values, regardless of prostate size, suggesting that current thresholds of technical proficiency may not be needed to achieve satisfying clinical outcomes at 12 months post-surgery.
UP.063 Frequency and Predictors of TUR Syndrome for Patients Undergoing TransUrethral Resection of Prostate (TURP) Younus MA, Nazim SM Aga Khan University Hospital, Karachi, Pakistan Introduction and Objective: Transurethral resection
of the prostate (TURP) is a standard surgical treatment for BPH using non-conductive irrigation fluid. Transurethral resection (TUR) syndrome is usually defined as a serum sodium level of <125 mmol/l combined with clinical cardiovascular or neurological manifestations. This study aimed to determine the risk factors for development of the clinical manifestations of TUR syndrome, and to investigate whether these clinical manifestations could be predicted by Hahn’s score. The objective was to determine frequency and predictors of Trans urethral resection (TUR) syndrome in patients undergoing TURP. Materials and Methods: It is a retrospective study from January 2014 to December 2014. A total of 131 patients were included with pre-operative ultrasound for prostate. All patients with incomplete data and with secondary or multiple procedures were excluded. TUR syndrome was diagnosed on basis of post-operative sodium level <125 and intra- or postoperative cardiovascular or neurological abnormalities using Hahn’s score. Patients were divided into groups with and without clinical manifestations of TUR syndrome, and potential risk factors were compared between the two groups, that included patients’ co-morbidities, duration of surgery, resected prostate weight, blood transfusion volume, and amount of irrigation fluid were seen. Results: In our study, a total of 131 patients were included, of which 9 (6.9%) developed TUR syndrome. There was a significant difference in the pre-operative prostatic weight between patients with (85.7 +/-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.062, Figure 1.
35.3 gm) and without (55.3+/- 29.4) TUR syndrome. There were significant differences in duration of surgery, resected prostate weight, irrigation volume and blood transfusion volume. Conclusion: Pre-operatively risk of developing TUR
syndrome should be communicated to patients with large prostatic size. Hahn’s score should be used prospectively to collect data regarding development of TUR syndrome. A prospective study with a larger sample size should be conducted.
UP.064 Impact on Quality of Life and Sexual Function in Males with Lower Urinary Tract Symptoms in China, Taiwan, and South Korea: A Subgroup Analysis of the LUTS Asia Study Liao L1, Chuang YC2, Liu SP3, Lee KS4, Yoo TK5, Chu R6, Sumarsono B6, Wang JY7 1
Dept. of Urology, China Rehabilitation Research Center, Capital Medical University, Beijing, China; 2 Dept. of Urology, Kaohsiung Chang Gung Memorial
Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Dept. of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; 4Dept. of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 5Dept. of Urology, Eulji General Hospital, Seoul, Korea; 6Astellas Pharma Singapore Pte Ltd, Singapore; 7Dept. of Urology, Beijing Hospital, China Introduction and Objectives: The term “lower urinary tract symptoms” (LUTS) describes storage, voiding, and post-micturition symptoms associated with conditions affecting the bladder, urethra, and urinary volume. These symptoms may reduce patients’ quality of life (QoL) and can impact their sexual function/satisfaction. Data are limited on the impact of LUTS on QoL and sexual function in Asian men. The objective of this subgroup analysis was to correlate LUTS severity and type with patient-assessed QoL and sexual function/satisfaction in Asian men. Materials and Methods: The LUTS Asia study
(NCT02618421) was an internet-based, self-administered survey conducted between June 2 and July
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
20, 2015. Subjects (≥40 years) were randomly selected from China, Taiwan, and South Korea consumer survey panels. For these analyses, LUTS was defined using the International Continence Society (ICS) 2002 symptom definition (ie, presence of ≥1 voiding, storage, or post-micturition symptoms) and symptom severity was assessed by the International Prostate Symptom Score (IPSS). The impact of LUTS on QoL was assessed by Patient Perception of Bladder Condition (PPBC) and IPSS QoL scores. Sexual function/ satisfaction was assessed with the International Index of Erectile Function (IIEF). The correlation between QoL scores, sexual function/satisfaction, and LUTS type and severity was analyzed. Results: Of the 8284 survey respondents, 4076 (49.2%) were men, and were included in these analyses. Men with moderate-to-severe LUTS were dissatisfied with their QoL and sexual function. Men with voiding, storage, and post-micturition symptoms had a poorer QoL than men with a fewer number of symptoms. In all countries, LUTS severity was negatively correlated with IIEF scores for erectile function, or-
149
UNMODERATED ePOSTERS gasmic function, sexual desire, and intercourse satisfaction (all with P<0.00001). Furthermore, men with voiding, storage, and post micturition symptoms had overall decreased sexual satisfaction, while men with post-micturition symptoms alone reported sexual satisfaction comparable to men without LUTS. Conclusion: Asian men with moderate-to-severe
LUTS reported dissatisfaction with their QoL, and LUTS severity was associated with decreased sexual function/satisfaction. The negative impact of LUTS on QoL and sexual function appears to be less apparent in men with fewer symptoms of lower severity.
UP.065
Conclusion: Combination therapy is more efficient
Jeh SU1, Yoon S1, Choi SM1, Hwa JS1, Seo DH2, Kam SC2, Lee C2, Lee SW1, Chung KH3, Hyun JS1
then alpha blockers on mono-therapy in the management of BPH complicated with AUR (1st episode) in well selected patients with less need for surgery.
UP.066 Does the Control of Metabolic Syndrome Improve LUTS and Sexual Function Due to HBP? A Unicentric Study
Introduction and Objective: Metabolic syndrome
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia Introduction and Objective: We evaluate and compare the efficiency at short and medium-term of medical management of 1st episode of acute urinary retention (AUR), due to benign prostatic hyperplasia (BPH), by Tamsulosin versus Tamsulosin and Dutasteride. Materials and Methods: Male patients aged more
than 55 years and presenting with AUR secondary to BPH for the 1st time were included in this study. Patients with prostate size <50 cm3 and/or high intra-vesical prostate protrusion (>10 mm) were not included in this study. After drainage by urethral catheter the patients were randomized in two groups: Group I: prescription of Tamsulosin 0.4 mg/ day and Group II: prescription of Tamsulosin 0.4 mg + Dutasteride 0.5 mg/day. Urethral catheter was removed after 10 days. If recovery of normal micturition, the same medical treatment will be continued for at least 6 months. If there was recurrence of AUR, surgical procedure is indicated. Patients will be controlled at 1 month then every 3 months by IPSS, ultrasound and Uroflowmetry. Success is defined by: IPSS <12, PVR <50 ml and Qmax >12 ml/sec. Results: During the study period, 50 patients were in-
cluded. The median age was 62.8 ±2.2 years. The prostate size ranged from 50 to 139 cm3. The two groups
UP.065, Table 1. Group I (n=26)
Group II (n=24)
p
62.1 ± 3.5
64 ± 3.7
0.7
Failure after catheter removal (10 days)
5
4
0.81
Success (1 month)
14
15
0.55
Success (3 months)
14
16
0.33
Success (6 months)
12
17
0.05
Need for surgery
9
2
0.025
Relationship Between Serum Testosterone and Nocturia in Men Without Benign Prostate Enlargement
1
Dept. of Urology and Urological Science Institute, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; 2Dept. of Urology, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; 3Dept. of Urology, Gyeongsang National University Changwon Hospital, Jinju, Republic of Korea Introduction and Objective: To clarify the relation-
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia
Sallami S, Abou El Makarim S, Touinsi H
150
UP.067
Sallami S, Abou El Makarim S, Touinsi H
Combination Medical Therapy in the Management of Benign Prostatic Hyperplasia Complicated with Acute Urinary Retention: Is It the Solution? A Randomized and Comparative Study About 50 Patients
Age
were comparable concerning age (p=0.7) and prostate size (p=0.3). Evolution of response to medical treatment of AUR complicating BPH in the 2 groups is summarized in table 1.
(MS) is a cluster of cardiovascular risk factors including obesity, hypertension, dyslipidemia and hyperuricemia. The association between metabolic syndrome and LUTS, in men with benign prostatic hypertrophy (BPH), has been reported in many series. We investigate whether the management of metabolic syndrome may improve LUTS and sexual function in patients with symptomatic and uncomplicated BPH. Materials and Methods: We included all patients who presented to Urology clinics in Tahar Maamouri Teaching Hospital in Nabeul for symptomatic BPH associated to MS between March 2014 and August 2015. Eighty-two patients (mean age 61.2±5.3 years) diagnosed with uncomplicated BPH were included. They were treated with phytotherapy or alpha-blockers in a prospective, observational, and longitudinal study. Combination therapies for MS included behavioral lifestyle changes with moderate-intensity resistance exercise, diet, adequate hydration, nutrition therapy and intensive medical therapy. Patients were examined after a minimum of 6 months from the time of their 1st visit to assess their erectile function (EF) using the short form of the International Index of Erectile Function (IIEF-5), the quality of micturition (IPSS score) and there was a need for surgical treatment. Results: In 33 patients (Group A), we found significantly improvement of obesity parameters (body weight, waist circumference, and BMI) compared to those at baselines with normal biological tests (total cholesterol, LDL cholesterol, triglycerides, fasting blood glucose, HbA1c) and normal blood pressure. Table 1 summarizes the evolution of LUTS, EF and the need for prostatic surgery. Conclusion: MS treatment resulted in a significant
and sustained improvement in LUTS and erectile function secondary to BPH with improvement in quality of life.
ship between serum total testosterone and nocturia in males without an enlarged prostate. Materials and Methods: Among the 1 029 male pa-
tients who visited our clinic for health screening from January 2010 to July 2014, 596 patients without benign prostate enlargement (BPE) were analyzed. To evaluate the effect of serum total testosterone on prevalence of nocturia and number of nocturia episodes, multivariate analyses were performed including the covariates of age, International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) score, body mass index, prostate specific antigen, prostate volume and maximal urinary flow rate. Results: Mean prostate volume was 21.70±4.34 cm3 and prevalence of nocturia (≥ 2 times/night) was 22.1%. Multivariate logistic regression analysis revealed positive associations of age (OR 1.048, P = 0.005), total IPSS (OR 1.217, P < 0.001) and testosterone level (OR 1.115, P = 0.041) with the prevalence of nocturia. Although the mean testosterone level was progressively elevated as the number of nocturia episodes increased, no consistent association with the number of nocturia episodes was seen for testosterone after adjusting for age, IPSS, IIEF score and maximal urine flow rate. Conclusions: Serum total testosterone level is significantly positively associated with the prevalence of nocturia. Therefore, in men without enlarged prostate, testosterone may have an opposing role in the etiology of nocturia.
UP.068 Improvement of the Detrusor Overactivity by a New Plant-Based Compound in Rats with Overactive Bladder Induced by Partial Bladder Outlet Obstruction Kim SJ, Choi SW, Bae WJ, Jeong HC, Hong SH, Lee JY, Kim SW Dept. of Urology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
UP.066, Table 1. IPSS < 10
Q max > 15 ml/s
IIEF-5 > 17
Group A (n=33)
27
21
15
3
Group B (n=49)
24
17
12
12
0.02
0.01
0.04
0.07
p-value
Prostatic surgery
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS Introduction and Objective: There are several antimuscarinics for the treatment of the overactive bladder (OAB), however, lots of patients cannot handle the medication due to side effects such as dry mouth, constipation, and cognitive impairment in spite of the efficacy. Therefore, it is important to develop OAB medication with good tolerability as well as efficacy. Natural plants are regarded as safe, and some recent studies reported the effect of medication from plant sources on voiding dysfunction. Therefore, we introduce the new plant-based compound made of natural plants to treat OAB. Materials and Methods: The new plant-based compound consists of 6 plant sources: 25% Corni Fructus, 25% Angelica gigantis Radix, 25% Lycii Fructus, 10% Cervi parvum cornu, 10% Ginseng Radix Rubra, and 5% Cassiae cortkex. Female Sprague-Dawley rats were assigned to 5 groups: control (n=6), OAB-induced rat (n=6), OAB-induced rat administered with solifenacin (1 mg/kg, n=6), and OAB-induced rat administered with new plant-based compound (400 mg/kg, n=6). The OAB was induced by the partial bladder outlet obstruction (BOO) of the urethra and solifenacin and the new plant-based compound were administered for 4 weeks. Cystometrograms were done after 4 weeks. The M3 muscarinic receptor, RhoA, ROCK-I, and ROCK-II expression were analyzed in the bladder. Results: Detrusor overactivity (DO) of the OAB-induced rats was noted by the partial BOO were confirmed by increased contraction pressure and decreased contraction intervals at cytometrogram. In addition, non-voiding contractions (NVD) were increased. There was a significant decrease in contraction pressure, increase in contraction intervals, and decrease in NVD in the OAB-induced rats administered with the new plant-based compound compared with the OAB-induced rats. These functional improvements were similar with the solifenacin-administered rats. The increased expressions of M3 muscarinic receptor, RhoA, ROCK-I, and ROCK-II were observed in the OAB-induced rats. Significant decreased expressions of M3 muscarinic receptor, RhoA, ROCK-I, and ROCK-II were observed in the OAB-induced rats administered with the new plant-based compound compared with the OAB-induced rats. Conclusion: The treatment effect of the new plant-
based compound on OAB was observed by the functional and molecular improvements. We suggest the new plant-based compound as a new treatment option for OAB.
UP.069 180-W XPS GreenLight Laser Vaporization Versus Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia: 2-Month Safety and Efficacy Results in Korean Patients Park JJ, Chae JY, Kim JW, Oh MM, Park HS, Kim JJ, Moon DG, Ahn ST Dept. of Urology, Korea University College of Medicine, Seoul, South Korea Introduction and Objective: To compare short-term
outcomes of 180W-XPS Greenlight photoselective vaporization of the prostate (XPS) to transurethral resection of prostate (TURP) on uroflowmetry and
IPSS at 2 months in patients with benign prostatic hyperplasia (BPH) Materials and Methods: A retrospective chart review was performed on 80 patients with BPH who underwent XPS in 2015. Controls were configured with 80 patients who underwent TURP. All parameters were collected retrospectively, including maximum urinary flow rate (Qmax), post-voiding residual (PVR), prostate specific antigen, IPSS, and complications. The presence of postoperative complications was verified. Results: XPS and TURP were similar in preoperative parameters respectively. The operative time of XPS was significantly longer than TURP (55.1±25.5 min TURP and 67.1±36.0 min XPS, p=0.041). XPS showed a significantly shorter hospital stay than TURP (4.3±1.1 vs. 2.8±1.3, p<0.001). Postoperative Qmax, PVR, IPSS of both operations were improved compared to baseline and XPS showed a significant higher improvement on QoL score than TURP. A single patient showed hematuria, but did not need transfusion in XPS. Conclusions: PVP treatment using 180W-XPS is a safe and effective procedure for treating BPH compared to TURP.
UP.070 Factors Influencing Prostate Volume Reduction in Patients with Benign Prostatic Hyperplasia with over 5 Years of Treatment Yoo D, Noh JH, Park SW, Kim JS Dept. of Urology, Kwangju Christian Hospital, Gwangju, Korea
60 cc (N=37), and 61-80 cc (N=30), the reduction of prostate volume was 14.2%, 23.4% and 27.1% respectively, so when the prostate volume was larger at the time of diagnosis, more volume decreased (p< 0.001). Prostate volume reduction based on serum PSA, IPSS and PVR did not show a significant difference. When divided into below 200 mg/dl (N=21), 200-239 mg/dl (N=42), and above 240 mg/dl (N=15) based on cholesterol level, the reduction of prostate volume was 24.2%, 22.3%, and 15.8% respectively, showing greater reduction as the cholesterol is lower (P< 0.045). In Group B, only the high level of cholesterol displayed a statistically significant increase in prostate volume (P< 0.05). Conclusion: The group of at least over 5 years of 5ARI
administration showed a reduction in prostate volume by 21.2% on average, while the group without the administration showed an average of 9.2% increase in prostate volume. Considering that prostate volume increases as a person ages, 5 years of 5ARI administration had a greater effect in reducing the prostate volume. Also, when the prostate volume is large and cholesterol is low at the time of 5ARI administration, greater prostate volume reduction can be expected.
UP.071 Analysis of Present Status for Surgery of Benign Prostatic Hyperplasia in Korea (2010 to 2014) Choi H1, Kim HJ2 1
Dept. of Urology, Korea University Ansan Hospital, Korea; 2Dept. of Urology, Dankook University College of Medicine, Cheonan, Korea
amine the factors that influence prostate volume reduction in patients who underwent treatment for over 5 years for benign prostatic hyperplasia.
Introduction and Objective: There is no established evidence of comparing efficacy and safety between surgical methods of benign prostatic hyperplasia (BPH). This study investigated the present status related BPH surgery in Korea during five years.
Materials and Methods: Out of 135 patients who first
Materials and Methods: County level data from the
Introduction and Objective: This study aimed to ex-
underwent transrectal ultrasonography (TRUS) and received drug treatment for over 5 years, who underwent second TRUS 5 years later from 2010 to 2015 were divided into Five-Alpha Reductase Inhibitor (5ARI) Administration Group (Group A: 78 patients) and Alpha Blocker Administration Group (Group B: 57 patients). Based on their age at the beginning of each treatment, volume of prostate, serum PSA, International Prostate Symptom Score (IPSS), postvoid residual volume (PVR) and blood cholesterol, the changes in their prostate volume were compared 5 years after the treatment. Results: The mean value of average age, volume of prostate, serum PSA, IPSS, PVR and cholesterol of Group A and Group B were 69.8±16.8 vs. 67.8±11.3, 42.9±39.2 cc vs. 31.3±19.7 cc, 2.34±6.2 ng/ml vs. 1.42±5.3 ng/ml, 22±10.2 pts. vs. 18±13.2 pts., 120±250 cc vs. 85±180 cc, 196±151 mg/dl vs. 188±118.2 mg/ dl respectively, and the average change of prostate volume showed 19.2±14.5% in Group A, whereas Group B showed 9.2±10.2% increase. When Group A was divided based on the age at the time of diagnosis in Group A into 50 s (n=15), 60 s (n=38), and over 70 s (n=25), the reduction in prostate volume was 18.5%, 25.9% and 19.4% respectively, displaying no significant difference (p=0.214); when divided based on prostate volume into 31-40 cc (N=11), 41-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
National Health Insurance Service and National Statistical Office were analyzed in this ecological study. The trend of the number of BPH related surgeries was analyzed, and age, geographic distribution and assort classification of hospital were also reviewed. Results: There is not much change in the total number of BPH related surgeries during five years. Although there is not much alteration in the number of conventional transurethral resections of the prostate (TURP), the number of holmium laser prostate surgeries (HOLEP) dramatically increased. The number of HOLEP overtakes the number of KTP laser after 2011 and it is anticipated that the gap will continue to rise. In the analysis of age, BPH related surgery is increased according to years in seventy while it is decreased in fifty and sixty. Meanwhile, after 2012, the number of BPH related surgeries decreased in local clinics, but increased in large hospitals in the metropolitan and this may be related with the increased number of HOLEP. In the analysis of geographical distribution, an uneven distribution according to country characteristics (metropolitan cities vs. nonmetropolitan cities) was shown. Conclusion: Through the data of the National Health
Insurance Service, we could comprehend the present status of BPH related surgeries in Korea. We could
151
UNMODERATED ePOSTERS UP.071, Table 1.
moved on the same day in 10 cases and in 37 cases, it was removed the next post-operative day, and patients left the hospital. At the follow-up, all patients had an IPSS, and Qmax amelioration with irritative symptom in 20% cases in the first week.
2010
2011
2012
2013
2014
6822
6604
6962
6656
6472
HOLEP
278
2030
2549
2772
3341
Conclusion: TURis offers the patient the same results
KTP
3313
2754
2104
1759
1413
Sum
10413
11388
11615
11187
11226
as monopolar technology, guaranteeing maximum safety, reducing the bleeding and requiring a short hospital stay.
TURP
know about the trend according to several factors, and we think these are valuable results as academic references as well.
UP.072 Lower Urinary Tract Symptoms and Urodynamic Findings in Women with Parkinson’s Disease Al-Zahrani AA University of Dammam, Saudi Arabia Introduction and Objectives: This study was designed
to assess the correlation between lower urinary tract symptoms (LUTS) and urodynamic (UD) findings in female patients with Parkinson’s disease. Materials and Methods: This was a retrospective
study on female patients with Parkinson’s disease who underwent urodynamic (UD) evaluation for LUTS. LUTS was graded as per Urogenital Distress Inventory Short Form. All UD readings were evaluated by a single physician. Spearman correlation coefficients were determined to correlate LUTS symptoms with the UD findings. Univariate logistic regression analysis was used to determine the independent factors for bladder outlet obstruction and detrusor over activity. Results: There were 17 UD reports that met the inclusion criteria and were analyzed. Patients were complaining of frequency (13, 76.5%), urgency (14, 82.4%), urgency urinary incontinence (13, 76.5%), nocturia (12, 70.6%), suprapubic or pelvic pressure (7, 41.2%), weak stream (11, 64.7%) or incomplete emptying (12, 70.6%). Eleven patients showed evidence of detrusor over activity (64.7%) and 7 patients (41.2%) had evidence of bladder outlet obstruction. There was no correlation between the urinary symptoms and presence of DO. Weak stream correlated moderately with presence of BOO. There were no specific LUTS that could predict DO or BOO in female patients with Parkinson’s disease. Conclusions: Female patients with Parkinson’s dis-
ease and LUTS have poor correlation with UD findings. LUTS and UD findings are complementary to reach a more precise diagnosis and a more appropriate management plan.
UP.073 Is Ambulatory BPH Surgery Possible? Bipolar Resection of the Prostate Using the TURis System: A Study About 25 Cases Rabii R University Hospital, Casablanca, Morocco Introduction and Objective: TURis has proven to be
effective in treating symptoms of BPH, with maximum safety without increasing the rate of compli-
152
cation and days stay. We report a pilot study of the feasibility of a TURis without an overnight stay, on select patients as a day-case procedure, by using modern anaesthetic techniques and the TURis system in Cheik Khalifa Hospital, Casablanca, Morocco. Materials and Methods: A total of 25 men who ful-
filled a number of selection requirements were included in the study. The usual parameters of symptoms (assessed using the AUA score, urinary flow rate and bladder residual volume on ultrasound) were included. The patients were also selected according to age, their medical fitness for day-case anaesthesia (ASA grade I-II) and prostatic size. Other essential inclusion criteria included proximity of home to hospital, the presence of partner/caregiver to escort them home and stay with them for at least 24 h, and access to a telephone. The patients were admitted at 7:00 am and started the TURis at 8:00 am under a locoregional anesthesia. The patients left the hospital at 8:00 pm (12 hours after). Results: All 25 patients who were selected for the study underwent surgery and attended follow-up as arranged. Anaesthesia and surgery were performed without complication in all patients. The mean prostate weight was 30 g (range 30 to 50). The mean operative time was 45 min (35-70). There were no conversions and no complications for any cases. The urethral catheter was removed on the same day in 10 cases and on the next postoperative day in 15 cases. All the cases left the hospital 12 hours after the surgery. At the follow-up, all patients had an IPSS, and Qmax amelioration with irritative symptom in 20% cases in the first week.
UP.075 Effect on Sexual Function Following Holmium Laser Enucleation of the Prostate (HOLEP) Kulkarni M1, Penev B2, Cynk M2, Henderson A2 1 Brighton and Sussex University Hospitals NHS Trust, United Kingdom; 2Maidstone and Tunbridge Wells NHS Trust, United Kingdom
Introduction and Objectives: To evaluate the pa-
tient-reported sexual function outcomes of holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms secondary to prostatic enlargement. Materials and Methods: A total of 71 patients were
evaluated in this retrospective study of a prospectively-recorded database. Sexual function was assessed before and after HoLEP procedure, using the Male Health Inventory Score. International Prostate Symptom Scores (IPSS) was also included for additional functional outcome analysis. Results: Mean patient age was 70 years. Mean prostate volume was 50 g (24-112 g). Scores regarding confidence and satisfaction with intercourse and the ability to maintain erection did not show significant change from baseline. Furthermore, the use of medications for erectile dysfunction did not change post HOLEP. There was, however, a significant improvement from baseline in IPSS score over the same time period. Conclusion: This preliminary data has demonstrated
as monopolar technology, guaranteeing maximum safety, reducing the bleeding and requiring a short hospital stay. Ambulatory BPH surgery is possible.
that HoLEP has a significant impact on IPSS with no adverse impact on patient-reported sexual function. We have begun a prospective study of patients, and will evaluate scores are more defined intervals. This represents an important tool that can be used during the pre-operative counseling of patients considering surgical therapy for benign prostatic hyperplasia.
UP.074
UP.076
Bipolar Resection of the Prostate Using the TURis System: A Study About 67 Cases
Relationship Between PSA Levels and Lifestyle in Asymptomatic Patients
Conclusion: TURis offers the patient the same results
Rabii R, Ayoub H University Hospital, Casablanca, Morocco Introduction and Objective: We reported the safety and efficacy of prostate bipolar resection using TURis system. Materials and Methods: We report 67 cases of men
with BHP who underwent a bipolar trans uretral resection using the TURis system. Results: The median prostate weight was 45 g (30 to 95). The mean operative time was 45 min (35-110 min). There were no conversions and no complications for all the cases. The bladder catheter was re-
Padilla-Fernandez B1, Virseda-Rodríguez ÁJ2, Bravo-Grande JL3, Sánchez-Escudero A4, Vicente-Arroyo MJ4, González-Casado I4, MartínGarcía I4, Lorenzo-Gómez A5, García-Cenador MB5, Lorenzo-Gómez MF6 1
Dept. of Urology, University Hospital of the Canary Islands’ Complex, Tenerife, Spain; 2Dept. of Urology, University Hospital of Salamanca, Spain; 3Dept. of Occupational Risks, University Hospital of Salamanca, Spain; 4Primary Care, University Hospital of Salamanca, Spain; 5Dept. of Surgery, University of Salamanca, Spain; 6Dept. of Surgery, University of Salamanca, Spain; Dept. of Urology, University Hospital of Salamanca, Spain
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS Introduction and Objective: Prostate screening is one of the most controversial debates in urological forums. We investigated the relationship between PSA levels and some lifestyle-related factors in asymptomatic patients.
UP.077, Table 1. Time Since Intervention
Number of Patients
Number Reporting an Improvement in Erectile Function
12-17 months
8
0 (0%)
18-23 months
12
2 (17%)
24+ months
4
1 (25%)
Materials and Methods: This was a multicentric
cross-sectional study evaluating the prevalence of lifestyle factors and their relationship with PSA serum levels in asymptomatic men over 50 years. Study groups: Group A (GA, n=364): men attending the urological outpatient clinic with systematic PSA evaluation; Group B (GB, n=346): men attending their primary care consultation with systematic PSA evaluation. Exclusion criteria included patients diagnosed under any prostatic disorder. Variables, including age, personal and family background, second diagnoses, marital status, working status, working time, diet, BMI, toxic habits, and PSA level were analyzed. Results: Lower mean age in GA (61.19 years) than in
GB (65.10 years). Mean PSA was 1.61 ng/ml (range 0.1-13) in GA, 6.07 ng/ml (1.17-122) in GB. Morning’s working time and more alcohol consumption was associated with a lower PSA, independently for age, in GA. Age was associated with higher PSA levels in GA, but inversely in GB (even after excluding the highest PSA level of 122 ng/ml). A higher work status was associated with higher PSA levels independently to age in GA and with lower PSA levels in GB. Higher PSA levels were not associated with a higher BMI (independently to age). Dyslipidemia, HTN and regular exercise were not correlated with PSA levels. Diet did not correlate with PSA levels. Smoking habit did not show any association with PSA levels. Conclusions: Dyslipidemia and high BMI were not associated with higher PSA levels. Mild alcohol consumption was associated with lower PSA levels. More studies are needed in order to confirm and explain these results.
UP.077 Prostatic Urethral Lift: Long-Term Impact on Sexual Function Pan TY, Al-Sameraaii A ACT Health, Canberra, Australia Introduction and Objective: There is reasonable evidence suggesting that the prostatic urethral lift has no negative impact on sexual function for up to 12 months following the procedure. The authors evaluated the longer-term impact on sexual function following this procedure beyond 12 months. Materials and Methods: In this prospective study, patients who received the prostatic urethral lift as a single procedure have been followed-up at 3, 6, 12, 18 and 24 months after their procedure. All consultations included relevant sexual health clinical history. Results: A total of 26 patients underwent the prostatic urethral lift between January 2014 and May 2015. Two patients were impotent both prior and after the procedure and were excluded from this study. The average patient age was 61 years (range 39 to 86). The average prostate volume was 45 cc (range 22 to 83). The mean number of clips implanted was 4.2 (range 2-7). There were no reports of decline in erection function, anejaculation or dysejaculation across all groups.
Conclusion: This study provides early data that sug-
UP.079
gests the prostatic urethral lift has no negative impact on sexual function up to 24 months following the procedure. It appears to be a safe and effective treatment for benign prostatic hyperplasia while preserving sexual function, an important component to the overall quality of life and satisfaction with the procedure for many patients.
The Cost-Effectiveness of Greenlight Laser Compared to Transurethral Resection of the Prostate for Patients with Benign Prostate Hypertrophy
UP.078 The Efficacy of Sacral Neuromodulation for the Treatment of Male Voiding Dysfunction Hamid R, Pakzad M, Ockrim J, Greenwell T University College London Hospital, United Kingdom Introduction and Objective: Sacral neuromodulation (SNM) is an established treatment for controlling overactive bladder symptoms especially in females. Itts role in lames is not well defined. We reviewed our experience with this technique in this group. Materials and Methods: We reviewed our prospec-
tively collected database to identify male patients with voiding dysfunction undergoing a trial of SNM over the last 18 months. All presented with voiding dysfunction with some in retention requiring self-intermittent catheterization (SIC). All underwent video-urodynamic studies (VCMG). All neurological causes were excluded with clinical examination and cross sectional imaging. Results: We identified 16 patients. The mean age was 44 years. Eight patients were performing SIC. One had a suprapubic catheter and 7 had voiding with straining. VCMG revealed no detrusor overactivity in any patients, with 10 demonstrating acontractile detrusor and 6 showing high pressure low flow system consistent with high-tone non-relaxing sphincter (HTNRS) on the accompanying video clip. All underwent a trial of tined lead for a minimum of 4 weeks. There was no significant benefit in 12/16 and the tined lead was removed. A successful outcome was demonstrated in 4/16 (25%) and permanent pulse generator was implanted. It stopped working after few months in 1 patient. One needed to be explanted due to infection. Currently, 2/16 patients have a working implant. Conclusion: It appears that SNM is not an optimal
therapy for the treatment of non-neurogenic voiding dysfunction in male patients. We feel that further work is required to identify specific-select patients with a larger cohort to evaluate its role in this particular condition.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Curtis A University Health Network, Toronto, Canada Introduction and Objective: Benign prostatic hypertrophy (BPH) is a non-cancerous enlargement of the prostate that affects up to 50% of men 50 years of age and older, and frequently leads to bothersome lower urinary tract symptoms (LUTS). Transurethral resection of the prostate (TURP) is the leading intervention used to ablate prostate tissue and restore normal urinary function. A newer energy based alternative called the Greenlight laser photoselective vaporization of the prostate (PVP) is less invasive, has a shorter surgical procedure, faster symptom improvement, and decreased morbidity compared to TURP. The present study compares case costs and complication rates of both methods. Materials and Methods: We employed a single center descriptive analysis of average case cost summaries of BPH surgical procedures PVP and TURP (both traditional and with Olympus power button; OP) over a 19-month timeframe (2013-2015). Proportion of total cases, total cost (surgical cost + hospital stay), and proportions of post-treatment complications were calculated. Results: There were 147 BPH surgical cases. PVP, TURP, and TURP with OP accounted for 29%, 62%, and 10% of cases, respectively. Notably, only 10% of PVP surgeries required in-patient hospital stays, whereas nearly all TURP cases were hospitalized. When cost of surgical procedure and hospital stay were calculated, PVP offered total cost savings over TURP and TURP OP of 30.2% and 33.4%, respectively. Furthermore, readmission rates within 60 days were 0% for PVP patients and 14% for TURP (due to mechanical or medical complications). Conclusion: The newer energy based PVP is a min-
imally invasive treatment intervention for BPH, requiring shorter surgical case duration over traditional TURP. We found that PVP offered savings of approximately 31% over TURP, and resulted in fewer complications that led to readmission. Considering its cost-effectiveness and medical benefits, PVP should be a leading treatment option for BPH related LUTS.
UP.080 Efficacy of the Coloplast Care Program for Catheter Users Curtis A, Van Asseldonk B University Health Network, Toronto, Canada
153
UNMODERATED ePOSTERS Introduction and Objectives: The Coloplast Care Program (CCP) is a telephone based patient transition support program for Coloplast product users. The present single center study evaluated the efficacy of the CCP in reducing catheter use, urinary tract infections (UTIs), and improving quality of life (QOL) for patients with bladder disorders. Materials and Methods: Patients completed a tele-
phone survey regarding the CCP assessing demographic and product information, daily catheter usage (total number), and UTI frequency (via rating scales from 1-never to 5-always) before and after the CCP. Satisfaction with various components of the CCP was also assessed. Mean values (M) and standard errors were calculated for all outcomes. Results: A total of 21 patients participated. Initially, patients reported using intermittent multiple use catheters (MUC; n = 14) or single use catheters (SUC; n = 1), external catheters (n = 1), or pads/briefs (n = 5). Notably, during the CCP, 5 (36%) MUC users switched to SUC. Furthermore, there was a significant interaction between catheter switching and frequency of UTIs (p < 0.05). Patients who switched from MUC to SUC reported less frequent UTIs after the CCP (M = 1.1 +/- 0.46), compared to before CCP (M = 2.6 +/0.43), whereas patients who did not switch reported no change (p = 0.48). The CCP did not impact daily catheter use. Patients who switched to SUC rated the CCP significantly higher than the no switch group on overall satisfaction, education and coverage support, assistance in locating a catheter provider and product, and improvement to overall QOL. Conclusion: This study presents preliminary results
demonstrating the efficacy of the CCP in helping patients with bladder disorders switch from MUC to SUC, likely contributing to the reduction in UTI frequency for these patients. Patients who switched reported higher CCP satisfaction and greater improvement in their QOL, compared to patients who continued to re-use catheters.
UP.081 Treatment-Related Complications of Various Pelvic Floor Repairs in Females over 70 Years Old Are Equivalent Tibi B1, Vincens E2, Durand M1, Kane A2, Salet Lizee D2, Gadonneix P2, Loeffler J3, Colomb F3, Severac F4, Chevallier D1, Amiel J1, Villet R2 1
Dept. of Urology, Hôpital Pasteur 2, University of Nice-Sophia Antipolice, Nice, France; 2Dept. of General Surgery and Gynecology, Diaconesses Croix Saint Simon Hospital, Paris, France; 3Dept. of Urology, Hospital Clavary, Grasse, France; 4Dept. of Public Health, University Hospital of Strasbourg, France Introduction and Objective: Several surgical techniques have been reported for pelvic organ prolapse in women. The purpose of this study was to assess treatment-related complications of various pelvic floor repairs in female aged from 70 to 80 years old. Materials and Methods: We performed a retrospec-
tive study involving elderly females over 70 years old with advanced pelvic organ prolapse who underwent surgical repair from December 2010 to 2013 at a reference center. Patients were assigned to one of three surgical groups consisting in sacrocolpopexy (SC),
154
native tissue repair surgery (NTR) and mesh repair surgery (MR). Treatment-related complications using Dindo grade, anatomical success rate, changes in quality of life (Qol) and perioperative data were collected during the follow-up. The Fisher’s exact test was used to assess treatment-related complications. Results: In all, 197 patients underwent a surgical repair, 53 (26%) SC, 85 (44%) NTR and 59 (30%) MR, in the 3-year follow-up. Fewer complications in SC group (p=0.041) were reported at 30 days but there was no difference regarding post-operative complications using Dindo grade (p=066). Median follow-up was 25 months. No ASA score difference was reported between groups. MR group had less concomitant hysterectomy than others (p<0.0001) and SC operative time was longer (p<0.0001). Overall, recovery time, anatomical success rate and Qol were comparable. Conclusion: All surgical techniques were equivalent
in terms of postoperative complications using Dindo Clavien classification in elderly females ranging from 70 to 80 years old.
UP.082 An Audit of Vesico Vaginal Fistula at Liaquat National Hospital and Liaquat University of Medical & Health Sciences Memon I Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan Introduction and Objective: To determine the com-
mon cause of iatrogenic genito-urinary fistula and its management in terms of success and failure rate. Materials and Methods: This was an interventional
study carried out in the Urology Department of Liaquat National Hospital Karachi and Liaquat University Of Medical & Health Sciences, Jamshoro from January 1, 2009 to December 26, 2015. A total of 193 patients with complaints of urinary incontinence due to iatrogenic fistula were included in the study. The data of patients was recorded on predesigned proforma, which included demographic characteristics, causes of fistula and management. Physical examination and investigations were carried out. Cases were operated on by a urologist. Success rate was observed till the 6 weeks after management. Results: Out of 193 cases, the most common type of iatrogenic fistula was vesicovaginal fistula, seen in 90.15% cases, while 5.69% cases had uretrovaginal fistula. Mean age of the patients was 29.0 ±1.06 SD. In the majority, 72% vesicovaginal fistula developed due to abdominal hysterectomy, while 12.95% of cases developed fistula after cesarean hysterectomy. Repair of fistula was attempted through transvaginal route in 72.12% of patients and through transabdominal route in 20.74% patients, while combined abdominovaginal route was adopted in 4.14% patients. Tissue interposition was done in 12 cases. All the patients with graft were repaired successfully and had no leakage of urine. A total of 95.34% were treated successfully after first attempt, while 4.65% patients had developed recurrence of fistula on 8 to 14 day. Conclusion: It is concluded that mostly iatrogenic
fistula developed due to gynecological hysterectomy.
UP.083 Pelvic Floor Muscle Injections for Hypertonicity in Women Han E1, Gaines N2, Gupta P2, Farrah M3, Killinger KA2, Boura JA4, Bartley J4, Gilleran J4, Sirls LT4, Peters KM4 1
Detroit Medical Center, Michigan State University, East Lansing, United States; 2Beaumont Health, Troy, United States; 3Oakland University, Rochester, United States; 4Beaumont Health, Oakland University William Beaumont School of Medicine, Rochester, United States Introduction and Objective: Pelvic floor (PF) dys-
function is a common cause of chronic pelvic pain (CPP). Injections of local anesthetics and steroids to the levator muscles have been shown to provide shortterm relief of acute pain and permit additional manipulation for pelvic floor physical therapy (PFPT). We evaluate outcomes after PF muscle injections in women at a tertiary care center. Materials and Methods: This was a retrospective review of women with CPP conditions who were treated with in-office PF muscle injections was completed from January 2012 to August 2015. Lidocaine 1% or 2%, bupivacaine 0.5%, and ropivacaine 0.5% were all used +/- triamcinolone 40 mg. Patients reported pain on a 0-10 scale for both levators before and 15 minutes after injection. Location, number of injections, and volume administered were recorded. Results: A total of 101 women underwent a total of 256 separate visits for PF muscle injections. A total of 201/256 (78%) were undergoing concurrent PFPT. Median number of visits was 2 with a median of 28 days between visits. Up to 6 injections into the obturators/levators were performed. At each visit, a mean of 5 injections with an average total of 19 cc of anesthetic +/- steroid were administered. A total of 65% of patients received bilateral PF muscle injections. Mean pain scores decreased by 6.3 and 6.7 on the VAS scale in the first 2 visits, respectively. Minor side effects (leg numbness, dizziness, nausea, bleeding, and headache) occurred in 26/256 visits (10%). Conclusions: Pelvic floor muscle injections can be an adjunct in women with pelvic floor dysfunction to control pain and aid in manual pelvic floor physical therapy.
UP.084 Pelvic Exenteration for Gynecologic Malignancies: Postoperative Complications and Oncologic Outcomes Romeo A, Jaunarena J, Pesce G, Zubieta ME, Gonzalez MI, Favre GA, Tejerizo JC Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: To evaluate complications, morbidity and oncologic outcomes of pelvic exenteration as treatment for gynecologic malignancies. Materials and Methods: Between January 2008 and December 2015, a total of 35 patients underwent pelvic exenteration, due to recurrence of gynecological cancer (cervix cancer 65.71%). Surgical outcomes, early and late postoperative complications, and recurrence/survival outcomes were assessed. A database was kept prospectively for all patients.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS Results: Three patients presented complex fistula (recto-vesico-vaginal fistula). Mean patient age was 53.8 years. Anterior exenteration was done in 20 patients, while 15 were total exenterations. Ileal conduit was done in 24 patients, neobladder in 6, cutaneous ureterostomy in 3 and augmentation cystoplasty in 2. Mean operative time was 321.8 minutes (120-480). Transfusion rate was 45%. Mean ICU stay was 3.7 days (0-12). Mean hospital stay was 13.31 days (535). Postoperative complications were divided in two groups, early (<30 days) and late complications (>30 days). A total of 25 patients (71.4%) had one or more early complications; sixteen (45.7%) had fever due to UTI, pyelonephritis or abdominal collection; 2 (5.7%) vesicovaginal fistulae; 4 (11.4%) rectovaginal fistula; 3 (8.5%) ARF;1 (2.85%) uronephrosis; 1 (2.85%) evisceration; 1 (2.85%) intestinal subocclusion; 1 (2.85%) DVT. With respect to late complications, eight patients (22.8%) had fever. Six (17%) presented with uronephrosis, and 5 (14.2%) with ureteral-pouch stricture. Five patients (14.2%) had ARF, 4 (11.4%) intestinal subocclusion, 3 (8.6%) rectovaginal fistula and 1 (2.85%) urinary fistula. Mean follow-up time was 20.3 months (2-60). Twenty patients (57.14%) had no evidence of disease after surgery in medical controls. Thirteen (37.14%) patients relapsed; ten (28.35%) received a posterior treatment with chemotherapy, radiotherapy or surgery. Four (11.4%) patients died after pelvic exenteration due to underlying disease. There were no surgery-related deaths. Conclusion: Pelvic exenteration has a high rate of
complications, but can be the last curative opportunity in patients with gynecologic malignancies. This procedure should be performed by multidisciplinary experienced teams in a tertiary medical center.
UP.085 A Changing Etiological Profile of Vesico Vaginal Fistulae: A Monocentric Experience (About 46 Patients) Mseddi MA, Hamza M, Rebai N, Masmoudi A, Bouassida M, Hadj Slimen M, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objective: Vesico vaginal fistulae
(VVF) is an iatrogenic pathology, which is in definite regression in North African countries. This complication has a significant impact on the image and physical integrity of young women. Obstetrical damage became less predominant over time in comparison to gynecological causes. The aim of our study was to investigate the evolution of the epidemiological and etiological profile of this pathology. Materials and Methods: We report our retrospective
series of 46 women treated in our institution in Tunisia for VVF between 1982 and 2015. We referred to Zmerli classification regarding the obstetrical VVF complexity. Results: Patients were divided into 2 groups, accord-
ing to the period of their admission, G1 (1982-1999) (27 patients), G2 (2000-2015) (19 patients). The mean age of the first group was 28 years, living in rural areas in 65% of cases. Obstetrical etiologies were predominant (70%). The VVF was considered as complex in 20% of cases. The mean age of the second group was 42.53 years. The gynecological etiology was pre-
dominant: 6 underwent uterine fibroma surgery, 5 for uterine cancer, 1 case was treated by pelvic radiotherapy. In addition, there were 3 cases of VVF caused by foreign object. The obstetric etiology was noted in 4 cases. Surgical approach consisted on 1.42 operations per patient (total of 60 operations). Total success was observed in 81%. Iterative surgery was considered in 4 cases, using suprapubic approach with interposition of omentum. Mitrofanoff external continent diversion was performed in 3 recurrent complex cases. Conclusion: Iatrogenic obstetrical VVF could be con-
sidered as a marker of good health level in developing countries. VVF is decreasing in Tunisia. The regression of VVF rates depends on the improvement of living conditions. Gynecological causes became more frequent than obstetrical ones because of improvement in investigations. However, prevention of avoidable cases and early recognition and treatment of VVF remain the best way for the successful management and better evolution in patients.
UP.086 The Role of Narrow Band Imaging (NBI) Cystoscope for Female Outpatients in a Urology Office
high success rate in recurrent stress urinary incontinence or intrinsic sphincter deficiency (ISD). The aim of our study is to analyze the outcomes of the Remeex surgeries in our department. Materials and Methods: We present a retrospective
study. We have treated 17 patients with a Readjustable Midurethral Sling (Remeex System) between May 2013 and December 2015. The variables studied were age, type of SUI, BMI, ICIQSF before surgery, complications, urinary continence and postsurgical satisfaction (questionnaire PGI-1). Results: Mean age of patients was 54.6 years (3480). Three patients had intrinsic sphincter deficiency (ISD) while the rest of the patients had recurrent stress urinary incontinence after previous surgeries (5 mini slings and 9 TOT). The mean BMI was 26.4. Mean pre-surgery ICIQSF was 18.2. Full continence was achieved in 94% patients (n=16) and 6% of patients (n=1) suffered minimal escapes. Mean PGI1 was 1.16. Only one patient developed complications; infection of the regulation device but continence persists. Conclusion: The Remeex sling is an effective, safe and
Ito T
reproducible surgical technique, which can be used in the case of failure of the previous anti-incontinence surgery, or in patients with ISD.
Dept. of Urology, Tamura Clinic, Tokyo, Japan
UP.088
Introduction and Objectives: Urinary frequency is
one of the most popular complaints of female patients in urology offices. The cause of urinary frequency sometimes is not unclear, and many urologists suspect Interstitial Cystitis (IC/BPS). However, hydrodistension sometimes doesn’t agree with patients. I usually perform cystoscopy with NBI. NBI cystoscope is an imaging technology that uses 2 particular bands (415 nm and 540 nm) to make the contrast tissue and vascular. The objective was to clarify the role of NBI cystoscope for female urinary frequency patients. Materials and Methods: This study examined 62 cases that complained about urinary frequency from October 2014 to October 2015. About these patients, the cause of frequency weren’t unclear. Anti-cholinergic drugs weren’t effective. Cystoscopy with NBI was performed for these patients. Results: In 8 of 62 cases, the changes were found on bladder mucosa. Final diagnosis of 7 cases were that 4 were bladder cancer (3 papillary and one carcinoma in situ), 3 were IC/BPS, and one was cystitis cystica. In 3 IC/BPS and CIS cases, changes of mucosa and area of lesion (redness, ulcer (Hunner’s lesion), proliferation of blood vessels) were clearer and more exact than regular light. Conclusions: NBI cystoscope was not only useful for diagnosis, but also for hydrodistension and TURBT.
UP.087 Readjustable Midurethral Sling: A Second Chance Guijarro Espadas A, Moscatiello P, Blazquez Vallejo C, Amaruch García N, García Ortells D, Jacome Pita FX, Sánchez Encinas MP Rey Juan Carlos University Hospital, Madrid, Spain Introduction and Objective: The use of the Readjust-
able Midurethral Sling (Remeex System) has shown a
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Vesicovaginal Fistulas After Gynecological Surgery: Efficiency and Functional Results Mseddi MA, Hamza M, Rebai N, Bouassida M, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Hospital, Sfax, Tunisia Introduction and Objective: The vesicovaginal fistula is a complication of pelvic surgery. It is an abnormal communication between the bladder and the vagina. It allows continuous and involuntary discharge of urine towards the vagina, without the possibility of control. The purpose of our study is to show the efficiency of the treatment and to estimate the functional results for gynecological vesicovaginal fistula. Materials and Methods: This was a retrospective study of 13 gynecological vesicovaginal fistula. These patients are brought together in the department of urology in the “CHU Habib Bourguiba Sfax” hospital. The patients were classified according to of ZMERLI’s classification. Results: Fifty-five percent of all vesicovaginal fistula were due to gynecological etiology Fistulas. The main etiology of fistulas vesicovaginal gynecological is the hysterectomy. This surgery was made for mild pathology in 61.53% of the cases. Vesicovaginal fistula were simple in 84.64% and complex in 15.39%. The transvaginal technique was practiced at a single case for low vesicovaginal fistula. That was a failure for this case. Transabdominal procedure was performed for this patient. First line transabdominal procedure was performed for 6 patients with excision of the fistulous duct. A patient having a fistula of diameter lower than 1 cm was operated by trans-vesical way with simple suture. Five patients had a trans-peritoneo-vesical access with excision of the fistulous duct and epiploic interposition. The number of surgical operations was 21 with 7 cases of success from the 1st cure, 4 cases
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UNMODERATED ePOSTERS required two cures and 2 cases underwent 3 interventions. The rate of failure was 7.7%. The cases of success were satisfied by the results of their interventions and they were able to resume their daily activities.
Conclusion: The prevalence of incontinent women
Conclusions: Gynecological vesicovaginal fistulas
Cystocele Repair with Trocarless Mesh System: 2-Year Results
are for the foreground today. They are more frequent than obstetric vesicovaginal fistulas. Their management today is well codified with a good success rate. A well-controlled surgical technique would lead to a good success rate. A 3-month delay must be respected before surgical repair.
UP.089 Five-Year Change of Urinary Incontinence, Five-Year Incidence and Quality of Life Among Women: A Population-Based Follow-Up Study Okyay P1, Kocak I2, Onde M1, Uslay Keskin T1, Beser E1 1
Dept. of Public Health, School of Medicine, Adnan Menderes University, Aydin, Turkey; 2Dept. of Urology, School of Medicine, Adnan Menderes University, Aydin, Turkey Introduction and Objective: This study aimed to de-
termine the change of prevalence and incidence rates of urinary incontinence and the quality of life among women after a five-year follow-up. Materials and Methods: The study was a popula-
tion-based follow-up study. The study group was the participants (n=200) of a previous study. McNemar Chi-square and McNemar-Bowker test were used. Type 1 error was stated as 0.05. The study was approved by Ethical Committee and granted by of Adnan Menderes University (TPF-09020). Results: A total of 148 (74.0%) women participated in the study. Five years ago, the overall prevalence of urinary incontinence was 23.9% (n=34). Of these 34 women, 2 of them were no longer incontinent in this study. A total of 12 (8.1%) women have become incontinent in this period. The prevalence of urinary incontinence was 29.7%. There was an increase in the prevalence, 6.7% (p=0.013). The incidence rate was 10.5% (12/114) for the five-year period. Among incontinent women, 54.5% (n=24) of women stated having urine leakage at least once a day. There was an increase in 10.4% for having urine leakage at least once a day during the period. There were 36 women (81.8%) who complained of ‘urine leakage affecting their daily life’. There was an increase in 10.4% for having a complaint about an impact on daily life (p>0.05). Only seven women with UI complained of an ‘effect on shopping or excursions outside the home’, three of them complained about an ‘effect on their working performances and friendship’, and one of them mentioned an ‘effect on their sexual life’. A total of 19 women (43.2%) complained of having anxiety and being nervous, 15 women (34.1%) complained of the requirement of wearing a pad or protector. Overall 30 women (75.0%) stated that they didn’t have an intention of taking medical assistance, only seven of them (17.5%) stated that they did. Three women (7.5%) stated they didn’t need assistance. Only three women used medication. There was no difference for the above factors between the previous and the current study.
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and urine leakage frequency have both increased over the five-year period.
UP.090
Yildiz G1, Ceylan Y2, Arslan D1, Arslan M3, Celik O4, Gunlusoy B2 1 Dept. of Urology, Dr. Suat Seren Chest Diseases and Surgery Teaching and Research Hospital, Izmir, Turkey; 2Dept. of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey; 3Dept. of Urology, Izmir University Medical Faculty, Izmir, Turkey; 4Dept. of Urology, Tepecik Teaching and Research Hospital, Izmir, Turkey
Introduction and Objective: The outcome of this study was to investigate the success and complication rate of EndoFast Reliant system as a new technology for the treatment of pelvic organ prolapse (POP) repair, with a 2-year follow-up. Materials and Methods: This study was comprised of
31 female patients with pelvic organ prolapse (POP) who underwent vaginal POP repair. All operations were performed between Jully 2013 and June 2015. Total follow-up was 24 mounts (1 month, 3 months, 6 months, 12 months, 24 months). All patients were evaluated with a clinical history, POP-Q measures, pelvic ultrasound, BMI, questionnaires on symptoms (PFDI) and quality of life scoring system. Results: Total follow-up was 24 months. The mean age was 53 years old (45-75). Mean body mass index was 28.5 (25.3-35.3), with 20 patients with a BMI of <30 and 11 patients with a BMI of >30. There were no statistically significant differences between the two BMI groups. There were no major intraoperative complications like bladder perforation, vascular injury and nerve damage. Prolapse has been anatomically resolved in 87.1% at 2-year follow-up. Four patients presented stage 1 non-symptomatic prolapse. Four cases (12.9%) had de novo stress urinary incontinence (SUI) and two cases had de novo urgency (6.4%) were diagnosed and treated. One case of mesh exposure was found (3.2%) and treated conservatively. There was no migration of fasteners or mesh. No patients showed urinary retention, postop groin pain or dyspareunia. There were no patients with postoperative sexual dysfunction. Conclusion: The EndoFast Reliant system was found
to have a high success rate at the 2-year follow-up. The procedure was easy to learn and had a lower complication rate.
UP.091 Long-Term Follow-Up After Ureteral Reimplantation with Psoas-Hitch Technique in Patients with Endometriosis Carmignani L1, Signorini C1, Maruccia S1, Marenghi C1, Picozzi S1, Finkelberg E1, Vizziello D1, Bracco B2, Vercellini P2 1 IRCCS Policlinico San Donato, University of Milan, Italy; 2Clinica Mangiagalli, University of Milan, Italy
Introduction and Objective: To investigate the relapse
of ureteral stenosis and the preservation of renal function in patients who underwent Politano-Leadbetter’s
ureteroneocystostomy (UNC) with psoas-hitch technique for endometriosis in a long-term follow-up; to study pre and post-operative symptoms and to report urological complications during pregnancy and delivery in patients who conceived. Materials and Methods: In this retrospective study,
we reviewed records of all patients with ureteral endometriosis treated by ureteral reimplantation and psoas-hitch. We collected pre-, intra- and post- operative data. Quality of life before and after surgery was studied with King’s Health Questionnaire and HADS Scale of Anxiety and Depression. Thirty patients underwent ureteral reimplantation with psoas-hitch technique. In all cases, the first part of the surgery was performed by a general surgeon or a gynaecologist who excised endometriotic lesions such as rectovaginal nodules, ovarian endometrioma or performed lysis of pelvic adhesions. Results: During a mean postoperative follow up of 67.97 ± 35.50 months, all patients reported significant symptomatic improvement and a better quality of life, verified by King’s Health Questionnaire and HADS Scale of Anxiety and Depression. None of the patients needed additional surgical treatment and no recurrence was observed. All patients had normal anatomic imaging during the follow-up. Four patients wished to conceive after surgery and two of them conceived spontaneously with a singleton pregnancy and underwent cesarean section. Both during and after the pregnancy, no hydroureteronephrosis or renal failure were found. Conclusion: Politano-Leadbetter’s ureteral reimplan-
tation with psoas-hitch technique is a safe procedure to preserve renal function and gives good results with no recurrence or re-stenosis of the ureter during a long-term follow-up.
UP.092 The Impact of Laparoscopic Sacrocolpopexy on Symptoms, HealthRelated Quality of Life and Sexuality Fourati M, Bouassida M, Hadj Slimen M, Mejdoub B, Rebai N, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objective: To evaluate the impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life (HRQL) and sexuality among women with symptomatic urogenital prolapse (UGP). Materials and Methods: A prospective analysis was
carried out including 29 women with symptomatic UGP. Validated tools were used to evaluate symptoms (Pelvic Floor Distress Inventory, PFDI-20) and HRQL (Pelvic Floor Impact Questionnaire, PFIQ-7). Sexual function was evaluated using the pelvic organ prolapse urinary Incontinence Sexual Questionnaire (PISQ-12). Measurements were recorded at the preoperative examination, then at 6 and 12 months after surgery. We compared the follow-up results with preoperative data. Results: At 6 months compared with the preoperative data, there was a significant improvement in PFDI-20 total mean score (15 vs. 86.1 P < 0.05). At 12 months, the improvement remained significant (10.2 vs. 86.1 P < 0.05) for all scores compared with the preoperative
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS function is restored in 66.7%. There are no adverse effects upon bowel function.
scores. There was no difference between results at 6 months and those at 12 months. The results showed a significant improvement in the PFIQ-7 score at 6 (12.2 vs. 111.4, P < 0.05) and 12 months (7.2 vs. 111.4, P < 0.05). Again, there was no significant difference between the scores at 6 months and those at 12 months. The total PISQ-12 score was linked significantly to pelvic symptoms (P < 0.05) but not with urinary symptoms and anorectal ones. At 6 months, the total mean PISQ-12 score had improved significantly compared with the preoperative score (35.1 vs. 22.3, P < 0.05). The total mean score remained significantly improved at 12 months (34.8 vs. 22.3, P < 0.05) and there was no statistical difference compared with the results at 6 months.
UP.094 Transvaginal Pelvic Floor Muscle Injection Technique: A Cadaver Study Peters K1, Sirls L1, Gupta P2, Gaines N2, Ehlert M2 1
Oakland University William Beaumont School of Medicine, Rochester, United States; Beaumont Health, Michigan, United States; 2Beaumont Health, Michigan, United States Introduction and Objective: Women with pelvic floor
dysfunction can present with tender areas on vaginal examination, which can be treated with pelvic floor muscle injection. We performed pelvic floor injections in a cadaver model with different colored pathology dye to determine the accuracy of drug delivery, location of fluid injected or fluid dispersion after injection.
Conclusions: Laparoscopic sacrocolpopexy resulted in the early improvement (primarily during the first 6 months) of all symptoms, HRQL and sexual function. This improvement was persistent in the medium-term.
Materials and Methods: Following our standard tem-
UP.093
plate, pelvic floor muscle injections were performed on 2 fresh cadaveric pelvises using a curved nasal cannula guide and 7-inch spinal needle. Two sets of injections were performed at the 1, 3, and 5 o’clock positions. One set is proximal, at the level of the ischial spine, and one set is distal, immediately behind the pubic bone, both passing through the vaginal wall into the pelvic floor muscles. Each injection used different colored pathology dye diluted in 2 cc of saline. At 1 o’clock distally the needle was advanced 1 cm beyond the end of the cannula guide and at all other positions advanced 2 cm. The first pelvis was dissected to examine dye penetration. Based on these results we modified our technique and repeated the injections on the second cadaver. We dissected the second pelvis and compared our findings.
The Functional Outcome and Level of Satisfaction Following Repair of VVF Hamid R1, Pakzad M2, Ockrim J2, Greenwell T2 1
Royal National Orthopaedic Hospital, London, England; University College London Hospitals, United Kingdom; 2University College London Hospitals, United Kingdom
Introduction and Objective: To assess urological, sexual, and bowel function following successful repair of vesico-vaginal fistulae of varying aetiology. Materials and Methods: A total of 18 women mean
age 48.8 years (range 25-69) having successful repair of vesico-vaginal fistula had telephone or in person interviews at a mean of 48.3 months (range 8-108) following successful repair of VVF (14 vagina land 4 abdominal). All women completed the UDI-6 and IIQ-7 to assess urological function, the LARS score to assess bowel function, the EQ5D to assess overall function and a health thermometer score to assess general wellness. Sexually active patients were asked to complete the PISQ-12 to assess sexual function. All women were also asked to complete these questionnaires retrospectively for their status immediately prior to VVF repair.
Results: The 1 o’clock proximal and distal injections infused the obturator internus and externus near the insertion at the ischiopubic ramus. The 3 o’clock injections stained the mid-body of the pubococcygeus and puborectalis. The distal 5 o’clock position was too deep and stained the fat of the ischiorectal space, while the proximal 5 o’clock injection was near the ischial spine and stained the area of the pudendal nerve. Our goal at the distal 5 o’clock position was to stain the iliococcygeus muscle, so for the second pelvis we shortened the needle depth from 2 cm to 1 cm beyond the cannula tip. In our second dissection the distal 5 o’clock injection had the same distribution, entirely in the fat of the ischiorectal space.
Results: See table 1. Conclusion: Successful repair of vesico-vaginal fistula
significantly improves urinary symptoms and distress, as well as general well being and quality of life. Sexual
UP.093, Table 1. Pre-VVF Repair (Mean + Range)
Post VVF repair (Mean + Range)
UDI-6 Score
16.33 (4-18)
8.11* (0-18)
IIQ-7 Score
19.22 (0-21)
4.50* (0-21)
LARS Score
8.89 (0-40)
9.17 (0-39)
0
13 (66.7)
Sexually active N (%) PISQ 12 EQ5D score Health thermometer’ (EQ5D)
N/A
17 (3-23)
5 (1-5)
2 (0-5)*
33.11 (0-82)
73.61 (10-100)*
* P< 0.01
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Conclusion: This transvaginal pelvic floor muscle in-
jection template delivers medication of choice to the proximal and distal obturator internus, externus, levator ani muscles and to the pudendal nerve. We could not reliably inject the pelvic floor muscles at the distal 5 o’clock site even after modifications. This is the first study to locate the distribution of pelvic floor muscle injections in a cadaver model. We confirm that 5/6 of our standard template injections infused the targeted pelvic floor muscles.
UP.095 A Prospective Multicentric Study Using Transvaginal Anterior Mesh with Apical Fixation for the Treatment of Anterior Vaginal Wall Prolapse with or Without Apical Vaginal Defect Silveira Brazao Jr. E1, Palma P1, Riccetto C1, Altuna S2, Delroy C3, Barreiro T1 1
University of Campinas (UNICAMP), Brazil; Universidad de Buenos Aires, Argentina; 3Hospital Sepaco, São Paulo, Brazil 2
Introduction and Objective: Surgical treatment of
genital prolapse has significant failure rates. Polypropylene prostheses have been employed to improve the effectiveness of surgical treatment. Despite good anatomic results, complications have been reported and new methods are being proposed. This study evaluated the safety and efficacy of a new surgical technique for the correction of anterior and apical vaginal prolapse. Materials and Methods: The study included 101
women with anterior and apical vaginal wall prolapse of stage ≥2 according to the Pelvic Organ Prolapse Quantification (POP-Q). Objective cure was considered with POP-Q ≤1 and subjective cure was assessed by a Quality of Life Questionnaire (ICIQ-VS). All patients underwent a single incision surgical repair through a type I polypropylene mesh fixed at the apical part of the sacrospinous ligament bilaterally and in the sub urethral portion in internal oblique muscle membrane. Statistical analysis used Fisher’s method, Odds Ratio and Wilcoxon test. Results: Mean Aa, Ba and C points before surgery was +1.7 (± 1.2), +3.1 (± 1.7) and -0.3 (± 3.3). At 24 months, point Aa and Ba were -2.1 ± 0.9 Ba and -2.3 (± 1.1), respectively, and point C was -6.7 (± 2.4) (p<0.01). Pre-operative ICIQ-VS was 28.8 (± 15.3) for vaginal symptoms, 10.0 (± 15.3) for sexual symptoms and 7.7 (± 6.4) for quality of life. At 6 months, there was a significant reduction of vaginal symptoms 8.4 (± 6.4) (p<0.01) and quality of life scores 1.1 (± 2.0) (p<0.01) that remained stable for 24 months. No bleeding and no surgical revision were observed. Mesh exposition occurred in 7 patients (7.2%). Five (5%) patients presented with urinary retention and 7 (7.2%) urinary tract infections. Conclusions: Our results demonstrate that the technique is safe and effective for the treatment of anterior/apical vaginal prolapse.
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UNMODERATED ePOSTERS UP.096 Perioperative Outcomes of Female Urethroplasty Raup V, Lu P, Vetterlein M, Loeppenberg B, Meyer C, Trinh QD, Eswara J Brigham and Women’s Hospital, Harvard Medical School, Boston, United States Introduction and Objective: Female urethroplasty
is rare and large single-institution series are lacking. We sought to assess the patient and perioperative characteristics of female urethroplasty using a large multi-institutional prospectively collected database. Materials and Methods: The American College of
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072013) was queried using Current Procedural Terminology (CPT) codes for urethroplasty (53400, 53405, 53415, 53430). Only female patients were included. Medical comorbidities, length of stay (LOS), operative time (pOT), 30-day complications, and need for readmission/reoperation were analyzed. Results: Forty female patients having undergone urethroplasty were identified, with a median age of 51 years at the time of surgery (22-77). Overall, the patients were very healthy, with a median body mass index (BMI) of 27 (17-47) and median ASA score of 2 (1-3). Medical comorbidities were as follows: 7 smokers (18%), 12 patients with hypertension (30%), 4 with diabetes mellitus (10%), and 3 with cardiopulmonary disease (7.5%). The median procedure length was 145 minutes (31-365 minutes), and the median length of stay was 1 day (0-6). Only three patients developed post-operative complications within 30 days of surgery (7.5%), all three of whom developed urinary tract infections (UTI). There were no readmissions or reoperations. Conclusions: To our knowledge, our study represents the largest prospectively collected multi-institutional cohort of female patients having undergone urethroplasty. The patients in this study were healthy and most patients were discharged within 24 hours. UTI was the only 30-day complication recorded, and the rate was low (7.5%). Thus, patients can continue to be confidently counseled that female urethroplasty is a safe procedure with very few perioperative complications.
UP.097 A Critical Appraisal of the History of Male Stress Urinary Incontinence Treatment: Past, Current and Future Syed K1, Gomez C2, Sayer P3, Gousse A1 1
Bladder Health and Reconstructive Urology Institute, Miramar, United States; 2Female Urology, Neurourology, Voiding Dysfunction and Reconstruction, University of Miami, Dept. of Urology, Miami, United States; 3Precision Medical Devices Inc, Fort Lauderdale, United States Introduction and Objective: Iatrogenic male stress urinary incontinence (MSUI) can have a significant impact on the quality of life. It is most often associated with urological procedures such as radical prostatectomy (RP), transurethral resection of the prostate (TURP), and radiation therapy. In the last decade, our
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understanding of this potentially devastating complication has increased and several surgical treatment options have been described. We present a brief review of these treatments and introduce a new therapeutic option in the evolution of MSUI management. Materials and Methods: Historical data was collected
using MEDLINE to search the literature from 1966 to March 2015. We then manually searched bibliographies to identify studies that our initial search may have missed. Results: External compressive devices were the first reported treatment option for MSUI described in 1750. These evolved to external compressive devices such as Berry’s fixed acrylic prosthesis (1961), Kaufman I (1970), Kaufman II (1972), Stamey’s male sling (1998), bone anchor sling (2001), AdVance transobturator sling (2007) and most recently the quadratic Virtue sling (2012). Similarly, circumferential dynamic compression evolved from the Foley (1947), Rosen artificial urinary prosthesis (1971), Scott’s artificial urinary sphincter- AUS (1973), and the one-piece ZSI 375 device (2013). Since the latest modification of the AUS in 1981, there has been minimal breakthrough in the development of novel circumferential dynamic compressive devices to treat MSUI. We present the development of a non-hydraulic, fluid-free, telemetric device based on blue tooth technology, which might serve as a prototype for future dynamic compressive devices to treat MSUI. Conclusions: The successful development of a fluid-free, remotely controlled AUS that allows for post-implant adjustable settings and remote tele-monitoring capabilities is possible and is the first of its kind. This harmonious blend of clinical medicine and cutting-edge technology may represent the future evolutionary course of MSUI treatment.
UP.098 Circumcision: How and When It Began, and its Future Malthouse T, Lam W, Akiboye D, Challacombe B Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom Introduction and Objective: Circumcision has been performed since ancient times, and arose independently in different cultures and eras, but why? What place does circumcision have in the modern world, and what role does it play in culture and disease prevention? Is it right to circumcise children without consent, and does the practice carry any potentially harmful consequences later on in life? What happens to those who aren’t content with being circumcised? Materials and Methods: A literature search was carried out online, and several medical databases were used. Results: The oldest pictorial evidence of circumcision was in ancient Egypt (2345-2181 B.C.), with justification that it was for ‘the sake of cleanliness’. Other explanations for circumcision are plentiful, including its use as a federal punishment, such as in Visigothic Spain. In the present day, the uptake of the procedure varies wildly in different populations. In the UK, the routine practice is not recommended. In South Africa, the routine practice is unlawful, yet in the United States and in South Korea, the vast majority are rou-
tinely circumcised. It also has a proven role in public health, lowering the risk of transmission of HIV. There seems to be a surge of men clamoring for their foreskins back, and there are several options available, explained by reasons of aesthetics and restoration of sensation. Circumcision reversal has also been around since Ancient Greece, where exercise was banned if the glans was exposed, as well as in Nazi Germany in order to avoid persecution, and modern techniques are certainly using all the technology available in order to help this group of men. Conclusion: Circumcision has a varied role in differ-
ent cultures and locations, with rationalization available for each approach taken. Despite support, routine infant circumcision has caused, for some, considerable distress enough to invest in techniques to reverse the procedure, including operative reversal.
UP.099 Applications of the Twinkling Sign in Ureteral Calculus, Its Role in Diagnosis and Clinical Implications: A Single Institution Study Panackal A KIMS Oman Hospital, Muscat, Oman Introduction and Objective: Twinkling is an artifact
seen on color Doppler ultrasound as a rapidly changing mixture of red and blue behind a stationary echogenic structure. Many recent studies have reported and encouraged the use of twinkling sign to improve the accuracy of ultrasound to detect ureteral stones. In this retrospective study, we evaluated the accuracy of Ultrasound (gray-scale and Color Doppler) in diagnosis of ureteral calculi and correlated it with clinical parameters. Materials and Methods: We evaluated 900 patients diagnosed with acute ureteric colic in the emergency room and in the urology outpatient from January 2009 to December 2014. All of them underwent ultrasound as the primary imaging modality. The twinkling artifact was graded as 0 to 2 (were grade 0 when absent, 1 when present but occupying a portion of acoustic shadowing, and 2 when occupying the entire acoustic shadowing) and correlated with presence or absence of pain, degree of hydronephrosis and passage of a Glidewire® guidewire across the ureteral calculus during ureterorenoscopy and also with the chemical composition of the stones. Results: Out of 900 patients, there were 800 males (90%) and 100 females (10%). Age range was 13-65 years. Our study found that color Doppler ultrasound with twinkling sign, diagnosis was made with confidence in 835 cases (92.7%). The presence or absence of twinkling was not associated with the degree of hydronephrosis. Twinkling was absent in 92% of patients with significant pain and grade 2 twinkling was seen in 69.5% without significant pain. The guidewire was difficult to pass in cases with absent twinkling compared to those with grade 2 twinkling, in which the guidewire and ureteral catheter crossed the calculus easily. Calculi of calcium oxalate dihydrate and calcium phosphate produced a grade 1 or grade 2 twinkling artifact. Absence of artifact was noted only for calcium oxalate monohydrate and urate stones. In 100% of grade 0 calcium oxalate stones, the monohydrate compound was predominant (>90%). In 100%
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS of grade 2 calcium oxalate stones, the dihydrate compound was predominant (>70%). Conclusions: There is no doubt that Spiral CT is superior in the demonstrating of ureteral calculi. The present study emphasized that utilization of color Doppler ultrasound in trained hands can provide an excellent alternative modality with high sensitivity and specificity in diagnosis of ureteric stone and also the presence of twinkling sign was associated with significant pain, difficult guidewire passage across the calculus and also noted a relationship between the morphology of urinary stones. These findings suggest that absent twinkling implies significant obstruction, while its presence indicates no significant obstruction and Color-flow sonography could play a role in detecting dense calcium oxalate monohydrate calculi, which in turn may help predict fragmentability.
UP.101, Table 1. Radiation Exposure Variables n = 21
Irradiation parameters
Mean number of Spot films
1.61
Exposure time (minutes)
0
Total radiation used (cgy/cm2)
3.82 (1.48-5)
Patient exposure (cgy/cm2)
0
Operator exposure (cgy/cm2)
0
Introduction and Objectives: Technological prog-
UP.102 A Comparison of MRI and TRUS in the Measurement of Whole Prostate Gland Volume and Potential Extension to Zones of the Gland
Comparison of the Results of Bladder Ultrasound in Wheel Chair Bound Patients in Sitting and Supine Position
ress in endoscopy permits visualization of stones and anatomy while decreasing the need for fluoroscopic control. We conducted a prospective study for 3 months with consecutive patients underwent URS stone extraction with the objective of minimizing radiation exposure. We measured the radiation doses received by both patients and surgeons in an attempt to define the minimum amount of fluoroscopy necessary during ureteroscopic procedures.
Al Shareef J, Aboelmagd M
Materials and Methods: From January to March
Al Hada Hospital, Taif, Saudi Arabia
2015, we measured radiation exposure in consecutive patients undergoing flexible or rigid (URS). The size and location of stones, emergent or elective URS, and the type of URS were recorded. Radiation badges were placed on sternum. Standard radiation precautions were followed and we limited the number of films. Mean radiation dose was calculated for patient and surgeon. We measured the total time of radiation exposure and recorded the number of spot films. Stonefree status was evaluated by CT scan. Univariate analysis by a Chi2 and a Student test was performed for different variables
UP.100
Introduction and Objective: In our Urology clinic,
we often receive wheel chair bound patients for follow up. It is difficult to shift these patients to examination couch for ultrasound to be done in supine position. We started doing ultrasound of urinary bladder in these patients in sitting position and compared the results in the same patients in supine position at the same time. The objective of doing ultrasound in sitting position in our study is to avoid accidental injuries to the patients during shifting, more comfortable to the patients, to save time in busy urology clinic and to decrease need of nursing staff. Materials and Methods: We performed the bladder
ultrasound for wheel chair bound patients in sitting position and compared the results after shifting these patients in supine position. Following parameters were observed: post void residual urine volume, presence of urinary bladder stones or masses and bladder wall thickness. Results: We found that the results of urinary bladder ultrasound in both sitting and supine position are the same for all mentioned parameters. Between February 2013 and August 2015, we studied 107 patients of different age groups and gender, 214 bladder scans were done. Conclusion: We can perform the bladder ultrasound
for wheel chair patients in sitting position instead of supine position, especially for estimation of post void residual urine volume. It will decrease the human effort, time taken for shifting these patients to couch and also minimize the chances of accidental injuries to these patients during shifting and patient safety.
Results: A total of 21 patients underwent URS, of which 13 had emergency rigid URS and 8 underwent elective flexible URS. The radiation exposure data are presented in Table 1. Notably, the emitted dose of radiation 3.82 cgy/cm2 was not transmitted either to patient or surgeon to a significant degree. Only 1-2 spot films per case were necessary. No fluoroscopy case exceeded one minute. Stone free rate was 81%. Follow-up imaging range was 24 to 90 days. We were unable to find differences in radiation exposure between the type of ureteroscopy, or urgent versus elective URS. Conclusions: Radiation exposure to both patient and surgeon can easily be minimized. Minimizing fluoroscopy does not change the effectiveness of the procedures and there is no evidence in our study of increased radiation exposure with flexible ureteroscopy. A larger study is needed to confirm our results.
UP.101 Radiation Exposure in Flexible and Rigid Ureteroscopy (URS) Minimizing Radiation Exposure to Patients and Surgeons Colomb F1, Loeffler J1, Prader R2, Tibi B2, Chevallier D2, Amiel J2, Durand M2 1
Centre Hospitalier de Grasse, France; 2Centre Hospitalier de Nice, France
Robinson S, Laniado M Frimley Health Foundation Trust, Surrey, United Kingdom Introduction and Objective: Modern MRI T2 weight-
ed images with manual contouring accurately measures the whole gland volume as well as the subdivisions of the gland, the central and the peripheral portions. These can yield a very high correlation coefficient (r = 0.86 Turkbey 2012). We compare conventional T2 MRI volume estimates with final histopathological volume assessment as the gold standard. We then compare TRUS whole volume estimate with histopathological volumes to generate 2 correlation coefficients. We then determined whether there was a significant difference between the two modalities. There was not. We further propose, given that there is no difference between the two, that the estimates of zonal volumes are probably just as accurate. This remains to be proved. However, differentiation of the two zones may be useful in assessing the gland from a point of view of risk of cancer and hyperplasia. TRUS is cheap and quick and in the hands of an experienced sonographer, just as useful. Materials and Methods: A total of 547 RP specimens with documented gland volumes from histology. There were 319 TRUS volumes documented pre operatively with 34 MRI volumes documented pre operatively. Two Pearson correlation coefficients were generated. Fishers R to Z transformation was done to compare the two. Two Bland Altman plots were generated comparing US to pathology and MRI to pathology. One Bland Altman plot was used to compare US and MRI. Results: See Table 1. Conclusions: There is no detectable difference in the accuracy of TRUS and MRI in the evaluation of whole gland volume, although TRUS appears marginally better. With dedicated radiologist and MRI experience, MRI will probably prove superior. However, with limited resources and an experienced physician using ul-
UP.102, Table 1. Transrectal ultrasound
Correlation coefficient
r = 0.706
Fishers r to z transformation
Magnetic resonance imaging
Correlation coefficient
r= 0.69
Z = 0.17 P = 0.865
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
159
UNMODERATED ePOSTERS trasound, reasonable volume estimations can be made. There is no logical reason why the separate zones should not be equally amenable to measurement.
UP.103 Magnetic Resonance Microscopy May Enable Distinction Between Normal Histomorphological Features and Prostate Cancer in the Resected Prostate Gland Durand M1,2,3, Robinson B4, Jain M4, Aronowitz E5, El Douahy Y1, Leung R1, Scier DS1, Ng A4, Donzeau D2, Amiel J2, Spincemaille P5, Villers A3,6, Ballon DJ5, Colomb F7 1 Dept. of Urology, Institute of Prostate Cancer and Lefrak Center for Robotic Surgery, New York, United States; 2Dept. of Urology, Hôpital Pasteur 2, CHU Nice, University of Nice-Sophia-Antipolis, France; 3 INSERM, U1189, ONCO-THAI, F-59037 Lille, France; 4Dept. of Pathology, Weill Medical College of Cornell University, New York, United States; 5Dept. of Radiology, Weill Medical College of Cornell University, New York, United States; 6Service d'Urologie CHU Lille, Université de Lille, F-59000 Lille, France; 7Dept. of Urology, Hospital Clavary, Grasse, France
Introduction and Objective: In vivo high-resolution
magnetic resonance imaging (MRI) at a microscopic level for the identification of prostate cancer (PCa) has not yet been achieved. This may be accomplished using MRI with high spatial resolution for ex vivo examination of prostate specimens. The objective was to determine imaging protocol parameters for characterization of prostate tissue at histologic length scales. Materials and Methods: Rapid acquisition with re-
laxation enhancement (RARE), spin echo (SE) and gradient echo (GRE) fast low angle shot (FLASH) data were acquired using ex vivo 3 Tesla or 7 Tesla magnetic field strengths from fresh prostatectomy specimens (n=15) obtained from either organ donor or PCa patients under Institutional Review Board approval. To achieve the closest correspondence between histopathological components and MRI images in terms of resolution and sectioning planes, multiple high-resolution imaging protocols (ranging from few
minutes to overnight) were tested. Ductograms were generated as part of image post-processing. Specimens were subsequently submitted for histopathological evaluation.
tumor vessels were occluded with polyvinyl alcohol particles (PVA), 99.5% Ethanol (E) or coils (C). PVA + E + C was used in 10 patients, PVA + E in 9, PVA+C in 4, PVA only in 5 and C only in 5.
Results: A total of 7 imaging protocols were tested (Table 1). Ex vivo 7 Tesla MRI identified normal components of prostate glands including ducts, blood vessels, concretions, and stroma at a spatial resolution of 60 X 60 X 60 mm3 to 107 X 107 X 500 mm3 (Figure 1). Malignant glands and nests of tumor cells identified at 60 X 60 X 90 mm3 were highly comparable to low magnification (x2) histopathology. Ductograms enhanced the differentiation between benign and malignant glands. The results of this study are encouraging, and further work is warranted with a higher sample size.
Results: The mean size of the lesions was 72 mm (25120 mm). The indications for intervention were size (50%), acute bleeding (27%), progress in size during active surveillance (20%) and haematuria (3%). All initial 34 procedures were successful according to the immediate post-embolization angiogram. Mean operating time was 164 minutes and most procedures were carried out in general anaesthesia (62%). A total of 4 patients (12%) had complications (myocardial infarction, pneumonia, rebleeding and abscess formation). Mean estimated GFR was 102 ml before AE and 103 ml after. At a mean follow-up of 44 months, 20 patients (59%) had a reduction in size. The mean reduction was 30%. A total of 10 patients had one or two repeat procedures due to progress in size in treated or untreated lesions or new bleeding episodes. A total of 47 embolizations were carried out in the 34 patients.
Conclusion: We demonstrated that critical histo-
pathological features of the prostate gland can be identified with high resolution ex vivo MRI examination and offer promise that MR microscopy of PCa will ultimately be possible in vivo.
UP.104
Conclusions: Selective embolization of angiomyolipomas is a safe procedure with low morbidity and good preservation of renal function. The main indications for AE were size (>50 mm) in 50% and acute bleeding in 27%. A prerequisite for this treatment is good collaboration between the urologist and an experienced interventionist.
Selective Embolization of Renal Angiomyolipomas Swärd J1, Henrikson O2, Lyrdal D3 1
Dept. of Urology, NU Hospital, Uddevalla, Sweden; Dept. of Radiology, Sahlgrenska University Hospital, Goteburg, Sweden; 3Dept. of Urology, Sahlgrenska University Hospital, Goteburg, Sweden
2
UP.105
Introduction and Objective: Renal angiomyolipomas
(AML) may cause flank pain or may be complicated by acute vessel rupture with retroperitoneal haemorrhage. The risk of bleeding increases with tumor size and prophylactic intervention is indicated when the size exceeds 40-50 mm. Selective arterioembolization (AE) is an attractive alternative to surgery in the management of AML. In this study we analyze a 16-year material of AE of AML at a tertiary referral center. Materials and Methods: Thirty-four patients (28 fe-
male, 6 male) with AML treated with AE 1999-2014 are included in a retrospective analysis. Eleven of them had tuberous sclerosis (TS). Selective cannulation was performed via the femoral artery and the
The Role of Ultra Low Dose CTKUB in Follow-up of Ureteric Calculi Not Visible on Plain X-Ray Jelley C1, Forster L1, Arad J1, Bardgett H1, Stewart A1, Forster J1, Mudhar G1, Mosli-Lynch C2 1
Bradford Royal Infirmary, United Kingdom; St Bartholomew’s Hospital, London, United Kingdom
2
Introduction and Objective: Unenhanced CTKUB is the investigation of choice in diagnosis of acute renal colic with sensitivity greater than 95%. Plain x-ray is used for radio-opaque calculi follow-up and has a low radiation exposure of 0.7 mSv. CTKUB delivers an average dose of 6 mSv and is used in the 40% of calculi not visible on plain x-ray. Repeated use of CT scans
UP.103, Table 1. Protocols of Imaging Acquisition Parameters of High-Resolution 3 Tesla and 7 Tesla Imaging Protocol
Specimen
Field Strength (Tesla)
Pulse Sequence
ACQ
TR (ms)
TE (ms)
FOV (cm)
Acquisition Matrix (cm)
Flip Angle
Slide Thickness (nm)
Echo Train
NEX
Time (h:mm:ss)
Resolution (mm2)
A
Whole glands
3
SE
2D
5066
105
6.0
320, 192
90
1.0
20
4
0: 13: 52
188x312x1000
B
Whole glands
3
SE
2D
6067
171
6.0
320, 192
90
1.0
22
3
0: 08: 30
188x312x1000
C
Whole glands
7
SE (RARE)
2D
2000
84.9
5.5
512, 512
90
0.75
24
16
0: 11: 00
107x107x750
D
Prostate sections
7
SE (RARE)
2D
2000
75.8
5.5
1024, 1024
90
0.50
12
14
0: 39: 40
54x54x500
E
Prostate sections
7
GRE (FLASH)
2D
101.4
5.5
5.5
512, 512
40
0.50
NA
12
0: 07: 47
107x107x500
F
Prostate sections
7
GRE (FLASH)
3D
26.3
13.1
6.0
1024, 1024, 192
15
0.06
NA
6
8: 36: 00
60x60x60
G
Prostate sections
7
GRE (FLASH)
3D
26.3
13.1
6.0
1024, 1024, 128
15
0.06
NA
3
2: 51: 00
60x60x90
160
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS were distal ureteric calculi. A total of 97% were of diagnostic quality with only 2 needing another confirmatory test. A total of 75% of patients passed their calculi after the 1st ULDCTKUB. In the remaining 25%, four patients had a subsequent CTU or CTKUB (7%). The mean effective radiation dose was 1 mSV in ULDCTKUBs compared to 5.4 mSV in the conventional CTKUBs.
UP.103, Figure 1.
Conclusions: ULDCTKUB is a diagnostically reliable and safe investigation with a radiation dose similar to plain x-ray and lower than annual background radiation of 2.7 mSv. We advocate ULDCTKUB as the primary imaging modality in the follow up of acute ureteric colic of calculi not visible on KUB x-ray.
UP.106 Operative Characteristics of Multiparametric Magnetic Resonance Imaging for Extracapsular Extension and Unfavorable Gleason Score in Intermediate and High-Risk Prostate Cancer Medina C1, Domínguez C1,2, Cataño JG1, Plata M2,3, Aguirre D2,3, Narvaez J4, Trujillo S4, Gómez F1,2, Trujillo CG1,2, Caicedo JI1,2 1 Dept. of Urology, Fundación Santa Fe de Bogotá University Hospital, Bogotá DC, Colombia; 2 Universidad de los Andes, School of Medicine; 3 Dept. of Pathology, Fundación Santa Fe de Bogotá University Hospital, Bogotá DC, Colombia; 4Dept. of Radiology, Fundación Santa Fe de Bogotá University Hospital, Bogotá DC, Colombia
Introduction and Objective: To evaluate the diagnostic performance of preoperative multiparametric MRI (mp-MRI) imaging as a predictor of extracapsular extension and unfavorable Gleason in patients with intermediate and high-risk prostate cancer. Materials and Methods: Patients with clinically local-
ized prostate cancer who underwent radical prostatectomy and had preoperative mp-MRI between May 2011 and December 2013 were enrolled. Mp-MRI was evaluated according to the European Society of Urogenital Radiology (ESUR) magnetic resonance prostate guidelines by two different readers. Histopathological prostatectomy results were the standard reference. Tesla spin echo image from a whole gland at a spatial resolution of 100 X 107 X 750 μm3 obtained with a scan time of 11 min (protocol C). This highlights vasculature and resolution of urethral wall using a surface coil to image a small area (A). The visible structures clearly approach the microscopic scale as shown in the magnification within the white dashed line highlighting the micro anatomy of intraprostatic tissue (B). Preoperative T2-weighted 1.5 Tesla MRI at a spatial resolution of 547 X 625 X 3000 μm3 and a scan time of approximately seven minutes (C). Only the coarsest features of the prostate gland are evident. A large area of interruption of ductal architecture in the peripheral zone is shown as a hypointense signal at lower left (arrow), which is traditionally evaluated as suspicious for malignancy. (D) 3 Tesla Inage of the same gland after surgical resection at a spatial resolution of 188 X 312 X 1000 μm3 and a scan time of approximately 14 minutes (protocol A). While the detail is improved, additional areas of hypointense signal appear in the peripheral zone, potentially confounding the diagnosis. (E) Histological preparation of the gland shown in (A) and (B). The hypointense zone at a resolution of 100 X 107 X 750 μm3 in a scan time of 11 minutes (protocol C) shows even greater detail, and begins to elucidate areas of stroma surrounding the ductal architecture. in the follow-up of urolithiasis has raised concerns about excessive accumulated radiation exposure. We assessed the effectiveness of using ultra low dose CTKUB (ULDCTKUB) for follow-up imaging.
ULDCTKUB for confirmed ureteric calculi not visible on plain x-ray. Patients were identified from our Radiology Management System with additional information from electronic records.
Materials and Methods: Between 2013 and 2015, we
Results: The average age was 42 years, with a mean stone size of 4.1 mm, two thirds on the right and 70%
retrospectively analyzed 60 patients who underwent
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Results: A total of 79 patients were included; mean age 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had extracapsular extension (ECE) evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At radical prostatectomy (RP), 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI for ECE were 54.8%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI were 20%, 98.4%, 86.7%, 66.7% and 88.7%, respectively. Conclusion: Mp-MRI contributes to a proper pre-
operative assessment of ECE, SVI, LNI and possible unfavorable GS prediction. The high specificity and negative predictive value of mp-MRI are important to rule out significant disease when compared to RP specimen histopathology analysis.
161
UNMODERATED ePOSTERS UP.107 Renal Hydatid Cyst: Is There Any Predictive Factor for Communicating with Collecting System (A Comparative Study About 79 Cases) Sallami S1, Khouni H2, Ben Hhouma S3, Chtourou M4 1
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; FSI Uinversity Hospital, Tunis, Tunisia; 3La Rabta University Hospital, Tunis, Tunisia; 4Dept. of Urology, Habib Thameur University Hospital, Tunis, Tunisia
3, 19, 7 and 2 patients respectively. Table 1 compared data of the two groups. Predictive factors were clinical (hydaturia) and on radiological imaging (communication between HRC and collecting system). Preoperatively, the cysto-urinary fistula was usually unique (93.5%), communicating with a calyx or the pelvis respectively in 77.4% and 22.6%. The fistula was large (greater than 2 cm) in 22.6% of the cases.
2
Introduction and Objective: Echinococcosis is an
endemic parasitic infestation in Tunisia and North Africa. It involves the kidneys in 4% of cases. Communication of renal hydatid cyst (RHC) with urinary collecting system requires specific management with basically fistula suture and ureteral stenting. Through a multicenter series, we evaluated predictive factors of communication between RHC with urinary collecting system. Materials and Methods: Between March 1991 and November 2015, 79 patients were operated for RHC in three teaching hospitals in north Tunisia. Communication of RHC with the collecting system was noted in 31 patients (39.2%). They were 18 males and 13 females with a media age of 39.7 years (19-76). We reviewed the clinical and radiological particularities of these cases. Patients were divided into two groups: Group I: simple RHC and Group II: RHC communicating with urinary collecting system. Results: History of hydatid disease was reported
in only 3 patients. The diagnosis was established on clinical features in 23 patients (74.2%) because of hydatiduria (debris resembling grape skins in the urine) with or without hematuria. Ultrasonography, IVU and CT scan performed in 31, 30 and 30 patients respectively. There was suspected cysto-urinary fistula in 16 patients. The RHC was type II, type III, type IV and type V (according to the Gharbi’s classification) in
Conclusions: Communication between RHC and urinary collecting system is a relatively frequent complication of RHC. Hydaturia and radiological suspicion were the main features of such complication.
UP.108 Radiological Referrals to Urology: A Tool to Promote Rapid Identification and Management of Urological Cancer Powell E1, Sami T2 1
University of Birmingham, United Kingdom; 2Dept. of Urology, Sandwell and West Birmingham Hospitals Trust, Birmingham, United Kingdom
Introduction and Objective: The Rhapsody Alert
System (RAS) is a notification tool used by Sandwell and West Birmingham Hospitals NHS Trust (SWBH). This computerized integration system allows radiologists and histopathologists to report suspicious/ cancerous lesions back to the requesting clinician, as well as directly to the relevant specialty MDT for follow-up. The system monitors patient cancer status and flags patients with possible new cancers, it aims to establish patients onto cancer care pathways early and support appropriate cancer management. This service evaluation investigated radiological RAS referrals to the Urology team at SWBH. Referral outcomes were investigated, with particular interest to new urological cancer diagnoses and treatment outcomes. We assessed management of these patients in accordance to the ‘National Cancer Waiting Times Standards’ introduced following the UK’s Department of Health ‘Cancer Reform Strategy’ (2007).
Materials and Methods: The study included 154
SWBH patients referred to Urology by RAS from Radiology between January 2015 and July 2015. Trust databases ‘Clinical Data Archive’ and ‘Somerset’ were accessed to record relevant referral follow-up data and outcomes. Results: A total of 101 patients (66%) had an outcome related to urological cancer; 69 (45%) received a new diagnosis of urological cancer, of these, 30 (43%) were treated successfully by the urology team, 23 (30%) had metastatic disease leading to rapid oncology referrals or palliation. A total of 148 (96%) patients were followed-up within 2 weeks of referral, as per national recommendations. Median time from referral until diagnosis was 5 weeks (range 1-28 weeks). Of the 59 patients treated, 28 (47%) initiated treatment within 1 month of referral, 48 (82%) within 62 days. Conclusions: This hospital trust is using a customized integration system that allows urgent notification of suspected cancers by radiologists and histopathologists to the appropriate team for follow-up investigations and care. Radiology referrals within this system are appropriately referring patients, resulting in new cancer diagnoses. Imaging at point of referral is leading to early diagnosis and successful treatment, or appropriate and timely care of urological cancers identified. Referrals are followed-up quickly and treatment is mostly being initiated within the recommended time frame.
UP.109 Diagnostic Value of Bi-Parametric MRI in Detection of Clinically Significant Prostate Cancer: A Comparative Analysis with Radical Prostatectomy Specimens Malthouse T, Pindoria N, Lam W, Van Rij S, Challacombe B, Popert R Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom Introduction and Objective: Multi-parametric MRI
UP.107, Table 1. Group I (n= 48)
Group II (n=31)
p
46.2 years (16-80)
39.7 years (19-76)
0.8
Gender (M/F)
20/28
18/13
0.15
Side of RHC (R/L)
22/26
14/17
0.95
Hydatid disease
6
3
0.7
Pyelonephritis
2
7
-
Hydaturia
0
23
<0.00001
Hematuria
4
8
-
Type I
6
0
0.13
Type II
2
3
Type III
21
19
Type IV
12
7
Type V
7
2
Radiological suspicion
5
16
Age
Medical history:
Clinical signs:
Gharbi’s classification:
162
0.00005
(mp-MRI) is increasingly used in detecting, localizing, and staging prostate cancer (PCa) prior to biopsy. However, it is costly, requires intravenous contrast, and time-consuming. Bi-parametric MRI (bp-MRI) takes shorter time to perform at a reduced cost. This study evaluated the ability of bp-MRI in detecting PCa when compared with mp-MRI, against radical prostatectomy (RP) specimens. Materials and Methods: A retrospective analysis was conducted at 2 institutions (January 2011-December 2015). Inclusion criteria: (1) PCa patients who had either bp-MRI or mp-MRI; (2) underwent RP as definitive treatment. Exclusion criteria: patients who underwent other PCa treatment prior to RP. All MRI images were reported using the PIRADs V1.0 scale. Concordance of MRI-detected lesions was compared with RP specimen. Fisher’s exact test was used for comparative analysis. Results: A total of 98 patients meet the inclusion criteria, with an equal split of 49 undergoing bp-MRI or mp-MRI. Of those with partial correlation, only 3 and 2 patients had significant PCa foci elsewhere in the bp-MRI and mp-MRI arm, respectively. There was no statistically significance difference in the concordance of bp-MRI and mp-MRI with RP specimens.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS cocele. A prospective study for establishing this tendency and mechanism will be required.
UP.109, Table 1. Level of correlation with RP specimen
bp-MRI
mp-MRI
UP.112
Complete correlation
26 (53%)
25 (51%)
Prostate Cancer, Biochemical Recurrence in Prostatectomized Patients: Assessment with 11C-Choline PET/ CT and Its Correlation with PSA
Partial correlation
12 (24%)
12 (24%)
No correlation
12 (22%)
12 (24%)
Conclusion: In our series, bp-MRI had equivalent
performance characteristics as mp-MRI in the detection and localization of CaP. A non-contrast bp-MRI can be used to optimize PCa detection with a shorter time at a reduced cost, and avoid the need for intravenous contrast.
UP.110 Evaluation of Urologist Radiation Exposure When Performing Retrograde Urethrograms Agrawal S1, Fisher R1, Lacy J2, Sivalingam S2, Wood H2 1 Case Western Reserve University School of Medicine, Cleveland, United States; 2Cleveland Clinic, United States
Introduction and Objective: Retrograde urethrograms (RUGs) are routinely performed by genitourinary reconstructionists (GURs) for diagnostic and surgical evaluation of urethral structural abnormalities. Performing RUGS exposes healthcare providers to direct radiation exposure when their hands are in the field and secondary scatter radiation exposure. The purpose of this study is to estimate annual occupational radiation exposure to GURs using calculated dosimetry of RUGs. Materials and Methods: Institutional reference air
kerma data collected from 393 RUGs performed from April 2014 to September 2015 was used to calculate shallow skin occupational doses, assuming GURs’ hands were in the field in each case for the entire case and radiation intensity changes inversely proportional to the distance from the fluoroscopy tube and patient table. Annual radiation exposure was estimated from total RUGs performed per year by GURs. Statistical analysis includes dose stratification for all cases, pooled t-test testing for two different personnel, and annual radiation dose estimates over cumulative cases. Results: Median direct skin dose/RUG was 0.9 mGy (range 0.1-86.8 mGy) and median exposure duration was 0.1 mins (range 0.02-5 mins). National 2014 to 2015 estimates of performed RUG procedures and secondary radiation dose/RUG indicate median annual secondary exposure for 50, 100, and 150 RUGs/ year correlated with minimum cumulative radiation dose of 45, 90, and 135 mGy, respectively. Median direct dose rate per RUG was 10.5 mGy/min (range 0.19-1.296 mGy/min). Median secondary skin radiation dose/RUG was negligible, 0.0009 mGy. RUGs performed in full surgical suites vs. outpatient procedure areas had no significant difference in radiation exposure (p=0.1892). A total of 98% of RUG cases reported direct skin radiation dose to GURs as less than 20 mGy per case. Conclusions: The upper limit of recommended skin
radiation exposure dose is 500 mGy. The annual
exposure results of this study are within these specifications, but are comparable to direct shallow skin radiation exposure from multiple non-contrast computed tomography (CT) imaging of the abdomen and pelvis (10 mGy/CT). RUG related radiation exposure to the GUR over a career may pose a significant health hazard, and one should consider all mechanisms to minimize occupational exposure or consider non-radiation utilizing diagnostic modalities.
UP.111 Influence of Retrograde Venous Flow Volume on Pain Resolution After Varicocelectomy for Painful Varicocele Shin HS, Park JS, Kang SH Catholic University of Daegu School of Medicine, South Korea Introduction and Objective: Varicocele is the abnormality of pampiniform plexus, which is the content of the testicular vein. When the pampiniform plexus is dilatated or congested, the patient feels scrotal pain. It is certain that the surgical treatment of varicocele reduces the scrotal pain but in some cases, the pain still remains after varicocelectomy. The authors analyzed the factors for reducing pain after varicocelectomy for painful varicocele. Materials and Methods: We retrospectively ana-
lyzed 192 patients who underwent varicocelectomy because of scrotal pain from 2008 to 2013. A total of 34 patients were excluded for abnormality of semen analysis from whole 126 patients before this study. We investigated preoperative age (<20, 20~30, >30), BMI (<18.5, 18.5~24.9, >25 kg/m2), unilateral or bilaterality, grade of varicocele (I, II, III), duration of pain (less than and more than 6 months), refluxed blood flow volume in the pampiniform plexus (<25, 25~35, >35 ml/min). We checked the reduction of the pain-complete remission, partial remission, persistent-permission and analyzed it. The statistical analysis was done by the Chi-square test and one-way ANOVA test. Results: The mean age of the patients was 23.1±5.6 years. Complete remission of pain was seen in 114 (59.4%) patients, and partial remission was seen in 58 (30.2%) patients. Twenty (10.4%) patients suffered from persistent pain. There were no statistically significant factors (age, BMI, bilaterality, grade of varicocele, duration of pain-correlate with pain reduction by multivariate analysis (p>0.05)). The refluxed blood flow volume in the pampiniform plexus showed significant relation with pain persistency, when the reflux flow volumes were increased, the pain tended to persist (p<0.05). Conclusion: The refluxed blood flow volume in the
pampiniform plexus showed significant relation with pain persistency after varicolectomy for painful vari-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Traverso S, Gonzalez C, Tinetti C, Fernando J, Arceluz MJ, Corona P Fundación Centro Diagnóstico Nuclear (FCDN), Buenos Aires, Argentina Introduction and Objective: To determine the effica-
cy of C-Choline-PET/CT in the detection of disease recurrence in prostatectomized patients due to prostate cancer (PC) who showed biochemical relapse, to describe findings and to correlate it with PSA levels. Materials and Methods: This was a retrospective,
cross-sectional study that involved 65 patients aged 50-81 (median age 65.5) between 2010 and 2015, who underwent radical prostatectomy due to PC and presented biochemical relapse (an increase in PSA levels) during follow-up, and who underwent a whole-body C-Choline-PET/CT scan acquired on a GE Discovery STE 16. Findings were described and also correlated with PSA levels. Results: Among our population (n=61), 71% (n=43) of the patients presented positive findings with regard to recurrent disease in C-Choline-PET/CT scan, while 29% of the exams (n=18) were negative. Those findings considered positives were validated by histological confirmation or clinical follow-up, and/or evaluation with other medical imaging modalities and involved different locations: prostate bed only (local recurrence) in 6.6% (n=4); exclusively lymph nodes (external iliac, internal iliac and common iliac, presacral space, obturatriz fossa, retroperitoneum and mediastinum) 34.4% (n=21) and only bone affectation 13.1% (n=8). In addition, 13.1% of the patients developed bone and lymph node compromise concomitantly, and only one patient (1.6%) developed prostate bed relapse and hepatic compromise. Of the patients who had a PSA level >3 ng/ml (n=29), 25 showed positive C-Choline-PET/CT scan findings (sensitivity 86%), while of the 32 patients with PSA level <3 ng/ml, 18 exhibited positive C-Choline-PET/ CT scan findings (sensitivity 56.3%). Conclusion: C-Choline-PET/CT is a useful diagnos-
tic tool for the detection of recurrence in prostatectomized prostate cancer patients who developed biochemical relapse, increasing the sensitivity with PSA levels >3 ng/ml.
UP.113 Accuracy of Multiparametric Magnetic Resonance Imaging Using 1.5 Tesla and Ultrasound: Guided Transrectal Cognitive Approach Contreras P, Blas L, Ríos Pita H, Mieggi M, Mondelo E, Rojas Bilbao E Hospital Alemán, Buenos Aires, Argentina Introduction and Objectives: Multiparametric pros-
tate magnetic resonance imaging (MP-MRI) helps to target biopsies. It has been shown to improve sensitivity and specificity compared with random biopsies.
163
UNMODERATED ePOSTERS However, data suggest that biopsy accuracy varies depending on the approach used (transperineal versus transrectal) as well as whether a 1.5 versus a 3 Tesla MRI is used. Our objective was to analyze the accuracy of a 1.5 T MP-MRI followed by transrectal cognitive approach. Materials and Methods: Data from a cohort of men
who underwent MP-MRI and cognitive transrectal biopsies plus random biopsies between January 2013 and September 2015 at the Hospital Aleman of Buenos Aires were reviewed. MP-MRI images were obtained using a Phillips 1.5 T. Images were reviewed by a single physician with more than 10 years of experience in prostatic MRI. Pirads 1 classification was followed and a cut-off value of 13 was used to differentiate between suspicious and non-suspicious lesions. Six core biopsies were obtained at the target zone. The rest of the prostate was divided in 6 zones; base, mid and apex on the both right and left sides. Three core biopsies were taken in each zone (2 peripherals and 1 in the transition zone). A Siemens SonoLine Prima ultrasound was used to perform the biopsies. All of them were obtained by a urologist with more than 10 years of experience in prostate biopsies. These were outpatient procedures, performed under sedation, and in lithotomy position. Biopsies were informed by 2 expert prostate cancer pathologists, each one with more than 10 years of experience. Sensitivity and specificity, as well as positive and negative predictive values were determined. Results: Data from 118 patients were analyzed. Median age was 63.8 years. Average prostatic specific antigen (PSA) was 8.09 ng%. Based on a cut off value of 13.69 (58.4%) out of 118 patients had suspicious lesions in MRI images. All 118 patients underwent biopsies. Biopsies of the MP-MRI abnormal area correlated with abnormal pathology results in 72% of patients. Of these patients, 41.9% had high-grade disease on pathology (Gleason 7 or higher). Overall, multiparametric prostate magnetic resonance images obtained with a 1.5 T MR had a sensitivity of 89% and a specificity of 36%. Positive predictive value was 66% and negative predictive value was 72%. Conclusions: In our series of 118 consecutive pa-
tients, target biopsies using 1.5 T MP-MRI and ultrasound-guided transrectal cognitive biopsies had a high accuracy in detecting prostate cancer.
UP.114 Correlation Between Prostate Cancer Localization in Multiparametric Magnetic Resonance Imaging and Radical Prostatectomy Histopathology Contreras P, Blas L, Vitagliano G, Ríos PIta H, Mondelo E, Chirife AM Hospital Alemán, Buenos Aires, Argentina Introduction and Objectives: Multiparametric pros-
tate magnetic resonance imaging (MP-MRI) helps to target biopsies, improving sensitivity and specificity, but there are currently not many studies comparing MP-MRI with radical prostatectomy specimens. Our objective was to determine the correlation between prostate cancer localization in multiparametric magnetic resonance imaging (MP-MRI) and radical prostatectomy histopathology.
164
these two cases and patients were operated using partial pericystectomy method.
UP.114, Table 1.
2
53
5.68
2
4
4
3
61
13.8
1
3
3
Results: The operating follow-ups show that no complications occurred. The average length of post-operative hospitalization was 4 days. Over 5 years after the surgical treatment, no recurrence of the disease was observed. Conclusion: The hydatid cyst is a public health prob-
Patient
Age
PSA
T2 c
T2 p
DWI
1
66
8.23
1
3
4
4
66
7.3
2
4
4
5
45
6.06
2
4
5
6
69
6.50
1
5
4
lem in North Africa. This disease usually has late-onset clinical symptoms. Diagnosis is made by imaging methods and surgery is the main treatment.
7
64
11.54
2
5
5
UP.116
8
69
8.36
1
4
4
9
69
8.11
1
4
5
Focal Xanthogranulomatous Pyelonephritis: A Monocentric Experience About 7 Cases
Materials and Methods: Data from a cohort of men who underwent MP-MRI and radical prostatectomy between January 2013 and September 2015 at the Hospital Aleman of Buenos Aires were reviewed. MP-MRI images were obtained using a Phillips 1.5 T. High-resolution T2-weighted images (T2WI) were obtained followed by diffusion-weighted imaging (DWI), MR spectroscopic imaging (MRSI) and MRI (DCE-MRI). Images were reviewed by a single physician with more than 10 years of experience in prostatic MRI and every MP-MRI sequence was analyzed. From radical prostatectomy specimens, whole-mount histological sections were studied and informed by 2 expert prostate cancer pathologists, each with more than 10 years of experience. Results: Data from 9 patients were analyzed. Laparo-
scopic radical prostatectomy was done in 6, and open approach was used in 3 patients. Results are summarized in table 1. Conclusions: Multiparametric magnetic resonance imaging was correlated with histopathological prostate cancer distribution. T2WI + DWI were particularly effective in detecting cancer localization.
UP.115 Isolated Retrovesical Hydatid Cyst Masmoudi A, Mseddi MA, Rebai N, Bouassida M, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Hospital, Sfax, Tunisia Introduction and Objective: Hydatid disease is a zoonotic parasitic infection caused by Echinococcus Granulosus, which is spread in many endemic regions of the world. The isolated retrovesical hydatid cyst is not very frequent. Due to its uncommon occurrence, genitourinary hydatid disease may cause considerable diagnostic difficulties and involves several management challenges for clinicians. We report 2 cases with isolated retrovesical hydatid cyst, manifested with urinary problems. Materials and Methods: From 2000 to 2015, 2 patients with isolated retrovesical hydatid cyst have been hospitalized. Lower urinary tract symptoms were identified during clinical analysis. One patient presented an acute urinary retention. Diagnosis was made through pelvic ultrasound and intravenous urography. The hydatic serology was negative for
Mejdoub B, Mseddi MA, Bebai N, Ben Abdallah I, Bouassida M, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Hospital, Sfax, Tunisia Introduction and Objective: Xanthogranulomatous
pyelonephritis (XGP) is a non-specific chronic inflammation of the kidney. It may result of a chronic renal infection. The focal form is often misdiagnosed as a renal tumor. The true preoperative diagnosis may be very hard. Materials and Methods: We reviewed the demographic data, clinical presentation, associated abnormalities, radiologic findings, surgical treatment and outcome of 7 patients presenting with focal XGP. Results: We reported the observation of six adults with the mean age of 45 years and a two-year-old girl. Clinical signs consisted of abdominal pain (5 cases), hematuria (2 cases), fever (2 cases) and palpable mass (3 cases). Urine culture was positive for proteus in 3 cases. Biological abnormalities noted were leukocytosis (5 cases) and anemia (4 cases). A computed tomography (CT) showed renal mass with irregular borders and an inhomogeneous density in 6 cases evoking a neoplastic process. Renal biopsy was performed in 3 cases. The lumber approach was used in all cases with low complication rate. We performed total nephrectomy in 3 cases and conservative surgery for 4 patients. Histological exam confirmed the diagnosis in all cases. Conclusion: Focal XGP should be considered when
there is anemia, leukocytosis, and evidence of urinary infection. Preoperative radiologic investigation is paramount for diagnosis, renal biopsy can confirm the preoperative diagnosis and nephrectomy is the treatment of choice, although partial resection or enucleation is more adequate.
UP.117 Fournier’s Gangrene Severity Index Score in the Prediction of Mortality Rate in Patients with Fournier’s Gangrene Djozic S1, Djozic J1, Bogdanovic J1, Sekulic V1, Vojinov S1, Dimitric Z1, Djozic M2, Popov M1, Marusic G1 1 Clinic of Urology, Clinical Center of Vojvodina, Novi Sad, Serbia; 2Clinic of Otorhinolaryngology, Clinical Center of Vojvodina, Novi Sad, Serbia
Introduction and Objective: Fournier’s gangrene (FG) is a form of fulminating and progressive necro-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS tizing fasciitis of perigenital region with the tendency to expand to perineum and perianal region, followed by sepsis and often death. Pathologically, this disease is characterized by necrosis of superficial and deep fascia (necrotizing fasciitis), coagulative necrosis of nutritional arteriole, infiltration of polymorphonuclears, and presence of microorganisms in affected tissue. Regardless known cause, in 95% of the cases, even with use of newest antibiotics, the disease is followed by considerate mortality. The goal of this paper is to try to predict the course and outcome of the disease using Fournier’s Gangrene Severity Index Score (FGSIS). Materials and Methods: During the period 2005 to
2015, 40 male patients with pathologically confirmed FG have been treated at Clinic of Urology, Clinical Center of Vojvodina, Serbia. Cause of infection came from: anorectal region in 11 patients, postoperative period after cystectomy in 2 patients, urethra in 6 patients, scrotum and perineum in 15 patients, penis in 5 patients and postoperative period after TUNA in 1 patient. Predisposing factors were: obesity, alcoholism, diabetes, immunodeficiency, bad hygiene, malignancies, injury. Comorbidities included diabetes, kidney insufficiency, malignancies, pneumonia and cardiomyopathy. All patients underwent aggressive treatment: preparation for surgical treatment, intravenous hydration and triple antibiotic therapy, debridement with wide open wound and every day dressing, correct urine/alvi derivation, intensive care unit monitoring with fluid, electrolytes, blood, protein substitution and control of vital parameters (dialysis if necessary), and wound reconstruction (in case of good treatment outcome). Results: During this period, 25% of patients died (10/40). Cause of death was sepsis in 7 patients and cardio-pulmonary complications in 3 patients. The other 75% of patients (30/40) were cured and went home in good condition. Patients who died were older (67 years, range 54-80) than survivors (56.5 years, range 42-71). Mean and total hospital stay for 40 patients was 59.9 (7-81) and 969 days, respectively. FGSIS was >9 (12±2) in patients who died, while patients with FGSIS <9 had positive outcome (cured). Conclusion: Fournier’s gangrene is a urological ur-
gency, which needs early recognition, aggressive surgical treatment and intensive care unit monitoring. It is followed by a high mortality rate. FGSIS is strongly correlated with mortality rate according to our results.
UP.118 Subinguinal Varicocelectomy under Spinal Anesthesia in a Fahr’s Syndrome Patient with Non-Obstructive Azoospermia Okçelik S1, Taşdemir S2, Öztürk E3, Soydan H4 1 Beytepe Military Hospital, Urology Dept., Ankara, Turkey; 2Beytepe Military Hospital, Neurology Dept., Ankara, Turkey; 3Beytepe Military Hospital, Anesthesia and Resuscitation Dept., Ankara, Turkey; 4 GATA Haydarpaşa Teaching and Research Hospital, Urology Dept., Istanbul, Turkey
Introduction and Objective: Fahr’s syndrome is a rare disease, which is identified for the first time by Fahr in 1930, dependent on calcium and phosphorus metabolism disorder, characterized by double sided,
symmetrical intracranial calcification. Although its clinical findings are parkinsonism, dystonia, tremor, chorea, dementia and mood disorders, it can occur with urological symptoms such as overactive bladder. Previously operation under general anesthesia in a Fahr’s syndrome patient was reported in the literature. However, there is no operation under spinal anaesthesia in the literature. In this report, after getting consent varicocelectomy and anesthesia experience in case of Fahr’s syndrome with non-obstructive azoospermia is presented.
postoperative six hours. Discharge was performed on postoperative second day. There wasn’t any problem associated with wound healing.
Materials and Methods: In this report, after getting
Effect of MOTILIPERM on Pregnancy in Sprague-Dawley Rats Administered 5 Alpha Reductase Inhibitor
consent varicocelectomy and anesthesia experience in case of Fahr’s syndrome with non-obstructive azoospermia is presented. Results: A 15-year-old male patient was admitted to
neurology outpatient clinic with dizziness, nausea, vomiting and hypertension complaints. It was learned that his parents had a history of relatives. There was no evidence of neurological disorder in physical examination. There wasn’t urinary incontinence or overactive bladder. Calcium (Ca) levels in the normal range, slightly lower ionized Ca, phosphorus was high in his routine tests. Parathormone of the patient was in the lower limit. Calcification was detected in the bilateral thalamus, globus pallidus and putamen in cranial magnetic resonance imaging and computed tomography. Urinary tract ultrasonography was reported as normal in terms of urinary stone disease. Twenty four-hour urine calcium and phosphorus were detected low. Creatinine clearance was normal. Doppler ultrasound was assessed normal, made due to the high level of blood pressure during headache. Bender Gestalt visual perception test and number sequence learning test is made to assess the cognitive function and it showed no signs of cognitive impairment. Patient got Fahr’s syndrome diagnosis with these findings. Then patient was followed up due to regressive complaints. At 21 years of age the patient admitted to urology outpatient clinic complained about left scrotal pain got the left grade III varicocele. Left testicle size was smaller. Doppler ultrasonography showed left sided dilated veins, which reached 4.5 mm in diameter at the widest part and detected prominent reflux flow, correlated with varicocele. Patient’s spermogram result was azoospermia. Ejaculate volume was 4 milliliter. These findings were evaluated nonobstructive azoospermia. Hormonal evaluation was done; FSH: 6.59 IU/L, LH: 6.95 IU/L, Estradiol: 27.96 pg/Ml, Prolactin: 10.94 ng/Ml, Total Testosterone: 351.07 ng/dL. Genetic analysis was evaluated as 46, XY (normal karyotype). Left subinguinal varicocelectomy surgery planned with these findings. Spinal anesthesia was preferred after talking with the patient and getting written consent. In operating room, blood pressure was 126/72 mmHg, heart rate 89 beat/min, and SpO2 was 97%, mallampati score was 1, and ASA score also 2. Preparation was made for difficult intubation with various size masks, tubes, blades and lma. The patient was positioned carefully for spinal anesthesia and 0.2mg/kg Bupivacain was administered intrathecally at the level of L4-L5. Left subinguinal varicocelectomy operation lasted for 45 minutes, and hemodynamically its course was stable. Patient was followed in recovery unit and was sent to clinic after motor block was discontinued. Routine catheter didn’t inserted. Patient made spontaneous urine at
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Conclusion: This is the first case showed coexistence
of Fahr’s syndrome and varicocele. This is also the first spinal anesthesia application in a FAHR’s syndrome patient. In this report, we showed that varicocelectomy can be performed under spinal anesthesia in a Fahr’s syndrome patient safely.
UP.119
Soni KKS1, Choi BRC1, You JHY1, Shin YSS1, Kim HKK2, Lee SWL3, Park JK1 1
Chonbuk National University Hospital, Jeonju, South Korea; 2Kyungsung University, Busan, South Korea; 3 Sungkyunkwan University School of Medicine, Seoul, South Korea and Objective: Finasteride and dutasteride (5α-reductase inhibitors) are commonly used for the treatment of young male baldness (MB) and benign prostatic hyperplasia. However, this treatment also causes adverse events in male sexual function including fertility. We evaluated the recovery effect to dutasteride 5 mg inducing adverse events by MOTILIPERM on Sprague-Dawley rats.
Introduction
Materials and Methods: Four groups were includ-
ed. The groups were the control (CTR) group, the CTR+dutasteride 5 mg /kg/day group, the dutasteride 5 mg/kg+MOTILIPERM 100 mg/kg/day group, and the dutasteride 5 mg/kg+MOTILIPERM 200 mg/kg/ day per oral daily for 90 days group. Body and genital organs weight, vas deferens and epididymis sperm count, sperm motility, testosterone level, number of offspring in each groups were evaluated. Each group included 10 male and 10 female rats. Results: The body weight decreased significantly in dutasteride 5 mg/kg+MOTILIPERM 100 mg/kg/ day, dutasteride 5 mg/kg+MOTILIPERM 200 mg/ kg/day compared with CTR and CTR+dutasteride 5 mg/kg/day. Testis weight, epididymis weight, seminal vesicle weight, prostate weight, penile weight, vas deferens sperm count and motility, epididymis sperm motility has statistical significant with CTR and CTR+dutasteride 5 mg/kg/day. Testosterone assay and epididymis sperm count was not statistically significant. Pregnant number was 10 female rat in control, 3 in dutasteride 5 mg/kg/day, 8 in dutasteride 5 mg/kg/day+MOTILIPERM 100 mg/kg/day, 4 in dutasteride 5 mg/kg/day+MOTILIPERM 200 mg/ kg/day, respectively. Mean offspring number was 13.6±2.46 rats in control, 3.8±6.29 in dutasteride 5 mg/kg/day (p=0.004), 8.9±5.2 in dutasteride 5 mg/ kg/day+MOTILIPERM 100 mg/kg/day (p=0.079), 4.8±6.37(p=0.723) in dutasteride 5 mg/kg/day+MOTILIPERM 200 mg/kg/day, respectively. Conclusion: Dutasteride could lead to male infertility.
The MOTILIPERM also could be an effective medicine to reduce the adverse events in sexual function that are caused by dutasteride.
165
UNMODERATED ePOSTERS UP.120
UP.121, Table 1.
A New Technique for Adult Undescended Testes: Orchiopexy with Magnification
Left varicocele
Ebiloglu T1, Aydogmus Y1, Kaya E2, Kibar Y2
Bilateral varicocele
P
3.9±1.2 (2-4)
2.57±0.78 (1-3)
0.164
76.16±33.74 (3-145)
57.39±33.12 (10-120)
0.023
A+B+C%
66.52±18.1 (1-90)
57.47±26.2 (0-95)
0.21
Introduction and Objectives: Orchiectomy is the pri-
A+B%
52.05±18.07 (0-85)
46.08±24.9 (0-85)
0.393
mary treatment modality in adult undescended testes. However, for bilateral undescended testes and patients unwilling to have their testes removed, orchiopexy is the recommended technique. Due to fibrous maturation in spermatic cord components, inguinal orchiopexy is difficult for adult cases. In this report, we investigated the use of magnification for inguinal orchiopexy operations.
A%
18.57±19.42 (0-80)
25.04±23.75 (0-70)
0.274
Volume
1
Dept. of Urology, Etimesgut Military Hospital, Ankara, Turkey; 2Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey
Materials and Methods: Between January 2013 and December 2015, 3 patients had orchiopexy for the treatment of undescended testes. The dissection was accomplished firstly by eyesight, then continued using a loupe with 3.5X magnification (Heine Binocular Loupe, Germany), and finalized with a surgical microscope with 40X magnification (Karl-Zeiss Surgical Miscoscope Opmi Vario 000000-1026-701, Germany). The effect of each dissection on unrestricted lengths was noted. Results: Two patients had right undescended testes, and 1 patient had bilateral undescended testes. With eyesight dissection, the unrestriction length was detected to be 5 (2-7) cm, with loupe, the unrestriction length was 6.8 (3-8) cm, and with the microscope, the unrestriction length was 7.5 (5-9) cm. There was no statistical difference between eyesight and loop dissection, or between loop dissection and microscopic dissection. However, the difference was significant between eyesight dissection and microscopic dissection (p=0.047). Conclusions: Microscopic dissection during adult inguinal orchiopexy offers the best unrestriction length. Further studies are needed to compare the magnification effect in inguinal orchiopexy.
UP.121 Comparison of Sperm Parameters in Patients with Left Sided Varicocele and Bilateral Varicocele Aydogmus Y1, Ebiloglu T1, Kaya E2, Oral E1, Kibar Y2 1
Dept. of Urology, Etimesgut Military Hospital, Ankara, Turkey; 2Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey
Count (x106)
B%
33.47±24.24 (0-85)
21.04±15.9 (0-80)
0.018
C%
14.37±7.09 (0-30)
11.82±10.36 (0-50)
0.05
D%
31.69±17.2 (5-99)
38.17±24.07 (0-90)
0.329
Normal Sperm%
68.3±13.1 (1-74)
43.95±27.07 (0-95)
0.004
Introduction and Objectives: Varicocele may exhibit
Materials and Methods: A total of 109 patients (200
a worsening effect on sperm parameters. In this report, we compared the sperm parameters of patients with left sided varicocele to the sperm parameters of patients with bilateral varicocele.
testicular units) with maturation arrest on testicular biopsies performed during microdissection TESE were retrospectively identified. Testicular size was measured by ultrasound scan (normal 3.5 cm and above) and FSH, and LH and testosterone levels were recorded. All patients had a negative genetic analysis for Y chromosome microdeletions and normal karyotype. All men underwent a microdissection sperm retrieval using a standard technique. Testicular biopsies were characterized according to the level of maturation arrest (early MA in case of Johnsen score (JS) ≤5 and late MA if JS >5). The mean and maximum JS, FSH, LH, Testosterone, testicular size and the sperm retrieval rates were analyzed between groups.
Materials and Methods: Between November 2012 and March 2016, a total of 82 patients with groin pain and clinical varicocele were enrolled in this study. Patients were divided into 2 groups. Group 1 had left sided varicocele, and group 2 had bilateral varicocele. Results: There were 59 patients in group 1, and 23 patients in group 2. The results are summarized in Table 1. Sperm count, category B% sperm, category C% sperm, and normal sperm were detected to be significantly less in group 2.
Clinical Effectiveness Unit, Royal College of Surgeons, England; 2University College Hospital, Dept. of Andrology, London, United Kingdom
Results: Median age of patients in early and late maturation arrest was 39 (IQR 34-45), 39 (IQR 33-46) respectively. The median FSH and LH levels were 15.7 IU/l (range 1.6-67) and 7.6 IU/l (range 1.4-28) respectively. The mean testosterone level was 13.5 ng/ dl (4.3-37), with no difference in testosterone levels in early or late MA, with overall sperm retrieval rates of 33.9%. Patients with early MA had significantly higher FSH and lower sperm retrieval rates than those with late MA (Table 1, p <0.05). Of note, 17 patients had mixed levels of maturation arrest.
Introduction and Objective: There is limited data re-
Conclusion: In patients with maturation arrest, sperm
porting on the outcome of men with maturation arrest (MA) undergoing mTESE. The aim of this study was to determine if the diagnosis of early or late maturation arrest affected sperm retrieval rates and to identify if early or late MA could be differentiated by hormonal factors.
retrieval rates are low in the early group compared to late with over 85% of patients having a negative mTESE. There is a better outcome in late MA patients, who also have significantly lower FSH levels. These results may be of prognostic value in differentiating men with early from late MA.
Conclusions: Bilateral varicocele affects the sperm
parameters more aggressively.
UP.122 Microdissection TESE in Men with Maturation Arrest: An Outcome Analysis Sujenthiran A1, Yap T2, Poullis C2, Abumelha S2, Al Mashat F2, Williamson E2, Ralph D2, Minhas S2 1
UP.122, Table 1. Characteristics of Maturation Arrest Groups (*P <0.05 = Significant Difference Between Groups)
Early MA Late MA *p-value for difference
166
Number in testicular units
Median Age (IQR)
Median Johnsen score (IQR)
Median testicular size (IQR)
Median FSH IU/l (IQR)
Median LH IU/l (IQR)
Median Testosterone nmol/l (IQR)
Sperm retrieval rate (%)
145
39 (34 – 45)
3.7 (2.8 – 4.6)
4 (2.0 – 4.0)
13.5 (6.0 – 22.9)
6.2 (5.0 – 11.3)
14 (9.4 – 17.0)
21 (14.3%)
55
39 (33 – 46)
5.7 (5.1 – 6.7)
4 (2.9 – 4.0)
7.5 (4.1 – 12.1)
6.3 (4.0 – 7.4)
14 (10.2 – 16.2)
31 (48.5%)
0.89
<0.0001
0.12
0.0003
0.06
0.65
<0.0001
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.123 Effect of the New Plant-Based Compound on Sperm Quality in Animals with Varicocele and Varicoclectomy Kim SJ, Choi SW, Bae WJ, Jeong HC, Hong SH, Lee JY, Kim SW Dept. of Urology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea Introduction and Objectives: Varicocele is one of the
common causes of male infertility to be corrected by surgical treatment. However, some infertility couples may not achieve pregnancy after varicocelectomy. Therefore, we evaluated the influence of the new Korean herbal compound (KH-204) on sperm function to find a method promoting the recovery effect of varicocelectomy in a varicocele animal model. Materials and Methods: Male rats were divided into
7 groups: the control group (n=10), animals induced varicocele (n=10), animals received the plant-based compound (200 mg/kg; n=10 and 400 mg/kg; n=10) after induction of varicocele, animals with varicoelectomy (n=10), animals with varicoceletomy received the plant-based compound (200 mg/kg; n=10 and 400 mg/kg; n=10). Varicocele was induced following recently proposed new animal model by partial ligation of the left renal vein and ligation of gonadal vein branches to the common iliac artery. Following varicocele induction, the plant-based compound was administered for 6 weeks. After 6 weeks, varicocelectomy was performed in the 30 rats with varicocele. Twenty rats with varicocelectomy received the plantbased compound for 6 weeks. And sperm motility and concentration were evaluated. Testes from the rats in all groups were removed, weighed, and subjected to histological examination. Apoptosis in the testes was measured by the TUNEL assay. The oxidative stress was evaluated by measurement of 8-hydroxy-2-deoxyguanosine (8-OHdG). Results: After 6 weeks, varicocele was well established. At 6 weeks, higher sperm motility and concentration were observed in varicocele-induced rats with the plant-based compound administration. Moreover, varicocele-induced rats with the plant-based compound administration showed higher spermatogenic cell density compared with the varicocele-induced rats. Also, it led to decreased apoptotic body counts and 8-OHdG concentrations significantly. In addition, rats with varicoceletomy and the plant-based compound administration showed more improved parameters compared with the rats with varicocelectomy, only. Conclusion: KH-204 may preserve the sperm func-
tion influenced by varicocele and more improved sperm function was expected after varicocelectomy. Therefore, the plant-based compound can contribute to preserve and improve sperm function related with varicocele.
UP.124 Erectile Dysfunction Severity as a Risk Predictor for Coronary Artery Disease Pourmand G1, Salem S2, Abdi S3, Saboury B2, Saraji A2, Shokohideh V2 1
Urology Research Center, Tehran University of Medical Sciences, Iran; 2Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Iran;
3
Dept. of Cardiology, Tehran University of Medical Sciences, Iran
dysfunction and penile deviations were carried out before and after 1 and 3 months of the interventions.
Introduction and Objective: Erectile dysfunction
Results: Erectile pain was reduced in the electromotive group from a mean of 5.1-1.0 in scale of 10 and from 5.4 to 3.6 in the injection group (p=0.006). Regarding plaque length, plaque width, penile curvature plaque volume and erectile dysfunction, the electromotive administration group showed better results, which, however, were not statistically significant (p>0.05).
(ED) is now beginning to be considered as an early manifestation of a subclinical systemic vascular disorder and may be an index of subclinical coronary artery disease (CAD). Materials and Methods: One hundred eighty-three
patients with newly diagnosed and documented CAD and 134 participants without CAD were enrolled in this case-control study at our referral center. Univariate and multivariate logistic regression analysis were performed to assess the effect of classic risk factors and ED severity on CAD; calculating odds ratio (OR) and 95% confidence interval (CI). Adjustments were made for potential confounding factors including age, hypertension, diabetes, dyslipidemia, obesity, and smoking. The prevalence of ED and the distribution of CAD risk factors (age, smoking, lipid profile, hypertension, obesity, and diabetes mellitus) were evaluated. The 5-item International Index of Erectile Function was used to evaluate the presence and the severity of ED. Results: The prevalence of ED in CAD-positive and
CAD-negative groups was 88.5% and 64.2%, respectively (P < 0.05). A statistically significant difference was found for all risk factors (except total cholesterol and low-density lipoprotein levels), and also ED prevalence between studied groups. Adjusted OR for age, diabetes, hypertension, hypercholesterolemia, and smoking demonstrated a significant confounding effect. Our results also revealed a significant association between severe ED and CAD (OR: 2.22, 95% CI: 1.116.03; P < 0.05). Conclusion: This study suggests that ED could be
considered as a surrogate marker, which can predict the occurrence of CAD, and severe ED could be regarded as an independent risk predictor in addition to the established ones.
UP.125 Comparison of Transdermal Electromotive Administration of Verapamil and Dexamethasone Versus Intra-Lesional Injection for Peyronie’s Disease
Conclusion: Transdermal electromotive drug admin-
istration yielded comparable results against current conventional intra-lesional injection technique and fared better in controlling erectile pain.
UP.126 Does L-Carnitine Therapy Add Any Extra Benefit to Standard Inguinal Varicocelectomy in Terms of Deoxyribonucleic Acid Damage or Sperm Quality Factor Indices? A Randomized Study Pourmand G1, Noori M1, Dehghani S1, Movahedin M2, Hoseini M2, Ahmadi A3 1 Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran; 2Dept. of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; 3Research and Development Center, Sina Hospital, Tehran University of Medical Sciences, Iran
Introduction and Objective: To evaluate if the addition of L-carnitine therapy to standard varicocelectomy adds any extra benefit in terms of improvement in semen parameters or deoxyribonucleic acid (DNA) damage. Materials and Methods: One hundred patients en-
rolled in this study and were randomly divided into 2 groups (50 patients in each group). In group 1, standard inguinal varicocelectomy and, in group 2, standard inguinal varicocelectomy plus oral antioxidant therapy (oral L-carnitine, 250 mg 3 times a day) were performed for 6 months. For all patients, routine semen analysis and DNA damage test of spermatozoa (by 2 methods of terminal deoxynucleotidyl transferase dUTP nick end labeling and protamine damage assay) were performed at baseline, and at 3 and 6 months postoperatively.
Urology Research Center, Tehran University of Medical Sciences, Iran
Results: In both groups, the improvement in semen analysis parameters and DNA damage was observed, but there was not any statistically significant difference between the 2 groups in these parameters. The slope of improvement in DNA damage was slightly better in group 2 (that was not statistically significant).
Introduction and Objective: To compare the efficacy
Conclusion: We observed that the addition of 750 mg
Pourmand G, Dehghani S, Namdari F, Salavati A, Allameh F
of transdermal electromotive administration and intra-lesional injection of verapamil plus dexamethasone for the treatment of Peyronie’s disease. Materials and Methods: Patients with Peyronie’s dis-
ease of less than 2-year duration were randomized into two groups of transdermal electromotive administration and intra-lesional injection of verapamil plus dexamethasone. During the 6-week therapy period, a single weekly dose of 10 mg verapamil and 4 mg dexamethasone solution was administered to 30 patients in each group, either by the transdermal electromotive method or via the conventional injection method by a syringe connected to a 25 G needle. Evaluations of plaque length, width, and volume, penile curvature, erectile
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
of L-carnitine orally daily to standard inguinal varicocelectomy does not add any extra benefit in terms of improvement in semen analysis parameters or DNA damage.
UP.127 Does Renal Transplantation Improve Erectile Dysfunction in Hemodialyzed Patients? What Is the Role of Associated Factors? Pourmand G, Moosavi S, Nikoobakht M, Saraji A, Salem S, Dehghani S Urology Research Center, Tehran University of Medical Sciences, Iran
167
UNMODERATED ePOSTERS Introduction and Objective: To assess the effect of successful renal transplantation on the improvement of erectile function in hemodialysis (HD) patients and the relationship between the degree of patient response and other factors. Materials and Methods: From September 2002 to November 2005, erectile function of 64 patients on HD for at least 6 months was evaluated pre-transplantation and 6 months post-transplantation using the International Index of Erectile Function, version 5 (IIEF-5). Sixty-four age-matched persons without renal impairment were enrolled as the control group to compare erectile dysfunction (ED) prevalence with the HD group. We evaluated duration of HD, age, and site of arterial anastomosis. In an attempt to find predictors of improvement of ED, after kidney transplantation, we performed linear regression analysis with a backward method. Results: The prevalence of ED in HD patients was
87.5%. Although there were some differences in the prevalence of ED between patients older versus younger than 50 years, the difference was not statistically significant. There was no relationship between the duration of dialysis and the severity of ED in HD group. Compared to the pre-transplant IIEF-5 score (13.59), there was significant improvement (19.16). In an attempt to find predictors of ED improvement, we used a linear regression analysis with a backward method. Pre-transplant IIEF-5 score, age at the time of transplant, and anastomosis to the common iliac artery showed significant associations with improvement, but the duration of dialysis and anastomosis to internal iliac or external iliac artery did not. Conclusion: The incidence of ED among hemodia-
lyzed patients is high. Kidney transplantation is the key treatment for this complaint. ED has a major negative impact on the quality of life and on family relations. Its treatment is associated with improvement of psychogenic factors. ED is a sensitive topic and many patients will not spontaneously discuss it with their physician, so it may be better to include potency evaluation in post-transplantation list evaluations.
Maximum Venous Diameter Is a Simple and Objective Measurement to Characterize Clinically Significant Varicoceles 2
2
ing the presence of CDU-reflux alone (correctly classified 82.5%, AUC=0.73). Conclusions: A threshold value MVD ≥3 mm accurately identifies more men with proven venography-reflux than CDU-detected reflux. MVD is a simple parameter that can be used to stratify men with clinically significant varicoceles who may benefit from therapeutic intervention.
UP.129 Trans-Rectal Ultrasonic Guided Opacification of Seminal Vesicle: Is It the Best Diagnostic Technique for Ejaculatory Duct Obstruction? Ghoneima W, Emran A, El Sheemy M, Abo Elelaa A, Meshref A, Fawzy K Cairo University, Cairo, Egypt Introduction and Objective: To evaluate trans-rectal ultrasonography (TRUS), TRUS-guided seminal-vesicle/cyst aspiration (SV/CA) and TRUS-guided seminal vesiculography (SVG) in the diagnosis of ejaculatory duct obstruction (EDO). Materials and Methods: Eighteen patients with
TRUS findings of EDO were selected from patients
UP.129, Table 1. Clinical Features of All Patients and Post-TURED Outcome in the 13 Patients All 18 pts.
TURED 13 pts.
Outcome after TURED No of pts. (%)
8 (44.4%) 2 (11.1%)
8 (44.4%) 2 (11.1%)
0/13 0/13
10 (55.6%) 1 (5.6%) 7 (38.9%)
10/13 (76.9%) 1/13 (7.7%) 2 (15.4%)
0/13 0/13 13/13 (100%)
15 (83.3%) 3 (16.7%) 0
11/13 (84.6%) 2/13 (15.4%) 0
1/13 (7.7%) 6/13 (46.2%) 6/13 (46.2%)
18 (100%) 0 0
13/13 (100%) 0 0
5/13 (38.5%) 2/13 (15.4%) 6/13 (46.2%)
11 (61.1%) 7 (38.9%) 0
11/13 (84.6%) 2/13 (15.4%) 0
0/13 0/13 13/13 (100%)
-
-
Presentation:
Painful ejaculation Hematospermia Semen analysis: Volume:
Low Anejaculation Normal Count:
Motility: 3
Sujenthiran A , Yap T , Abumelha S , Walkden M , Kirkham A3, Minhas S2 1 St George’s University Hospitals NHS Foundation Trust, London, United Kingdom; 2University College Hospital, Dept. of Andrology, London, United Kingdom; 3University College Hospital, Dept. of Radiology, London, United Kingdom
Introduction and Objective: Varicoceles are present
in up to 15% of the general population and approximately 35% of men evaluated for infertility. Colour Doppler ultrasound (CDU) is commonly used in the diagnostic evaluation of varicoceles, although CDU remains operator-dependent. Furthermore, the diagnostic criteria used are complex and non-standardized. This study aims to define a simple and reliable haemodynamic parameter predicting the presence of reflux in clinically significant varicoceles compared to the gold standard of venography.
168
Results: A total of 107 men (70 unilateral, 37 bilateral) underwent CDU. A total of 144 testis units were included, with a mean MVD of 3.5 mm (range 2-7 mm). Of 144 men, 108 (75%) testes demonstrated CDU-reflux. A total of 97 testes underwent venography, of which 73 had demonstrable reflux. MVD in testes with venography-detected reflux was 4.0 mm (range 2-7 mm) compared to 2.7 mm (range 2-4 mm) in those without reflux (p<0.01). The optimal MVD for discriminating men with and without venography-diagnosed reflux was 3.0 mm (sensitivity 95.9%, specificity 58.3%, correctly classified 86.6%, AUC=0.86). MVD ≥3 mm was a more accurate discriminator of identifying patients with venography-reflux than us-
Azospermia Oligospermia Normal
UP.128
1
Materials and Methods: Data were retrospectively collected on men presenting to a tertiary referral center with subfertility, testicular pain or palpable mass over an 11-year period (2004-2015). Men with a clinically significant varicocele (defined as grade II/ III) underwent CDU and measurement of maximum venous diameter (MVD). A proportion also underwent venography at the time of therapeutic embolisation. Receiver-operator characteristic (ROC) analyses identified the optimal MVD to detect reflux on CDU and venography.
Absent Low Normal Fructose:
Absent Low Normal Clinical examination: Unilateral atrophic testis
1 (5.6%)
Epididymal fullness:
Unilateral Bilateral
2 (11.1%) 10 (55.5%)
Vas deferens:
Unilateral absence Unilateral nodule Unilateral varicocele
1 (5.6%) 1 (5.6%) 5 (27.9%)
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS presenting with infertility from 2005 to 2008. TRUS indications were low semen volume, azospermia, low volume oligospermia or low seminal-fructose volume. Patients with abnormal hormonal profile (FSH, LH, testosterone or prolactin) or retrograde ejaculation were excluded. TRUS, SV/CA and SVG were performed for all patients. TRUS findings suggesting EDO were ED dilatation >2 mm, SV dilatation >15 mm or intra-prostatic cyst. EDO was diagnosed if >3 sperms/hpf were detected in the aspirate. After SV/ CA, a contrast media (Iopromide) was injected under fluoroscopy. EDO was diagnosed if no dye reached the urethra or bladder during SVG. Following SVG, transrectal SV chromotubation was done. A total of 5 ml of diluted methylene blue was injected into the SV under direct cystoscoic visualization of verumontanum and ED orifices. Absence of methylene blue emission from ED was diagnostic of EDO. Results: Median age was 32 (22-42) years old. Clinical features are presented in Table 1. TRUS revealed EDD (10), prostatic-cyst (10), and/or SV dilatation (14 patients). SV/CA revealed sperm in 8 patients (44.4%). Contrast did not reach the bladder or urethra in 13 patients (72%) during SVG. Chromotubation was done when contrast reached the bladder or urethra (remaining 5 patients) to document patency. Complications were epididymo-orchitis (2), gross haematospermia (2%), fever (1%) and extravasation (2). Transurethral resection of ED (TURED) was performed in 13 patients. Postoperative outcome is presented in Table 1. Testicular biopsy was done in 5 patients for whom TURED was not performed and in one patient who did not show significant improvement in semen analysis after TURED. Impairment of spermatogenesis was detected. Non-assisted pregnancies were reported in 5/13 patients (38.5%) after TURED during follow-up period (30-54 months). Conclusion: SVG and chromotubation are more spe-
cific than TRUS for diagnosing EDO, which helps to select the patients who will respond to TURED, and avoid the more invasive open-vasography.
UP.130 Combating Infertility Through Ligating One Vessel at a Time: Al-Adan Experience Al Shammari A1, Fouad A2, Nanouh A2, Al Otaibi K2, Bubshaite S2, Al Hajeri D2 1 Adan Hospital, Kuwait City; Ministry of Health, Kuwait City, Kuwait; 2Ministry of Health, Kuwait City, Kuwait
Introduction and Objective: We review the outcomes
of varicocelectomy procedures in a single surgeon series. Materials and Methods: The study followed 116 pa-
tients undergoing varicocelectomy by a single surgeon at a single institution over four years from 2012 to 2016. A database was kept prospectively for all patients. Results: Of those 33 who reported primary infertility, 21 had secondary infertility, and 56 had an undefined infertility (primary or secondary infertility). In addition, 7 had scrotal pain, 1 had a small single testicle, and 1 had recurrent varicocele as a diagnosis. The average age among the patients was 32 years (+/6.8). Among the 116 patients undergoing surgery, the dataset comprised 108 micro-subinguinal procedures,
4 open inguinal, and 4 laparascopic. About 24% had low concentration (<15), 31.35% prolonged liquefaction time (<30 mins), 78.2% low motility (<50), 27.8% had abnormal viability (<30), 38.8% had volume (below 2.5 ml), 17.7% had poor morphology (<30), and 54.6% had abnormal counts (<10 million). Among patients who provided post-operative semen test results, some improvement was noted, namely an increase in motility, normal morphology, and count. Albeit liquefaction time increasing insignificantly, post-operative volume showed significant improvement. A total of 92.4% of the surgeries were complication-free. The reported complications were scrotal swelling (1.9%), fever, surgical emphysema, spinal headache, subinquinal hematoma, and accidental artery ligation (0.95%). Among the 18 patients who reported their infertility status pre-operatively, 33% (95% CI: 10-43.3%) have reported post-operative pregnancy. The rest of the dataset is still being followed up. Conclusion: Patients undergoing varicocelectomy
procedures have shown improvement in fecundity and sperm analysis. However, it is still early to conclude since the dataset is still being followed up.
UP.131 Surgical Treatment of Varicocele Improves Fertility and Facilitates Medically-Assisted Procreation Smaoui W, Touaiti T, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Academic Medical Center, Sfax, Tunisia Introduction and Objective: To assess the effect of varicocelectomy in sperm quality and natural pregnancy and to determine if it can change couple candidacy for assisted reproductive technology (ART) procedures. Materials and Methods: We performed a retrospective study about 164 infertile men with varicocele associated to sperm abnormalities. We divided our patients into four groups, according to the total motile sperm count (TMC). Group 1 included 21 azoospermic men, group 2 included 62 patients who had a TMC strictly less than 1.5 × 106, group 3 included 22 patients who had a TMC between 1.5 and 5 × 106 and group 4 included 59 patients who had a TMC strictly greater than 5 × 106. All patients underwent surgical or percutaneous embolisation to repair varicocele. Results: After treatment, the mean spermatozoid concentration and motility were significantly increased, respectively from 24.8 to 29.2 × 106 spermatozoids per millilitre and 14.4 to 23.2%. Spontaneous pregnancy was observed in 59 couples (35.9%). Concerning the couples who had no pregnancies (105), 51 (48.5%) showed increase of the TMC, which allowed them to change the foreseen preoperative ART to another simpler one. Conclusion: Varicocelectomy has significant potential
not only to improve sperm quality and natural pregnancy, but also to downstage the level of ART needed for the management of male infertility.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
UP.132 The Best Objective Response of Metastatic Lesions Is Associated with the Survival of Patients with Advanced Renal Cell Carcinoma Treated with Sunitinib Miyake M, Hori S, Morizawa Y, Tatsumi Y, Nakai Y, Anai S, Tanaka N, Fujimoto K Dept. of Urology, Nara Medical University, Japan Introduction and Objective: We investigated the prognostic relevance of the best objective response of metastatic target lesions in the metastatic renal cell carcinoma patients treated with sunitinib. Materials and Methods: Radiographic analysis of the best objective response according to the Response Evaluation Criteria in Solid Tumors (RECIST) was evaluated in 48 patients. Clinical and pathological variables including the Heng risk classification and sunitinib-related adverse events were compared among four patient subgroups (complete response or partial response [CR/PR], stable disease [SD], progressive disease [PD], and those without treatment evaluation [NE]). Kaplan-Meier and Cox proportional regression analyses of progression-free survival and overall survival were conducted to find significant prognostic factors. Results: The best objective response was CR/PR in 12 (25.0%) patients, SD in 22 (45.8%), PD in 6 (12.5%), and NE in 10 (20.8%). The incidence of hypertension and hypothyroidism was correlated with the better tumor shrinkage of metastatic lesions. Progression-free survival was 15, 9, 7 and 2 months in the CR/PR, SD, PD, and NE groups, respectively, while the corresponding median overall survival was 60, 24, 17, and 18 months, respectively. Cox proportional regression analysis revealed that hazard ratios for risk of death of the SD, PD, and NE groups were 4.5 (P = 0.06), 7.9 (P = 0.02), and 4.9 (P = 0.04), respectively, as compared to the CR/PR group. Conclusions: Our results suggested that the better tumor shrinkage of metastatic lesion was a prognostic marker for both progression-free survival and overall survival in sunitinib treatment.
UP.133 Renal Cell Carcinoma with Tumor Thrombus of the Inferior Vena Cava: Is Upfront Surgery Beneficial? Carson JA1, Hong HH2, Lee LS2 1
Centre for Quantitative Medicine, Dukes-NUS Medical School, Singapore; 2Dept. of Urology, Singapore General Hospital, Singapore Introduction and Objective: Surgical extirpation for
RCC with IVC invasion is technically challenging and uncommon. The oncological impact of upfront surgery has not been described. We aim to report operative and oncological outcomes following nephrectomy and venous thrombectomy in a single institution, and compare overall survival (OS) with a cohort of patients managed conservatively. Materials and Methods: All patients diagnosed with
RCC with IVC thrombus between January 1, 2001 and December 31, 2014 in a single institution were identified, and data were reviewed for demographics, performance status and tumor thrombus levels.
169
UNMODERATED ePOSTERS Pathological and operative outcomes were analyzed in the surgical cohort. Cancer specific survival (CSS) and OS were computed with Kaplan Meier analysis. Prognostic factors were determined using univariate and multivariate analyses. Statistical significance was defined as p<0.1. Results: There were 51 patients identified, comprising 31 and 20 in the surgical (Sx) and non-surgical (NSx) cohorts. For the Sx cohort, 5-year OS and CSS was 48% and 45% respectively with a median OS of 25.7 months (range: 0.13-163). A total of 17 of the 31 operated patients (55%) received adjuvant systemic therapy, while none received neoadjuvant treatment. Multivariate analyses showed presence of metastases and collecting duct invasion as independent predictors for OS (p<0.1). Five patients (16%) from the Sx cohort underwent cytoreductive surgery and median OS was 13.0 months (range: 9.1-30.9 months). In the NSx cohort, 75% (15/20) had distant metastasis at diagnosis, with a 5-year OS of 13.4 months. Patients with better baseline Eastern Cooperative Oncology Group (ECOG) statuses had better survival outcomes (p<0.1). The mean OS of patients (n=5) with M0 disease was 18.8 months (median 13.57, range: 5.6-45.8). When comparing the two cohorts, the advantage conferred by surgery was a 38.2 month longer median OS (p<0.0001). In the Sx cohort, the median operative time and length of stay was 270 minutes (mean: 282.3, range: 115-585) and 7 days (mean: 10, range: 3-37) respectively. Immediate post-operative complications were seen in n=14 patients (45.2%) comprising n=10 minor (Clavien-Dindo class I-II) and n=4 major complications (Clavien-Dindo class III-IV). There were no intraoperative mortalities. Cardiopulmonary bypass and atrial tumor removal may predict the presence of complications but this is not statistically significant (p<0.1486). Conclusion: Although it is technically difficult, sur-
gery in these patients can be performed with reasonable operative outcomes. Aggressive upfront surgical approach can confer a survival benefit in non-metastatic patients, especially those with good ECOG status. Cytoreductive surgery has a limited benefit to survival but may serve a palliative intent.
UP.134 Prognostic Value of the Anatomical Location of Upper Urinary Tract Urothelial Carcinoma: About 55 Cases Sallami S1, Chtourou M2 1
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; 2 Dept. of Urology, Habib Thameur University Hospital, Tunis, Tunisia
Introduction and Objective: The prognostic significance of pyelum versus ureteral urothelial carcinomas is controversial. We evaluated the prognostic value of the anatomical location of transitional cell carcinoma (TCC) in the upper urinary tract. Materials and Methods: We retrospectively ana-
lyzed data from 55 patients with upper urinary tract TCC (UTTCC). Patients were treated surgically between 1995 and 2011. Tumor location and other clinic-pathological variables were evaluated regarding cancer recurrence and survival. Recurrence and cancer-specific survival probabilities following tumor resection were analyzed using the Kaplan-Meier
170
method and log rank test. Univariate and multivariate analyses were performed using Cox proportional hazards regression model. Results: Mean patient age was 69.5 years (range, 2587 years); median follow-up was 48.2 months (range, 37-154 months). TCCs were in the pyeleum or the calyx (n=35), the ureter (n=11), and in both locations (n=9). The majority of the patients (62%) had pT2 or pT3 primary tumors. There was no significant difference between the number of patients with transmural tumor growth (pT3-pT4) in the proximal ureter or pyelum (40%) when compared with distally located tumors (18.2%) (p=0.30). None of the patients with Ta/cis, T1, or T2 primary tumors had nodal or distant metastatic disease, either initially or during follow-up. Median overall and disease-specific survivals were 39.7 months and 43.2 months, respectively. The repartition of tumor stage and grade was similar in the pyelum pelvis and the distal ureter (p=0.41 and p=0.46, respectively). The tumor location did not significantly affect the 5-year bladder recurrence rate (p=0.73). The disease-specific survival rates were 89.1% for patients with tumors in both the pyelum and distal ureter locations. There was no significant impact of UTTCC location on 5-year survival. Conclusion: Tumor location does not appear to be an
independent prognostic factor for patients with UTTCC. Patients with pyelum or distal ureter TCC with the same tumor grade and stage had the same risk of bladder cancer recurrence and survival. We recommend the same surveillance protocol regardless of the tumor location.
UP.135 Clamping Vessel Loop: An Alternative Method of Laparoscopic Partial Nephrectomy Rizaldi F, Renaldo J, Soebadi D, Djatisoesanto W Dept. of Urology, Universitas Airlangga, Surabaya, Indonesia Introduction and Objective: Many hospitals in de-
veloping countries only have standard laparoscopy equipment. This standard equipment does not include the laparoscopy Satinsky clamp or the Bulldog clamp. We report an alternative technique for achieving transient vascular occlusion using clamping vessel loop during laparoscopic partial nephrectomy. Materials and Methods: A 52-year-old-woman with
solid left renal tumor was incidentally diagnosed with ultrasound. CT abdomen was confirmed solid tumor in the lower pole of the renal tumor. Transperitoneal laparoscopic partial nephrectomy was performed. We used the open Hasson technique and inserted first 10 mm trocar. Four trocars were used. After the renal vessels were dissected, vessel loop was inserted via 10 mm trocar and was winded twice around the vessel using a laparoscopic dissector. After the vessel had been looped, both distal ends of the vessel loop were clamped by curved clamp outside of the 10 mm trocar. When vascular occlusion was required, gentle traction of the curved clamp. Clamping vessel loop was successful for vascular occlusion. Results: Laparoscopic partial nephrectomy was suc-
cessfully performed without open conversion. The renal warm ischemia was 45 minutes. The laparoscopic
operating time was 490 minutes. Intraoperative blood loss was 500 cc. Renal function was normal pre-post operative (0.9 vs.1.2). Surgical margin was negative. Histopathology result showed renal cell carcinoma. Conclusions: Vessel loop can be safely used in laparoscopic partial nephrectomy. The advantage of this method that controls vessel loop clamping is that it is easy to evaluate parenchymal suture and partial vascular occlusion.
UP.136 Prognostic Significance of HypoxiaInducible Factor 1-alpha in Patients with Clear Cell Renal Cell Carcinoma Veselaj F1, Kerliu-Manxhuka S2, Frangu B1, Hyseni S1, Kryeziu D1, Osmani N1, Neziri A1, Selmani L1, Shahini L2, Xharra S3 1
Clinic of Urology, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo; 2Dept. of Pathology, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo; 3Regional Hospital, Prizren, Republic of Kosovo
Introduction and Objective: Clear cell renal cell carcinoma (ccRCC) is the most predominant renal tumor with unpredictable tumor behavior. The aim of this study was to investigate the prognostic value of expression of hypoxia inducible factor 1-alpha (HIF1α) in ccRCC. Materials and Methods: Tumor samples taken from 40 patients with histopathology diagnosis of ccRCC and tissue samples taken from 20 normal kidneys as a control group were examined by immunohistochemical staining for HIF-1α. Results: Expression of HIF-1α was higher in the ccRCCs than in non-tumor kidney tissue at a statistically significant level (HIF-1α: X2-test = 8.76, P=0.012). Expression of HIF-1α in ccRCC is positively correlated with MVD (r = 0.07 P = 0.632), tumor nuclear grade (r=0.181, P=0.262) and the degree of tumor hemorrhage (r=0.08, P=0.589). However, expresion of HIF-1α in ccRCC is negatively correlated with VEGF-A (r = -0.07, P = 0.666), tumor size (r = -0.264, P=0.09), pathological stage (r = -0.05, P=0.754), tumor necrosis (r = -0.164, P=0.309), DFS (r = -0.157, P = 0.332), PFS (r = -0.146, P = 0.682) and CSS (r = -0.676, P = 0.136). Conclusion: Expression of HIF-1α in ccRCC was sig-
nificantly higher than in normal kidney tissue. The expression of HIF-1α may be responsible for angiogenesis in ccRCC, however this angiogenic factor plays an important role in the prognosis of ccRCC patients.
UP.137 Radiofrequency Ablation of Renal Tumors: 5-Year Follow-Up Sung GT1, Kim S1, Bae YK2 1
Dong-A University Hospital, Busan, South Korea; 2Jeil Hospital, Ulsan, South Korea Introduction and Objective: The aim of this study was to retrospectively evaluate the long-term results of radiofrequency ablation (RFA) of small renal masses (SRMs).
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS Materials and Methods: Percutaneous or laparo-
UP.139
scopic RFA was performed on 55 confirmed renal tumors in 53 patients. The follow-up included physical examination, chest radiography, creatinine, and contrast-enhanced CT or MRI. To confirm pathologic criteria of complete ablation, 35 patients underwent follow-up biopsy. Recurrence was defined as contrast enhancement after 3 months or lesion growth at subsequent imaging or viable cancer cells on follow-up biopsy.
Mandatory Bilateral Nephron Sparing Surgery in a Patient with Birt-Hogg-Dubé Syndrome: A Report of Our First Case in Argentina
Results: Technical success was achieved in 52/55 renal tumors (94.5%). The mean tumor size was 2.25 cm and the mean follow-up period was 62.5 months. Repeated RFA was necessary in 8 tumors due to incomplete ablation. The overall complication rate occurred in 43% in 19 patients and the low-grade complications accounted for 95.6% of the overall complications. Five patients were found to have recurrence at various follow-up intervals and the distant metastasis was found in 4 cases. Currently, 50 of 53 patients are alive on serial follow-up.
drome (BHD) is an autosomal dominant genetic disorder characterized by mutation in the FLCN gene, which codes for the protein folliculin. Though its function is not fully understood, it appears to be related to mTOR signaling and the AMPK pathway. It is highly expressed in subcutaneous tissue, type I pneumonocytes and distal nephrons. The most common clinical manifestations are tricodiscomas and folliculomas, which are pathogenomonic lesions found on the face and upper trunk, and spontaneous pneumothorax and pulmonary cysts. Kidney tumors, both cancerous and benign, can also occur synchronously and bilaterally. The goal of our paper is to report the mandatory nephron sparing approach in this first case in Argentina.
Conclusion: RFA is considered a useful treatment
for selected patients with SRMs and also for nephron-sparing. Our long-term data suggest excellent therapeutic outcome with RFA, while achieving effective local tumor control.
UP.138 Verrucous Carcinoma of the Renal Pelvis Fourati M, Mejdoub B, Hadj Slimen M, Omar K, Rebai N, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objective: Verrucous carcinoma is
an unusual type of well-differentiated squamous cell carcinoma, first described in the ENT sphere. The kidney location is rare. We aimed to study clinicopathological aspects of this type of carcinoma and to discuss their prognosis. Materials and Methods: We reported on three observations of pelvis verrucous carcinoma among a cohort of 14 patients presenting with pelvis squamous cell carcinoma. Results: The average age was 57 years. Two men and 1
woman were affected. A history of chronic irritation, inflammation, and nephrolithiasis were notified in all cases. The histopathological findings of the surgical specimen revealed an extensive keratinizing squamous metaplasia with an area of verrucous acanthosis. The carcinoma did not invade the lamina propria. Patients with verrucous carcinoma compared to those with pelvis squamous cell carcinoma had best prognosis with best survival rate (38.2 months vs. 8.42 months). Conclusion: The risk factors of verrucous carcino-
ma are essentially lithiasis and/or urinary infection. Clinical symptoms are not specific. Diagnosis is histopathological. Prognosis seems to be better than other types of squamous cell carcinoma.
Burioni A, Bruno L, Camean J, Villoldo G, Villaronga A Instituto Oncológico Alexander Fleming, Buenos Aires, Argentina Introduction and Objectives: Birt-Hogg-Dubé syn-
Materials and Methods: We report the case of a 28-year-old patient diagnosed with bilateral multifocal renal carcinoma, found incidentally, who underwent a left open partial nephrectomy in 2014, resecting two 3 cm tumors, diagnosed as hybrid oncocytoma (pTa). During the study plan, the presence of bilateral pulmonary bullae was identified by TC. Physical examination showed skin lesions in the neck and pinna, which were biopsied and diagnosed as foliculomas. New TC showed bilateral tumors larger than 3 cm. Results: After studies of the clinical findings, a FLCN complete gene sequencing was performed, being exon 5 gene mutations carrier. Having established a genetic diagnosis of BHD, a right partial nephrectomy was performed and a left partial re-nephrectomy in 2016, resecting four right lesions and one left lesion larger than 3 cm. In both cases, ischemia time was less than 15 minutes and the tumor pathology was hybrid oncocytoma and clear cell carcinoma. Conclusions: The nephron sparing partial surgery is required in these patients with genetic diagnosis of BHD in lesions 3 cm in diameter or larger. Renal parenchyma must be preserved as much as possible, minimizing ischemia time should also be done, and resecting small lesions should be avoided because they are of low malignant potential. These patients should be treated in an interdisciplinary way in high volume centers, avoiding early radical nephrectomy.
UP.140 Sequential Robot-Assisted Bladder Diverticulectomy and Simple Prostatectomy: Technique and Surgical Outcomes Shen Z, Zhong S, Zhang M, Chen S, Xu T Huashan Hospital Fudan University, Shanghai, China Introduction and Objective: Bladder diverticulum is
mostly a complication of subvesical obstruction. The
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
gold standard of treatment used to be open diverticulectomy and prostatectomy. A more contemporary resolution is endoscopic, in two steps: the first transurethral resection of the prostate, the second laparoscopic diverticulectomy. The aim of the study was to present a one-session procedure-robot-assisted bladder diverticulectomy combined with robotic-assisted simple prostatectomy. Materials and Methods: From August 2013 and De-
cember 2014, we successfully operated on three men aged 63 to 78 years for symptomatic large benign prostatic hyperplasiaand a secondary bladder diverticulum, with the use of the robot-assisted bladder diverticulectomy combined with robot-assisted simple prostatectomy approach. The prostate calculated preoperative volume was 100, 105 and 120 ml, respectively. The residual urine volume was 100, 160 and 300 ml, respectively. The bladder diverticulum volume calculated by transabdominal ultrasonography preoperative was 90, 150 and 280 ml, respectively. All patients underwent follow-up 6 weeks after surgery and every 3 months thereafter. Results: All procedures were successfully performed by robotic surgical system. The operative time was 90, 110 and 130 min, respectively. The estimated blood loss was 60, 100 and 120 ml, respectively. The postoperative bladder irrigation was 2 days. The Foley catheter was removed after a negative cystogram and median time to catheter removal was 7 days. Patients were discharged on the ninth (range 7-11 days) postoperative day with no intra- or postoperative complications. The average 17-month follow-up (range 15-19 months) confirmed good operative results in all cases. Conclusion: Bladder diverticulum is a relatively rare
disease. With the help of a robotic surgical system, one session of robot-assisted bladder diverticulectomy and robot-assisted simple prostatectomy is the preferred method for treatment of subvesical obstruction due to large benign prostatic hyperplasia and bladder diverticulum at our institution.
UP.141 Application and Outcomes of Robotic-Assisted Nerve-Sparing Radical Prostatectomy Shen Z, Zhong S, Zhang M, Chen S, Qin L Huashan Hospital Fudan University, Shanghai, China Introduction and Objective: Erectile dysfunction has
become one of the intractable postoperative complications due to radical prostatectomy. One contentious area is the nerve retention during the operation, which involves a balance of risks between tumor residual and recurrence when sparing cavernous nerve versus the risk of postoperative erectile dysfunction without reservation. Recently, there has been no definite evaluation on the outcomes of the nerve-sparing surgical method during robot-assisted laparoscopic prostatectomy. Herein, we analyze the clinical cases retrospectively to evaluate the surgical outcomes. Materials and Methods: Clinical cases of 86 patients suffered from localized prostate cancer were collected between March 2010 and January 2016. All patients with mean age of (66.7±8.6) years and a mean baseline PSA of (23.1±11.2) μg/L, received robot-assisted laparoscopic prostatectomy in Huashan Hospital or
171
UNMODERATED ePOSTERS Ruijin Hospital. The transperitoneal approach was adopted in all cases. Erectile function evaluation was performed according to the International Index of Erectile Function-5 (IIEF-5). Erectile function of all the patients included was normal with a score on the aforementioned questionnaire of greater than 22. On the basis of the preoperative prostate biopsy or imaging examination, different surgical methods were preformed respectively. Unilateral bilateral nerve vascular bundles (NVBs) were preserved if they were not invaded by tumor, and if one side NVB was aggressed, the operator resected the invaded NVB. Robot-assisted laparoscopic technology was employed to dissect the apex of the prostate below the pubic prostate ligament, meanwhile, preserved the retropubic dorsal vein complex. Judge the position of bladder neck correctly, and perfect anastomosis of anterior wall of bladder neck, which was sewed on the pubic prostate ligament to reduce the tension and to protect the anastomosis, and posterior wall of bladder neck were performed respectively. Besides, urethral anastomosis should be performed at 8, 12, 2, 4 and 6 o’clock with avoiding deep suturing at 5 and 7 o’clock. Notice should be taken to protect the urethral sphincter and the periprostate blood vessel bundle. Mucosal eversion should be performed after the reconstruction of the bladder neck. Anastomosis between bladder neck and urethral end with interrupted, free-tention sutures. Results: A total of 86 operation procedures were successfully performed with the da Vinci robotic system and there was no open conversion. Mean operation duration were similarly 158±47 min; the mean estimated blood loss and postoperative length of hospital stay were 328±254 ml and 8.4±3.1 days. Two cases of urine leak and two cases of lymphatic leak occurred after operation. The positive surgical margin rate was 20.5%. After the mean follow-up of 25 months, 81.4% (70/86) of the patients restored the erectile function in 6 months with IIEF-5 score of more than 22. Conclusion: The benefits of the da Vinci® robotic sys-
Introduction and Objectives: To summarize the
Introduction and Objective: To evaluate the safety,
measures and effectiveness of perioperative nursing in patients undergoing Da Vinci robot-assisted laparoscopic urological surgeries, and to evaluate the effect of robotic surgeries on the modern philosophy of nursing.
feasibility and reproducibility of a robot-assisted simple prostatectomy (RASP) in cases of symptomatic large volume benign prostatic hyperplasia.
Materials and Methods: The clinical data of 720 pa-
tients undergoing Da Vinci robot-assisted laparoscopic urological surgeries from March 2010 to February 2016 were retrospectively analyzed. Upper urinary tract operations included 512 cases (71.1%) and lower urinary tract operations included 208 cases (28.9%). The upper urinary tract operations included adrenalectomy (214 cases), partial nephrectomy (106 cases), nephrolithotomy or ureterolithotomy (75 cases), pyeloureteroplasty (42 cases), radical nephrectomy (27 cases), renal cyst unroofing (23 cases), nephroureterectomy (9 cases), paraganglioma resection (9 cases), double kidney resection (5 cases), and ligation of renal artery aneurysms (2 case). The lower urinary tract operations include radical prostatectomy (122 cases), radical cystectomy (38 cases), partial cystectomy (28 cases), vesical diverticulectomy (7 cases), urachal cyst resection (5 cases), retroperitoneal lymph node dissection (4 cases), high ligation of spermatic vein (2 cases), and repair of vesicovagina fistula (2 cases). The transperitoneal approach was adopted in all cases. Three robot arms and one satellite hole were used in the upper abdominal surgeries, 3 or 4 arms were used in the lower abdominal surgeries. Preoperative care focused on psychological nursing and preoperative preparations. Postoperative care included psychological nursing, strict monitoring of vital signs, respiratory care, operative incision and drain tube nursing, diet nursing, early functional exercise, and close observation to prevent the postoperative complications. The operation duration, blood loss, recovery time of intestinal function, time of out-of-bed activity, time of removing drainage tube and catheter, and postoperative hospital stays were compared between the first 360 surgeries and the last 360 surgeries.
tem over conventional operation are readily apparent: superior ergonomics, optical magnification of the operative field within direct control of the console surgeon, and enhanced dexterity, precision, and control of operative movements, which can protect the pelvic floor muscles and important vessels and nerves. When dissecting NVB from basal part of prostate and pelvic floor muscles, ultrasonic scalpel and bipolar coagulation should be avoided to present the thermal injury. Use the right-angle dissection forceps to separate NVB between the fascia of levator ani muscle and prostate capsule antegradely. Titanium clip is a good choice to stop bleeding. Besides, prostic ligaments should be dissected first then clip the vessels of the prostate capsule with Ham-O-lock so that less bleeding occurs when the vessels are cut. Robotic-assisted nerve-sparing radical prostatectomy can elevate the rate of NVB retention with less demage and faster restoration of erectile function.
Results: Compared with the first 360 surgeries, the last 360 surgeries had a shorter operation duration (101.7±68.2 min vs.130.9±71.6 min), less blood loss (192.9±216.2 ml vs. 253.4±261.5 ml), a shorter recovery time of intestinal function (0.6±0.4 d vs. 1.0±0.9 d), a shorter time of out-of-bed activity (2.0±2.5 d vs. 3.3±3.1 d), a shorter time of removing drainage tube (5.1±2.2 d vs. 7.5±3.0 d) and catheter (5.8±4.2 d vs. 9.2±5.1 d), and a shorter postoperative hospital stays (7.1±3.8 d vs. 12.0±4.3 d).
UP.142 Effect of Robot-Assisted Laparoscopic Urological Surgeries on the Modern Philosophy of Nursing
Robot-Assisted Simple Prostatectomy for Large Volume Benign Prostatic Hyperplasia: An Initial SingleCenter Experience in China
Peng X, Shen Z, Zhong S, Wang X
Shen Z, Zhong S, Chen S, Zhang M, Qin L
Huashan Hospital Fudan University, Shanghai, China
Huashan Hospital Fudan University, Shanghai, China
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Conclusion: Da Vinci robot-assisted laparoscopic
urological surgeries have obvious advantages, with less trauma, less bleeding, satisfactory results, fewer complications and faster postoperative recovery. They can significantly reduce the difficulty and workload of nursing care and improve nursing care quality and efficiency.
UP.143
Materials and Methods: From January 2014 to July 2015, 16 consecutive patients underwent RASP for large volume benign prostatic hyperplasia. The median age of patients was 69 years (range 62-79 years). The median prostate volume on preoperative transrectal ultrasonography was 98.3 (80-130) mL. The median prostate-specific antigen (PSA) value was 3.69 (1.2-6.9) ng/mL. The median preoperative International Prostate Symptom Score (IPSS), quality of life (QOL), maximum flow rate (Qmax), and postvoid residual (PVR) were 22.9, 4.8, 8.9 mL/s, and 78 mL, respectively. Results: All procedures were successfully performed by RASP. There were no intraoperative complications and no conversions to open surgery. The median operation time was 92.5 minutes (range 80-110 minutes). The median estimated blood loss was 125.5 mL. Intraoperative blood transfusion was required in one patient (6.3%). The median specimen weight on pathological examination was 86 g, and the average amount of removed tissue was 83.5%. The median (range) hospital stay was 5.1 days (range 4-7 days) while the media (range) Foley catheter duration was 7.9 days (range 6-10 days). Early functional outcomes demonstrated significant improvement from baseline with a 48% reduction in median IPSS, a 67% reduction in median QOL, a 230% increase in median Qmax, and an 84% reduction in median PVR (P<0.005). This study is limited by small sample size and short follow-up period. Conclusions: Our technique of RASP is a safe, feasible and reproducible procedure with outcome advantages when compared with the open or with other minimally invasive techniques (laser or laparoscopy). Good functional outcomes suggest it is a viable option for symptomatic large volume benign prostatic hyperplasia and can be used for patients requiring concomitant procedures.
UP.144 Off-Clamp Robotic Partial Nephrectomy: Initial Experience at Huashan Hospital Shen Z, Zhong S, Zhang X, Chen S, Zhang M Huashan Hospital Fudan University, Shanghai, China Introduction and Objective: Although robotic partial nephrectomy (RPN) has become an established treatment for small renal tumors, many studies have demonstrated a negative impact of warm ischemia time (WIT) on the renal function. It is known that the baseline renal function preoperatively, the amount of remaining renal parenchyma left postoperatively, and the length of WIT are the three main factors contributing to the final renal function after RPN. Due to the fact that WIT may have a negative impact on renal function, various surgical techniques have been proposed to minimize or eliminate WIT, such as segmental renal artery clamping and off-clamp RPN. Offclamp RPN that can eliminate any potential harmful effect of warm ischemia during RPN may decrease the risk of ischemic reperfusion injury to the kidney. Thus, the purpose of this study was to evaluate our initial renal functional outcomes of off-clamp RPN.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS Materials and Methods: A retrospective review of
our off-clamp RPN experience between January 2014 and January 2016 was performed. All patients with preoperative and postoperative serum creatinine determinations were included. Patient demographics and perioperative outcomes, including renal functional outcomes, were analyzed. Results: In this study, twenty-two patients with a
mean age of 54.4 years (standard deviation [SD]=9) had a median follow-up of 3 months (range 1-36 months). Ten patients had a renal tumor on the left side, and the remaining has the tumor on the right side. The mean tumor size was 3.4 cm (SD=0.8). In all patients, no conversion to open surgery was needed. WIT was 0 minutes. Mean operative time was 117 minutes (SD=51), and median estimated blood loss was 108 mL (range 70-800 mL). No blood transfusion was needed. No intraoperative complications developed, and no positive surgical margins were found. At the end of follow-up, the mean estimated glomerular filtration rate (eGFR) was 74.3 mL/ min/1.73m2 (SD=37.1), compared with 75.7 mL/ min/1.73m2 (SD=28.9) preoperatively (P=0.47). Therefore, the mean decline of eGFR of 1.9 mL/ min/1.73m2 (SD=7.1) was not significant. Conclusions: Off-clamp RPN is associated with minimal decline in renal function on short-term follow-up. More studies and continued monitoring of renal function are needed to determine whether off-clamp RPN provides any advantage in renal function preservation compared to the traditional RPN with hilar clamping.
UP.145 Perioperative Nursing in Patients Who Undergo Robot-Assisted Laparoscopic Partial Nephrectomy Peng X, Shen Z, Wang X, Zhong S Huashan Hospital Fudan University, Shanghai, China Introduction and Objective: To summarize the mea-
sures and effectiveness of perioperative nursing in patients undergoing robot-assisted laparoscopic partial nephrectomy (RALPN). Materials and Methods: The clinical data of 106
patients undergoing RALPN and 85 patients undergoing open partial nephrectomy (OPN) were retrospectively analyzed and compared. The mean age in RALPN groups was (52.5±8.2) years, ranging from 42 to 64 years. The average tumor diameter was (3.2±0.7) cm. The mean age in OPN groups was (54.2±9.9) years, ranging from 38 to 66 years. The average diameter of tumors was (3.4±0.5) cm. Preoperative care focused on psychological nursing and preoperative preparations. Postoperative care included psychological nursing, strict monitoring of vital signs, respiratory care, operative incision and drain tube nursing, diet nursing, early functional exercise, and close observation to prevent the postoperative complications. The operation duration, warm ischemia time, blood loss, recovery time of intestinal function, time of outof-bed activity, time of removing drainage tube and catheter, and postoperative hospital stays were compared between the two groups. Results: The differences of operation duration, warm
ischemia time and blood loss between the two groups were not significant (P=0.32, 0.23, 0.12). The RALPN
group had advantages over OPN group in the recovery time of intestinal function, time of out-of-bed activity, time of removing drainage tube and catheter, and postoperative hospital stays (P=0.00, 0.02, 0.04, 0.00, 0.03). Three patients in the RALPN group had hypercapnia but were cured by corresponding treatment. The patients were followed up for 2 to 52 months, and all survived without serious complications.
UP.147
Conclusion: Compared to OPN, RALPN has obvious advantages including less trauma, fewer complications and faster postoperative recovery. It can significantly reduce the difficulty and workload of nursing care, and improve the quality and efficiency of nursing care too.
Introduction and Objective: The aim of this study was to present the surgical outcomes of using robotic surgical system to perform selective segmental renal artery clamping during partial nephrectomy in our initial case series.
UP.146
Materials and Methods: A retrospective review of
Robot-Assisted Laparoscopic Surgery for Complicated Pheochromocytomas Involving Large Vessels
robotic-assisted laparoscopic partial nephrectomy (RALPN) with segmental renal artery clamping by a single robotic surgeon from December 2013 to June 2015 was performed. All patients received computed tomographic angiography (CTA) and three-dimensional reconstruction before operation to identify renal artery branch anatomy in exquisite detail and predict the segmental renal artery clamping position. Patient demographics, tumor characteristics, and perioperative results were analyzed. GFR levels were also recorded preoperatively, and at 3 months postoperatively to evaluate the renal function.
Shen Z, Chen S, Zhong S, Zhang M, Xu T Huashan Hospital Fudan University, Shanghai, China Introduction and Objective: To study the feasibility and safety of da Vinci robot-assisted laparoscopic resection of complicated pheochromocytomas with large vessel involvement. Materials and Methods: Three large pheochromocy-
tomas of 3 patients were resected through da Vinci robot-assisted laparoscopic surgery from February 2015 to March 2015. One patient was male and 2 patients were female. Two patients presented with paroxysmal dizziness, palpitation and hypertension, and another with palpitation and chest pain. CT, ultrasound and laboratory results all indicate the diagnosis of pheochromocytoma. Two cases presented with right-sided adrenal pheochromocytoma located between the liver and vena cava, one presented with left-sided para-aortic paraganglioma located in the level of middle to lower part of left kidney. The tumor size was 5.9 cm×5.7 cm, 7.3 cm×4.9 cm, and 5.8 cm×4.8 cm, respectively. All surgeries were performed by lateral transperitoneal approach. Four trocars (3 robotic arms and 1 assistant port) were used in the operation of left-sided tumor and 5 trocars (3 robotic arms and 2 assistant ports) were used in the operations of right-sided tumors. Results: All three operations were successful, and fluctuation of blood pressure (>50 mmHg) was observed in 1 case. The mean docking time of da Vinci surgical system was 10 minutes. The operative time was 120, 60, and 85 min, respectively. The estimated blood loss was 200, 100, and 200 ml, respectively. The length of stay was 5, 7, and 4 days, respectively. Symptoms disappeared and blood pressure returned to normal level after the surgeries. Postoperative hemorrhage or infection as well as other complications were not found. The diagnosis of pheochromocytomas was confirmed by pathology. No recurrence was found during the follow-up of 2 to 3 months. Conclusion: For complicated pheochromocytomas
compressing large vessels like the vena cava and aorta, resection through conventional laparoscopy surgery may be difficult. Da Vinci robot-assisted laparoscopic surgery may have the advantage of being a more delicate and safe manipulation with less complications, and therefore deserves widespread use.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
The Surgical Outcomes of Using a Robotic Surgical System to Perform Selective Segmental Renal Artery Clamping Shen Z, Zhong S, Zhang M, Chen S, Zhang X Huashan Hospital Fudan University, Shanghai, China
Results: RALPNs were performed successfully in all 18 cases. Of 18 cases in which selective segmental artery clamping was attempted, 16 were completed successfully, while 2 cases were progressive clamping from segmental to main renal artery clamping. The mean surgical time was 155 min, and the mean regional warm ischemic time was 28 min. The mean estimated blood loss was 440 ml. There were 3 complications, including 1 case of grade I, and 2 cases of grade II. No patients had positive surgical margin. The mean hospitalization stay was 12.6 days. The mean GFR at 3 months postoperatively was comparable with the preoperative GFR, which was not statistically significant (42.3±4.5 vs. 36.4 ±2.8, p>0.05). Conclusions: With the advent of robotic surgical system, surgeons can enjoy three-dimensional visualization, increased degrees of freedom, and relief of tremor, which lends itself well to easily dissecting and isolating the segmental renal artery. However, these potential advances require additional clinical investigations.
UP.148 Diagnosis and Treatment of Adult Ureteroceles Mseddi MA, Hamza M, Bouassida M, Rebai N, Hadj Slimen M, Mhiri MN Habib Bourguiba Hospital, Sfax, Tunisia Introduction and Objectives: Ureteroceles are cystic
dilatations of the distal ureter. The use of prenatal ultrasound exam and early management of this pathology make it rare at adult age. Our objective was to study clinical characteristics and treatment of this malformation. Materials and Methods: This was a retrospective sin-
gle center study of 23 cases of ureteroceles diagnosed and treated at adult age (18 patients). This study was done from January 1993 to February 2016.
173
UNMODERATED ePOSTERS Results: The mean age was of 42 years (24-72 years). It included about 5 men and 13 women. The revealing symptom was essentially represented by flank pain in 15 cases (83.33%) and painful bladder signs in 11 cases (61.11%). The ultrasound suspected the diagnosis in 3 cases. The diagnosis was confirmed by the intravenous urography in 15 cases and in one case by an uroscanner. Ureteroceles was complicated with ureteral stones in 10 cases and bladder stones in 2 cases. Hydronephrosis was noted in 3 cases. The primary endoscopic incision of a ureterocele was performed in 17 patients and in one case we performed a bilateral Politano-Leadbetter reimplantation. The mean follow-up was 3 years. Only one case was complicated with vesico-uretral reflux. Conclusion: Adult ureteroceles is a rare obstructive
uropathy. The primary endoscopic incision seems to be the preferred treatment for the management of ureteroceles. In most cases the endoscopic approach completely eliminates the need for major open surgery. Early diagnosis at childhood may avoid renal failure.
UP.149 Laparoscopic Adrenalectomy: A Moroccan Experience of the Retroperitoneal Approach Rabii R, Ayoub H University Hospital, Casablanca, Morocco Introduction and Objective: Laparoscopic adrenalectomy has largely replaced open adrenalectomy for the resection of adrenal tumors, which are not adrenocortical cancer or malignant pheochromocytoma. Laparoscopic retroperitoneal adrenalectomy is a particularly useful technique in patients with tumors <7 cm and body mass index <45 kg/m2 when compared with laparoscopic transabdominal adrenalectomy. The objective was to report our experience with the retroperitoneal approach at the University Hospital of Casablanca, Morocco. Materials and Methods: Between January 2005 and
January 2016, we performed a total of 102 laparoscopic adrenalectomies via the retroperitoneal approach, including 66 on the left and 36 on the right side, in 71 women and 31 men 22 to 64 years old (mean age was 49.3) with adrenal neoplasms. Average adrenal tumor size was 29 mm (range 12 to 46). All procedures required 4 trocars. The following parameters were studied: intraoperatively: operating time, blood loss, blood pressure, heart rate, and postoperatively: infectious, haemorrhagic and thromboembolic complications. Results: There were no patient deaths. The conversion rate to open surgery was 0.8% and estimated blood loss was 170 ml (range 0 to 550). None of the patients were transfused. We report an injury to the adrenal vein that was repaired intraoperatively, and 2 minor liver injuries, including 1 breach of the pleura. The mean length of hospital stay was 2.75 days (range 1 to 12). Histology showed Conn’s disease in 19, 28 phaeochromocytomas, 14 adrenal incidentalomas, Cushing’s disease in 39 and 2 metastases. Conclusions: Retroperitoneoscopic adrenalectomy
may be performed effectively and safely, with a low complication rate, independently of the etiology of the lesion.
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UP.150
an improvement in LND operative time (p=0.017) and EBL (p=0.011) was seen. A concomittant reduction in analgesic requirement and total operative time was also observed, but they were not statistically significant. The pathological outcomes comprised pT2 (n=6), pT3 (n=2) and pT4 (n=1) and n=3 with node positive disease. The histological subtype was mostly highgrade urothelial carcinoma. Neoadjuvant and adjuvant chemotherapy was administered to one and 4 patients respectively. At a median follow-up of 12.2 months, the cancer specific and overall survival was 89.0%. In both patients with OBS reconstruction, daytime continence was achieved in 6 and 2 months, and nighttime continence in 12 and 2 months respectively. Tumescence sufficient for penetration was possible with oral medications. At establishment of continence, both patients achieved maximum functional capacities of 350 ml and 400 ml with post-void residual urine <50 ml.
The Learning Curve for RoboticAssisted Radical Cystectomy and Intracorporeal Urinary Reconstruction Neo SH, Cheng C, Lee LS Singapore General Hospital, Singapore Introduction and Objective: Robot-assisted radical cystectomy (RARC) with intracorporeal urinary reconstruction is technically demanding and has a steep learning curve. The aims were to evaluate the initial learning curve of RARC with intracorporeal urinary reconstruction on operative, perioperative and pathological outcomes. Materials and Methods: Data from all patients who
underwent totally intracorporeal RARC for primary urothelial carcinoma of the bladder between December 1, 2013 and December 30, 2015 were prospectively collected and analyzed. These included the following variables: demographics, operative times (classified into time taken for bladder extirpation (BE), pelvic lymph node dissection (LND) and urinary reconstruction (Recon)), estimated blood loss (EBL), complication rates, postoperative analgesia requirement, pathological TNM stage and length of stay (LOS).
Conclusion: RARC with intracorporeal urinary re-
construction may be technically feasible in an institution with moderate surgical workload using a structured approach.
UP.151 Treatment Approach and Outcomes of Children with Dysfunctional Voiding as Well as Overactive Bladder
Results: Seven patients and 2 patients underwent RARC with intracorporeal ileal conduit and orthotopic bladder substitute (OBS) creation respectively. All patients had performance status ECOG 1 or better, with a mean age of 61 years (range 46-72) mainly comprising male patients (n=8). As a cohort, the median operative time (minutes) for BE, LND and Recon were 120, 65 and 180 respectively with a median node count of 20. The median EBL, time of ileus was 400 ml and 5 days respectively. Upon dichotomizing the study cohort into the first five patients and the remaining patients,
Irkilata HC1, Köprü B2, Topuz B1, Uğuz S1, Kibar Y1, Dayanç MM3 1
Gulhane Military Medical Academy, Ankara, Turkey; Konya Military Hospital, Turkey; 3Liv Hospital, Istanbul, Turkey
2
Introduction and Objective: Dysfunctional voiding (DV) and overactive bladder (OAB) are the subgroups of lower urinary tract dysfunction (LUTD) in children. These two subgroups of LUTD can be simul-
UP.151, Table 1. Treatment Outcomes Treatment Type
Biofeedback
Anticholinergic
Gender
N
Age Mean±SD
Female
82
7.82±
VDSS Mean±SD Pre-treatment
Post-treatment
17.51±
9.27±
Male
24
9.38±
15.71±
6.88±
Female
22
8.36±
16.18±
11.05±
Male
12
9.08±
18.75±
8.92±
UP.151, Table 2. Statistical Analysis Results Female
p-values
Male
Age
Pretreatment
Post-treatment
Age
Pretreatment
Post-treatment
0.241
0.371
0.159
0.679
0.128
0.280
Biofeedback Anticholinergic
UP.152, Table 1. VV/ EBC PVR
Group 1, n=56 (40%)
Group 2, n=60 (42.8%)
Group 3, n=24 (17.2%)
A
B
C
D
A
B
C
D
A
B
C
D
40
7
7
2
25
12
15
8
11
5
3
5
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS taneously diagnosed in a child. Standard urotherapy is the first choice treatment. When standard urotherapy is unsuccessful, biofeedback and anticholinergics can be used. In this study, we investigated the outcomes of biofeedback and anticholinergic therapy on children with DV as well as OAB. Materials and Methods: Between 2012 and 2014, children were evaluated with non-invasive diagnostic tools (urine analysis, 2/3 day voiding diary, dysfunctional voiding symptom score (VDSS), uroflowmetry with electromyography (UF-EMG), and urinary ultrasonography). A total of 140 children diagnosed as DV and OAB. Patients were divided into two groups according to dominant pathology and managed with proper treatment. If dominant pathology was DV, the child was treated with biofeedback and if dominant pathology was OAB, the child was treated with anticholinergics. Patients were evaluated with VDSS divided to gender in pre and post-treatment periods. Results: Treatment outcomes were presented in
Table 1. Statistical analysis results were seen in Table 2. Conclusion: Children with DV as well as OAB can be
managed by biofeedback or anticholinergic therapy.
UP.152 Evaluation of Postvoid Residual Urine Values to Compare with Voided Volume / Expected Bladder Capacity in Children with Overactive Bladder Topuz B1, Köprü B2, Gürağaç A3, Irkilata HC1, Kibar Y1, Dayanç MM4 1
Gulhane Military Medical Academy, Ankara, Turkey; 2 Konya Military Hospital, Turkey; 3Tatvan Military Hospital, Bitlis, Turkey; 4Liv Hospital, Istanbul, Turkey Introduction and Objective: Children with overactive bladder (OAB) classically presented with urgency, frequency, with or without urge incontinence. It’s supposed that children with OAB have lower voided volume (VV) than expected bladder capacity (EBC). Postvoid residual urine (PVR) is uncommon in these children. In this study, we aimed to classify the children with OAB using VV and PVR in order to recommend the proper treatment approach. Materials and Methods: Between 2012 and 2014, 140
children with LUTD symptoms were evaluated with non-invasive diagnostic methods (3-day voiding diary, dysfunctional voiding symptom score (VDSS), urine analysis and urinary ultrasonography). Expected bladder capacity was calculated using the formula [age(years)+1] x 30 ml and VV/EBC ratios were calculated. Children were divided into 3 groups according to VV/EBC ratio (Group-1: 0-0.5, Group-2: 0.5-1, Group-3: >1). Children were also divided into 4 groups according to PVR (Group-A: 0-20 ml, Group-B: 20-50 ml, Group-C: 50-100 ml, Group-D: >100 ml). Results: OAB was diagnosed in 140 patients (100 female and 40 male). Sub classifications of children with OAB can be seen in Table 1. Fifty-six (46%) children with OAB have lower VV than 50% of EBC and most of them (71%) don’t have significant PVR. Most children with OAB have normal VV but 84 of them (60%) have significant PVR.
Conclusion: Most children with OAB may have nor-
mal VV in spite of significant PVR, so PVR value has to be evaluated before the treatment approaches.
UP.153 Clinical Implications of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome in the Prepubertal Age Group Han JH, Lee YS, Im YJ, Kim SW, Han SW Dept. of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Introduction and Objective: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare syndrome characterized by Müllerian duct and renal anomalies. It is usually regarded as a disease of adolescence; however, due to a number of possible complications, the management of patients before puberty should not be overlooked. We assessed the clinical course of prepubertal patients to propose appropriate management. Materials and Methods: We retrospectively assessed
43 prepubertal OHVIRA syndrome patients who were diagnosed and followed up at our institution from July 2004 to June 2015. We reviewed medical records, focusing on presentation, radiologic findings, surgical management, and the overall clinical course. Results: Median age at diagnosis was 1.3 months and median follow-up period was 20.0 months. The most common accompanying ipsilateral urologic anomalies were ectopic ureter and ureterocele, while the most common contralateral anomaly was vesicoureteral reflux. During the follow-up period, six patients (14.0%) required surgery at a median age of 31.2 months due to recurrent urinary tract infection, uncontrolled vaginal distention compressing adjacent organs, urinary incontinence, or intractable abdominal pain. Conclusions: While OHVIRA syndrome is known as a
postpubertal disease, about 13% of prepubertal patients in our study required surgery. When ectopic ureter insertion into the vagina is present, further treatment may be needed to address the complications caused by continuous urine production. Patients should be monitored for complications arising from either obstructed hemivagina or renal anomalies with regular follow-up, especially before the age of five years.
UP.154 Laparoscopic Management of Complicated Urachal Remnants Jeong HJ Wonkwang University Hospital, Iksan, Korea Introduction and Objective: Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report our 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue expecting a lesser invasiveness, lower morbidity and report the feasibility of this approach with the efficacy and outcomes. Materials and Methods: Seven patients with a mean
age of 36.5 years who had symptomatic urachal diseases received laparoscopic excision between July
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
2004 and July 2012. Using four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records and the pathologic results were evaluated retrospectively. Results: There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a longer admission, with a Foley catheterization period (14.4, 11 days). Pathological evaluations showed 6 cases of infected urachal cyst, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We have not found postoperative complications, including any symptoms of recurrence with or without infection, or voiding difficulty during a mean follow-up of 46.3 months. Conclusion: The perioperative surgical outcomes
achieve infection control and symptomatic relief, as well good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be safe and effective, and a better cosmetic alternative, with the advantages of being a minimally invasive approach.
UP.155 Different Uroflowmetry Patterns According to Negative EMG-Lag Time Kim SW, Lee YS, Han SW Dept. of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Introduction and Objective: Based on uroflowmetry
(UF) with electromyography (EMG), children ≤2 seconds of EMG-lag time can be diagnosed as idiopathic detrusor overactivity disorder (IDOD). However, due to the absence of a low limit of delayed EMG-lag time, which might cause an obscure diagnosis between IDOD and dysfunctional voiding (DV). We evaluated UF patterns in children demonstrating EMG-lag time < 0 to investigate the association between delayed relaxation of EMG and UF patterns. Materials and Methods: We retrospectively reviewed
results of UF-EMG in children with lower urinary tract symptoms between May 2010 and July 2015. Children with neurogenic or anatomical abnormality were excluded. A total of 652 UF-EMG results were reviewed. After excluding cases showing EMG-lag time ≥0 or consistently active EMG during voiding, 79 demonstrated negative EMG-lag time. UF patterns were classified into “bell”, “tower”, “staccato”, “interrupted” and “plateau”. Bell and tower patterns were further classified into Group I (non-obstructive) and others were classified as Group II (obstructive). Results: A mean age of 6.99±2.64 years (range 3 to 13) at UF-EMG. Overall, a mean EMG-lag time was -5.11±4.01 (range -16 to 0) and maximal flow rate was 18.34±7.00. Tower shape of UF pattern was seen in 3 and bell shape in 38, which were classified into Group I together. Tower shape of UF demonstrated shortest EMG-lag time of -2.50±0.50 (range -3 to -2) while plateau patterns showed longest of -9.17±4.55 (range -3 to -16). Based on ROC analysis, EMG-lag time reflected obstructive patterns of UF (Group II) and cutoff point was approximately -4.75 sec with AUC of 0.944 (95% CI 0.900-0.989, p<0.001). In a linear re-
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UNMODERATED ePOSTERS gression analysis, EMG-lag time is positively correlated with average urine flow rate (R=0.357, p=0.001). Conclusions: We demonstrated a different UF patterns according to EMG-lag time in negative EMGlag time cases. Delayed relaxation of EMG less than -4 or -5 might be considered as a sign of obstruction associated with DV.
UP.156 Therapeutic Benefit of Endoscopic Surgery for Functional Disorders of the Lower Urinary Tract in Pediatric Patients Mizuno K, Hayashi Y, Kamisawa H, Moritoki Y, Nishio H, Kato T, Kurokawa S, Nakane A, Maruyama T, Yasui T Dept. of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Japan Introduction and Objective: For accurate diagnosis,
urethrocystoscopy is often performed. In the present study, we reviewed our experiences and evaluated the efficacy of endoscopic surgery for the pediatric patients. Materials and Methods: We reviewed the medical re-
cords of 14 patients (11 boys and 3 girls) who underwent endoscopic procedures from December 2000 to October 2015 in our hospital. Mean age of their first visit was 6 years and 4 months old. Their chief complaints were daytime incontinence (n=8), pain on urination (n=2), dysuria (n=2), urinary tract infection (n=1), and others (n=1). We performed urodynamic studies as objective evaluation of voiding function, and assessed subjective symptoms by interview to the patients and their parents. Furthermore, postoperatively we evaluated the treatment effects. Results: Three cases of urethral stricture, 2 posterior
urethral valves, and 1 urethral ring were recognized, and we performed urethrotomy for these 6 cases. In another 7 cases, we could not detect abnormal findings of urethra. Because of specific findings of the bladder mucosa, such as petechial hemorrhage and glomerulations, hydrodistenstion of the bladder was performed in the 4 cases. Of the 5 cases in which bladder biopsy was also performed, 2 cases had specific histopathological findings of interstitial cystitis (IC). Conclusions: In all cases that received urethrotomy, voiding disturbance disappeared, suggesting that various symptoms were caused by obstruction of lower urinary tract. Of the 5 cases that received the hydrodistenstion of the bladder, 4 cases had improved symptoms. IC is a difficult condition to diagnose because the symptoms are non-specific. Some children with various types of voiding dysfunction may be an early manifestation of IC. Voiding disturbance in the pediatric patients was involved in not only anatomical abnormalities, but also functional disorders of bladder. It is likely that the endoscopic procedures are one of the effective treatments.
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UP.157 Posterior Urethral Valves Among Patients Attending Paediatric Urology Unit in Mulago National Referral Hospital, Kampala, Uganda: A 10Year Restrospective Review Kibansha Matumaini H, Nassanga R Mulago National Referral Hospital, Kampala, Uganda Introduction and Objectives: We conducted a 10year retrospective review of children (<12 years) admitted to the pediatric urology unit of Mulago National Referral Hospital in Uganda, to determine the prevalence of PUV, understand the commonest interventional surgical procedure performed and to determine the time interval between vesicostomy and valvular secondary ablation. No previous study has been conducted to understand the magnitude of PUV among pediatric cases admitted to the unit. Materials and Methods: Clinical case files for pa-
tients that have undergone surgical treatment for PUV between 2006 and 2015 were extracted from the records department of Mulago National Hospital and validated by the operating theatre register. A review of the inpatients register was conducted to determine the number of pediatric surgical admission in the review period. Data on socio-demographic profiles, clinical presentation at index admission, surgical procedure conducted at index presentation, and the time between index surgical procedure and secondary ablation was captured and entered in Epi-data statistical program for analysis. Results: A total of 93 cases with posterior urethral valve disease were seen in the 10-year period, accounting for 12.7% of the total pediatric urological admissions in the unit in the review period. The annual PUV cases seen in the unit have increased by 142% in the period. The median age was 24 months (range 1-120 months) with majority (79.9%) undergoing vesicostomy as the primary surgical procedure. Less than one in five (17.2%) underwent primary valve ablation. The commonest clinical presentation (44%) was difficulty in passing urine. The average time interval between admission and the primary surgical procedure was 36 days (range: 0-327 days). Younger age was associated with longer time intervals. The median time interval from vesicostomy to secondary valve ablation was 11.2 months (range: 2.4-60 months). Conclusion: Posterior urethral valve disease in Mulago has significantly increased in the last 10 years with the majority of the cases requiring vesicostomy as the primary surgical intervention. The interval between vesicostomy and secondary ablation is significantly long.
UP.158 Free Tube Graft Urethroplasty for Repair of Moderate to Severe Hypospadias Obara K, Yamana K, Takizawa I, Anraku T, Tadokoro A, Kuroki H, Tomita Y Div. of Urology, Niigata University Graduate School of Medical and Dental Sciences, Japan Introduction and Objective: We report the outcome of applying free tube graft urethroplasty for repair of moderate to severe hypospadias with chordee.
Materials and Methods: We retrospectively evaluated our series of 50 patients who underwent the free tube graft urethroplasty for repair of moderate to severe hypospadias with chordee. Complete degloving of prepuce other than the mucosal collar and urethral plate was carried out. The urethral plate and dysplastic corpus spongiosum were transected at the coronal sulcus. Free graft was harvested from the dorsal prepuce that is at least 17 mm in width and at a distance that is longer than the length needed to replace the urethra. Then, the graft was rolled over a 10-Fr catheter and approximated with a running subcuticular 7-0 polydioxanone suture. Free tube graft was anastmosed to native urethra with running 7-0 polydioxanone suture. A second layer with interrupted 7-0 polydioxanone subcutaneous suture was applied. The glance was divided in the midline to create glanular wings. The glanular wings were approximated using 7-0 polydioxanone suture. Well-vascularized tissue was brought over the graft and skin closure was achieved using a Byars flap. We used a 8 Fr silicon catheter as a urethral stent that leave in place for 7 to 10 days. Results: After releasing the chordee, the hypospadiac orifice was retracted to become penile in 26 patients (52%), penoscrotal in 18 (36%), and scrotal in 6 (12%). A single-stage repair was successful in 37 patients (74%) without any complications. Of the remaining 13 patients (26%) with postoperative complications requiring surgical intervention, meatal stenosis developed in two (4%), urethrocutaneous fistula in nine (18%), urethral diverticulum without meatal stenosis in one (2%) and meatal regression in one (2%). In all patients the meatus became clearly slit-like. Conclusion: The free tube graft is appropriate for
repair of moderate to severe hypospadias. Our procedure yielded favorable outcomes functionally and cosmetically with a low postoperative morbidity rate.
UP.159 Hair Coil Strangulation of the Penis: Single Center Experience with 21 Cases Shoukry A, Ali A, El Zoheiry M, Daw K, Abou Elela W, Abdelwahab M, Shouman A, Sheemy M, Elghoneimy M, Morsi H, Lotfi A, Badawy H Cairo University, Giza, Egypt Introduction and Objective: Hair coil strangulation of the penis is an uncommon presentation in children. Parental awareness and basic hygienic measures may save many children from many possible penile complications such urethrocutenous fistula, penile gangrene and amputation. Materials and Methods: Twenty male patients suffer-
ing from an injury by a hair coil presented between April 2011 and January 2014 to our pediatric urology department at Cairo University. A total of 19 patients had ventral urethrocutenous fistula, one patient had a complete urethral resection and another had a gangrenous glans. All children were previously circumcised, fistulae were closed by adequate fistula dissection and primary transverse closure in addition to multiple tissue layers coverage. Patients with complete urethral resection were repaired by direct end-to-end anastomosis. Procedures were performed by multiple surgeons.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS Results: The mean age of the boys was 5 ± 2.6 years. The mean follow-up was 9.9 ±6.3 months. The urethral catheter was left in all patients for 7 days. We had 4 complications in the form of 4 urethrocutenous fistulas. The fistulae are scheduled for delayed primary closure. Conclusion: High index of suspicion may save many
children from severe urethral and penile injuries. Repair of urethrocutenous fistulae caused by hair coil strangulation is a demanding procedure, but has a high success rate.
UP.160 Single Center Experience of the Outcome of Exstrophy-Epispadias Complex Repair in Children Iqbal N1, Hussain I1, Masood A1, Hasan A1, Mahnoor N1, Naqvi SA1, Haider A1, Khan F2, Akhter S1 1 Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan; 2KMC, Peshawar, Pakistan
Introduction and Objective: We evaluated the out-
come of epispadias’ repair in children in terms of successful results and complications. Materials and Methods: We included 19 children in
our study from December 2010 to January 2015. Two patients had classic bladder exstrophy and 17 patients had complete epispadias. Of the 17 patients with complete epispadias, 6 patients came for failed prior surgery for the repair of complete epispadias. These 17 patients underwent modified Cantwell-Ransley repair. The 2 patients with classic bladder exstrophy underwent 2-stage repairs. In the first stage, the abdominal and bladder wall were closed, and in the second stage, modified Cantwell-Ransley repair was done for urethral repair. Results: Patients were followed for 6 months to 4 years
(follow-up range). Mean operative time for modified Cantwell-Ransley repair was 4 hours and mean hospital stay was 4.9±3 days. Wound infection was not observed in ay patients. Urinary tract infection was seen in 1 patient and post-operative fever was seen in 3 patients. A catheter was placed in place for 7 days. During follow-up, urethrocutanous fistula was seen in 1 patient, which closed spontaneously. Dorsal chordee was still present to some extent in 3 children. Urine stream was good, except in one patient who had failed prior repairs. He underwent bladder neck closure and continent catheterizable stoma. One patient had incontinence, and required bladder neck reconstruction and continent catheterizable stoma. Conclusion: When performed by expert hands, mod-
ified Cantwell-Ransley repair can give good results in terms of successful repair and lesser complication rates. Patients with prior failed surgeries have difficult repair and re-failure chances are higher.
UP.161
Introduction and Objective: The neutrophil to lym-
Repair of Exstrophy-Epispadias Complex by the Kulkarni Method
phocyte ratio (NLR) is a marker of systemic inflammation and has been reported as a prognostic indicator in many tumours, including head and neck, vuval and anal. This study assessed whether there is an association with death in men with advanced squamous cell carcinoma of the penis.
Iqbal N1, Hussain I1, Naqvi SA1, Mahnoor N1, Haider A1, Yousuf A1, Hasan A1, Nawaz G1, Zahid H2, Akhter S1 1 Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan; 2Shifa International Hospital, Islamabad, Pakistan
Introduction and Objective: The repair of exstro-
phy-epispadias complex (EEC) poses a challenge to pediatric urological surgeons. Many techniques have evolved over time to treat this congenital anomaly and they have their own pros and cons. In any type of epispadias repair, care is taken to achieve the goals of correcting the dorsal chordee, glanular reconstruction and satisfactory cosmetic appearance. In 2002, Bharati Kulkarni reported a new method for repairing exstrophy-epispadias complex (EEC) at a second stage by using flaps from the area of skin between the penis and scrotum. They said that it had good cosmetic outcome in terms achieving normal penoscrotal relation in all patients who underwent repair by this technique. We evaluated outcome of epispadias repair by this technique in 5 children in terms of successful cosmetic results and complications. Materials and Methods: We used this technique in 5 patients (age between 1 and 7 years). All of them were males. As described by Kulkarni Flaps were marked on normal pigmented skin area lying between penis and scrotum. Incision was then encircled around root of penis and urethral strip of adequate size was marked. Flaps were raised exposing attachment of corpora cavernosa to ischiopubic rami and bulbospongiosus muscle. Urethral strip was tabularized over 6 or 8 Fr feeding tube. Absorbable 6/0 suture was used for this tabularization of urethra. Corpora cavernosa were approximated in midline over ventralized urethral tube. Normal pigmented skin flaps (skin area between penis and scrotum) were rotated superiorly and sutured in symphyseal area by absorbable vicryl rapid 4/0. A tight dressing was placed around the penis for 7 days and catheter kept in place for 7 to 10 days. Patients were followed for 1 to 6 months. They were evaluated in terms of cosmetic appearance and correction of chordee and quality of urine stream. Results: The Cosmetic and functional results were very satisfactory in all 5 patients in terms of penis dependent appearance, and urine stream was good in all patients and near to normal penoscrotal anatomical appearance was achieved in all operated cases. No wound infections or other complications were seen. Conclusion: This modified technique can give good
results in terms of successful repair and good cosmesis.
UP.162 Does the Preoperative Neutrophil to Lymphocyte Ratio Predict Survival in Advanced Penile Cancer? Mount C, Sujenthiran A, Coscione A, Tinwell B, Yap T, Watkin N, Ayres B Dept. of Urology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: A retrospective review of a prospectively recorded database at a specialist penile cancer center was performed. All men with advanced penile cancer (nodal stage N2 and N3) treated from 2000 until June 2015 were identified. NLR was calculated from the preoperative full blood count measured prior to the first penile cancer operation. Results: A total of 179 men were identified. Median age at diagnosis was 64 years old (range 30-94). A total of 83 of them died. The median NLR for the whole cohort was 3.55 (range 0.42-23.3). Those with a higher than median NLR were 2.02 times more likely to die compared to those with a lower than median NLR (95% confidence interval 1.4-2.9; p=0.0001 Fisher’s Exact test). When compared with age, N2/N3 status, presence of extracapsular spread, presence of pelvic nodes, aggressive penile cancer subtype and lymphovascular invasion in a multiple regression analysis, NLR was the only significant variable associated with death (p=0.005). NLR did not predict extracapsular nodal spread or pelvic node involvement in multiple regression analysis, although lymphovascular invasion in the primary tumour was associated with extracapsular spread (p=0.0011). Conclusion: Preoperative NLR is simple to calculate
and a higher value is associated with death in advanced penile cancer.
UP.163 The Significance of Close Surgical Margins in Organ Sparing Surgery for Penile Squamous Cell Cancer Sri D, Sujenthiran A, Lam W, Corbishley C, Yap T, Sharma D, Ayres B, Watkin N Dept. of Urology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom Introduction and Objectives: Organ sparing surgery (OSS) for penile squamous cell cancer (pSCC) is established. A 5 mm margin has previously been considered oncologically safe. This study evaluates the significance of close surgical margins in OSS and clinico-pathological factors that may influence local recurrence. Materials and Methods: Analysis was carried out on
an on-going prospective database, which includes accurate recording of surgical margins. Between March 2001 and September 2012, 332 patients treated with OSS for pSCC had clear surgical margins. Local recurrence was defined as residual invasive disease not identified at first surgery. Fisher’s exact test was used to analyze the impact of close surgical margins on local recurrence. Results: Of 332 patients, 64% had <5 mm clear deep surgical margin with 16% clear by <1 mm. Overall, 4% (15) of patients had local recurrence, with median time to recurrence of 6 months. Eight were embolic spread and 7 residual contiguous disease. Lympho-
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UNMODERATED ePOSTERS vascular invasion (LVI) was present in 67% and cavernosal involvement in 27%. There was a statistically significant relationship between cavernosal involvement (p = 0.04), LVI (p = 0.0001) and local recurrence. There was no significant relationship (p = 1.00) with close surgical margins (<5 mm vs. >5 mm. However, a margin of <1 mm did show increased risk of local recurrence (p = 0.0003). Conclusion: Recurrence due to contiguous residual
disease in margin clear OSS in our experience is very low (2%). Tumour embolism is as likely to occur. We conclude that a deep clear margin of 1 mm or more is sufficient in the absence of LVI and/or cavernosal involvement.
UP.164 Defining a Standardized Protocol for the Management of Positive Surgical Margins Following Penile Cancer Organ-Sparing Surgery Sujenthiran A, Sri D, Corbishley C, Yap T, Sharma D, Ayres B, Watkin N Dept. of Urology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom Introduction and Objective: Organ-sparing surgery (OSS) in the treatment of penile squamous cell cancer (pSCC) requires a compromise between functional/ cosmetic preservation and local oncological control. Management of positive surgical margins (PSM) following OSS remains controversial and a standardized evidence-based protocol is required. Materials and Methods: Data was prospectively collected on patients with pSCC treated with OSS in a supra-regional penile cancer network from 2001 to 2014. Patients who underwent OSS with non-curative intent and/or received adjuvant chemoradiotherapy were excluded. Early re-resection was performed for extensive contiguous deep margins or non-healing graft sites, following MDT review. Remaining patients were under surveillance and reviewed intensively in a specialist clinic. Outcomes included residual invasive disease, local recurrence and extent of PSM. Results: A total of 42 patients had a PSM following 375 OSS procedures (median follow-up 28 months). A total of 23 patients underwent early re-resection (6 residual invasive disease, 2 PeIN and 15 no residual disease). Patients with residual disease required 1-3 further re-resections before being rendered disease-free. Two patients had local disease recurrence requiring completion penectomy. A total of 19 patients on surveillance had no local recurrence. Extent of positive margin in the early re-resection group was 6.5 mm versus 4.3 mm in the active surveillance group (p<0.05). Conclusions: Our protocol ensures safe oncological follow-up and limits operative burden following OSS. Only 6 of the 42 PSMs had residual disease. Patients with contiguous deep margins or non-healing grafts benefit from early re-resection. Patients not meeting these criteria can be closely monitored. Extent of PSM may be used to determine which arm of the protocol to enter.
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UP.165 Management of Meatal Stenosis in Patient with Kaposi’s Sarcoma of Glans Penis Masmoudi A, Mseddi MA, Bouassida M, Jmal H, Rebai N, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Hospital, Sfax, Tunisia Introduction and Objective: Kaposi’s sarcoma involv-
ing the glans penis was first described in 1902, and is a rare lesion even in the presence of generalized disease. Few cases of meatal involvement have been reported in the literature. This disease affects the reticuloendothelial system. We report a HIV-negative patient who had a meatal stenosis caused by Kaposi’s sarcoma, which was successfully recovered after having undergone surgical treatment and radiation therapy. Materials and Methods: We report a 62-year-old patient hospitalized for urethral meatal stenosis. Clinical exam revealed a pinpoint meatus. The patient was operated using the meatotomy method. Unfortunately, a recurrence of the disease was observed two months later, with a very tight meatal stricture and emergence of two reddish macules on the glans penis. The diagnosis was carried out through biopsy. Serological tests were negative for HIV markers and positive for HHV 8.The surgical procedure consists on a urethroplasty and excision of typical Kaposi’s sarcoma lesion involving the glans penis and the meatus followed by a radiation therapy. Results: The operating follow-ups showed that no
complications occurred. The length of post-operative hospitalization was 2 days. Transurethral catheter removal was done after 7 days. No recurrence was observed after 8 months of monitoring. Conclusion: Although penile Kaposi’s sarcoma is ex-
tremely rare, it should be considered as a differential diagnosis of non-specific lesions, regardless of HIV status or patient age. Local surgery is recommended especially for isolated lesions. Other treatments may include cryotherapy, electrosurgery and radiotherapy. Recurrence is rare if lesions are completely excised.
UP.166 Impact of Lymphoedema on Quality of Life Following Radical Lymph Node Dissection for Penile Cancer White E, Minter J, Coscione A, Lam W, Sharma D, Yap T, Watkin N, Ayres B Dept. of Urology, St George’s Hospital NHS Trust, London, United Kingdom Introduction and Objective: Inguinal and pelvic
lymphadenectomy in penile cancer can result in significant lymphoedema. The aim of this study was to assess the impact of any lower limb and/or genital lymphoedema on quality of life using a validated questionnaire. Materials and Methods: Between June and December 2015, 26 consecutive patients who attended the clinic for surveillance following their lymph node surgery were asked to complete the validated LYMQOL LEG questionnaire with functional, appearance, symptoms and mood domains. One patient declined and was excluded from analysis. A total of 16 patients had both
inguinal and pelvic lymph node dissections. Twelve patients had adjuvant inguinal +/- pelvic chemoradiotherapy. Results: Median patient age was 62 years (interquartile range 61-65). Median time since nodal surgery was 25 months (18-36). The patients reported worse functional domain scores overall than appearance/symptoms/ mood. Comparing inguinal lymphadenectomy only to inguinal and pelvic lymphadenectomy, 22% men averaged a poor overall score on the functional domain compared with 50%. For the appearance domain, it was 11% vs. 13%, for symptoms domain, it was 11% vs. 25%, and for the mood domain, it was 0% vs. 38%. The median overall quality of life score was 9/10 (89) inguinal dissection only vs. 8/10 (6-10) for inguinal and pelvic node dissection. Multiple logistic regression analysis showed a statistically significant correlation between symptom score and whether the patient had had adjuvant chemoradiotherapy (p=0.015). Conclusions: Inguinal and pelvic lymphadenectomy in penile cancer impacts more on function than appearance, symptoms or mood. However, patients generally score their overall quality of life quite high.
UP.167 Oncological Outcome Following Glans Resurfacing for Superficially Invasive Penile Cancer Ayres B1, Coscione A1, Lam W1, Kaul A1, Yap T1, Corbishley C2, Watkin N1 1
Dept. of Urology, St George’s Hospital NHS Trust, London, United Kingdom; 2Dept. of Pathology, St George’s Hospital NHS Trust, London, United Kingdom
Introduction and Objective: Glans resurfacing involves excision of the penile glans and subcoronal epithelial and sub epithelial tissues followed by partial thickness skin grafting to the denuded corpus spongiosum. We and others have reported an incidental finding of penile cancer in 16-40% of glans resurfacing cases for penile intraepithelial neoplasia (PeIN), which were successfully treated. As a result, we have extended the use of this technique to all presumed superficially invasive penile squamous cell carcinomas (pSCC) presenting to our unit. Materials and Methods: Since February 2004, 81 pa-
tients had glans resurfacing at our unit for pSCC, 27 of these were partial glans resurfacing. Data were recorded prospectively in a database and outcome measures of positive margin rate, early revision rate and local recurrence rate were assessed. All cases have had their pathology reviewed for this study. Results: The median age was 63 years (interquartile range 54-70) and median follow-up was 30.2 months (interquartile range 19-43). On final histology, 44 men (54%) were pT1a, 15 (19%) pT1b and 22 (27%) were pT2. Three patients (4%) with pathologically clear surgical margins developed a local recurrence or new primary; one was a glans recurrence (at 14 months) requiring a glansectomy, one was a urethral new primary (39 months) requiring a radical penectomy and one was a glans new primary (45 months) requiring a redo glans resurfacing. A total of 19/81 patients (23%) had a positive margin; 16 positive deep margins and 3 positive glans margins (all partial glans resurfacing
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS cases). A total of 27% pT2 had positive deep margins compared to 17% pT1. Four men (5%) had early revision surgery (glansectomy), 2 had residual cancer and 2 had PeIN. The remainder were closely observed and 3 developed a recurrence (4%) at median follow-up of 20 months (13-37) and were treated with wide local excision. The overall recurrence and revision rate was 12%. There was no correlation between higher stage and recurrence rate. Conclusion: In our experience, recurrence following
glans resurfacing for pSCC is low if surgical margins are clear. Focal positive margins can be closely observed as many will not recur and those that do can usually be managed with wide local excision.
UP.168 Dynamic Sentinel Inguinal Node Biopsy in Squamous Cell Carcinoma of the Male Urethra 1
1
1
2
Mahesan T , Coscione A , Lam W , Corbishley C , Heenan S3, Ayres B1, Watkin N1 1 Dept. of Urology, St George’s Hospital NHS Trust, London, United Kingdom; 2Dept. of Pathology, St George’s Hospital NHS Trust, London, United Kingdom; 3Dept. of Nuclear Medicine, St George’s Hospital NHS Trust, London, United Kingdom
Introduction and Objective: Squamous Carcinoma of the Male Urethra (SCCmu) is a very rare condition. In the absence of evidence based guidelines, our specialist genital cancer center multi-disciplinary team (treating a defined population of 11 million people) agreed to manage SCCmu as is done for penile carcinomas. This included the assumption that SCCmu first metastasized to the inguinal nodes. Materials and Methods: Since 2001, all confirmed
primary SCCmu (pendulous, glanular and meatal) were recorded on a prospective database. From 2004, clinically inguinal node negative (cN0) patients were offered a dynamic sentinel node biopsy (DSNB) as part of their staging. The cohort was validated by 2 members of the team independently to exclude cases of confirmed or suspected penile cancer involving the urethra. Lymphoscintigraphy was performed as per a previously described protocol for penile cancer. Results: A total of 80 SCCu were identified. Fifty-two patients with cN0 inguinal nodes underwent DSNB to 93 inguinal basins. Mean follow-up was 28.9 months. Fifteen patients and 18 basins had positive nodes identified. No patient had a false negative study. No patient was shown to develop pelvic node or distant metastases in the absence of a positive inguinal node. Conclusion: In this pilot study, we have shown for the
first time that SCCmu first metastasises to the inguinal nodes and that staging with DSNB identifies patients at risk of micro-metastatic disease.
UP.169 Surgical Management of Fungating Inguinal Masses in Penile Cancer with Myo/Fasciocutaneous Flap Reconstruction Mahesan T1, Coscione A1, Corbishley C2, Tinwell B2, Ayres B1, Watkin N1, Soldin M3 1
Dept. of Urology, St George’s Hospital NHS Trust, London, United Kingdom; 2Dept. of Pathology,
St George’s Hospital NHS Trust, London, United Kingdom; 3Dept. of Plastic Surgery, St George’s Hospital NHS Trust, London, United Kingdom
primary outcome measures were recurrence and positive margin rate. Secondary measures included periand post-operative complications.
Introduction and Objective: Patients with advanced
Results: A total of 23 patients were recruited. A total of 19 completed surgery with 3 awaiting 2nd stage closure and 1 declined closure. Mean patient age was 62 years. Histology identified 13 invasive cancers (8 T1, 3 T2, 2 T3) and 10 PeIN. Ten were arising from the glans and 13 from the urethra. There were no intra-operative complications. Three patients experienced Clavien-Dindo grade I/ II post-operative complications, and two patients experienced urethral fistulas, one transient. Despite frozen section, the positive margin rate after 1st surgery was 30%. Further resection at second stage left 1 positive in situ margin (4.3%). The current follow up is 5 years with no recurrences or urethral strictures.
penile cancer present a severe challenge with fungating inguinal tumour deposits. Surgical excision with pedicled myo/fasciocutaneous flap reconstruction is one treatment option. We evaluated our experience at a specialist penile cancer center over a 12-year period. Materials and Methods: A total of 19 patients were
identified from a prospectively collected database. Complications, length of stay and survival data were analyzed. Results: A total of 21 myo/fasciocutaneous flap reconstructions were performed for fungating inguinal masses. Two patients underwent bilateral procedures. Median length of stay was 18 days (range 7-161). A total of 13 patients (68%) suffered complications (10 x Clavien II, 2x Clavien IVa and 1x Clavien V). A total of 16 patients (84%) had additional treatment with either chemo or radiotherapy. A total of 13 patients (68%) died of their disease with a median survival of 186 days following surgery (18-937). Six patients are still alive with a mean follow-up of 866 days (1451919). Accounting for readmission stay, either for further procedures or deteriorating health, patients spent a mean of 21.5% of their survival or follow-up time in the hospital. Four of the 6 living patients completed a validated lymphoedema quality of life questionnaire (LYMQOL) and report similar outcomes to patients who have had groin and/or pelvic node surgery without flaps.
Conclusion: This is the first reported series of ure-
thral-preserving surgery for distal urethral tumours. Our initial results show that this technique is technically feasible and oncologically effective.
UP.171 Penile Cancer in Australia: Penectomy, Lymph Node Management and Oncological Outcomes in a Contemporary Cohort Manning T1, O’Brien J2, Christidis D1, Perera M1, Chen E1, Lawrentschuk N1 1
Dept. of Urology, Austin Health, Melbourne, Australia; 2University of Melbourne, Austin Hospital, Melbourne, Australia
Conclusion: Surgical excision and flap reconstruction
Introduction and Objectives: Penile cancer is a rare
is associated with a significant complication rate and length of hospital stay. However, 84% of our cohort lived for more than 3 months without a discharging and painful fungating lesion and 32% are alive with a mean follow-up of 28 months.
disease in Europe and North America, but represents upwards of 1-2% of all male malignancies in Asia and South America. Over the last decade, the centralization of treatment and the emergence of more sophisticated interventions have improved oncological outcomes in many developed countries. We aim to report the contemporary treatment oncological outcomes for penile cancer in Australia.
UP.170 Substitution Urethroplasty for Treatment of Distal Urethral Invasive Squamous Cell Carcinoma/PeIN Kulkarni M1, Coscione A1, Sahu M1, Sujenthiran A1, Sharma D1, Ayres B1, Corbishley C2, Watkin N1 1
Dept. of Urology, St George’s Hospital NHS Trust, London, United Kingdom; 2Dept. of Pathology, St George’s Hospital NHS Trust, London, United Kingdom
Introduction and Objective: Urethral cancers comprise <1% of urological malignancies and require specialist multi-disciplinary management. Tumours present as primary urethral carcinoma or intra-urethral extension of penile carcinoma. Using techniques developed for benign stricture disease, we have extended the role to reconstruction of the penile urethra for carcinoma and in situ disease. Materials and Methods: Patients with urethral car-
cinoma, intra-urethral extension of penile carcinoma or in situ disease after glans resurfacing were included. All patients were discussed in a supra-regional multi-disciplinary meeting. Patients were offered synchronous or delayed substitution urethroplasty with buccal mucosal grafts and frozen section. Patients were staged according to TNM 7 classification. The
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: A retrospective multicenter
database of patients undergoing surgical intervention for penile cancer was created assessing patients between January 1999 until March 2016. Records were reviewed to identify the mode of therapy, pathology and recurrence patterns. Kaplan Meier regressions were performed to calculate cancer-specific survival outcomes in this cohort. Results: A total of 41 patients were included in the analysis with a median follow-up of 24 months. Histopathologically, 90% of cases represented squamous cell carcinoma and 5% for carcinoma in situ. At presentation, 6 patients (15%) had clinically palpable inguinal lymphadenopathy, with a further 5 (13%) being detected on CT imaging. Inguinal lymph nodes were sampled in a total of 20 (49%) of patients, with 8 (20%) undergoing sentinel node biopsy. Radical inguinal lymphadenectomy was performed in 12 cases (30%). Partial penectomy was the most common operative management for the primary tumour (n=24, 56%), followed by circumcision (n=9, 22%) and radical penectomy (n=8, 20%). Of patients who received organ-preserving surgery, 6 (15%) experienced disease recurrence within 4 years. Histopathological
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UNMODERATED ePOSTERS staging of the primary tumours demonstrated pTis (10%), pT1 (14%), pT2 (71%), pT3 (5%), and pT4 (0%). Nodal disease was demonstrated to be with pN0 tumors (58%), N1 (5%), N2 (21%), N3 (16%). Kaplan-Meier analysis showed a 5-year cancer-specific survival of 84%. Conclusions: Over the past decade, the shift toward
management of penile cancer within a tertiary center has occurred. This has resulted in increased organ-preserving surgery and sampling of inguinal nodes. These changes have resulted in acceptable oncological outcomes.
UP.172 Expression of TWIST1, KAI1 and E-Cadherin Proteins in Penile Cancer Samples from Brazilian Amazonian Men Batista L1, Teixeira T2, Marques A2, Silva C1, Khayat A1 1
Federal University of Para, Belem, Brazil; 2Federal University of Amapa, Macapa, Brazil Introduction and Objective: Penile neoplasm is a rare
disease in developed nations but common in developing areas, such as the Brazilian Amazonia, where it is stated to be a major Public Health problem by its mutilating features. In the search for more reliable prognosis indicators, many genes and proteins associated with penile carcinogenesis have been evaluated for a better understanding of the oncologic process. The aim of this research is to determine if there is some role of the expression of TWIST1, KAI1 and E-cadherin proteins in penile carcinogenesis in Brazilian men who live in Amazonia. Materials and Methods: This research has a retro-
spective design, which analyzed 109 patients submitted for penile neoplasm biopsy between January 2012 to November 2014 at Ophir Loyola Hospital, Pará State, Brazil. The protein expression of TWIST1, KAI1 and E-cadherin in penile tissues with benign and malign lesions was investigated, to look for evidence of immunoreactivity pattern in penile neoplasms and non-neoplasm tissues and to correlate that immunoreactivity pattern with the progression, invasion and other clinicopathological features of penile neoplasms. Data were statistically analyzed by Bioestate 5.3 software. Results: In relation to E-cadherin, 48.6% of the patients had lower expression of this protein when compared to non-neoplasm tissues, which was statistically significant (p<0.001, OR=32.211, IC95%=4.188-247.757). Association of abnormal expression of E-cadherin with pathological features was not found. Higher expression of TWIST1 was associated with T2-T4 tumors (p=0.027, OR: 14.000, IC95%=1.329-147.429). No association between the defective expression of the KAI1 protein and penile neoplasms was found. Conclusions: In Brazilian Amazonian men, low-expression of E-cadherin protein and higher-expression of TWIST1 are associated with penile cancer. The higher-expression of TWIST1 is also associated with advanced penile tumors, suggesting its possible use as a prognostic marker of the neoplasm. There isn’t any association with defective expression of KAI1 protein and penile cancer in the same population.
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UP.173 May Cachexia Be an Advantage for Penile Length? Okçelik S1, Gök M1, Soydan H2, Ateş F2, Yilmaz Ö2, Şenkul T2
matometric parameters, but present study is the first one assessed the relationship between cachexia and penile length. As a result cachexia may be an advantage for penile length.
UP.174
Dept. of Urology, Beytepe Military Hospital, Ankara, Turkey; 2Dept of Urology., GATA Haydarpasa Teaching and Research Hospital, Istanbul, Turkey
Comparison of Factors Affecting the Success of Distal Hypospadias Repair in Adults
Introduction and Objective: The aim of the present
Okçelik S1, Soydan H2, Ateş F2, Yilmaz Ö2, Malkoç E2, Adayener C2, Şenkul T2, Karademir K2
1
study was to assess the relationship between penile length and somatometric parameters, especially cachexia. Materials and Methods: After getting written consent,
weight and heights of all patients, admitted to the internal medicine outpatient clinic due to weight problems, were measured and recorded by an internal medicine specialist. Flaccid and stretched states of penis were measured from pubic bone to tip of glans along the dorsum of the penis using a rigid metric ruler by a single urology specialist. Patients with urogenital abnormalities were excluded from the study. The penile length, age, weight and heights were recorded. Body Mass Index (BMI) was computed as the ratio of weight to the square of height. Patients were divided into three groups according to body mass index as cachexia, normal weight and obesity. Groups were defined: Group 1: Cachexia BMI<18.5; Group 2: normal weight BMI 18.5 and 25; Group 3: obesity BMI>30. Mean and median penile lengths were calculated. These three groups were evaluated in terms of whether there is a difference between flaccid and stretched penile length. Also correlation between weight, height and penile length was determined. Statistical analyses were performed using the SPSS for windows ver. 16.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was set at p < 0.05. Results: One hundred and twenty four patients enrolled in the study between September 2014 and September 2015. Fourteen patients were in cachectic group. Fifty-six patients were in normal weighted group. Fifty-four patients were in obese group. Both flaccid and stretched penile lengths were statistically different in these groups (p<0.001; p<0.001)(Kruskall Wallis test). When we compared the groups separately cachectic group’s penile lengths were significantly longer than normal weighted group at both (p<0.01;P=0.02)(Mann Whitney U test). Cachectic group’s penile lengths were significantly longer than obese group (p<0.001;p<0.001)(Mann Whitney U test). Also normal weighted group’s penile lengths were longer than obese group (p<0.001;p<0.001). When we evaluated the correlations between flaccid penis length and other parameters, height and stretched penile length was positively correlated (p=0.003, r=0.267; p<0.001, r=0.916). Weight and BMI was negatively correlated (p<0.001, r=-0.613; p<0.001, r=-647). Age wasn’t correlated (p=0.058, r=-0.17). When we assessed the correlations between stretched penile length and other parameters with spearman’s correlation test, height and flaccid penile length was positively correlated (p<0.01, r=0.318; p<0.001, r=0.916). Weight and BMI were negatively correlated (p<0.001, r=-0.533; p<0.001, r=-0.583). Age wasn’t significantly correlated (p=0.51, r=-0.05). Conclusion: There were several studies which evalu-
ated the relationship between penis size and many so-
1
Dept. of Urology, Beytepe Military Hospital, Ankara, Turkey; 2Dept. of Urology, GATA Haydarpasa Teaching and Research Hospital, Istanbul, Turkey
Introduction and Objective: To determine the factors affecting the success of distal hypospadias repair in adults. Materials and Methods: Medical records of adult pa-
tients who underwent distal hypospadias repair in our clinic between December 2001 and January 2016 were reviewed. Patient’s age, external urethral meatus location, hypospadias status (primary/redo), anaesthesia type (local/spinal), diversion type (suprapubic/transurethral catheter), catheter diameter and the surgeons performed the operation were recorded as factors affecting the operation success. Only patients, operated with tubularisation incised plate uretroplasty (TIPU) technique, were included. Results were classified as succesfull, stricture, fistula and slough. We compared the factors affecting the success. SPSS 16.0 were used for statistical assessment and logistic regression analysis was used to deter-mine success. P<0.05 was considered to show statistical significance. Results: One hundred and eight patients underwent distal hypospadias repair in our clinic between December 2001 and January 2016. Mean age was 21.44±2. Thirty-eight patients had distal penil, 67 patients had subcoronal, 2 patients had coronal and 1 patient had glanuler hypospadias. Eighty-eight patients had primary, 12 secondary, 5 tertiary and 3 cripple hypospadias. Seventy-eight patients underwent TIPU under local anaesthesia, 30 patients underwent under spinal anaesthesia. Suprapubic catheter used in 92 patients and transurethral catheter used in 16 patients. Sixteen different surgeons performed the operations. Seventy operations were successful. Three strictures, 24 fistulas and 11 slough determined. Overall success rate was 64.81%. Patient’s age, external urethral meatus location, anaesthesia type, diversion type, catheter diameter and the surgeons did not affect the surgical outcomes. Only hypospadias status (primary/ redo) affected the success (p=0.037) (Table 1).
UP.174, Table 1. Comparison of Factors p-value
Surgeon
0.46
Meatus Location
0.06
Primer/Redo
0.03
Anaesthesia Type
0.24
Catheter Diameter
0.78
Diversion Type
0.56
*Logistic Regression Analysis
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS Conclusion: The only factor affecting surgical out-
comes of distal hypospadias repair in adults seems to be hypospadias status (primary/redo). It might be due to lack of second layer in the redo operations.
UP.175 Is There Any Relationship between Mean Platelet Volume and Varicocele? Okçelik S1, Gök M2, Şener3, Ateş F4, Soydan H4, Yilmaz Ö4, Şenkul T4 1
Dept. of Urology, Beytepe Military Hospital, Ankara, Turkey; 2Dept. of Internal Medicine, Beytepe Military Hospital, Ankara, Turkey; 3Dept. of Biochemistry, Beytepe Military Hospital, Ankara, Turkey; 4Dept. of Urology, GATA Haydarpasa Teaching and Research Hospital, Istanbul, Turkey Introduction and Objective: To assess the relation-
ship between mean platelet volume levels and varicocele and may mean platelet volume be related to the physiopathology of varicocele? Materials and Methods: Three hundred and nine patients enrolled in the study between September 2014 and March 2015. All physical examinations were made by a single urologist. Peripheral venous blood samples were collected to tube including ethylenediaminetetraacetic acid (EDTA-K2) anticoagulant between 8:30 AM and 12 AM after an overnight fasting. All complete blood count (CBC) analyses were done within 2 hours after venipuncture using Mindray BC 5500 Auto Hematology Analyzer (Mind-ray Bio-Medical Electronics Co., Ltd., Shenzhen, China). Medical records of the patients were retrospectively analyzed. Patients were divided into two groups. Group 1: Grade III varicocele group; Group 2: Control group. Patients with undescended testis, hypotrophic testis, atrophic testis, chronic illness and obesity were excluded from the survey. Only grade III varicocele patients were included in the study to see the difference better. We recorded the patient’s age, red blood cell (RBC), hemoglobin (Hb), mean corpuscular volume (MCV), white blood cell (WBC), platelet (PLT), mean platelet volume (MPV) values. Statistical analyses were performed using the SPSS for windovs ver. 16.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was set at p<0.05. Results: Three hundred and nine patients enrolled in the study between September 2014 and March 2015. Mean age was 22.94±1.71, mean RBC was 5.29±0.43, mean Hb was 16.21±1.03, mean MCV
was 91.01±5.96, mean WBC was 6.97±1.76, mean PLT was 248.01±56.76, mean MPV was 10.89±6.40. 144 patients had grade III varicocele and 165 patients had normal physical examination. The results of the patients were shown on the Table 1 separately. The age of the two groups was similar. There wasn’t any significant difference for RBC, Hb, MCV, WBC levels between two groups. Platelet levels were significantly low in varicocele group. MPV levels were high in varicocele group, but it wasn’t statistically significant. Conclusions: Although mean platelet volumes high in varicocele group, it wasn’t statistically significant. According to that mean platelet volume may not be related to the physiopathology of varicocele.
UP.176 A Big Cavernosal Penile Hemangioma: Conservative Treatment Can Be an Alternative Yilmaz Ö1, Okçelik S2, Soydan H1, Malkoç E1, Ateş F1, Şenkul T1 1
Dept. of Urology, GATA Haydarpasa Teaching and Research Hospital, Istanbul, Turkey; 2Dept. of Urology, Beytepe Military Hospital, Ankara, Turkey
T2-weighted images, heterogeneous enhancement of the lesion in the post-contrast series (Figure 2). Five mm hyperemic field was seen just proximal to the navicular fossa and right in the urethrocystoscopy made for the hematuria evaluation. After talking with the patient we decided to follow up this lesion without making any invasive treatment. Penile hemangiomas are seen mostly in infants and young adults. They are cavernous and capillary structure. Cavernous hemangiomas are more profound, blue and purple lesions include the physical examination of our patients. Ultrasonography, cavernosography, MRI can be used in the diagnosis of these lesions. We benefit from the less invasive ultrasound and MRI imaging. Especially by giving clear information about the boundaries of lesion MRI images of the lesion was effective in our treatment decision. Cystoscopy also can define the lesion. Because they are benign, penile hemangioma treatment indications are bleeding, pain during erection, and are causing cosmetic deformity. Surgical excision is no longer the preferred method of treatment
UP.176, Figure 1.
Introduction and Objective: Haemangiomas are seen on penis are very rare benign lesions. Surgical excision, electrofulguration, cryotherapy, sclerotherapy and laser fulguration are treatment alternatives. In this case we determined a penile haemangioma which is decided to be followed up. Materials and Methods: In this case we determined a
penile haemangioma which is decided to be followed up. Results: A 20-year old man admitted to Urology outpatient clinic with the complaint of caused mild pain during erection and macroscopic haematuria last two years. Also he palpated a mass in his penis during erection. In his physical examination there was a 4 cm palpable lesion evident mass during erection, which starts from midpenile level ranging to glans penis. It was located in the right ventrolateral corpus cavernosum. There was no change on the color and consistency was soft (Figure 1). Doppler ultrasonography showed 9x16x25mm haemangioma, which is located distal to the corpus cavernosum, the boundaries cannot be clearly distinguished. In contrast MRI evaluation there was a 37x10 mm sized haemangioma which is in the right neighborhood corpus spongiosum. It was T1-weighted images isointense, hyperintense on
UP.176, Figure 2.
UP.175, Table 1. Comparison of Normal and Grade III Varicocele Patients’ Hemogram Levels Normal Patients
Varicocele Patients
P
Age
22.77±1.33
23.15±2.06
0.309**
RBC
5.31±0.45
5.28±0.42
0.665**
Hb
16.24±0.95
16.18±1.12
0.604*
MCV
91.32±5.62
90.65±6.33
0.458**
7.22±1.82
6.68±1.66
0.052**
PLT
256.18±56.36
238.65±55.95
0.007*
MPV
10.55±0.94
11.28±9.32
0.327**
WBC
*Independent samples t test **Mann Whitney U test
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
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UNMODERATED ePOSTERS because it carries the risk of bleeding during frequent nocturnal erections. Laser fulguration can be used for small and superficial lesions. We decided it would be appropriate conservative approach in this case because of the deformity that may occur after excision and also risks of complications such as bleeding and erectile dysfunction. Conclusion: As a result, conservative method should
be considered in the case of severe bleeding, deformities, disorder of sexual function in large penile hemangioma, which is a rare and benign lesion.
UP.177 Accuracy of Ultrasound Diagnosis After Blunt Scrotal Trauma (10 Years of Experience) Abdelkader O1, Mohy El Den K2, El Nashar A1 1
Suez Canal University Hospital, Ismailia, Egypt; 2 Fayoum University Hospital, Egypt Introduction and Objective: To evaluate the role of
ultrasonography (US) and its accuracy, sensitivity and specificity for the diagnosis of testicular rupture after blunt scrotal trauma. Moreover, tunica albuginea breach, testicular hematoma, testis avulsion, epididymal injuries and hematocele are examined. Materials and Methods: Between 1998 and 2008, 24
patients presented to Suez Canal University Hospital after blunt scrotal trauma and underwent surgical exploration. All patients had an emergency scrotal US examination with the use of a 7.5-10 MHz linear transducer. US findings were compared with the surgical findings to calculate the sensitivity and specificity of US for each type of lesion. Results: Out of 24 patients, 12 were diagnosed as having testicular rupture and tunica albuginea breach was visualized on US in 6 patients. Sensitivity and specificity of US were 92% and 50% for testicular rupture, 85% and 75% for hematocele, 80% and 79% for testicular hematoma, and 100% and 96% for testicular avulsion, respectively. US diagnosis of epididymal injuries was poor as it failed to detect 3 out of 5 epididymal lesions. Conclusion: US was highly sensitive in the diagnosis
of testis rupture. This can provide information on the integrity of the scrotal contents that can help the physician to determine the optimal treatment.
UP.178 An Unusual Case of Testicular Sarcoid Robinson S, Kalsi J Frimley Health Foundation Trust, Surrey, United Kingdom Introduction and Objective: Benign sarcoid lesions
can occur in any genitor-urinary structure. They may present as infection, inflammatory or malignant conditions. We present a patient who was initially felt to have malignancy of the testis. In addition to the unusual features of this condition, we note that this was a bilateral case. We present an unusual history and subsequent investigations and treatment, as well as a review of this unusual condition. Sarcoidosis is a condition of unknown aetiology that can affect multiple organ systems with non-caseating granulomas. It affects 1 to 6 of every 1000 people worldwide although 1/10,000 in the united states. African-americans are
182
affected 3-20 times higher than whites and women 10 times more than men. Chest x ray will show bilateral hilar lymphadenopathy in 90% hence most common symptoms are respiratory. There are also genitourinary manifestations, which mostly affect the epididymis. The testis is next and is usually in the 20-40 year age group and black men. It is bilateral in <10%. It usually involves nodular diffuse painless testis with extension into epididymis, and there may be extensive interstitial inflammation. Special stains are negative for fungi and tuberculosis. Materials and Methods: This is a case report. We present an unusual history and subsequent investigations and treatment, as well as a review of this unusual condition. A total of 31 cases were documented in a review from 2001. Results: US: The testicles present bilaterally with multiple focal heterogenous lesions, in keeping with malignancy. CT shows enlarged mediastinal and hilar lymph nodes. Lung nodules are probably metastatic. The liver showed inhomogeneous enhancement and it is difficult to exclude small metastatic deposits. There are multiple aortocaval and para-aortic lymph nodes. There are enlarged pelvic sidewall lymph nodes. There are bilateral enlarged inguinal lymph nodes. There is elevated alkaline phosphatase. Anaemia: Serum Angiotension converting enzyme 310 elevated. Semen: 7 million. Biopsy groin lymph node packed by sarcoidal type epitheloid granulomas. The features are those of granulomatous lymphadenitis and highly suggestive of sarcoidosis. Skin punch biopsy. Sarcoidal type epithelioid granulomas within mid and deep dermis. Biopsy groin lymph node packed by sarcoidal type epitheloid granulomas. The features are those of granulomatous lymphadenitis and highly suggestive of sarcoidosis. Skin punch biopsy. Sarcoidal type epithelioid granulomas within mid and deep dermis. Treatment includes steroids after biopsy with resolution. Conclusions: This was initially referred as an unusual case of bilateral testis cancer with possible metastatic disease. Subsequent investigation confirmed systemic sarcoid with testicualt involvement which responded to medical treatment.
UP.179 The Effect of Acupuncture and Varicocelectomy on Varicocele Pain: Early Results of Our Patients Ebiloglu T1, Aydogmus Y1, Baklaci K2, Kaya E3, Oral E1, Kibar Y3 1 Dept. of Urology, Etimesgut Military Hospital, Ankara, Turkey; 2Dept. of Physical Therapy and Rehabilitation, Etimesgut Military Hospital, Ankara, Turkey; 3Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey
groups. Group 1 had acupuncture, and group 2 had open sub-inguinal varicocelectomy. Results: There were 16 patients in group 1, and 24 patients in group 2. The mean VAS score of patients before application of treatments was 8.37 ± 0.95 and 7.12 ± 0.89, in group 1 and 2, respectively (p=0.412). These values were decreased to 5.18 ± 1.69 (p=0.02), and 2.1 ± 1.72 (p=0.0001) after the application of treatments, respectively (p=0.001). Conclusions: Despite a significant effect of acupuncture on varicocele pain, varicocelectomy is still the best method for pain resolution.
UP.180 The Effect of GUARDIX-SL Instillation to Prevent Urethral Stricture After Transurethral Bladder Surgery Choi SM1, Yoon S2, Lee SW2, Jeh SU2, Hwa JS2, Seo DH3, Lee C3, Kam SC3, Chung KH3, Hyun JS3 1
Dept. of Urology, Gyeongsang National University Hospital, Jinju, Korea; 2Gyeongsang National University Hospital, Jinju, Korea; 3Gyeongsang National University Changwon Hospital, Korea Introduction and Objective: To evaluate the effects of
GUARDIX-SL (hyaluronic acid/carboxymethylcellulose) instillation on the occurrence of urethral stricture after transurethral bladder surgery. Materials and Methods: From January 2011 to June
2014, we retrospectively investigated records of patients who underwent transurethral bladder tumor surgery in our hospital. Among 174 patients, 74 patients received GUARDIX-SL instillation (Group A) and 100 patients did not (Group B). Each patient was evaluated at preoperation, postoperative 12 weeks. Baseline characteristics were compared and the effectiveness of GUARDIX-SL was evaluated by the International Prostate Symptom Score (IPSS) for uroflowmetry parameters. Results: Baseline characteristics of the two groups were not significantly different. Urethral stricture occurrence were 2 (2.7%) in Group A and 11 (11.0%) in Group B and significantly different (p = 0.040). IPSS total, obstructive subscore, irritating subscore and Quality of life (QoL) were significantly increased at 12 weeks from baseline in Group B (p = 0.023, 0.030, 0.029 and 0.011, respectively). Maximal flow rate was significantly decreased at the same period (p = 0.018). However, univariate and multivariate logistic regression analysis showed that GUARDIX-SL instillation was not significant protective factor for urethral stricture occurrence (p = 0.057 and 0.057). Conclusion: During transurethral bladder tumor
Introduction and Objectives: To evaluate the effect of
surgery, GUARDIX-SL instillation decreased the occurrence of urethral stricture, however it was not significant protective factor. Additional well-designed studies are needed.
different techniques (acupuncture and varicocelectomy) on varicocele pain.
UP.181
Materials and Methods: Between November 2012
and December 2015, a total of 40 patients with left groin pain and clinical varicocele were enrolled in this study. A visual analogue scale (VAS) classifying the pain in ten scores was used to assess the severity of pain before and one month after acupuncture or operations. Patients were randomly divided into 2
Intra-Vaginal Pressure as a Predicting Success Factor of Testicular Hydrocele Sclerotherapy in Adults: 58 Controlled Cases Sallami S, Abou El Makarim S, Kammoun O, Touinsi H Tahar Maamouri Teaching Hospital, Nabeul, Tunisia
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS Introduction and Objective: The purpose is to de-
termine the long-term effectiveness of Polidocanol sclerotherapy in treatment of idiopathic testicular hydrocele (ITH) and to evaluate the intra-vaginal pressure (IP) as a recurrence risk factor. Materials and Methods: From October 2009 to September 2014, a total of 58 adult patients with unilateral and nonseptated ITH were treated by sclerotherapy. All patients underwent scrotal ultrasonography to eliminate any associated pathology (as testis cancer). All patients underwent an IP measurement, complete aspiration of vaginal liquid under ultrasonographic control and instillation of Polidocanol 3% (2 ml for every 200 ml of aspirated vaginal liquid). Controls were conducted after 3, 6 months and then every 6 months. In cases of recurrence a 2nd sclerotherpy was proposed. Success is defined as absence of hydrocele at clinical and ultrasonographic (volume <10 ml) examinations. We had evaluated patients who were at least one year past their cure. Results: The mean age was 52.7 years (21-79). The hydrocele was in the right side in 38 patients. The mean aspirated volume was 254 ml (85-490) and the mean IP was 20.6 cmH2O (1.5-48). The recurrence rates at 3, 6 and 12 months were respectively 15.5%, 18.9% and 20.7%. In one patient, hydrocele was successfully resolved with a second sclerotherapy treatment. The overall success rate was 81% with a mean follow-up period of 29.7 months (16-64). The patient’s age and volume of hydrocele were not predictive of recurrences (p>0.2). The mean IP was 16.8 and 35.3 cmH2O, respectively in non-recurrent and recurrent hydroceles. A positive correlation was found between the IP and the rate of recurrence (p<0.002). The cut-off value of IP was 19 cmH2O. Postoperative complaints included testicular moderate pain in 3 patients and orchitis in one case. As time went on, 11 (18.9%) patients had reoccurrances. Eight patients had a second cure, 7 of them had an IP>20 cmH2O. Conclusion: Hydrocele aspiration and sclerotherapy
with Polidocanol is a simple, safe and effective option with durable results. IP>19 cm H2O is highly correlated to the risk of recurrence thus sclerotherapy should be indicated in low pressure ITH.
UP.182 Tunical Plication for the Treatment of Penile Curvature: Factors Predicting Residual and Recurrent Curvature Akiboye D1, Campbell A1, Kaul A2, Lam W2, Watkin N2 1
Epsom and St Heliers University Hospitals, London, United Kingdom; 2St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
Introduction and Objective: The surgical manage-
ment of penile curvature has traditionally been the Nesbit’s tunical excision procedure. Corrective surgery without disruption of the tunica, such as the Lue “16 dot” plication, is used ostensibly to minimize complications. We investigated the effectiveness of “16 dot” plication in correcting penile curvature, and early failure from recurrent curvature. Materials and Methods: Data on patient age, erectile function, etiology, pre-operative curvature, type of corrective procedure, curvature at end of proce-
dure and first follow up were recorded prospectively on the BAUS National Audit Database from August 2010 August 2014. Patient notes were scrutinized for evidence of residual curvature (>10°) or recurrence. Multiple regression analyses were used to determine any correlation between the variable and outcome factors. Results: A total of 170 patients underwent corrective surgery for penile curvature over the study period, of whom 63 had “16 dot” plication and complete data records. The rate of residual curvature was 6.3% and the rate of recurrent curvature was 7.9% (all had successful revision surgery). Multiple regression analysis showed residual curvature at end procedure was significantly correlated with pre-operative lateral curvature independent of severity (not dorsal or ventral) (p = 0.0086). No other factors showed significant correlation. Recurrent curvature was also statistically significantly associated with pre-op lateral curvature but not severity of pre-op curvature, age or erectile function status (p = 0.0354). Conclusion: Pre-operative lateral curvature is the
strongest predictor of residual and recurrent curvature with plication surgery, possibly due to less robust lateral tunica. The “16 dot” technique is effective at correcting dorso-ventral curvature but should be used with caution for correcting biplanar and predominantly lateral deformities.
UP.183 Comparison of Grafting Methods After Plaque Incision for Surgical Correction of Peyronie’s Disease: Bovine Pericardium and Saphenous Vein Culha MM, Simsek E, Teke K, Yuksekkaya M, Uslubas AK, Yilmaz H Kocaeli University, Turkey Introduction and Objective: Surgical correction is useful for patients with stable Peyronie’s disease (PD), severe curvature of the penis and adequate rigidity. The present study aims to demonstrate the surgical outcomes of PD patients treated with plaque incision and grafting technique at long-term follow-up. Materials and Methods: A total of 42 patients under-
went plaque incision and grafting technique between 2000 and 2011. All patients had adequate erection before surgery. Bovine pericardium was used in group 1 (19 patients) and saphenous vein was used in group 2 (23 patients) for grafting. Preoperatively artificially induced erection demonstrated dorsal curvature greater than 80 degrees (stable for at least six months) in all patients. The fibrous plaque was incised with a residual tunical defect and covered with the graft immediately. Postoperatively, all patients were contacted by six month periods, and invited to an office visit or phone interview. Mean follow-up period was 58 months for group 1 and 63 months for group 2. Results: No difference was present in patient age (group 1 43.4 vs. group 2 45.1) between the two groups. The average operative time was shorter (group 1 101 min vs. group 2 142 min) (p<0.01) in group 1. No differences were found regarding satisfactory straightness (94% group 1 vs. 91% group 2), patient satisfaction (78% group 1 vs. 82% group 2) loss of sensation (10% group 1 vs. 13% group 2) postoper-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
ative erectile dysfunction (5% group 1 vs. 4% group 2) and penile shortening (10% group 1 vs. 13% group 2) between the two groups in the long term follow-up. There were no major complications or graft related adverse events in either group. Conclusions: Based on our results, both grafting techniques are effective surgical options for the correction of PD.
UP.184 The predictive efficacy of hypoechoic lesion in ultrasound for prostate cancer: five-year experience in a moderated 10-core transperineal prostate biopsy procedure Zhang L, Cai Y, Jiang H, Ding Q Dept. of Urology, Huashan Hospital, Fudan University, Shanghai, P.R.China Introduction and Objective: To investigate the predictive efficacy of hypoechoic lesion for prostate cancer at different levels of serum PSA in the procedure of TRUS-guided 10-core trans-perineal prostate biopsy (TP-PBx). Materials and Methods: From 2011.1.1 to 2015.12.15,
patients who had elevated level of PSA above 4 ng/ ml or susceptible nodule of prostate gland in DRE received the moderated 10-core TP-PBx procedure with the collaboration between the urologist and the physician of ultrasound medicine. We divided the prostate gland into 10 areas in the sonographic image including the apex, base, body, posterolateral of peripheral zone and the internal zone in lobes on both sides. Hypoechoic nodules were detected as the region of interest (ROI). When the ROI was located in a certain area, the free-hand targeted biopsy procedure was performed. Otherwise, the systematic TP-PBx was performed. Patients were informed consent. Clinical parameters involving age, DRE, PSA, PV, pathological diagnosis, Gleason score, novel Gleason group, positive cores, and ROI type, were documented. ROI type I refers to small nodule occupying less than the half volume of peripheral zone (PZ) in the unilateral lobe. ROI type II refers to the volume of the hypoechoic lesion larger than the half and less than the whole PZ in unilateral lobe. ROI type III refers to the lesion infiltrating the whole PZ area of one lobe. ROI type IV refers to the diffused invasion in bilateral lobes. ROI type V is the incidence of multiple hypoechoic lesions in the whole prostate gland. Statistics analysis was conducted with the software of SPSS v20.0. Results: We consecutively collected 882 cases and 9 cases were excluded because of the failure of Gleason scoring. Thus, 873 cases met the criteria and were enrolled. There were 493 cases with no visible lesion of hypoechoic nodule in TRUS and 380 cases with the hypoechoic lesion. The total cancer detection rate is 47.77%. The predictive efficacy of hypoechoic lesion for prostate cancer varies among different PSA intervals. The sensitivity, specificity, positive predict value (PPV) and negative predict value (NPV) are 90.0%, 44.83%, 38.46%, 92.86% when PSA is less than 4ng/ ml. When PSA ranges from 4-10ng/ml, the sensitivity, specificity, PPV, NPV are respectively 58.18%, 76.88%, 41.03%, and 78.35%. In the group with PSA 10-20ng/ ml, those four values are 59.41%, 80.00%, 64.52%, and 76.30%. In the group with PSA 20-100ng/ml, the
183
UNMODERATED ePOSTERS UP.184, Table 1. ROI=1 (N=180)
PSA intervals (ng/ml)
Cases
ROI=2 (N=41)
Detection rate
Cases
ROI=3 (N=40)
Detection rate
ROI=4 (N=87)
Detection rate
Cases
Detection rate
Cases
ROI=5 (N=32) Cases
0-4
Cancer Non-Cancer
9 14
39.13
0 1
0%
0 0
N/A
0 0
N/A
2 0
100%
4-10
Cancer Non-Cancer
26 32
44.83%
0 3
0%
2 0
100%
4 2
66.67%
5 4
55.56%
10-20
Cancer Non-Cancer
31 19
62.00%
12 6
66.67%
5 1
83.33%
10 1
90.90%
8 1
88.89%
20-100
Cancer Non-Cancer
28 13
69.29%
11 1
91.67%
20 0
100%
28 3
90.32%
8 1
88.89%
>100
Cancer Non-Cancer
4 0
100%
7 0
100%
12 0
100%
39 0
100%
3 0
100%
UP.184 Chart 1. PSA intervals
0-4
4-10
10-20
20-100
>100
Gleason Group 1
Gleason Group 2
Gleason Group 3
Gleason Group 4
Gleason Group 5
ROI (-)
0
0
0
1
0
ROI (+)
5
1
5
0
0
ROI (-)
14
3
5
1
0
ROI (+)
13
9
10
2
3
ROI (-)
16
8
11
6
0
ROI (+)
20
12
16
10
8
ROI (-)
20
11
10
11
6
ROI (+)
11
21
28
15
20
ROI (-)
1
2
3
0
4
ROI (+)
1
6
14
20
24
4 values are 60.81%, 67.14%, 79.64%, and 44.76%. In the last interval of PSA more than 100ng/ml, the 4 values are 86.67%, 100%, 65%, 23.08%. The comparison of detecting cancer by different ROI type with respective PSA intervals is presented in the Table 1. The visible lesions are inclined to be detected in patients with higher Gleason score. The details are in the Chart 1. Conclusion: The hyopechoic lesion in TRUS present-
ed different predictive efficacy in the respective PSA intervals and it is probably associated with more aggressive clinical significance. A well-designed biopsy strategy should be applied in the circumstance when this visible lesion is confronted during the procedure.
UP.185 Correlation Between Magnetic Resonance Imaging and Pathology of Radical Prostatectomy Specimens: A Prospective Study Castelucci R1, Sánchez Gómez FJ2, Linares Quevedo AI2, Cogorno L2, Ríos González E2, Salmerón Beliz I2, Cogollos Acuña I2, Muñoz Fernández De Legaria M2, Salinas S2, Martínez Piñeiro L2
tection of indolent and low-risk PCa. The use of multiparametric magnetic resonance imaging (mpMRI) may be useful to select those suspicious areas of prostate cancer, where can be applied a focal treatment, without compromising the quality of life of patients. The objective was to study the correlation between mpMRI suspicious areas and prostate cancer histopathology areas of patients undergoing laparoscopic radical prostatectomy (LPR). Materials and Methods: A total of 235 biopsy-naive
subjects with elevated PSA levels and/or an abnormal digital rectal examination (DRE) were consecutively enrolled from July 2011 through October 2015. All subjects underwent mpMRI prostate and transrectal ultrasound-guided biopsy (TRUSGB). Subjects with normal MRI scans (Pirads 1, 2) underwent TRUSGB only, following the Vienna Nomogram; each equivocal (Pirads 3) or suspicious lesion (Pirads 45), was additionally biopsied using two cores. Of 96 patients with prostate cancer, 66 (68.8%) underwent LRP. Among these, we studied the correlation between mpMRI imaging and histopathology of radical prostatectomy specimens, making a comparative analysis by areas.
1
Infanta Sofía Hospital and European University, Madrid, Spain; 2Infanta Sofía Hospital, Madrid, Spain
Introduction and Objectives: The current diagnosis
of prostate cancer (PCa) sometimes leads to overde-
184
Results: A total of 66 patients underwent LRP with a median age of 64 years (IQR 10.8), median serum PSA level at diagnosis of 6.1 ng/ml (IQR 4.7) and median suspicious areas per patient of 1 (IQR 1). mpM-
P value
Detection rate
RI was suspicious (Pirads 45) in 52 patients (78.8%), equivocal (Pirads 3) in 9 cases (13.6%) and non-suspicious (Pirads 12) in 5 patients (7.6%). Histological examination of radical prostatectomy specimens with suspicious and equivocal areas on mpMRI, showed the presence of Gleason Score ≥ 7 in 59 cases (89.4%). Among these, 88.1% were men with suspicious mpMRI (Pirads 45), 6.8% with equivocal mpMRI (Pirads 3), and 5.1% with non-suspicious mpMRI (Pirads 12). The rate of detection of PCa Gleason Score ≥ 3 + 4 was higher in patients with suspicious mpMRI (Pirads 45) compared to equivocal mpMRI (Pirads 3) (sensitivity 94.5% and 57.1% respectively). The estimated PPV for Pirads 45 and Pirads 3 lesions was 98.1% and 50%, with a concordance of 92.9% and 36.4% respectively. A total of 22 patients with Gleason biopsy Score 3 + 3 (78.6%), were reclassified to Gleason Score ≥ 7 after studying LRP specimen (68.2% Pirads 45, 18.2% Pirads 3, and 13.4% Pirads 12). Only 6 patients (21.4%) with Gleason biopsy Score 3 +3 held the same Gleason Score after studying the LRP specimen (16.7% Pirads 45 and 83% Pirads 3). Conclusions: mpMRI seems to improve the identification of clinically significant PCa areas. However, it is still necessary to optimize imaging tests to provide a focal treatment in these patients.
UP.186 Prospective Study of Diagnostic Accuracy Comparing Prostate Cancer Detection by Transrectal Ultrasound Guided Biopsy Versus Magnetic Resonance Imaging with Subsequent Guided Biopsy Castelucci R1, Linares Quevedo AI2, Sánchez Gómez FJ2, Díez Rodríguez J2, Cogollos Acuña I2, Salmerón Beliz I2, Muñoz Fernández De Legaria M2, Salinas Moreno S2, Martínez Piñeiro L2 1
Infanta Sofia and European University, Madrid, Spain; 2Infanta Sofia Hospital, Madrid, Spain
Introduction and Objective: The current diagno-
sis of prostate cancer (PCa) uses transrectal ultrasound-guided biopsy (TRUSGB) and sometimes leads to overdetection of indolent and low-risk PCa. Advances in multiparametric magnetic resonance imaging (mpMRI) suggest that imaging and selective magnetic resonance guided biopsy (MRGB) may be
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS superior to TRUSGB. The objective was to compare the diagnostic efficacy of MRGB with TRUSGB. Materials and Methods: A total of 235 biopsy-naive
subjects with elevated PSA levels and/or an abnormal digital rectal examination (DRE) were consecutively enrolled from July 2011 through October 2015. All subjects underwent MRI prostate and TRUSGB. Subjects with normal MRI scans (Pirads 1, 2) underwent TRUSGB only, following the Vienna Nomogram; each equivocal (Pirads 3) or suspicious lesion (Pirads 4-5) was additionally biopsied using two cores. Results: Of 235 men, 96 (40.9%) had PCa. TRUSGB detected 87 cases of PCa (37.0%) and 9 additional cases of PCa were detected only by MRGB. The mpMRI was equivocal for PCa (Pirads 3) in 70 subjects and suspicious (Pirads 4-5) in 103 cases. Among these, TRUSGB detected Pca with Gleason score >7 in 21.4% (Pirads 3) and 71.2% (Pirads 4-5) of the cases respectively. MRGB detected Pca with Gleason score >7 in 10% (Pirads 3) and 74.2% (Pirads 4-5) of the cases respectively. The estimated sensitivity of MRGB for Pirads 3, and Pirads 4-5 lesions was 75.0% and 96.9% respectively, with the same NPV in both groups (96.8%). Conclusions: mpMRI followed by selective biopsy seems to improve the diagnosis of intermediate and high risk PCa compared to standard TRUSPB.
rads 4.5) in 4 (44.4%), equivocal (Pirads 3) 4 (44.4%) and non-suspicious (Pirads 1.2) in 1 patient. All of them were clinical stage, but according to the histology of suspicious areas on mpMRI in the prostatectomy, 6 patients (66.7%) had Gleason 3 + 4, and only 3 (33.3%) had Gleason 3 + 3. All cases with suspicious imaging (Pirads 4.5) and 50% with equivocal imaging (Pirads 3) had Gleason 3 + 4; the other 50% of cases with equivocal imaging (Pirads 3) and one patient with no suspicious MRI (Pirads 1.2) had Gleason 3 + 3. The pathological stage was pT2a in 4 (44.4%) and pT2c in 5 (55.6%). Eight patients (88.9%) had negative margins, and 1 case (11.1%) had a single positive margin in the apex. Conclusions: The study of suspect areas (Pirads 4.5) and misleading (Pirads 3) on mpMRI seems to improve the identification of patients with unfavorable histology candidates for focal therapy.
UP.188 Correlation Between Gleason Score of Biopsy and That of the Part of Radical Prostatectomy: Results According to the Degree of Tumor Differentiation Abbar M, Jaouad C, Ahmed A Dept. of Urology, Military Hospital, Rabat, Morocco Introduction and Objective: Gleason scores of pros-
UP.187 Reclassification in Candidate Patients for Focal Therapy: Correlation Between Transrectal Biopsy and Histology of the Lesions Observed in Multiparametric Magnetic Resonance Imaging (mpMRI) on Radical Prostatectomy Specimens 1
2
Linares Quevedo AI , Castelucci R , Sánchez Gómez FJ1, Linares Espinós E1, Cogollos Acuña I1, Salmerón Beliz I1, Muñoz Fernández De Legaria M1, Salinas Moreno S1, Martínez Piñeiro L1 1
Infanta Sofía Hospital, Madrid, Spain; 2Infanta Sofía Hospital and European University, Madrid, Spain Introduction and Objective: Focal therapy is a strategy by which the overtreatment burden of the current prostate cancer pathway could be reduced, but diagnosis must be optimized for proper selection of candidates. We studied the correlation between transrectal biopsy and histology of the lesions observed in MRI on the part of radical prostatectomy in potential patient candidates for focal therapy according to PRIAS criteria. Materials and Methods: A total of 235 biopsy-naive
subjects with elevated PSA levels and/or an abnormal digital rectal examination (DRE) were consecutively enrolled from July 2011 through October 2015. All subjects underwent mpMRI prostate and transrectal ultrasound guided biopsy (TRUSGB). Of 96 patients with prostate cancer, 66 (68.8%) underwent radical prostatectomy. Of these, 9 subjects meet PRIAS criteria and could have been candidates for focal therapy. Among these, we studied the correlation between TRUSGB and histopathology of every mpMRI suspicious lesion of radical prostatectomy specimens, making a comparative analysis by areas. Results: The 9 patients had median age 58 years, median PSA of 5 ng / ml (PSA density 0.11) and median of 1 core affected. MRI showed suspicious lesions (Pi-
tate biopsies were compared with both Gleason score and pathological stage in radical prostatectomy (RP). The objective was to assess the clinical implication and the prognostic impact of these anomalies. Materials and Methods: A total of 234 patients who
underwent radical retropubic prostatectomy were examined. In total, all of our patients were included, all of whom had been diagnosed with adenocarcinoma by transrectal prostate biopsies. Results: The largest discrepancy was found in well-differentiated tumors. The accuracy for a Gleason score of 2-4 on needle biopsy was 23%. Of the 108 evaluable patients with a Gleason score of 5-7 on biopsy, 84 (78%) were correctly classified. All Gleason scores of 8-10 on needle biopsy were correctly classified. A total of 54 of 162 patients (33%) with a Gleason score of <7 had cancer with Gleason score above 7 (up grading). A total of 18 patients (60%) with both a Gleason score of <7 of the biopsy needle and to the prostatectomy specimen were confined to the prostate. Conclusion: The error risk grading is more important
with well-differentiated tumors and in patients with a Gleason score of <7 on the needle biopsy. The predictions using the Gleason score are sufficiently accurate to justify its use in all pathological studies of prostate needle biopsies.
UP.189 Age-Specific Reference Ranges of Serum Prostate-Specific Antigen in Iranian Men Pourmand G1, Ayati M2, Razi A3, Karami A4, Ramazani R5, Ahmadi A6, Akbari Asbagh P7, Mashhadi R1, Pourmand S4 1
Urology Research Center, Tehran University of Medical Sciences, Iran; 2Dept. of Urology-Oncology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Iran; 3Dept. of Urology, Shariati Hospital, Tehran University of Medical Sciences,
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Iran; 4Dept. of Urology, Qazvin University of Medical Sciences, Iran; 5Iran Ministry of Health and Medical Education, Tehran, Iran; 6Research and Development Center, Sina Hospital, Tehran University of Medical Sciences, Iran; 7Dept. of Pediatric Cardiology, Vali-Asr Hospital (Imam Khomeini Hospital Complex), Tehran University of Medical Sciences, Iran Introduction and Objective: Prostate-Specific Anti-
gen (PSA), also known as gamma-seminoprotein or kallikrein-3 (KLK3), is the best marker for early diagnosis of prostate cancer. Since age and race affect PSA levels, determining age-specific reference ranges of PSA in every community is necessary for increasing the efficiency rate of PSA. The aim of the present study was to evaluate the normal distribution of total prostate-specific antigen (TPSA) and free prostate-specific antigen (FPSA) and determine age-specific reference ranges of PSA in Iranian men. Materials and Methods: In this cross-sectional study, 1200 normal men with the age range of 50 to 79 referred to Shahid Rajaie Hospital, Qazvin Province in Iran, from 2011 to 2013. After excluding patients with prostate cancer and urinary tract infection, 1020 men were included in this study. Then, their blood samples were collected and after the extraction of serum from blood, serum levels of FPSA and TPSA were measured using commercial kits; the reference range of PSA was specified for each age group and compared with reference ranges of other populations. Results: The mean age of the patients was 61.03±7.5 years and the mean values of FPSA and TPSA were 0.47±0.6 ng/ml and 1.56±2.05 ng/ml, respectively. PSA serum levels (95th percentile range) in 50 to 59, 60 to 69 and 70 to 79-year age groups were 0-3.6 ng/ ml, 0-5.7 ng/ml and 0-6.8 ng/ml, respectively. TPSA (r= 0.2, P< 0.001) and FPSA (r= 0.22, P< 0.001) were significantly associated with age. In addition, a significant relationship was found between TPSA serum levels and alcohol consumption (P= 0.017), smoking (P< 0.001) and family history of prostate cancer (P= 0.014). Conclusion: Findings of the present study showed
that PSA levels are correlated with age. Moreover, the PSA age-specific reference range obtained in this study is different from other races and is specific to Iranian men. Therefore, age specific reference ranges of PSA obtained in the present study can increase PSA test sensitivity and specificity by reducing unnecessary diagnostic procedures and early detection of prostate cancer in Iranian men.
UP.190 Implication of Postoperative Phosphodiesterase 5 Inhibitor Use on Biochemical Recurrence After Radical Prostatectomy Lee JN1, Chung JW1, Ha YS1, Choi SH1, Kwon SY2, Kim G3, Kim BS1, Kim HT1, Kim TH1, Yoo ES1, Kwon TG1, Chung SK1, Kim BW1 1
Kyungpook National University School of Medicine, Daegu, South Korea; 2Dongguk University College of Medicine, Seoul, South Korea; 3Gumi CHA Medical Center, CHA University, Bundang, South Korea and Objective: Phosphodiesterase 5 inhibitors (PDE5i) are widely used for recovery of
Introduction
185
UNMODERATED ePOSTERS erectile function in patients with prostate cancer after radical prostatectomy. However, there are controversies in oncologic outcomes of PDE5i use. Therefore, we tried to analyze the effect of PDE5i on oncologic outcomes in patients after radical prostatectomy. Materials and Methods: From January 2011 to De-
cember 2014, 440 patients with prostate cancer underwent radical prostatectomy. Of these patients, 172 patients who underwent bilateral neurovascular bundle sparing and were confirmed under pT2N0M0 were included in this study and divided into three groups: Group A1 (PDE5i use group for rehabilitation, n=76), Group A2 (PDE5i use group on demand, n=27) and Group B (No PDE5i use group, n=59) and we retrospectively analyzed the effect of PDE5i on biochemical recurrence (BCR, defined as two consecutive prostate-specific antigen (PSA) levels ≥ 0.2 ng/ml) of prostate cancer. Results: Mean patient age was 64.4 years, mean preoperative PSA was 7.0 ng/ml and mean follow-up period was 26.3 months. Open radical prostatectomy and robot-assisted laparoscopic radical prostatectomy were performed in 31 and 141 patients, respectively. There were no significant differences in mean age, preoperative PSA, operative methods, pathologic Gleason score and surgical margin (SM) status and mean follow-up period between group A1, A2 and B. BCR occurred in 17 (22.4%), 5 (13.5%) and 10 (16.9%) patients in group A1, A2 and B, respectively (p=0.484). In addition, there was no significant difference in PSA recurrence-free survival of three groups on Kaplan-Meier survival curve analysis (p=0.142). Multivariable Cox regression showed that operative methods, pathologic Gleason score and SM status were risk factors for BCR between group A1, A2 versus B (p<0.05) and between group A1 and group A2 (p<0.05). Conclusion: In this study, the use of PDE5i did not
show any adverse effects on BCR after radical prostatectomy. Therefore, PDE5i can be safely used for recovery of erectile function in patients with prostate cancer after radical prostatectomy.
UP.191 Open Radical Prostatectomy Reproducing Robot-Assisted Radical Prostatectomy: Involving Antegrade Nerve Sparing and Continuous Anastomosis Kwon SY1, Lee KS1, Seo YJ1, Kim KH1, Kim TH2, Lee JN2, Ha YS2, Kim G3 1
Dongguk University College of Medicine, Gyeongju, Korea; 2Kyungpook National University School of Medicine, Daegu, Korea; 3Gumi CHA Medical Center, Bundang, Korea Introduction and Objectives: To present modified RRP using the same method as RALP and compare its surgical outcomes with RALP. Materials and Methods: During the modified procedure, the bladder neck was dissected first as for RALP. After dissection of vas deferens and seminal vesicle, the prostate was dissected in an antegrade fashion with bilateral nerve saving. Finally, the urethra was cut at the prostate apex. After careful hemostasis, a Rocco suture was applied, and then urethrovesical anastomosis was performed as for RALP. A cathe-
186
ter was then placed and the bladder was filled with 120 ml of normal saline to check for leakage; the catheter was left in place for 6 days. Clinicopathological findings and rates of incontinence of the 322 patients that underwent RRP (N= 99) or RALP (N= 223) at our institution from January 2011 through December 2013 were evaluated. Results: Perioperative characteristics and complica-
tion rates were similar in the RRP and RALP groups except for mean estimated blood loss (p<0.001) and operative time (p<0.001). Incontinence rates at 1, 3, 6, and 12 months after RRP decreased from 76.8% to 67.6%, 47.5%, and 10.1%, respectively, and after RALP decreased from 70.0% to 53.4%, 39.5%, and 5.4%, respectively. Positive surgical margin rates were non-significantly different in the RRP and RALP groups (30.3% and 37.2%, respectively). Conclusions: RRP reproducing RALP was found to
have surgical outcomes comparable to RALP. This novel method might be adopted as a standard procedure by experienced urologic surgeons.
UP.192 The Role of Tumor Location (Apex Versus Non-Apex) in Biochemical Recurrence After Radical Prostatectomy Park CM, Kim SJ Dept. of Urology, GangNeung Asan Hospital, SacheonMyeon, South Korea Introduction and Objective: We investigated the effect of tumor location (apex vs. non-apex) on pathological characteristics and biochemical recurrence (BCR) after radical prostatectomy. Materials and Methods: We retrospectively studied
the records of 181 patients who underwent radical prostatectomy between 2010 and 2014. Review of pathology reports was performed and tumor predominant location (apex vs. non-apex) was defined. Patients who were treated with neoadjuvant hormonal therapy and had transitional zone tumor predominantly were excluded. Differences in clinicopathological characteristic and BCR were examined. Results: Of 181 patients, 77 patients (42.5%) had apex tumors. Patients with apex tumor had lower pathological stage (76.6%, 20.8%, 2.6% vs. 62.5%, 23.1%, 14.4%, p=0.018) and lower rate of perineural invasion (48.1% vs. 71.2%, p=0.001). There was no significant difference in age, BMI, preoperative prostate specific antigen (PSA), pathological Gleason score and the rate of positive surgical margin (PSM), or lymphovascular invasion. Tumor location was not associated with BCR for the entire cohort. Apex tumor and nonapex tumors had similar 3-year BCR-free survival (70.9% vs. 68.9%, p=0.610). On univariate analysis, preoperative PSA, Gleason score, tumor stage, PSM, perineural invasion and lymphovascular invasion were independent predictors of BCR. On multivariate analysis, tumor stage and Gleason score retained significance as independent predictors of BCR. Tumor location was not directly associated with BCR. Conclusion: Apex-dominant prostate cancer was as-
sociated with favorable pathological features. However, BCR after radical prostatectomy is independent of the location of the index tumor.
UP.193 High Neutrophil-To-Lymphocyte Ratio Predicts Poor Clinical Outcome in Patients with Castration-Resistant Prostate Cancer Treated with Docetaxel Chemotherapy Yao A, Haraguchi T, Inoue T Hyogo Cancer Center, Akashi, Japan Introduction and Objective: Recent evidence indi-
cates that inflammation is an essential component of the pathogenesis and progression of cancer. We aimed to evaluate the prognostic significance of the neutrophil-lymphocyte ratio (NLR) in patients receiving chemotherapy with docetaxel for castration-resistant prostate cancer (CRPC). Materials and Methods: Fifty-seven CRPC patients
treated between 2009 and 2014 were included in this retrospective study. Univariate and multivariate Cox regression models were used to predict overall survival (OS) and progression-free survival (PFS) after chemotherapy initiation. Results: The median OS and PFS were determined as 19.0 months (range 1-61) and 10.0 months (range 1-56), respectively. The cut-off level of NLR was set as the median value of 3.5 among all patients in this study. In Kaplan-Meier analysis, the median OS and PFS were shorter in patients with a high NLR compared to those with a low NLR (15 vs. 20 months; p=0.0125 and 9.5 vs. 15 months; p=0.0132, respectively). The OS and PFS periods in patients with a high NLR were significantly shorter than those of patients with a low NLR (p=0.0178 and 0.0176, respectively). In the multivariate analysis, a high NLR was an independent predictor of OS and PFS (HR 2.728; 95%CI 1.05-7.09; p=0.039, and HR 2.376; 95%CI 1.12-5.06; p=0.024, respectively). Conclusion: The present study results suggest that
the NLR is a useful prognostic factor in patients with CRPC treated by docetaxel chemotherapy.
UP.194 Lower than Expected Incidental Prostate Cancer Rates? Robinson S, Motiwala H, Laniado M Frimley Health Foundation Trust, Surrey, United Kingdom Introduction and Objective: Prostate cancer is often
described as becoming a certainty if one lives long enoughWe have analysed the prostates on 218 men who underwent radical cystectomy for bladder cancer. We report the incidental histological diagnosis of prostate for each decade. We compare this to rates from the literature. Materials and Methods: Review of epidemiological
date on incidental and clinical prostate cancer. Retrospective analysis of any histological diagnosis of incidental prostate cancer in men undergoing radical cysto-prostatectomy at our institution. Results: See Table 1. The frequency of prostate cancer diagnosed at autopsy reflects the progressive increase with age. It is equivalent in American and Japanese and American Caucasian and African Americans. This is divergent from the observed clinical finding of prostate cancer as established by Rich in 1935 and
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.194, Table 1. Number of patients
Prostate cancer detected
Observed %
Expected % Martin/Sakr
P (for Sakr)
3
0
0
30
0.4
40-49
9
2
22
40
0.6
50-59
27
7
26
45
0.24
60-69
72
33
46
70
0.03
70-79
75
40
54
80
0.0009
80-89
32
18
60
90?
0.003?
Age in years
30-39
confirmed by Franks 1954. Regarding worldwide incidence, it is rare before 50. A total of 85% of people are diagnosed after 65 years of age. Autopsy evidence reveals 30% in men in the 4th decade, 50% in their 6th decade and >75% of men over 85. Sekr performed autopsies in 525 men and found much higher rates, at 80% for men in their seventies. Regarding our population, our population is mostly Caucasian at 75%, while 25% are Asian, and 1% are of African origin. It is also a radical cystectomy cohort and the effect of bladder cancer is unknown. However, our study shows significantly less cases expected from 60 and above. The frequency of prostate cancer diagnosed at autopsy reflects the progressive increase with age. It is equivalent in American and Japanese and American Caucasian and African Americans. This is divergent from the observed clinical finding of prostate cancer as established by Rich in 1935 and confirmed by Franks 1954.
Results: A total of 43 patients with CRPC treated with a second-line novel ARDT were included. Overall, 50% decline/30 days in PSA was observed in 34% of patients and a median PSA-PFS of 3.4 months and a PFS of 3.1 months. After adjusting for potential confounders including prior exposure to docetaxel and number of prior anti-androgen agents, time to development of CRPC was an independent factor associated with PSA-PFS (hazard ratio [HR]: 0.99; 95% confidence interval [CI]: 0.99-1; P=0.02) and PFS (HR: 0.99; CI: 0.98-1; P=0.01). PSA response (50% decline) to first-line novel ARDT correlated negatively with PSA-PFS with second-line novel ARDT (HR: 1.7; 95% CI: 1.14-2.53; P=0.02). Traditional ADRT time >16m (HR: 0.05791; 95% CI: 0.007-0.440; P=0.0059), cPSA / iPSA ratio% (HR: 0.078; 95% CI: 0.009-0.63; P=0.0169) and visceral meta (HR: 15.19; 95% CI: 2.32-99.1; P=0.00447) were associated with OS.
Conclusions: Major studies have shown very high incidental prostate cancer rates with ageing. Other studies have shown less. Our bladder cancer series shows less cancer to a significant degree. Is this an aberrant finding or does it reflect changing behaviour of prostate cancer?
Conclusions: Second-line ARDT is associated with modest outcomes in patients with CRPC. The cPSA / iPSA ratio% of CRPC is the new strongest predictor of OS, which suggest that we should prescribe ENZ or ABI at an early CRPC stage to obtain good prognosis in these patients. Future studies in patients receiving long-term ARTD should include the identification of predictive biomarkers to facilitate treatment.
UP.195
UP.196
Prognostic Factors for Clinical Outcomes in Patients with CastrationResistant Prostate Cancer Treated with Enzalutamide and Abiraterone
Prostate Cancer Detection Rate in Patients Receiving Transrectal Prostate Biopsy Using Two Different Nomograms According to Patients’ Age and Prostate Volume
Takeda H Tosei General Hospital, Seto, Japan Introduction and Objective: Prognostic factors associated with clinical outcomes in patients with castration-resistant prostate cancer (CRPC) treated with Enzalutamide (ENZ) and Abiraterone (ABI) in the second line setting have not been formally evaluated. Materials and Methods: We retrospectively reviewed
and analyzed medical records of all patients with CRPC who received treatment with ARDT. We analyzed potential clinical factors associated with post treatment endpoints including 50% decline in prostatic-specific antigen (PSA) clinical or radiographic PFS and overall survival (OS). Prognostic univariate and multivariate Cox proportional hazard models were developed and assessed in factors about PSADT, GS, traditional ARDT time, visceral meta, LN meta and cPSA (Definition: PSA at ENZ or ABI treatment) /iPSA ratio%.
Hori S, Tanaka N, Nakai Y, Miyake M, Morizawa Y, Tatsumi Y, Konishi N, Fujimoto K Nara Medical University, Japan Introduction and Objective: The aim of this study is to provide clinically available nomograms allocating 6 to 12 biopsy cores. We compared the cancer detection rate between two nomograms (namely, the former group and latter group) and analyzed predictive parameters for prostate cancer. Materials and Methods: From April 2006 to July 2014, 1 605 patients undergoing an initial prostate biopsy were enrolled in the study. The number of biopsy cores was allocated from 6 to 12 cores according to patients’ age and prostate volume. We have updated the nomogram in March 2009. In the former groups, we divided patients into four groups for age (59 or less, 60 to 64, 65 to 69, and 70 or more). In the latter group, we divided patients into four different age groups (69 or less, 70 to 74, 75 to 79, and 80 or more). The number
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
of patients was 936 in the former group and 669 in the latter group. We compared the cancer detection rate in all cases and patients with serum PSA in gray zone of 4.0-10 ng/mL. The detection rate of clinically insignificant prostate cancer was compared between two groups. In addition, we investigated the predictive parameters associated with positivity of prostate cancer for patients with serum PSA in gray zone. Results: Of the 1 605 patients, 813 (51%) were diagnosed with prostate cancer. The cancer detection rate was 48% (449/936) in the former group and 54% (364/669) in the latter group, demonstrating that the cancer detection rate as a whole was significantly higher in the latter group compared to the former group. As for the subanalysis of the PSA gray zone cases, the cancer detection rate was 38% (206/548) in the former group and 41% (149/366) in the latter group, demonstrating that there was no difference in the cancer detection between the two groups. The detection rate of clinically insignificant cancer was significantly lower in the latter group (7%) compared to the former group (15%). A multivariate analysis revealed that age (p<0.01), digital rectal examination (p=0.04), prostate volume (p<0.01), the finding of TRUS (p=0.04), and volume/biopsy ratio (p<0.01) were independent parameters associated with positivity of prostate cancer in the patients with PSA grey zone. Conclusion: The cancer detection rate in the nomo-
grams provided here is similar to previous reports. In the latter nomogram, the detection rates of clinically significant cancer and clinically insignificant cancer were more acceptable compared to the former one. Twelve cores at a maximum under TRUS-guided needle biopsy may be sufficient as an initial prostate biopsy in prostate cancer diagnosis.
UP.197 Is There a “Will Rogers Phenomenon” in Multiparametric MRI Targeted Biopsies? Bass E1, Orczyk C1, Grey A1, Freeman A2, Jameson C2, Allen C2, Ramachandran N2, Punwani S2, Emberton M1, Ahmed H1 1
University College London, United Kingdom; University College London Hospitals, United Kingdom; 2 University College London Hospitals, United Kingdom Introduction and Objective: Prostate biopsy is an integral part of the diagnosis of prostate cancer. As techniques evolve, treatments will demonstrate improved outcomes due to grade inflation. This is an example of the Will Rogers phenomenon, that suggest that if more accurate, newer techniques result in grade inflation, more aggressive disease is moved from a good prognostic group to a poor prognostic group, thereby improving the prognosis of both groups. This study aims to investigate whether the Gleason grade diagnosed at TRUS biopsy is upgraded at transperineal MRI targeted biopsy resulting in the Will Rogers Phenomenon. Materials and Methods: This retrospective analysis
examined patients presenting at a single tertiary referral center for prostate cancer between July 2012 and July 2015. Inclusion criteria were a Gleason score of 7 on TRUS biopsy and a subsequent MRI cognitive targeted transperineal prostate biopsy within 12 months. Primary, secondary and totals of the overall Gleason score were recorded. Differences between these val-
187
UNMODERATED ePOSTERS ues were compared for significance using Wilcoxon signed-rank tests (p<0.05). Results: A total of 118 patients satisfied the inclusion criteria having undergone 12 zone TRUS biopsies followed by MRI cognitive targeted transperineal biopsy. At TRUS, 105 patients were graded with 3+4 and 13 with 4+3 disease. Pathological assessment following transperineal targeted biopsy resulted in a clear upshift in Gleason score. A total of 89 patients were graded at 3+4, 22 at 4+3, 6 at 4+4 and a single patient with 4+5 disease. The differences between the primary and total Gleason score were significant (p<0.05). Conclusion: This analysis demonstrates significant
upgrading of histological disease status. This may result in the Will Rogers phenomenon. However, further evaluation with long-term studies is required to determine whether upgrading of Gleason 7 disease truly improves survival in both good and poor prognostic groups, if an upgrade in Gleason grade results in reduced survival overall, and what the clinical implications of these observations are.
UP.198 Leptomeningeal Metastasis from Prostate Cancer: A Case Report Feki J1, Guermazi Z1, Mseddi MA2, Hadj Slimen M2, Toumi N1, Khanfir A1, Boudawara T3, Mhiri MN2, Daoud J4, Frikha M1 1
Dept. of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia; 2Dept. of Urology, Habib Bourguiba Hospital, Sfax, Tunisia; 3Dept. of Anatomopathology, Habib Bourguiba Hospital, Sfax, Tunisia; 4Dept. of Radiotherapy, Habib Bourguiba Hospital, Sfax, Tunisia Introduction and Objective: The most common met-
astatic sites in prostate cancer are the lymph nodes and bone. Leptomeningeal metastases from prostatic adenocarcinoma are exceptional, reported in less than 0.5% of cases. Diagnosis is established by the demonstration of malignant cells in the cerebrospinal fluid (CSF) or by the presence of enhancing tumor nodules on cranial or spinal MRI. Materials and Methods: We report a case of prostate adenocarcinoma metastatic to the meninges, diagnosed in a 71-year-old man. Results: A 71-year-old man was followed for a prostatic adenocarcinoma metastatic to the bone. He was treated with medical castration followed by complete androgen deprivation therapy with monthly injections of bisphosphonates. The evolution is marked by the occurrence of hormonal escape, eight months later. So, a chemotherapy based on Docetaxel plus Prednisone was initiated. The evolution was marked by the appearance, in the seventh cycle, of an intracranial hypertension syndrome with headaches, vomiting and diplopia. Brain magnetic resonance imaging (MRI) showed a left frontal enhancing meningeal thickening with a heterogeneous aspect of the clivus and the sphenoid bone. Then, the patient received palliative radiotherapy and the evolution was marked by regression of diplopia and partial improvement of intracranial hypertension syndrome. A repeat MRI done two months after showed an increase in the left frontal meningeal disease associated with diffuse meningeal enhancement caused by the meningeal carcinomato-
188
sis. Lumbar puncture did not show neoplastic cells. The patient died 5 months after the onset of meningeal metastasis. Conclusion: Treatment options for leptomeningeal
metastasis are limited to the intrathecal injection of methotrexate or cytarabine with or without radiotherapy. The median overall survival is limited to a few weeks.
UP.199 A Higher Ratio of Serum Calcium to Magnesium Is Associated with Aggressive Clinicopathological Characteristics in the Patients Who Underwent Radical Prostatectomy Ha YS1, Chung JW1, Lee JN1, Choi SH1, Kwon SY2, Kim G3, Kim BS1, Kim HT1, Kim TH1, Yoo ES1, Kwon TG1, Chung SK1, Kim BW1 1
Kyungpook National University School of Medicine, Daegu, Korea; 2Dongguk University College of Medicine, Seoul, Korea; 3CHA Gumi Medical Center, Junggu, Korea Introduction and Objective: Changes in magnesium
(Mg) concentration and calcium-to-magnesium ratio (Ca/Mg) have been shown to play a critical role in cell proliferation that can lead to cancer. We evaluated the association between preoperative Ca/Mg ratio and clinicopathological characteristics of prostate cancer (PCa). Materials and Methods: Preoperative serum levels of Ca, Mg, and Ca/Mg level were retrospectively analyzed in 154 consecutive patients who underwent radical prostatectomy (RP) at our institution between February 2014 and June 2015. Blood Ca, Mg, and the Ca/Mg ratio were analyzed in relation to patients’ demographics and clinicopathological characteristics. Results: The Ca/Mg ratio was positively correlated with preoperative PSA (r= 0.195, P=0.015) and PSA density (r= 0.316, P<0.001). Serum Mg levels were significantly lower in patients with diabetes compared with those without diabetes, and the Ca/Mg ratio was significantly higher (P<0.001, both). Preoperative Ca/Mg ratio was found to be significantly higher in subjects with pathologic Gleason score (pGS ≥8) than those with pGS≤7 [Mean (95% CI), 4.56 (4.40-4.71) vs. 4.36 (4.27-4.46); P=0.023]. However, Ca/Mg ratio was not a preoperative predictor of high pGS (≥8) according to multiple logistic regression analysis [OR, 1.702; 95% CI, 0.711-4.077; P=0.232]. Conclusion: Our study showed that a higher ratio of
serum Ca to Mg was closely associated with worse clinicopathogical parameters, such as higher PSA, PSA density and pGS (≥8). Our results suggest that the Ca/Mg ratio may be a useful serological marker that can further characterize oncologic features of patients with PCa. A multicenter prospective study with long-term follow-up is recommended to further assess the utility of this ubiquitous cost-effective marker.
UP.200 Prognostic Value of the Bone Scan Index (BSI) Among Men Treated with ART for Metastatic CastrationResistant Prostate Cancer Takeda H Tosei General Hospital, Seto, Japan
Introduction and Objective: The bone scan index
(BSI), which is obtained using a computer-aided bone scan evaluation system, is anticipated to become an objective and quantitative clinical tool for evaluating bone metastases in prostate cancer. We assessed the usefulness of the BSI as a prognostic factor in patients with metastatic castration-resistant prostate cancer (mCRPC) treated using ART. Materials and Methods: We analyzed 43 patients who received novel androgen receptor targeted therapies (ART) such as abiraterone and enzalutamide for mCRPC. The Bonenavi system was used as the calculation program for the BSI. The utility of the BSI as a predictor of overall survival (OS) after ART and diagnosis was evaluated. The Cox proportional hazards model was used to investigate the association between clinical variables obtained at ART, ALP, patient age, visceral metastasis, hemoglobin (Hb), lactase dehydrogenase (LDH), albumin (Alb), PSA doubling time, and BSI and OS. Results: The median OS after ART was 9.7 months. Death occurred in 11 (74.4%) of patients; all deaths were caused by prostate cancer. In multivariate analysis, two factors were identified as significant independent prognostic biomarkers for OS after ART; these were visceral metastasis (HR: 15.19; 95% CI: 2.3299.1; P=0.00447) and BSI (>1% vs. ≤1%; HR, 7.56; p=0.0037). Conclusions: The BSI and visceral metastases were independent prognostic factors for OS after ART. The BSI might be a useful tool for risk stratification of mCRPC patients. The BSI was found to be a strong predictor of OS in mCRPC patients. Additionally, the change in BSI demonstrated an additive clinical value to the change in PSA in mCRPC patients being treated with ART.
UP.201 Lateral Decubitus Position Versus Lithotomy Position: Which Is the Best Way to Minimize Patient’s Pain Perception During Transrectal Prostate Biopsy? Moon KH, Choi JY, Ko YH, Song PH, Jung HC Dept. of Urology, College of Medicine, Yeungnam University, Daegu, South Korea Introduction and Objectives: Considering the dis-
tinctive nature in terms of psychological stress and anal tone of position which was generally selected between lithotomy and conventional left lateral decubitus (LLD), we postulated its effect on pain perception during biopsy, and investigated their association in Korean men who have a relatively smaller prostate than the western population. Materials and Methods: A prospective study for the comparison of two biopsy positions performed in a different working day was conducted for 208 men (lithotomy position: n=86, left lateral decubitus position: n=122). The decision on the position was made solely based on the patient’s preference for the biopsy day, and all procedures were performed according to the identical protocol (12-core prostate biopsy with intrarectal lidocaine gel), probe, and needle. The maximal degree of pain during the entire process was assessed using a visual analogue scale (VAS), immedi-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS ately after the procedure. After propensity matching, a total of 152 patients were finally selected (lithotomy group: n=76, left lateral decubitus group: n=76), and peri-biopsy parameters were compared.
Results: No differences were observed between group across all variables including age, body mass index, prostate volume, prostate-specific antigen level, international prostate symptom score, and cancer de-
tection rate, except mean (±standard deviation) VAS score (3.89±2.01 vs. 4.58±2.22, p=0.049) (Table 1). In simple correlation analysis, VAS score showed significant association solely with patient’s position (Pear-
UP.201, Table 1. Characteristics of Patients (Before and After Propensity Score Matching) Before matching (n=208)
After matching (n=152)
Total
LLD position (n=122)
Lithotomy position (n=86)
p-value
Total
LLD position (n=76)
Lithotomy position (n=76)
p-value
Age (years)
67.81±8.33
67.73±8.881
67.93±7.539
0.861
67.16±8.45
66.72±9.19
67.59±7.67
0.528
Prostate volume (g)
42.17±25.86
40.33±20.25
4478±32.14
0.258
42.84±27.86
40.56±21.14
45.12±33.24
0.315
Pre-biopsy PSA (ng/dL)
22.99±18.8
16.01±18.81
22.76±27.50
0.050
18.77±22.87
16.11±17.88
21.44±26.82
0.151
135 (88.8)
67 (88.2)
68 (89.5)
12 (7.9)
7 (9.2)
5 (6.6)
5 (3.3)
2 (2.6)
3 (3.9)
6 (4.9)
2 (3.4)
4 (6.3)
116 (95.1)
56 (96.6)
60 (93.8)
23.86±2.60
23.92±2.45
23.79±2.76
31 (20.4)
16 (21.1)
15 (19.7)
121 (79.6)
60 (78.9)
61 (80.3)
Number of biopsy (%) First
180 (86.5)
103 (84.4)
77 (89.5)
Second
21 (10.1)
15 (12.3)
6 (7.0)
Third
7 (3.4)
4 (3.3)
3 (3.5)
With palpable nodule
9 (5.4)
5 (5.3)
4 (5.4)
Without palpable nodule
159 (94.6)
89 (94.7)
70 (94.6)
BMI
23.82±2.67
2371±2.57
23.97±2.77
With DM
36 (17.3)
20 (16.4)
16 (18.6)
Without DM
172 (82.7)
102 (83.6)
70 (81.4)
0.456
0.763
Nodule on DRE (%) Pre-biopsy variables
0.620
0.485
0.682
0.754
Prior history of DM 0.712
1.000
Pyuria at time of biopsy (%)
Intra & post– biopsy variables
With pyuria
10 (4.8)
6 (4.9)
4 (4.7)
Without pyuria
198 (95.2)
116 (95.1)
82 (95.3)
6 (3.9)
4 (5.3)
2 (2.6)
146 (96.1)
72 (94.7)
94 (97.4)
Total IPSS
14.12±8.15
13.24±9.11
15.49±6.19
VAS score
4.29±2.20
4.54±2.28
3.89±2.02
0.042
15.28±7.94
15.07±9.40
15.49±6.19
0.745
0.041
4.24±2.14
4.582.22
3.89±2.01
0.049
0
4 (2.1)
4 (3.4)
1
11 (5.6)
4 (3.4)
-
3 (2.0)
3 (3.9)
-
7 (9.2)
10 (6.6)
3 (3.9)
7 (9.2)
2
37 (19.0)
19 (16.0)
18 (23.7)
27 (17.8)
9 (11.8)
18 (23.7)
3
22 (11.3)
4
38 (19.5)
11 (9.2)
11 (14.5)
19 (12.5)
8 (10.5)
11 (14.5)
24 (20.2)
14 (18.4)
30 (19.7)
16 (21.1)
14 (18.4)
5
19 (9.7)
15 (12.6)
4 (5.3)
6
37 (19.0)
23 (19.3)
14 (18.4)
0.601
0.105
11 (7.2)
7 (9.2)
4 (5.3)
32 (21.1)
18 (23.7)
14 (18.4)
7
8 (4.1)
4 (3.4)
4 (5.3)
6 (3.9)
2 (2.6)
4 (5.3)
8
15 (7.7)
11 (9.2)
4 (5.3)
13 (8.6)
9 (11.8)
4 (5.3)
9
-
-
-
-
-
-
10
4 (2.1)
4 (3.4)
-
1 (0.7)
1 (1.3)
-
Number of biopsy core
12.13±0.627
12.02±0.589
12.29±0.648
12.19±0.524
12.08±0.271
12.30±0.673
12 core (%)
179 (86.1)
112 (91.8)
67 (77.9)
129 (84.9)
70 (92.1)
59 (77.6)
23 (15.2)
6 (7.9)
17 (22.4)
56 (36.8)
29 (38.2)
27 (35.5)
Over 12 core (13-16, %)
29 (13.9)
10 (8.2)
19 (22.1)
Pca detected (%)
85 (40.9)
54 (44.3)
31 (36.0)
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
0.006
0.007
0.254
0.681
0.157
0.009
0.022
0.867
189
UNMODERATED ePOSTERS son’s coefficient = -0.165, p=0.042). In multiple linear regression models regarding the effect of clinical variables on VAS score, patient position was a single independent predictor favoring lithotomy position to decrease perceived pain (B=-0.928, p=0.024). Conclusion: With the routine use of topical lidocaine
gel, the position of the patient was a single factor associated with VAS in performing prostate biopsy with an extended scheme. This data suggests lithotomy position as a proper way to perform transrectal prostate biopsy in comparison with conventional lateral decubitus position.
UP.202 The Correlation of Multiparametric MRI with PSA Sensitivity and Specivity in the Diagnosis of Prostate Cancer Kaya E1, Ebiloglu T2, Akgun V1, Yalcin S3, Battal B1, Zor M1, Alp BF1, Yildirim I1 1
Gulhane Military Medical Academy, Ankara, Turkey; Etimesgut Military Hospital, Ankara, Turkey; 3Agri Military Hospital, Agri, Turkey 2
Introduction and Objectives: Advancements in magnetic resonance imaging (MRI) technology made the authors question the use of multiparametric MRI of the prostate (MP_MRI-P) for the detection of prostate cancer (Pca). In this article, we examined the effect of MP_MRI-P on PSA sensitivity and specifity for the detection of Pca. Materials and Methods: Between January 2011 and
January 2016, a total of 229 men who had prebiopsy MP_MRI-P and transrectal ultrasound prostate biopsy (TRUSP-B) were enrolled in this retrospective study after written consent. The indications for TRUSP-B were PSA ≥4 ng/ml, or abnormal palpation of prostate on rectal digital examination (RDE) in patients with more than 10-years life expectancy. Results: When the PSA <4 ng/ml, negative MP_
MRI-P findings caused a significant increase in specifity (p=0.04). However, there was no chance in sensitivity when there were positive MP_MRI-P findings. When PSA was between 4-10 ng/ml with free/total PSA ratio <10%, no change was detected in sensitivity and specifity according to MP_MRI-P findings (p=0.229). When PSA was between 4-10 ng/ml with free/total PSA ratio >25%, there was a significant increase in specifity if there were negative MP_MRI-P findings (p=0.049). Also, positive MP_MRI-P findings caused an increase in sensitivity. When PSA>10 ng/ml, there was no change in sensitivity and specifity (p=0.73). Conclusion: MP_MRI-P causes a significant increase
in PSA specivity when the PSA <4 ng/ml, and PSA between 4-10 ng/ml with free/total PSA ratio >25%.
UP.203 Is the Cancer of the Prostate Risk Assessment Score a Valid Tool to Predict Biochemical Recurrence, Metastasis and Death After Radical Prostatectomy in Argentineans Patients? Bengió RG, Arribillaga L, Bengió V, Orellana S, Montedoro A, García Öntö H, Epelde J, Bengió RH Centro Urológico Profesor Bengió, Córdoba, Argentina
190
Introduction and Objective: The aim of the present
study was external validation to determine whether the Cancer of the Prostate Risk Assessment score (CAPRA-S) predicts biochemical recurrence, metastasis and death for prostate cancer after radical prostatectomy in the Argentinean population. Materials and Methods: A total of 216 patients were
studied. Probability of score to predict biochemical recurrence after radical prostatectomy was analyzed by Cox proportional method. Biochemical recurrence, metastasis and cancer specific free survival was determinate by Kaplan method. Exactitude of CAPRA-S score to predict biochemical recurrence, metastasis and death by prostate cancer was made in accordance with Harrells concordance index. Results: Median follow-up was 74 months. Biochemical recurrence index increase proportionally with the increment of the CAPRA-S score. In the stratification of patients in low, intermediate or high risk, biochemical recurrence free rate were 85%, 54% and 4% respectively. Concordance index (C-Index) to biochemical progression, metastasis and death by prostate cancer were 0.85, 0.90 and 0.90 respectively. Conclusions: The CAPRA-S score is an easily applicable tool and had a high predictive ability to determine biochemical recurrence, metastasis and death by prostate cancer in our population. Concordance Index in these variables was higher than 0.85.
UP.204 Laparoscopic Radical Prostatectomy in Prostatic Stromal Tumor of Uncertain Malignant Potential Kwak KW, Oh TH, Kim TH Sungkyunkwan University School of Medicine, Samsung Changwon Hospital, Changwon, South Korea Introduction and Objective: Prostatic stromal tumor of uncertain malignant potential (STUMP) is a rare and distinctive proliferative lesion characterized by an expansion of the specialized prostatic stroma. The clinical significance and management of STUMP is uncertain because of its rarity and lack of long-term follow-up. Materials and Methods: A 44-year-old male visited our hospital because of abnormal finding in transrectal ultrasound (TRUS) of prostate at other urology clinic. On digital rectal examination, a 2-cm tender, well demarcated nodule was palpated in left lobe of prostate. Prostate-specific antigen (PSA) was 1.0 ng/ ml, and the urine culture showed no urinary tract infection. TRUS of prostate demonstrated a 35-mm heterogeneous echogenic lesion with interval increase of size in left peripheral zone of prostate. The patient underwent TRUS-guided needle biopsy of prostate with 12 cores. Results: Pathological examination showed spindle
cell proliferative lesion with focal hypercellularity and moderate cellular atypia in multiple cores of left prostatic lobe, favoring malignant tumor. On immunohistochemical study, the atypical stromal cells displayed intense cytoplasmic immunoreactivity for vimentin and no significance for Ki-67. Prostate magnetic resonance imaging (MRI) revealed 4.0-cm mass originating from the left lobe of prostate without
extracapsular extension and a 11-mm lymph node in right common iliac chain that was assumed to be metastatic lesion. To differentiate this lesion with prostate sarcoma and to treat severe LUTS of the patient, we decided to perform laparoscopic radical prostatectomy. We performed laparoscopic radical prostatectomy with standard pelvic lymph node dissection; right neurovascular bundle (NVB) was spared and left NVB was excised widely. The final pathologic results showed prostatic STUMP with moderate cellularity and marked pleomorphism, lack of mitotic figures, necrosis and stromal overgrowth. The patient has been continent (never used pad) and capable of sexual intercourse with medication of tadalafil 20 mg since 6-months postoperatively. At the 48-month postoperative follow-up, there is no evidence of disease recurrence. Conclusion: This case shows that a patient with pros-
tatic STUMP treated by LRP has been tolerable in both oncologic and functional outcomes until final follow-up. It might be valuable to study the clinical significance of this case through further long-term follow-up.
UP.205 Prostate Cancer Screening: Diagnostic Value of 12-Core Transrectal Biopsy Versus Saturation Prostate Biopsy as an Initial Biopsy Strategy (A Comparative Study About 100 Patients) Sallami S1, Abou El Makarim S1, Chtourou M2 1
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; Dept. of Urology, Habib Thameur University Hospital, Tunis, Tunisia
2
Introduction and Objective: Although the standard
12-core transrectal biopsy technique is easy, safe and fast; it is reported to have a low rate of prostate cancer (Pca) detection. Saturation biopsy technique is indicated for high-risk patients after two normal prostatic biopsies with progression of PSA values. We evaluate the improvement in the rate of Pca detection using the standard versus saturation prostate biopsy as initial biopsy strategies. Materials and Methods: A total of 100 consecutive men underwent an initial transrectal saturation prostatic biopsy for Pca screening. All of them had a normal prostate in the digital rectal examination with a PSA level ≤10 ng/ml. The median age was 62.2 ± 2.5 years (57-70). The median PSA level was 8.7 ng/mL (range: 3.1 to 10.0). The median prostate volume was 52.3 cm3 (24-112). Saturation prostate biopsy (at least 26 cores) was performed under apical periprostatic local anesthesia (Lidocain 2%) using an 18-gauge biopsy needle. For each patient, we compared the histo-pathological data of the standard 12-core to all cores of the saturation biopsy technique. Results: Histopathology studies concluded to 21 Pca and 2 high-grade PIN. The Pca detection rates were 11% and 21% with standard and saturation techniques respectively (p=0.05). We didn’t noted serious complications but prostatitis (n=1), orchitis (n=2) and hematuria >5 days (n=6). The procedure was well tolerated: VSA <5 in 81 patients. Conclusions: Transrectal saturation prostate biopsy is significantly superior to standard needle in detecting
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS prostate cancer. Pain and local complications are low. This technique may improve significantly the detection rate of Pca in high-risk patients without need to rebiopsy.
UP.206 The Risk of Suicide after the Diagnosis of Prostate Cancer in an Oncology Center in São Paulo: Early Results Zendron M, de Cássio Zequi S, Cardoso Guimarães G, Cruz Lourenço MT AC Camargo Cancer Center, São Paulo, Brazil Introduction and Objective: Patients with cancer may be at increased risk of suicide. Research investigating suicidal risks in patients after receiving the diagnostic of several malignancies is scarce in Brazil. The objective of this study was to identify the incidence, the associated factors and the risk for suicidal behavior (SB) in a cohort of patients diagnosed with prostate cancer (PC). Materials and Methods: One hundred and five pa-
tients were invited to participate in this research after being diagnosed with low and intermediate, D’Amico risk PC, between September 2015 and March 2016. The section of risk of suicide in Mini International Neuropsychiatric Interview (MINI), the Hospital Anxiety and Depression Scale (HADs) and the Substance Abuse Screening Tool (CAGE) were applied before the patients start the treatment. Psychiatric treatment, family history of SB and the use of psychotropic drugs were investigated. The institutional committee on ethics in human investigation has approved this project on July 14, 2015, nr. 1.169.723. Results: Three patients refused to participate and two were excluded. Mean age was 63.2 years; mean time between diagnostic and interview was 2.2 months. No smokers were 89%. According CAGE questionnaire, 1% were at risk for alcoholism and in the HADs questionnaire, 17% scored for anxiety and 7% for depression. A total of 7% of the participants underwent psychiatric treatment and 15% had a family-related history of SB. Intake of medication for sleep or for anxiety and depression was reported by 15%. Five patients presented with SB (5%) in the MINI questionnaire, 3% had low risk, 1% had moderate risk and 1% were at high risk for suicide. Conclusion: In this cohort, 5% of the patients with PC
reported risk of suicide and family history of SB may considered at risk for suicide and may deserve better evaluation. The results of this pilot study suggest more efforts of screening to raise awarenss among clinicians of others risks factors for suicide after PC diagnosis.
UP.207 Preventing Unnecessary Invasive Cancer-Diagnostic Tests: Changing the Cut-Off Points Pourmand G1, Ramezani R2, Sabahgoulian B3, Nadali F4, Mehrsai A5, Nikoobakht M5, Allameh F5 1
Urology Research Center, Tehran University of Medical Sciences, Iran; 2CDC Cancer Office, Ministry of Health and Medical Education, Tehran, Iran; 3 Bistoon Ultrasound Clinic, Tehran, Iran; 4Dept. of Hematology, Allied Health Medicine, Tehran University of Medical Sciences, Iran; 5Urology Research
Center, Sina Hospital, Tehran University of Medical Sciences, Iran Introduction and Objective: To determine a cut-off
point of tPSA and PSAD to prevent unnecessary invasive cancer-diagnosing tests in the community. Materials and Methods: This study was performed on
688 consecutive patients referred to our center due to prostatism, suspicious lesions on digital rectal examination and/or elevated serum PSA levels. All patients underwent transrectal ultrasound guided biopsies and obtained PSAD. Serum levels of tPSA and fPSA were measured by chemiluminescence. Comparisons were done using tests of accuracy (AUC-ROC). Results: Prostate cancer was detected in 334 patients, whereas the other 354 patients were suffering from benign prostate diseases. The mean tPSA in case and control groups were 28.32±63.62 ng/ml and 7.14±10.04 ng/ml; the mean f/tPSA ratios were 0.13± 0.21 and 0.26±0.24 in PCa and benign prostate disease groups; the mean PSAD rates were 0.69±2.24, 0.12±0.11, respectively. Statistically significant differences were found (P <0.05). Using ROC curve analysis, it was revealed that AUC was 0.78 for tPSA and 0.80 for f/tPSA. Sensitivity was 71% for the cut-off value of 7.85 ng/ml. For f/tPSA ratio, the optimal cutoff value was 0.13, which produced the sensitivity of 81.4%. For PSAD, it was 15%. Conclusion: As this trial is different from the Europe-
an and American values, we should be more cautious in dealing with prostate cancer upon the obtained sensitivity and specificity for PCa diagnosis (7.85 ng/ mLfor tPSA, 15% for PSAD and 0.13 for f/tPSA ratio).
UP.208 Serum Calcium Concentration and Prostate Cancer Risk: A Multicenter Study Salem S1, Hosseini M2, Allameh F2, Babakoohi S3, Mehrsai A2, Pourmand G2 1 Urology Institute, University Hospitals Case Medical Center, Dept. of Urology, Case Western Reserve University, Cleveland, United States; 2Urology Research Center, Tehran University of Medical Sciences, Iran; 3 Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, United States
Introduction and Objective: This study sought to fur-
ther evaluate the possible effects of serum calcium level on prostate cancer (PC) risk, with considering the age, body mass index (BMI), and sex steroid hormones. Materials and Methods: Using data from a prospective multicenter study, serum calcium concentration as well as thorough demographic and medical characteristics were determined in 194 cases with newly diagnosed, clinicopathologically confirmed PC and 317 controls, without any malignant disease, admitted to the same network of hospitals. Serum total and ionized calcium levels were categorized into tertiles. Multivariate logistic regression model was used to estimate odds ratios (OR) and corresponding 95% confidence intervals (CI) after adjustment for major potential confounders, including age, BMI, smoking, alcohol, education, occupation, marital status, family history of PC, and sex hormones level. Results: The mean serum calcium level (±SD) in case and control groups was 9.22 (±0.46) mg/dl and 9.48
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
(±0.51) mg/dl, respectively (P<0.001). After adjustment for mentioned confounders, a significant trend of decreasing risk was found for serum total calcium concentration (OR = 0.27, 95% CI = 0.12-0.59, comparing the highest with the lowest tertile) and ionized calcium (OR = 0.25, 95% CI = 0.10-0.58). An increase of 1 mg/dl in serum calcium level was associated with a significant decrease in PC risk (OR = 0.52; 95% CI = 0.34-0.76). Conclusion: Our findings reveal the inverse associa-
tion between serum total and ionized concentrations and PC risk, which supports the hypothesis that calcium may protect against PC. Furthermore, no evidence was found regarding age, BMI, and sex steroid hormones to modify the association between serum calcium and PC risk.
UP.209 The Role of PTEN Gene in the Progression of Prostate Cancer Pourmand G1, Ziaee AA2, Abedi AR1, Alavi HA3, Ahmadi A1, Saadati HR2 1 Urology Research Center, Tehran University of Medical Sciences, Iran; 2Institute of Biophysics and Biochemistry, University of Tehran, Iran; 3Dept. of Pathology, Day Hospital, Tehran, Iran
Introduction and Objective: The aim of this study was to clarify the role of PTEN gene in the progression of prostate cancer. Materials and Methods: A total of 51 formalin-fixed paraffin-embedded specimens of prostate cancer were analyzed for PTEN mutations. Tissue microdissection and polymerase chain reaction/single-strand conformation polymorphism methods were used. Clinical and pathologic data of the patients were reviewed with regard to PTEN mutation. Results: The Gleason score (GS) was less than 7 in 29 (56.8%), 7 in 11 (21.6%), and greater than 7 in 11 (21.6%). Tumor stage was IIa, IIb, IIc, and IV in 14 (27.4%), 4 (7.8%), 21 (41.2%), and 12 (23.6%) patients, respectively. Eleven of 12 stage IV tumors had metastases at the time of presentation. Six of 51 cases (11.6%) showed mutations in PTEN, which involved exons 1, 2, and 5. Two of these cases had localized and the others had advanced prostate cancer. One case of the tumors with PTEN mutation had a GS of 7 and 5 had GSs greater than 7. Patients with a positive mutation of PTEN had a significantly greater GS (P<0.001), lower survival rate (P=0.001), higher tendency to metastasis (P=0.002), and higher prostate-specific antigen (P=0.03). Cox proportional hazard model showed that only GS was significantly correlated with mortality (P=0.03). Conclusion: Patients with prostate cancer who had
PTEN mutation had also a significantly greater GS, poorer prognosis, and higher rate of metastasis. However, this mutation cannot predict the prognosis, and the GS is a more precise factor.
UP.210 Quality of Life After IntensityModulated Radiation Therapy, 125I Brachytherapy, and Combined 125I Brachytherapy plus Stereotactic Body Radiotherapy for Prostate Cancer Nakai Y, Tanaka N, Anai S, Miyake M, Fujimoto K Nara Medical University, Japan
191
UNMODERATED ePOSTERS Introduction and Objective: To evaluate the quality
of life (QOL) after intensity-modulated radiotherapy (IMRT), 125I brachytherapy, and combined 125I brachytherapy plus stereotactic body radiotherapy (SBRT) for prostate cancer patients. Materials and Methods: We conducted a single-in-
stitution, prospective trial for patients undergoing IMRT, 125I brachytherapy (seed), and combined 125I brachytherapy plus SBRT (seed + SBRT). All patients who received radiotherapy in our institution between 2010 and 2014 were enrolled in this trial. QOL was estimated using the Expanded Prostate Cancer Index Composite questionnaire before each treatment and at 1, 3, 6, and 12 months thereafter. Data were analyzed by the mean domain score and multivariate analyses to determine factors associated with urinary and bowel domain scores at 1 year. Results: Data were analyzed from 589 patients (IMRT, n = 141; seed, n = 235; and seed + SBRT, n = 213) at baseline and from 555 (IMRT, n = 123; seed, n = 227; and seed + SBRT, n = 205) at 1 year. Mean declines in urinary summary scores at 1 year across patients treated with IMRT, seed, and seed + SBRT were -0.01, -3.4, and -4.1 points, respectively. Mean declines in bowel summary scores at 1 year across the patients treated with IMRT, seed, and seed + SBRT were -3.5, -1.1, and -2.8 points, respectively. In multivariate analysis (reference IMRT) of the urinary domain, seed [odds ratio (OR) = 1.91, p = 0.02] and seed + SBRT (OR = 2.14, p < 0.01) were predictive factors for the decline in urinary domain scores. In multivariate analysis (reference seed) of the bowel domain, IMRT (OR = 2.27, p < 0.01) and seed + SBRT (OR = 1.62, p = 0.04) were predictive factors for the decline in bowel domain scores. Conclusion: QOL at 1-year in urinary domain after seed and SBRT declined compared with that after IMRT. QOLs at 1-year in bowel domain after IMRT and seed + SBRT declined compared with that after seed.
UP.211 The Protective Effect of Diabetes Mellitus Against Prostate Cancer: The Role of Sex Hormones Pourmand G1, Baradaran N2, Ahmadi H2, Lotfi M3, Mehrsai A4 1 Urology Research Center, Tehran University of Medical Sciences, Iran; 2Urology Research Center, Tehran University of Medical Sciences, Iran; 3Dept. of Radiology, Shahid-Faghihi Hospital, Shiraz University of Medical Science, Shiraz, Iran; 4Urology Research Center, Sina Hospital,Tehran University of Medical Sciences, Iran
Introduction and Objective: Diabetes mellitus (DM)
has been associated with a decreased risk of prostate cancer (PC) in several reports. The hormonal environment of diabetic patients is believed to be an important contributing factor in this regard. Materials and Methods: Using data from a multi-cen-
ter case-control study in Iran, base line testosterone, sex hormone binding globulin (SHBG), estradiol, and albumin levels as well as thorough demographic and medical characteristics of 194 newly diagnosed prostate cancer patients were determined. There were 317 ethnicity-matched men with no cancer as controls as
192
well. Data was analyzed for hormones of interest in DM patients regarding their cancer status. Results: Of 511 enrolled patients, 21 cases and 63 controls were diagnosed as DM. Patients with DM were significantly less likely to have PC (OR: 0.44, P<0.003). Time since DM diagnosis was also inversely correlated with the risk of cancer (P trend<0.0001). Control patients had significantly higher testosterone, estradiol, and testosterone/SHBG ratio (P<0.05). As time since DM diagnosis increased by quartiles, testosterone significantly increased (P trend<0.05). The risk of PC also significantly declined (P trend<0.0001) following an initial remarkable increase early after DM diagnosis. After including the hormones in the logistic regression model, there was a weak, yet significant inverse association of testosterone/ SHBG and DM duration with the risk of PC. Conclusion: Based on our results DM duration is
inversely correlated with the risk of prostate cancer. Our results do not support the hypothesis that sex hormones, including testosterone, play a major role in the protective effect of DM against PC.
UP.212 A Retrospective Study Investigating Risk Factors for Prostate Cancer: What Does It Mean for the Clinician? Akman J, Green J, Chowdhury S Whipps Cross University Hospital, London, United Kingdom Introduction and Objective: Prostate cancer remains a major cause of death amongst men worldwide. Although there have been recent advances in identifying common causes, there is insufficient evidence to demonstrate the degree of disease that these factors may cause. The aim of this study is to investigate the correlation between various risk factors and the severity of prostate cancer within the Whipps Cross Hospital catchment area in London, United Kingdom. Materials and Methods: A retrospective, cohort study
was conducted on 184 patients who attended the prostate clinic at Whipps Cross hospital over a continuous six-month period in 2015. Patients with prostate cancer were confirmed using transrectal ultrasound guided biopsy. Low-risk cancer was defined as a collective Gleason score of less than 7, intermediate risk as 7 and high risk as above 7. Data on different ethnic groups, smoking status and first-degree relatives with the disease were collected. Relative risks were calculated to assess the significance of the results. Results: A total of 30% (n=55) of the 184 patients who attended the clinic were diagnosed with prostate cancer. Average age of those diagnosed was 65. Smokers were 4 times more likely to be diagnosed with lowrisk prostate cancer (p=0.0003, 95% CI 1.94 to 9.42, NNT 5). Black patients were twice as more likely to get low and intermediate forms of the disease (p=0.0445, CI 1.02-5.9, NNT=5 and p=0.0296, 95% CI 1.08-4.35, NNT 4 respectively). Having a first-degree relative with prostate cancer was not identified to be a significant risk factor (p=0.3291, 95% CI 0.76-2.27). Conclusion: Smoking seems to be a modifiable risk
factor of prostate cancer. This study also demonstrates that being of African heritage increases one’s risk of prostate cancer to the extent of requiring urgent
management. This highlights the need for increased awareness for both patients and clinical staff, of the aforementioned risk factors, in order to improve patient outcomes.
UP.213 Relationship Between Androgen Deprivation Therapy and the Appearance of Kidney Stones Arrabal-Martín M1, Díaz-Convalía E1, Cano-García MdC2, Arrabal-Polo MA1, Miján Ortiz JL1, Cózar-Olmo JM1 1
Complejo Hospitalario Granada, Spain; 2Instituto IBS Granada, Spain Introduction and Objective: Androgen deprivation
therapy in prostate cancer is associated with the appearance of adverse effects, which include osteoporosis and metabolic syndrome. Both of these are related to nephrolithiasis. The objective of this study is to analyze the relationship of new cases of renal stones in patients with androgen deprivation therapy. Materials and Methods: A total of 85 patients were divided into two groups in this case-control study. Group 1: 41 patients on androgen deprivation therapy and Group 2: 44 patients not on androgen deprivation therapy. A descriptive study was performed, by comparing the means using the Student’s t-test and the analysis of the percentage of lithiasis between groups by applying the Chi-Square test, and the subsequent calculation of the risk (OR) of lithiasis appearing, with a 95% confidence limit. The statistical analysis was performed using the SPSS 20.0 program, with a P≤0.05. Results: A new appearance of lithiasis was observed in 12 cases (29.3%) in Group 1 compared to 2 cases (4.5%) in Group 2 (p=0.0001), at 4.4 years from starting the androgen deprivation therapy. The estimated Odds Ratio (OR) was 8.69 (95% CI; 1.81-41.76). Conclusion: The mechanisms that may explain the appearance of renal calculi in patients on this treatment are based on the presence of Randall plaques, a decrease in urine pH, and an increase in urine calcium with a decrease in urine citrate. However, long-term prospective studies with metabolic control are required to be able to establish the causes to explain the appearance of this phenomenon in patients on treatment with androgen deprivation therapy base on luteinizing hormone-releasing hormone (LH-RH) analogues.
UP.214 New Open Anterograde Anatomic Radical Retropubic Prostatectomy Technique RRP2A Borges Carrerette F, Alexandro da Silva E, Salvador Junior E, Rocha Perrone F, Teofilo Figueiredo Filho R, Costa Lara C, Damião R State University of Rio de Janeiro, Brazil Introduction and Objective: The refinement of surgical technique after incorporation of new technology has contributed to better oncological and functional outcome in radical prostatectomy (RP). May the surgical technique used in robot assisted radical prostatectomy (RARP) be offered to patients who don’t have access to expensive and complex technologies? Can we perform the same operation through an open incision without additional cost and with the same
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS materials? The goal of this study is to describe a new technique of anterograde anatomic radical retropubic prostatectomy (RRP2A), already used in RARP, but through an open retropubic access, without adding complexity or cost. Materials and Methods: Ten patients were submitted
to RRP2A as described below: Ligation of prostatic venous plexus; Dissection and preservation of bladder neck; Dissection of deferent ducts and seminal vesicles with little traction and low intensity monopolar electrocautery; Nerve sparring unilaterally or bilaterally; Ligation of the prostatic lateral pedicle; Retroprostatic and apex dissection; Section of the dorsal venous plexus; Exposure and section of abdominal
urethra; Urethrovesical anastomosis with Van Velthoven running suture, with two monofilament absorbable 3.0 string.
pilot study has motivated a prospective randomized trial with a larger number of patients to evaluate the superiority of RRP2A over the RRP technique.
Results: See Tables 1 and 2.
UP.215
Conclusion: Our study was able to reproduce the surgi-
Oncological and Functional Outcomes of Robotic Radical Prostatectomy in High-Risk Prostate Cancer Patients
cal technique performed in RARP through an open incision, using the same materials as in Walsh open radical prostatectomy (RRP) without technical difficulties, augmentation of risk or surgical time. We evidenced good short-term oncological and functional outcomes. This may be an evolution to the way to perform RRP and can also serve as training to new specialists and residents, preparing them to apply this skill in robot or laparoscopy, shortening their learning curve. This
UP.214, Table 1. Pre Operatory Data Prostate Biopsy
Age
PSA pre op
Prostate volume
Side
Gleason
AMSF
53
5.4
20
Bilateral
ECC
65
2.9
40
Left
Patients
D’Amico Risk
Digital prostate exam
7 (3+4)
Intermediate
Normal
7 (4+3)
Intermediate
Left node Increased without nodes
PITO
58
10.4
30
Right
6 (3+3)
Intermediate
VBM
61
3.68
56
Left
7 (3+4)
Intermediate
Left node Increased without nodes
JEF
61
11.83
32
Bilateral
6 (3+3)
Intermediate
ACC
69
7.5
27
Left
7 (4+3)
Intermediate
Left node
MJA
57
14.5
40
Bilateral
6 (3+3)
Intermediate
Increased without nodes
JFC
68
3.49
50
Right
6 (3+3)
Low
Right node
MCC
62
4.29
40
Right
*
Low
Increased without nodes
PAS
71
23
50
Right
6 (3+3)
High
Increased without nodes
62.5
8.7
38.5
53 - 71
2.9 - 23
20 - 56
70% unilateral 40% right 30% left
50% = 6 40% = 7
70% intermediate 20% low 10% high
40% with nodes
Average Range
Takeda H Tosei General Hospital, Seto, Japan Introduction and Objective: In this retrospective
study, we report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk prostate cancer (HRPC), classified according to the D’Amico risk criteria and with a minimum follow-up of 1 year. Materials and Methods: A total of 34 patients who had at least one preoperative HRPC feature and underwent RARP were included. Mean patient age and preoperative serum prostate-specific antigen level were 67.99±7.5 years and 16.84±11.0 ng/ml, respectively. Preoperatively, 5.0%, 6.7%, 28.3%, 5.0%, and 55.0% patients had prostate biopsy-proven Gleason scores of 5+4, 4+5, 4+4, 3+5, and <8, respectively. Bilateral neurovascular bundle (NVB)-sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 0 (0%), 5 (14.7%), and 29 (85.2%) patients, respectively. Results: Mean console time, Hb blood loss, duration of hospital stay, and urethral catheter removal time were 165.4±62.4 minutes, 1.95mg/dl ml, 9.13 days, and 6.32 days, respectively. During the perioperative period (days 0-30), 3 minor and 1 major complications occurred as categorised using the modified Clavien classification. No complications were detected during post-operative days 31-90. The positive surgical margin rate was 27.2%. Mean follow-up was 27.8±11.1 months. Biochemical recurrence was detected in 1 (2.9%) patient. Of the total 34 patients, 78% were fully continent (0 pad/day), 91% wore 1 pad/day.
UP.214, Table 2. Peri and Post Operatory Data Time (min/day)
Prostate volume
surgery
hosp
drain
catheter
PSA post op
Gleason post op
Stage
Margin
Continence
Follow-up
AMSF
23
150
3
3
7
0.00
7 (4+3)
pT2c N0
Negative
Incontinent 1 diapers/day
12 months
ECC
34
200
3
3
8
0.003
7 (4+3)
pT2c N0
Positive
90 days
10 months
PITO
39
150
4
3
7
0.01
7 (4+3)
pT2c N0
Negative
0 day
9 months
VBM
60
120
3
3
7
0.41
7 (3+4)
pT2c N0
Negative
0 day
9 months
JEF
22
150
5
3
16
0.01
7 (4+3)
pT3b N0
Positive
0 day
8 months
ACC
40
140
4
4
7
0.02
7 (4+3)
pT3a N1
Positive
0 day
8 months
MJA
42
200
3
3
7
0.08
7 (4+3)
pT2c N0
Positive
3 days
8 months
JFC
67
90
3
3
7
0.04
6 (3+3)
pT2c N0
Negative
Incontinent 1 diapers/day
5 months
MCC
43
125
3
3
7
0.01
6 (3+3)
pT2a Nx
Negative
0 dias
5 months
PAS
41
130
3
3
7
0.01
7 (3+4)
pT3a N0
Negative
90 days
4 months
35.7
145.5
3.4
3
8
0.058
23 - 67
90 - 200
3-5
3-4
7 - 16
0 - 0.41
50% immediate 80% -90days
7.8 months
Patients
Average Range
80% = 7 20% = 6
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
70% T2 30% T3
40% positive
4-12 months
193
UNMODERATED ePOSTERS Conclusion: Based on our experience, RARP in
UP.217
HRPC is a relatively safe procedure with satisfactory oncological and functional outcomes.
Adherence to NICE Guidelines for Active Surveillance of Men with Prostate Cancer: A Comparative Study at Sandwell and West Birmingham NHS Trust
UP.216 Effect of Low-Dose Rate Brachytherapy on Serum Testosterone Levels in Men with Prostate Cancer Hara N, Nishiyama T, Takizawa I, Kasahara T, Maruyama R, Tomita Y Div. of Urology, Dept. of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Japan Introduction and Objectives: Although elevated se-
rum testosterone levels following definitive local therapy in men with prostate cancer have been presumed to be associated with the decreased secretion of inhibin from their ablated prostates, related studies on the effect of low-dose rate brachytherapy (LDR) have barely been presented. The aim of the present study was to clarify the manner of serum testosterone levels after LDR and the association of them with treatment efficacy. Materials and Methods: A total of 81 men (age: 5979, median 66 years) with localized prostate cancer receiving LDR, who had a post-treatment observation period of 24 months or longer, were retrospectively studied. PSA levels at diagnosis ranged between 3.3 and 21.2 (median: 11.3) ng/ml. Gleason scores were 6 and 7 in 65 (80.2%) and 16 (19.8%), respectively. V100 was 74.2-100 (median: 89.1)%, and D90 was 104-322 (median 153) Gy. Median observation period was 53 months. A total of 34 men managed with active surveillance were studied as control group to comparatively assess the change in serum testosterone levels. Results: The overall survival rate was 100%. One patient experienced biochemical recurrence. PSA levels at observation after LDR ranged between 0.01 and 3.7 (median: 0.33) ng/ml. Serum testosterone levels after LDR increased by 20.2% (range: 124 and 1428, mean: 620 ng/dl) compared with those at diagnosis (range: 82 and 1 001, mean: 516 ng/dl) (p<0.0001). In the control group managed with active surveillance, testosterone levels were similar between at diagnosis and after LDR (p=0.171). Although no association was observed between serum testosterone and PSA levels after LDR (r=0.128, p=0.2766), after LDR, men with testosterone levels higher than 700 ng/dl seemingly showed lower PSA levels than those with testosterone lower than 500 ng/dl (0.27 vs. 0.58 ng/ml, p=0.210). PSA and testosterone levels at diagnosis, biopsy Gleason score, %positive core, V100, and D90 had no association with PSA levels after LDR. Conclusion: In men with localized prostate cancer,
LDR increased their serum testosterone levels by about 20%. After LDR, those with higher testosterone levels were likely to show lower PSA levels, although not significant. Thus, elevated serum testosterone levels following LDR possibly reflects its treatment efficacy.
194
Patton E University of Birmingham, England Introduction and Objective: This audit aims to inves-
tigate if all aspects of the updated active surveillance protocol realised by NICE in January 2014 are being carried out, and quantify the change in practice the guidelines have produced. Materials and Methods: Retrospective data were collected in February and March 2016 at Sandwell and West Birmingham NHS trust. Patients diagnosed with Prostate Cancer during March to December 2013, and April to December 2014 who were eligible for all treatment options, were identified through patient lists from weekly MDT meetings. Patients who selected to undergo Active Surveillance were then identified through examining their notes on the trust’s electronic patient records database. For each patient, clinical letters, pathology and radiology results were consulted, allowing comparison of their treatment to the recommended treatment. Results: For the 2013 cohort, 0/21 DREs were performed in Year 1. For Year 1 of the 2014 cohort, there were 1/22 DREs carried out, an increase of only 4.55%. Of the 2013 patients, 7/23 had an MRI at enrolment (30.43%). For the 2014 patients, 9/23 had an MRI at enrolment (39.13%). Of the 2014 patients that did not have an MRI at enrolment, 11 had an MRI later in their treatment. For 7 of them, this prompted a template re-biopsy or a change in their treatment plan (63.64%). Conclusion: The increase of only 4.55% shows that
the implementation of the guidelines had a negligible impact on the number of DREs being carried out in Year 1 of Active Surveillance. There was an increase of only 8.7% in the number of MRIs being carried out at the start of the Active Surveillance programme between 2013 and 2014. The high percentage of 2014 patients that had a template re-biopsy or change in treatment plan prompted by their delayed MRI raises the question that had these patients received an MRI at enrolment, would they not have required a change in treatment plan? This would have saved them emotional distress, and reduced costs to the NHS.
UP.218 New Anterograde Anatomic Radical Retropubic Prostatectomy (RRP2A) Versus Open Retrograde and Laparoscopic Radical Prostatectomy Carrerette F, Rocha Perrone F, Silva Salvador Junior E, da Silva EA, Teofilo Figueiredo Filho R, Costa Lara C, Damião R State University of Rio de Janeiro, Brazil Introduction and Objective: The refinement of surgical techniques and the incorporation of new technology have contributed to better oncological and functional outcome in radical prostatectomy (RP). The goal of this study is to compare the new RRP2A
to radical retropubic prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP). Materials and Methods: Fifteen patients with indi-
cation for RP were randomized from March to July 2015, with five patients in each arm. The new RRP2A performs an anterograde dissection, preserving bladder neck, abdominal urethra, endopelvic fascia and nerve bundles, with the confection of a Van Velthoven running urethrovesical anastomosis, as in videoassisted surgery, but through an open incision. Results: All RRP2A procedures were completed as planned, without conversion to RRP or major complications. All patients (but one) achieved full continence by the time of catheter removal, which occurred one week before the other groups. By the third month of follow-up, all patients in the RRP2A group were continent. No patients in the RRP group and only one patient in the LRP group evolved the same way. All important data are displayed in the table below. Conclusion: This was a pilot study to define param-
eters to evaluate the feasibility, safety and benefit of RRP2A. We compared our first cases of RRP2A with the well-mastered RRP, both performed by the residents. A professor operated the LRP cases. The design of the study permitted bias. The next step will be the development of a study with a larger sample, prospective, randomized and controlled trial, in order to gain statistic significance. This new technique may be the evolution of open RP, and can also be used to prepare new specialists, who in the future, will perform RARP or LRP, decreasing their learning curve.
UP.219 The Specificity and Possible Diagnostic Value of Alterations in the PhysicalChemical Characteristics of Blood Plasma in Men with Prostate Tumors Alibegashvili M1, Bochorishvili I1, Gordeziani M1, Ramishvili L1, Gabunia N2, Chigogidze T2, Khazaradze A1 1
Faculty of Exact and Natural Sciences, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia; 2 Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia Introduction and Objective: The development of a
malignant tumor is accompanied by the appearance of novel tumor specific proteins in blood plasma. The increased composition of acute-phase proteins as well as appearance of modified forms of native proteins and tumor specific proteins (“marker” proteins) takes place in blood plasma. The aim of the study was to establish the specificity and possible diagnostic value of alterations in the physical-chemical characteristics of blood plasma in case of men with prostate tumors. Materials and Methods: Several methods have been used to study the changes that take place in blood plasma during tumor development, including Spectrofluorescence analysis, Differential Scanning Microcalorimetry and Gel Electrophoresis. The object of the study was blood plasma of men with benign prostate hyperplasia (BHP), benign prostate hyperplasia with high-grade prostatic intraepithelial neoplasia (HGPIN) regions and malignant prostate tumor. Results: The study of blood plasma of men with prostate tumors with fluorescence spectroscopy (in
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS amount of middle molecular weight (MMW) substances in blood plasma and erythrocytes.
UP.218, Table 1. VARIABLES
RRP2A
LRP
RRP
PREOPERATIVE DATA AGE
62.8 (58-69)
63.4 (70-54)
66.2 (69-60)
PSA
7.26 (2.9-11.83)
10.32 (4.50-17.45)
11.37 (5.95-15.6)
6 (3+3) (1) 7 (3+4) (2) 7 (4+3) (2)
6 (3+3) (3) 7 (3+4) (1) 8 (4+4) (1)
6 (3+3) (3) 7 (3+4) (2)
D’AMICO RISK SCORE
Intermediate (5)
Low (2) Intermediate (2) High (1)
Low (2) Intermediate (3)
SURGICAL TIME (min)
152 (120-200)
268 (230-300)
142 (120-240)
HOSPITAL STAY (day)
3.8 (3-5)
5.2 (4-6)
3.8 (3-5)
SUCTION DRAIN (day)
3 (3-4)
5 (4-6)
4 (3-5)
CATHETER (day)
9 (7-16)
14
14
0.09 (0.00-0.41)
0.02 (0.00-0.03)
0.02 (0.00-0.07)
GLEASON SCORE (HISTOPATOLOGY)
7 (3+4) (1) 7 (4+3) (4)
6 (3+3) (1) 7 (3+4) (3) 7 (4+3) (1)
6 (3+3) (1) 7 (3+4) (4)
TNM
pT2cN0 (3) pT3bN0 (1) pT3aN1 (1)
pT2cN0 (4) pT3aN0 (1)
pT2bN0 (2) pT2cN0 (3)
POSITIVE MARGIN
3 pT2cN0 1 pT3bN0 1 pT3aN1 1
2 pT2cN0 1 pT3aN0 1
2 pT2cN0 2
4 5 0
1 1 4
0 0 5
GLEASON SCORE
PERI AND POSTOPERATIVE DATA
PSA
CONTINENCE 0 DAYS 90 DAYS INCONTINENCE
Materials and Methods: Red blood cells and blood
plasma of patients with Benign Prostatic Hyperplasia (BHP), Benign Prostate Hyperplasia with PING(3-4) regions and Cancer of the Prostate (CaP) served as material for the studies. Sorption capacity and permeability of erythrocyte membranes, as well as the activity of antioxidant enzymes (CAT, SOD) and amount of MMW substances, had been determined spectrophotometrically. Results: Sorption capacity of erythrocytes stayed the same in cases of BHP and was increased in patients with BHP with PING(3-4) regions and CaP. Erythrocyte permeability was slightly increased by the following dynamics: control group A BHP with PING(3-4) A CaP. SOD activity was sharply increased in cases of BHP and decreased in patients with CaP. CAT activity was altered only for patients with CaP. The amount of MMW substances was raised in all studied groups. The maximum level of the substances accumulation was observed in erythrocytes of patients with BHP with PING(3-4) regions, although in erythrocytes of Cap patients it still remained increased. Endogenous intoxication coefficient was the highest in cases of BHP with PING(3-4) regions. Conclusion: Increased sorption capacity of erythro-
cytes in patients with BHP with PING(3-4) regions and CaP on the one hand and decreased activity of antioxidant enzymes on the other hand points to the alteration of erythrocyte membrane organization during tumor intoxication and reflects the formation of SEI in cases of given pathology. Accumulation of MMW substances, in cases of BHP with PING(3-4) regions and CaP, points to the importance of the assessment of the substances. Formation of SEI was especially expressed in patients with BHP with PING(3-4) regions, which is indicative of the aggressiveness and poor prognosis of the given form of pathology.
UP.221 ultraviolet and visible regions) has been revealed the increase of plasma proteins peak intensity on 340-360 nm, as well as the reduced nicotinamide coenzymes corresponding peak intensity on 450-470 nm. The study of blood plasma by differential scanning microcalorimetry has revealed the increased portion of thermostable (acute-phase) proteins and appearance of modified forms of the given proteins. In the electropherogram of the blood plasma proteins, the additional 98 KD protein has been revealed in the case of benign prostate hyperplasia with HGPIN regions, compared with the control. Also, the appearance of low-molecular weight proteins (41, 38 and 32 KD) in the case of BHP and BHP with HGPIN regions and 88KD in the case of the malignant tumor has been detected. Conclusion: It has been established that in blood plas-
ma of men with prostate tumors, a portion of thermostable (acute-phase) proteins is increased and the appearance of modified forms of the given proteins takes place. The detected changes in blood plasma are expressed in temperature resistance of studied system. The specificity of the studied changes and possible diagnostic value of the used methods (Spectrofluores-
cence analysis, Differential Scanning Microcalorimetry) have been estimated.
Free Radical Processes and Prostate Cancer
UP.220
Kotrikadze N1, Ramishvili L2, Alibegashvili M2, Khazaradze A2, Chigogidze T3
Some Criteria of Endogenous Intoxication in Cases of Prostate Tumors Kotrikadze N1, Zibzibadze M2, Alibegashvili M2, Gordeziani M2, Gabunia N3, Bezhuashvili I2, Chigogidze T3 1
Dept. of Biology, Faculty of Exact and Natural Sciences, Ivane Javakhishvili Tbilisi State University, Georgia; 2Faculty of Exact and Natural Sciences, Ivane Javakhishvili Tbilisi State University, Georgia; 3 Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Georgia Introduction and Objectives: The syndrome of endogenous intoxication (SEI) represents the pathological condition with accumulation of endogenous toxins in biological fluids. The study of the EI of men with prostate tumors has been performed by the assessment of the following parameters: sorption capacity of erythrocytes, permeability of erythrocytes membranes, antioxidant enzymes (Superoxide-dismutase (SOD) and Catalase (CAT)) activities and
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
1
Dept. of Biology, Faculty of Exact and Natural Sciences, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia; 2Faculty of Exact and Natural Sciences, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia; 3Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
Introduction and Objective: The aim of this study was the study of Fe-S (2Fe-2S, 3Fe-4S and 4Fe-4S) centers and free radical processes corresponding signal (g=2.00) in tumor tissues and mitochondria gained from tumor tissue of men with prostate cancer. Materials and Methods: The electron Paramagnetic
Resonance (EPR) method was used for the study. EPR spectra were recorded in the temperature interval of 90-100K. The object of the study was benign and malignant prostate tumor tissue and the mitochondrial suspension gained from these tissues. Results: As a result of the study the EPR spectra was recorded for free radicals (g=2.00), as well as for Fe-S clusters (2Fe-2S, 3Fe-4S and 4Fe-4S) at g=1.94,
195
UNMODERATED ePOSTERS g=2.01, relatively. However, the signal of Fe-S clusters (g=1.94, g=2.01) was decreased and free radicals signal was increased (g=2.00) in cases of malignant tumor tissue. On the EPR spectra of mitochondrial suspension gained from benign tumor tissue of prostate, a high-intensity signal of cytochrome P450 was recorded at g=2.25 and the signal of Mn2+ complexes was recorded at g=2.14, which should be caused by Mn2+ containing superoxide dismutase. In the mitochondrial suspension gained from malignant tumor tissue of the prostate, a sharp increase of cytochrome P450 signal (g=2.25) and a decrease of superoxide dismutase signal (g=2.14) has been detected. Signals of Fe-S clusters (g=1.94, g=2.01) have not been detected for the mitochondrial suspension gained from tumor tissues. Conclusion: The decrease in EPR signals (g=1.94,
g=2.01) of Fe-S clusters was accompanied by the intensification of free radical processes in malignant tumor tissue of the prostate. The intensification of free radical processes and the damage of Fe-S clusters in malignant tumor tissue of prostate point towards the impeded function of Fe-S cluster-containing Respiratory Chain Complexes I and II. The sharp increase of cytochrome P450 signal in the mitochondrial suspension gained from malignant tumor tissue of the prostate points towards impeded steroidogenesis in prostate epithelial cells and towards the weakening of the antioxidant system (reduced superoxide dismutase signal).
UP.222 Equol, a Metabolite Converted from Daidzein by Enterobacteria, Has Chemopreventive and Inhibitory Effects Against Prostate Cancer Tatsumi Y1, Miyake M2, Hori S2, Nakai Y2, Anai S2, Torimoto K2, Fujii T1, Konishi N1, Fujimoto K2, Morizawa Y2 1
Dept. of Pathology, Nara Medical University, Kashihara, Japan; 2Dept. of Urology, Nara Medical University, Kashihara, Japan
Introduction and Objective: Previous reports suggested lower incidence of prostate cancer in Asian countries as compared to western countries are due to higher intake of soy isoflavone-rich diet in Asian countries. Equol, known to be an intestinal metabolite from daidzein, is one of the most common isoflavones. Equol has been shown to have the strongest binding affinities to estrogen receptors and estrogenic activities among the daidzein metabolites. We aimed to investigate whether equol intake would inhibit carcinogenesis and cancer progression using mouse prostate cancer model. Materials and Methods: Four-week-old TRAMP
(transgenic adenocarcinoma mouse prostate)/FVB hybrid mice were randomly divided into two groups: equol diet group (n=30) and control diet group (n=30). The equol diet group was fed including the 0.1%. Five mice of both groups were sacrificed at three time points: week 10, 20 and 25. Prostate tissues, paraaortic lymph nodes, liver and lungs were resected and subjected to H&E staining and immunohistochemical analysis for Ki-67 and epithelial mesenchymal transition (EMT)-related markers including E-cadherin, vimentin, slug and snail.
196
Results: Cancer-specific survival of the equol diet group was significantly longer compared to that of the control diet group (median overall survival, 31 vs. 23 weeks, P<0.01). The incidence of prostatic intraepithelial neoplasia (PIN) in the equol diet group in week 10 was significantly lower than the control diet group (27.8% vs. 45.8%, P<0.01). The incidence of prostate cancer and Ki-67 labeling index in the equol diet group in week 20 was significantly lower than in the normal diet group. Microscopic analysis of lung tissues revealed intake of the equol diet lowered the incidence of metastasis compared to the control diet (26.7% vs. 86.7%, P<0.01), which was mediated by the suppression of EMT in the equol diet group (retain of E-cadherin and low expression of slug).
Conclusion: TPB is increasingly being utilized by
Conclusion: Our findings suggested that equol intake
Kang HW, Seo SP, Kim WT, Kim YJ, Jang H, Yun SJ, Lee SC, Kim WJ
could inhibit tumor growth and lung metastasis of spontaneously-developing prostate cancer via suppression of EMT. Soy isoflavones-rich diet containing daidzein and its metabolite, equol, might suppress aggressiveness and tumor progression, resulting in improvement of the outcome and prognosis of human prostate cancer.
UP.223 Training and Experience in Transperineal Prostate Biopsy: A Single Center Study McGrath S, Fojecki GL, Papa N, Perera M, Lawrentschuk N University of Melbourne, Dept. of Surgery, Austin Hospital, Melbourne, Australia Introduction and Objective: Prostate cancer (CaP) is
the leading cause of cancer in men, with one in six being diagnosed within their lifetime. To date, prostatic biopsy remains the gold standard in prostate cancer diagnosis. Traditionally, prostatic biopsy is performed transrectally under transrectal ultrasound guidance (TRUS). Inherent flaws with TRUS biopsy result in inadequate sample of the apex and anterior prostate. Transperineal prostate biopsy (TPB) has been recently introduced to improve prostate sampling and subsequent accuracy. We aimed to assess the learning curve of TPB in a large metropolitan teaching hospital. Materials and Methods: We reviewed all TPBs that were performed at a single institution since its implementation (n=69) in February 2015. The procedure was performed by surgeons and senior trainees. Statistical analysis of procedure time was compared from the beginning of the implementation at our institution to current date. Control data was obtained from TRUS biopsies (n=74) performed at our institution in the recent period. Results: TPBs were taken from 69 patients age 48-84 years (Mean 65 +/- 7.5). Overall TPB mean procedure time was 65.7 minutes (SD 19.4 minutes), significantly longer than TRUS biopsies (21.4 minutes, SD 18.3) p<0.0001. Operative time decreased with increasing experience (first 23 cases mean: 76.7 minutes SD: 21.8; middle 23 cases mean: 67.3 minutes SD: 9.5; last 23 cases mean: 53.2 minutes SD: 17.5). It was found that with every 10 cases performed, the procedure time decreases by 5.5 minutes (95% CI: -7.42,-3.52) P<0.001 following a standard linear regression, and it continues to fall.
urologists as an accurate sampling method of prostate tissue. Our institution found that TPB procedure time decreases with every 10 cases performed. It is unclear as to what is an acceptable mean procedural time for TPB, and how many cases it takes to achieve this. Further studies regarding specific operator training may be useful for determining this.
UP.224 Next Generation Sequencing Analysis Reveals Differentially Expressed mRNAs in Castration-Resistant Prostate Cancer Compared to Castration-Sensitive Prostate Cancer
Dept. of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea Introduction and Objective: Androgen deprivation
therapies are standard treatment for locally advanced or metastatic prostate cancer (PCa). Many patients develop progressive castration-resistant disease state, with a poor prognosis. Despite extensive studies, the molecular mechanisms underlying castration-resistant prostate cancer (CRPC) progression are unclear. The aim of this study was to identify a genetic signature of CRPC comparing castration-sensitive prostate cancer (CSPC) using next-generation sequencing. Materials and Methods: Using RNA sequencing
(RNA-seq), we compared the mRNA expression levels in 18 tissue samples from 4 paired and 5 unmatched PCa patients. Eight paired tissue samples (CSPC and after CRPC) were collected from 4 same patients and 10 unmatched samples were derived from 5 castration-sensitive prostate cancer and 5 different CRPC patients. Differentially expressed genes were identified and further validated in four independent cohorts (non-cancer BPH, n=61; hormone naive advanced prostate cancer, n=60; CSPC, n=14; and CRPC, n=14), using a quantitative reverse transcription-polymerase chain reaction analysis. Results: Two highly expressed and 10 under-expressed genes in CRPC compared to CSPC were identified using RNA-seq. Consistent with RNA-seq data, AR and SPINK1 were highly expressed in CRPC tissue compared with tissue from CSPC (P<0.001 and P=0.022, respectively). SP8, CEACAM20 and CEACAM22p genes, which were under-expressed in CRPC in RNA-seq were significantly under-expressed in CRPC compare to CSPC in validation cohort (P=0.001, P=0.007, and P=0.015, respectively). Moreover, SERPINB11, SP8, CBLN2, CEACAM20 genes, which were under-expressed in CRPC in RNA-seq significantly under-expressed in non-Pca BPH tissue compared with PCa tissue (P<0.001, P=0.025, and P<0.015, respectively). Conclusions: Our study identified a genetic signature of CRPC compared to CSPS using next-generation sequencing analysis. Differentially expressed genes might serve as progression-related markers and as a therapeutic target for CSPC.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.225 Zero Hospital Admissions for Infection After 577 Transperineal Prostate Biopsies Using Single Dose Cephazolin Prophylaxis Pepdjonovic L1, Tan GH2, Huang S1, Mann S1, Frydenberg M3, Moon D1, Hanegbi U1, Landau A1, Snow R1, Grummet J3 1
Australian Urology Associates, Melbourne, Australia; 2 Alfred Health, Melbourne, Australia; 3Australian Urology Associates, Melbourne, Australia; Monash University, Melbourne, Australia Introduction and Objective: To determine the rate of
hospital admissions for infection after transperineal biopsy of prostate (TPB) with single dose cephazolin prophylaxis using a prospective database. Materials and Methods: A total of 577 patients un-
dergoing transperineal biopsy of the prostate (TPB) had 2 g of cephazolin given intravenously at induction of anaesthesia. Data collected from these patients included age, PSA, prostate volume, number of cores taken and post operative complications. Results: No patients were readmitted to hospital with infection post TPB. Six patients developed acute urinary retention, 1 patient had clot retention, and 1 patient developed clinical prostatitis treated with oral antibiotics in the community. Conclusion: It is safe to use single dose cephazolin
only as antibiotic prophylaxis prior to TPB, negating the need for quinolones. This study supports the current Therapeutic Guidelines recommendation for TPB prophylaxis and the existing evidence that sepsis post TPB is a rare complication. Whether any antibiotic prophylaxis is needed at all for TPB is the subject of a future study.
UP.226 MiR-4638-5p Inhibits Prostate Cancer Tumorigenesis and Angiogenesis by Regulating PI3K/AKT Signaling Pathway Feng N
expression or inhibition of miR-4638-5p could cause suppression or promotion, respectively, of cell proliferation, colony formation and angiogenesis in vitro. Conclusion: In summary, our work revealed that
overexpression of miR-4638-5p could inhibit tumorigenesis and angiogenesis in PCa.
UP.227 Cardiovascular Events in Surgical Castration for Prostate Cancer: Analysis of a Single Institution Scavuzzo A, Reynoso Noveron N, Santana Rios Z, Sanchez VO, Jimenez Rios MA INCan-Instituto Nacional de Cancerologia, Dept. of Urology, Mexico City, Mexico Introduction and Objective: The relationship be-
tween androgen deprivation therapy (ADT) and cardiovascular disease (CVD) remains controversial. We investigate the potential effects of surgical castration (SC) on the risk of coronary heart disease, myocardial infarction, diabetes (DM), and sudden cardiac death in men with prostate cancer (PC). Materials and Methods: This single-institution,
retrospective cohort study included 285 men who underwent bilateral orchiectomy for metastatic PC between January 2004 to December 2013. The purpose of the present analysis is to report diagnosis of DM, CVD, hypertension (HTN), and cerebrovascular events after SC. Results: Mean follow-up was 8.1 years. Data collection is summarized on table 1. Two (0.7%) patients reported cerebrovascular disease after SC. Thromboembolic events in 22 patients (7.7%). Four patients (1.4%) died of myocardial infarction and 85 (29.8%) died of mPC. Conclusion: Medical ADT is associated with an in-
creased risk of cardiovascular complications. Instead in our series, SC seemed to be associated with a low rate of CVD and DM.
UP.227, Table 1.
Affiliated Wuxi No.2 Hospital, Nanjing Medical University, China
Characteristics
Introduction and Objective: MicroRNAs (miRNAs)
Mean (SD)
are conserved small noncoding RNAs, which play a significant role in tumor development and progression. A growing body of research indicates that miRNAs are closely related to prostate cancer (PCa). The purpose of this study was to elucidate the molecular mechanisms of microRNA-4638-5p (miR-4638-5p), a brand new miRNA, as a tumor suppressor in PCa. Materials and Methods: In this present study, we in-
vestigated the expression level of miR-4638-5p among androgen dependent prostate cancer (ADPC) and castration resistant prostate cancer (CRPC) tissues from Chinese patients using miRNA microarray and qRTPCR analyses. MiR-4638-5p’s role in cell proliferation, colony formation and angiogenesis in PC3 and DU145 cells in vitro and tumorigenesis in vivo were studied. Results: We found that the expression of miR-46385p was significantly decreased in CRPC compared with ADPC and functional analyses showed that over-
n =285
Age, years
66.7 (9.3)
Diagnosis of DM before-SC
No Yes
246 (86.3%) 39 (13.7%)
New diagnosis of DM after-SC
Yes
10 (3.5%)
HTN before-SC
No Yes
235 (82.5%) 50 (17.5%)
New diagnosis of HTN after-SC
Yes
14 (4.9%)
Baseline CVD before-SC
No Yes
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Clinical Characteristics and Monitoring Patterns Among Men with Clinically Localized Prostate Cancer Followed with Expectant Management Versus Immediate Treatment in an Integrated Health Care System Cheng IN1, Wang L2, Morgenstern D3, Asner I3, Kariburyo F4, Wang Y4, Xie L4, Danella J5, Meadows E5 1
Roche Molecular Diagnostics, Pleasanton, United States; 2Genentech, Inc., South San Francisco, United States; 3Roche Diagnostics International, Rotkreuz, Switzerland; 4STATinMED Research, Ann Arbor, United States; 5Geisinger Health System, Danville, United States
Introduction and Objective: Expectant management
(EXM) including active surveillance and watchful waiting is a viable strategy for men with clinically localized prostate cancer (PCa). The objective was to compare characteristics and treatment trends for men managed with EXM vs. immediate treatment (IMT) in Geisinger Health System, a community-based health care system in the US, as evidence from the community setting is limited. Materials and Methods: A retrospective cohort study was conducted using linked electronic health records from men aged ≥40 years with clinically localized PCa (T1 or 2, PSA ≤15, Gleason ≤7 (3+4)) diagnosed between January 2005 and October 2013. Cohorts were defined as receiving any treatment (IMT) or no treatment (EXM) within 6 months after index PCa diagnosis. Characteristics were compared between the EXM and IMT cohorts. Monitoring patterns were reported within the first 18 months for EXM. Results: A total of 1425 men met inclusion criteria (EXM 362; IMT 1063). The proportion of men managed with EXM increased from 20% in 2005 to 35% in 2013. Although there were no significant differences between the EXM and IMT groups in index PSA, tumor stage or BMI, the EXM group was older (65.6 vs. 62.8 years, p<0.0001), had a higher Charlson comorbidity index (CCI ≥2, 21.5% vs. 12.2%, p<0.0001), had a higher proportion of low-risk PCa (65.2% vs. 55.0%, p=0.0007) and had a lower proportion with Gleason=7 at diagnosis (22.9% vs. 35.5%, p<0.0001). For the EXM cohort, 181 (50%) of men eventually received treatment. Of the 212 men with ≥1 urology visit and remaining untreated for ≥18 months, 85.8% had ≥1 follow-up PSA while 19.3% underwent a repeat biopsy. For the subgroup analysis stratifying men by D’Amico risk classification, 29% (236/821) of low-risk vs. 20% (117/578) of intermediate-risk PCa received EXM. Among men receiving EXM, 50% of low-risk vs. 53% of intermediate-risk PCa eventually received treatment. Conclusion: The proportion of men managed by
279 (97.9%) 6 (2.1%)
CVD after-SC
Yes
UP.228
5 (1.8%)
EXM increased over the 10-year study period. Men in the EXM cohort had a higher proportion of lowrisk PCa but were older with a higher CCI. These data provide insight into how clinically localized PCa was managed in a community setting.
197
UNMODERATED ePOSTERS UP.229
Introduction and Objectives: Although there are sev-
Materials and Methods: A total of 906 patients re-
Percentage Tumour Volume Predicts Biochemical Recurrence in Low-Risk and Intermediate-Risk Prostate Cancer
eral clinical practice guidelines, the management of prostate cancer is still controversial. The aim of this study is to review treatment strategies for prostate cancer followed in a tertiary care academic center in Buenos Aires, Argentina.
ferred for PSA based screening to Americo Brasiliense State Hospital, without any treatment for prostatic diseases, previous history of lower urinary tract infections, quimitherapy, radiotherapy or surgery, were included. The patients were divided in groups following a self-denominated color skin (white, brown and black) and according to age: Group (1) < 40; Group (2) 40-49; Group (3) 50-59; Group (4) 60-69; Group (5) 70-79; Group (6) ≥80 years old. PSA was collected following the International Federation of Clinical Chemistry (IFCC) 1, by Immulite 2000® (Siemens, USA). For statistical analyses, we used software SPSS (version 17, IBM, USA), following one-way ANOVA and correlation indices of Pearson Spearman’s Rho, p< 0.05.
Thomas B1, Shaw G2, Dawson S3, Vowler S3, Warren A1, Gnanapragasam V4, Shah N1, Neal D4 1
Materials and Methods: We analyzed the treatment
2
strategies for patient with prostate cancer diagnosed between January 2011 and June 2015 at the Hospital Alemán, Buenos Aires. Demographic data and the treatment strategies based on the age group were analyzed. Patients were arbitrarily separated into 3 groups: under 60 years, between 60 and 75 years and over 75 years.
Cambridge University Hospitals, United Kingdom; University College London Hospitals, United Kingdom; 3Cancer Research UK Cambridge Research Institute, United Kingdom; 4University of Cambridge, United Kingdom Introduction and Objective: There is controversy re-
garding the significance of prostate tumour volume as a predictor of recurrent prostate cancer. This study investigated whether tumour volume variables were independent predictors of prostate cancer recurrence in unscreened populations. Materials and Methods: Pre-operative clinicopathological variables, histopathology and follow-up information were obtained from a prospectively collected dataset of the first 850 consecutive patients in a robotic radical prostatectomy series. Univariate and multivariate analysis was performed on the dataset using Cox regression to identify predictors of prostate cancer recurrence defined as follow-up PSA>0.2 ng/ ml or triggered adjuvant therapy after a detectable ultrasensitive PSA. Further multivariate analysis was then performed on the D’Amico high-risk group and D’Amico intermediate and low risk group separately. Tumour volume on final pathology was calculated by a specialist uro-pathologist. Results: Analysis was based on 841 patients with complete survival data. A total of 63 patients had a biochemical recurrence. Median follow-up was 366 days (range 0 to 2195 days). Tumour volume (median 4.4 cc) and percentage tumour volume (median 10%) were both significant predictors of recurrence on univariate analysis (p<0.001 in both cases). On multivariate analysis of the whole dataset, and in the D’Amico high-risk group, neither tumour volume nor tumour volume percentage was statistically a significant predictor. In a separate multivariate analysis of the combined D’Amico low and intermediate groups, percentage tumour volume was significant (p=0.032) with a hazard ratio of 1.02 (95% confidence interval: 1.00 to 1.05) implying a two per cent increase in risk of prostate cancer recurrence with every one per cent increase in the percentage of total prostate occupied by tumour. Conclusion: Tumour volume percentage in a relative-
ly unscreened population may be an independent predictor of recurrent prostate cancer in D’Amico lowrisk and intermediate-risk groups but not in high-risk cancer and this may reflect the biology of these tumours. It is potentially useful in counselling patients post-operatively regarding prognosis and need for adjuvant treatment.
UP.230 Treatment Patterns for Prostate Cancer in a Tertiary Care Academic Center in Buenos Aires, Argentina Blas L, Contreras P, Mieggi M, Vitagliano G, Ríos Pita H, Guglielmi JM Hospital Alemán, Buenos Aires, Argentina
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Results: A total of 260 patients with prostate cancer treated at our service were analyzed. Overall, 19.2% (50 patients) received radical prostatectomy (RP), 10.0% (26 patients) primary androgen deprivation therapy (ADT), 49% (127 patients) radiation treatment (RT) and 9.5% (25 patients) active surveillance (AS), 10.0% (26 patients) androgen deprivation therapy plus radiotherapy (ADT+RT) and 2.3% (6 patients) brachytherapy (BT). Group age analysis showed the following results: Group 1: 63 patients. Median age was 54.59 years (45-59) and average prostate specific antigen (PSA) was 9.17 ng/dl. According to Gleason classification: Gleason 6: 37 patients, Gleason 7: 15, Gleason 8: 6, and Gleason 9: 5 patients. Of the 63 patients, 25 received RP (39.7%), ADT 2 patients (3.2%), RT 20 patients (31.8%), BT 2 patients (3.8%), AS 11 patients (17.2%) and ADT + RT 3 patients (4.8%). Group 2: 161 patients. Median age was 67.48 years (60-74), average PSA was 11.05 ng /dl. According to Gleason classification: Gleason 6: 82 patients, Gleason 7: 52, Gleason 8: 16, Gleason 9: 10 and Gleason 10: 1 patient. Of the 161 patients: 28 received RP (17.3%), ADT 12 patients (7.5%), RT 86 patients (53.4%), BT 4 patients (2.5%), AS 14 patients (8.7%) and 17 patients (10.6%) ADT + RT. Group 3: 46 patients. Median age was 79.75 years (75-93), average PSA 19.1 ng/dl. According to Gleason classification there were Gleason 6: 14 patients, Gleason 7: 17, Gleason 8: 10, Gleason 9: 4 and Gleason 10: 1 patient. Of the 46 patients, 1 patient received RP (2.1%), ADT 14 (30.4%), RT 20 (43.4%), AS 2 (4.3%) and ADT + RT in 9 patients. Conclusions: In our tertiary care academic center, localized prostate cancer was most commonly treated with external-beam radiation therapy.
UP.231 Brazilian PSA Reference Values Obtained from a Sample of Screened Patients: Age and Ethnicity Distribution Rodrigues Junior AA, Cologna AJ, Tucci Jr. S, Molina CAF, dos Reis RB Ribeirao Preto School of Medicine, Sao Paulo University, Ribeirao Preto, Brazil Introduction and Objective: The parameters, and even the relevance of PSA based screening, have been discussed nowadays. In this scenario, is it important to get normal reference values of PSA from the Brazilian population? The objective of this study was to describe the PSA reference values distributed by age and ethnicity.
Results: We analyzed 608 white, 161 brown and 66 black subjects, with PSA values (ng/dl) of 1.51 ± 1.59, 1.69 ± 2.10 and 2.11 ± 2.90, respectively (p=0.002). The PSA values (ng/dl) for age groups 1 to 6 were 0.68 ± 0.48; 0.88 ± 0.56; 1.21 ± 1.19; 1.70 ± 1.87; 2.04 ± 2.05 and 2.66 ± 3.32, respectively (p<0.01). Conclusion: The PSA values presented positive and
significant correlation with age and ethnicity, according to previous literature reports. We believe that is the first report of these features with a focus on the Brazilian population.
UP.232 Reporting and Ideal Testosterone Levels in Men Undergoing Androgen Deprivation for Prostate Cancer: Time for a Re-Think Cabarkapa S1, Manning T2, Christidis D2, Perera M2, Lawrentschuk N3 1 The University of Melbourne, Australia; 2The Austin Hospital, Heidelberg, Australia; 3The Austin Hospital, Heidelberg, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia
Introduction and Objective: Prostate specific an-
tigen (PSA) and testosterone levels are useful monitoring tools for prostate cancer (PC) progression. Correlation between high levels of testosterone and PC progression has underlined the need for chemical or surgical castration. A recent statement from The European Association of Urology (EAU) has defined castration at a lower level <20ng/dL (0.7 nmol/L) than historically agreed upon. This has conferred improved survival rates and a longer duration of response to therapy. Although Androgen Deprivation Therapy (ADT) is commonly used to achieve chemical castration there are currently no standardized reference ranges for testosterone levels in the setting of chemical castration. This study aims to evaluate the proportion of patients on ADT who have undergone concurrent PSA and testosterone testing to determine whether appropriate monitoring of hormonal castration is occurring, in an effort to improve treatment aims and current guidelines. Materials and Methods: We reviewed current labo-
ratory reporting variances in a tertiary institution in those men that were undergoing ADT for prostate cancer. Of these men, we identified those who were chemically castrate and those tested for PSA and testosterone levels at the same time. We assessed patient testosterone values or the subsequent ranges provided
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS and the variance in the reporting of these values within this group of patients. Statistical analysis of patient groups was undertaken. Results: A total of 60 public tertiary hospital patients were reviewed, 47 of which had lab-based data available. Forty-seven patients for inclusion in this study. There were 51.1% of included patients who had PSA and testosterone testing concurrently, and 23.4% of included patients on ADT had T testing within the last 12 months. Statistical analysis of different ADT agents and level of chemical castration was performed with no significant difference between agents found. Conclusion: A large proportion of patients on ADT
were not being assessed for castration effectiveness with testosterone levels. We suggest that a standardized guideline for testosterone levels in ADT should be agreed upon by authoritative bodies to ensure optimal survival benefit to this patient population.
UP.233 Prostate Cancer: Rectal Recurrence After Radical Prostatectomy Romeo A, Andrade Becerra C, Martinez P, Giudice C, Viaña B, Villamil AW Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: Few studies report un-
usual presentations of metastatic prostate cancer. We report our institutional experience with a rare presentation of recurrence of prostate cancer. Materials and Methods: We reviewed a clinical case
of rectal recurrence of prostate cancer. Clinical and pathological data were collected. A PubMed search was performed, including the last 24 years (19822016) and all relevant publications were assessed using the following keywords: prostate cancer, rectal recurrence AND radical prostatectomy. No results were found. Results: In 2003, a 78-year-old patient underwent radical prostatectomy. Pathology reported a Gleason 6 (3+3), (pT2c-pN0-M0). Postoperative PSA controls were 0.02 ng/ml in the first year. PSA then increased up to 1.16 ng/ml in 2009 without metastases and salvage radiotherapy was indicated. In 2010, PSA continued progression and the patient started androgen deprivation therapy. In 2014, the patient developed castration-resistant cancer with a PSA value of 28.1 ng/ml and testosterone level of 0.3 ng/ dl. During treatment, the patient started complaining of rectal pain and tenesmus. CT scan and MRI were performed, and the thickening of rectal and bladder posterior wall was observed. Bone scan did not show pathological images. A rectal biopsy was performed, reporting poorly differentiated carcinoma. An immunohistochemistry: CK7 (-), CK20 (-), CDX2 (-) y PSA (+). Choline PET-CT scan was done. Hypermethabolic rectal wall thickening was observed, with SUV of 13.8 and diffuse bladder captation with SUV of 6. Cystoscopy didn’t show bladder mucosa lesions. Simultaneously, the patient started treatment with abiraterone acetate. In 2015, the patient had a PSA level of 7 ng/ml with rectal and bladder recurrence without other extrapelvic metastases. Anterior and posterior exenteration, ileal conduit (Bricker) and terminal colostomy were performed. Pathology reported prostate adenocarcinoma, with Gleason score of 9 (4+5), with
transmural infiltration of rectal and bladder wall with one positive lymph node. The patient continued with abiraterone acetate treatment and PSA descended to 0.03 ng/ml.
Conclusions: Ureteral injury in gynaecologic surgery is a serious complication. Emergency condition, surgeon experience and age were the most important risk factors of this complication.
Conclusion: Prostate cancer recurrence in the rectum
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after radical prostatectomy and salvage radiotherapy in patients without metastasis is a rare condition. Similar reports have not been found in the literature. Anterior and posterior pelvic exenteration seems to be the treatment of choice in these cases.
Are Urologists Getting French-Fried? Discrepancy Between the Advertised Label Sizes and the Actual Sizes of Endoscopic Urological Materials
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Kulkarni S, Joshi P, Hunter C, Surana S, Homouda A
What Are the Risk Factors for Ureteral Injuries in Gynaecologic Surgery? About 65 Cases
Kulkarni Center for Reconstructive Urology, Pune, India
Sallami S1, Abou El Makarim S1, Ben Reguaya L2 1
Tahar Maamouti Teaching Hospital, Nabeul, Tunisia; 2 Menzel Temim Teaching Hospital, Nabeul, Tunisia Introduction and Objective: We analyzed, through a multicentric series of iatrogenic ureteral injuries observed in gynaecological surgery, risk factors leading to such serious complications. Materials and Methods: We retrospectively reviewed
the records of all patients who had ureteral injuries during gynaecological surgery between January 2000 and December 2015 in three teaching hospitals in the north of Tunisia. Extracted data included age, surgical indication, operative findings, affected side, clinical presentation, imaging investigation and management. These data were examined and analyzed. Chi-squared test was used for statistical analysis. A p-value of less than 0.05 was considered statistically significant. Results: During the study period, 65 adult female patients were hospitalized for gynaecological surgery and had accidently ureteral injuries. Age of the patients ranged from 25 to 71 years (mean age 45.3 years). Most patients (n=46) were from the rural community. Three patients underwent preoperative radiotherapy for gynaecological malignancy. Surgery was performed for hemorrhagic delivery (n=18), uterine fibroma (n=21), cesarean delivery (n=9), cervix cancer (n=5), endometrial cancer (n=3), endometrioma surgery (n=2), ovarian cancer (n=3), ovarian cyst (n=2), uterine leiomyoma (n=1) and uterus bicornis (n=1). Hysterectomy accounted for 35 injuries, and it was hemostatic in 18 patients with uncontrollable hemorrhagic delivery. Surgery was performed by a senior gynecologist in 17 patients. Injuries were recognized intra-operatively in 14 cases only and were repaired immediately. All injuries were unilateral and in the right side in 53 patients. The young age of patients (p=0.04), surgeon experience (p=0.03), operating in emergency condition (p=0.05) and dissecting the right ureter (p=0.04) were the most significant risk factor of ureteral injury. Most of lesions were identified secondarily (2 days-9 months): renal colic (n=49), fever (n=19), urine by the drain (n=6), hematuria (n=4) and septic shock (n=2) and vaginal leakage (n=3). Ureteral lesions were complete or partial ureteral rupture (n=21), ureteral ligation (n=27) and burn by electrocoagulation (n=17). Treatment consisted in ureteral JJ stenting (n=22), uretero-ureteral anastomosis (n=5), ureter-vesical implantation (n=31) and 7 patients required nephrectomy.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Introduction and Objective: In the 19th century, Jo-
seph Charriere developed a uniform, standard gauge for catheters and medical instruments. Urethral stricture disease was at the heart of the inception of the modern French scale. A Charriere unit is now commonly known as a Fr unit. If we measure our endoscopic urologic equipment, would the actual measurements be equivalent to the labeled advertized sizes? This was the question our study aimed to answer. Materials and Methods: The standard definition of
the Fr scale is a circumference in mm. A 30 Fr dilator is equivalent to a 30 mm circumference. The mathematical definition of the Fr scale is diameter in mm X by Pie (3.14). A 10 mm X 3.14 is equal to 31.4 Fr. Furthermore, what about an elliptical object? If the unit of measurement is the diameter, what diameter is used for measurement? Much of our current endoscopic equipment is elliptical. We analyzed 3 different instruments: a 26 Fr TURP sheath, an elliptical 20 Fr cystoscopy sheath and a 6/7.5 rigid ureteroscope. A digital caliper was used to make at least 30 measurements of each diameter and circumference at proximal, mid, distal part. The size of the instrument was derived using two formulas, for diameter and circumference. Results: By diameter, the actual size of the 26 Fr TURP sheath is 27 Fr. A 20 Fr cystoscopy sheath at the narrow portion was 6.09 mm/18 Fr, and at the wide portion 7.96 mm/24 Fr. 6/7.5. The ureteroscope, at the distal end was 6.75 to 9.22 Fr. The proximal portion was 3.52 mm, equal to 10 Fr. By using the formula of circumference, the 26 Fr TURP sheath measured over 27 French, 20 Fr sheath was 23 Fr. The 6/7.5 Ureteroscope was 9.33-12 French. Conclusions: The sizes of our endoscopic instruments are larger than the labeled size. In order to maintain consistency and clinical validity, circumference in mm should be used for calculating and labeling size. In his paper entitled “The Truth About Laser Fiber Diameters”, Dr. Oliver Traxer concludes that most of the information conveyed to urologists regarding laser fiber diameter may be incorrect. Instrument-induced urethral strictures are the second most common cause of urethral strictures. Endourologists should know that the actual size of the endoscope may not be the same as the size that is written on the endoscope itself.
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UNMODERATED ePOSTERS UP.237 A New Technique of Staged Urethroplasty for Complex Penile Strictures Kulkarni S1, Barbagli G2, Joshi P1, Surana S1, Homouda A1 1
Kulkarni Center For Reconstructive Urology, Pune, India; 2Center for Reconstructive Urology, Arezzo, Italy Introduction and Objective: A two-stage urethroplasty with buccal mucosa graft (BMG) is indicated for patients with complex penile strictures including failed hypospadias repair. Some patients have no urethral plate, severe spongiofibrosis, or complete dehiscence. Prior to 2010, we were performing staged urethroplasty, with BMG placement on the first stage. The graft was re-evaluated six months later and stage 2 tubularization was performed. We were not satisfied with additional staging procedures that resulted from graft contracture, scarring, and fistula formation, so we began to consider more effective methods. After 2010, we began performing a Johanson staged urethroplasty in the first stage. The second stage was a single procedure with dorsal inlay of buccal mucosa and tubularization. Our objective is to evaluate success of each procedure. Materials and Methods: We retrospectively reviewed
the charts from 2007 to 2013. In group I, the graft was placed on the first stage, from 2007 to 2010. In group II, from 2010 to 2013, the graft was placed during the second stage at time of tubularization. Results: Common etiology for complex penile strictures in both groups was failed hypospadias (44%). Mean age of group I was 19 years (8-21) and mean age of group II was 23 years (8-34). After mean follow-up of 45 months, 30 patients from group and 38 patients from group II were reviewed. For group I, 25% had contraction of buccal graft requiring additional graft placement, 1 patient had fistula, 1 had dehiscence, and 1 developed urethral stricture at meatus. Of those in group II, 38 patients, 34 (89.5%) were successful and 4 (10.5%) failed. No patient required revision surgery before the second stage.
et al., 2011). However, after PR most patients suffer from severe stress urinary (SUI) needing an artificial urinary sphincter as a second stage procedure. The purpose was to assess the efficacy and safety of the AMS 800 device in stress incontinent patients with a history of PR.
UP.239
Materials and Methods: Since 2009, we prospective-
Einstein Healthcare Network, Philadelphia, United States
ly collect data for all patients who undergo AMS 800 implantation due to SUI at our tertiary center. Further follow-up (FU) consisting of pad test, maximal urinary flow rate (Qmax), post void residual urine, radiography, and standardized questionnaire is scheduled 6, 24 months and every two years thereafter. In this analysis only patients who underwent a PR due to recurrent anastomtic strictures as a first stage procedure and ≥ 3 months later an implantation of the AMS 800 due to SUI as a second stage procedure were included. Primary and secondary endpoints were continence and complication rate. Results: A total of 15 patients with a mean FU of 25.2 months (IQR 6-48) were available for analysis. At baseline mean age was 60 yrs (range 23-77). A distal bulbar double cuff was used in 86.7% or a single transcorporal cuff in 13.3%. Social continence defined as a usage of not more than 2 pads/day was reached in 93.3%, subjective continence was reached in 73.3% and objective continence defined as a maximum usage of ≤ 1 pad/day was reached in 73.3% of all patients. Complications consisted of mechanical failure, arrosion and infection leading to explantation occurred in 3 of the patients. According to Kaplan Meier analysis 90.9% of the implanted AMS 800 devices were still in place at 43 months FU (without statistically significant difference when compared to patients of our data base without previous urethroplasty (Log Rank= 0.99, see Figure1). Conclusion: At midterm FU the AMS 800 seems to
be safe and effective in stress incontinent patients after PR.
Intralesional Collagenase Clostridium Histolyticum Significantly Improves Outcomes in Men with Multidirectional Peyronie’s Disease Gor R
Introduction and Objectives: Peyronie’s disease (PD) remains a burdensome physical and psychosocial disease with a limited number of effective, non-surgical treatment options. Disordered collagen deposition is the accepted mechanism of plaque formation responsible for curvature. Collagenase Clostridium Histolyticum (CCH) is an FDA approved injectable treatment considered first line therapy for PD. CCH enzymatically disrupts the plaque, rendering it susceptible to plastic changes via penile modeling. Penile traction therapy (PTT) applies tension on the plaque, and via mechanotransduction, may also remodel collagen, facilitating straightening. The impact of adjunctive treatment with a penile straightening device is unknown, and herein, is the aim of this study. Materials and Methods: All men with a palpable penile plaque and stable penile curvature of at least 30 degrees for at least one year were included. Each patient underwent four treatment cycles, a minimum of six weeks apart. A complete treatment cycle included two injections, 24-72 hours apart, followed by a combination of penile modeling performed 24-72 hours after the second injection, and two hours of daily penile traction. All directions of curvature were evaluated in a homogenous fashion in the erect state with the aid of a goniometer. Paired t-test was used to evaluate difference in post-treatment curvature. Results: Eighteen men had complete data. A total of 10/18 (56%) had two directions of curvature. Mean time between pre and post treatment curvature assessment was 7.8 months. Seven patients had injec-
UP.238, Figure 1. Kaplan Meier Analysis Comparing Patients With and Without Perineal Reanastomosis
Conclusion: Complex penile stricture patients can be
managed with staged urethroplasty. Placing the BMG during the second stage rather than contemporary first stage is superior to the technique of BMG placement during first stage. This modification decreases patient morbidity, improves success, and results in a small, but significant paradigm shift in the management of failed hypospadias. The technique is reproducible in the hands of any surgeon, avoiding the risk of contraction of the transplanted graft.
UP.238 Prospective Analysis of AMS 800© Implantation after Perineal Anastomosis Ludwig TA, Maurer V, Marks P, Kluth L, Rosenbaum C, Mandel P, Reiss P, Engel O, Riechardt S, Fisch M, Dahlem R, Schüttfort V Dept. of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany Introduction and Objective: Perineal reanastomosis
(PR) is an effective treatment for recurrent anastomotic strictures after radical prostatectomy (Reiss
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36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS tion related complications, including procedural pain, hematoma, ecchymosis, and edema (Clavien I). There were no traction-related complications. Pre and post treatment primary curvature was 48.5 and 36 degrees respectively, resulting in a 25.8% reduction (P=0.049). Mean pre and post treatment secondary curvature was 21.8 and 5 degrees respectively, resulting in a 72% reduction (P=0.001). Conclusion: CCH with penile traction offers clinically
significant improvement in patients with both single and dual curvature PD without traction related complications. Given the robust response to CCH by the secondary curvature, these patients may benefit from a second course of treatment to their primary curvature.
UP.240 Non-Ischemic, ContinencePreserving, Dorsal Inlay Buccal Mucosal Graft Urethroplasty in Females: A Novel Technique Panda A, Singh JC, Devasia A Christian Medical College, Vellore, India Introduction and Objective: Description of a new
technique of female dorsal inlay buccal mucosal graft urethroplasty, which is non-ischemic and continence-preserving. Materials and Methods: Two patients with recurrent female urethral strictures were included. They were advised to stop dilatation 3 months prior to ensure accurate delineation of the stricture. Lithotomy position, stay sutures on the external meatus at 11 and 1 o’clock positions. A guidewire is placed through the stricture into the bladder. With a sharp blade, the urethra is incised at the 12 o’clock from the inner mucosal surface and extended beyond the stricture, short of the bladder neck. The incision is deepened full thickness and stay sutures are taken on both sides to reduce bleeding, increase exposure and improve vision. A nasal speculum is then inserted through the urethra into the bladder. Opening the speculum gives an excellent view of the incised urethra and the proximal bladder neck. The urethral edges are spread away from the midline by opening of the speculum with additional sharp dissection from inside the urethra. No dissection is done around the urethra, the dorsal and lateral surfaces are not detached from the surrounding tissue. This preserves the vascular supply from the top and sides and avoids injury to the clitoral bodies and neurovascular bundles. Five 4-0 PDS sutures are placed using a ski needle in an outside-in fashion; one at the apex of the incision and 2 each on either side. A defatted buccal mucosal graft of appropriate size is then parachuted inside with its tip sutured with the apical stich and the other 4 sutures on either side. The edges are then sutured to the sides of the urethra and the graft quilted to fix the graft and also to achieve haemostasis. The distal end of the graft is tailored and fixed to the vulval mucosa with interrupted sutures. A 18 Fr catheter is placed in the bladder, fixed on the abdomen and removed after 3 weeks. Results: Both patients voided well after catheter re-
moval. Cystoscopy showed complete graft uptake and a widely patent urethra. There was no stress leak.
Conclusions: Minimal dissection around the urethra and incision of the stricture under direct vision prevents ischemia to the urethra and allows continence preservation. The excellent graft uptake prevents recurrent narrowing and results in an excellent functional and anatomical outcome.
UP.241 Two-Stage Management of Severe Bladder Neck Contracture with Associated Urinary Incontinence in Geriatric Patients After Prostate Cancer Treatment Syed K1, Bandukwala N2, Gousse A1 1
Bladder Health and Reconstructive Urology Institute, Miramar, United States; 2Female and Reconstructive Urology, PPG Urology Specialists, Atlanta, United States Introduction and Objective: Anastomotic bladder neck contracture (BNC) associated with urinary incontinence (UI) is a major complication associated with significant impact on quality of life (QOL) in patients who have undergone radical prostatectomy (RP) and/or radiation therapy (RT) for clinically localized prostate cancer. We report our experience using a two-stage rather than a synchronous, approach in the management of complicated bladder neck contracture (BNC) in a geriatric population. Materials and Methods: A retrospective chart reviewed from June 2012 to August 2015 identified 59 patients with the diagnosis of RT or RP induced BNC associated with UI. Sixteen patients proceeded with our two-stage management, which consisted of initial deep transurethral incision of bladder neck contracture (TUIBNC) with Collin’s knife electrocautery followed by implantation of an AMS-800 artificial urinary sphincter (AUS) after documented stabilization of BNC with bladder neck patency demonstrated cystoscopically. Results: Patients older than 65 were assigned to the geriatric subpopulation and the final study group was comprised of 14 patients (mean age 76 years). Prostate cancer treatment consisted of RP in 3 patients, RT in 6 patients, and a combination of RP and RT in 5 patients. Eleven patients required only one TUIBNC and 3 required more than one TUIBNC prior to AUS implant. At mean follow-up of 55 weeks, 11/14 patients (78.5%) were socially continent using less than 1 pad/day and reported great satisfaction with the device. All patients have remained clinically patent thus far and none have required repeat TUIBNC after AUS implant. Average pre- and post-operative post void residuals were 15 mL and 4.93 mL with a percent change of -67%. Data analysis was performed using Microsoft Excel ToolPak. Conclusions: A two-staged approach for treatment of SUI and BNC is highly successful with no patients requiring further treatment. In addition, patients remain socially continent and have high satisfaction rates. Delayed implantation allows adequate resolution and stabilization of the BNC. Chronologic age alone should not deter from AUS placement, as many patients are highly motivated to receive curative treatment of their incontinence. This is the first study that demonstrates that a staged approach is safe and
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
effective and can significantly improve the QOL of geriatric patients.
UP.242 The Effect of Radiotherapy on the Outcome of the Repair of Urorectal Fistulae Ivaz S, Frost A, Dragova M, Bugeja S, Andrich D, Mundy A Institute of Urology, University College London Hospitals, United Kingdom Introduction and Objectives: Urorectal fistulation
is an uncommon consequence of a number of conditions but particularly after the treatment of prostate or rectal cancer. While there is little doubt that post-surgical fistulae can be repaired with satisfactory results, the impact of radiotherapy on the outcome of fistula repair is controversial. Herein we review our experience. Materials and Methods: We have repaired 127 urorectal fistulae after the treatment of prostate or rectal cancer in the last 10 years with a minimum of one year of follow-up. A total of 24 patients have died or have been lost to follow-up leaving 103 patients. A total of 41 patients had an abdomino-perineal repair and 62 patients had a transperineal repair. Of the 41 patients having an abdomino-perineal repair, 37 (90%) had had radiotherapy, or the combination of radiotherapy and surgery. Only 4 patients (10%) had a surgical cause of their fistula. In the transperineal group 18 had had previous radiotherapy (29%) and the remaining 44 (81%) were purely post-surgical fistulae. The principle indication for an abdomino-perineal repair was to deal with sepsis in the pre-sacral space or to deal with radiotherapy problems affecting the bladder or otherwise for omental wrapping of any repair. Results: After a transperineal repair, there were 5 failures in each of the two groups. All 10 failures underwent an abdomino-perineal repair subsequently with a satisfactory outcome in 4 out of 5 in each group. The overall success rate of transperineal repair, therefore, is in excess of 95%. After abdomino-perineal repair, the success rate in both groups was in excess of 90% in both the surgical and the irradiation group. Conclusion: A total of 91% of patients with post-sur-
gical fistulae can be treated by transperineal surgery with a 98% success rate. Only 31% of post-irradiation patients can be treated transperineally. The other 69% will require an abdomino-perineal repair and both approaches are only suitable in carefully selected patients, although the results are satisfactory in 95%. Although the overall success rate is satisfactory the postoperative morbidity of post-irradiation patients undergoing abdomino-perineal surgery is high (62%).
UP.243 Mechanisms and Frequency of Urologic Complications in 73 Cases of Pelvic Fractures Fourati M, Hadj Slimen M, Mejdoub B, Rekik S, Chaabouni A, Rebai N, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia
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UNMODERATED ePOSTERS Introduction and Objective: We aimed to analyze the
UP.245
urological complications of pelvic fractures and to establish a correlation between the type of urological complication and the type of pelvic fracture.
Penile Fractures: The Long-Term Results of Immediate Surgical Management
Materials and Methods: We conducted a retrospec-
tive study including 73 cases of urological complications of pelvic fractures. The modified Tile AO classification was used to understand the mechanisms underlying urological complications. Results: Men were more concerned (95%), than women. The average age was 33.8 years. Street accidents were the leading cause with 41 cases (56%). The urethra was the most affected (40 cases: 26 type A fractures, and 14 type B fractures). The bladder was affected in 15 cases: 7 intraperitoneal ruptures of the bladder (5 type C fractures and 2 type B fractures) and 6 extraperitoneal ruptures of the bladder (type A fracture). A concomitant lesion of bladder and urethra was notified in 8 cases (type C fracture). Conclusion: Urological complications of pelvic frac-
tures are rare, but must be systematically investigated. The modified Tile AO classification is useful to understand the mechanisms responsible for urological complications of pelvic fractures. Unstable fractures (type B and C) have the greatest risk of urological complications.
UP.244 Johanson Urethroplasty (JU) for Recurrent Long Segment Anterior Urethral Stricture Ugwumba F1, Echetabu KN2, Okoh AD2 1
Dept. of Surgery, Urology Unit, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria; 2 Dept. of Surgery, Urology Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria Introduction and Objective: To assess the outcome of
Johanson’s urethroplasty in the management of recurrent long segment anterior urethral strictures. Materials and Methods: A total of 41 patients who had Johanson’s urethroplasty for recurrent long segment urethral strictures, from January 2008 to December 2014 were included in the study. Parameters assessed were hospital stay duration, complications of repair, other morbidities and patency/Qmax at follow-up. Results: A total of 41 patients were seen. Etiology of
stricture was post urethral catheterization and inflammatory in 89% of cases. Mean hospital stay for 1st stage surgery was 2 weeks, with severe wound infection seen in 26.2% of cases. Intervals between 1st and 2nd stages ranged from 12 weeks to 61 weeks. Satisfactory voiding was achieved in 97% at 1 year, with mean Qmax at 1 year being 21.3 ml/sec. Fistula formation was the commonest long-term complication, in 36% of cases. Conclusion: Johanson’s urethroplasty is a valuable
salvage tool for recurrent long segment anterior strictures.
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Fourati M, Hadj Slimen M, Mejdoub B, Chaabouni A, Rekik S, Rebai N, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objectives: Penile fracture is a rela-
tively uncommon form of urologic trauma. The aim of this study was to determine clinical features of penile fracture, to evaluate early results and complications of surgical management, and to assess postoperative sexual satisfaction. Materials and Methods: This was a retrospective
study (January 1985 to December 2014) including 156 patients treated surgically for penile fracture. Mean age of patients was 27 years (16-73). A total of 84 patients were summoned and evaluated postoperatively by the international index of erectile function. Results: Hospital presentation varied between 1 hour
and 10 days. The most common causes were forced manipulation (52%) and trauma during sexual intercourse (27.5%). Clinical features were typical in all cases, and no further investigations were necessary for diagnosis. Patients typically presented with complaints of a penile “cracking” sound (96%), sharp penile pain, rapid detumescence and swelling (100%). Penile haematoma was observed in 95.5%, 7 patients had urethral bleeding and suggesting associated urethral injury. Immediate surgical treatment was performed via a sub coronal circumferential degloving incision in 96% of cases and a localized longitudinal penile incision was done in 4% of cases. Corpus cavernosum fracture was bilateral in 9. Ten urethral injuries were noted. Treatment consisted of evacuation of the haematoma and repair of the corpus cavernosum defect. Anastomosis of the transected urethra was performed over a urethral catheter. There were no significant complications during or soon after surgery. Patients were followed up for 4 months to 12 years. Subjective good erectile function was reported in 91% of cases, pain during erection in 16% of cases and low penile curvature in 6 (4% of cases). Conclusions: Diagnosis of penile fracture is usually made clinically and no further investigations are required. Immediate surgical management has good results, shorter hospitalization and low morbidity. It guarantees an early return to satisfactory sexual activity and normal voiding.
UP.246 Experience with Using the Digestive Tract to Replace the Ureter Fourati M1, Mejdoub B1, Hadj Slimen M1, Fourati H2, Rebai N1, Mhiri MN1 1
Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia; 2Dept. of Radiology, CHU Habib Bourguiba, Sfax, Tunisia
Introduction and Objective: To define the role of the digestive tract as a substitute material for the repair of extensive lesions of the ureter. Materials and Methods: A total of 16 consecutive patients underwent ureteroplasty using the digestive tract for unilateral lesions of the ureter. Mean age was
35 years (12 to 57 years). The indication was given for iatrogenic ureteral injuries (6 cases), specific infectious stenosis (5 cases), retroperitoneal fibrosis (3 cases), valves of the ureter (1 case) and a ureteral tumor (1 case). The mean length of ureteral damage was 7 cm (6-15 cm), located at the iliac ureter (6 cases), ilio-pelvic (7 cases) and all the ureter (3 cases). The graft used was the appendix in 9 cases from slight extended damage of the right ureter. For the 7 remaining patients, we used an ileal graft because of the impossibility of using the appendix for larger lesions of the ureter. Patients were followed for 7.5 years on average (1-14 years). Results: The immediate postoperative course was simple in all cases. Improvement of renal function was observed in 81% of cases. Dilatation decreased in 87%. The main postoperative complications were residual renal failure (3 cases) and stenosis of the uretero-appendicular junction (1 case). Conclusion: Digestive tract can be used as a conduit
for the replacement of large ureteral defects with good and stabilized results.
UP.247 Urethral Injury Associated with Penile Fracture: A Report of Ten Cases Fourati M, Hadj Slimen M, Mejdoub B, Rekik S, Chaabouni A, Rebai N, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objective: Urethral injury associated to penile fracture is relatively rare. Early diagnosis and immediate surgical repair is recommended. The aim of our study is to stress the clinical and therapeutic aspect of this urological emergency. Materials and Methods: Between January 1985 and December 2014, a total of 10 male patients with urethral injury associated to fracture of the corpora cavernosa were studied retrospectively among 156 cases of penile fracture. Results: The average patient age was 31 years (2645 years). Urethral bleeding was noted in 7 patients. Immediate surgical exploration via a penile circular subcoronal incision permitted, after the evacuation of the haematoma, the identification of the corpora cavernosa lesion, which was unilateral (6 cases) and bilateral (4 cases) in association with urethral injury, which was partial (6 cases) and complete (4 cases). The tunica albuginea defect was closed; urethral laceration was then repaired with prolonged urethral catheter placement. With a mean follow-up of 10 years, all patients have a normal erection and pain-free intercourse. Two short urethral strictures were observed and managed non-operatively with good outcome. Conclusion: Urethral lesions associated to penile
fracture affect most frequently young adults. Incidence of such association varies between 2 and 14%. The occurrence of urethral lesions is usually related to vaginal intercourse. The mechanism of trauma is very suggestive, and clinical features are usually typical and additional imaging exams are rarely required. Prompt surgical treatment is the only guarantee for a satisfactory functional result.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.248 Risk Factors for Recurrent Ureteropelvic Junction Obstruction After Open Pyeloplasty
renal disease, history of dialysis and the type of renal transplantation. Preoperative investigation and preparation, as well as details of anesthetic management, were also recorded.
Smaoui W, Touaiti T, Rebai N, Mhiri MN
Results: General anesthesia was performed in 82% of
Dept. of Urology, Habib Bourguiba Academic Medical Center, Sfax, Tunisia
patients and for the rest of the patients, spinal, epidural and combined spinal and epidural were done. The age of the patients was in the range of 12 to 68 years, with a mean of 36 ± 11 years. The mean surgery duration was 2.9 ± 1.1 hours. The most important consideration during surgery is keeping the mean arterial pressure above 95 mmHg and maintaining fluid load with crystalloid.
Introduction and Objective: Recurrent ureteropelvic junction obstruction after open pyeloplasty is a serious complication for which treatment remains challenging. We identified risk factors for persistent obstruction. Materials and Methods: We retrospectively reviewed
the charts of 438 patients who underwent open pyeloplasty between 1990 and 2013. Of these patients, 32 (7.3%) experienced recurrent ureteropelvic junction obstruction. Age, initial preoperative hydronephrosis grade, differential renal function, stones stasis, crossing vessels, ectopic ureteral implanting, a horseshoe and ectopic kidney, retrograde pyelography and stent placement were analyzed. Univariate and multivariate analyses were performed to identify predictive factors for pyeloplasty failure. Results: Median age at surgery was 50 years (range
15-77 years) and median follow-up was 3 years. Of the 438 patients, retrograde pyelography was done in 186 patients (42.4%) and stents were used in 350 (80%). Age, degree of hydronephrosis, differential renal function, stone stasis and stent placement did not have an impact on pyeloplasty outcome on univariate analysis. Recurrent ureteropelvic junction obstruction developed in 26 of 252 who did not undergo initial retrograde pyelography versus in 6 of 186 who did (10.6% vs. 3.2%, p=0.005). On multivariate analysis, lack of retrograde pyelography, crossing vessels, ectopic ureteral implanting, a horseshoe and ectopic kidney, showed significant association with pyeloplasty failure despite adjustment for other risk factors (p<0.05). Conclusion: Identifying predictors of recurrence of
ureteropelvic junction obstruction is paramount in the decision-making revision process.
UP.249 Anesthetic Experiences of 1000 Cases in 10 Years in Renal Transplantation: A Retrospective Study Reza Khajavi M1, Pourfakhr P1, Etezadi F1, Gooran S2, Dehghani S2, Pourmand G2 1
Dept. of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Iran; 2Urology Research Center, Tehran University of Medical Sciences, Iran Introduction and Objective: Since the first renal
transplantation surgery, clinical studies have failed to ascertain the benefit of one anesthetic technique over another. This article provides an overview of the important issues to be considered in these patients, and also discusses several anesthetic challenges in these surgeries. Materials and Methods: Through a retrospective study, we described our experiences over 10 years, from 2002 to 2012, in 1000 cases of living and cadaveric transplants. We reviewed their medical history and noted age, sex, blood groups, cause of end stage
Conclusion: The type and amount of fluid replace-
ment therapy, and optimizing hemodynamic status before and during reperfusion of the transplanted kidney, are of particular importance during renal transplantation surgery.
UP.250 Kidney Transplantation in Old Recipients Romeo L1, Tobar V2, Peri L3, Musquera M3, Alcaraz A3 1
Hospital Español de Mendoza, Argentina; 2Clínica Foscal, Santander, Colombia; 3Hospital Clinic de Barcelona, Spain Introduction and Objective: Over the last decades,
a rise in the incidence of chronic kidney disease and end stage renal disease has been observed around the world. This situation is due to an increase in the aging population, and a higher incidence of diabetes mellitus and hypertension, which cause an increment in the mean age of patients requiring a kidney transplant. In a situation of scarce kidney transplant grafts, a dilemma appears when we have to transplant those old recipients. Materials and Methods: We retrospectively reviewed
a series of 285 patients (190 men and 95 women) who received a first kidney transplant from a cadaveric donor from May 2005 and May 2010 in the Hospital Clinic de Barcelona. Of these patients, 243 patients were younger than 70 years old (Group A) and 42 were older (Group B). The variables analyzed were recipient age, surgical complications, delayed graft function, tumor development, and biopsy proven acute rejection and graft survival. A T-student test was used to compare quantitative variables, Pearson’s Chi-Squared test to compare categorical variables and Kaplan-Meier estimator to calculate survivals. Results: Mean ages of the recipients were 54.23 in A (20.39-69.89) vs. 73.48 in B (70.06-81.43). There were no statistical differences between groups regarding development of urological complications after transplantation: urinary stenosis (4.9% in A vs. 4.8% in B) (p:1), urinary tract fistula (3.3% vs. 7.1%) (p:0.21) and linfocele (4.5% vs. 2.4%) (p:1). No statistical difference was found between vascular complications: arterial stenosis (2.1% vs. 0%) (p:1), arterial thrombosis (0.8% vs. 2.4%) (p:0.38) and venous thrombosis (1.2% vs. 2.4%) (p:0.47). Similar rates of delayed graft function were presented (25.5% vs. 28.6%) (p:0.67). However, young patients were more likely to present with acute rejection on biopsies controls (25.9% vs. 11.9%) (p:0.049). With a median follow-up of 50.82 months, the estimated surveillance of the recipients
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
were 90.2% (A) vs. 73% (B) (p:0.001). On the other hand, the estimated graft surveillance was 87.7% (A) vs. 88% (B) (p:0.721). Conclusions: This study shows that elderly recipients are acceptable candidates for kidney transplantation. Kidney transplant provides long-term graft survival and a good quality of life even in elderly patients.
UP.251 Outcomes of Kidney Transplant in Patients with a BMI of Less than 20 and a BMI of Greater than 30 Romeo L1, Tobar V2, Peri L3, Musquera M1, Alcaraz A1 1
Hospital Español de Mendoza, Argentina; 2Clínica FOSCAL, Santander, Colombia; 3Hospital Clinic de Barcelona, Spain Introduction and Objective: The benefit of kidney
transplantation in patients with abnormal body mass index is controversial. Some studies have demonstrated a recipient being overweight as a risk factor, while others have demonstrated no significant adverse effect on patient and graft survival. Having underweight patients has also been related to early graft loss. The objective of our study is to determine the effect of extreme body mass index (BMI) on graft survival after renal transplantation. Materials and Methods: We conducted a retrospective review of kidney transplants performed in our center between February 2006 and February 2010 in Hospital Clinic de Barcelona. A total of 372 patients were including in the analysis. We categorized recipients according to BMI at transplantation. Patients with a BMI between 20 and 25, which are usually more suitable for surgery, were compared with patients with those with a BMI< 20 and> 30. We analyzed development of surgical complications, delayed graft function, length of hospitalization and biopsy proven acute rejection, as well as graft and patients survival. Pearson’s Chi-Squared test was used to evaluate the association between BMI and surgical complications, delayed graft function, hospital stay, acute rejection and graft failure. The Kaplan-Meier estimator test was used for calculating graft survival. Results: Patients with a BMI> 30 were more likely to develop urinary tract infection (45.7% vs. 28.4%, p: 0.03. OR: 2.12, IC 95% 1.04-4.30), with a higher incidence of wound site infections (13.5% vs. 2.7%, p<0.01. OR: 5.64, IC 95% 1.78-17.85) comparing with the group of reference. No other statistical differences were presented in the occurrence of other surgical complications, length of hospitalization, delayed graft function and acute rejection. On the other hand, recipients with a BMI of less than 20 did not show a difference compared with the reference group in the development of variables analyzed previously. With a median of follow up of 50.82 months, graft and patient survival were similar in the 3 groups. After 3 years, the grafts survival were: 95% (BMI< 20), 95% (BMI=25-30) and 90% (BMI> 30), p: 0.23. Conclusions: Although abnormal weight may be related with certain surgical complications, body mass index is not an independent factor for graft loss and overall survival. We believed that those patients have similar outcomes than patients with body mass index
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UNMODERATED ePOSTERS in the normal range and should be considered for transplantation.
UP.252 Outcomes of Pediatric Renal Transplantation: Urological Versus Non-Urological Causes of End Stage Renal Disease Hussein A, Shoukry A, Fadel F, Morsi H, Shouman A, Aboulela W, Daw K, Aly H, Badawy H, Eissa M, Hussein A Cairo University, Egypt Introduction and Objectives: Causes for end stage renal disease (ESRD) in children can be categorized into urological causes, where the cause of ESRD is due to urinary tract dysfunction, or non-urological causes, where the cause is due to renal parenchymal disease, causing renal dysfunction and ultimately ESRD. We sought to compare the outcomes of urological and non-urological causes of ESRD. Materials and Methods: Patients were divided into 2 groups: urological causes of ESRD versus non-urological causes of ESRD. All patients had at least 6 months of follow-up. The main outcomes included the effect on complications and renal function. Comparisons were carried out using Chi square or student T-test. Multivariate logistic regression analysis was used to define the effect of different variables on the outcome of renal transplantation Results: Our study included 123 patients. Ninety-one patients were male and 23 were female, and mean age was 9 years. Mean follow-up was 50 months. Two thirds of the patients had non-urological causes of ESRD. Patient survival was 100%, and only 1 patient needed a graft nephrectomy 3 months after the transplant. Mean eGFR was 117 ml/min, and did not significantly differ between the 2 groups (p=0.13). Multivariable logistic regression showed that gender (OR 8.7, 95% CI 2.9-26, p=0.0001) and having urological (OR 0.28, CI 0.08-0.98, p=0.05) were significant predictors of better renal function. Non-urological causes of ESRD were significantly less likely to develop complications following renal transplantation (OR 0.28, CI 0.09-0.89, p=0.03). Conclusions: Our data has shown that after intermediate follow-up, patients with non-urological causes of ESRD are more likely to have better long-term renal functions, and are less likely to develop complications following renal transplant. Female patients were also more likely to have better long-term renal function than male patients. However, if the underlying urologic problem is appropriately addressed before transplantation, and closely followed after the procedure, satisfactory and comparable outcomes to patients with normal urinary tracts could be achieved.
UP.253 Peritoneal Dialysis Catheter Placement by Open Surgical Technique: Nikdu Experience Islam MW National Institute of Kidney Diseases & Urology, Dhaka, Bangladesh Introduction and Objective: Peritoneal dialysis is an
underutilized mode of dialysis. Providing peritoneal
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access with a minimum of complications is the key to successful home peritoneal dialysis. The success of catheter placement is critically important for the ability to stay on peritoneal dialysis over the long-term. This article describes the peritoneal dialysis (PD) catheter implantation by open surgical technique, outcome and complications of CAPD catheter. Materials and Methods: In this prospective study, peritoneal dialysis catheter (PDC) for continuous ambulatory peritoneal dialysis was inserted into the abdominal cavity using an open surgical approach. We described our experience of open surgical minimal invasive technique of CAPD catheterization from July 2012 to June 2015. A total of 40 catheters were inserted successfully. Patients were followed up for a variable period of 3-36 months. Results: In this study, common indications of CAPD
catheter insertion were CKD-5 due to diabetic nephropathy, chronic glomerulonephritis, and hypertensive nephrosclerosis. Common catheter related complications were peritonitis, hypokalaemia, exit site infection, catheter malfunction. Late peritonitis remains the major drawback of PD treatment, with the need of temporary or permanent changeover to the HD treatment in 10% of the patients. Conclusion: Enrichment of the physician’s interest
and experience, along with a multidisciplinary approach to outline the optimal strategy of PD-catheter insertion and management of complications may improve technique and patients’ survival and decrease the morbidity.
UP.254 Five-Year Clinical Effects of Donor Bone Marrow Cell Infusions in Kidney Allograft Recipients Pourmand G1, Solgi G2, Gadi V3, Paul B3, Mytilineos J4, Mehrsai A1, Ranjbar M5, Mohammadnia M6, Nikbin B5, Amirzargar AA5 1
Urology Research Center, Tehran University of Medical Sciences, Iran; 2Dept. of Immunology, School of Medicine, Hamadan University of Medical Sciences, Iran; 3Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, United States; 4 Transplantation Immunology, Institute for Clinical Transfusion Medicine and Immunogenetics Ulm; Dept. of Transfusion Medicine, University Hospital Ulm, Ulm, Germany; 5Molecular Immunology Research Center, Tehran University of Medical Sciences, Iran; 6 Dept. of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Introduction and Objective: Augmentation of microchimerism in solid organ transplant recipients by donor bone marrow cells (DBMC) infusion may promote immune hyporesponsiveness and consequently improve long-term allograft survival. Materials and Methods: Between March 2005 and July 2007, outcomes for 20 living unrelated donor (LURD) primary kidney recipients with concurrent DBMC infusion (an average of 2.19 ± 1.13 x 109 donor cells consisting of 2.66 ± 1.70 x 107 CD34+ cells) were prospectively compared with 20 non-infused control allograft recipients given similar conventional immunosuppressive regimens.
Results: With five years of clinical follow up, a total of 11 cases experienced rejection episodes (3 DBMI patients vs. 8 controls, p = 0.15). One DBMC infused patient experienced chronic rejection vs. two episodes (1 biopsy-confirmed) in the control patients. Actuarial and death-censored 5-year graft survival was significantly higher in infused patients compared with controls (p = 0.01 and p = 0.03, respectively). Long-term graft survival was significantly associated with pre-transplant anti-HLA antibodies (p = 0.01), slightly with peripheral microchimerism (p = 0.09) and CD4+CD25+FoxP3+ T cells (p = 0.09). Immunosuppressant dosing was lower in infused patients than controls, particularly for mycophenolate mofetil (p = 0.001). Conclusion: The current findings as well as our pre-
vious reports on these patients indicates clinical improvement in long-term graft survival of renal transplant patients resulting from low-dose DBMC infusion given without induction therapy.
UP.255 Does Hypertension Remain After Kidney Transplantation? Pourmand G, Dehghani S, Rahmati MR, Mehrsai A, Gooran S, Alizadeh F, Khaki S, Mortazvi SH, Pourmand N Urology Research Center, Tehran University of Medical Sciences, Iran Introduction and Objective: Hypertension is a com-
mon complication of kidney transplantation, with a prevalence of 80%. Studies in adults have shown a high prevalence of hypertension (HTN) in the first three months of transplantation while this rate is reduced to 50-60% at the end of the first year. HTN remains a major risk factor for cardiovascular diseases, lower graft survival rates and poor function of transplanted kidneys in adults and children. Materials and Methods: In this retrospective study,
medical records of 400 kidney transplantation patients of Sina Hospital were evaluated. Patients were followed monthly for the 1st year, every two months in the 2nd year, and every three months after that. Results: In this study 244 (61%) patients were male. Mean ± SD age of recipients was 39.3 ± 13.8 years. In most patients (40.8%), the cause of end-stage renal disease (ESRD) was unknown followed by HTN (26.3%). A total of 166 (41.5%) patients had been hypertensive before transplantation and 234 (58.5%) had normal blood pressure. Among these 234 individuals, 94 (40.2%) developed post-transplantation HTN. On the other hand, among 166 pre-transplant hypertensive patients, 86 patients (56.8%) remained hypertensive after transplantation. In all, 180 (45%) patients had post-transplantation HTN and 220 patients (55%) didn’t develop HTN. Conclusion: Based on the findings, the incidence of
post-transplantation hypertension is high, and kidney transplantation does not lead to remission of hypertension. On the other hand, hypertension is one of the main causes of ESRD. Thus, early screening of hypertension can prevent kidney damage and reduce further problems in renal transplant recipients.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.256 Effect of Renal Transplantation on Sperm Quality and Sex Hormone Levels Akbari F1, Alavi M1, Djaladat H2, Pourmand G3, Dehghani S3 1
IVF Unit, Mirzakoochak Khan Hospital, Tehran, Iran; Dept. of Endocrinology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Iran; 3Urology Research Center, Tehran University of Medical Sciences, Iran 2
Introduction and Objective: To assess the effect of
successful renal transplantation on semen variables, sexual function and sex hormone profiles in a clinical trial. Materials and Methods: Thirty patients on hemodial-
ysis underwent renal transplantation. Before and after surgery, their sperm density, motility and morphology were analyzed, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and testosterone levels were measured and compared, and sexual function was assessed using an abbreviated version of the International Index of Erectile Function (IIEF), with a successful outcome defined as a level of satisfaction of 4 or 5 on a 5-point scale. The paired t-test was used to assess the statistically significance of differences in all analyses. Results: Sperm motility improved significantly (P<0.001) but there were no significant changes in morphology or density (P=0.33 and 0.068, respectively). Testosterone levels increased and FSH, LH and prolactin decreased significantly (P<0.05) after renal transplantation. The IIEF showed that of the 30 patients, 14 were impotent before surgery and only six remained so afterward (P<0.05). Conclusion: Although sperm morphology and den-
sity did not improve after renal transplantation, there were highly significant changes in sperm motility. Hormonal levels in patients on hemodialysis improved after transplantation and returned to nearly normal. Sexual function was also significantly better. Further studies are needed to confirm these results.
UP.257 Clinical Relevance of Pre and PostTransplant Immune Markers in Kidney Allograft Recipients: Anti-HLA and MICA Antibodies and Serum Levels of sCD30 and sMICA Solgi G1, Furst D2, Mytilineos J2, Pourmand G3, Amirzargar AA4, Dehghani S3 1
Dept. of Immunology, Medical School, Hamadan University of Medical Sciences, Iran; 2Dept. of Transplantation Immunology, Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, University of Ulm, Germany; German Red Cross Blood Donor Services Baden-Württemberg-Hessia, Ulm, Germany; 3Urology Research Center, Tehran University of Medical Sciences, Iran; 4Molecular Immunology Research Center, Tehran University of Medical Sciences, Iran Introduction and Objective: This retrospective study
aims to determine the prognostic values of HLA and MICA antibodies, serum levels of sCD30 and soluble
form of MHC class I related chain A (sMICA) in kidney allograft recipients. Materials and Methods: Sera samples of 40 living unrelated donor kidney recipients were tested by ELISA and Flow beads techniques for the presence of anti HLA and MICA antibodies and the contents of sCD30 and sMICA. HLA and MICA antibody specification were performed by LABScreen single antigen beads to determine whether the antibodies were directed against donor mismatches. Results: Within the first year post operatively, 9 of 40 patients (22.5%) showed acute rejection episodes (ARE), and four of them lost their grafts compared to 31 functioning transplants (P=0.001). The presence of HLA antibodies before and after transplantation was significantly associated with ARE (P=0.01 and P=0.02 respectively). Sensitization to HLA class II antigens pre-transplant was strongly associated with higher incidence of ARE (P=0.004). A significant correlation was found between ARE and appearance of non-donor specific antibodies (P=0.02). HLA antibody positive patients either before or after transplantation showed lower graft survival rates than those without antibodies during three years follow-up (P=0.04 and P=0.02). Anti-MICA antibodies were observed in 8/40 (20%) and 5/40 (12.5%) of patients pre and post-transplant respectively. Coexistence of HLA and MICA antibodies was shown in 2 of 4 cases with graft loss. A significant increased level was sCD30 at day 14 (P=0.001) and insignificant decreased levels of sMICA pre and post operatively were detected in rejecting transplants compared to functioning graft group. Conclusion: Our findings support the view that moni-
toring of HLA and MICA antibodies as well as sCD30 levels early after transplant has a predictive value for early and late allograft dysfunctions and the presence of these factors are detrimental to graft function and survival.
UP.258 Infectious Complications After Kidney Transplantation: A Single-Center Experience Pourmand G1, Salem S1, Mehrsai A1, Ebrahimi R2, Pourmand MR1, Dehghani S1 1 Urology Research Center, Tehran University of Medical Sciences, Iran; 2Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Iran
Introduction and Objective: Infectious complications after renal transplantation are associated with significant morbidity and mortality. The prevalence of infections in transplant recipients varies from country to country. This study sought to assess the overall incidence of post-transplant infectious complications at our research center in Iran, compared with other centers in the world. Materials and Methods: Between 2002 and 2004, 179 renal transplantations were performed in our center. Of these, 142 were studied and followed for 1 year. Immunosuppressive regimens utilized cyclosporine, mycophenolate mofetil, and prednisolone. Results: The overall incidence of infections was 54.2%. The most common sites of infections were the urinary tract (41.5%) and the respiratory tract (6.3%). The most frequent causes of infections were Klebsiella
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
(24%) and cytomegalovirus (CMV) (17.6%). Wound infection occurred in 4.9% of the patients. Three (2.1%) patients developed hepatitis C and 2 (1.4%) had mycobacterial infections. There was no case of Pneumocystis pneumonia. Overall mortality was 7.7%. Infection-related mortality was 3.5%. Conclusion: In conclusion, this study indicates infec-
tions as the cause of morbidity and mortality in the post-transplant period. There was a low incidence of tuberculosis (2% yearly) and a high incidence of CMV disease in our recipients.
UP.259 An Aspect of Kidney Transplantation from a Related Living Donor Rabii R University Hassan II, Casablanca, Morocco Introduction and Objective: The kidney transplantation (KT) is the wire chief of organ transplants, and remains the ideal solution for patients with end stage renal disease (ESRD). It provides several advantages over other substitution techniques, such as improving the quality of life after KT as well as avoiding postoperative mortality. Materials and Methods: In this work, we report the
experience at the University Hospital of Casablanca regarding the KT from living donors over a period of 2 years. We have described the various steps taken by the patient with ESRD, candidate for transplant, from the beginning to the final transplantation. We also identified, analyzed and discussed the complications those patients faced, including the surgical ones. Results: Between December 2013 and December 2015, 16 consecutive kidney transplants were performed in the University Hospital of Casablanca. The specific characteristics of our couples, grafts and the surgical methods were described. The surgical complications were studied in details. The average age was 45.6 years for our donors, and 32.9 years for our recipients (pediatric recipients were excluded). Among our recipients, the average time between the start of dialysis and transplantation was 35 months and the average of residual diuresis was 400 ml/day. A total of 62.5% of our recipients had conserved diuresis. The postoperative evolution was simple for our donors, with no postoperative mortality (0%) and an average of 6.3 days of hospitalization. As for recipients, 6 surgical complications were recorded (37.5%). Vascular thrombosis was found in 2 of our recipients (12.5%) who were involved in graft loss after failure of surgical recovery. Lymphocele was observed in 2 patients (12.5%) in whom treatment was based on repeated ultrasound-guided punctures and antibiotic therapy. Laparoscopic marsupilisation was used in one of our 2 patients with lymphocele after treatment failure. In terms of urological complications, one patient had a urinary fistula (6.25%), with vesico-urethral reflux VUR (6.25%) after the removal of the double J stent (6.25%). In the same patient, endoscopic treatment was chosen as an alternative with a view to repair the antireflux system. Conclusion: Despite the small number of transplants
in our series, the results of our experience were very encouraging compared to literature’s data, which
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UNMODERATED ePOSTERS promises a better future for the patients with ESRD in our region.
UP.260 Kidney Transplantation from an Unrelated Living Donor Rabii R, Goultaiene A, El Moutawakkil T University Hassan II, Casablanca, Morocco Introduction and Objective: Kidney transplantation is the optimal treatment modality for ESRD. Although it is authorized in other countries, transplantation from an unrelated living donor is not practiced in our country. Only transplants from related and cadaveric donors are practiced. Materials and Methods: The aim of our study is to evaluate the knowledge of patients with ESRD on various therapeutic modalities, including kidney transplantation, and their expectations regarding the origin of the donor (related, unrelated or cadaveric). Results: Our work is a descriptive cross-sectional
study, established through a field survey conducted among a random sample of 170 patients over a period of three weeks. The respondents were represented by patients of four dialysis centers in Casablanca. The average age of our patients was 49 years with 56% of patients being female, and 78.2% of patients had medical coverage. The majority of our patients (71.8%) were on hemodialysis for at least 1 year, 64% of patients were informed about renal transplantation after beginning hemodialysis, and 56.5% of our patients preferred the cadaveric donor. A total of 83.5% were not registered on the national waiting list, while 16.5% were enrolled with a mean duration of 2 years. A total of 100% of our patients were never informed about transplantation from an unrelated donor, but 89.4% of them were for this type of transplant. Conclusion: This study allowed us to get an idea about
patient knowledge on kidney transplants, and their opinion surrounding unrelated living donors, which could provide a solution to the organ shortage in our country. We take these findings as a model for the national programs in Iran and Israel, countries with a virtually non-existent waiting list.
UP.261 A Randomized Prospective Comparison of Pure Laparoscopic and Laparoendoscopic Single-Site plus One-Port Donor Nephrectomy Lee KW1, Jang H2, Ha US1, Hong SH1, Lee JY1, Kim SW1, Cho HJ1 1
Dept. of Urology, College of Medicine, The Catholic University of Korea, Seoul St Mary’s Hospital, Korea; 2 Dept. of Urology, College of Medicine, The Catholic University of Korea, Daejeon St Mary’s Hospital, Korea Introduction and Objective: The purpose of this
study was to present a comparison between pure laparoscopic and laparoendoscopic single-site plus oneport donor nephrectomy (LESSOP-DN) with respect to clinical outcomes, cosmetic results and short-term recovery results. Materials and Methods: This is a prospective, randomized and comparative study. This trial was prospectively randomized for 55 consecutive living do-
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nors underwent LESSOP-DN (29 left DN) and pure laparoscopic donor nephrectomy (PLDN) (25 left DN) from December 2014 and October 2015. The primary end point of this study was a cosmetic result from a patient-reported questionnaire. We evaluated demographics, clinical outcomes, pain scores using visual analogue scale (VAS) and results of the questionnaire including the RAND 36-item short-form health survey (SF-36) and patient-reported overall convalescence. Results: There were no demographic differences between both groups, including donors and recipients. The mean time to renal extraction (62.9±13.5 vs. 67.7±11.9 minutes, p=0.173), warm ischemia time (161.3±43.3 vs. 160.0±40.2 seconds, p=0.903), estimated blood loss (25.7±36.4 vs. 29.6±58.4 minutes, p=0.764), transfusion (0 vs. 1 case), length of hospital stay (3.6±1.3 vs. 3.6±1.2 days, p=0.932) and complication rate (10.3% vs. 15.4%, p=0.696) were similar in both LESSOP-DN and PLDN groups. Conversion to hand-assisted surgery during the study period was required in one LESSOP-DN (3.4%). The postoperative pain scores using VAS and analgesic requirements converted to morphine equivalent dosage (90.33±38.94 vs. 94.23±41.33 mg, p=0.718) were similar till discharge day after surgery. The LESSOP-DN group had a smaller incision length (4.7±0.8 vs. 6.2±1.2 cm, p<0.001) and similar cosmetic scores (18.0±4.3 vs. 19.1±4.1, p=0.539). One graft loss from each group occurred. The donor’s quality of life (SF36), body image scores, and recovery and satisfaction data were comparable for both groups. Conclusion: This trial suggests that LESSOP-DN
offers a safe and effective alternative to PLDN with comparable surgical results. LESSOP-DN group has smaller incision size than PLDN. LESSOP-DN might contribute comparable recovery and cosmetic results to the altruistic donors.
UP.262 Safety of Polymer Clips in Laparoscopic Living Donor Nephrectomy: An Indonesian Experience Sidabutar K, Hamid AR, Rasyid N, Wahyudi I, Mochtar C University of Indonesia, Depok, Indonesia; Ciptomangunkusumo Hospital, Jakarta, Indonesia Introduction and Objective: To assess the reliability
and safety of polymer clips for vascular control in laparoscopic living donor nephrectomy. Materials and Methods: We collected data retrospec-
tively from all laparoscopic living donor nephrectomies performed at Ciptomangunkusumo Hospital, Jakarta, Indonesia. Polymer clips were applied for both renal artery and renal vein ligation. The incidence of polymer clip failure was recorded accordingly. Results: Between November 2011 and August 2015, we evaluated 260 patients who underwent laparoscopic living donor nephrectomies in a center. The left kidney was harvested from 219 (84.5%) patients. Multiple renal arteries were discovered in 25 (9.6%) patients. For all cases, we used polymer clips to control the renal artery (XL and L) and renal vein (XL). We placed 2 clips as proximal as possible to the aorta or caval vein. The median estimated blood loss was
100 (20-2000) ml. A blood loss of 2000 ml occurred in one case of clip dislodgement. The median time to clip (the length of time from first incision to renal artery clamping) was 155 (68-318) minutes. The median warm ischemic time (the length of time from clamping to cold ischemic time) was 3.01а(1.22-30.43) minutes. There were 10 cases with warm ischemic time of more than 10 minutes. Three cases (1.2%) of clip failures occurred. One patient needed conversion to open surgery to achieve adequate vascular control. Two patients experienced improper locking of the polymer clips, necessitating clips reapplication. Conclusion: The use of polymer clips for vascular
control in laparoscopic living donor nephrectomy is а reliable and safe when properly applied. However, the evaluation of renal vascular stump after harvesting donor kidney is an important step to ensure the right placement and safety of polymer clips.
UP.263 Experience of Open Versus HandAssisted Live Donor Nephrectomies at Shifa International Hospital Iqbal N, Younes N, Butt FI, Bhatti JRA, Hasan A, Ehsan AA, Jamil MI, Masood A, Zahid H, Akhter S Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: Several surgical techniques have been developed so far to minimize donor postoperative complications. Laparoscopic live donor nephrectomy has evolved as a minimally invasive modality. Here we share our experience of 335 live donor nephrectomies to find out the differences in outcome of open and hand-assisted laparoscopic donor nephrectomies. Materials and Methods: All patients underwent pre-operative evaluation and were counseled in detail about the possible risks and complications of the surgery. The patients were analyzed for age, gender, procedure time, hospital stay and on table and post operative complications (sepsis, wound infection, hernia, UTI, hematuria, incision site or flank pain). Results: A total of 335 potential renal donors, 110 who underwent open surgery using flank incision, 235 donors who had live hand-assisted laparoscopic donor nephrectomy, were included. The mean age of patients was 34.73 ±11.49 and 35.73±10.35 years in the open and laparoscopic groups respectively. In the laparoscopic group, 134 patients had midline supra umbilical incision for introducing the gel port for use for left hand introduction into the abdominal cavity of the donor. In 66 patients, left para median incision was used for gel port due to the larger abdominal girth or circumference in these patients. In another 35 patients, right para median incision was used owing to the smaller abdominal circumference in them. Total mean operative time was 288.92±69.84 and 318.92±56.08 minutes in the open and laparoscopic groups respectively. Hospital stay time in days was 4.47±1.02 and 3.47±0.89 in the open and laparoscopic groups. Warm ischemia time was 74.32±9.41 and 162.89±121 seconds respectively. In terms of complications, we noted blood loss of 300 ml on average in 3 patients and 19 patients in the two groups. Post operatively, while prolonged ileus requiring nil per orally for more than 24 hours was seen in 4 pa-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS tients in open while 13 patients in the laparoscopic group. Incisional hernia was seen in 1 (0.45%) patient only (0.42%) in the laparoscopic group. Hypertension was seen in one (0.42%) patient, while depression was evident in 1 (0.4%) patient only postoperatively in the laparoscopic group. Conclusion: Operative time and hospital stay and
warm ischemic time were longer in the laparoscopic group but early recovery was a good sign.
UP.264 Experience of Pediatric Renal Transplantation at Shifa International Hospital Iqbal N, Khan MA, Khawaja A, Hasan A, Alam MU, Jamil MI, Hussain I, Akhter S Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: Pediatric kidney trans-
plant recipients have challenges including drug metabolism and clearance, perfusion of transplanted organs, and risk for post transplant lymphoproliferative disease. They have special quality of life issues such as cosmetic side effects, stunted growth, and problems of adolescent children’s non-adherence to immunosuppressive therapy. We share our experience regarding outcome and complications in pediatric transplants. Materials and Methods: A total of 37 patients un-
derwent live related kidney transplant at our center from June 2005 to December 2015. They were evaluated before renal transplant, and cross matching and HLA typing was done. A total of 23 children had a single antigen match, while 5 patients had 2 antigen matches, 7 patients had 3 antigen matches, one had 4 antigen matches and 1 patient had 6 antigen matches. Kidney transplant was done by standard technique and the kidney was placed in the abdomen and the renal artery was anastomosed to the aorta. The ureter was anastomosed to the bladder by creating a submucosal tunnel for antireflux mechanism. We collected data retrospectively for variables like age, weight, mean operative time, mean hospital stay and JJ stent.
UP.265 Prostate Carcinoma in Solid Organ Transplant Recipients Tillou X1, Guleryuz K1, Chahwan C1, Bouvier N1, Altieri M2, Belin A3, Doerfler A1 1 Dept. of Urology and Transplantation, University Hospital of Caen, France; 2Dept. of Hepatology, University Hospital of Caen, France; 3Dept. of Cardiac Transplantation, University Hospital of Caen, France
Introduction and Objectives: Improvements in immunosuppression and anti-infection drugs in solid organ transplantation have led to a significant increase in survival for patients and grafts. Prostate cancer (PC), being the most common tumor in men and given the increasing number of old male recipients, should show an increasing incidence in solid organ transplant recipients (SOTR). The aim of this study was to analyze retrospectively our liver (LTR), kidney (KTR) and cardiac transplant recipients (CTR) treated for PC. Materials and Methods: Between January 1993 and
December 2005, we found 50 cases of PC in 1 467 male SOTR (3.4%) (30 cases in KTR, 14 PC cases in LTR and 6 cases in CTR). Median age at diagnosis was 64.35 (range 51.7-77.6) years old and the median interval from transplantation to diagnosis was 66.36 (9.1-241.5) months. Median PSA level was 7 (0.5-14) ng/ml. Clinical stages were T1, T2 and T3 in respectively 28, 17 and 5 patients. Diagnosis was suspected during screening because of prostatitis or bone pain (44 and 1 patients, respectively). Three PC were discovered after prostate transurethral resection. Results: A total of 35 patients (23 KTR, 10 LTR and 3 CTR) underwent radical prostatectomy (RP). Histological findings were 26 pT2c and 9 pT3 tumors, with 5 positive surgical margins. Gleason score (GS) was 5 in 1 case, 6 in 27 cases, 7 in 6 cases and 9 in 1 case. One patient with positive pelvic lymph nodes was given hormonotherapy. Another had a biochemical
UP.266 Prostate Cancer Before Renal Transplantation: A Multicenter Study Tillou X1, Chahwan C1, Bouyé S2, Brichart N3, Culty T4, Iselinb C5, Pfister C6, Sallusto F7, Salomon L8, Verhoest G9, Viart L10, Doerfler A1 1 Dept. of Urology and Transplantation, University Hospital of Caen, France; 2Dept. of Urology and Transplantation, University Hospital of Lille, France; 3 Dept. of Urology and Transplantation, University Hospital of Tours, France; 4Dept. of Urology and Transplantation, University Hospital of Angers, France; 5Dept. of Urology and Transplantation, University Hospital of Geneva, Switzerland; 6Dept. of Urology and Transplantation, University Hospital of Rouen, France; 7Dept. of Urology and Transplantation, University Hospital of Toulouse, France; 8Dept. of Urology and Transplantation, University Hospital of Créteil, France; 9Dept. of Urology and Transplantation, University Hospital of Rennes, France; 10Dept. of Urology and Transplantation, University Hospital of Amiens, France
Introduction and Objective: The surgical issues of
renal transplantation (RT) after localized prostate cancer (PC) treatment and oncological outcomes after transplantation in patients on the waiting list with
Treatment
KTR
LTR
CTR
Transplanted male population
851
361
255
Radical Prostatectomy
22
10
3
BOLA
1
2
2
External Beam Radiotherapy
2
1
0
Radiotherapy + Brachytherapy
1
0
0
HIFU
1
0
0
Hormonotherapy
2
0
1
Active surveillance
0
1
0
1
0
0
Median age at PC (min-max) (years old)
64 (52-78)
64 (52-71)
62 (54-70)
Median Time between PC and Transplantation (months)
57 (9.1-189)
61 (11-141)
76 (33-158)
Time after treatment (months)
72 (14-199)
63 (5-103)
27 (4.9-65)
2
1
1
Clinical monitoring
Follow-up
Conclusion: Pediatric renal transplant poses chal-
lenges like graft failure, medication compliance and follow-up problems in developing country like ours.
Conclusions: Prevalence of PC in SOTR remains controversial, even though a significant increase can be expected in the coming decades. It is therefore recommended to systematically screen male transplant recipients after 50 years of age because outcome is much better if PC is diagnosed and treated early. Radical prostatectomy is feasible in KTR as well as in LTR and CTR.
UP.265, Table 1.
Results: We operated on 37 children having end stage
renal disease for renal transplant with a mean age of 13.06± 3.90 years. Mean dry weight was 37.53±15.40 kilograms. Mean operative time was 396.57±25.04 minutes and mean hospital stay was 6.14±0.89 days. There was a single renal artery in 35 patients, while 2 children had 2 renal arteries. Permanent graft dysfunction was seen in 6 patients, while graft failure was seen in 5 patients. Time of rejection was 6 months for 5 children, 7 to 12 months for 1 patient and after 1 year for 4 patients. One patient had graft failure after 10 years. We used a double J stent for ureter in 5 patients. Recurrent UTI was seen in 9 patients. One patient had a stricture at vesicoureteric junction while another patient had ureteric stricture at mid ureter. They were managed by re-implantation of the ureter. We had 86% graft survivals in first six months, 83.7% after one year and 67.56% survival after 5 years.
recurrence at 10 months and was treated with salvage radiotherapy. One patient is still on active surveillance. With a mean follow-up of 63.4±42.3 (0.6-199.1) months, two KTR died from KP, 3 and 11 years after hormonotherapy and RP respectively.
Specific death
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
207
UNMODERATED ePOSTERS a history of PC were unknown. Our study examined characteristics of recipients and prostate cancer discovered during pre-renal transplantation check ups. We also analyzed surgical difficulties of renal transplantation related to PC treatment (RP, lymph nodes dissection or radiotherapy) and the results of renal transplantation after radical prostatectomy. The oncological follow-up before and after renal transplantation were analyzed, especially the time-lapse between PC treatment and renal transplantation according to the D’Amico PC classification Materials and Methods: We performed a retrospective data analysis including all patients diagnosed with PC before renal transplantation in 10 urology and transplantation departments across the country. Fifty-three patients were treated for PC prior to renal transplantation from August 2003 to December 2015. Forty PC cases were diagnosed during the pre-transplant check-up and 11 after individual screening. Two patients were diagnosed on chip analysis after transurethral resection. Results: The median age at diagnosis of PC was 59.7 years old. The median PSA rate at diagnosis was 6.9 ng/ml. A total of 29, 23 and 1 PC cases were low, intermediate and high-risk, respectively, according to D’Amine classification. Forty-seven patients were treated by radical prostatectomy (RP): 28 retropubic, 17 laparoscopic and 2 by a perineal approach. Eighteen patients had a lymph node dissection. Four patients were treated with external radiotherapy and 2 by brachytherapy. Eight patients underwent radiotherapy after surgery. The median time between PC treatment and RT was 34.3 months. A total of 25 RT (47.1%) were described as difficult by the operator. Post-transplantation surgical complications were not significantly associated with difficult dissection (p=0.2) but vessel dissection difficulties were associated with lymph node dissection (p=0.002). No recurrence of PC was observed after a median follow-up of 34 months. Eleven recipients were transplanted less than 24 months after prostatectomy (23.4%) and among them 6 less than 15 months (12.7%). Median time between PC treatment and RT was shorter for patients with low D’Amico risk than for patients with intermediate or high D’Amico risk: 25.4 vs. 46.6 months with a statistical difference (p=0.0005). Conclusion: PC discovered before RT should be
treated with RP to assess the risk of recurrence and decrease waiting for a RT. If PC is at low-risk of recurrence, it seems possible to shorten the waiting time before the RT after a multidisciplinary discussion meeting.
UP.267 The Impact of Donor Type on Graft Survival Rate Fourati M, Mejdoub B, Hadj Slimen M, Chaabouni A, Rekik S, Rebai N, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objective: We have usually considered that live-donor renal transplant (LRT) has better results than cadaveric donor renal transplant (CRT). The aim of this study was to determine the impact of donor type on graft survival rate and complication rate.
208
Materials and Methods: We reviewed records of 284
UP.269
patients who received renal transplants from living donors (GP1) and 53 patients (GP 2) from cadaveric donors, from 1994 to 2014. Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS) software (version 20). Qualitative variables were analyzed with chi 2 test. The log-rank test was applied to the survival analysis.
Serum Vitamin D Level in Benign Prostatic Hyperplasia and Hypogonadism Has Different Correlations According to Metabolic Status
Results: The mean age at transplantation was 42 years (18-73 years) in the first group and 33 years in the second group. There was no significant difference in the two groups concerning acute graft rejection (p=0.16), vascular complications (p=0.41) and urological complications (p=0.46). Survival curves of the two groups were stackable. Conclusion: CRT can have comparable results with
LRT. Thus, CRT could constitute a precious solution to palliate the lack of living donors.
UP.268 Does Renal Transplantation with Multiple Arteries Affect Graft Survival? Smaoui W, Touaiti T, Rebai N, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Academic Medical Center, Sfax, Tunisia Introduction and Objectives: We compared shortand long-term outcomes of renal transplants with single versus multiple arteries. Materials and Methods: We retrospectively analyzed
data from kidney transplants from 208 living donors performed between 1994 and 2015. Renal grafts were divided into two groups: single renal artery (n=192) versus multiple renal arteries (n=62). The groups were compared regarding early and late vascular and urological complications. Patient and graft survivals were compared using Kaplan-Meier survivorship curves with comparisons using the log-rank test. Results: Both groups were comparable regarding acute rejection episodes, post-transplant hypertension, post-surgery renal artery stenosis, and urologic complications. Only hemorrhagic complications and renal artery thrombosis were significantly higher in the multiple renal arteries group (P=0.027 and 0.03, respectively). Warm ischemia time was significantly longer in the multiple renal arteries group without any influence on the incidence of acute tubular necrosis (P=0.2). Mean creatinine clearance at 1 year was 67 versus 51 ml/min/1.73 m (2) (P=0.5) and at 5 years, 61 versus 56 ml/min/1.73 m (2) (P=0.1) for the single versus multiple renal arteries groups, respectively. Return to hemodialysis was necessary for 18.8% of the single and 16.1% of the multiple renal arteries group. Conclusion: The use of an allograft with multiple re-
nal arteries is a safe, successful surgical procedure, that does not influence patient or graft survival, or increase surgical complication rates, provided the surgical team is evolved with technical skill.
Lee JW1, Yeo JK2, Cho DY2, Park MG2 1
Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea; 2Inje University, Seoul Paik Hospital, Korea Introduction and Objective: To investigate the differences in relationships between serum vitamin D levels, prostate volume, and hypogonadism according to metabolic status. Materials and Methods: A total of 612 men (48.3±7.8 years) enrolled in the study underwent physical examination and biochemical/hormonal blood testing (fasting glucose, total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, creatinine, uric acid, total testosterone [TT], vitamin D, calcium, phosphate, homocysteine, and prostate-specific antigen). International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), and Aging Male Symptom scale (AMS), that enabled identification and grading of lower urinary tract and hypogonadism symptoms, were assessed, and transrectal ultrasound prostate evaluations were performed in 200 men. Results: TT showed a significant positive correlation with vitamin D (r=0.161, p=0.000), while the number of metabolic components and erectile function (EF) score, also showed statistically significant negative correlation (r=0.178, p=0.000 and r=0.161, p=0.035, respectively). When the participants were divided into two groups according to metabolic syndrome status and compared, the level of vitamin D was statistically significantly lower in the group with metabolic syndrome than in the group without diagnosis of metabolic syndrome (p=0.001). When analysis was conducted separately on the group with metabolic syndrome (n=135) to examine correlations between vitamin D, TT, prostate volume, and IPSS, the results showed that vitamin D was not significantly correlated with any of the factors. In contrast, when analysis was performed on the group without diagnosis of metabolic syndrome (n=477), vitamin D showed a significant positive correlation with TT (r=0.205, p=0.000), and significant negative correlations with prostate volume (r=-0.186, p=0.029), IPSS (Quality of Life, r=-0.184, p=0.033), and AMS sub-item scores (r=-0.182, p=0.036). Conclusions: Vitamin D was closely associated with metabolic status and TT, and an association between vitamin D and benign prostatic hyperplasia was also found, in the absence of a diagnosis of metabolic syndrome. The association between vitamin D and hypogonadism varied according to presence or absence of metabolic syndrome. Therefore, when treating patients with BPH or hypogonadism, clinical usefulness of vitamin D can differ depending on metabolic status.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.270
Erectile Function (IIEF) 5>21). The most frequent complication was subcutaneous penile edema in three patients (13.6%), which was resolved within about 3 months after surgery.
The Outcome of Multiple Slit on Plaque with Plication Technique for the Treatment of Peyronie’s Disease Park JJ, Ahn ST, Chae JY, Kim JW, Oh MM, Park HS, Kim JJ, Moon DG
Conclusion: As a modified technique, multiple slit on
plaque with plication is a simple, non-invasive and effective technique for correcting penile curvature regardless of curvature severity. The degree of penile curvature does not significantly predict the amount of penile length loss.
Dept. of Urology, Korea University College of Medicine, Seoul, South Korea Introduction and Objective: To evaluate the postoperative outcome of multiple slit on plaque plication technique for the treatment of Peyronie’s disease.
UP.271 Serum Uric Acid as a Risk Predictor for Erectile Dysfunction
Materials and Methods: We retrospectively evaluated
22 patients who underwent plaque incision with penile plication for surgical treatment of Peyronie’s disease who failed medical treatment between 2009 and 2014. Patients were grouped by pre-operative degree of penile curvature such as 5 mild (degree <30°), 11 moderate (60°> degree ≥30°), and 27 severe (degree ≥60°). On the thorough review of medical records, we evaluated (a) correction of the curvature; (b) sexual function; and (c) any penile shortening or other complications.
Pourmand G1, Salem S2, Heydari R3, Mehrsai A3 1
Urology Research Center, Tehran University of Medical Sciences, Iran; 2Urology Institute, University Hospitals Case Medical Center, Dept. of Urology, Case Western Reserve University, Cleveland, United States; 3 Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Iran Introduction and Objective: Serum uric acid (UA)
is now beginning to be considered a risk predictor for cardiovascular diseases. However, little is known about the effect of hyperuricemia on the risk of developing other systemic vascular disorders, especially erectile dysfunction (ED).
Results: The mean postoperative follow-up period
was 39 months. Complete correction of the curvature was obtained in 21 patients (95%). As an inevitable complication, minimal penile shortening (<1.5 cm) was reported by 14 patients (82%) but did not adversely affect sexual intercourse (0%) and all patients accepted for penile shortening. A total of 19 patients had good erectile function (International Index of
Materials and Methods: Two hundred and fifty-one
patients aged 45.2 ± 10.1 years with newly diagnosed and documented ED and 252 age-matched partici-
Number of patients, No. (%) Age (y), median (range) Preoperative curvature, de (range)
Site of curvature, No.
Mild -Group I (degree<30°)
Moderate -Group II (60°>degree≥30°)
Severe -Group III (degree≥60°)
P-value
5 (22)
11 (50)
6 (27)
55 (23-75)
50 (27-63)
0.63
20 (20)
45 (30-50)
76 (60-90)
0.37
Dorsal 8 Lateral 3
Dorsal 1 Lateral 1 Ventral 2 Combined 2
0.82
Mild (degree<30°)
Moderate (60°>degree≥30°)
Severe (degree≥60°)
37 (28-41)
32 (19-42)
35 (25-42)
0.53
2 (0-5)
7 (0-10)
14 (10-25)
0.001
Postoperative curvature, de (range)
P-value
Correction, de, mean (range)
14 (10-20)
37 (20-44)
43 (32-65)
0.47
Loss SPL, cm, mean (range)
0.5 (0.3-0.7)
0.6 (0.2-1.0)
0.6 (0.2-1.0)
0.52
Patients with pain after 1 month, No. (%)
1 (20)
1 (9)
1 (16)
0.91
Patients with repeat procedures, No. (%)
0 (0)
0 (0)
1 (16)
0.18
IIEF-5 score at long-term follow-up, No. (mean 39 months)
<10
0
<10
0
<10
1
10-21
0
10-21
2
10-21
0
>21
5
21
9
21
5
Abbreviation: mo, months; de, degrees; No., numbers; SPL, stretched penile length. IIEF, International Index of Erectile Function
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
hMaxi-K Gene Transfer in Males with Erectile Dysfunction: A Preliminary Report on Safety Sabah Al Ahmad Urology Centre, Kuwait City, Kuwait; Dasman Diabetic Centre, Kuwait City, Kuwait; 2Albert Einstein College of Medicine, New York City, United States
Introduction and Objective: hMaxi-K consists of the
UP.270, Table 2. Objective and Patient-Reported Outcomes After Operation
Time to survey, mo, mean (range)
be considered a risk predictor for ED. Furthermore, hyperuricemia can be regarded as an independent risk factor in addition to the established ones.
Arun N1, Abul F1, El Tafahny A1, Melman A2
Abbreviation: No., Numbers; y, years; de, degrees
Degree of Curvature
Conclusion: Our findings reveal that serum UA can
1
57 (50-63)
Dorsal 3 Lateral 1 Ventral 1
Results: The mean serum UA levels in ED-positive and ED-negative groups were 6.12 ± 1.55 mg/dl and 4.97 ± 1.09 mg/dl, respectively (P < 0.001). On analysis of unadjusted variables, statistically significant differences were found for all variables, including serum UA, between ED-positive and ED-negative groups. After adjustment for major risk factors, a significant trend of increasing risk was found for serum UA concentration (OR 5.95, 95% CI 2.96-11.97; P < 0.001, comparing the highest with the lowest tertile). An increase of 1 mg/dl in serum UA level was associated with an approximately twofold increase in risk of ED (OR 2.07; 95% CI 1.63-2.64).
UP.272
UP.270, Table 1. Preoperative Characteristics of Patients Degree of Curvature
pants without ED (aged 45.1 ± 8.4 years) were enrolled in this case–control study. Univariate and multivariate logistic regression analysis were performed to assess the effect of serum UA on ED; odds ratio (OR) and 95% confidence interval (CI) were calculated. Adjustments were made for potential confounding factors, including obesity, hypertension, diabetes, dyslipidemia, serum triglyceride, and smoking. Serum UA concentration and the distribution of potential ED risk factors (age, smoking, lipid profile, hypertension, obesity, and diabetes mellitus) were evaluated. Serum UA levels were organized into tertiles. The five-item International Index of Erectile Function was used to evaluate the presence and the severity of ED.
0.79
gene for the α-pore subunit of the maxi-K channel, hSlo, inserted into a plasmid vector. Administration into the corpora increases expression of maxi-K channel in smooth muscle cells and an increased efflux of K+ across the cell membrane resulting in decreased entry of Ca++ ions. This allows the corporal smooth muscle to relax resulting in erection. Phase 1 studies have shown good efficacy with sustained results. Our study is a double-blinded, placebo controlled, parallel design, Phase 2A study to evaluate the safety and efficacy of a single intracavernous injection of hMaxi K (8000 μg and 16000 μg) or placebo. In this preliminary report, we present the safety aspects. Efficacy is not being reported, as the study is ongoing, and the blinding code will be broken only at completion. Materials and Methods: The study population included 18 men with erectile dysfunction (erectile function domain score of International Index of Erectile Function (IIEF) < 21) attributable to an underlying, stable medical condition and who have had unsuccessful results with prior therapy. Intracavernosal injection of hMaxi-K was done between June 2015 and February 2016. Patients were evaluated at weeks 1, 4, 8, 12, and 24 following injection with physical examination,
209
UNMODERATED ePOSTERS vital signs, electrocardiogram, laboratory evaluation, and IIEF/Sexual Encounter Profile questionnaires. Results: Minor adverse events observed included hyperglycemia in 5, hypomagnesemia in 2, hyperkalemia in 2, hyponatremia in 1, elevated liver enzymes in 2, proteinuria in 3, and microscopic hematuria in 2. All events were mild, not related to the drug, and reversed on follow-up. Transient hypertension in 1 patient and prolonged QTc in 2 patients, were recorded which also reversed on follow-up. One patient developed charcot’s arthropathy. There was no local adverse event except for 1 patient who developed pain at the site of injection after 1 week, which resolved subsequently. Overall, there were no serious or persistent adverse events attributable to the drug injection. Conclusion: Intracavernous injection of hMaxi-K
seems to be safe and well-tolerated by the patients. The study is continuing in order to establish its efficacy.
UP.273 Clinical Outcomes of Androgen Replacement Therapy (ART) in Japanese Patients with Late-Onset Hypogonadism (LOH) Syndrome: Comparison of Total and Free Testosterone Value Matsuda H, Kuratsukuri K, Nakatani T Dept. of Urology, Osaka City University, Graduate School of Medicine, Japan Introduction and Objective: The Japanese late-onset
hypogonadism (LOH) guideline uses serum free testosterone (FT) level for diagnosis of LOH syndrome. On the other hand, the European and American guidelines use total testosterone level (TT) for diagnosis of LOH syndrome. Serum total testosterone levels below 8 nmol/L (231 ng/dL) require substitution of testosterone in the E.A.U. recommendations. In this study, we compared serum free testosterone level and total testosterone level in patients who visited our LOH syndrome outpatient department. We also investigate clinical outcomes of androgen replacement therapy (ART) in patients with LOH syndrome. Materials and Methods: Two hundred and thirty male patients who visited our LOH syndrome outpatient department from January 2008 to September 2013 were targeted in this study. Average patient age was 55.1 years old. Average AMS score in patients was 51.7 points. Results: Only 20 patients (8.7%) had a low value (less
than 2.31 ng/ml) and 86 (37.4%) patients had a low and borderline value (less than 3.46 ng/ml) in serum total testosterone (TT) level. On the other hand, 99 patients (43.1%) had low values (less than 8.5 pg/ml), and also 175 examples (76.1%) had low and borderline values (less than 11.8 pg/ml) in serum free testosterone (FT) level. Androgen replacement therapy (ART) was carried out for 3 months in 84 patients with LOH syndrome. Sixty-nine patients (82.1%) were effective for ART. Only four patients dropped out of the androgen replacement therapy because of dysuria and plethora. Fifty-four patients (83%) with low values (less than 8.5 pg/ml) in serum free testosterone (FT) were effective for ART in 53 patients. A total of 25 patients (80.6%) who had borderline values (less than 11.8 pg/ml) in serum free testosterone (FT) level were effective for ART in 31 patients.
210
Conclusion: Including borderline cases, high fre-
quency patient is suited at the diagnostic criteria of LOH syndrome using serum FT value compared to TT value. It might be necessary to also consider the measurement of the auxiliary total testosterone, and compensation of the isolation testosterone by age. Androgen replacement therapy (ART) was also effective in patients with LOH syndrome, and not only those with a low value but also those with a borderline value in serum free testosterone (FT).
UP.274 Prevalence of Erectile Dysfunction in Men Screened for Prostate Cancer Acuña J1, Marió C1, Salazar I2, Novoa C1, Leyton R1 Hospital Dipreca, Santiago, Chile; 2Facultad de Medicina Universidad de los Andes, Santiago, Chile
1
Introduction and Objective: Erectile dysfunction
(ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. The prevalence of ED ranges from 30 to 83% in different groups of men. In patients who underwent prostate cancer (PC) screening, we have found reports between 37.5 and 53.9%. The instrument most commonly used in these studies is the IIEF-5 questionnaire. In Chile, there are no studies of ED frequency using a standardized tool. Our objective is to estimate the prevalence of ED among screened men for prostate cancer in our center, Dipreca Hospital. Materials and Methods: This is a cross-sectional study. Men over 45-years-old screened for PC in Dipreca Hospital between July and November 2015 were included. The study was approved by the local ethics committee. With 81 006 men over 45 years, active in this institution, a sample calculation was performed, obtaining a sample of 648 men to survey. We included 720 consecutive cases. Written informed consent was obtained. A score of ≤21 was considered as ED. Demographic data, laboratory tests and medical history were obtained. We searched for association between these factors and the presence of ED using logistic regression, using a significance value of p<0.05. Results: We obtained a complete questionnaire of 677
men with an average age of 51.2 years (DS±6, 45-74). The prevalence of DE is 46.97% (n=318) in our study group. We found a statistically significant association of presence of ED with body mass index (BMI) and age. Conclusion: This is the first cross-sectional study of
ED in our country, using a validated instrument. The prevalence of 46.97% is similar to comparable studies in other countries using the same instrument. We found an association with BMI and age, two known risk factors of ED. We found that IIEF-5 was an easy tool for an initial assessment of erectile function. This study opens a window for other studies for better knowledge of ED and its epidemiology in our country.
UP.275 Management of Unconsummated Marriage Smaoui W, Touaiti T, Rebai N, Hadj Slimen M, Mhiri MN Dept. of Urology, Habib Bourguiba Academic Medical Center, Sfax, Tunisia
Introduction and Objective: To identify the clinical features of unconsummated marriage (UCM) amongst couples, the etiological factors, the therapeutic approaches and to clarify the different evolutive aspects. Materials and Methods: In this retrospective study,
the files of 80 consecutive couples followed for UCM between 2000 and 2010 at our andrology consultation were reviewed. Results: The mean age of the husbands was 36 years (22-82 years), while that of the brides was 28 years (17-57 years). The average length of marriage was 14 months (range 3 months-7 years). Couples had little knowledge of sexology. The sexual dysfunctions noted were erectile dysfunction in 40% of cases, premature ejaculation in 5%, a combination of premature ejaculation with erectile dysfunction and decreased libido in 15%, vaginismus in 12.5% and the associated causes (erectile dysfunction with vaginismus) in 27.5%. The first-line treatment was based on a sexological approach consisting of sex education and sex therapy, associated in some cases with oral drugs and as second-line treatment, sometimes intracavernous injections. After a mean follow-up of 5 months (range 1-15 months), the outcomes of treatment were good prognosis with consummation of marriage in 57 cases (71.25%), failure with UCM in 18 cases (22.25%) and not known in five cases (6.25%). Conclusion: UCM is quite frequent in the Arab Islam-
ic world. The best treatment is prevention based on sexual education of youngsters and treatment of sexual dysfunctions for people who consult before marriage.
UP.276 Amount of Liquid Taken Doesn’t Affect the SWL’s Success in the Upper Ureteral Stones Soydan H1, Okçelik S2, Saraçoğlu F3, Ateş F1, Yilmaz Ö1, Malkoç E1, Şenkul T1, Karademir K1 1
Urology Dept., GATA Haydarpasa Teaching and Research Hospital, Istanbul, Turkey; 2Urology Dept., Beytepe Military Hospital, Ankara, Turkey; 3Urology Dept., Kasimpasa Military Hospital, Istanbul, Turkey Introduction and Objective: To investigate wheth-
er taking different amounts of liquid after the SWL procedure effects stone clearance rates in the upper ureteral stones. Materials and Methods: The study planned as single
centered and prospectively. Patients who had radiopaque upper ureteral stones that planned SWL treatment enrolled in the study. Stone size, count of SWL shock, the amount of energy, weight of patients were recorded. After the procedure, patients were divided into 3 groups. Group 1:Daily 1500 cc, group 2:Daily 3000 cc, group 3:Daily 4500 cc water intake was suggested. Patients were checked after processing an average of 11.8 (3-52) days. Control was done with plain abdominal radiography. Stone clearance was recorded. Statistical evaluation was made with SPSS. Results: Between July 2012 and July 2014, 55 patients were included in the study. There were 24 patients in group 1, 18 patients in group 2, 13 patients in group 3. Stone size according to the groups of patients (Table 1), the number of SWL shocked at the amount of energy applied, weight did not differ (Table 2). There was no difference for stone clearance during control
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS and sex distribution, and also the location and type of calculi.
UP.276, Table 1. 1500
3000
4500
Mean
9.58
9.05
7.30
Standard deviation
3.67
3.90
2.42
Median
8.5
8.0
7.0
N
24
18
13
P*
0.088
Kruskal Wallis test
UP.276, Table 2. 1500
3000
4500
P**
SWL shock count*
3000
3000
3000
0.673
Amount of Energy
58.77
60.29
71.42
0.094
Weight
80.50
80.0
68.0
0.295
24
18
13
N
*Median values; ** Kruskal Wallis test
UP.276, Table 3.
Materials and Methods: We searched the MEDLINE for relevant literature dating back to 1980. This review compared the trends in epidemiological factors affecting urolithiasis in the developed and the developing countries during the past decades. Results: People in the developing countries are more likely to contract kidney calculi at a younger age than in the developed countries. Although calculus disease is still more prevalent in men than in women, the latter are increasingly affected in both worlds. Uric acid calculi are more prevalent in the developing than in industrialized countries. There is a progressive increase in the frequency of calcium oxalate and calcium phosphate calculi in the developing countries where these used to be less frequent. Conclusion: The incidence and prevalence of urinary
calculi is increasing globally. Many factors including aging of the population, changes in diet, global warming, and employment of more accurate diagnostic tools seem to be involved in this increase. An increasing affluence and adaptation of Western diet habits in many developing countries seem likely to contribute to the changes.
tal number of 359 patients who had surgery within the period. Records of all patients presenting to the 37 Military Hospital with stone disease between the periods of December 2012 to December 2015 were collected. Information of all patients who had intracorporeal lithotripsy were also collected and analyzed. An endo-urology log sheet was used to record procedure on patient’s name, age, sex, indication for operation, location of stone, intraoperative complications, type of instruments/materials, stone analysis, follow-up dates. All patients between the ages of six months to seventy years, male and female, presenting with stones diseases within the period were included. Patients with stone disease who were managed with open surgery were excluded.
UP.278, Table 1. Complications INTRAOPERATIVE PCNL
Guide wire breakage
2
“dropped stone”
1
Severe bleeding (requiring blood transfusion)
1
URS
UP.278
Ureteral mucosal injuries
Urolithiasis and Intracorporeal Lithotripsy at the 37 Military Hospital, Accra, Ghana
Vesico-ureteric orifice injuries
2
Renal perforation
1
Adusei B, Mante S, Kyei N, Amegbor J, Yegbe P
PCNL
37 Military Hospital, Accra, Ghana
Severe bleeding (requiring transfusion)
(Table 3). Group 1-2, p = 0.151; group 1-3, p = 0.507; group 2-3, p=0.537. In binary comparison there was no significant difference (Mann-Whitney U test).
Introduction and Objective: The purpose of this
Reno-cutaneous fistula
1
study is to determine the indications and complications of intracorporeal lithotripsy in our institution.
Severe pain
2
Conclusions: It seems that doesn’t increase the suc-
Materials and Methods: The study was a retrospec-
cess rate of stone clearance to increase the daily water intake from 1500 cc to 4500 cc after SWL in the upper ureteral stones.
tive study carried out at the urology unit of the 37 Military Hospital between 2012 and 2015. A total of 42 patients had intracorporeal lithotripsy out of a to-
1500
3000
4500
Successful
12
13
8
Unsuccessful
12
5
5
Total
24
18
13
p
0.344
(chi – Square test)
UP.277 National Profiles of Urinary Calculi: A Comparison Between Developing and Developed Worlds
5
POST-OPERATIVE
1
URS
Severe Pain
4
Haematuria
4
UP.278, Figure 1. Indications
Alatab S1, Pourmand G1, El Fatih El Howairis M2, Buchholz N3, Najafi I4, Pourmand MR5, Mashhadi R1, Pourmand N1 1
Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Iran; 2Mediclinic City Hospital, Dubai, United Arab Emirates; 3Sobeh’s Vascular & Medical Center, Dubai, United Arab Emirates; 4Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Iran; 5 Dept. of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Iran Introduction and Objective: The incidence of uro-
lithiasis has increased in both the developed and the developing countries during the past decades. Economically, the increase of urolithiasis contributes to the rise of the healthcare burden everywhere. Moreover, this increase has been associated with a change in the epidemiology of urolithiasis in terms of age
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
211
UNMODERATED ePOSTERS Results: Lithotripsy constituted 42/359 (11.7%) surgical cases done within the period. The commonest age of presentation was between the ages of 31-40 years (26.2%), with men more likely to develop stones than women in a ratio of about 2:1. The commonest indication for lithotripsy was pain (92.8%) and hydronephrosis (61.9%), (Figure 1). Ureteric stones were more common (50%), with the commonest site being the proximal ureter, followed by renal stones (45%). The commonest procedure was the ureteroscopic approach constituting about 72.10%, whilst ureteral mucosal injury (5/43) (11.62%), was the commonest intraoperative complication (Table 1). Postoperative complications included reno-cutaneous fistula (1/43) (2.32%), severe bleeding (requiring blood transfusion) (1/43), after PCNL; haematuria (4/43) (9.30%). Conclusion: Urolithiasis can occur at any age and
the mode of presentation may vary depending on the age though rare in the first year of life. Intracorporeal lithotripsy is becoming a common procedure for urolithiasis. It is a safe procedure and most patients are operated due to severe pain.
UP.279 Effectiveness of Flexible Ureteroscopy in Patients with Urinary Tract Abnormalities Kaya E1, Bedir S1, Kopru B2, Zor M1, Ebiloglu T3, Yilmaz S1, Uguz S1 1
Gulhane Military Medical Academy, Ankara, Turkey; 2 Konya Asker Hastanesi, Konya, Turkey; 3Etimesgut Asker Hastanesi, Ankara, Turkey Introduction and Objective: Flexible ureteroscopy (F-URS) has an increasing role for large renal stones, which are located at different anatomical positions. This procedure is easily applicable when the patient has normal urinary tract anatomy. In this report, we presented our F-URS experience in patients with horseshoe kidney, duplicated ureter, ileal loop cutaneostomy. Materials and Methods: We retrospectively reviewed
6 consecutive patients with abnormal urinary tract anatomy as horseshoe kidney (n=3), ileal loop cutaneostomy due to radical cystectomy (n=1), dublicated ureter (n=1) and severe scoliosis (n=1) between January 2012 and February 2016. All procedures were performed by a single surgeon. The location of stones was determined with intravenous urography (IVU) or computed tomography (CT). Urinary tract infection was treated with antibiotics according to the urine culture. All procedures were performed at lithotomy position under general anesthesia with the exception of the patient with ileal loop cutaneostomy, which was performed at prone position. Results: The mean patient age was 42.5 years (range
23-66 years). All patients were male. Four patients were stone-free. One of three horseshoe kidney patients had 26 mm lower calixy stone. After surgery, his stone size was reduced to 15 mm, and 3 sessions of adjuvant ESWL were required. Following the unsuccessful ESWL, second FURS was performed successfully. The patient with duplicated ureter had a 20 mm stone in upper pole and a 14 mm in lower pole. The lower pole was stone-free, but two cycles of ESWL were performed to the 6 mm upper pole residual stone. The patient with loop cutaneostomy had a 14 mm stone located in left UPJ and similarly, the patient with sco-
212
UP.279, Table 1. Patient-Stone Characteristics and Postoperative Outcomes Variable
Age
Value
42.5 (23-66)
Gender (n)
Introduction and Objective: Currently extracorpore-
al shockwave lithotripsy (ESWL) is the treatment of choice for most renal calculi not exceeding 20 mm. This study was designed to assess prospectively the usefulness of measuring urinary calculi attenuation values by NCCT in predicting the fragmentation as well as ultimate clearance of stone with ESWL. Materials and Methods: A cross sectional prospec-
Male
6
Female
0
Urinary Tract Abnormality (n) Horseshoe kidney
3
Duplicated ureter
1
Ileal loop cutaneostomy
1
Scoliosis
1
Stone Size (mm)
18.1 (10-26)
Stone Side (n) Right
4
Left
2
Stone location (n) Renal pelvis
4
Upper calyx
0
Middle calyx
1
Lower calyx
1
Stone free rate (%)
67.7
Mean operative time (mm) Mean fluoroscopy time (min)
50 (40-65) 36.6 (20-50)
Mean hospitalization time (day)
1.5 (1-3)
Mean complication rates
1 (16.4%)
liosis had a 15 mm stone placed also in UPJ. Urethral catheter and ureteral catheter were removed at postoperative 1st and 20th days, respectively. The patients were discharged at 1.5 days (1-3 days) postoperatively. Minor complications, like hematuria and fever, were observed, but all of them were resolved during follow-up. For all procedures, patient demographics, hospitalization stay, stone size, operation time, fluoroscopy time, stone free rate and complication rate were summarized in Table 1. Conclusions: In recent years, endoscopic stone sur-
gery has gained new advancements with technological developments. However, the literature is limited about patients with abnormal urinary tract disorders. F-URS seems to be a safe and effective procedure for different urinary tract anatomy. Studies involving larger patient series will yield more information to clinicians.
UP.280 Value of Hounsfield Unit on Computed Tomography in Prediction of Renal Stone Fragmentation After Extracorporeal Shockwave Lithotripsy (ESWL) Rahman MM National Institute of Kidney Diseases & Urology, Sher-e-Bangla Nagar, Dhaka-1207, Bangladesh
tive analytical study was conducted in three tertiary level hospitals from January to June 2015. Fifty patients with solitary renal stone, 5-20 mm in size were included. Patients were evaluated by taking history, physical examination, laboratory and radiological investigations. Calculus attenuation was measured in Hounsfield units on non-contrast computed tomography. Patients were treated with ESWL by an electromagnetic Lithostar multiline lithotripter. Stone fragmentation was assessed during the procedure by change in stone size and/or outline, separation of stone fragments or disappearance of it at 4 weeks. Results: Mean density of stones and shockwaves received for fragmentation were relatively lower in success than failure group (p<0.001). The majority of the males and females were in success group. The majority patients with right-sided stones and more than fifty percent of patients with left-sided stones were also in the success group. The success rate is high in group 1 with lower calculus attenuation value (<700 HU) and lower in group 3 with higher calculus attenuation value (>900 HU). In the success group, the mean number of shockwaves received for fragmentation of stones in group 1, group 2 and group 3 were 2505.75, 2614.06 and 2711.5 respectively. Significantly lower numbers of shockwaves were required in group 1 with lesser calculus attenuation value than in group 3 with relatively higher calculus attenuation value. BMI and SSD were not significantly different between success and failure group. Stones with lower attenuation values on non-contrast CT are fragmented more than stones with higher attenuation values. Conclusion: Hounsfield units measurement of renal
stone on non-contrast computed tomography before ESWL predict the stone fragmentation rate. This information may be beneficial for selecting the preferred or alternative treatment options for patients with urinary calculi.
UP.281 Spontaneous Rupture of the Upper Urinary Tract Caused by Ureteral Calculi: Effectiveness of Primary Ureteroscopic Treatment Sallami S1, Abou El Makarim S1, Chtourou M2 1
Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; Dept. of Urology, Habibi Thameur University Hospital, Tunis, Tunisia
2
Introduction and Objective: Spontaneous rupture (SR) of the urinary collecting system with perirenal and retroperitoneal extravasation of the urine is an unusual and serious condition that is typically caused by ureteral-obstructing calculi. We evaluate endoscopic management, and follow-up assessments through a series of 17 cases. Materials and Methods: Between 1998 and 2015, 17
patients were admitted for SR of the urinary collecting
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS system proximal to a lithiasic obstruction. There were 10 males and 7 females. The mean patient age was 51.7 years (27-80). Two patients had a history of ipsilateral nephrolitiasis. At presentation, all patients had sudden severe flank pain without response to NSAIDs at the left and the right side in 9 and 8 patients respectively. There were no other urinary symptoms but fever (n=7), vomiting (n=1) and microscopic hematuria (n=2). All patients had radiography, ultrasonography (US), intravenous urography (IVU), and/or computed tomography (CT). Ureteroscopy (URS) was performed and ureteral stones were fragmented with a pneumatic lithotripter. Results: SR was secondary to an obstructing calcu-
lus in all cases. Its size ranged from 5 mm to 15 mm. Radiological and endoscopic tests revealed that the perforations were in the proximal ureter (n=9), renal pelvis (n=4), distal ureter (n=1), and upper renal calyx (n=3). URS revealed a distal ureteral stone (n=2), iliac ureteral stone (n=1) and proximal ureteral stone (n=7). Patients were managed successfully by primary endoscopic treatment of ureteroscopic lithotripsy and stenting. Two patients were treated by extracorporeal shock wave lithotripsy (ESWL) for residual fragments with total fragmentation. Follow-up US showed a decrease of perirenal fluid after an average of 5 days (range, 3-7 days), followed by a total resorption of perirenal fluid collection at the 1-month evaluation. Nine months after the extravasation, all patients were stone-free in radiological explorations without clinical problems. Conclusion: SR of the urinary collecting system is a
rare pathological condition. It should be considered in cases of unusual renal colics. Ureteroscopic lithotripsy followed by double-J stenting of the ureter appears to be a quick, safe, and effective management approach.
UP.282 Complications and Outcomes Following Extracorporeal Shock Wave Lithotripsy: A Prospective Study of 3 241 Patients Salem S, Pourmand G, Mehrsai A, Zartab H, Shahdadi N, Dehghani S Urology Research Center, Tehran University of Medical Sciences, Iran Introduction and Objective: Extracorporeal shock
wave lithotripsy (SWL) has become the least invasive treatment modality with high success rates for urinary calculi. However, its established efficacy has been associated with a number of side effects and complications. Materials and Methods: This study sought to further
evaluate the incidence rate and management of the post-SWL complications and also the efficiency of procedure in a large scale of patients. Results: During a 51-month period, 3 241 consecutive adult patients with the mean age of 38.1 years (range 15-75) and urinary calculi (C4 mm) underwent SWL at our referral center and were followed for 3 months prospectively. Overall, 3 614 stones (kidneys (83.5%), ureters (15.8%) and bladder (0.7%)) in 3 241 patients were treated requiring 7.245 SWL sessions. Stone-free state occurred in 71.5% calculi and success rate in 79.8% patients. Re-treatment was necessary in 37.2%
patients. Auxiliary procedure and efficiency quotient were 5.6% and 0.50, respectively. SWL success rate decreased as the stone size increased (P=0.0001). The stone-free rate was correlated with the location of the stone. During the study period, 4 075 complications occurred in our patients. Colicky pain (40%) was the most frequent symptom followed by gross hematuria (32%) and steinstrasse (24.2%). Symptomatic bacteriuria developed in 9.7% patients. Escherichia coli (30.4%) was the most causative organism. Conclusion: In conclusion, the complication rate fol-
lowing SWL was high in our study. However, the majority was mild and managed conservatively or with the minimal intervention. Moreover, the management of urinary calculi in adults using SWL was proved to be safe and efficient, particularly for ureteral stones <10 mm, renal pelvic stones <20 mm, and bladder stones <30 mm.
47, sediment WBC ≤ 5/HPF: no pyuria 56). Operation-related variables were compared. Results: For postoperative fever episodes, the pyuria group didn’t show significantly different results compared to the no pyuria group (p=0.467). Mean age was 62.8 and 56.7 years, respectively (p=0.032). Pre-operative PCN was 44.7% vs. 14.3%, respectively (p<0.01). Percentage of male patients, BMI, presence of diabetes mellitus, stone laterality, location, size and operation time were not significantly different between the two groups. Conclusion: The incidence of postoperative infection
didn’t increase in patients with pyuria before URSL compared to patients with no pyuria.
UP.284 Results of PCNL in the Supine Position: About 191 Procedures
UP.283
Khouni H1, Boulma R1, Sallami S2, Ben Rais N3
Correlation Between Pyuria and PostOperative Urinary Tract Infection After Ureteroscopic Lithotripsy for Patients with Pyuria Before the Operation
1
FSI University Hospital, La Marsa, Tunisia; 2Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; 3 Military University Hospital, Tunis, Tunisia Introduction and Objective: The aim of our work is
Jung W, Ha JY, Kim BH, Park CH, Kim CI
to evaluate the results of PCNL in the supine position and to determine its benefits.
Keimyung University, Daegu, South Korea Introduction and Objective: To evaluate the correla-
tion between preoperative pyuria and post-operative infection in patients with pyuria before ureteroscopic lithotripsy (URSL). Materials and Methods: We retrospectively analyzed
103 patients who underwent URSL for ureter stones between July 2011 and July 2015. All URSL were performed by a single surgeon. The subjects were divided into two groups depending on the presence of preoperative pyuria (sediment WBC > 5/HPF: pyuria
Materials and Methods: This is a descriptive and analytic retrospective study on 174 patients who had 191 PCNL between April 2008 and December 2015. Results: Average patient age was 50 years (range from 23-57 years). Most patients were males (66%). One hundred and eleven PCNL (62%) were performed for pyelocaliceal lithiasis. We obtained immediately good results in 129 procedures (71.6%). This group is represented by the “stone-free” (111 patients) and those who have kept insignificant residual fragments (18
UP.283, Table 1. Comparison of Pre-, Intra- and Post-Operative Parameters According to Pre-Operative Pyuria Variables
Pyuria (n=47)
No pyuria (n=56)
p-value
0.140
Gender (%)
Male
27 (57.4)
39 (69.9)
Female
20 (42.6)
17 (30.4)
Age (yrs.)
62.8
56.7
0.032
BMI (kg/m2)
25.0
25.5
0.394
11 (23.4)
9 (16.1)
Diabetes mellitus (%)
0.454 0.435
Stone laterality (%)
Right
24 (51.1)
33 (58.9)
Left
23 (48.9)
23 (41.1) 0.069
Stone location (%)
Upper
27 (57.4)
20 (35.7)
Middle
6 (12.8)
14 (25.0)
Lower
14 (29.8)
22 (39.3)
9.8
9.8
0.949
Stone size (mm)
49.9
58.8
0.097
Pre-operative PCN (%)
21 (44.7)
8 (14.3)
0.001
Post-operative fever (%)
8 (17.0)
11 (19.6)
0.467
Operation time (min)
BMI, body mass index; PCN, percutaneous nephrostomy
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
213
UNMODERATED ePOSTERS cases). After further treatment (LEC, second session of PCNL, ureteroscopy or medical treatment), the success rate increased to 83.3%. No predictive factor of good or bad outcome was determined. Complication rate in our series was 19%, and were dominated by post-operative infections and urinary fistulas. Two predictor factors of complications were identified, including diabetes and poor outcome of PCNL.
UP.286
Conclusion: PCNL in the supine position seems to be
Introduction and Objective: Percutaneous nephroli-
easier to implement and has fewer complications. It offers more advantages for the management of upper urinary tract lithiasis. Our study confirms the results of this position, and its feasibility and advantages compared to the classical prone position.
thotomy (PCNL) was viewed as the gold standard for the treatment of large stones. Prone PCNL has several potential disadvantages, such as circulatory compromise and ventilator difficulty especially in obese patients. We aim to determine the efficacy and safety of simultaneous supine PCNL and semi-rigid ureteroscopic lithotripsy (URSL) for renal stones combined with huge upper ureter stone (>1.5 cm).
UP.285 The Outcome of Management of Proximal and Distal Ureteric Stones in Children: A Comparative Study Iqbal N, Ikram Y, Khan A, Umar Alam M, Yousuf A, Ayaz Khan M, Malik Y, Pir A, Hussain I, Akhter S Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: To compare the outcome of Swiss lithoclast in ureteroscopic management of proximal and distal ureteric stones in children. Materials and Methods: From January 2013 to April 2015, a total of 22 children with proximal ureteric stones (group 1) and 14 patients with distal ureteric stones (group 2) underwent ureteroscopic pneumatic lithotripsy at our center. They were below the age of 17. Swiss pneumatic lithoclast was used to break the stone after introduction of 4/6 Fr semi rigid ureteroscope into the ureter. Stone-free rate was defined as residual stone fragments of less than 3 mm on follow-up X ray KUB (Kidney ureter and bladder) after 2 weeks of ureteroscopic intervention. Patients in two groups were assessed for stone size, mean operative time, stone free rates, need for recheck ureteroscopy and complications. SPSS version 16 was used for statistical analysis. Results: Mean age was 8.18 ± 5.70 years for the proximal stone and 9.16±5.25 years for the distal stone group. Mean stone size was 10.25± 6.8 mm for the proximal stone group and 11.49± 5.86 mm for the distal stone group. Mean operative time was 43 minutes and 32 minutes for the proximal and distal stone groups respectively. Stone-free rate after a single procedure was 77.27% for the proximal and 86% for the distal stones group. Stone-free rates reached 100% for both groups after repeat procedures. Complications included post op sepsis in 2 (9%) patients of the proximal group and 1 (7%) patient of the distal group. Conclusion: The outcome of ureteroscopic manage-
ment was successful in both proximal and distal ureteric stone groups. However, recheck URS was done more frequently in the proximal ureteral stone group.
214
Simultaneous Supine Percutaneous Nephrolithotomy and SemiRigid Ureteroscopic Lithotripsy for Renal Stones Combined with Huge Upper Ureter Stone Huang TY Kaohsiung Medical University Hospital, Taiwan
Materials and Methods: Between September 2014 and May 2015, a total of 20 patients underwent simultaneous supine PCNL and semi-rigid URSL at the Kaohsiung Medical University Hospital. The present study was supervised by the review board of our institution. Mean patient age was 55.5 years (range 32 to 76) and male to female ratio was 2:1. Left renal stone was two times as common as a right renal stone. The mean maximal diameter of stones was 2.3 cm (range 1.3 to 4.8). Results: Mean operation time was 78.6 minutes (range 25 to 235), and mean hemoglobin levels before and after operation were 12.8 g/dl (range 10.5 to 14.8) and 11.9 g/dl (range 9.5 to 14.1), respectively. All of the patients were stone-free after the operation, and none of them needed an additional percutaneous drainage tube. Two patients suffered from fever after the operation. No patient needed post operative transfusion. The average hospital stay was 4.2 days (range 2 to 7).
Simultaneous supine PCNL and semi-rigid URSL are technically with efficacy for stone removal especially in renal stones combined with huge upper ureter stone (>1.5 cm). Obstruction can be relieved efficiently without obvious complications. Our experience showed that supine PCNL combined semi-rigid URSL merit further application.
Conclusion:
UP.287 A Simplified Technique of Percutaneous Calyx Puncture without Moving the C-Arm in the Split Leg Modified Lateral Position Lezrek M1, Tazi H2, Bazine K3, Slimani A3, Ammani A3, Kasmaoui EH3, Qarro A3, Baddouch A3, Alami M3 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; Dept. of Urology, El Ghassani Hospital, Fes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco; 3Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco Introduction and Objectives: Mostly, for percutane-
ous calyx puncture, the progression of the needle penetration has to be monitored with 2 planes at 0° and 30°, by rotating the C-arm. We present our technique of percutaneous fluoroscopic calyx puncture without
rotating the C-arm, in the split-leg modified lateral position. Materials and Methods: Since 2003, in our routine percutaneous renal surgery, fluoroscopic calyx puncture is performed without moving the C-arm. The patients are placed in the split-leg modified lateral position. Percutaneous access is performed under fluoroscopic guidance, with the X-ray beam perpendicular to the tract. The C-arm is placed in a fixed position between 10° to 15°. This position of the C-arm allows monitoring the needle in both the cephalo-caudal and latero-medial movements; the needle has to be aligned with the targeted calyx during the whole puncture. To find the kidney’s lateral edge and the calyx, in the antero-posterior plane, the needle is displaced, from posterior to anterior by small increment positions. Meanwhile, a slight jiggle of the needle is performed. To avoid parenchymal injuries, the tip of needle must be outside the renal parenchyma. It stays 1.5 to 2 cm outside the calyx. When the needle pushes the kidney and the calyx is indented, it is the correct anterio-posterior position. Then, the needle is advanced through parenchyma and just few millimeters into the calyx. Results: Calyx puncture without moving the C-arm is feasible. It is the only technique used in our department since 2003. We think that it is easy and quick too. In our experience this technique is easier to teach and to explain, thus many urologists had mastered the calyx puncture. Therefore, it had helped the spread of percutaneous renal surgery to more than 10 centers. In addition, this technique has been used in the prone position, and it can be used in the supine position. Conclusions: This technique of calyx puncture without moving the C-arm is feasible. We think that it can be easily performed. In addition, in our experience this technique is easier to teach and to explain, thus many urologists had mastered the calyx puncture and percutaneous renal surgery.
UP.288 Percutaneous Second Look Reentry under Endoscopic Vision Lezrek M1, Tazi H2, Bazine K3, Slimani A3, Ammani A3, Kasmaoui EH3, Qarro A3, Beddouch A3, Alami M3 1
Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco; Dept. of Urology, El Ghassani Hospital, Fes, Morocco; 2Dept. of Urology, El Ghassani Hospital, Fes, Morocco; 3Dept. of Urology, Military Hospital Moulay Ismail, Meknes, Morocco Introduction and Objectives: We present our experi-
ence of percutaneous reentry during second session Percutaneous renal surgery, under endoscopic vision, without fluoroscopy. Materials and Methods: The procedure is performed
when there are residual stones after a first session of percutaneous renal surgery, which can be treated by a second PCNL session. Under general or spinal anesthesia, the patient is placed in the split-leg modified lateral position. The skin and nephrostomy catheter are disinfected, and Betadine soaked gauze are left around the nephrostomy catheter for at least 15 minutes. Under fluoroscopic guidance, a guidewire is inserted through the nephrostomy catheter and it is coiled in the renal pelvis or passed down
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS the ureter. The nephrostomy catheter is removed. A 24 Fr Amplatz sheath is back-loaded over the 24 Fr nephroscope. Under endoscopic vision, the nephroscope is advanced through the percutaneous tract beside the guidewire, until reaching the caliceal cavities. Then, the Amplatz sheath is advanced over the nephroscope to the kidney. The guidewire is left outside the Amplatz sheath.
sessions was greater in the adult group as compared to the pediatric group. There was no significant difference in outcome in terms of stone-free rate between both groups of our study.
Results: From January 2012 to May 2015, 12 patients
Iqbal N1, Rahim W1, Alam MU1, Ikram Y1, Hasan A1, Younas F2, Akbar MK1, Khawaja A1, Akhter S1
had a second look-PCNL. The reentry under endoscopic vision was possible in all cases in a few minutes time. Save in one case, which had pus retention at the first puncture, and an 18 Fr nephrostomy catheter was placed. The second look was scheduled 3 weeks after the first session. The 21 Fr nephroscope had reached the collecting system, however the introduction of the 24 Fr Amplatz sheath was difficult. Therefore, dilation of the tract was performed with the 24 Fr Amplatz dilator. In all cases no complication was noted, no hemorrhage, and no extravasations. Conclusion: This technique of percutaneous reentry
under endoscopic vision is a possible, quick and safe technique.
UP.289 Comparison of Extracorporeal Shock Wave Lithotripsy for Lower Pole Renal Stones Between Children and Adults: A Single Center Study Iqbal N1, Khan MA1, Hussain T1, Iqbal S1, Billah RM1, Haq A1, Ghalib N1, Farooqi HMU2, Aslam M3, Akhter S1
UP.290 PCNL in Old Age Patients: A Single Center Experience
1
Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan; 2Pakistan Kidney Institute, Islamabad, Pakistan
Introduction and Objective: PCNL is procedure of choice in adult patients with renal stones larger than 2 cm. Miniaturization of endoscopic instruments has made it possible to do minimally invasive endoscopic procedures for renal stones. We share our experience of old age PCNL in terms of safety and efficacy in a group of 47 old age patients (above 60 years of age). Materials and Methods: This is a retrospective observational study of 47 old age patients who underwent PCNL from January 2011 to November 2015 at Shifa International Hospital, Islamabad. PCNL was done by standard technique. The patients were analyzed for age, gender, presenting symptoms, stone size, site, PCNL approach, operative time, stone clearance, hospital stay and pre-operative and post-operative complications. Data were collected by chart review on specified performa. SPSS ver16 was used for data analysis.
1
Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan; 2RMC Basic Sciences, Rwalpindi, Pakistan; 3COMSATS Biosciences, Islamabad, Pakistan Introduction and Objective: We wanted to evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for lower pole renal stones in children and adults and to compare the respective results. Materials and Methods: From January 2011 to Janu-
ary 2015, ESWL was performed for treatment of lower pole renal stones in 34 children and 120 adults. We used Modulith SL X lithotripter 4th generation Storz medical equipment for ESWL. The stone-free rates, number of ESWL sessions required, complication rates and auxiliary procedures used were evaluated in a comparative manner. Results: Mean stone size 1.25±0.53 cm in the adult
group and 1.00±0.44 cm in the paediatric lower pole stones group. Stone clearance rate was 47% in the pediatric group and 45% in the adult group. In the pediatric group, the number of sessions was 1 in 25 (73.52%) and 2 sessions in 9 (26.48%) patients, while in the adult group, it was one session in 76 (64%), and 2 or more sessions in 36% of cases. In the pediatric group, hematuria was seen in 1 (2.9%), sepsis in 2 (5.8%) patients and steinstrause in no patient, while in the adult group, heamaturia was seen in 9 (7%), sepsis in 8 (6.7%) and steinstrause in 2 (1.7%) patients. Conclusions: The results of ESWL for urolithiasis in lower pole stones is inferior comparatively both in adults and children. Complication rates for lower pole stone ESWL were similar in both the children and adult groups in our study. The number of ESWL
Results: A total of 47 old age patients with a mean age of 66.36 ± 4.95 years were included. Mean stone size was 2.56 ± 0.56 cm. Mean operative time was 152.26 ± 107 minutes and mean hospital stay was 3 ± 0.95 days. Post-operative transfusion was required in 1 (2.12%) only. There was no episode of sepsis or perinephric collection. Pre-operative stone clearance was 90.88% ± 13.46%. Conversion to open surgery was not seen in any cases. DJ stent was placed in 36/47 (76.6%) cases. Conclusions: PCNL is a safe and effective way of
treating renal stones in the old age population.
UP.291 Comparison of Standard Versus Tubeless Percutaneous Nephrolithotomy Iqbal N, Malik Y, Nadeem U, Pir A, Khalid M, Arshad H, Majeed M, Akhter S Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: Renal stone disease is
one of commonest urological disorders recognized since ancient times, having an approximate prevalence of 2-3% in the general population. It’s estimated that lifetime risk of developing a kidney stone is almost 12%. Pakistan is situated in the stone belt region of the world, with a high incidence of kidney stones. Renal stones used to be removed by means of open surgery, but the introduction of minimally invasive, endoscopic techniques and extra-corporeal shock wave lithotripsy (ESWL) have almost replaced the classically performed open surgery for the removal of renal stones.
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Materials and Methods: From January 2011 to De-
cember 2015, PCNL was performed in 308 adults out of which tubed PCNL (in which nephrostomy tubes were used postoperatively) was done in 167 patients (group 1) and tubeless PCNL in 141 patients (group 2). We performed tubeless PCNL when there was a presence of residual fragments, bleeding, and decision to relook in office for remaining fragment extraction with the help of a flexible nephroscope. We used adult-size 27 French nephroscope for PCNL by standard technique. The nephrostomy tube used in the tubed PCNL group was 16 Fr. The stone-free rates, mean operative time, mean hospital stay, mean drop of hemoglobin level, use of analgesics doses and pain control, complication rates and ancillary procedures used were evaluated in a comparative manner. Results: The mean age in this study was 44.29±14.84 years and 45.60±14.33 years in group 1 and 2 respectively, and the mean stone size was 3.32±1.94 cm and 3.37±1.99 cm in group 1 and 2 respectively. The mean operative time was 141.29±72.30 minutes and 139.85±58.13 minutes in the two respective groups. The mean drop in hemoglobin level was 0.76 g/dl and 1.37 g/dl in these groups. The mean analgesic dose required was 3.56±0.45 doses in group 1 and 3.15±0.38 doses in group 2 (p value 0.98). The mean hospital stay was 3.37±1.21 days and 3.01±1.23 days in group 1 and 2 respectively (p value 0.052). The mean stonefree rate was 90.28%±15.87% and 94.81%±10.98% in the two groups (p value 0.19). Postoperative blood transfusion was done in 7 and 5 patients respectively. Postoperative sepsis was seen in 10 and 1 patients (p value significant) respectively. Ancillary procedure of ESWL was seen in 40 and 17 patients respectively (p value significant). There was no significant difference in terms of mean stone free-rates, mean hospital stay and use of analgesics doses between the two groups. Conclusion: The results of tubed PCNL and tubeless
PCNL are almost similar in terms of safety and stonefree rates when intraoperative decision about placing nephrostomy tube is made judiciously.
UP.292 Comparison of the Outcome of Extracorporeal Shock Wave Lithotripsy (ESWL) and Percutaneous Nephrolithotomy (PCNL) for Treating Multiple Pole Renal Stones in Adults: A Single Center Study Iqbal N, Haq S, Khawaja A, Iqbal S, Hussain T, Hasan A, Tariq N, Akhter S Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: To retrospectively evaluate and compare the effectiveness of extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) for treating multiple pole adult renal stones. Materials and Methods: From January 2013 to July 2014, ESWL was performed in 106 patients and PCNL was done in 39 adult patients. We used Modulith SL X lithotripter 4th generation Storz medical equipment for ESWL, and adult 27 French nephroscope for PCNL by standard technique. The stone-free rates, number of retreatment required, complication rates
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UNMODERATED ePOSTERS and auxiliary procedures used were evaluated in a comparative manner. Results: Mean Stone size was 1.22±0.56 cm in the ESWL group and 2.80±1.10 cm in the PCNL group. Stone clearance rate was 50% for ESWL and 88.5% for PCNL. In the ESWL group, haematuria was seen in 5 (4.7%), sepsis in 5 (4.7%) and steinstrause in 2 (1.9%) patients, while in the PCNL group, 2/39 patients (5.1%) had sepsis, post-operative transfusion was needed in 2/39 (5.1%) and perinephric collection was done in 3 (7.7%) patients. In the ESWL group, the number of sessions required in multi poles was one session in 55 patients (51.9%), 2 sessions in 28 (26.4%), and more than 2 sessions in 22 (21%) patients. Conclusion: For the treatment of multiple pole re-
nal stones in adults, percutaneous nephrolithotomy has better stone clearance as a single procedure than shock wave lithotripsy. Retreatment rate was high in the ESWL group, but complication rate was higher in the PCNL group.
UP.293 Gonadal Vessel Position Can Be Correlated with Ureteral Stones Radfar MH, Valipour R, Naroui B, Sotudeh M Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction and Objective: Urinary system obstruction can be caused by vascular abnormalities such as retrocaval ureter, ovarian vein syndrome, and ureteropelvic junction obstruction with aberrant vessels. Our goal was to evaluate the correlation between aberrant and gonadal vessels and ureteral stones. Materials and Methods: Patients with upper ureteral stones scheduled for laparoscopic transperitoneal pyelolithotomy were included in the study, and their data were collected prospectively. Demographic and preoperative data, stone characteristics, and the presence of gonadal vessels immediately distal to the ureteral stone were recorded. Results: Twenty-five patients (17 men and 8 women) were included in the study. The mean age of patients was 46.02 ± 14.09 years (range 21-78). Eighteen (72%) patients had gonadal vessels crossing the ureter immediately distal to the ureteral stone. There was a significant correlation between the presence of crossing gonadal vessels and the size of the ureteral stone (P=0.026). Conclusion: The presence of crossing gonadal vessels
is associated with larger ureteral stone size. It seems that ureteral stones might be stuck proximal to the crossing gonadal vessel. Moreover, crossing gonadal vessels might be used as an anatomical landmark to find ureteral stones in laparoscopic ureterolithotomy.
UP.294 Laparoscopic Pyelolithotomy in Patients with and Without a History of Previous Renal Surgery Radfar MH1, Valipour R1, Kashi AH2, Dadpour M1, Nouralizadeh A1, Simforoosh N1 1
Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of
216
Medical Sciences, Tehran, Iran; 2Shahid Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran
in terms of the same parameters. Comparisons were conducted using SPSS 16.0 and p<0.05 was considered statistically significant.
Introduction and Objective: Laparoscopic pyelolitho-
Results: In our clinic, 27 patients underwent PCRPLND between the years 1996-2012. The mean pre-orchiectomy AFP was 1919 (1-17500) ng/ml, mean beta HCG was 13822 (1.2 to 226.567) mIU/ ml. Orchiectomy pathology results were mixed germ cell tumor in 20 patients, embryonal carcinoma in 4 patients and yolk sac tumor in 2 patients. Poor prognostic factors were detected in 11 patients. Pre-chemotherapy mean mass size was 69.3 (30-125) mm. While post-chemotherapy mean mass size was 41.2 (12-120) mm. No decrease in 8 patients’ mass size was observed. Live tumor was detected in 4 (15%), teratoma in 14 (54%), necrosis in 8 (31%) patients who underwent PC-RPLND. PC-RPLND pathology results of 15 patients whose orchiectomy pathology was without teratoma, 6 patients had teratoma, 7 necrosis, 3 viable tumors. While PC-RPLND pathology of 11 patients whose orchiectomy pathology with teratoma was teratoma in 8, necrosis in 2 and viable tumor in 1 patients. Teratoma was detected in 3, necrosis in 3, viable tumor in 1 of seven patients whose orchiectomy pathology had EC more than 50%. Necrosis was detected in one patient whose orchiectomy pathology had EC more than 50% and vascular invasion. Necrosis was diagnosed in one of 2 patients who only had vascular invasion, while teratoma was observed in the other one. Teratoma was detected in 6, viable tumors in 2, necrosis in 1 of nine patients without these risk factors. Necrosis in 7, teratoma in 8, viable tumors in 2 was found in 17 good risk group patients according to IGCCC. Teratoma in 2, live tumors in 1 was observed in 3 intermediate risk group patients. Teratoma in 3, necrosis in 1, viable tumors in 1 seen in 5 poor risk group patients. Teratoma was detected in 6, live tumors in 2 of 8 patients whose mass size didn’t decrease. There was only one patient whose mass size decreased more than 90% and PC-RPLND pathology was necrosis. Two patients underwent metastasectomy surgery for residual mass in lung. One of them had necrosis and the other teratoma. Ureteral avulsion in one patient, renal vein injury in other, vena cava injury in 4 patients were experienced. Inferior mesenteric artery was cut because of extreme adherence to mass and no complication was encountered during the postoperative period. Anterior branch of the right renal artery was ligated in one patient. Postoperative 70% renal loss in the same side was detected via renal DMSA scintigraphy. Prolonged lymphatic drainage in 4 patients was resolved with conservative treatment. Partial resection could be conducted in two patients. Live tumor cells were detected in these two patients and they died despite of additional chemotherapy. There were no significant differences in post chemotherapy mass size and live tumor rates between the patients with and without complications. Patients were surveyed for 27 means (3-60) months.
tomy (LP) is an alternative option for treating large, one-piece pelvic stones in an extrarenal pelvis. A history of previous surgery is a relative contraindication to laparoscopic surgery because of high probability of access related and other complications. Our goal was to evaluate whether previous renal surgery is associated with surgical outcome in patients undergoing LP. Materials and Methods: In this retrospective study,
we collected data from 190 consecutive patients who underwent laparoscopic pyelolithotomy from April 2002 to December 2015. The patients were divided into two groups; group A: 163 patients without history of surgery, group B: 27 patients with history of kidney surgery (percutaneous or open stone surgery). Results: There was no significant difference in preoperative and stone features between the groups. The mean duration of surgery was not different between the groups (170 minutes in group A and 179 minutes in group B (p=0.7)). The mean length of hospital stay was 4.9 and 4.6 days in groups A and B, respectively (p=0.2). None of the patients in group B needed conversion to open surgery. There was no significant difference in stone-free rate, hemoglobin decrease, packed cell transfusion, urine leak, fever, and other complications. Conclusion: A history of previous renal surgery does
not seem to affect the outcome of laparoscopic pyelolithotomy. LP is safe and feasible for treating pelvic stones in patients with a history of previous renal surgery.
UP.295 Retrospective Analysis of Postchemotheraphy Retroperitoneal Lymph Node Dissection (PC-RPLND) Results in Patients with NonSeminomatous Testicular Cancers Soydan H1, Malkoç E1, Okçelik S2, Yilmaz Ö1, Ateş F1, Dursun F3, Karademir K1, Şenkul T1 1
GATA Haydarpasa Teaching Hospital, Clinic of Urology, Istanbul, Turkey; 2Beytepe Military Hospital, Urology Dept., Ankara, Turkey; 3Gümüşsuyu Military Hospital, Urology Dept., Istanbul, Turkey Introduction and Objective: Resection of residual
masses after chemotherapy in patients with non-seminomatous testicular cancer is recommended. In our study, we evaluated the patients’ data underwent post chemotherapy retroperitoneal lymph node dissection (PC-RPLND). Materials and Methods: Patients with advanced
staged tumors and Non-seminomatous germ cells and having residual mass after chemotherapy whose tumor markers returned to normal were selected in the study. Pre-chemotherapy mass size, post-chemotherapy mass size, decrease rate in the mass size, prognostic factors of local tumor, International Germ Cell Collaborative Classification (IGCCC) risk groups, and teratoma existence in primary pathology, PC-RPLND pathologies were compared for fibrozis, teratoma or viable tumor presence. In addition, patients with and without intraoperative complications were compared
Conclusion: Our data is coherent with the current
literature. The mass size decrease rate, teratoma presence in orchiectomy material, IGCCC risk groups and local prognostic factors are not accurate predictive factors in determining the PC-RPLND pathology.
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.296 Microinvasive Germ Cell Tumor of the Testis: Two Cases Okçelik S1, Soydan H2, Yilmaz I3, Malkoç E2, Zor M2, Ateş F2 1 Beytepe Military Hospital, Urology Dept., Ankara, Turkey; 2GATA Haydarpasa Teaching and Research Hospital, Urology Dept., Istanbul, Turkey; 3GATA Haydarpasa Teaching and Research Hospital, Pathology Dept., Istanbul, Turkey
Introduction and Objective: We report two cases of
microinvasive seminoma, which is a preclinical precursor lesion for testicular germ cell tumors. Materials and Methods: In the present case reports, we evaluated the microinvasive seminoma cases after getting consent. Results: Case 1: A 24-year-old male patient present-
ed to our outpatient clinic with a palpable testicular mass. His medical history revealed two orchidopexy. The patient presented to our outpatient clinic in December 2012. He had a palpable mass at his right testicle and grade III varicocele at the left side. His tumor markers were normal. Ultrasonographic evaluation revealed a right testicle with 5 cc volume and a mass measuring 9x7.7 mm diameter in the testicle. Sperm count and analysis revealed azoospermia with a total of 2.5 cc volume. The patient underwent right radical orchiectomy and left varicocelectomy. In macroscopic examination, the resected right testicle was 1.8 cm in greatest dimension. Histopathological examination of the testicle revealed diffuse IGCN. The tubular basement membranes were thickened and a few of them had calcifications (microliths) in their lumens. There was tubular atrophy with sclerosis. No spermatogenesis was evident. In one focus, a few numbers of atypical cells with large nuclei, prominent nucleoli and large clear cytoplasm were seen in the intertubular area of the testicle. The tumor cells did not form an expansile mass. Diastase-sensitive PAS positivity was seen in the cytoplasm of these atypical cells. These atypical cells showed immunoreactivity for placental-like alkaline phosphatase (PLAP), CD117 and OCT3/4. The greatest dimension of the intertubular area infiltrated by these cells was below 1 mm. Then, the whole testicle was submitted for histological examination and there was no additional focus of a tumour. Finally, the pathologic diagnosis of the resected specimen suggested microinvasive seminoma and diffuse IGCN (also called unclassified (IGCNU), with extratubular extension). CT of the chest and abdomen were normal. No recurrences or metastasis were seen in his twenty months follow-up. Case 2: A 21-year-old male patient admitted to the general surgery outpatient clinic with right inguinal hernia. Ultrasonography revealed no testicle on the right side and microlithiasis in the left testicle, except for findings suggestive of right inguinal hernia. The patient underwent right inguinal hernia repair. During the operation, the right testicle was found to be in the proximal inguinal canal. Following urology consultation, right orchiectomy was performed simultaneously for tumor prophylaxis. The resected right testicle was 2.8 cm in its greatest dimension. Macroscopic examination did not reveal any gross abnormalities except for small testis size. Histopathological examination of the testicle also revealed diffuse IGCN, thickened tubular basement
membranes, microliths in a few of tubule lumens and tubular atrophy with sclerosis, similar to that in the first patient. In one focus, between the lymphocytic cells, a small group of malignant germ cells with large nuclei, prominent nucleoli and large clear cytoplasm that destroy the architecture of the interstitium by expanding the intertubular space of the testis were observed. These atypical cells showed immunoreactivity for PLAP with cytoplasmic membrane staining. PAS positivity was seen in the cytoplasm of these atypical cells. The greatest dimension of the intertubular area infiltrated by these cells was 1.2 mm. Then, the whole testicle was submitted for histological examination and there were 2 more additional foci of these atypical cells with 1 mm and 0.8 mm. Finally, the pathologic diagnosis of the resected specimen suggested seminoma and diffuse IGCN. In this case, the diagnosis of seminoma was established due to multifocality and the dimension of the infiltrated area (>1 mm). There was no vascular invasion, rete testis, epididymis or spermatic cord invasion. Chest and abdomen CT was normal. The patient received adjuvant radiation therapy. He had no disease recurrence or metastasis during follow-up. Conclusions: MGCT is a secondary precursor for TGCT that must be treated with orchiectomy that followed by radiotherapy if necessary. Ultrasonographic surveillance of microlithiasis increases the diagnosis of precursor lesions.
UP.297 Preoperative Testosterone Levels Are Associated with Testicular Germ Cell Tumor Histology Hugen C1, Shin D1, Cortessis V2, Daneshmand S1 1 University of Southern California Institute of Urology, Los Angeles, United States; 2Dept. of Preventive Medicine, University of Southern California, Los Angeles, United States
Introduction and Objective: Testicular germ cell
cancer incidence has increased over the past several decades. Unfortunately, epidemiologic studies have been unable to identify causative factors to explain the increasing incidence. The androgen receptor and androgen signaling are potential mechanisms that have been implicated in testicular germ cell carcinogenesis. We hypothesized that pre-orchiectomy testosterone levels may predict testicular cancer histology. Materials and Methods: An IRB approved retrospective review was performed on patients who underwent radical orchiectomy at our institution for germ cell tumors between 2009 and 2014. Patients were included if they had a total testosterone level measured prior to orchiectomy. Logistic regression was performed to determine if pre-orchiectomy testosterone level was associated with testicular cancer histology. Results: A total of 89 patients met inclusion criteria during the study period, of whom 51 had non-seminomatous germ cell tumors (NSGCTs) and 38 had seminomatous germ cell tumors. Median age was 30.3 (range: 18.8-52.0) and 26.6 (range: 16.7-53.5) years for seminomatous and NSGCTs, respectively. After correcting for age, when pre-operative level of serum testosterone was tested as a continuous variable it was negatively associated with seminoma histology (OR 0.998 per unit testosterone, p=0.045). When pre-op-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
erative testosterone was categorized by very low (<200 ng/dl), low (200-350 ng/dl), and normal (>350 ng/dl) values, tumor histology was associated in the same direction with testosterone level, but the association did not achieve statistical significance (p=0.319). Conclusions: Preliminary data suggest that pre-orchiectomy testosterone levels are negatively associated with seminomatous germ cell tumor histology. Further study is needed with a more robust patient population to determine if this association remains.
UP.298 Neuroendocrine Testicular Tumors: A Systematic Review and Meta-Analysis Mseddi MA1, Hadj Slimen M1, Hamza M1, Charfi C2, Bouzguenda M3, Bouassida M1, Mnif H2, Rebai N1, Boudawara T2, Mhiri MN1 1
Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia; 2Dept. of Anatomic Pathology, CHU Habib Bourguiba, Sfax, Tunisia; 3CHU Habib Bourguiba, Sfax, Tunisia
Introduction and Objective: The purpose of this study is to examine the main epidemiological, clinical, paraclinical, pathological, therapeutic and evolutionary features of patients with testicular neuroendocrine tumors (TNET). Materials and Methods: This was a meta-analysis and systematic review for cases of published testicular neuroendocrine tumors. Nine case series and sixteen case reports were identified by searching PubMed database and qualified for inclusion in this study. We added the data obtained from our experience, one case treated in the department of urology in Habib Bourguiba Hospital in Sfax, to the published cases. Results: A total of 132 cases were collected through our literature review and our case study. Median age at diagnosis was 39 years old (range 10-83 years of age). The majority of patients were consulted in the six months following the beginning of symptoms. The most common presenting symptom was either a testicular mass or a swelling in 38.46% of cases. Carcinoid syndrome was documented in 10.60% of patients. The clinical examination revealed a palpable mass in 44.70% of patients. This mass was painless and firm in most cases. Serum tumor markers (β-HCG, AFP and LDH) were within normal limits in all patients except in one case. Only 12 patients had a high level of 5-HIAAμ. Most testicular neuroendocrine tumors (76.52%) were primary and pure. The tumors were positive for chromogranin (100%), synaptophysin (100%) and cytokeratin (93.10%). Metastases were detected at time of diagnosis in eight cases (6.06%). The most affected organ was the liver in four cases. The main treatment was radical orchiectomy performed in 127 patients (96.21%). The clinical course was good, only nine patients died within an average period of 33 months. The 5-year overall survival rate was 78.70% and the 5-year specific survival rate was 84.30% Conclusions: Most neuroendocrine tumors of the testes have a benign clinical course. The diagnosis of testicular carcinoids is based on the immunohistochemistry study. The treatment of choice for these tumors is radical orchiectomy. Somatostatin analogues were reported to be effective in patients with carcinoid
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UNMODERATED ePOSTERS syndrome. They can also stabilize metastatic disease progression.
UP.299 Is There a Learning Curve for Retroperitoneal Lymph Node Dissection? Thomas B1, Dev H2, Shaw G3, Lee E1, Riddick A1, Neal D2 1
Cambridge University Hospitals, United Kingdom; University of Cambridge, United Kingdom; 3 University College London Hospitals, United Kingdom 2
Introduction and Objective: Retroperitoneal Lymph
Node Dissection (RPLND) for testicular cancer is an operation performed in specialized institutions, often with relatively low numbers than other urological cancer operations and with decreased opportunity for case selection due to centralization. We investigated the change in peri-operative outcomes with increasing experience after a mentorship period. Materials and Methods: The first 30 RPLNDs performed by a single surgeon in a centralised RPLND service were analysed using a prospective database. All RPLNDs were performed for residual masses after chemotherapy. The first 5 cases were performed jointly with a senior surgeon (group A) and acted as a control group. The second 5 cases were performed with a senior surgeon available (group B) and the following 20 cases (analyzed in sequential groups of 5 RPLNDs, groups C to F) were performed independently. Operative duration, blood loss, length of stay and lymph node yield were analyzed. Results: There were no statistically significant differ-
ences between the first 5 cases (group A) and the last 5 cases (group F) for operative duration, blood loss, length of stay and lymph node yield. Operative duration was significantly increased (p=0.02) in group C (median 300 minutes) compared to group A (median 150 minutes) then decreased over the subsequent 15 cases (groups D to F) with median operative duration 240 minutes in group F. Blood loss was significantly increased (p=0.02) in group C (median 800 ml) compared to group A (median 200 ml). Blood loss further
increased in group D but decreased over the next 10 cases (median 400 ml in group F). There was a trend for decreasing length of stay with increasing experience that stabilized after 10 cases (median 6 days for groups C to F). Lymph node yield decreased significantly (p=0.01) in group B (median 6 lymph nodes) compared to group A (median 14 lymph nodes) but increased with further experience over the next 20 cases (median 15 lymph nodes in group F). Conclusion: Peri-operative outcomes are initially
affected in the independently performed cases after mentorship. However, they appear to improve and plateau after a relatively small number of independent cases, which may be related to the competency for this surgery being derived from more commonly performed urological cancer surgeries. Analysis of the outcomes over a longer time period, and controlling for the factors affecting the difficulty of surgery would be useful for further analysis.
UP.300 The Association of Testicular Mass and Intratesticular Epidermoid Cyst: A Retrospective Study
pathological result. When the literature was analyzed, there were no more cases that reported comparison with our study. Results: The patients mean age was 21 years (range 20-29). Nine of 13 patients had the testicular mass in the right testicle and 4 patients had it on the left side. All of the patients’ tumour markers (AFP, B-HCG and LDH) were in normal range. One patient had testis localization in the right inguinal canal. The mean tumour size was 18.6x15.8 mm. The most common tumour localization in the testicle was in the middle of the testis. Five of 16 patients had radical orchiectomy while the others had partial orchiectomy (Table 1). Conclusion: According to our retrospective study, it
is clearly seems that with the development of frozen section pathological evaluation, the surgical approach turns to partial orchiectomy. According to nature of our study, the close follow-up of these patients was absent. Prospective randomized clinical studies may demonstrate a sufficient follow-up procedure of these patients.
UP.301
Topuz B, Coğupligil E, Yilmaz S, Uğuz S, Zor M, Kaya E, Alp BF, Yildirim I Gulhane Military Medical Academy, Ankara, Turkey Introduction and Objective: Testicular epidermoid cysts are rare benign testicular lesions that affect mostly young men. They account for approximately 1-2% of all testicular tumors. Generally, the testis has a palpable, painless mass. Tumor are markers within normal ranges. Ultrasonographic imaging shows a well-demarcated complex intraparenchymal lesion. The aim of this retrospective study is to demonstrate the characteristics of this tumour. Materials and Methods: We retrospectively detect-
ed the clinical data of patients treated with radical or partial orchiectomy for testicular mass between 1995 and 2016. We found 16 patients whose pathological results showed intratesticular epidermoid cyst. Three of 16 patients had insufficient data except for the
Primary Testicular Plasmocytoma: An 8-Year Follow-Up Fourati M, Mejdoub B, Hadj Slimen M, Rekik S, Chaabouni A, Rebai N, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objective: Approximately 60 cas-
es of testicular plasmocytoma have been reported in medical literature. However, only 24 of them are isolated tumors without previous history or progression to multiple myeloma. Materials and Methods: We reported on a new case
of primary testicular plasmocytoma treated by orchidectomy and adjuvant radiotherapy with the highest survival rate ever observed. Results: A 63-year-old patient presented with progressive and painless enlargement of the right testicle since six months. Testicular ultrasound showed
UP.300, Table 1. Characteristics of Patients Who Have Sufficient Information Number
Surgical time
Age (year)
Tumour laterality
Testis localization
Tumour marker
Tumour localization
Tumwour size (mm)
Types of surgery
1
2002
20
Right
Scrotal
Normal
Middle of the testis
26x24
Radical orchiectomy
2
2004
23
Left
Scrotal
Normal
Middle of the testis
18x17
Radical orchiectomy
3
2004
21
Right
Inguinal
Normal
Middle of the testis
16x10
Radical orchiectomy
4
2004
21
Right
Scrotal
Normal
Upper of the testis
20x20
Radical orchiectomy
5
2009
21
Right
Scrotal
Normal
Middle of the testis
22x20
Partial orchiectomy
6
2009
21
Left
Scrotal
Normal
Middle of the testis
13x11
Partial orchiectomy
7
2009
21
Right
Scrotal
Normal
Upper of the testis
18x17
Partial orchiectomy
8
2011
26
Right
Scrotal
Normal
Lower of the testis
19x13
Partial orchiectomy
218
9
2011
29
Right
Scrotal
Normal
Upper of the testis
20x15
Partial orchiectomy
10
2011
25
Left
Scrotal
Normal
Lower of the testis
24x22
Partial orchiectomy
11
2012
25
Right
Scrotal
Normal
Lower of the testis
18x12
Partial orchiectomy
12
2015
21
Left
Scrotal
Normal
Lower of the testis
17x14
Partial orchiectomy
13
2016
24
Right
Scrotal
Normal
Middle of the testis
12x11
Partial orchiectomy
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS diffusely enlarged, heterogeneously echogenic right testicle and epididymis with significant hyperemia. Laboratory values were not significant for an abnormal urinalysis or white blood cell count. Testicular tumour markers (α-fetoprotein, β-HCG and lactate dehydrogenase) were within normal limits. A right radical inguinal orchiectomy was performed. Immunohistochemical stains were positive for lambda light chain, CD138 and vimentine. Adjuvant radiotherapy was given at a dose of 50 Gy. There was no evidence of bone marrow involvement or systemic signs of myeloma. After eight years of follow-up, investigations did not find any metastasis or local recurrence. Conclusion: Primary testicular plasmocytoma is a
rare lesion. Radical inguinal orchiectomy is the treatment of choice and it seems that adjuvant radiotherapy improves survival rate.
UP.302 Our Experience in the Treatment of Testicular Yolk Sac Tumor in Children: 10 Cases 1
1
1
ologically, the overall prevalence in testicular tumors is less than 1%. It is linked to the persistence of high levels of ACTH. The objective is to present a rare case of adrenal rest tumor in the elderly.
the increasing publicity of the Movember campaign. Cancer awareness was inconsistent. Testicular cancer shows a significant association in one of the 11 years only and prostate cancer in only two years.
Materials and Methods: Patient CJ, male of 85 years old with no known urological history, with a history of bilateral inguinal hernia repair, consultation testicular heaviness. Physical examination area hard stone is evident in right testicle, and increased diameter of the left testicle. The right testicle ultrasound reported a heterogeneous nodular image with irregular edges, with increased Doppler signal inside. Her placement is decided, markers are requested and performed the next day a right orquifuniculectomy. Pathology report showed linkable chart ectopic adrenal cortex.
Conclusions: We concluded that the Movember campaign is universally linked with novelty facial hair and weakly associated with public awareness in prostate and testicular cancer. Whilst the funds generated by the campaign should be applauded, more could be done to link the campaign and the moustaches to an awareness of common male cancers.
Results: The literature related to the subject, mostly linking of these tumors with congenital adrenal hyperplasia is discussed. The limited literature on this finding in adulthood, and its implications, are mentioned. Conclusion: We recommend that all testicular tumors
1
Fourati M , Mejdoub B , Hadj Slimen M , Rebai N , Ben Dhaou M2, Jallouli M2, Mhiri MN1 1 Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia; 2Dept. of Pediatric Surgery, CHU Hedi Chaker, Sfax, Tunisia
Introduction and Objective: We aimed to describe
a 24-year clinical experience in managing testicular yolk sac tumors in pediatric patients and to discuss the optimal treatment for these tumors. Materials and Methods: We conducted a retrospec-
tive study including 10 pediatric patients who presented with testicular yolk sac tumor followed in our institution from 1990 to 2014. Results: The average age was 16 months. All patients
presented with a painless scrotal mass. Serum alpha-fetoprotein (AFP) levels were elevated in all cases. Ultrasonography identified the yolk sac tumors as solid masses. All patients underwent inguinal orchiectomy. Imaging showed retroperitoneal lymph node in one case. Nine patients presented with testicular yolk sac tumor at stage I. Seven patients received postoperative chemotherapy. Serum AFP levels returned to normal 1 to 2 months after surgery. Only one surgically treated patient had relapsed (lung metastases). Survival rates ranged from 25 months to 11 years. Conclusion: The survival rate of young boys with tes-
ticular yolk sac tumor is very good because of both effective chemotherapy and likely, the inherent characteristics of the tumor in this age group.
UP.303 Adrenal Rest Tumor in the Testicle: A Case Report Blanco F1, Caradonti M1, Silva E1, Puscinski A1, Villalon L1, Juffe L2 1
Hospital Aeronáutico Central, Buenos Aires, Argentina; 2Hospital Ramos Mejía, Buenos Aires, Argentina
Introduction and Objective: Adrenal rest tumors
(TRS) in the testicle are caused by ectopic adrenal cortical tissue. The reason for this presentation is the low frequency of these lesions in adult patients. Epidemi-
should be explored, and if necessary, to make the orchiectomy, since the prevalence of SDB is an unusual entity in this age group. According to our search, this is the first case reported in the elderly.
UP.304 The Movember Campaign: Promoting Hairiness but Not Raising Awareness Khan J1, Papa N2, D’Arcy F1, Dowling C1, Wrafter P1, Kelly J1, Durkan G1, Rogers E1 1
Dept. of Urology, University Hospital, Galway, Ireland; 2Dept. of Urology, Austin Hospital, Heidelberg, Victoria, Australia; University of Melbourne, Victoria, Australia
Introduction and Objective: Internet search trends
have previously been used to examine public interest in health issues including cancer screening, kidney stones, and erectile dysfunction. The Movember campaign became international in 2007 and encourages men to grow a moustache during the month of November. The campaign’s aims include promotion of prostate and testicular cancer (dubbed “Men’s cancer”) awareness. We examined Internet search activity to see if the Movember campaign successfully generates public interest in “Men’s cancer”. We reviewed Internet search activity for the search terms “prostate cancer”, “testicular cancer”, “Movember” or “moustache” over an eleven-year period from 2004 to 2015. Materials and Methods: Google Trends was used to
review weekly Internet search activity from January 2004 to December 2015. The weeks in November from 2007 to 2015 were examined for changes in search activity for our chosen search terms, which could be attributed to the annual Movember campaign. Results are expressed as a percentage of peak search activity. Results: Average weekly search activity for the period from January 2004 to December 2015 were for prostate cancer 12.03%, testicular cancer 6.73%, Movember 3.29% and Moustache 7.61%. Average weekly search activity for the weeks of November from 2007 to 2015 were for prostate cancer 11.29%, testicular cancer 5.78%, Movember 31.16% and Moustache 13.15%. Throughout the 11 years assessed, only searches for the term “moustache” was statistically associated with
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
UP.305 The Impact of a Simplified Pelvitrainer Curriculum on Basic Laparoscopic Skills of Junior Urologists and Visceral Surgeons: A Prospective Study Including 20 Residents Bouassida M1, Mseddi MA1, Touati T1, Hadj Slimen M1, Hentati N2, Mhiri MN2 1
Dept. of Urology, Habib Bourguiba Hospital, Sfax, Tunisia; 2Dept. of Surgery, Habib Bourguiba Hospital, Sfax, Tunisia
Introduction and Objective: Laparoscopic surgery is clearly different from open surgery and therefore requires a different training setup. Laparoscopy training has evolved in recent years. We describe a simplified training program using the pelvitrainer to improve the basic laparoscopic skills of junior urologists and visceral surgeons. Materials and Methods: This is an analytical pro-
spective study focusing on the skill progress of 20 residents in surgical specialties and with different levels of training. Our program started with 4 inanimate tasks that included peg transfer, disc cutout, needle guidance and intracorporeal knot tying. Each task was practiced for a one-hour training session with an objective evaluation (time necessary to achieve every task and quality criteria in the 2 first tasks) at the initial attempt and at the end of the training session. Results: Residents were 28 years old (26-31). The sex ratio was 4/1. Two specialties were represented: visceral surgery (12 residents) and urology (8 residents). The continuous evaluation of these trainees showed that there was a significant decrease in the time required to perform each of the 4 tasks at the end of their corresponding sessions compared to the base line values. Task 1: the average time decreased from 4 min 25 sec to 2 min 30 sec (p = 0.00). The average number of dropped objects decreased from 0.8 to 0 (p = 0.037). Task 2: the average time decreased from 4 min 44 sec to 3 min 19 sec (p = 0.019). The average length of cutting beyond the lines decreased from 2.1 cm to 0.6 cm (p = 0.005). Task 3: the average time decreased from 8 min 36 sec to 4 min 43 sec (p = 0.004). Task 4: the average time decreased from 4 min 7 sec 2 min 12 sec (p = 0.001). Conclusion: The results of this study confirm that
such a model allows the training of surgeons to progress significantly. The Pelvitrainer is a powerful and inexpensive tool that can help in the improvement and in the retention of the basic laparoscopic skills of the junior residents.
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UNMODERATED ePOSTERS UP.306
UP.307
Evaluating the Effectiveness of an Online Journal Club: Experience from the International Urology Journal Club
Concurrent and Predictive Validation of Robotic Simulator Tube 3 Module
Thangasamy I1, Loeb S2, Leveridge M3, Stork B4, Davies B5, Woo H6 1
Urological Society of Australia and New Zealand, Sydney, Australia; University of Queensland, Brisbane, Australia; 2Dept. of Urology and Population Health, New York University, United States; 3Dept. of Urology, Queen’s University, Kingston, Canada; 4West Shore Urology, Muskegon, United States; 5Dept. of Urology, University of Pittsburgh Medical Center, United States; 6 Sydney Adventist Hospital Clinical School, University of Sydney, Australia Introduction and Objective: The International Urol-
ogy Journal Club was developed to promote a global and robust discussion of latest evidence-based research. The objective of our study is to evaluate the effectiveness of the first international Twitter-based urology journal club (#urojc) using Kirkpatrick’s evaluation model, and to quantify the development of #urojc into a robust educational platform. Materials and Methods: A 13-item survey was sent via Twitter to all 3127 participants of #urojc. Twitter metrics such as number of users, tweets and impressions for the journal club during its first two years were obtained via a third-party service called Symplur using the hashtag #urojc. Qualitative analysis was also performed of individual tweets to assess for relevance to the discussion. Kirkpatrick’s four-level evaluation model (reaction, learning, behaviour and results) was applied to objectively analyze the effectiveness and impact of #urojc. Results: Overall reaction (Kirkpatrick Level 1) to #urojc was overwhelmingly positive. Consultant urologists were the most active participants, while urology trainees reported the most educational value. Forty-five percent of junior consultant urologists and trainees reported a change of practice (Kirkpatrick Level 3) as a result of participation in #urojc. The total number of unique users of #urojc almost doubled from year one to year two, with an increase of three new countries per month. While the number of tweets per month and author participation also increased from year one to year two, the proportion of content-relevant tweets remained stably high at approximately 60%. Conclusion: To our knowledge, this is the first time
Kirkpatrick’s evaluation model has been applied to a journal club. The overall reaction to International Urology Journal Club by participants is positive with change of practice also reported. Thus, it appears that #urojc achieves levels 1 and 3 of Kirkpatrick’s evaluation model. Further investigation is required for evaluation of level 2 and 4. The journal club continues to draw robust participation from a global audience, and serves as a benchmark for twitter-based journal clubs in other specialties.
220
Kim JY, Shim JS, Pyun JH, Cho S, Kang SH, Cheon J, Lee JG, Kim JJ, Park HS, Kang SG Dept. of Urology, Korea University College of Medicine, Seoul, Republic of Korea Introduction and Objective: We previously described
a new procedure specific module (“Tube 3”) to allow the practice of vesicourethral anastomosis after robot-assisted radical prostatectomy. Herein, we report a predetermined proficiency level of Tube 3 and preliminary validation to explore whether this new module can lead to performance improvement in the da Vinci system. Materials and Methods: Eight urology residents and
three urology fellows performed the Tube 3 module for 1 hour daily for 7 days. The learning curve was depicted through a scatterplot and the stable point was identified through the cumulative sum (CUSUM) chart. Concurrent and predictive validations were performed with the da Vinci system. The mean time to complete the task and end product rating score between Tube 3 training group and no Tube 3 training group were compared. Results: Concerning the learning curve, about 41 repetitions comprising about 5 hours were needed to achieve this stable point when the mean time to complete Tube of 384 seconds was set as a target. With regarding to the concurrent and predictive validation, there significant differences were evident in the mean time to complete 16 needle passages and the vesicourethral anastomosis and the end product rating score. Conclusion: The VR (virtual reality) simulator can
yield sufficient improvement in technical performance in Tube 3 within 5 hours. The acquired proficiency can be transferable to the vesicourethral anastomosis using the da Vinci system.
UP.308 A Model for Sustainable Surgical Training in Resource-Poor Countries: Reconstructive Urology DeLong J, Virasoro R Eastern Virginia Medical School, Urology of Virginia; Norfolk, United States Introduction and Objective: Surgical disease ac-
counts for significant morbidity, particularly in resource-poor settings. The Dominican Republic (DR) has a high rate of trauma and urethral injury, and a great unmet need for reconstructive urology. We have provided surgical education and service via medical missions; however there are always many more patients requiring care than we can treat in short trips. With our initiative, we seek to develop a translatable model of surgical education by integrating hands on training with a surgical curriculum to train fellows in reconstructive urology who will remain in country to continue to serve their communities. Materials and Methods: We present our experience in the DR over a 3-year period. All visits have included a site and needs assessment. We have been able to obtain key support from local societies and buy-in
from physicians. Needs assessed included equipment, facility requirements and education/surgical training including preoperative, operative and postoperative evaluation. Results: We have evaluated over 130 patients with urethral pathology in 5 week-long missions. The majority of patients had experienced previous failed surgery and on average spent 6 years or more with their condition prior to our evaluation, often unable to work. Average patient age was 42. Approximately 50% of strictures were iatrogenic, another 35% due to trauma and the remainder varied. Overall operating room capability is acceptable and there is great need for equipment and education. In our short time we have already begun to see an impact on local care delivery. Conclusion: We believe that our surgical training
model is translatable across many resource-poor settings, and can vastly improve delivery of medical care. Short medical missions, though immediately helpful, should lead to local development so that sustainability becomes a focus. We have developed a fellowship that will start in July 2016 and aim to train a total of 3 fellows over 4.5 years to meet the reconstructive needs in the DR. Integrated curriculum, frequent site visits and off-site training will help make it successful. Outcomes data will be continually assessed and provide a framework for future development and improvement.
UP.309 Factors Affecting the Response Rate of Frequency Volume Chart Park M, Kim SC, Chung JS, Oh CK, Park SS, Park SH Dept. of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea Introduction and Objectives: Frequency volume chart (FVC) is an important tool which can confirm bladder capacity, nocturnal polyuria and daytime voiding habit. However, many clinicians have been reluctant to use the FVC because of low response rate. The current study investigated factors affecting and measures improving the response rate of the FVC. Materials and Methods: We prospectively divided 129 patients (male: female=110:19) with complaints of voiding problem into two groups: group A with whom a doctor personally explained the necessity and the completion method of a FVC followed by the nurse’s explanation; group B with whom a nurse explained the method without the doctor’s explanation. The response rate was grouped into the following 3 grades; completed the FVC for 48 hours or more as “complete response”, failed to record for >48 hours or everything as “incomplete response”, did not record or summit as “non-response”. The complete and incomplete responses were regarded as “response”. The patient’s factors included private insurance, income, education, past medical history, urologic treatment history and international prostate symptom score (IPSS) were evaluated. Results: The mean age was 61.6±12.0 years (22-85) and there is no significant difference between two groups. The response rate (RR) (p=0.038) and complete response rate (CRR) (p=0.130) were 94.3%, 86.4% in group A and 82.9%, 75.6% in group B, respectively. The RR according to age was showed no
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS significant difference between two groups. The CRR was increased by doctor’s explanation in patients aged <50 years, but it was not in patients aged ≥70 years. The RR was decreased in patients without the private insurance and with the elementary or university graduate. The RR was increased with doctor’s explanation in patients with high school graduate or higher. Without doctor’s explanation the CRR was decreased in patients with urologic medical history. Conclusions: The RR of FVC was increased by doctor’s explanation in patients aged <50 years, without private insurance, with high school graduate or higher. To explain personally the necessity and the completion method of a FVC by doctor was a help to record accurately the FVC in patients.
UP.310 Frequency of Unsecured Catheterization and Its Effect on Quality of Life of Patients at a Tertiary Care Hospital Khan MA Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: Urethral catheters are
often at risk of inadvertent pulling forces that may results in multiple complications. Standard care of indwelling urethral catheter includes proper securement to prevent urethral traction, maintaining sterile and closed drainage system, keeping drainage bag below bladder and off the floor, daily meatal care, hand wash, wearing clean gloves prior to any manipulation of the catheter and obtaining urine sample aseptically from sampling port. Traction on urethra by the dragging effect of a urinary bag can result in urethral pain and discomfort, pressure ulcers mostly at peno-scrotal junction and urethral meatus and pressure necrosis at bladder neck. This can be avoided by securing the catheter. Simple but important basic measures of catheter care, such as securing of urinary catheters, are poorly researched and reported in the literature. We aim to determine the frequency of unsecured urethral catheters and its effect on quality of life. Materials and Methods: This observational study
was performed at Shifa International Hospital from October 2015 to January 2016. Data of 500 admitted patients were collected using a preformed performa. The urology department was excluded from the study to minimize selection bias. Results: Mean age of 52.48 ± 19.23 years. A total of
51% were male and 49% were female. Duration of catheterization was 4.43 ± 5.7 days. In surgical units, 26% of catheters were secured, while in medical units, this figure was 10%. A total of 97% of cases had a catheter of size 16 Fr, and 91% had latex Foley catheter. Only in 14.4% patients was the catheter secured. In 84.8% patients, the catheter affected quality of life, while 14.2% of patients were not bothered by it. Independent sample t-test was applied to compare the catheter securement and quality of life of the patients. The p-value was found to be less the 0.05. These findings indicate that catheter securement practices are inadequate despite several guidelines published on catheter care and it affects quality of life of the patient. Conclusion: A significant number of non-urological
patients have unsecured urethral catheter even at a
tertiary care hospital. This necessitates the improvement of resident and nursing education.
UP.311 Care Strategy in Urology and Continuing Education in Rural Areas: A Project of the Moroccan Endourologic Association Rabii R, Ayoub H University Hospital, Casablanca, Morocco Introduction and Objective: Access to care in rural areas and benefit from the same technology as in urban areas is a right of every Moroccan citizen. Continuous training to new leading technologies for urologists is an obligation. This procedure is experiencing lots of difficulty in developing countries. The objective was to examine the treatment of patients with BPH, and continuing education of urologists in areas of medical desert using an equipped mobile caravan. Materials and Methods: Between November 25, 2015
and December 15, 2015, the Moroccan Association of endourology operated in 6 cities in southern Morocco, using a medical caravan. A total of 38 transurethral resections of the prostate were performed. All procedures were carried out with a bipolar device in physiologic saline (TURis). The resectoscope used was an Olympus 26F in continuous flow-type Iglesias with continuous aspiration. Results: The mean age of the cohort was 58 years (range 55-68). All patients had severe dysuria according to IPSS score. The mean weight of the glands was 32 (range 30-45). All patients were operated under a locoregional anesthetic, without using irrigation. All patient left the hospital within the same day with analgesia and antibiotics and were reviewed the next day to remove the urethral catheter. None of the patients operated on experienced a TUR syndrome or a thermal skin lesion, or any other complication. A total of 11 urologists attended resections and received training.
lian urological tertiary center. Of this group, 38 were under 65 and 45 were 65 or over. A total of 78% of participants were either current or ex-smokers. The link between smoking and urological malignancies (kidney, bladder, penile and prostate) was poorly understood when compared with other malignancies (with the exception of bowel and brain cancer). Only 44% of participants were aware of the link between smoking and prostate cancer. Furthermore, dividing our cohort of participants into those with a known urological malignancy and those without revealed some interesting findings. Participants with a known urological malignancy were less aware of the link between smoking and all pathological conditions (both malignant and non-malignant). Analyzing our cohort by age demonstrated overall that younger participants were better educated on the risks of smoking. It was interesting to find that in the age group most likely to be affected by the condition (age >65 years), only 28% of participants identified a causal link between smoking and erectile dysfunction. Conclusions: This study demonstrates that patient education regarding smoking is poor, particularly in urology. Our cohort demonstrated better knowledge of the links between smoking and non-urological malignancies. Moreover, having a urological malignancy diagnosis was associated with poorer understanding of smoking, suggesting urologists must take a more active role in patient education. It is worth noting that this is a pilot study and currently, data is being collated from a greater number of participants. The ultimate goal is to establish a pool of data with enough power to change current approaches to educational techniques.
UP.313 Correlation of Robot Simulator Practice and Enhanced Robotic Surgery Outcome: Analysis of the VesicoUrethral Anastamosis Learning Curve
Conclusion: Our experience concludes that the use
Kim S, Kang S, Park H, Cheon J, Lee J, Kim J, Kang S
of TURis technology makes possible the treatment of BPH in rural areas and continuous training of urologists.
Korea Anam Hospital, Seoul, Korea
UP.312 How Much Do Our Patients Truly Know About Smoking? A Pilot Analysis of a Large Urological Cohort Khan M, Manning T, Papa N, Nzenza T, Simionato L, Lawrentschuk N Austin Health, Melbourne, Australia Introduction and Objective: We review the knowledge of smoking as a risk factor for urological disease in a cohort of urology outpatients. Materials and Methods: A pilot trial of patients attending all urology outpatient clinics from August to October 2015 at a large Australian tertiary center were given the opportunity to complete a standardized 4-page questionnaire on the subject of smoking as a risk factor for urological pathologies (both malignant and non-malignant) upon registering their arrival. Responses were then collated and statistical analysis was performed. Results: Data were collected on 83 patients presenting to the outpatient urology clinic of a large Austra-
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Introduction and Objective: The application of ro-
bot-assisted surgeries is expanding in the field of genitourology and consequently extensive investigation of these learning curves is presently occurring. If the operator were to preoperatively use the simulator program for practice, we believe that this may contribute to better results. In this study, the use of a simulator program for vesico-urethral anastomosis (VUA) during robot-assisted laparoscopic radical prostatectomy (RALP) and its effect on surgical outcome is investigated. Materials and Methods: A total of 45 cases of RALP during January 2014 and July 2015 have been included in this study. The three robot naive surgeons were put through sufficient practice of vesico-urethral anastomosis using the simulator program preoperatively. The learning curve for the simulator and the actual surgery was analyzed using the cumulative sum analysis. Results: Simulator completion time, needle passage completion time for VUA and the total time for VUA completion were analyzed using the cumulative sum analysis to find the learning curve. Results show that simulator completion time reached a plateau of 283.1
221
UNMODERATED ePOSTERS seconds at 36 repetitions. Needle passage completion and VUA completion time reached a plateau of 11.9 minutes and 14.9 minutes at 19 and 24 cases, respectively. Also, VUA completion time of 45 cases were divided into three groups each consisting of 15 cases, where the average time of completion was comparatively analyzed. The mean time was 19.93 minutes for group 1 (cases 1 to 15), 13.87 minutes for group 2 (cases 16 to 30), and 10.93 minutes for group 3 (cases 31 to 45).
‘@home’ or ‘pal@ night’ team to provide in-hours and out-of-hours catheter service within the community.
Conclusion: Sufficient practice of VUA through the
Hand-Assisted Laparoscopic Donor Nephrectomy: Initial Experience of Junior Surgeons at Pakistan Kidney Institute, Shifa International Hospital
robot simulator can enhance surgical outcomes. However, additional research with more subjects for the VUA robot simulator model should be investigated to further support our findings.
Conclusion: We need to be aware of significant mor-
bidity of the LTC and its economic burden. Patients can be managed in the community with better communication between primary and acute care. This is more cost-effective, allows a better patient experience, and improves quality of care.
UP.315
UP.314
Iqbal N, Alam MU, Afzal RM, Hasan A, Yousuf A, Rahim W, Jamil MI, Haroon M, Khan IA, Akhter S
Management of Long-Term Urinary Catheter: Integrating Tertiary Care with Community Based Care
Pakistan Kidney Institute, Islamabad, Pakistan; Shifa International Hospital, Islamabad, Pakistan
Tay LJ1, Karrouze I2, Thompson P3 1
King’s College Hospital NHS Foundation Trust, London, United Kingdom; Rotherham General Hospital Foundation Trust, United Kingdom; 2King’s College Hospital NHS Foundation Trust, London, United Kingdom; South Lambeth Integrated Care, London, United Kingdom; 3King’s College Hospital NHS Foundation Trust, London, United Kingdom Introduction and Objectives: Long-term catheter
(LTC) problems are a common presentation at the Emergency Department (ED) and are a significant burden to the services to the National Health Service. We carried out an audit of patients presenting to ED with catheter problems. We introduced a urinary catheter passport as an integrated pathway, and discuss potential solutions to this issue. Materials and Methods: Two audits were carried out in
2014 and 2015 of all patients presenting to the ED with a urinary catheter problem, specifically auditing reasons for presentation, time of presentation, intervention received and availability of community support. Results: In the initial audit (2014), 78 patients presented to the ED over 10 weeks (8 per week), with 42% presenting between 9 pm to 5 pm. In the re-audit (2015), 130 patients presented over 15 weeks (9 per week), with 62% presenting between 8 am to 8 pm. In both years, the commonest reasons for attendance were blocked catheters (47% and 23%) and catheter bypass (23% and 17%). Of these, more than twothirds (69%) only required their catheter to be flushed or changed. In 2014, 15% of patients required a referral to urology compared to 5% in 2015. The majority of patients self-attended ED as there was no access to a district nurse, likely because district nurses only commissioned to provide catheter care to housebound patients. For some patients, district nurses were unable to deal with the catheter problem. To improve communication between health and social care professionals on the management of LTC, we introduced a urinary catheter passport, as an integrated approach. This also empowers patients to manage their own catheter. In addition, we propose: a) Specialist continence team capacity to be increased, to include longer availability hours b) District nurses commissioned to provide services for both ambulatory and housebound patients from 8 am to 8 pm. c) Commissioning
222
Introduction and Objective: The learning curve to achieve competency in laparoscopic donor nephrectomy is not well defined according to a study. Here we share our experience of 220 hand-assisted laparoscopic donor nephrectomies. We had a training program and junior surgeons including residents and the junior consultants were trained. Materials and Methods: It was a retrospective observational study followed prospectively later on. It included 220 patients who underwent live hand-assisted laparoscopic donor nephrectomy from December 2011 to November 2015. Results were assessed by the confidence level of the operating junior surgeon in terms of the handling of the tissues and separating and freeing the relevant structures in right planes taught by the director of the program. They initially did the cases under direct observation of the chief surgeon, then under indirect supervision, and then finally a completely independent donor nephrectomy. The patients were analyzed for age, gender, procedure time, hospital stay and on table and post operative complications (sepsis, wound infection, hernia, UTI, hematuria, incision site or flank pain). Results: A total of 220 potential renal donors underwent live hand-assisted laparoscopic donor nephrectomy at our center. The mean age of patients was 35.62 ±10.30 years. Of them, 83 were male (37.72%) while 137 (62.27%) were female. Total mean operative time was 318.92±56.08 minutes. Hospital stay time in days was 3.58±0.97 days and warm ischemia time was 164.78±137 seconds. Regarding complications, we noted blood loss of 300 ml on average in 18 (8.18%) patients only not requiring transfusion. Vomiting was seen in 13 (5.9%) patients post-operatively, while prolonged ileus requiring nil per orally for more than 24 hours was seen in 13 (5.9%) patients. Hematuria was seen in 2 (0.9%) patients, while fever was noted in 4 (1.8%) patients. Incisional hernia was seen in 1 (0.45%) patient only. Hypertension was seen in one (0.45%) patient, while depression was evident in 1 (0.45%) patient only postoperatively.
UP.316 How Are Communication Skills Being Taught in Urology and Other Procedure-Based Subspecialties? A Critical Review of Limited Literature Kieran K1, Rosenbaum M2 Seattle Children’s Hospital, United States; 2University of Iowa, Iowa City, United States 1
Introduction and Objective: Excellent patient-physi-
cian communication skills increase the understanding of medical conditions, facilitate shared decision-making regarding treatment planning, improve clinical outcomes, and decrease lawsuits. Surgical and procedure-based subspecialties (PBS) have generally been slow to incorporate formal communication skill teaching (CST) into curricula for postgraduate trainees. Materials and Methods: We reviewed the currently published literature on CST in PBS in order to assess the current state and inform future directions for research and teaching. Manuscripts published in English within the last 15 years were reviewed for content relating to CST, specialty, and outcome. Results: Eighteen manuscripts were found, addressing one of 8 domains (assessment methods [8 papers], teaching methods [6 papers], simulation [6 papers], curriculum development [5 papers], formal communication skill-building courses [4 papers], direct observation and modeling [1 paper], standardized patients [2 papers], and biometric training (1 paper]). Only one published manuscript related to CST in urology (see Table 1). Conclusions: While research on CST has been published in several PBS, orthopedic surgery is the only PBS with ongoing, adaptable, formal CST for resident and attending physicians. Most currently published manuscripts on CST in PBS are specialty-specific and focus on only 1-2 of the CST domains. Only six papers (and none in urology) focus on teaching methods. Opportunities exist to share information and create more integrated models for CST in PBS.
UP.316, Table 1. Distribution of Published Literature on Communication Skill Teaching in Procedure-Based Subspecialties Orthopedic surgery
4
22.2%
General surgery
3
16.7%
Anesthesia
3
16.7%
Otolaryngology
2
11.1%
Neurosurgery
1
5.6%
Urology
1
5.6%
Conclusion: We had good, encouraging experience
Radiation oncology
1
5.6%
regarding training junior consultants and urology residents in performing live hand-assisted laparoscopic donor nephrectomies.
Operative (surgeon/ anesthesiologist) teams
2
11.1%
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.317 The Politics of Genitourology and Psychology Michailov MC1, Neu E1, Senn T1, Lütge C1,2, von Brockdorff ML1,3, Neu R1, Bauer HW1,4, Ernst G1,5, Martin D1, Hofstetter A1,6, Hohlbrugger G1,7, Madersbacher H1,8, Weissenbacher ER1,9, Welscher U1, Stainov RG1,10, Schratz M1,11, Weber G1,12 1
Inst. Umweltmedizin c/o ICSD/Int.Acad.Sci. e.V., POB 340316, 80100 Muenchen, Germany; 2Techn. Univ. Muenchen, Dir. Inst. Ethics, Germany; 3Univ. Muenchen, Fac. Law, Germany; 4Univ. Muenchen, Free Univ. Berlin, Med. Fac. (Urology), Germany; 5 Univ. Muenchen, Med. Fac. (Urology), Germany; 6 Univ. Muenchen (Urology), Dir.a.D., Klinikum Grosshadern, Germany; 7Med. Univ. Innsbruck (Urology), Austria; 8Klinikum Innsbruck, Dir. (Urology), Austria; 9Univ. Muenchen, Dir.a.D., Dept. Gynecology, Germany; 10Univ. Fulda, Univ. Sofia, Bulgarian Acad. Sci., Germany; 11Univ. Innsbruck, School of Education (Dean), Austria; 12 Univ. Luxembourg&Vienna, Fac. Psychology (Dean), Austria Introduction and Objective: Genitourology (GU) is
a fundamental clinical science related to enormous problems of humanity, including over and underpopulation, contraception, gravidity, infertlity, infections (HIV, etc.), oncological diseases, etc. The creation of an integrative genitourology (andrology, gynecology, urology) related to spiritual, experimental and clinical medical disciplines is necessary to counteract these problems. Psychology has a central position not only in GU education, including moral behavior of medical and research personnel, but also in psychosomatic therapy to GU supporting holistic medicine founded by Hippocrates, Galenus, Hua T’ua and Paracelsus. Materials and Methods: Related to medical-philos-
ophy. Results: This is a proposal and discussion about
education and research on psychology and genitourology. During the opening ceremony of the 18th World Congress Psychosomatic Medicine (ICPM 2005 Kobe) their majesties Emperor and Empress of Japan, Prime Ministers for Science Education and others, and prominent scientists were present. Emperor Akihito honoured the congress with strategical ideas, available also for psychology and all anthropological health sciences, “total symptoms of mind and body, seeking ways of holistic care … it is extremely important for patients ... my hope contributes ... the progress of medical science and people’s happiness in the entire world”. Yujiro IKEMI/ICPM-Ex-President opened a new dimension in medicine and psychology through the integration of oriental somatopsychic theory and self-regulation practises (Yoga, Qigong, Zen meditation, etc.) with occidental psychosomatics (Th.von UEXKÜLL). GU and psychological societies (American, Asian, European), especially FIGO/SIU/ IUPsyS could establish “Political GU and Psychology” Committees preparing proposals for the creation of an integrative GU including better psychological, philosophical, ethical, etc. education of students in GU/post graduate and round-table discussions on this matter during congresses (involving scientists and politicians) giving recommendations for UNES-
CO-WHO-EU-governments. An International Academy for Genitourology (IAGU), similar to European Acad Neurology (EAN) founded 2015 in Berlin, could promote integrative GU including oriental-holistic medicine, and especially GU, psychology and philosophy counteracting enormous dominance of occidental-one. IAGU could be related to an international hospital for GU, founded by a network of national clinics and institutes (gynecology, obstetrics, urology, and also psychology, philosophy, etc.) from selected countries, e.g. America/Argentina, USA, Asia/China, India, Japan, Europe/France, Germany, Great Britain, Russia, Afro-Asia/Ethiopia, Jordan, Israel, etc. with common educational and research programmes, personnel and international employees, e.g. international professors, possibility for whole-life-work and honorary-institute-directors, etc. Conclusions: A new kind of education in GU by interdisciplinary, holistic and multidimensional fundamentals in the fields of psychology, philosophy, informatics, and experimental and clinical medicine could open a new dimension in GU therapy and prophylaxis (incontinence, overactive bladder, renal hypertension, infections, oncological disease, etc.) in the context of the UNO-Agenda21 for better health, ecology and economy on a global level.
UP.318
= 1, PGY3 = 2, PGY4 = 17, PGY5+ = 66, unlisted = 5. On univariate analysis, there was no significant association found between resident involvement and overall 30-day complication rate (p=0.6840) or specifically need for reoperation (p=0.5476), transfusion (p=0.2645), or wound complication (p=0.7778). No association was found with increased length of hospital stay (p=0.5245), but prolonged operative time approached significance (p=0.0613). No other significant associations were found. Conclusions: The safe ability for residents to be involved in surgical procedures is paramount to the success of surgical training programs. With the changing healthcare climate, there is increasing concern that resident involvement may affect clinical outcomes. In this study, we found that while resident involvement is nearly associated with prolonged operative time, patient outcomes were not significantly affected. This suggests that resident involvement in this type of elective case is a safe method of surgical training and is to be encouraged.
UP.319 Urinary Retention Secondary to Hematuria and Clot Formation: A Standardised Washout May Improve Outcomes
Resident Involvement in Elective Adrenalectomies Does Not Affect Patient Outcomes
McGrath S, Christidis D, Nahar K, Lawrentschuk N
Lu P, Raup V, Vetterlein M, Loeppenberg B, Meyer C, Trinh QD, Eswara J
Introduction and Objective: Urinary retention sec-
Brigham and Women’s Hospital, Harvard Medical School, Boston, United States Introduction and Objective: Resident operative expe-
rience is an integral element of building an excellent surgical training program. To ensure a safe balance of providing optimal surgical care to patients while training urologic surgeons, there are regulations in place regarding resident autonomy and appropriate attending oversight. Here, we investigate how surgical resident participation affects the peri-operative outcomes of elective adrenalectomies performed by urologic surgeons. Materials and Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (20072012) were queried using Current Procedural Terminology (CPT) codes for adrenal gland explorations (60540), laparoscopic adrenalectomy (60650), and adrenal gland exploration with excision of adjacent/ retroperitoneal tumor (60545). Traumatic cases were excluded, and only surgeries performed by urologic surgeons were evaluated. Prolonged hospital stay (pLOS), prolonged operative time (pOT), and several 30-day complication variables were analyzed. These variables included mortality, need for blood transfusion or reoperation, and all infectious, thromboembolic, neurologic, cardiac, pulmonary, or renal events. pOT and pLOS were defined as an operating time and a hospital length-of-stay of 75th percentile or greater, respectively (pOT=193.25 minutes and pLOS=4 days). Results: Out of 291 adrenalectomies, 91 (31.1%) were performed with the assistant of a urologic resident physician. Post-graduate years were as follows: PGY2
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Austin Hospital, Melbourne, Australia ondary to hematuria with clot formation (URHC) is a common situation confronting urologists and other healthcare professionals, particularly in the emergency department setting. A thorough washout may lead to more rapid resolution and potential discharge of the patient. The aim of this study was to assess the outcomes of a comprehensive manual bladder washout in a cohort referred to urology with URHC. Materials and Methods: We prospectively collected ethics approved data on patients with URHC referred to our urology service over three years. Patients were excluded if they were already under the urology service. The standardised washout consisted of the “Last clot plus 1000 cc Rule”: the healthcare professional must use a further 1000 cc of sterile saline wash once a clot is returned. Also, the catheter is manipulated to all bladder quadrants. Patients were followed until discharge. Results: Twenty-six patients aged 55-85 (mean 67.5) were eligible and underwent our defined standard washout for URHC. Three common referral scenarios emerged: emergency department de novo presentations (n=11), internal medicine patients often with coagulation issues (n=9), and surgical patients on routine heparin (n=6). Urologists used substantially more fluid for the bladder washout (mean 5.39 L) compared to referring teams (mean 0.11 L). All but one patient (n=25) required Foley catheter upsizing (22-24 Fr 3-way catheter), with 13 patients requiring continuous bladder irrigation. Mean time to discharge from the urology service was 36 hours (SD 15 hours). Two patients required surgical intervention to control ongoing haematuria, while six patients were discharged with an IDC in situ.
223
UNMODERATED ePOSTERS Conclusions: The key to reducing morbidity and minimizing procedures and costs is for urologists to educate and empower healthcare professionals to understand the principles of a manual bladder washout and to engage in the correct management from the outset. We believe that standard management of the URHC should consist of the “Last clot plus 1000 cc Rule” with manipulation of the catheter around the bladder to all quadrants and bladder neck or what we know colloquially refer to as “Australian rules for bladder washout”.
UP.320 Female Cystectomy with Orthotopic Urinary Diversion: Is Fear of Urethral Recurrence Justified?
UP.320, Table 1. Demographic Data
Age
52 (27.2)
60-69
79 (41.4)
70-79
51 (26.7)
80-89
9 (4.7)
BMI
African American
University of Southern California Institute of Urology, Los Angeles, United States
Hispanic
Materials and Methods: We reviewed our institution-
al cystectomy database to identify all female patients who underwent radical cystectomy with orthotopic urinary diversion for primary bladder cancer with curative intent from 1990 to 2011 with a minimum of 3-year follow-up. Demographic, pathologic, complication, and outcome data were compiled and statistical analyses were performed. Results: From 1990 to 2011, a total of 191 women un-
derwent radical cystectomy with orthotopic neobladder for bladder cancer with curative intent. Demographic data are shown in Table 1 while pathologic, complication, and outcome data are shown in Table 2. The 30-day and 90-day complication rates were 37.2% and 44.0%, respectively. The 30-day operative mortality rate was 1.6%. On multivariate logistic regression, only age was associated with 30-day (p<0.028) and 90-day (p<0.020) complication rates. There were 5 patients (2.6%) with positive urethral margins on final pathology, of which 1 was also positive on frozen section. There was one single case of urethral recurrence in a patient who did not have a positive urethral margin. There was no association between primary tumor location (trigone, bladder neck, urethra) and the location of recurrence (distant vs. local). The 5-year recurrence free and overall survival rates were 62.3% and 60.7%, respectively. Median overall survival was 9.4 years.
Range
65
33-84
27 (6)
26
16-54
Race
Asian
version following radical cystectomy is performed significantly less frequently in female patients compared with males. Reasons for this disparity are likely related to functional outcomes as well as fear of local urethral recurrences. We present our long-term oncologic outcomes in women with orthotopic urinary diversion.
Median
64 (10) Total (%)
<60
Hugen C, Miranda G, Cai J, Schuckman A, Djaladat H, Daneshmand S
Introduction and Objective: Orthotopic urinary di-
Mean (SD)
Caucasian
5 (2.6) 7 (3.7) 167 (87.5) 8 (4.2)
Middle Eastern
3 (1.5)
Other
1 (0.5)
ASA Score
1-2
51 (33.6)
3-4
101 (66.4)
Chemotherapy
Neoadjuvant Adjuvant
19 (10) 48 (25.1)
UP.321
Introduction and Objectives: Orthotopic neobladder
Factors Affecting Continence After Radical Cystectomy and Orthotopic Neobladder Clifford T, Bazargani S, Cai J, Wayne K, Schuckman A, Djaladat H, Daneshmand S
(ONB) is the gold standard form of urinary diversion following radical cystectomy (RC) at our institution. Herein we evaluate factors affecting continence in patients after RC and orthotopic diversion using a validated pad usage questionnaire.
USC Institute of Urology, Los Angeles, United States
Materials and Methods: Using our IRB approved database, we identified 1786 patients that underwent
UP.321, Figure 1. Male Patients Reporting Continence (No Pad Usage or Pads As “Almost Dry”) After ONB
Conclusions: Radical cystectomy with orthotopic urinary diversion can be performed safely with pathologic, survival, and recurrence rates similar to those in large published series of predominantly male patients. Urethral recurrence remains a rare event with long-term follow-up. Female patients with negative intraoperative urethral margin are candidates for orthotopic diversion.
224
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.320, Table 2. Pathology, Complications, and Outcomes Pathologic Stage
0
Total (%)
CIS/a
36 (18.9)
1
24 (12.6)
2A
22 (11.5)
2B
22 (11.5)
3A
23 (12.0)
3B
41 (21.4)
4 LN +
Mean (SD)
Margins +
Range
2 (1.1) 46 (24.1)
LN Removed LVI
Median
21 (11.0)
1 (5)
0
0-50
52 (29)
47
0-142
57 (29.6)
Complications
21 (13.38)
Infectious
34 (21.7)
GI
16 (10.9)
GU
9 (5.7)
Neurologic
8 (5.1)
Pulmonary
6 (3.8)
DVT
8 (5.1)
Wound
4 (2.6)
Neobladder-vaginal fistula Other
8 (4.2)
Conclusion: Most episodes of febrile UTI occurred
38 (24.2)
Survival
5-year RFS
62.3%
5-year OS
60.7%
Materials and Methods: From January 2001 to August 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Each episode of febrile UTI and the associated pathogen was identified, and the probability of febrile UTI was evaluated using Kaplan-Meier methods. A videourodynamic test was performed in 36 patients within 6 months of surgery. Logistic regression analysis was conducted to identify risk factors associated with febrile UTI. Results: Median follow-up was 25 months and 54 episodes of febrile UTI were identified in 46 patients. Of the 54 episodes of febrile UTIs, 33 (61.1%) occurred during the first month post-surgery, and 88% occurred within 6 months after surgery. While Escherichia coli was the most common associated pathogen overall, Enterococcus species were the most common pathogen during the first month after surgery. Although ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P=0.023), ureteral stricture accounted for only 6 episodes (11.1%, 6/54) of febrile UTI. On videourodyamic examination, patients with febrile UTI had a significantly larger residual urine volume (212.0±193.7 vs. 90.5±148.2, P=0.048) than those without.
6 (3.1)
Bleeding
UTI increases the risk of developing urosepsis and has the potential to affect renal function outcomes. In this study, we investigated the incidence of febrile UTI and associated pathogens with time after surgery, and aimed to identify urodynamic parameters associated with increased risk of febrile UTI after ileal neobladder reconstruction.
Overall Survival-years
10.65
9.4
0-21.5
within 6 months after surgery and Enterococcus species were the most common pathogen during the first month after surgery. Although ureteral stricture was an independent risk factor for febrile UTI, incomplete emptying of the neobladder seems to play an important role in the early post-operative period.
UP.323 open RC from 2001 to 2015. ONB was constructed in 1128 (63.2%) patients, of whom 954 were male (84.6%). Starting in 2012, these patients were prospectively followed and asked to complete a validated, pictorial questionnaire at their follow-up visits to assess the number, size, and wetness of pads used at day and night. Patients were defined as continent if they reported no pad usage or pads as “almost dry.” Questionnaires were stratified into distinct postoperative time intervals. Female patients and those with artificial urinary sphincters or a history of radiation were excluded. Multivariable logistic regression was performed. Results: A total of 189 male patients with available pad usage questionnaires were followed from September 2012 to August 2015. A total of 447 pad usage questionnaires were collected, with 351 interval distinct when separated into intervals of <3 months, 3-6 months, 6-12 months, 12-18 months, 18-36 months, and more than 36 months (n=64, 61, 58, 49, 61, 58 respectively). Day and nighttime continence rates are shown in Figure 1. In multivariate analysis, age less than 65 was associated with greater likelihood of daytime (OR 2.77, CI 1.65-4.61, p<0.0001) and nighttime continence (OR 1.72, CI 1.13-2.63, p<0.01) while di-
abetes was associated with worse daytime continence (OR 0.49, CI 0.27-0.91, p<0.02). Overall catheterization rate was 13.1%.
Risk Factors for Metabolic Acidosis After Radical Cystectomy and Ileal Neobladder
Conclusions: Daytime continence after RC and ONB is excellent, although nighttime continence remains problematic. Older age and diabetes are associated with worse daytime continence after radical cystectomy and ONB. Of these factors, only age is significantly associated with worse nighttime continence.
1
Dept. of Urology, Ewha Woman’s University School of Medicine, Seoul, Korea; 2Dept. of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea; 3Dept. of Urology, Ilsanpaik Hospital, Goyang, Korea; 4Ewha Woman’s University School of Medicine, Seoul, Korea
UP.322
Introduction and Objectives: Metabolic acidosis in patients with ileal neobladder is a well-known complication, particularly in patients with impaired renal function. However, data on serial changes of acidotic status is limited. In this study, we investigated the serial change of metabolic acidosis and identified associated risk factors in patients who underwent radical cystectomy and ileal neobladder.
Febrile Urinary Tract Infection After Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer Kim KH1, Kim YS2, Cho IR3, Lee DH4 1
Ewha Woman’s University School of Medicine, Seoul, Korea; 2Dept. of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea; 3Dept. of Urology, Ilsanpaik Hospital, Goyang, Korea; 4Dept. of Urology, Ewha Woman’s University School of Medicine, Seoul, Korea
Introduction and Objective: Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder. Febrile
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Lee DH1, Kim YS2, Cho IR3, Kim KH4
Materials and Methods: From January 2010 to August 2014, 149 patients underwent radical cystectomy and ileal neobladder reconstruction for bladder cancer in our institution. After excluding 26 patients with a follow-up of less than 12 months and incomplete data, the final study cohort included 123 patients. Metabolic acidosis was defined as a serum bicarbon-
225
UNMODERATED ePOSTERS ate level less than 22 mg/dl and impaired renal function was defined as GFR <50 ml/min. The presence of metabolic acidosis was evaluated at 1 month, 1 year and 2 years after surgery. Multivariate logistic regression analysis was conducted to identify risk factors associated with development of metabolic acidosis at each time after surgery. Results: Of 123 patients, 16 patients had diabetes and 14 patients had impaired renal function. Mean preoperative level of bicarbonate was 25.9 ml/dl and the level was 20.9, 23.6 and 24.6 ml/dl at 1 month, 1 year and 2 years, respectively. Metabolic acidosis was observed in 52%, 19.5% and 7.3% of patients at 1 month, 1 year and 2 years after surgery, respectively. While patients with impaired renal function had significantly lower bicarbonate levels at 1 month and 1 year after surgery than their counterparts, bicarbonate levels at 2 years after surgery did not differ according to renal function. Patients with diabetes had significantly lower bicarbonate levels at 1 year and 2 years after surgery than patients without diabetes. At 1 month after surgery, impaired renal function was the only independent risk factor associated with metabolic acidosis (OR 3.87, P=0.046). At 1 year after surgery, diabetes was the only independent risk factor associated with metabolic acidosis (OR 5.68, P=0.002). At 2 years after surgery, both age and diabetes were significant risk factors associated with metabolic acidosis. Conclusion: Approximately half of patients have ex-
perienced metabolic acidosis at 1 month after ileal neobladder reconstruction and preoperative impaired renal function was the most significant risk factor for developing metabolic acidosis in the early post-operative period. However, the incidence of metabolic acidosis decreased to less than 20% at 2 years, and diabetes and age were the independent risk factors for developing metabolic acidosis in this period.
UP.324 Resonance Metallic Ureteral Stent (MUS) in Extrinsic Ureter Obstruction: Results and Failure Risk Factors Vitagliano G, Rico L, Contreras PN, Lopez FM, Guglielmi JM, Ameri C Hospital Alemán, Buenos Aires, Argentina Introduction and Objective: Extraluminal urinary tract obstruction due to benign or malignant retroperitoneal pathology produces secondary hydronephrosis. Whatever the cause, it requires unilateral or bilateral urinary diversion to decide whether to treat symptoms or to protect kidney function. The resonance ureteral stent with a suggested durability of 12 months is one of the treatment options. In previous publications, a serum creatinine above 2 mg/dl and radiation therapy have been proposed as stent failure risk factors (SFRFs). Materials and Methods: Medical records of patients who had a MUS placed between 2009 and 2015 at our institution were retrospectively analyzed. Age, sex, etiology and place of obstruction, laterality, hydronephrosis grade, serum creatinine and previous treatments were all considered as pre-stenting variables. Time to stent replacement, cause of withdrawal or exchange, complications, serum creatinine, hydronephrosis and evolution of patients with FRFs were all accounted as follow-up variables.
226
Results: A total of 39 patients fulfilled the search criteria and were included in the analysis. Average age was 63 years (34-91 years) with a female majority (64.1%). Malignancy was the most frequent cause of obstruction (82%) with cervical uterine cancer being the most frequent of them. Average stent duration was 8.8 months. Nephrostomy tube removal after stenting was possible in 39% of the cases. Only three patients required a new nephrostomy tube because of evolving hydronephrosis. Regarding failure risk factors, 14 cases had pre-stenting radiotherapy and 8 patients had a serum creatinine above 2 mg/dL. A total of 8 complications were found that required a premature stent replacement. All of these patients presented with at least one SFRF. Urinary tract infection was the most common (17.9%), followed by stent intolerance (12%) and stent migration (5%). Conclusion: From our experience, the utilization of
resonance MUS showed an acceptable success rate and a level of complications similar to previous publications. Patients with SFRFs presented a higher complication rate, which is in concordance with existing data.
UP.325 Urinary Undiversions: Functional Results and Complications According to the Clavien Classification System Zubieta ME, Alvarez Garzon J, Gonzalez MI, Favre GA, Tejerizo JC Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: During patients’ follow-up after radical cystectomy and urinary diversion, many of them do not adapt or have complications with the reservoir. Therefore, a urinary undiversion is considered. The purpose of this paper is to assess the urinary undiversion surgeries performed in our service by analyzing the causes, complications and functional results. Materials and Methods: A retrospective study of patients who underwent urinary undiversion in a 48-month period between August 2010 and October 2014 was conducted. Patients’ electronic medical records were reviewed for demographic and pathologic data collection. Complications were graded according to the Clavien-Dindo classification, and functional results were collected from the undiversions. Results: During the period under study, 7 patients underwent urinary undiversion surgeries. Of these, 71% (n=5) were female, and mean age was 64.3 years (SD 7.6 years). Median follow-up was 14 months (range 2-48 months). Five patients were “undiverted” from Bricker diversion into ileal neobladder, and 2 from neobladder into heterotopic continent urinary diversions due to persistent urinary incontinence and neovesico-vaginal fistula. Complications, according to the Clavien-Dindo classification during the first 60 days, were similar to those of the primary radical cystectomies. Clavien I: 1 case, Clavien II: 3 urinary tract infection, Clavien 3b: 1 neovesico-intestinal fistula. Regarding the functional results, five patients who underwent urinary undiversion to neobladders (100%) were found to have complete daytime continence. Nighttime continence in these patients was complete in 60%. None of the undiversions to neobladder required intermittent catheterization for the emptying of the reservoir. There were no uret-
eral-pouch strictures and only one patient had urethral-pouch stricture. Conclusion: Urinary undiversion is a feasible, highly
complex surgical procedure, which requires experienced centers, and through which good surgical and functional results are obtained. In our series, we did not find a complication rate higher than that of radical cystectomy. Undiversion surgery must be performed in select patients, in which the presence of oncological disease has been excluded and to whom the potential risks and benefits of surgery have been explained.
UP.326 Evolution of Impaired Renal Function After External Continent Urinary Diversion (Mitrofanoff Principle) Fourati M, Mejdoub B, Hadj Slimen M, Rebai N, Chaabouni A, Rekik S, Mhiri MN Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia Introduction and Objective: To study the evolution
of impaired renal function after external continent urinary diversion (Mitrofanoff principle) (ECUD-M) associated with ileocystoplasty. Materials and Methods: Over 18 years from 1992 to
2014, ECUD-M with ileocystoplasty was performed in 169 patients with mean age of 27 years. Renal impairment was evident in 86 patients (34 children and 52 adults). Results: Ninety percent of patients demonstrated a neurologic bladder and mild to moderate renal failure. Initially, all patients underwent continuous bladder drainage for a mean of 3 weeks. Renal function improved in 70 patients, although with persistent mild renal insufficiency. The other patients demonstrated moderate persistent residual renal insufficiency. During a mean follow-up of 13 years (range 1-22 years), renal function returned to normal in 26 patients, stabilized at lower values in 30, and remained moderate in 10. After a mean follow-up of 9 years (range 6-15 years), renal failure gradually worsened, increasing to higher values in 12 patients and leading to hemodialysis in 8. Four patients underwent living-donor kidney transplantation, with good evolution. Conclusion: ECUD-M with ileocystoplasty can lead
to normalization unless stabilization of impaired residual renal function by eliminating the obstructive factor provides self-adequate management of the diversion. The procedure delays the need for hemodialysis therapy, and enables patients to prepare for kidney transplantation into a previously reconstructed lower urinary tract.
UP.327 A Computational Model for the Analysis of Urinary Reservoirs and Its Clinical Applications Monteiro V1, Onate E1, Oller S1, Gasser TC2 1
Università Politecnica de Catalunya, Barcelona, Spain; 2The Royal Institute of Technology, Stockholm, Sweden
Introduction and Objectives: An adequate artificial bladder is still a challenge to overcome. The computa-
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS tional model presented here intends to assist the conception of artificial solutions for bladder replacement. The numerical model for the urinary bladder was implemented using Finite Element Method, taking into account anatomical morphometry of the organ, non-linear behavior of the biological material, and reservoir-urine interaction to capture urodynamic response of filling and voiding. Materials and Methods: The numerical simulation
of bladder reservoirs is complex and requires an approach to combine non-linear geometry, a non-linear constitutive model and fluid-structure interaction. To address the aspect of organ morphometry, the geometry of the artificial bladder originates from the reconstruction of magnetic resonance images. Boundary conditions and applied loads are treated according to the expected values of abdominal pressure given by cystometry. For the representation of the smooth material, some simplifications were made, and classic non-linear continuum mechanics theory was applied. A homogenized model represents the detubularized ileum tissue, where extracellular substance is described with a hyperplastic formulation and collagenous fibers by a viscoelastic model. The interaction of the urine and the organ is modeled via the Particle Finite Element Method, allowing the reproduction of filling and voiding of the neobladder with urine. The proposed computational urodynamic problem is solved monolithically. Results: The computational model was subjected to the analysis of the orthotopic ileal neobladder. Cystometry data collected from a patient who had undergone radical cystectomy were used to compare with numerical results. The same trend is recovered in pressure-volume curves. Maximum pressure was
kept below the limit value of 40 cmH20 (see graphs 1 and 2). Conclusions: Clinical applications of the computational model include the prediction of urodynamic variables to assist on the prototyping phase of the artificial bladder. The numerical analysis may be useful to reproduce the mechanical behavior of a viscoelastic 3D printed organ or study the influence of the geometry on the urodynamic response of the orthotopic neobladder. An example of pressure-volume curves for the analysis of the orthotopic ileal neobladder is presented.
UP.328 The Management of Calculi Developed in a Mitrofanoff External Diversion Fourati M1, Fourati H2, Hadj Slimen M1, Mejdoub B1, Rekik S1, Rebai N1, Mhiri MN1 1
Dept. of Urology, CHU Habib Bourguiba, Sfax, Tunisia; 2Dept. of Radiology, CHU Hedi Chaker, Sfax, Tunisia
used detubulazied ileum for bladder augmentation in all cases. Calculi developed after a mean period of 5 years (range 2-10 years). The treatment consisted on introduction of a rigid cystoscope (16 Fr) through the conduit in 6 cases, and using urethro-cystoscopy when bladder neck was not closed (5 cases). The mean size of the 11 calculi, which were treated endoscopically, was 15 mm (range 9-25 mm). Their fragmentation was performed by Suiss lithoclast. We do not dispose of Lazer devices in our institution. Extraction of all fragments was done by Dormia Basket. Conclusions: Calculi developed in a mitrofanoff ECUD is a frequent complication of such reconstructive surgery. It could be treated endoscopically in most cases with no morbidity.
UP.329 Surgical Outcomes of the Continent Catherizable Ileal Cecocystoplasty Levy M1, Chandrapal J2, Myers JB2, Elliott SP1 1
University of Minnesota, Minneapolis, United States; University of Utah, Salt Lake City, United States
2
Introduction and Objectives: Analysis of the results of stones, developed within an external continent urinary diversion (ECUD), which were treated endoscopically through the Mitrofanoff conduit. Materials and Methods: Between 1992 and 2015, 180
patients were treated by a Mitrofanoff ECUD at our institution. Among them, 15 (8%) developed stones in their continent neo bladder. Results: Mean age of patients was 28 years (range 1145), with 9 men and 6 women. The bladder pathology which led to the Mitrofanoff ECUD was of neurological origin in all cases. The external conduit was the appendix in 14 cases and the ileum (Monti) in 1 case. We
UP.327, Graph 1. Voiding Condition Pressure (Pa) vs. Volume (mL)
UP.327, Graph 2. Filling Condition Pressure (Pa) vs. Volume (mL)
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Introduction and Objective: Cutaneous catheterizable channels allow for continent bladder emptying when the native urethra is compromised or inaccessible. There are many different surgical approaches to creating cutaneous catheterizable channels. Each technique has benefits as well as limitations. Continent catheterizable ileal cecocystoplasty (CCIC) is a technique that utilizes a tapered limb of ileum as a catheterizable channel, the ileocecal valve as the continence mechanism, and the cecum as a bladder augmentation. In this study, we sought to describe surgical outcomes for CCIC. Materials and Methods: This study was a retrospective review from 2 institutions’ combined database of patients who underwent CCIC. We identified patients undergoing CCIC at the University of Minnesota and the University of Utah between 2011 and 2015. Exclusion criteria was <90 day follow-up after surgery. Data included patient demographics, etiology of bladder dysfunction, surgical approach utilized, and complication rates. Results: Our study population included 70 patients. The mean age was 43.6. A total of 22 (31%) of patients were male. The etiology of bladder dysfunction resulting in CCIC, 33 (47%) had a spinal cord injury, 3 (4%) had spina bifida, 6 (9%) had cerebral palsy, 9 (13%) had multiple sclerosis, 3 (4%) had a CVA, 8 (11%) had other neurologic etiology, 8 (11%) had non-neurologic etiology. A total of 46 (67%) of patients underwent an open surgical approach, while 23 (33%) underwent a combined open and laparoscopic approach. A total of 52 (74%) of patients had a midline incision, and 18 (26%) had a pfannenstiel incision. A total of 41 (56%) of all patients had a post-operative complication within 90 days from surgery. Of these complications, 71% were Clavien Grade II, 24% Clavien grade III and 4% Clavien grade IV. There were no Clavien grade V. At 90 days following surgery, stomal stenosis rates were 8%. One required open revision, and the rest were managed conservatively with dilation or steroid cream. At 90 days following surgery, 87% of patients had stomal continence, 77% had urethral continence, and 72% had both. At 90 days, 1 patient had a ventral
227
UNMODERATED ePOSTERS hernia, 4 had parastomal hernia, and all had midline incisions at the original surgery. Conclusions: CCIC is a surgical approach with stomal continence and stenosis rates comparable to other catherizable channel techniques. There are significant perioperative risks, but the vast majority of complications were Clavien grade II.
UP.330 Outcomes of Urinary Diversion Created for Adverse Effects After Gynecologic Radiation Levy M1, Myers JB2, Voelzke BB3, Chandrapal J2, Carolan A1, Broghammer J4, Elliott SP1
similar to published reports of patients with prior pelvic RT, supporting the hypothesis that this is high-risk surgery. Further characterization of this population will aid in preparing patients and providers for clinical decision-making regarding reconstructive surgery.
UP.331 Evaluation of Gastrointestinal Complications Following Radical Cystectomy Using Enhanced Recovery Protocol
Introduction and Objectives: Late sequelae of radiotherapy (RT) gynecologic malignancies include poorly compliant, small capacity bladders, ureteral strictures, fistula formation, chronic urinary tract infections, pelvic pain, and chronic hemorrhagic cystitis. When conservative management fails, urinary diversion may be performed. Urinary diversion in this setting is understood to be high-risk surgery but the outcomes have not been well characterized. Materials and Methods: Patient data were retrospectively collected from 4 institutions between 2008 and 2015. We included women with cervical or vulvar treated with RT who underwent urinary diversion with or without cystectomy for management of RT adverse effects (not for cancer management). Outcomes included the incidence of perioperative (<90 days post-operative) complications of any kind as well as long-term urinary complications (>90 days), including ureteral stenosis, stomal complications, and fistulae. Results: A total of 17 patients were identified who met study criteria. Median follow-up was 2.5 years. Median age at time of urinary diversion was 56 years (37-77), and median Charlson score was 4 (2-12). Median time from RT to urinary diversion was 8 years (1-49). A total of 94% had prior abdominal surgery not including hysterectomy, 41% had prior colostomy or ileostomy, 18% had prior open surgical attempts at urinary tract reconstruction. Regarding type of urinary diversion, 24% underwent an Indiana pouch, 35% ileal conduit, and 41% transverse colon conduit. The median length of hospital stay at the time of urinary diversion was 8 days (range 5-80). A total of 71% had at least one complication within 90 days of urinary diversion, 24% required an additional operation within 90 days, 30% had a Clavien grade 2 complication, 24% grade 3, and 17% grade 4. For the entire study follow-up period, 18% of patients had subsequent ureteral stenosis, 18% had stomal stenosis, and 29% formed fistula. Conclusions: In our population of women undergo-
ing urinary diversion secondary to sequalae of RT for gynecologic malignancies, we found a high rate of perioperative complications, including a 22% reoperation rate within 30d. While long-term fistula rates, as well as ureteral stenosis rates are higher than published reports of non-irradiated patients, they are
228
Conclusions: Our institutional ERAS protocol for RC was associated with a significantly shorter time to bowel function recovery, fewer GI complications, and a shorter LOS. This protocol should be considered to reduce GI morbidity associated with open RC.
UP.332 Perioperative Outcomes of Enterocystoplasty in Adults
Bazargani S, Daneshmand S, Ahmadi H, Miranda G, Cai J, Schuckman A, Djaladat H
Raup V, Lu P, Loeppenberg B, Meyer C, Vetterlein M, Trinh QD, Eswara J
USC Institute of Urology, Los Angeles, United States
Brigham and Women’s Hospital, Harvard Medical School, Boston, United States
1
University of Minnesota, Minneapolis, United States; 2 University of Utah, Salt Lake City, United States; 3 University of Washington, Seattle, United States; 4 University of Kansas, Kansas City, United States
compared to controls (4 (range 3 -16) days vs. 9 (range 5-23) days; p<0.001).
Introduction and Objectives: Gastrointestinal (GI) complications are common after radical cystectomy (RC) and urinary diversion (UD). We evaluated whether our institutional enhanced recovery after surgery (ERAS) protocol was associated with changes in GI function and complication rates in the first 30 days after RC compared to our previous traditional method of postoperative care. Materials and Methods: Using our bladder cancer
IRB approved database, we identified 377 consecutive patients who underwent open RC and UD using our ERAS protocol from May 2012 to December 2015. We compared their bowel activity in the postoperative period as well as GI complications for the first 30 days to a control group who were treated with traditional (non-ERAS) post-operative care from 2003 to 2012. Complications were recorded based on Clavien-Dindo system. Results: A total of 145 patients on ERAS arm and 144 matched controls were included in the study. Median time from surgery to first bowel movement was 2 days in the ERAS arm and 5 days in the control group (p=0.003). GI complications within 30 days occurred in 19 (13%) patients with the ERAS protocol and 40 (27%) of controls (p<0.001). The most common GI complication was postoperative ileus (POI)/partial small bowel obstruction (pSBO) in both groups (7% vs. 23%; p<0.001) (Table 1). Nasogastric or gastric tube placement was required in 11 patients (7%) in the ERAS arm compared with 25 patients (17%) controls (p=0.01), while total parenteral nutrition was required in one (0.6%) patient in the ERAS cohort and 8 (6%) controls (p=0.02). Median length of hospital stay (LOS) was significantly shorter in ERAS cohort
Introduction and Objective: Enterocystoplasty has been used to treat neurogenic bladder in both children and adults. While this procedure has been well studied in children, the literature for adult patients is lacking. In this study, we examined the perioperative outcomes of adult enterocystoplasty. Materials and Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2007-2012) was queried using Current Procedural Terminology (CPT) codes for bladder augmentation (51960). Medical comorbidities, length of stay (LOS), operative time (OT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed. Prolonged OT and LOS were defined as an operating time and a hospital length of stay of 75th percentile or greater, respectively (pOT=6.6 hours and pLOS=8 days). Results: A total of 42 patients having undergone enterocystoplasty were identified, with a median age at time of surgery of 47 years (17-73). Of these patients, 23 were female (54.7%), 12 were either paraplegic or quadriplegic (28.6%), and 13 were dependent upon caretakers to accomplish activities of daily living (ADLs) (30.9%). Nine patients underwent concurrent ileovesicostomy creation (21.4%). Median OT was 5.2 hours (310 minutes) and median LOS was 7 days. Nine patients developed post-operative complications within 30 days (21.4%), two of whom developed multiple complications (4.8%). Complications included superficial skin infections (4, 9.5%), organ space infections (1, 2.4%), sepsis (2, 4.8%), urosepsis
UP.331, Table 1. GI-Related Complications in Patients on ERAS Protocol vs. Matched Non-ERAS ERAS patients (n=145)
Non-ERAS controls (n=144)
30-day GI complication rate (%)
19 (13)
40 (27)
0.003
Ileus/pSBO (%)
10 (7)
34 (23)
<0.001
P-value
Intractable nausea/vomiting (%)
4 (3)
3 (2)
0.5
Need for NG/G-tube (%)
11 (7)
25 (17)
0.012
Need for TPN (%)
1 (<1)
8 (6%)
0.02
C. Diff diarrhea (%)
3 (2)
1 (<1)
0.3
30-day readmission rate due to GI complication (%)
2 (10)
2 (5)
0.1
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS (4, 9.5%), DVT (1, 2.4%), and PE (1, 2.4%). Three patients required blood transfusion (7.1%), and 3 required re-operation (7.1%). There were no 30-day postoperative mortalities. On univariate analysis, superficial skin infection was found to be associated with prolonged OT (0.0196) and dependence upon a caretaker (p=0.0451). No other significant associations were found. Conclusions: Enterocystoplasty is a generally safe
procedure, with no perioperative mortalities and few patients requiring reoperation or blood transfusions. This operation appears to be equally safe in patients with functional limitations, and concurrent ileovesicostomy was not associated with further complications. Every effort should be made to decrease operative time to avoid the formation of superficial wound infections, and optimal wound care should be established in patients dependent upon a caretaker.
UP.333 Neurophysiological Treatment of Urinary Incontinence Iatsyna O1, Pirogov V1, Vernigorodskii S2, Yalovenko K3 1
2
The Institute of Urology, Kiev, Ukraine; Vinnitsa National Medical University, Ukraine; 3Week-end Clinic, Ukraine Introduction and Objective: The increase in the prev-
alence of the disease in stress urinary incontinence, social status issues and the lack of effectiveness of treatment methods lead to further study of this issue. As pathogenetic treatment of urination disorders, promising method is the use of electrical stimulation, which was widely used in 90 years, and in the past years has different versions, such as sacred, tibial neuromodulation, high-intensity pulsed magnetic ES, administration of botulinum toxin, etc. Materials and Methods: The objective is to study
the effectiveness of ES application in the treatment of stress urinary incontinence in women. A total of 162 women aged 20 to 75 years with disease duration from 2 to 20 years with frequent urination, imperative urge to urination and incontinence were selected and examined. The first group included women whose incontinence is associated with degree of disorders of urinary tract, which occurred after delivery. The second group included patients aged over 55 years without gynecological changes. The third group included patients, in which the cause of urinary incontinence clinically was failed to establish, likely they had neurogenic urination disorders. In the majority of patients with urinary incontinence was noted the reduced tone of the external sphincter. This allowed the use of the ES as a therapeutic measure. The AMPLIPULS electrostimulator was used. ES was conducted endourethral combined with rectal and vaginal in the daily basis (10-15 days) for 10 minutes. Results: Incontinence was not observed in 47 of 53 patients from the first group. However, 8 of them in 3-6 months had a relapse. Level of urethra sphincter and perineum muscle electroactivity increased by 4050%. In 9 patients, improvement occurred only after the 3rd course of the ES. Positive changes occurred within 1-2 months in 19 patients after 2 courses, improvement was observed in 11 patients of the first group. Minor changes, even after 3 courses of ES were
observed in the 3rd group, in 18 patients. There was no positive reaction even after 4-5 courses of ES in 14 elderly patients. Conclusion: ES acting on neuromuscular structures of
the bladder compressive device improves their functional status and blood circulation, increases its tone and contractile ability. The immediate positive results of treatment were obtained in 84.3% of women.
UP.334 Reliability of Valsalva Leak Point Pressure in Female Stress Urinary Incontinence Kim JS1, Yoo DH1, Nam JY1, Lim DH2, Kim MK3, Jeong HJ4, Yang EM5, Park SW1, Noh JH1 1
Dept. of Urology, Kwangju Christian Hospital, Gwangju, Korea; 2Dept. of Urology, College of Medicine, Chosun University, Gwangju, Korea; 3Dept. of Urology, Chonbuk National University Medical School, Jeonju, Korea; 4Dept. of Urology, Wonkwang University School of Medicine, Iksan, Korea; 5Dept. of Pediatrics, Chonnam National University Hospital, Gwangju, Korea Introduction and Objective: The valsalva leak point pressure (VLPP) on urodynamic study (UDS) is measured to evaluate the severity and characteristic of incontinence. The aim of this study was to investigate the test-retest reliability of VLPP in female stress urinary incontinence (SUI). Materials and Methods: Our study included 80 wom-
en who underwent UDS to evaluate SUI. The UDS was performed by a single operator consecutively within a 30-minute period. Intra-class Correlation Coefficient (ICC) was used to investigate the test-retest reliability. All definitions of urinary incontinence corresponded to recommendations of the International Continence Society. Results: The mean age was 58.9 ± 7.4 years. Among enrolled patients, 34 had only SUI, while 46 patients had mixed urinary incontinence (MUI). The 32 patients had underlying diseases such as diabetes mellitus (DM), cerebrovascular disease or spinal disease. Overall, test-retest reliability of VLPP on UDS is excellent (ICC 0.94, P < 0.01). When enrolled patients were divided into several groups by incontinence type and presence of underlying diseases, test-retest reliability of VLPP is excellent in each group (ICC 0.96, P < 0.01 in a SUI group; ICC 0.93, P < 0.01 in a MUI group; ICC 0.95, P < 0.01 in a group without underlying diseases; ICC 0.92, P < 0.01 in a group with underlying diseases). Conclusion: The test-retest reliability of urodynamic
VLPP in female SUI is excellent regardless of comorbidity factors such as MUI, DM, cerebrovascular disease or spinal disease. The VLPP on UDS is a reliable tool in female SUI.
UP.335 Botulinum Toxin Type A for Lower Urinary Tract Dysfunction: Efficacy, Safety and Adherence to Treatment Padilla-Fernandez B, Hernandez-Hernandez D, Cabral-Fernandez AV, Gonzalez-Perez L, GarciaAlvarez C, Concepcion-Masip T, Castro-Diaz DM University Hospital of the Canary Islands’ Complex, Tenerife, Spain
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
Introduction and Objectives: The purpose of our
study was to evaluate the efficacy and safety of onabotulinum toxin type A for the treatment of idiopathic overactive bladder (iOAB), neurogenic overactive bladder (nOAB) and painful bladder syndrome (PBS). We also evaluated treatment discontinuation rates and the reasons. Materials and Methods: Between January 2013 and June 2015, 120 treatments were performed in 95 patients. The treatment area was located at the outpatient clinic, and we used a rigid cystoscope to perform the procedure under topical intravesical anaesthesia. The injection pattern in patients with iOAB was 10 detrusorian injections, in patients with nOAB 20 detrusorian injections and in patients with BPS 3 injections in the trigone. Before treatment, detailed anamnesis and physical examination, urinalysis and urine culture, ultrasound, urodynamics (videourodynamics for nOAB patients) were performed, and the ICIQ-SF was given to iOAB and nOAB patients, and the visual analogue pain scale (VAS) to BPS patients. Follow-up: one visit two weeks after treatment and again after 3 months for the evaluation of efficacy (with ICIQ-SF, VAS and global response to treatment scale) and of complications. Patients asked for reevaluation when they felt that the effect of the toxin diminished or disappeared. Results: We performed 120 treatments in 95 patients. iOAB was the most frequent indication (71.6%), followed by BPS (14.7%) and nOAB (13.7%). Mean age was 65 years. Global response rate was 65.2%: in the iOAB group 69.8% patients had a favourable response, in the nOAB group 68.7% and in BPS group 30.7%. Haematuria appeared in 21.4% of patients, urinary tract infection in 28.6%, urinary retention (requiring intermittent self-catheterization) in 6.25% and general symptoms in 8.9%. All complications were managed without admission. Dropout rate was 39.8%, and 65% of them due to lack of effect. The procedure was well tolerated when performed at the outpatient clinic with topical intravesical anaesthesia (mean intraoperative VAS 3.57/10). Conclusions: Intradetrusor injection of botulinum toxin is an easy and safe procedure, with minor, easyto-manage complications. It shows very good results in idiopathic and neurogenic overactive bladder, and it can be considered in patients with BPS who are refractory to second-line treatments.
UP.336 Clinical Predictors Associated with Intrinsic Sphincter Deficiency in Women with Stress Urinary Incontinence Lee J, Kim Y Jeju National University Hospital, South Korea Introduction and Objective: Recently, intrinsic sphincter deficiency (ISD) is known to be important for surgery results of stress urinary incontinence (SUI). The aim of this study is to determine the predictive clinical factors of ISD (valsalva leak point pressure, VLPP<60 cmH2O) in female patients with SUI. Materials and Methods: We classified the patients into three groups according to the value of VLPP>90 cmH2O (AI: anatomical incontinence), between 61 cmH2O and 90 cmH2O (EV: equivocal) and <60 cm-
229
UNMODERATED ePOSTERS H2O (ISD). In all groups, we performed a full examination, evaluation of history, physical examination, uroflowmetry and complete urodynamic study. Univariate analysis was performed by Χ2 (chi squared) and T-test for categorical variables, respectively. The multivariable study was performed by logistic regression method in order to get clinical predictors of VLPP<60 cmH2O. A statistically significant p-value was considered as less than 0.05. Results: A total of 189 patients were divided into three groups: 56 patients (AI), 64 patients (EV) and 69 patients (ISD). Univariate analysis showed that a significant difference is associated with age (p = 0.019) and Stamey classification (p = 0.006) between ISD and AI. However, in multivariate analysis, the only independent predictor of ISD is the presence of grade III symptoms in Stamey classification (p = 0.05). Conclusions: The degree of urinary incontinence is a relevant clinical factor to predict the ISD. If evaluating a patient in equivocal group, a degree of urinary incontinence should be considered.
UP.337 The Reason Why Some Sling Designs Can Be Prone to Infection Iakovlev V1, Blaivas J2 1
Div. of Pathology, St. Michael’s Hospital, University of Toronto, Canada; 2Dept. of Urology, Weill Cornell Medical College, New York, United States
Introduction and Objective: ObTape midurethral slings have been reported in the literature in association with higher rates of infection. We compared pathology of excised ObTape and knitted monofilament mesh slings. Materials and Methods: Records of the pathology
department were searched retrospectively. Seven ObTape excision cases were identified (n=7), all received as medico-legal consultations. These were compared to the more common monofilament slings (n=105). Results: Mean age of the patients at excision was 55 (range 27-67) and 53 (25-76) years for ObTape and monofilament meshes respectively. All 7 ObTape specimens (100%) were excised to treat infection/ erosion in comparison with 37% (p=0.01) of monofilament slings. In ObTape group all specimens confirmed the presence of inflammation: ranging from chronic only (n=2, 29%) to acute with purulent exudate (n=5, 71%). In 4 (57%) cases, microscopic slides included a gross portion of the mesh. The mesh was associated with acute inflammation and in one case bacterial colonies. The mesh was composed of multifilament bundles (manufactured welding multifilament bundles into a square mesh pattern). Within the multifilament bundles, the interstices between the fibers were filled mostly by giant cells and mononuclear macrophages typical of foreign body type inflammation. There was no tissue ingrowth into the bundles. The mesh fibers showed a thick external layer of polypropylene degradation with extensive cracking of the surface. In comparison, the excised monofilament meshes had larger spaces between the fibers allowing ingrowth of vascular scar tissue with unobstructed cell traffic. The degree of polypropylene degradation was also lower in the monofilament slings.
230
Conclusion: There were a number of features of the
ObTape mesh which are important for understanding why they are prone to infection. 1) After implantation the interstices within the multifilament bundles acted as a small-pore mesh, 2) smaller spaces were obstructed by foreign body inflammation so the pathway for an acute inflammatory response (neutrophils) to bacterial infection was limited, 3) the surface of the mesh fibers extensively cracked due to polypropylene degradation providing extra surface and sheltering cavities for bacteria. These findings provide information for our understanding of the sling complications and considerations for future developments in the sling designs.
UP.338 Outcomes Following Transobturator Sling Placement for Men with Moderate to Severe Urinary Incontinence Suarez OA, Zuckerman J, McCammon KA Eastern Virginia Medical School, Norfolk, Virginia Introduction and Objective: The AdVance male tran-
sobturator sling is ideally suited for men with mild stress urinary incontinence (SUI). However, some patients with severe SUI may elect this as their treatment option. It is the objective of this paper to review the outcomes following transobturator sling placement for men with moderate-severe urinary incontinence. Materials and Methods: We performed a retrospective review of men who underwent AdVance sling placement for SUI at our institution from 2006 to 2013. Men with preoperative leakage equal or greater than 4 pads a day were studied. Those who had a history of pelvic radiation therapy were excluded. Patients were grouped as Cured (0 to 1 pad daily after surgery), improved (50% or more reduction in daily pads) and failed (less than 50% reduction in daily pads). Data was compared and statistically evaluated among all groups at 3-months follow-up. Patients who were cured at 3 months were followed at 24 months and analyzed. Results: Fifty-nine patients met our inclusion criteria. Eighty eight percent had a history of radical prostatectomy. The mean number of pads a day for the overall cohort was 6. At 3-months follow-up 42 (71%) patients were cured, 11 (18.6%) patients improved and 6 (10%) patients failed. Table 1 represents the evaluated data on this cohort. None of them reached statistical
significance, however when comparing body mass index (BMI) in cured plus improved patients (28.2) vs. failed patients (31.9) statistical significance was reached (T test p=0.02). Of those 42 cured patients, only 24 had a 24-months follow up, of which 19 (45%) remained cured. No statistical significance was proven when comparing data from patients who remained cured at 24 months vs. those who were no longer cured at the same time frame. The percentage of men cured at 3-, 12- and 24- months were 71%, 69%, and 61% respectively. Conclusions: AUS is the gold standard for more severe SUI but the AdVance transobturator male sling is another reasonable option for patients with moderate-severe SUI with an acceptable cure rate at 24-months follow-up. Patients with a BMI greater than 30 tend to have a higher risk for failure.
UP.339 Short-Term Experience with the Adjustable Transobturator System ATOMS® for the Treatment of Male Stress Urinary Incontinence Manso M1, Alexandre B2, Costa D1, Azevedo V1, Antunes Lopes T1, Martins da Silva C3, Cruz F3 1 Dept. of Urology, Centro Hospitalar São João, Porto, Portugal; 2Faculdade de Medicina do Porto, Porto, Portugal; 3Dept. of Urology, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina do Porto, Porto, Portugal; i3S Institute, Porto, Portugal
Introduction and Objective: Post-prostatectomy in-
continence (PPI) is a complication of radical prostatectomy (RP) and transurethral resection of the prostate (TURP). The gold-standard treatment for PPI is the artificial urinary sphincter (AUS). However, slings have been introduced in the last years for patients who cannot control or do not want to use an AUS. We examine the outcome of an adjustable transobturator male system (ATOMS®) in men with PPI. Materials and Methods: Twenty-eight men were implanted with ATOMS® between 2012-2014. Two were lost for follow-up and one did not want to be evaluated since he had the sling removed. Of the remaining 25 patients, 11 (44%) received adjuvant radiotherapy. Severity of PPI was assessed by the number of pads used per day (PPD). Eight patients used 1-2 PPD (mild), 8 used 3-5 PPD (moderate) and 9 used >5 PPD (severe). Patients were considered cured if they
UP.338, Table 1. Outcomes Following Transobturator Sling Placement for Men with Moderate to Severe Urinary Incontinence Cured
Improved
Failed
Age (mean)
64.7
65.7
64.1
ANOVA p=0.93
BMI (mean)
28.6
27.8
31.9
ANOVA p=0.1
Pads (mean)
5.6
6.3
6.3
H Test p=0.1
Bladder neck contracture
11
3
1
Chi2 p=0.8
Previous procedure
4
3
1
Chi2 p=0.3
Detrussor overactivity
12
4
3
Chi2 p=0.5
VLPP < 60
20
6
5
Chi2 p=0.2
Normal Compliance
34
9
6
Chi2 p=0.5
Bladder contractility index < 100
19
6
5
Chi2 p=0.2
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS stopped wearing pads or started wearing only 1 PPD, and improved if the number of PPD decreased by half. The Incontinence Quality of Life questionnaire and a verbal question “would you repeat or recommend the procedure” were used. Complications were assessed. Results: After a mean follow-up of 21.56 months, 16 (64%) patients were cured and 2 (8%) were improved. A mean of 1.54 adjustments were necessary until the desired effect was reached. A decreasing success of the procedure was observed with the increasing severity of PPI (87.5% cured if mild, 62.5% if moderate, 44.4% if severe PPI). Patients who received radiotherapy had inferior results as well (71.4% cured if no previous radiotherapy, 54.5% with previous radiotherapy). The most frequent complication was transient scrotal or perineal pain, affecting 8 (32%) patients. In one (4%) case erosion of the scrotal port occurred, which was corrected without the removal of the device. Globally, 84% would repeat the procedure. Conclusion: The ATOMS® offers good rates of cure
and improvement of PPI, with low complication rates. ATOMS® should be considered as a first choice in patients with mild to moderate forms of PPI as well as in patients with impaired dexterity or cognitive status.
UP.340 Very Low Real Time Rate of Urinary Retention After Intradetrusor Botox® for Non-Neurogenic Overactive Bladder Syed K1, Gomez C2, Gousse A1 1
Bladder Health and Reconstructive Urology Institute, Miramar, United States; 2Female Urology, Neurourology, Voiding Dysfunction and Reconstruction, University of Miami, Dept. of Urology, United States Introduction and Objective: According to the most
recent AUA/SUFU guidelines, intradetrusor onabotulinumtoxinA (BTN/A) is a standard, evidence strength grade B, third line treatment for refractory non-neurogenic overactive bladder (OAB). Urinary retention is the most common clinically significant reported side effect ranging from 5.4% to 43% in previous studies. The aim of this study was to investigate the real time rate of urinary retention in patients treated with BTN/A for refractory non-neurogenic OAB in a multi-institutional study. Materials and Methods: Retrospective chart review
identified 71 patients who were treated with 100 U BTN/A for refractory non-neurogenic OAB from August 2011 to July 2015 at two institutions. Using a flexible cystoscope, 100 U Botox® reconstituted with 10 mL normal saline was administered. Injections of 1mL (10 units/mL) were administered in 10 evenly distributed sites sparing the trigone. Pre and post BTN/A post-void residuals (PVR) were reviewed. Urinary retention was defined as PVR >200 mL requiring clean intermittent catheterization (CIC). Results: After exclusion, the study group consisted
of 66 patients with a mean age of 67 years and 30% were men. Mean pre and post-procedural PVR were 14.06 mL and 69.21 mL respectively. Eight patients (12.12%) were noted to have elevated PVR >200 mL post injection however only one patient (female) required initiation of CIC. The rate of urinary retention was 1.5% (N=1). There was no correlation with age,
history of previous radiation, diabetes or prior use of a neuromodulator device. Conclusions: Contrary to prior studies, our patient cohort demonstrates a very low risk of real time urinary retention rates in appropriately selected patients treated with BTN/A for refractory non-neurogenic OAB.
UP.341 The Efficacy of Intra-Detrusor Dysport® (Abobotulinumtoxin-A) Injection on Patients with Neuropathic Bladder and Long-Term Suprapubic Catheter Hamid R1, Omar I1, Burki J1, Pakzad M2, Ockrim J2, Greenwell T2 1
Royal National Orthopaedic Hospital, London, United Kingdom; 2University College London Hospitals, United Kingdom
Introduction and Objective: Botulinum toxin A is an
established therapy for the treatment of neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients. However, its use in patients with a long-term suprapubic catheter (SPC) and neuropathic bladder dysfunction (NBD) has not been studied. We reviewed our experience with intra-detrusor dysport (IDD) injections in this group of patients. Materials and Methods: This was a retrospective study. We identified 30 patients with NBD and SPC who complained of persistent urinary incontinence in spite of being on anticholinergic medications. There were 18 males with a mean age of 51.53 years (range 17-86). All patients had prior documented NDO on video-urodynamics (VCMG) secondary to either SCI or spinal deformity. Results: All patients were operated as day cases and no patient had any intra or post-operative complications. All 30 patients reported improvement in their symptom of urinary incontinence after the IDD injection. The mean time interval between IDD injection and urodynamic study was 8.88 months (range 4-18). The average dosage of abobotulinum-A was 896.55 U (range 500-1000 U). Conclusion: We conclude that IDD injections can
be used to control persistent urinary incontinence secondary to neuropathic bladder dysfunction in patients with long-term SPC.
UP.342 Long-Term Efficacy and Compliance with Onabotulinum Toxin A for the Treatment of Overactive Bladder Symptoms Hamid R1, Pakzad M2, Ockrim J2, Greenwell T2 1
Royal National Orthopaedic Hospital, London, England; 2University College London Hospitals, United Kingdom
Introduction and Objective: Onabotulinum toxin
A is now an established therapy for the treatment of symptoms of overactive bladder. The long-term results in routine clinical practice are still not established. We evaluated our patients who had undergone injections 5 years ago for compliance and efficacy of this treatment. Materials and Methods: This was a retrospective analysis of patients who underwent onabotulinum
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
toxin A injections for symptoms of overactive bladder from October 2009 to September 2010. All patients had failed treatment with conservative management and oral medications. All had pre-injection urodynamics. The method of bladder management before and after injection along was noted. Results: We identified 24 patients in the non-neurogenic group during this period. The mean age was 60 years (range 30-83). All patients had idiopathic detrusor overactivity. Nineteen patients were voiding spontaneously and 5 were combining this with self-intermittent catheterization (SIC). A variable dose of onabotulinum toxin A was used (100U: n=3, 200U: n=14:300U: n=7). Twelve of 24 (50%) patients continue to have repeated injections and are very satisfied with the outcome. Another 7 did get benefit but have been lost to follow-up. It could not be ascertained if they are undergoing further injections at a different hospital or having an alternative treatment modality. The injections failed in the remaining 5 patients for various reasons (non efficacious: n=2, recurrent urinary infections post injections secondary to needing SIC: n=2, weakness of limb post injection: n=1). The bladder management did change post injection with 7 voiding spontaneously, 6 on SIC and remaining 6 using a combination of two methods. The change in bladder management did not influence the patient’s decision for re-injection apart from 2 patients who suffered from infection. The mean duration of action was 8 months (range 6-12) and the mean number of injections was 7 (range 2-10). Conclusion: We demonstrate that repeated injections
with onabotulinum toxin A are efficacious, and at least half of the patients continue to come back for further injections. These are well tolerated with no increase in morbidity over this period.
UP.343 The Use of ICIQ-SF to Distinguish Incontinent Patients According to the Severity of Their Urinary Leakage Rodrigues Jr. AA, Cologna AJ, Tucci Jr. S, Molina CAF, dos Reis RB Ribeirao Preto School of Medicine, Sao Paulo University, Ribeirao Preto, Brazil Introduction and Objective: The distinction between
urinary incontinent patients with severe leakage and patients with low and moderated urinary leakage presents a direct clinical application: an accurate surgical treatment indication. We analyzed the hypothesis that ICIQ-SF can be used for this purpose, using urodynamic and one-hour PAD test as validation tools. The objective was to correlate ICIQ-SF with PAD-test and urodynamic to distinguish patients with severe incontinence from those with moderate and low urinary leakage. Materials and Methods: We retrospectively analyzed
88 patients, 46 male and 42 female, all diagnosed with urinary incontinence between June 2012 and July 2015 at HC-FMRP-USP. A Portuguese validated version of ICIQ-SF were applied to all patients. The total score, and individualized scores for the frequency, intensity and bother due urinary leakage were annotated. The question about intensity of urinary leakage was used to separate groups into low, moderate and severe leakage. The one-hour PAD test, and urody-
231
UNMODERATED ePOSTERS namic evaluation were also performed, with the following variables annotated for each group: PAD test (g), maximum urinary flux (ml/s), bladder cystometric capacity (ml), maximum detrusor pressure (cmH2O), and abdominal leak-point-pressure (cmH2O). One-way ANOVA with Bonferoni post-test, Student’s t-test and Spearman-Rho correlation test were performed, considering p<0.05. Results: All patients reported urinary incontinence
on ICIQ-SF and present PAD with higher than 2 g weigh. The PAD test weights respectively for low, moderate and severe urinary leakage were 10.3 ± 10.4 g; 64.6 ± 77.8 g and 126.4 ± 130.2 g, p=0.005. The comparison between patients with severe leakage and those grouped with moderate and low leakage showed 40.6 ± 64.0 g vs. 126.4 ± 130.2 g, p=0.01. The comparison between patients with low leakage and patients grouped into moderate and severe leakage showed 10.3 ± 10.4 g vs. 81.2 ± 95.9 g, p=0.007. The variables derived from ICIQ-SF showed no positive correlation with all urodynamic derived variables, but showed positive correlation with PAD test, p=0.01. Conclusion: Our results showed that is possible to use
ICIQ-SF to distinguish patients according to the severity of urinary leakage. However, these promising and preliminary results demand further investigation.
UP.344 Botox Treatment Is Highly Effective for Overactive Bladder Maeda Y1, Sekiguchi Y2 1
UP.345 A Snapshot of Current Trends in Urodynamic Practice in Korea: National Health Insurance Data Study Pyun JH1, Cho S1, Oh MM1, Kang SG1, Park Jy1, Bae JH1, Kang SH1, Park HS1, Moon DG1, Cheon J1, Kim JJ1, Kim JH2, Lee JG1 1 Korea University College of Medicine, Seoul, Republic of Korea; 2Soonchunhyang University, Soonchunhyang University Medical College, Seoul, Republic of Korea
Introduction and Objectives: The prevalence of lower urinary tract symptoms (LUTS) increases with age among Korean men and women. The aim of this study is to investigate the recent trends of functional voiding studies including urodynamic studies (UDS) and uroflowmetry in Korea. Materials and Methods: Data were retrieved from the National Health Insurance Review & Assessment Service (HIRA) from 2010 to 2014 in Korea. We analyzed the number of cases and patients that had performed UDS and uroflowmetry per year. Trend tests and regression tests were done to evaluate the trend of frequency rate of UDS and uroflowmetry. For covariates, year, sex, and the grade of hospital were considered. To explain the trend change in UDS, we also investigated data of surgical cases related with SUI.
Showa University, Tokyo, Japan; Yokohama Women’s Clinic LUNA, Japan with type A botulinum toxin (BoNT-A) for intractable overactive bladder patients. National Health Insurance does not cover the treatment of urological diseases with BoNT-A in Japan. A total of 12 overactive bladder patients treated with BoNT-A from June 2009 to April 2014 were prospectively included in the study. Nine cases that we followed up more than 6 months were subjected. Materials and Methods: Botox injection was per-
formed 12 times for 9 patients. A 100 U of Botox (Allergan, Irvine, California, USA) was diluted in 10 ml 0.9% NaCl. Under local anesthesia and sedation, Botox was injected through a flexible cystoscope into 10 to 20 sites in the trigone and floor of the bladder. Patients were evaluated for the effectiveness by the change with questionnaires; Overactive Bladder Symptom Score (OABSS), Quality of life (QOL) index before the treatment (baseline; BL) and after treatment in 1, 3 and six months. Statistical analysis was performed using the paired t test, in which P<0.05 was considered statistically significant. Results: The median age at the time of treatment was 72 years old. Average score of OABSS, IPSS, and QOL were 10.9, 18.7, 5.6 at Bl, respectively. Each parameter was significantly improved after treatment. OABSS, IPSS, and QOL scores were decreased 38.5%, 28.3%, 42.9%, respectively, at 6 months post operatively compared with BL. Conclusions: The effectiveness of treatment with
BoNT-A for the control of overactive bladder was the same as the US study.
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Conclusions: Despite the fact that prevalence of LUTS is known to increase accordingly with age and that the number of uroflowmetries performed each year is increasing, the number of UDS cases is decreasing continuously. Thus, it can be concluded that the role of urodynamic study may have been emphasized on female urinary incontinence. Further research and discussions are needed to enhance the role of urodynamic study in other voiding dysfunctions.
UP.345, Table 1. The Number of Urodynamic Study Cases
2
Introduction and Objectives: We provide treatment
Results: For the last 5 years, UDS was performed more frequently in small hospitals than in big hospitals (mean: n= 16.669 vs. 11.231), especially in women compared to men (mean: n=48.216 vs. 7.585). The total number of UDS performance showed a significant decrease throughout the years (from 59.208 to 53.816) with its steep decline in small hospitals and for female patients (p<0.001). The performance of anti-incontinence surgery showed a sharp decline for the last 5 years (p<0.001). These results showed that the positive correlation between the decrease in the number of UDS and surgical cases related with SUI was statistically significant. On the other hand, uroflowmetry was performed more in big hospitals (mean: n=211.728 vs. 111.973) and showed an annual increase of cases in all age groups, especially for male patients (mean: n=259.591 vs. 64.111).
Year 2010
2011
2012
2013
2014
Big
23.120 (23.550)
22.041 (22.554)
21.871 (22.283)
21.749 (22.162)
21.343 (21.756)
Small
35.095 (35.658)
33.978 (34.496)
32.287 (32.698)
31.372 (31.787)
34.523 (32.059)
7.333 (7.546)
7.672 (7.971)
7.296 (7.501)
7.104 (7.323)
7.363 (7.582)
50.394 (51.662)
47.915 (49.079)
46.470 (47.480)
45.587 (46.626)
45.122 (46.234)
Patient n (Treatment n)
Hospital
Sex Male Female
Values are presented numerically
UP.345, Table 2. The Number of Uroflowmetries Year 2010
2011
2012
2013
2014
Big
134.170 (176.095)
143.591 (190.192)
162.221 (214.291)
173.366 (231.384)
182.409 (246.680)
Small
65.302 (85.631)
71.612 (94.859)
81.076 (112.265)
87.991 (125.449)
98.961 (141.661)
Male
155.673 (208.901)
169.293 (228.897)
188.958 (260.196)
204.532 (285.865)
222.064 (314.094)
Female
41.196 (52.825)
43.063 (56.154)
50.637 (66.360)
53.199 (70.968)
55.475 (74.247)
Patient n (Treatment n)
Hospital
Sex
Values are presented numerically
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS UP.346 Ileal Augmentation Cystoplasty: Indications, Complications and Functional Outcomes Jaunarena JH, Zubieta ME, Pesce GE, Gonzalez MI, Favre GA, Tejerizo JC Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: Bladder augmentation is indicated in neurogenic and non-neurogenic severe bladder dysfunction. Usual findings can include low compliance, low capacity, detrusor overactivity and urinary incontinence, refractory to first and second-line treatments. We review the complications and functional outcomes of ileal augmentation cystoplasty. Materials and Methods: Between January 2004 and December 2014, 46 patients underwent bladder augmentation. Open surgery was performed in 44 cases, while 2 were robotic-assisted. Augmentation patch was done with a 45 cm distal ileum segment. Twenty-four patients received a self-catheterizable conduit. We assessed surgical indication, relevant clinical and surgical background, renal function, type of surgical procedure, immediate (first 3 months after surgery) and long-term complications (more than 3 months after surgery), objective and subjective results regarding continence and urinary function. Results: Mean patient age was 53 years, and mean fol-
low up was 31 months. Male-female ratio was 0.92/1. Twelve patients had neurogenic bladder, and 28 had a non-neurogenic microbladder. Non-catheterized patients referred severe incontinence (26), associated to urgency and increased daytime frequency. Twenty-seven patients had had more than one previous abdominal or perineal surgery, and 12 had received pelvic radiotherapy. All patients were reassessed one year after surgery: mean bladder capacity increased from 137 ml to 279 ml (p<0.001), incontinence significantly improved, and renal function presented no significant changes. Only 1 patient persisted with severe incontinence after surgery and had to undergo a new bladder augmentation. Twenty-nine patients (63%) presented immediate complications: 22 were Clavien I and II, and 7 Clavien III and IV. Thirteen patients had long-term complications, including 4 with urinary fistulas, 3 with bladder stones and 2 with conduit stenosis. Conclusion: Even though bladder augmentation is
associated with a high complication rate, it can sometimes be the only choice of treatment in patients with severe urinary dysfunction.
UP.347 Prevalence of Detrusor Underactivity in Men and Women with Lower Urinary Tract Symptoms in Japan Takahashi R1, Takei M2, Namitome R1, Yamaguchi A2, Eto M1 1
Dept. of Urology, Kyushu University, Fukuoka, Japan; 2Dept. of Urology, Harasanshin Hospital, Fukuoka, Japan
Introduction and Objective: Although detrusor un-
deractivity (DU) is thought to be a common geriatric condition, it has received little scientific attention and the true prevalence of DU among the communi-
ty-dwelling elderly remains largely unknown. In the present study, we examined the prevalence of DU in men and women presenting with lower urinary tract symptoms (LUTS) in Japan. Materials and Methods: A multichannel urodynamic
study (UD-2000, Medical Measures Systems), including a pressure flow study (PFS), was carried out in accordance with the guidelines of the International Continence Society and the results of 20 207 patients with LUTS were reviewed. DU was defined as a bladder contractility index <100. Results: In both men and women, the prevalence of DU gradually increased with age and reached more than 60% (men) and 80% (women) in patients aged over 80 years. The trend was more remarkable in patients aged over 60 years. The prevalence of DHIC (detrusor hyperactivity with impaired contractility) also gradually increased with age. In men, the prevalence of DU in patients diagnosed with BPH (benign prostatic hyperplasia), NB (neurogenic bladder) and OAB (overactive bladder) was 46.3%, 56.5% and 51.7%, respectively. In women, the prevalence of DU in patients with diagnosed OAB, UI (urinary incontinence), NB, POP (pelvic organ prolapse) and IC (interstitial cystitis) was 60.3%, 53.3%, 72.7%, 64.6% and 75.5%, respectively. Conclusion: DU is a common mechanism underlying
LUTS in men and women, especially in the elderly population.
UP.348 Similarity Analysis Between Catheterless Urodynamic Study Using Penile Cuff and Conventional Urodynamic Study for Evaluation of Male Lower Urinary Tract Symptom Han C1, Bae S1, Park B1, Lee Y1, Kang S1, Cho Y2, Lee SJ3 1
The Catholic University of Korea, Uijeongbu St.Mary’s Hospital, South Korea; 2The Catholic University of Korea, Yeouido St.Mary’s Hospital, South Korea; 3The Catholic University of Korea, St. Vincent's Hospital, Gyeonggi-do, South Korea
Introduction and Objectives: Various examination tools are used for the evaluation of lower urinary tract function, including uroflowmetry, urodynamic study (UDS), questionnaire, etc. Conventional UDS has some disadvantages such as a long time for the test, and pain or discomfort due to catheter insertion. The objective of this study is to identify similarities between catheterless UDS using penile cuff and conventional UDS. Materials and Methods: From October 2013 to May
2015, 30 patients who were diagnosed with benign prostate hyperplasia, neurogenic bladder, or prostate cancer who agreed to be examinated were included in the study. All patients underwent penile cuff UDS (CT3000) and conventional urodynamic study. Also, uroflowmetry, transrectal ultrasonography and urine analysis were done. We compared the urodynamic results with the penile cuff test results, ICS nomogram and Newcastle nomogram. Results: Mean patient age was 69.1 years old and mean BMI was 25.63 kg/m2. Mean prostate volume was 72.85 cc and PSA was 12.04 ng/dL. A total of 24
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
patients were diagnosed with BPH, 2 patients were diagnosed with neurogenic bladder, and 4 patients were diagnosed with prostate cancer in later examination. In conventional UDS, 19 showed obstructive pattern, 3 showed equivocal, 4 showed unobstructive pattern, and 4 patients failed to void. On cuff test, 18 obstructive, 3 unobstructive, 6 low pressure low flow, and 3 high pressure high flow were identified. A total of 15 patients had the same result on UDS and cuff test, 5 patients were similar results. Four pateints who failed voiding on UDS was low pressure low flow in cuff test and maximal cuss pressure were lower than 100 mmHg. Six patients were represented opposite result between UDS and cuff test. In detailed analysis, Qmax in pressure flow study and maximal intravesical pressure was highly correlated with Qmax in cuff test and Qmax in uroflowmetry (R=0.829, 0.398, 0.374, P<0.001, 0.036 ,0.042). Maximal cuff pressure was correlated with Qmax in pressure flow study (R=0.443, P=0.018). Conclusions: Penile cuff UDS represented 80% of concordance in prediction of lower urinary tract function compared to conventional UDS. Especially, the patients who had ‘low pressure low flow’ in cuff test also failed in voiding on conventional UDS, so it might be possible to predict bladder function indirectly. These results might be helpful in the prediction of postoperative result on voiding after TUR-P or HoLEP, and may replace conventional UDS.
UP.349 Precid Score: An Innovative Predictive Clincial Tool of Involuntary Detrusor Contractions in Women with Overactive Bladder Arribillaga L, Ledesma M, Bengió RG, Pisano F, Montedoro A, Orellana S, García Önto H, Bengió RH Centro Urológico Profesor Bengió, Córdoba, Argentina Introduction and Objective: Overactive bladder
(OAB) is a weakening condition that affects an important group of people, altering their quality of life. Traditionally this syndrome has been associated with the presence of involuntary detrusor contractions (IDC) in the filling phase of the cystomanometry; this urodynamic observation is called overactive detrusor (OAD). IDC identification in the urodynamic study in patients with OAB is around 50%. In this way, the association between OAB and OAD is not yet clear. Taking into account the above-mentioned information, the creation of a model that improves the predictive ability of OAB symptoms by itself is essential. The aim of this study was to create a predictive model of CID (PRECID) in order to improve the diagnostic accuracy of OAD, associating OAB symptoms with other clinical parameters in the female population. Materials and Methods: A total of 727 women who
underwent urodynamic studies for urogynecological causes were evaluated. Demographics data, personal pathological background, as well as surgical, symptoms, physical exam, mictionary record (micturition chart) and urinary culture, were collected in all patients who previously underwent uroflowmetry and urodynamic studies. A logistic regression model was carried out in order to determine independent predictors of presence of involuntary detrusor contraction (IDC). OR estimation was use to assign a score
233
UNMODERATED ePOSTERS to each one of the significant variables (p<0.05) in the logistic regression model. To conclude, we performed a ROC curve in order to determine the predictive ability of the score in relation to the presence of OAD.
UP.351
Results: Presence of OAD was evident in 210 women (29%). In the logistic regression analysis, independent predictors of OAD were micturition urgency, UUI, nicturia, absence of SUI symptoms, presence of diabetes, reduction of vaginal trophism and vesical capacity under 150 ml. The IDC diagnosis probability increases directly as the score raises (Score 0: 4% until Score ≥10: 88%). Sensitivity is 71% and specificity 72%. The area under the curve of PRECID score was 0.784 (p>0.001).
1
Conclusions: PRECID score is a clinical tool that shows higher diagnostic accuracy than OAB symptoms alone when predicting overactive detrusor (OAD).
UP.350 Clinical Predictors of Abdominal Leak Pressure Point (ALPP) of Less Than 60 cm H2O in Women with Stress Urinary Incontinence Arribillaga L, Ledesma M, Bengió RG, Orellana S, Pisano F, Montedoro A, Bengió RH Centro Urológico Profesor Bengió, Córdoba, Argentina Introduction and Objective: To determine predictive
clinical factors of ALPP < 60 cm H2O in patients with stress urinary incontinence (SUI). Materials and Methods: A retrospective, observational and descriptive study was designed in women referred to urodynamics study for stress urinary incontinence. Three groups of patients were made according to ALPP value: > 90 cm H2O, between 60 and 90 cm H2O and < 60 cm H2O. In all patients, we made a complete interrogation, including an evaluation of clinical records, physical examination, uroflowmetry and a complete urodynamics study. For univariate analysis we used chi square or t test for categorical or continuous variables respectively. We used logistic regression method for multivariate analysis to determinate clinical predictors of ALPP < 60 cm H2O. In all cases, we considered a p-value < 0.05 statically significant. Results: Of 158 patients, 65 had an ALPP > 90 cm
H2O, 64 patients had an ALPP value was between 60-90 cm H2O and 29 patients had a value that was > 60 cm H2O. Univariate analysis showed that an ALPP value < 60 cm H2O was associated with age (p=0.003), menopause (p=0.008), anti incontinence surgery and hysterectomy history (p=0.02), Stamey stage classification (p=0.006), fixed urethra (p=0.003) and positive empty stress test (p=0.005). However, in the multivariate analysis, the independent predictors for ALPP < 60 cm H2O founded, were: fixed urethra (p=0.014), positive empty stress test (p=0.027 and stage III Stamey’s symptoms (p=0.005)). Conclusion: Fixed urethra, positive empty stress test
and high grade of Stamey’s Stage SUI symptoms are independent clinical predictors of ALPP < 60 cm H2O in patients with SUI.
234
Urodynamics Evaluation of Men with Incontinence After Radical Prostatectomy Salazar A1, Salazar I2, Castro C1, Mario C3 Unidad de Urologia, Hospital de Carabineros de Chile; 2Facultad de Medicina, Universidad de los Andes, Chile; 3Servicio de Urologia, Hospital Direccion de Prevision de Carabineros de Chile
Introduction and Objective: Urinary incontinence is a common problem after radical prostatectomy (with a wide range of reported incidence, from 2% to 87%) and is often viewed by patients as the symptom which most disrupts their quality of life. Most patients (9095%) regain total urinary control after radical prostatectomy but this can take up to 1 or 2 years to achieve, with a small percentage (2% to 4%) experiencing permanent incontinence. This risk varies in the literature. The etiology of incontinence has been attributed mainly to sphincteric deficiency and/or bladder abnormalities. To define the origin of urinary incontinence after radical prostatectomy, urodynamic studies (UDS) in 56 incontinent patients were performed. UDS may not serve to predict outcome following intervention, but serve to diagnose the type of incontinence present. While some routinely recommend UDS prior to a surgical intervention, the utility of this practice has not been proven to affect outcomes. Materials and Methods: We reviewed the UDS re-
sults to assess the filling urodynamic parameters for 56 consecutive men referred for urinary incontinence after radical prostatectomy. Results: The mean patient age was 67.8 (47 to 81) years, and the mean interval since radical prostatectomy was 57 (1 to 144) months. A total of 25 (44.6%) patients had detrusor overactivity (DO). Stress urinary incontinence (SUI) was demonstrated by UDS in 27 men (48.2%), with a mean abdominal leak point pressure of 90 (30-147) cm H2O, 15 of them had SUI + DO. In 3 (5.3), UDS was normal and 1 (1.7) had diminished compliance. Conclusions: UDS remain the gold standard for diagnosing the type of incontinence in patients post-prostatectomy and can be used to diagnose bladder dysfunctions such as detrusor overactivity or decreased compliance. It can also be used to determine the severity of SUI, that could be useful selecting an appropriate procedure for postprostatectomy incontinence based upon incontinence severity.
UP.352 Urodynamic Estimation of Detrusor Contractile Function: The Bladder Contractility Index (BCI) Orsolya M1, Ghirca VM2, Frunda EA3, Chibelean C1 1
University of Medicine and Pharmacy Tirgu Mures, Clinic of Urology, Romania; 2County Hospital Mures, Clinic of Urology, Romania; 3University of Medicine and Pharmacy Tirgu Mures, Romania Introduction and Objective: Underactive bladder
(UAB), a common cause of LUTS, is a poorly understood clinical condition, with a lack of accepted diagnostic methods and criteria. We evaluate the importance of urodynamic findings and bladder con-
tractility index (BCI) in the estimation of bladder contraction strength. Materials and Methods: Between January 2013 and December 2015, a total of 182 patients with voiding dysfunctions underwent urodynamic investigations. BCI was evaluated. Detrusor underactivity was defined by pdetQmax<30 cmH2O and BCI less than 100 using the formula: PdetQmax+5 Qmax. Mean patient age was 57.92 years, women accounted for 55.29% of patients while men accounted for and 44.70%. Results: In all of the cases urodynamic studies were performed: uroflowmetry, filling cystometry and pressure flow. In 85 (46.70%) patients bladder underactivity was identified. Concerning the aethiology, 21 males had BPH, diabetes was observed in 29 cases (34.11%), history of pelvic surgery was seen in 27 patients (31.76%), psychotropic medication was taken by 20 patients (23.52%), neurologic comorbidities were observed in 12 cases (14.11%), spinal cord pathology was seen in 10 cases (11.76%), and patients were aged over 75 in 12 cases (14.11%). Post void residual urine (PVR) of more than 100 ml was found in 66 cases (77.64%). A total of 7 (8.23%) patients presented with complete urinary retention and 12 (14.11%) had no PVR. Uroflowmetry revealed a Qmax value >15 ml/sec in 22 cases (25.88%) while in 56 (65.88%) patients Qmax was <15 ml/sec. The mean Qmax value was 8.18 ml/sec (2 ml/sec-21 ml/ sec). Regarding the shape, it was regular in 62 cases (72.94%), irregular, interrupted 23 patients (27.05%), terminal dribbling was identified in 35 (41.17%) patients. During filling cystometry there was only one case of associated detrusor hyperactivity 1 woman (1.17%) with multiple sclerosis and TVT. The mean value of Pdet was 13.15 cmH2O (5 cmH2O-29 cmH2O). Bladder contractility index showed limits: 1798, with a mean value of 57.63. Conclusions: In the case of detrusor underactivity, there is a great need of consensus regarding diagnostic criteria. Urodynamic investigations are of great importance, and the BCI seems to offer a solution to identify bladder underactivity.
UP.353 The Correlation Between Retrograde Leak Point Pressure and 24-Hour Pad Weight for Men with Post Prostatectomy Incontinence Hamid R1, Pakzad M2, Ockrim J2, Greenwell T2 1
Royal National Orthopaedic Hospital, Stanmore, England; 2University College London Hospitals, United Kingdom
Introduction and Objective: To assess the correlation between retrograde leak point pressure (RLPP) and 24-hour pad weight (24PW) in men with post prostatectomy incontinence. Materials and Methods: We performed RLPP and 24PW measurements on 61 patients with post-prostatectomy stress urinary incontinence (SUI). We examined the relationship of RLPP and 24PW. We also reviewed the urodynamic and clinical data of these patients to explain our findings. Results: The mean age was 69.5 years (SD + 7.4, range 51-87). The mean RLPP was 36.8 cmH2O (SD +/- 15.3, range 9-76), and the mean 24PW was 499
36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE — SIU 2016 ABSTRACT BOOK
UNMODERATED ePOSTERS g (+ 677 g, range 16.5 g-3177 g). There was a strong and significant negative correlation between RLPP and 24PW (r=0.56, p<0.0001). RLPP was a strong predictor of cases of mild/moderate (<400 g) and severe (>400 g) incontinence. Patients with RLPP ≤30 had significantly higher 24PW (mean 825 g, median 768 g) when compared with patients with RLPP >30 (mean 257.8 g, median 100 g), p<0.0001. Conclusions: There is a good correlation between
RLPP and 24PW. RLPP can distinguish between mild/ moderate and severe levels of incontinence. RLPP could be used as an objective and more reliable substitute to pad weight to objectify and stratify SUI in post-prostatectomy patients.
UP.354 Urodynamic Findings in Adults with Moderate to Severe Cerebral Palsy Cotter KJ1, Levy M1, Goldfarb RA1, Liberman D1, Katoriski J2, Elliott SP1 1
University of Minnesota, Minneapolis, United States; Gillette Lifetime Specialty Healthcare, St. Paul, United States
2
Introduction and Objective: Cerebral palsy (CP) is a heterogeneous congenital syndrome unified by abnormalities in movement and posture. Patients may also suffer from cognitive impairment and voiding dysfunction. According to the literature, urodynamics (UDS) in children with CP have been consistent with an upper motor neuron bladder with DSD; however, little is known about UDS findings in adults with CP. Materials and Methods: Patients underwent eval-
uation at the Gillette Lifetime Specialty Healthcare Transitional Urology Clinic. UDS were retrospectively analyzed from patients’ first assessment upon entry into the transitional clinic. We included patients seen in the clinic from 2011-2014, ≥18 years of age, with a diagnosis of CP. When more than one UDS was performed, we included only the most recent. Results: Of 211 patients with CP seen in the clinic between 2011-2014, 49 underwent UDS. Their average age was 30, and 55% were men, while 45% were women. A total of 98% had Gross Motor Functioning Classification System (GMFCS) scores of 3-5 out of 5, indicative of moderate to severe CP. UDS was initiated for irritative voiding symptoms in 55%, obstructive voiding symptoms in 25%, hydronephrosis in 18%, and other reasons in 2%. A total of 57% also had incontinence. Detrusor sphincter dyssynergia (DSD) was seen in 12%, detrusor overactivity (DO) in 30% and DLPP >40 mm Hg in 51%. Median compliance was 18 mL/cm H2O (0.78-365). Maximum cystometric capacity (MCC) ranged from 80-1400 mL and was <300mL in 30%. A total of 19% had a MCC <300mL and compliance less than 20. A total of 12% had a MCC <300 and DLPP >40. Pathology on UDS was seen in all GMFCS levels. Conclusions: UDS findings in symptomatic adult CP patients are varied. A total of 51% had upper motor neuron bladder findings, similar to that seen in the pediatric literature, but 6% had large flaccid bladders and half had concerning findings, such as compliance <20 or DLPP >40 cm H2O. A total of 19% of patients
had small capacity bladders and poor compliance. Our results suggest that if left unmonitored or without intervention, upper urinary tract damage could ensue. Further characterization of this population is needed in order to correlate these UDS findings with clinical outcomes.
UP.355 Urinary Tract Infections After Urodynamic Studies: Incidence and Predictors
though it is not commonly used in some countries. We describe our experience with DES in an unselected cohort of patients. Materials and Methods: Patients receiving DES (2 mg) + aspirin (100 mg) as second line hormonal therapy for CRPC between January 2011 to December 2013 were identified retrospectively from the clinical database. The primary endpoint was biochemical response.
Jaunarena JH, Pesce G Hospital Italiano de Buenos Aires, Argentina Introduction and Objective: Antibiotic treatment and prophylaxis before and after urodynamic studies (UDS) are controversial. We review the incidence of urinary tract infections (UTI) after UDS and analyze UTI predictors. Materials and Methods: We performed a retrospective analysis on a prospectively collected database on UDS. Between March 1st, 2014 and November 30th, 2015, 291 patients underwent UDS. Patients who had at least a 1-month follow-up were included for analysis (203). All patients had urine cultures taken before UDS. UTI risk factors were assessed. Asymptomatic bacteriuria was defined as a positive urine culture without UTI symptoms. UTI was defined as a positive urine culture plus UTI symptoms. Patients with negative urine culture did not receive antibiotic prophylaxis. Patients with asymptomatic bacteriuria received antibiotic prophylaxis the day of the study. We did not perform UDS on patients with UTI. UTI were registered up to 30 days after the UDS. Fisher’s exact test was used for analyzing predictors of UTI after UDS. Results: Male to female ratio was 0.53. Mean patient age was 59 years. Mean follow-up was 9.5 months. Forty-eight patients (24%) received antibiotic prophylaxis before UDS and 155 did not. Only 14 patients (7%) had UTI after UDS: 9 had received antibiotic prophylaxis, and 5 had not. Patients with risk factors for UTI included indwelling catheter 10.84% (22), diabetes 9.85% (20), bladder augmentation 3.45% (7), intermittent self-catheterization 13.8% (28), recurrent-UTI 18.7% (38), pelvic radiotherapy 8.8% (18), and pelvic-organ prolapse 6% (13). We found a significant association between asymptomatic bacteriuria and UTI after the study (p=0.0009). Among the mentioned risk factors for UTI, indwelling catheter significantly predicted UTI (p=0.04). Conclusion: In our series, UTI after UDS was 7%. We found that asymptomatic bacteriuria and indwelling catheter were significant predictors for UTI after UDS.
UP.356 Biochemical Response with Diethylstilbestrol (DES) in Castration-Resistant Prostate Cancer (CRPC): Experience in a Heterogeneous Population
Results: A total of 82 patients were included. Demographic characteristics are shown in Table 1. The PSA response was 78%. In the group of responders, 63.4% had a good response (PSA decline of >50%), 63.4% had a partial response (PSA decline from 30% to 50%) and 21.4% had a poor or didn´t show response (PSA decline <30%) (Table 2). The median time to PSA progression was 10.4 months. Thromboembolic complications were seen in 6% (n=5). Conclusions: DES should still be considered as a management option in CRPC, in the pre-Docetaxel setting. Biochemical response was longer with a significant and acceptable toxicity profile.
UP.356, Table 1. Demographic Characteristics Demographic Characteristics
N= 82
Age (years) Mean (range)
64.5 (47-82)
PSA level at diagnosis of CRPC, ng/mL Median (range)
66.8 (0-3019)
Gleason T
6 7 (3+4) 7 (4+3) 8 9 10
1 (1.2) 1 (1.2) 13 (15.9) 24 (29.3) 39 (48.8) 3 (3.7)
Clinical stage (TNM)
T1c T2 T3 T4
2 (2.4%) 69 (84.1%) 10 (12.2%) 1 (1.2%)
Bone metastases
Si No
70 (85.4%) 12 (14.6%)
UP.356, Table 2. Response
Santana Rios Z, Scavuzzo A, Osornio V, Herrera A, Montalvo G, Meneses A, Martínez P, Jimenez MA
Response
N (%)
Good (>50%)
52 (63.4%)
National Cancer Institute, México
Partial (30-50%)
8 (9.8%)
Diethylstilbestrol (DES) is an effective therapeutic option in CRPC, al-
Poor / Non responder (<30%)
22 (26.8%)
Introduction
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Objectives:
SIU 2016 ABSTRACT BOOK — 36th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D’UROLOGIE
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