KSS/London South Regional Meeting incorporating the annual ...€¦ · English CL, Afshar M, Pickering L, Tree A, Ayres B, Watkin N., St George's Hospital, St George's University

In partnership with the Ministry of Defence

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

KSS/LondonSouthRegionalMeetingincorporatingtheannualDerekPackhamMemorialMedialandinauguralBillChoiaward.

Tuesday20thNovember2018

PostgraduateEducationCentre,FrimleyParkHospital,SurreyGU167UJ.

Convenors:MrAhmedAli,MrMuddassarHussain,MrAndrewChetwood

Programme:

1000 ArrivalandCoffee:

1030-1230 KSSSTCmeeting(consultantsandtraineereps)

1230-1300 JointKSS/LondonSouthMeeting

1300-1400 Lunch(Includingsponsorsexhibits)

1400-1530 Traineepresentations,Session1(Uro-oncology)

1530-1600 Coffee(includingsponsorsexhibits)

1600-1730 TraineePresentations,Session2(Benignurology)

1730-1800 PresentationfromMrIanEardley,ConsultantUrologist,LeedsTeachingHospitalsandVicePresident,RoyalCollegeofSurgeons.

1800-1815 BAUSQ&AwithMrTimO’Brien,VicePresidentofBAUS

1815-1830 Trainingupdates,AwardofDerekPackhamMemorialMedal,PrizesandtheinauguralBillChoiaward

1830-1930 DrinksandcanapesinthePGECwithdinnerafterwardsatVillaBianca,FrimleyHighStreetGU167JF(5minswalkfromhospital)

WelookforwardtowelcomingyoutoFrimleyParkforagreatdayofpresentationsandacademicdiscussion.Eachpresentationwillbe7minswith3minsforquestions.Pleasecontactanyofuswithquestionsaboutthedayandpleasecontactoneofustoconfirmyourattendancefordinner.

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

Hopetoseeyouonthe20th

Withbestwishes

Ahmed,MuddassarandAndrew.

[email protected],[email protected],[email protected]



Session1–Uro-oncology

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

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

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

14.30PSAScreeningTsunami-TheStephenFryEffect?MattStanowskiandBenEddy.EastKentUniversityHospitalsNHSFoundationTrustPresentingauthor:MattStanowski

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

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

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

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

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



Session2–Benignurology

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

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

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

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

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

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

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

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

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



TitleofpresentationOncologicalandFunctionalOutcomesfollowingSalvageHigh-IntensityFocusedUltrasound(HIFU):Asinglecentreevaluation10yearslater

AuthorsDownC,MalthouseT,SturchP,WhiteE,LarnerT.

InstitutionBrighton&SussexUniversityNHSTrust

PresentingauthorChrisDown

[email protected]

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



TitleofpresentationRoboticassistedradicalprostatectomyafterfocaltherapy:oncological,functionaloutcomesandpredictorsofrecurrence

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

InstitutionGuy'sandSt.Thomas'NHSFoundationTrust

PresentingauthorThomasStonier

[email protected]

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



TitleofpresentationConcordanceofclinicalT3stageasreportedonmulti-parametricmagneticresonanceimagingtofinalpathologicalstagingofradicalprostatectomyspecimen

AuthorsMStanowski,MKQuraishi,IMorrison,EStreeterandBEddy

InstitutionEastKentUniversityHospitalsNHSFoundationTrust

PresentingauthorMKQuraishi

[email protected]

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



TitleofpresentationPSAScreeningTsunami-TheStephenFryEffect?

AuthorsMattStanowskiandBenEddy

InstitutionEastKentUniversityHospitalsNHSFoundationTrust

PresentingauthorMattStanowski

[email protected]

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



TitleofpresentationTREXIT-oneyearon.Canwemakeacleanbreakfromthetrans-rectalbiopsy?

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


PresentingauthorLukeStroman

[email protected]

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



TitleofpresentationLongtermevaluationofqualityassuranceandlearningcurvefordynamicsentinelinguinallymphnodebiopsyinpenilecancer

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

InstitutionStGeorge'sHospital

PresentingauthorSylviaYan

[email protected]

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



TitleofpresentationIsAgeanIndependentPredictorforSurvivalOutcomesinPenileCancer

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

InstitutionStGeorge'sHospital,StGeorge'sUniversityHospitalsNHSFoundationTrust

PresentingauthorDrCarolineLouiseEnglish

[email protected]

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



TitleofpresentationRetroperitoneal Robot-Assisted Partial Nephrectomy in obesepatientsAuthors

RGeorgiou,MMalki,MHussain,NBarber

Institution

FrimleyHealthNHSFoundationTrust

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

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

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

Conclusions:RetroperitonealRAPNisfeasibleinpatientswithhighBMIandprovidesgoodsurgicalaccesstotreatnon-anteriorrenalmasses.RetroperitonealRAPNisassociatedwithlessbloodloss,shortersurgicaltimewhencomparedtotransperitonealRAPNstudies.



TitleofpresentationSpecialistMDTforUpperTractUrothelialCarcinoma–doesitchangeanything?

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


PresentingauthorJuneTay

[email protected]

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



TitleofpresentationIsvitaminB6supplementationneededforcystinuricpatientstakingPenicillamine?

AuthorsNaeemaFarrah,LindaRoss,HayleyWells,DavidGame,KayThomas,MatthewBultitude


PresentingauthorNaeemaFarrah

[email protected]

AbstractINTRODUCTION:

D-Penicillamineisacystinechelatorthatformsadisulphidecomplexwithcysteinetoincreaseitssolubility.StudieshavesuggesteditcancausevitaminB6deficiencyandsomerecommendroutinesupplementationwithpyridoxine.Weassessedourpatientcohorttoseeifsupplementationisrequired.

METHODS:

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

RESULTS:

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

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

CONCLUSIONS:

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



TitleofpresentationTotallyTubelessUltra-miniPercutaneousNephrolithotomyintheManagementofRenalCalculi:ASingleCentreUKExperience.

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

InstitutionEastbourneDistrictGeneralHospital

PresentingauthorJosephGabriel

[email protected]

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



TitleofpresentationInvestigatinguretericcolic:aretheBAUSguidelinesfeasible?

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

InstitutionDepartmentofUrology1,EmergencyMedicine2andRadiology3,KingstonHospital,GalsworthyRoad,KT27QB

PresentingauthorAndrewBrown

[email protected]

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



Titleofpresentation

Istheanswerintheirgenes?Phenotypeoffirst-degreerelativeswithcystinuria

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


PresentingauthorFrancescaKum

[email protected]

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



TitleofPresntation

Initialsinglecentreexperienceof4DprostaticUrethrallift(Urolift):Aminimallyinvasivetechniqueforsymptomaticbenignprostatichyperplasia(BPH).

Authors

RaghavVerma,KengNg,NeilBarber.

Institution

FrimleyHealthNHSFoundationTrust.

Presentingauthor

RaghavVerma

Contactemail:

[email protected]

Abstract

Introduction:

UroLiftisatransurethral,minimallyinvasiveprocedureusedtoholdtheprostaticlaterallobesawayfromurethrallumenforpatientssufferingwithsymptomaticBPH.IthasbeenshowntobeeffectiveinrelievinglowerurinarytractsymptomsinBPHwhilemaintaininggoodsexualfunction.4DUroliftisanewtechniqueinimplantdeliveryusedtomaximallywidentheprostaticurethraatbladderneck.

Methods:

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

Results:

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

Conclusion:

Initialresultsfrom4DUrolifthasshowngoodcomparable,ifnotbetteroutcome,withimprovementoflowerurinarytractsymptomswithoutcompromisingsexualfunction.



TitleofpresentationBacterialProstatitisisasignificantfindinginpatientswithsymptomaticurethralstricturedisease

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

InstitutionStGeorge'sUniversityNHSTrust

PresentingauthorDeliaToomey

[email protected]

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



TitleofpresentationPatientsatisfactionandserviceevaluationfollowingpostprostatectomystressurinaryincontinencesurgery

AuthorsYoussefChedid,KieranSheimar,ClaireTaylor,SachinMalde,ArunSahai

InstitutionGuy'sandStThomas'NHSFoundationTrust

PresentingauthorYoussefChedid

[email protected]

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



TitleofpresentationIntravesicalBotulinumToxinAInjectionsinpatientsonanti-plateletandanticoagulationtherapy

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

Institution1StGeorgesHealthcareNHSTrust.2StGeorges,UniversityofLondon.3UniversityCollegeLondonHospitals4Epsom,StHelierHospital

PresentingauthorElsieMensah

[email protected]

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



TitleofpresentationTheDevelopmentofaValidatedPatientReportedOutcomeMeasure(PROM)forPenileCurvatureSurgery

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

InstitutionEpsom&StHelierUniversityHospitalNHSTrust,London.

PresentingauthorDejiAkiboye

[email protected]

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

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KSS/London South Regional Meeting incorporating the annual ...€¦ · English CL, Afshar M, Pickering L, Tree A, Ayres B, Watkin N., St George's Hospital, St George's University