Poster Sessions

TABLE OF CONTENTS

BAUS Annual Meeting, 25–28 June 2012, BJUI Glasgow, SECC SUPPLEMENTS Poster Sessions

Tuesday 26 June 2012 Poster Session 1 11:00–12:30 Alsh PROSTATE CANCER DIAGNOSIS Chairmen: Mr Rick Popert & Mr Garrett Durkan Posters P1–P10

Poster Session 2 11:00–12:30 Carron UPPER TRACT DISORDERS AND IMAGING Chairmen: Mr Toby Page & Mr Chandra Shekhar Biyani Posters P11–P20

Poster Session 3 14:00–16:00 Alsh SCIENTIFIC DISCOVERY Chairpersons: Mr Rakesh Heer & Mrs Caroline Moore Posters P21–P34

Poster Session 4 14:00–16:00 Carron STONES Chairpersons: Mr Daron Smith & Miss Kay Thomas Posters P35–P45

Wednesday 27 June 2012 Poster Session 5 11:00–12:30 Alsh BLADDER CANCER Chairpersons: Ms Jo Cresswell & Mr Rik Bryan Posters P46–P57

Poster Session 6 11:00–12:30 Carron TECHNIQUES AND INNOVATION Chairmen: Mr Ghulam Nabi & Mr John McGrath Posters P58–P67

Poster Session 7 14:00–16:00 Alsh FEMALE UROLOGY AND LUTS Chairpersons: Mr Chris Harding & Miss Mary Garthwaite Posters P68–P82

Thursday 28 June 2012 Poster Session 8 11:00–12:30 Alsh ANDROLOGY Chairmen: Mr Richard Pearcy & Mr Mike Foster Posters P83–P92

Poster Session 9 11:00–12:30 Carron RENAL CANCER Chairmen: Mr Simon Williams & Mr Neil Barber Posters P93–P102

Tuesday 26 June 2012 BJUI Poster Session 1 SUPPLEMENTS 11:00–12:30 Alsh PROSTATE CANCER DIAGNOSIS Chairmen: Mr Rick Popert & Mr Garrett Durkan Posters P1–P10

P1 compared with the most affl uent. This biopsies due to uncertainty about their A population based analysis of deprivation gap represents an estimated individual risk of having prostate cancer. socioeconomic circumstances and 1,764 under-diagnosed cases of prostate Biopsies of the prostate are generally safe incidence of prostate cancer cancer over this 5-year period. The but can be associated with signifi cant K Shafi que, R Oliphant, D Morrison signifi cant deprivation gap occurred in low morbidity. We look at whether PSA density Institute of Health & Wellbeing, University grade disease, only. can be used to reliably predict the of Glasgow, United Kingdom Conclusion: The increase in prostate cancer likelihood of having signifi cant prostate incidence among most the affl uent is cancer. Background: It has been suggested that mainly due to an increase in the diagnosis Method: We looked retrospectively at all the higher incidence of prostate cancer of low grade disease. This suggests that patients who underwent diagnostic observed in more affl uent men may be differential use of screening, rather than a template prostate biopsies from April explained by greater use of screening. This true difference in risk of disease, explains 2007–November 2011. Demographic data, study describes trends in overall and the observed deprivation gap. PSA, prostate volume, number of cores, and grade-specifi c prostate cancer incidence by histology results (divided into 1) benign 2) socio-economic circumstances in the West P2 clinically insignifi cant 3) clinically of Scotland from 1991–2007. Can PSA density predict your risk of signifi cant) were collated. PSA density was Methods: Incident cases of prostate cancer having prostate cancer? then correlated with histological results. (ICD-10 C61) from the West of Scotland S Fernando, BSI Montgomery, SJ Bott Results: There were 514 patients with a were extracted from the Scottish Cancer Frimley Park Hospital NHS Trust, Surrey, mean age of 68.4 years. PSA density ranged Registry from 1991 to 2007. Socioeconomic United Kingdom from 0.01 to 1.31. circumstances were measured using the Carstairs score and disease grade (high Introduction: Increasingly, patients with a versus low) was measured using the raised PSA are subjected to prostate Gleason score. Results: In total, 15,519 incident cases of prostate cancer were diagnosed in the West of Scotland between 1991 and 2007. Table for P2 Overall incidence increased by 70% from 44 PSA Density Benign Insignifi cant Cancer Signifi cant Cancer per 100,000 in 1991 to 75 per 100,000 in 2007, an average annual growth of 3.6%. 0.01–0.05 11 (78.6%) 1 (7.1%) 2 (14.3%) Incidence was inversely associated with 0.06–0.15 122 (53.3%) 45 (19.7%) 62 (27.0%) deprivation with the highest rates among 0.16–0.30 105 (50.0%) 24 (11.4%) 81 (38.6%) the more affl uent groups. From 2003–2007, 0.31–0.45 9 (28.0%) 2 (6.2%) 21 (65.6%) the deprivation gap in incidence was 40.3 0.46–0.60 4 (30.8%) 2 (15.4%) 7 (53.8%) per 100,000 (P < 0.001; trend), with rates 0.61–1.31 0 (0.0%) 0 (0.0%) 6 (100.0%) 37% lower among the most deprived

The incidence of clinically signifi cant Table for P3 prostate cancer increases with PSA density. Gleason = 4 + 3 Gleason = 3 + 4 MCCL = 6 mm MCLL = 4 mm At lower PSA densities the likelihood of having benign or clinically insignifi cant Target condition 7% (10) 38% (53) 26% (36) 38% (53) disease is far greater than having present, % (N) signifi cant prostate cancer, but still not Sensitivity 93 67 81 70 negligible. Specifi city 63 69 68 71 Of note, no patients with ‘clinically Positive predictive 12 40 32 44 insignifi cant’ cancer have required value treatment to date. Negative predictive 99 87 95 87 value Conclusion: An individual’s PSA density AUC of ROC 0.82 0.71 0.80 0.75 can predict their likelihood of having clinically signifi cant prostate cancer. This information should be used when counselling patients about the need for prostatic biopsy. This may avoid Conclusion: Mp-MRI showed high negative (1–32) and number of cores taken 29 unnecessary biopsies and morbidity. predictive value (87–99%) at all thresholds (16–43). 71 were diagnosed with PCa used. It seems to have ideal attributes as a (51%). 343 (17%) of total 2004 cores were P3 triage test to rule-out clinically important positive, Gleason 6 (20%), 7 (60%) and Can multi-parametric MRI prior to fi rst disease so men could defer a prostate 8–10 (20%). Mean MPC was 51% (1–100), TRUS biopsy rule out clinically important biopsy. ATLPC 51 mm (1–139) and MTL 5 mm prostate cancer? A validating cohort (1–16). PSA, PSAD and %fPSA showed study using template prostate mapping as P4 linear correlation (r = 0.44, 0.54 & −0.36 a reference test Predictive value of PSA, PSAD and %free respectively). AUC for PSA (0.81) was M Abd Alazeez, HU Ahmed, E Anastasiadis, PSA for PCa diagnosis, Gleason score (GS) superior to sPSA and %fPSA (0.76&0.29). M Arya, A Kirkham, M Emberton and Cancer Volume (CaV) in men PSAD predicted GS 7–10 (p = 0.004), MPC University College London Hospital, United undergoing Transperineal Template Guided (p = 0.001), ATLPC (p = 0.002) and MTL Kingdom Saturation Biopsy (TTSB) (p = 0.001). At cut-off of 0.10, PSAD has KC Ekwueme, H Simpson, HD Zakhour, sensitivity 96%, avoiding unnecessary Introduction: Gleason grade and maximum NJ Parr biopsy in 20%. %fPSA was unreliable cancer core length (MCCL) have been used Wirral University Teaching Hospital, United predictor of GS (p = 0.58) and CaV. to risk stratify prostate cancer. We Kingdom Conclusions: PSAD reliably predicts PCa evaluated whether multi-parametric MRI diagnosis, high grade and CaV in men (mp-MRI) could be used to rule-out Introduction and Objective: Persistent undergoing TTSB. PSAD >0.10 has high clinically important disease using different suspicion of PCa despite negative TRUSB sensitivity and value in deciding to offer target defi nitions incorporating grade and presents a dilemma. TTSB is useful, TPSB. MCCL. although expensive and associated with Patients and Methods: 138 men with signifi cant morbidity. To improve predictive P5 elevated PSA and no prior biopsy value of PSA additional serum forms and What is the optimum antibiotic policy for underwent mp-MRI (index test), modifi cations are reported, but are Transrectal Ultrasound guided Prostate (T2-weighted, Dynamic contrast enhanced unreliable in the setting of TRUSB, probably Biopsy? and Diffusion-weighted imaging), followed because the technique fails to detect a PM Thompson, H Nemade, by template prostate mapping (TPM) signifi cant proportion of tumours. We J Philpott-Howard, S Sheehan, W Wang, biopsies (reference test). Analysis was at postulated that predictive values should be S Chandersekara whole-gland level. Four target conditions superior in relationship to TTSB. KIngs College Hospital, London, United were used to represent clinically signifi cant Patients and Methods: A modifi ed TTSB Kingdom prostate cancer; was performed on 139 patients with 1– Gleason = 4 + 3 persistently elevated PSA despite median of Introduction: The infective risk of 2– Gleason = 3 + 4 2 (1–6) negative TRUSB. Prior to TTSB, Transrectal Ultrasound guided Prostate 3– MCCL = 6 mm serum PSA (sPSA), PSAD and %fPSA were Biopsy is well recognised. There remains 4– MCCL = 4 mm documented and evaluated for ability to an unacceptable complication rate of Results: 98/138 (71%) of patients had predict PCa diagnosis, GS and CaV septicaemia with no universally accepted cancer detected by TPM. (maximum % core, MPC, aggregate of antibiotic policy. This study follows the The table displays accuracy fi gures: tumour lengths from positive cores, ATLPC pathway of infection, identifying organisms and maximum tumour length, MTL). and antibiotic sensitivities. Results: Median age was 63 (48–85), PSA Materials and Methods: 67 patients were 10 ng/ml (2–114), prostate volume 44cc enrolled over 6 months. Patients had (18–90), PSAD 0.21 (0.01–2.99), %fPSA 10 pre-biopsy urinalysis and post-biopsy blood

cultures collected at 5 minutes, 1 and 24 Patients and Methods: Since 2007, we TPSB (183 patients) or MDA biopsy (249 hours. Ciprofl oxacin and metronidazole have carried out 840 transperineal sector patients) following initial negative were administered as prophylaxis. Each prostate biopsies (TPSB). 384 patients with transrectal biopsy. Follow up data was patient had 12 biopsies and needle low to intermediate risk disease considered available for between 1–5 years. washings were cultured. suitable for AS, following initial TRB Results: Patient characteristics in the TPSB Results: Analysis of the needle washing histology, underwent TPSB using our and MDA group were respectively as showed the bacteria to which the patients standardised 6–8 sector technique with a follows: Median age 62 years (range 28–78) were exposed. There were ≥1 bacteria maximum of 32 cores. and 69 years (range 42–84), Median PSA cultured in 61/67 patients (91.0%). 51/67 Results: Median age was 63 years (38–84 9 ng/ml (range 0.65–45) and 9.1 ng/ml (76.0%) had Gram-positive bacteria years). Median PSA 7.14 ug/l (0.14–58 ug/l). (range 1.1–54). Median number of biopsy including 16 Enterococcus faecalis. 23/67 135 patients had Gleason 3 + 3, 103 cores taken was 32 (range 12–128) in the (34.3%) patients had Gram-negative Gleason 3 + 4, 37 Gleason >3 + 4 disease TPT group and 16 (range 13–19) in the bacteria, of which Escherichia coli was and 109 had PIN, ASAP or benign histology, MDA group. most frequently isolated. Ciprofl oxacin after TPSB. 150 patients underwent 1 out of the 183 patient with benign resistance was 20% amongst Gram- defi nitive early treatment, 131 (34.1%) due TPSB was subsequently diagnosed with negative organisms. 11/67 (16.4%) had to an upgrade or higher volume; 19 chose prostate cancer (pT1a) compared to 23 anaerobic bacteria, all of which were defi nitive treatment rather than AS. Of the (9%) out of 249 men in MDA group sensitive to metronidazole. 6/67 (9.0%) had remaining 234, 29 were subsequently (P < 0.0001). 48% of patients with positive blood cultures, 4/67 (6.0%) having discharged on watchful waiting and 205 subsequent diagnosis of cancer in the signifi cant bacteraemias: 2 Enterococcus (53.4%) continued on AS. 63 of these had MDA group had low risk disease, 33% faecalis; 1 Bifi dobacterium spp (plus repeat TPSBs, within local protocol, at intermediate risk and 19% high risk disease. Corynebacterium spp); and1 Lactobacillus median follow up of 2 years. In 58/63 Negative predictive value for MDA biopsy spp. (92%) the grade and volume was and TPSB were 91% and over 99%, Conclusion: The alarming rate of unchanged. Overall, 5/205, (2.44%) required respectively. fl uoroquinolone resistance in both treatment for progression; 4/205 (1.95%) Conclusion: It appears TPSB, is a very Gram-negative and Gram-positive chose active intervention, despite no reliable investigation to exclude prostate organisms identifi ed is consistent with the progression. cancer. It has a NPV of over 99% and rising incidence of infective complications Conclusions: TRB may under-estimate therefore patients with benign TPSB can be reported in the literature. Based on this Gleason grade or cancer volume. TPSB prior strongly reassured with high degree of data, we propose an alternative to AS aids risk stratifi cation with a low certainty that the risk of missed prostate prophylactic regimen. Agents such as conversion to treatment rate at 2 years caner is negligible. broad-spectrum beta-lactams, (2.4%); allowing clinicians and patients to glycopeptides, aminoglycosides and accept and embark on active surveillance P8 metronidazole should be considered. In with confi dence. Primary Transperineal Sector Biopsies high risk patients, transperineal prostate (TPSB) of the prostate: evaluation in biopsies could be considered as a safer P7 clinical practice alternative. Benign secondary transperineal sector RT Chang, R Popert, L Vyas, E Morris, M Tsui, biopsy versus MD Anderson prostate H Yamamoto, S Duasko, I Meiers, A Chandra, P6 biopsies – a multicentred long term B Challcombe, D Cahill Active surveillance with confi dence: the follow-up evaluation Guy’s and St Thomas’s NHS Foundation place of Transperineal Sector Biopsies K Saeb-Parsy, R Chang, L Vyas, F Esperto, Trust, London, United Kingdom (TPSB) to improve risk stratifi cation in S Tang, J Kinsella, V Gnanapragasam, localised prostate cancer B Challacombe, A Doble, R Popert, C Kastner Introduction: Screening studies indicate L Vyas, J Kinsella, M Zhao, C Gilchrist, Addenbrooke’s Hospital, Cambridge, United that in patients undergoing primary P Acher, R Chang, H Yamamoto, A Chandra, Kingdom transrectal sextant biopsies, 25% are D Cahill, B Challacombe, R Popert positive. This increases to 44% using Guys and St Thomas’ NHS Foundation Trust, Introduction: Transperineal sector biopsy extended 12 core biopsy protocols, but may London, United Kingdom (TPSB) and MD Anderson (MDA) biopsy still under sample the anterior peripheral (transrectal sampling of peripheral and zone. Introduction: Patients with low risk transition zones) is often undertaken We have evaluated transperineal sector prostate cancer on transrectal biopsy (TRB) following initial negative standard biopsies (TPSB) as a primary modality may be suitable for active surveillance (AS). transrectal biopsy. We conducted a multi within an asymptomatic population Understaging and grading at diagnosis can centred study evaluating patient undergoing routine PSA testing. result in delayed treatment and risk poorer characteristics and long-term outcome of Patients and Methods: 185 patients were oncological outcomes. Most AS series patients whose TPSB or MDA biopsy were referred following general health screening report up to 30% progression rates. AS benign. assessment with a median age of 59 yrs patients desire reassurance regarding their Methods: The data was collected from and a median PSA of 6.10 ng/mL (0.7– individual progression risk. patients in two UK centres with benign 182 ng/mL).

A total of 24 to 38 cores were taken using of patients can harbour cancer in the Resonance Imaging (MRI) and technetium- our peripherally directed TPSB approach as anterior zone of the prostate and an 99m bone scintigraphy (BS). BS lacks a day case procedure without active surveillance strategy depends diagnostic specifi city, and the increased catheterisation. We determined the entirely on choosing the right follow up sensitivity of MRI allows for a superior detection rate, characteristics and location strategy. imaging modality in the detection of bone of cancers, clinical progress and Materials and Method: A retrospective metastases. With the use of a modifi ed MRI complications. audit of TTGP biopsies performed in two protocol imaging the pelvis and lumbar Results: 137 patients had abnormal hospitals between 2006 and 2011 was spine synchronously, we evaluate the histology and in 116 (62.7%) cancer was conducted. The parameters recorded distribution characteristics of bone found. Of these, Gleason sums of 6, 7 and included patient demographics, previous metastases, and review the need for BS as >7 were seen in 75, 36 and 5 patients biopsy results, TTGP biopsy indications and an additional staging investigation. respectively. In 48 patients (26%) the results, management decisions and Patients/Methods: A retrospective histology was benign. complications. single-centre review of 859 patients Anterior disease was found in 38 patients Results: 800 men had undergone TTGP (median age 71, range 44–98) with newly (32.8%) and in 17 (15.3%) this was biopsies during this period out of whom diagnosed prostate cancer was performed confi ned to the anterior sectors only. 223 had been on active surveillance. 70 of between January 2008 and 2011. Patients 30 patients are on active surveillance, 39 these men (31%) were found to have more with positive BS were identifi ed and have had brachytherapy. 30 patients with signifi cant disease on TTGP biopsies and imaging reviewed to determine distant intermediate to high risk disease had were offered radical treatment. Anterior metastatic spread in the absence of lumbar robotic radical prostatectomy, the disease was found in 65 men (30%) in the or pelvic disease. In instances where MRI remaining 17 have had hormones and or AS group. In the overall group three was performed, lesions were radiotherapy. patients developed haematuria (0.4%) cross-referenced. 4 patients had urinary retention and 3 had requiring overnight admission, 65 (8%) Results: 313 patients underwent BS as part haematuria requiring an overnight stay patients developed urinary retention, fi ve of their standard sequential investigation (1.6%). No urosepsis or urinary tract patients developed sepsis (0.6%) and three for metastases. Of these, 88 were positive infections requiring additional antibiotics patients (0.4%) reported erectile for metastatic spread of which 53 cases were seen. dysfunction. (60%) confi rmed widespread metastases. Of Conclusions: Primary TPSBs are safe, offer Conclusions: In this large audit TTGP the remaining thirty-fi ve patients, 11 (13%) high cancer detection rates and aid biopsies have shown the potential for being BS with equivocal areas were shown to be treatment stratifi cation. an additional tool available to the urologist false positives on further imaging. 21 (24%) looking after AS patients. This data can be cases had at least one area of increased P9 used to counsel patients and the tracer uptake within the pelvic-lumbar The role of transperineal template guided complication rate, particularly sepsis with region. 3 BS (3%) revealed isolated prostate biopsies in the active surveillance associated morbidity, remains low. abnormalities outside of the pelvic-lumbar patient region. BS John, S Javed, SRJ Bott, SEM. Langley P10 Conclusion: Although conventional MRI Royal Surrey County Hospital, Guildford, Is concurrent technetium-99m bone lacks whole-body coverage, focused United Kingdom scintigraphy redundant in the assessment imaging of the lumbar spine, pelvis and of metastatic disease in prostate cancer femoral heads can exclude clinically Introduction: Transperineal template patients undergoing magnetic resonance signifi cant metastatic disease. This guided prostate (TTGP) biopsies have gained imaging of the prostate? potentially lends further credence to the prominence recently because of the search P Hughes, R Nair, AK Gupta, T Larner adoption of MRI as the sole imaging for better methods of sampling the Brighton and Sussex University Hospitals, modality for local staging. prostate. This is of particular importance for United Kingdom the patient with prostate cancer who has been placed on active surveillance (AS). It is Introduction: Current staging protocols also well known that a signifi cant number for prostate cancer involve Magnetic

Tuesday 26 June 2012 BJUI Poster Session 2 SUPPLEMENTS 11:00–12:30 Carron UPPER TRACT DISORDERS AND IMAGING Chairmen: Mr Toby Page & Mr Chandra Shekhar Biyani Posters P11–P20

P11 (58%); mid 5/38 (13%); proximal 10/38 conversion and failure, hence we have Outcomes of the rendezvous procedure (26%); proximal and distal 1/38 (3%). previously offered patients endopyelotomy. for the management of complex ureteric Successful placement of double-J stent was We have recently changed our practice. strictures achieved in 36/38 (95%) of procedures. Patients and Methods: We analysed our ER Ray, D Allen, J Bycroft, C Allen, RD Smith, At a mean follow-up of 40 months (range PUJ obstruction database (282 patients over S Choong, M Kellett, T Philp 2–96), of patients: 17/37 (46%) are 17 years) to identify those treated after University College Hospital, London, United stent-free, unobstructed, with preserved failed primary procedures. Data was Kingdom renal function, having required no further collected prospectively. 51 patients (28F, intervention; 7/37 (19%) have thermo- 23M; median age = 31) were identiﬁ ed. Introduction: Impassable ureteric strictures expandable metallic stents, with preserved Median follow up was 27 months (range: 3 require a combined endourological and renal function; 3/37 (8%) have long-term months–15 years). radiological approach known as the double-J stents; 5/37 (13%) died of Results: 36/51 primary operations were rendezvous procedure. This avoids early malignancy with a functioning stent; 4/37 pyeloplasties (2 trans-, 10 retro-peritoneal open reconstruction and is valuable in (11%) have been reconstructed; 1/37 (3%) laparoscopic; 24 open). Median time to high-risk and palliative patients. We had a nephrectomy for non-function. failure was 9 months (range: 3 months to present the outcomes from our series Conclusion: ’Impassable’ complex ureteric 12 years). The most common presenting updated from 2002. strictures are passable. Internal drainage symptom was ongoing loin pain. Patients and Methods: All rendezvous was achieved in 95% of cases using the 33/51 secondary operations were procedures carried out in a tertiary centre rendezvous procedure. Nearly half of these endopyelotomies, 18 were pyeloplasties (4 (1998–2011) were reviewed. All patients patients required no subsequent open, 14 transperitoneal laparoscopic). had failed attempts at retrograde or intervention after stent removal. 10/33 endopyelotomies as a secondary antegrade stenting, or both. Using procedure subsequently failed, while only antegrade access to the ureter, and P12 1/18 pyeloplasties failed. Time to secondary simultaneous retrograde ureteroscopy, the A comparison of transperitoneal failure ranged from 2 to 70 months. 10 stricture was balloon dilated to 9Fr and a laparoscopic pyeloplasty versus patients subsequently underwent a 3rd double-J stent placed. endopyelotomy after failed treatment for operation; one was managed conservatively. Follow up comprised regular clinical review, PUJ Obstruction 6 patients underwent endopyelotomy, 3 diuretic renography, serum creatinine, M Vannahme, K Davenport, S Mather, transperitoneal laparoscopic pyeloplasty, estimated GFR, and retrograde ureteroscopy. J Philip, AG Timoney, FX Keeley and 1 a nephrectomy. No further treatment Results: 38 procedures were carried out on Southmead Hospital, North Bristol Trust, was necessary in these patients. 37 patients (one bilateral). 21/37 (57%) United Kingdom No conversions were necessary for patients were male and the mean age secondary laparoscopic pyeloplasty. There was 58. Introduction: Our outcomes for primary were no major complications. Aetiology was complication of: stones transperitoneal laparoscopic pyeloplasty Conclusions: Conversion and complication 13/38 (34%); open surgery 17/38 (45%); (97%) are superior to primary rates from secondary transperitoneal neoplasia +/− radiotherapy in 8/38 (21%). endopyelotomy (70%). Re-do pyeloplasty, laparoscopic pyeloplasty in experienced Ureteric stricture site was: distal 22/38 however, was felt to carry a high risk of hands are low and success rates (94%) are

considerably higher than for endopyelotomy medication confi rm its effi cacy and correlation between presence of stent and (70%). Laparoscopic pyeloplasty is now provides useful information when intra-operative renal pelvic pressure. considered a viable option for PUJ counselling patients preoperatively. obstruction after failed previous treatment, P15 even open pyeloplasty. P14 Flexible ureteroscopy and laser under Correlation between pre-operative ureteral local anaesthesia with intra-ureteric P13 stents, intra-operative renal pelvic bupivicaine The role of Laparoscopic Nephrectomy in pressures, and post-operative pain and M Mikhail, N Wilson, A Young the management of benign symptomatic sepsis in patients undergoing fl exible Southend University Hospital, United poorly functioning renal disease ureteroscopy and laser lithotripsy Kingdom AM Mainwaring, NS Awsare, NJ Fenn SM Malde, M Bolgeri, N Shrotri, R Krishnan Morriston Hospital, Swansea, United Kent and Canterbury Hospital, United Introduction: Flexible ureterorenoscopy Kingdom Kingdom and laser (FURS) is usually performed under general or spinal anaesthesia. In some Introduction: Laparoscopic Nephrectomy Introduction: Ureteric stenting has been patients in whom these forms of (LN) is now widely used to treat RCC. Its advocated prior to ureteroscopy in order to anaesthesia are contraindicated or high use in benign poorly functioning renal facilitate stone-free rates and reduce risk, the procedure can be performed under disease is reported but little data exists complications. However, its effect on local anaesthesia with intravenous sedation on symptom control in this group of post-operative pain is unknown. Increased and analgesia. We report the fi rst series of patients. renal-pelvic pressure is considered to be a patients given intra-ureteric bupivicaine as Patients/Methods: Between 2005 and signifi cant cause of post-operative pain in the primary form of anaesthesia. 2011, 49 patients underwent LN for benign patients undergoing fl exible ureteroscopy Patients and Methods: A retrospective disease. The renal unit was the presumed and laser lithotripsy. However, clinical data analysis was made of all patients who cause of chronic renal pain (n = 20), on the topic are few. underwent FURS for calculi or carcinoma recurrent urinary tract infection (n = 11), Purpose: This study aims to analyse the under local anaesthetic, with the use of both pain/infection (n = 5) or diffi cult to correlation between presence of pre- intra-ureteric bupivicaine (0.5%, 20 ml). control hypertension requiring medication operative ureteral stents, renal pelvic Bupivicaine was infused via a ureteric (n = 13). A retrospective review of hospital/ pressures, post-operative pain-scores and catheter prior to introducing the general practice records, theatre/pathology rates of sepsis in patients undergoing ureteroscope and commencing laser databases and patient review was fl exible ureteroscopy for renal calculi. ablation. performed. Data collected included Methods: We prospectively collected data Results: Ten patients had a total of 28 operative details, complication rates on 42 patients undergoing fl exible procedures under local anaesthesia. recorded using the Clavien Classifi cation ureteroscopy and Holmium : YAG laser Forty-three per cent of these did not and symptom control. lithotripsy for renal stones. Intra-renal require any sedation or intravenous Results: All procedures were completed pressure was measured with transducers at analgesia as an adjunct to the bupivicaine. laparoscopically with a mean operative the beginning and end of the procedure. No procedures were abandoned due to pain time 170 min. There were no open Post-operative pain was assessed using a and there were no conversions to general conversions. There was no change in post visual-analogue scale (0–10). Correlation anaesthesia and no complications operative creatinine levels. Complications coeffi cients were calculated between the secondary to local anaesthetic. occurred in 10 (20%) patients with Clavien presence of pre-operative ureteric stent, Conclusion: FURS can be safely performed Classifi cation was; Grade 1 : 4 patients; intra-renal pressure, energy used and under local anaesthesia with intra-ureteric Grade 2 : 4 patients, Grade 3b:1 patient, post-operative pain. bupivicaine. It is well tolerated and avoids Grade 4 : 1 patient. Symptoms responded Results: 28 patients had a pre-operative the risks associated with general and spinal well to surgery. 22 (88%) reported stent with a mean initial pelvic pressure of anaesthetic. We advocate the use of this improvement of loin pain and 14 (87.5%) 16.4cm H2O (4–44). Fourteen patients did technique in a carefully selected cohort of patients with resolution of their recurrent not have a ureteric stent pre-operatively, patients but larger prospective studies are UTIs. In the hypertension group there was although the mean initial pelvic pressure needed to investigate pain levels, success no immediate reduction in post-operative was similar at 17.3cm H2O (4–40). There rates and specifi c criteria for the use of blood pressure however on follow up 2 was no correlation between the presence of local anaesthetic. (15%) were able to stop all a pre-operative ureteric stent (r = −0.08), antihypertensive medication, 6 (46%) were intra-operative initial (r = −0.03) or fi nal able to reduce their medication with no pelvic pressure (r = 0.004) and post- change in 5 (39%) patients. operative pain score or incidence of Conclusions: These data confi rm the post-operative sepsis. operative safety of LN in patients with Conclusion: Routine placement of ureteric symptomatic benign renal disease. The stents prior to ureteroscopy does not affect excellent success rate in symptom control post-operative pain or sepsis rates. The and reduction in antihypertensive explanation may be the absence of

P16 P17 principle is imperative. Here we review Leak test decreases damage to fl exible Is a KUB x-ray necessary as part of radiation dosage for new urolithiasis ureteroscopes Haematuria evaluation? patients, referred electively, for a one year F Khan, F Anjum, H Marsh, S Madaan, M Moazzam, I Abraham, A Rajesh, MA Khan period following their diagnosis. IK Dickinson, S Sriprasad Leicester General Hospital, United Kingdom Methods: A retrospective study of Darent Valley Hospital, Dartford, United treatment-naive patients referred electively Kingdom Purpose: A KUB x-ray along with an to the stone clinic over a fi ve month period ultrasound (USS) is routinely performed as from Jan 2010 was undertaken. The analysis Introduction and Objectives: part of the work-up in the one-stop included all imaging modalities related to Advancements have lead to fi ne calibre Haematuria clinic. However; it has recently stone disease performed within 1 year of fl exible ureterorenoscopes (FURS) with been suggested that a KUB x-ray is not the initial presentation. A standard dexterity at the expense of fragility, leading needed as an USS is adequate. We, radiation dose used for X rays, in addition to damage by surgical handling and high therefore, determined the value of KUB to individual doses of other investigations repair costs. Damage is due to fl uid entry x-ray in our Haematuria clinic. and treatments per patient was calculated into the FURS. Some FURS have an inbuilt Materials and Methods: We retrospectively to establish the total dose of radiation mechanism for testing leaks. The purpose of reviewed the records of 533 consecutive administered. this study was to examine the outcome of patients who attended the Haematuria Results: A total of 45 patients were the pressure leak test on the condition of clinic between September 2005 and March identifi ed. They underwent an average of FURS after every use and analysing the 2006. All patients underwent a KUB x-ray, 5.6 radiologic investigations during the damage and costs of maintenance. USS and fl exible cystoscopy. IVP, CT or MRI year. Studies performed included a mean of Methods: Consecutive 95 (n = 95) scan was subsequently performed where 2.9 X-ray KUBs (range 0 to 9), 1.2 CT KUBs procedures of FURS and laser fragmentation indicated. (range 0 to 3), 0.9 ESWL (range 0 to 7), and performed with ACMI DUR 8 (Group 1) Results: A total of 371 (70%) male and 0.5 screening episodes (range 0 to 3). The were compared with prospective 98 162 (30%) female patients with a mean median total effective radiation dose was procedures (n = 98) performed using Storz age of 53 years (range: 20–86 years) were 12 mSV, with maximum dose recorded was Flex X2 Ureteroscopes (Group 2). The Flex included. Out of 533 patients 37 (7%) had 34.4 mSV. None of the patients exceeded X2 ureteroscope has an in-built leak test an abnormal KUB x-ray. USS confi rmed the annual maximal dose recommended by facility but the Gyrus ACMI does not. All urolithiasis in only 10 (27%) of these 37 ICRP of 50 mSV. scopes in Group 2 were tested for pressure patients. However; subsequent IVU or CT Conclusion: Management of patients with leak after every procedure. The outcome of demonstrated urolithiasis in 9 patients renal stones can be effectively achieved the tests were recorded. (24%) with normal USS. Furthermore, 10 with acceptable radiation dose exposure. It Results: The groups 1 and 2 were patients (27%) with abnormal KUB x-ray is important to adhere to the ALARA comparable for grade of surgeon; stone and a normal USS did not reveal any principle to minimise risk to the patient. location, size & number; access sheath abnormalities on either an IVU or CT. In usage; size of laser fi bre and duration of addition, 8 patients (22%) with abnormal P19 laser. In Group 1 there were 7 scope KUB x-ray and a normal USS did not have The patient care benefi t of CT KUB damages resulting in repairs/replacement any follow-up radiological studies and over IVU as primary imaging for acute amounting to costs £29575 (7.1% damage). all had radio-opacities less than 4 mm in renal colic In Group 2, three scopes revealed a positive, size. An USS alone would have missed A Abroaf, A Rogers, W Robson, S McClinton, pressure leak tests implying damage with 9 out of 19 (47%) confi rmed cases of D Thomas, R Pickard repair costs of £6362 (3.1% damage) (p < urolithiasis. Freeman Hospital, Newcastle Upon Tyne, 0.05). Signifi cant cost savings and Conclusion: Our study indicates that a KUB United Kingdom reduction in downtime were made in x-ray should be included as part of Group 2. haematuria evaluation in order to avoid Introduction: Non-contrast CT (CT KUB) Conclusions: Pressure leak testing missing urolithiasis. has superior diagnostic accuracy for renal following FURS helped to signifi cantly colic but its availability remains restricted control costs of maintenance and repair. P18 in some areas of the UK. The aim of this Newer scopes should have a leak testing Radiation dosage in management of study was to determine whether use of CT mechanism. patients with urolithiasis KUB improved patient care. I Omar, M Wynn, W Finch, L Lee, Material & Methods: We prospectively R Balakomar, O Wiseman identifi ed patients suffering acute renal Cambridge University Hospital, colic for the SUSPEND trial from January to Addenbrooke’s Hospital, United Kingdom April 2011. The study population comprised 50 patients who had undergone CT KUB as Introduction/Purpose: There is increased primary diagnostic imaging; principally at concern about the amount of radiation the referral unit, and 50 who had patients with urolithiasis receive during undergone IVU; principally at neighboring their management. Adherence to the ALARA units without a urology emergency service.

Data on length of stay, time to diagnosis P20 74 patients. Case notes were reviewed and time to stone free were abstracted Ultrasound in Pyelonephritis – is there a to determine patient demographics, from clinical records. All radiology was role? a single centre experience duration of admission and radiological reviewed. M Heetun, J Nariculum, P Le-Roux fi ndings. Results: The cohorts were well-matched Epsom and St Helier Hospital, United Result: 70 patients were female (94%) and for gender and age. Length of stay [Median Kingdom 4 male (6%). Median age was 34 years (IQ range)] was 33 (10–57) hours in the CT (range 16–91). Average admission duration KUB cohort and 41 (26–65) hours in the Introduction: Pyelonephritis, defi ned as a was 3 days. 63 (85%) patients had normal IVU cohort (p = 0.23). Four patients in the bacterial or fungal infection of the renal ultrasound imaging and 11 (15%) patients CT KUB cohort required further imaging parenchyma and collecting system, forms a had abnormal fi ndings. In this latter group, compared to 42 (including 10 CT KUB) signifi cant component of the emergency 8 patients demonstrated kidneys with in the IVU cohort, with a median (IQ urological caseload. On admission, most increased echogenicity, 4 with thickened range) time to defi nitive diagnosis of patients will undergo ultrasound imaging to urolthelium and 1 with pyelonephrosis. Of 2.5 (1.75–3.8) hours and 13.5 (9.2–27) exclude complications or precipitating these 11 patients, 5 patients were diabetic hours respectively (p < 0.0001). Time to factors. Presently, there is a paucity of and 4 had a previous history of stone free was similar for both groups advice regarding whether ultrasound pyelonephritis. (p = 0.97). imaging is indicated and if so, which Conclusion: Ultrasound is not indicated in Conclusion: Although fi ndings from this patients should be imaged. This study the majority of patients admitted with prospective cohort study should be reviewed the cases of patients admitted pyelonephritis. Imaging should be reserved cautiously interpreted, they suggest with pyelonephritis over a 2 year period. for patients with precipitating factors such that use of IVU results in a delay to Methods: Selection criteria (raised white as diabetes, immunosuppression or a defi nitive diagnosis, leading to a longer cell count/C-reactive protein and a positive previous history of pyelonephritis. Such hospital stay. The routine use of CT KUB is urine culture) was applied to a prospective practice can help reduce in-patient stay, therefore supported from a patient care database of 300 patients admitted with a avoid unnecessary imaging and reduce perspective. diagnosis of pyelonephritis. This identifi ed costs.

Tuesday 26 June 2012 BJUI Poster Session 3 SUPPLEMENTS 14:00–16:00 Alsh SCIENTIFIC DISCOVERY Chairpersons: Mr Rakesh Heer & Mrs Caroline Moore Posters P21–P34

P21 acid) to 45% buffer B (90% acetonitrile, plasma membrane-associated protein, Pathways analysis in kidney cancer using 0.08% formic acid) was run over 87 min Adipocyte enhancer-binding protein 1, proteomics approach to separate peptides. Progenesis LC-MS fatty acid binding protein 5, Mr Zakikhani, Mr Atrih, Dr Lamont, v4.0 was used to identify differences lysophosphatidylcholine acyltransferase , Mr Goodman, Prof Fleming, Mr Nabi between normal and tumor samples. The Monoacylglycerol lipase isoform 2), Ninewells Hospital, University of Dundee, software relies on good retention time protein modifi cation and degradation United Kingdom reproducibility between runs and can (Proteasome subunit beta type-8, confi dently detect and quantify the same SUMO-activating enzyme subunit 1, Background: Renal cell carcinoma (RCC) is feature across all samples. The proteins Ubiquitin-like modifi er-activating enzyme responsible for approximately 4,000 deaths identifi cation was carried out using: 6, Protein disulfi de-isomerase A5) and per year in the UK. We describe a Uniprot_Swall; FDR less than 1%; Peptide stress response (Peroxiredoxin-4, Superoxide comprehensive proteomic analysis and Mass Tolerance: ± 5 ppm and Fragment dismutase, Cytochrome b-245 heavy subsequently a pathway and network Mass Tolerance: ± 0.6 Da Max Missed chain). approach to identify biological processes Cleavages: 2. Conclusion: A comprehensive pathway and involved in clear cell RCC (ccRCC). The Results: Twenty samples (normal and network analysis using proteomics analysis objective being to investigate novel cancer) were analysed from 10 patients. A has discovered highly signifi cant pathways biomarkers of RCC which could be used for total of 1,900 proteins were identifi ed from from a set of clear cell RCC samples. This early diagnosis and predict response to all 48 LC-MS runs (minimum 2 unique key information of pathways activation will treatment. peptide/protein). 477 proteins showed lead to development of novel assays for Methods: Kidney tumour tissues paired between 2 and 20 fold difference in normal early diagnosis and prognosis of renal with normal renal tissue were obtained at and cancer samples (minimum 2 unique cancer. the time of radical nephrectomy or nephron peptide/protein-Figure 1). 152 proteins sparing surgery. Samples were stored at were up-regulated in cancer patients and −80 and processed using validated FASP 324 proteins were down-regulated in method for proteomic analysis. Each sample cancer patients. When evaluated by several was analysed in triplicate. The LC/MS pathway and biological process analysis analysis was carried on Dionex ultimate programs, these proteins are demonstrated 3000 (trap column: acclaim Pep-Map to be involved with a high degree of nano-trap (75 μm id × 2 cm, separation confi dence (p values < 2.0 E-05) in column: acclain Pep-Map RSLC 100 μm, glycolysis (Phosphoglycerate kinase, 15 cm) coupled to LTQ Orbitrap Velos. The Glycogen debranching enzyme, LTQ Orbitrap Velos was operated in CID top Glyceraldehyde-3-phosphate 10 mode at a resolution of 60,000. A dehydrogenase, Pyruvate kinase gradient of 98% buffer A (0.1% formic isozymes. . . .), lipid metabolism (Adipocyte

Figure 1 for P21: PCA analysis demonstrates clear differences between normal and cancer this study was to identify hypoxia regulated samples miRNAs (HRmiRNAs) and assess their functional importance. Principal Components Analysis Methods: We cultured 6 cell lines in 0.5 normoxia and 0.1% hypoxia. miRNA expression was quantifi ed using Real time 0.4 4061T QPCR. HIF regulation was assessed and 0.3 putative hypoxia response elements were confi rmed using chromatin 0.2 4061N 3982N immunoprecipitation. Functional work was analysed using western blot and fl ow 0.1 4614T 4082N 4017T cytometry. 0.0 4082T Results: We identifi ed 6 miRNAs 3982T 4499T 68143 4082T 3991N consistently upregulated in hypoxia across Principal Components 2 −0.1 4020N 4614N cell lines and a number of cell line specifi c 4020T 4499N −0.2 4017N HRmiRNAS. miR-145 was upregulated 45-fold by hypoxia in RT4 cells. miR-145 is −0.3 a target of p53 and is known to induce − − − 0.3 0.2 0.1 0.0 0.1 0.2 0.3 caspase dependent and independent Principal Components 1 apoptosis in other tumour types. We found miR-145 was regulated by hypoxia in a HIF1 dependent manner and confi rmed the P22 in these pathways. All mice were genotyped presence of 2 hypoxia response elements. Development and Characterisation of a via PCR. Overexpression of miR-145 induced Bladder Cancer Model Results: At day 100 post induction of the apoptosis and treatment of cells with R Williams, B Shorning, S Datta, Cre-Lox system 100% of mice which were antimiR-145 inhibited apoptosis in RT4 HG Kynaston, AR Clarke homozygous for LKB1 and PTEN fl oxed cells. Cardiff University Health Board, United genes developed urothelial cell carcinoma. Conclusion: We have identifi ed a number Kingdom Mice homozygous for either gene in of hypoxia regulated miRNAs in bladder isolation did not develop bladder cancer. cancer. The upregulation of miR-145 in Introduction: Mouse models of cancer can Integrin linked kinase (ILK) was hypoxia leads to apoptosis and may improve understanding of the biology of up-regulated in the bladder and ILK regulate cell/tumour growth via a HIF/p53 cancer and development of novel inhibitors may have some potential in dependent pathway. miR-145 may have a therapeutic agents. The aim of this project bladder cancer treatment. potential role in the management of was develop and characterize a bladder The carcinomas showed massive mTOR/PI3K bladder cancer. cancer model which is relevant to human up-regulation. This up-regulation was bladder cancer. In human bladder cancer completely reversed by rapamycin (an mTOR P24 the PTEN gene is frequently altered in inhibitor) and the phenotype reverted to Evaluation of molecular markers for combination with genes downstream of that of a normal mouse bladder. predicting risk of progression in high LKB1 in the AMPK pathway. grade non-muscle invasive bladder cancer We report on our further investigation and P23 (HGNMIBC) using automated quantitative development of this mouse model. Our goal Hypoxia regulated miRNAs in bladder analysis is to produce an effective model of invasive cancer GD Stewart, A Pipili, FC O’Mahony, A Laird, bladder cancer, which can be used to C Blick, A Ramachandran, D Cranston, RM Gailer, L McLornan, KM Grigor, G Smith, identify and evaluate future molecular J Catto, AL Harris DJ Harrison, P Mariappan therapies. The Weatherall Institute of Molecular Western General Hospital, Edinburgh, United Materials: Mice with an outbred genetic Medicine, John Radcliffe Hospital, University Kingdom background were generated to have of Oxford, United Kingdom copies of the LKB1 and PTEN genes fl anked Introduction: There is a need for with a LoxP site. Using the AhCreER Introduction: Hypoxia is a state of low biomarkers to help identify aggressive recombinase promoter transgene both oxygen and a feature of most tumours. The HGNMIBC. In this study, we evaluated LKB1 and PTEN were deleted from the mechanisms which allow cancer cells to several putative prognostic protein markers urothelium. survive and continue to grow in hypoxia are using in situ automated quantitative Methods: The wnt, AMPK, mTOR and PI3K co-ordinated by the transcription factor analysis immunofl uorescence (AQUA). molecular pathways were assessed using HIF. One class of genes regulated by HIF are Materials & Methods: From a q-PCR. Immunohistochemistry/ micro RNAs. MicroRNAs are short stranded prospectively recorded dataset of 784 immunofourescence and western blotting RNA that primarily inhibit protein bladder cancer patients presenting were used to confi rm up/down-regulation expression from target mRNA. The aim of 1991–1996 with clinical outcomes, 132

HGNMIBCs were identifi ed. Recurrent action (MOA) of TAMS has not been 1 μM A317491 (ATP receptor antagonist) disease or progression was managed with studied. and 100 μM indomethacin (COX-inhibitor) BCG, radical radiotherapy or cystectomy. Materials/Methods: TAMS was used to on SCs was assessed at low (150 mls) and Patients were stratifi ed by clinical end- activate the pudendal-to-bladder inhibitory high (450 mls) bladder volumes. Statistical points: (A) stable disease, (B) progression to refl ex non-invasively in 12 normal female analysis using repeated-measure ANOVA muscle invasive disease but successful cats under α-chloralose anesthesia. The and Dunett’s post-hoc test. curative therapy, and (C) bladder cancer bladder was infused with saline, and 5 Hz Results: There was no signifi cant metastasis/death. A tissue microarray (TMA) transcutaneous stimulation at different correlation between bladder volume and of HGNMIBC was created from archival intensities was applied. The effect of basal intravesical pressure or SC frequency. tissue. Using AQUA, cytoplasmic/nuclear different stimulation pulses was tested Amplitude of SCs increased with rising expression and differential expression during fi lling cystometrograms, and anal bladder volume and reduced signifi cantly across clinical outcomes of the following sphincter EMG and tibial nerve activity was when bladders were emptied and refi lled proteins, previously investigated in bladder recorded at increasing stimulation with 150 mls of fresh Krebs. SC amplitude cancer, were determined: p53, p21, intensities. remained elevated when bladders were E-cadherin, N-cadherin, B-catenin, Results: TAMS inhibited isovolumetric fi lled and drained down to 150 mls. Aurora-A, VEGFR-1, HIF-1α and caspase-3. bladder contractions when stimulation Intravesical A317491 or indomethacin had Results: Adequate archival pathology intensity was above 2 times the threshold no effect on SCs. material was available from 100 HGNMIBC (T) for inducing anal sphincter twitching. Conclusions: Perfused isolated pig bladders patients to create the TMA (G3pTa = 15 The stimulation also signifi cantly increased can be used to study SCs. Amplitude of SCs patients, G3pTa = 57 patients and G3pTx = bladder capacity during CMG when the may be a means of communicating the 28 patients). Signifi cant increase in stimulation intensity was above 2T. state of bladder fullness to the CNS. expression was found between clinical Conclusions: This study demonstrates that Urothelium-derived factors could be outcome groups B and C for the following TAMS can inhibit bladder contractions and involved in driving SCs, but the lack of an proteins: cleaved caspase-3 (nuclear P = increase bladder capacity by selectively intravesical drug effect points to the 0.012 [Mann-Whitney test]; cytoplasmic modulating pudendal nerve through skin importance of adluminal mediator release. P = 0.016), cytoplasmic p53 (P = 0.036) surface electrodes in a feline model without and cytoplasmic HIF-1 α (P = 0.042). activation of the tibial nerve. The results P27 Conclusions: This is the fi rst study using indicate the potential utility of this The effect of botulinum toxin type A on next generation AQUA immunofl urescence transdermal neuromodulation method in synatosomal-associated protein 25 and in bladder cancer. Expression levels of the clinical treatment of overactive bladder neuropeptide Y immunoreactivity cleaved caspase-3, p53 and HIF-1 α symptoms. SN Datta, A Pullen, R Popat, TP Rosenbaum, differentiated HGNMIBC patients who S Elneil, P Dasgupta, CJ Fowler, A Apostolidis developed curable muscle invasive disease P26 National Hospital for Neurology and from those developing incurable disease. Use of the isolated perfused whole pig Neurosurgery, London, United Kingdom Further validation of these and other bladder for investigating spontaneous proteins, in a prospective series, may aid contractions Materials and Methods: Bladder biopsies identifi cation of patients with aggressive BA Parsons, B Vahabi, MJ Drake from 32 patients with DO were obtained HGNMIBC who would potentially benefi t Bristol Urological Institute, United Kingdom before and at 4 and 16 weeks after from early cystectomy to improve their treatment with intradetrusor BoNT/A via outcome. Introduction: Afferent discharge is the fl exible cystoscopy. Patients with NDO were main factor causing the switch from urine injected with 300 units of Allergan BoNT/A, P25 storage to voiding. Urothelium may whereas patients with IDO with 200 units. Selective activation of feline pudendal modulate afferent nerves by releasing Control biopsies were taken from 9 patients nerve with a Transdermal Amplitude- signaling molecules that act in autocrine/ during investigation for asymptomatic Modulated Signal (TAMS) using skin paracrine fashion. Indeed, raised ATP and microscopic haematuria. surface electrodes to inhibit bladder prostaglandin levels have been detected in Immunohistochemical expression was activity urine from overactive bladder sufferers. studied using commercial antibodies to C Tai, B Shen, J Wang, H Liu, J Subbaroyan, Afferent discharge has been linked to SNAP-25 and NPY, and quantifi ed by image J Roppolo, W de Groat spontaneous contractions (SC) exhibited analysis. University of Pittsburgh, Department of during bladder fi lling, so aim was to study Results: SNAP-25 immunoreactivity was Urology, United States effects of intravesical volume and drugs on noted in the suburothelium and the SCs of an isolated large animal bladder. adjacent detrusor muscle layer, with no Introduction: Previous preclinical studies Materials and Methods: Isolated pig differences found between controls and DO have shown that bladder activity can be bladder viability was maintained by patients. Suburothelial immunoreactivity inhibited using a transdermal amplitude pump-perfusion. Bladders were fi lled with was increased compared to the muscle and modulated signal (TAMS) applied to skin Krebs buffer and intravesical pressure, SC remained unchanged following successful surface electrodes by modulating pudendal frequency and amplitude were measured at treatment with BoNT/A. NPY nerve activity. However, the mechanism of different volumes. Effect of intravesical immunoreactivity was observed in

suburothelial fi bre-like structures and was a signifi cant association between ERG to differentiate those men undergoing RALP increased in DO patients compared to immunopositivty with higher Gleason score who demonstrated early biochemical controls. Post-BoNT/A decreases in NPY (P = 0.04), and also advanced tumour stage relapse from those that did not. immunoreactivity were progressive but did (P = 0.03). 7/10 samples positive for ERG Furthermore correlation with an not reach statistical signifi cance. immmunocytocheistry had positive independent clinical data set provided Conclusions: SNAP-25, the substrate for TMPRSS2:ERG status confi rmed using FISH evidence that high levels of CDC2, MELK, BoNT/A action, is no differently expressed or transcript urinary assays. Corresponding AURKA and RAD17 at RALP predicted those in overactive bladders when compared to biopsy tissue analysis confi rmed the men with poor survival outcomes (p < controls, but is more densely found in the presence of TMPRSS2:ERG positive cells in 0.001). With the ready availability of suburothelium compared to the adjacent all cases which were positive using the affordable transcript testing this data could detrusor muscle layer. By contrast, the above urinary assays. be used to identify specifi cally those men sympathetic marker NPY is increased in the Conclusion: Urinary ERG who should be targeted for adjuvant suburothelium of DO bladders. Treatment immunocytochemistry can identify prostate treatment. The era of personalised medicine with BoNT/A does not affect SNAP25 cancer patients prior to biopsy and appears is close immunohistochemical expression, as to identify patients with more aggressive expected, but tends to reduce the levels of disease. Protein based gene fusion detection P30 NPY towards normalisation. may identify more cancer patients than Tyrosinase single nucleotide currently described transcript based urinary polymorphisms affect susceptibility to and P28 assays. outcome to prostate cancer Urinary ERG immunocytochemistry can DK-C Mak, C Luscombe, N Rukin, identify prostate cancer patients prior to P29 S Ramachandran, RC Strange prostate biopsy Towards derivation of a distinct signature University Hospital of North Staffordshire, P Pal, EJ Hollox, R Hew, L Cresswell, permitting personalised treatment in Stoke on Trent, United Kingdom JH Pringle, JG Barwell, JK Mellon, RC prostate cancer Kockelbergh AD Lamb, NL Sharma, R Russell, Introduction: UV radiation in natural Leicester General Hospital, United Kingdom A Ramos-Montoya, H Whittaker, sunlight is an essential factor in vitamin D H Ross-Adams, G Shaw, K Wadhwa, S Hori, metabolism. Increased sun exposure and Introduction and Objectives: Urinary A Warren, DE Neal vitamin D levels have been reported to TMPRSS2:ERG transcript detection has been Cambridge Research Institute/Addenbrooke’s reduce the prostate cancer risk and used to identify prostate cancer patients. Hospital, Cambridge, United Kingdom infl uence outcomes. The effect of UV Immunochemical detection of fusion exposure may be infl uenced by skin positive cells has recently been made A signifi cant proportion of men with pigmentation. Polymorphisms in genes feasible following the availability of highly prostate cancer (CaP) have clinically involved in this process have been shown to specifi c ERG antibodies. We evaluated ERG insignifi cant disease and many of those be associated with prostate cancer risk. immunocytochemistry on exfoliated urinary who go on to have radical treatment could Tyrosinase is an enzyme involved in melanin cells as a diagnostic tool for prostate well have been managed in an expectant production. Animal model studies suggest a cancer. manner. In addition, a proportion of those protective effect of tyrosinase inhibition in Materials and Methods: Patients with an men with seemingly low or intermediate prostate cancer. To evaluate the relevance elevated age-specifi c PSA and/or abnormal risk CaP progress rapidly and defy the of tyrosinase in prostate cancer DRE were selected for prostate biopsy. statistics that suggest CaP to be an susceptibility, we investigated tyrosinase 30 mls of post-DRE urine was collected indolent disease. It would be useful to be gene (TYR) single nucleotide polymorphisms prior to prostate biopsy. Exfoliated urine able to target these men at an earlier stage (SNPs) prostate cancer risk and outcomes. cells were isolated, then underwent for adjuvant therapy. We obtained prostate Patients and Methods: Prostate cancer immunocytochemical assessment using an tissue from 13 men undergoing HoLEP as cases and controls with BPH were recruited anti-ERG antibody and evaluation of benign controls; 88 men undergoing RALP to investigate the association of prostate TMPRSS2:ERG status using transcript and as a primary CaP group with matched cancer risk with TYR polymorphism. FISH based urinary assays. Corresponding benign controls; and 12 men with CRPC Nineteen SNPs in TYR were selected. We biopsy tissue samples were studied using undergoing channel chTURP. We extracted investigated the association of these SNPs FISH and immuohistochemistry to RNA and profi led each sample on the with grade of cancer at diagnosis and determine TMPRSS2:ERG status and ERG Illumina expression array platform. This survival after starting androgen ablation immunoreactivity. data underwent rigorous bioinformatic therapy. Results: 102 samples were processed for quality control and was then interrogated Results: The cohort consisted of 553 immunocytochemical analysis of which 94 to produce a list of biologically relevant cancer cases and 370 BPH controls. Logistic were scorable. 10/46 (20%) patients with factors that differentiate aggressive disease regression models demonstrated signifi cant adenocarcinoma had positive ERG urine from primary CaP and benign tissue. These associations between SNPs at TYR exon 2 immunocytochemistry. The remaining included CDC20, AURKA, AURKB, PLK1, (p = 0.043, OR = 1.55) and rs118206 (p = patients with HGPIN, ASAP and benign E2F2, MELK, RAD17, Cyclin E, AMACR, 0.05, OR = 1.86) with prostate cancer risk. histology were negative (P = 0.003). There GDF15 and MSMB. These genes were able Using Cox regression analysis, SNPs at

rs501301 were signifi cantly associated with P32 P33 disease specifi c survival (p = 0.037, HR Circulating miR-141 as a diagnostic Upregulated FGFR1 expression is 0.570). biomarker for prostate cancer and for associated with the transition of Conclusions: We highlight the effects of monitoring response to treatment hormone-naive to castrate-resistant tyrosinase SNPs on prostate cancer BD Kelly, N Miller, KJ Sweeney, GC Durkan, prostate cancer susceptibility and outcomes. This study E Rogers, K Walsh, MJ Kerin I Ahmad, K Armstrong, J Edwards, supports the involvement of tyrosinase the National University of Ireland, Galway CN Robson, HY Leung interaction between sunlight exposure and The Beatson Institute for Cancer Research, prostate cancer risk, and the potential use Introduction: Mi(cro)RNAs are small Glasgow, United Kingdom of genetic markers in determining prostate non-coding RNAs whose differential cancer risk. expression in tissue has been implicated in Introduction: Prostate cancer (PC) the development and progression of represents a global health issue. Treatment P31 prostate cancer. The discovery of miRNAs in for locally advanced and metastatic PC SPRY2 loss enhances ErbB traffi cking and the blood of patients with a variety of remains unsatisfactory. The androgen PI3K/AKT signalling to drive human and malignancies makes them an ideal receptor (AR) has been validated in having mouse prostate carcinogenesis biomarker for prostate cancer diagnosis. a key role in both naïve and castrate- I Ahmad, M Gao, R Patel, HY Leung The aim of this study was to determine if a resistant PC (CRPC). However, the The Beatson Institute for Cancer Research, panel of circulating miRNAs can distinguish signifi cance of other signalling pathways in Glasgow, United Kingdom patients with prostate cancer from those CRPC is less well validated. with benign disease attending a rapid Methods: To gain a better insight into the Introduction: Loss of SPRY2 and activation access prostate assessment clinic. molecular signalling cascades involved in of receptor tyrosine kinases are common Methods: RNA was extracted from clinical CRPC, we performed gene events in prostate cancer (PC). However, the whole-blood samples from 102 patients (75 expression profi ling using the Illumina DASL molecular basis of their interaction and with biopsy proven cancer and 27 benign assay and studied matched hormone-naive clinical impact remains to be fully samples) attending a prostate assessment (HN) and CR prostate tumours (n = 10 examined. SPRY2 loss may functionally clinic. Samples were reverse-transcribed pairs). Ingenuity Pathways Analysis (IPA) synergise with aberrant cellular signalling using stem-loop primers and expression was used to identify potential networks to drive PC and to promote treatment levels of each of 14 candidate miRNAs involved, and further validation was resistant disease. were determined using real-time performed in in vitro cell models and Methods: Here, we report evidence for quantitative PCR. miRNA expression clinical tumours. positive feedback regulation of the levels were then correlated with Results: Expression of 50 genes was ErbB-PI3K/AKT cascade by SPRY2 loss using clinicopathological data and subsequently signifi cantly different between HN and a variety of in vitro, pre-clinical in vivo analysed using qBasePlus software and CRPC. IPA revealed two networks of models and clinical PC tissue microarrays. Minitab. particular interest, including AR and FGFR1, Results: Reduction in SPRY2 expression Results: Circulating miRNAs were detected respectively. FGFR1 expression was resulted in hyper-activation of PI3K/AKT and quantifi ed in all subjects. The analysis confi rmed to be signifi cantly upregulated in signaling to drive proliferation and invasion of miRNA mean expression levels revealed CRPC (P ≤ 0.005), and abnormal FGFR1 by enhanced internalisation of EGFR/HER2 that 4 miRNAs were signifi cantly expression was associated with shorter time and their sustained signalling at the early dysregulated, including the tumour to biochemical relapse in HNPC (P = 0.006) endosome in a PTEN-dependent manner. suppressor let-7a (p = 0.005), along with and less favourable disease-specifi c survival This involved p38 MAPK activation by PI3K the oncogenic miR-141 (p = 0.01). In 20 in CRPC (P = 0.018). to facilitate clathrin-mediated ErbB patients undergoing a radical retropubic- Conclusion: For the fi rst time, our gene receptor endocytosis. Finally, in vitro and in prostatectomy, the expression levels of expression profi ling experiment on archival vivo inhibition of PI3K suppressed miR-141 returned to normal at day 10 tumour materials has identifi ed upregulated proliferation and invasion, supporting PI3K/ post-operatively. Using regression analysis a FGFR1 expression to be associated with PC AKT as a target for therapy particularly in panel of 4 miRNAs could be used in progression to the CR state. patients with PTEN-haploinsuffi cient, low combination to detect prostate cancer with SPRY2 and ErbB expressing tumours. an AUC of 0.78 and a PPV of 80%. P34 Conclusion: SPRY2 is an important tumour Conclusion: Our fi ndings identify a unique Comparative genomics and phylogenetic suppressor in PC; its loss drives the PI3K/ expression profi le of miRNA detectable in foot-printing of androgen response AKT pathway via functional interaction the blood of prostate cancer patients. This elements in human, murine and canine with the ErbB system. identifi es their use as a diagnostic degradome genes biomarker for prostate cancer. CN Molokwu Royal Hallamshire Hospital, Sheffi eld, United Kingdom

Introduction: Extracellular matrix (ECM) degradation and remodelling is required for

tumour progression and metastasis. Methods: The 3000 bp sequence up-stream metalloproteases with ECM degrading, Prostate cancer (CaP) progression is of the human, murine and canine pro-angiogenic and anti-angiogenic dependent on androgen receptor (AR) metalloproteinase genes were obtained properties, as well as those with unknown signalling even in the castration-resistant from the Ensembl genome browser and functions. state. Mice are widely used as in vivo screened for conserved AREs using Conclusions: Several metallopreteinase models of human disease, and dogs are the NUBIScan. Human metalloprotease genes show conservation of AREs in the only non-human mammal that frequently gene promoters containing putative promoter regions between human, murine develops CaP in nature. Comparative AREs were aligned with the murine and and canine homologs. This provides genomics and phylogenetic foot-printing canine homologs and the ARE sequences further evidence that dysregulation of enables comparative analysis of genes analysed. metalloproteinases by abnormal AR between species for conserved regulatory Results: 17 of 23 MMP, 15 of 22 ADAM, signalling may be contributing to the regions containing androgen response 13 of 19 ADAMTS and 4 natural inhibitor mechanism of CaP progression. The elements (AREs), which could identify the gene promoters had at least one putative development of speciﬁ c metalloprotease proteases that are evolutionally ARE. Several of these were conserved inhibitors is required to clarify the role of programmed to effect AR regulated ECM across the human, murine and canine individual metalloproteases in CaP degradation. genomes. These included genes for progression.

Tuesday 26 June 2012 BJUI Poster Session 4 SUPPLEMENTS 14:00–16:00 Carron STONES Chairpersons: Mr Daron Smith & Miss Kay Thomas Posters P35–P45

P35 pure stones was equal (males 13% and procedures. Of these, the predominant Composition of urinary tract calculi: females 12%). biochemical constituent was consistent analysis of 6 year data at a UK referral Discussion: Men are three times more with the defi nitive stone biochemistry in centre likely to have clinically signifi cant renal 82% of cases (14/17 of analyzable dust DP Patel, R Samra, C Nayar, P Mohammed, stones than women which is consistent specimens). Two of the three ‘mismatched’ J Berg, R Devarajan with historical published data. Interestingly cases were mixed calcium oxalate/calcium Sandwell and West Birmingham Hospitals nearly two thirds of stones in men are phosphate stones, and differed only in the NHS Trust, City Hospital, Birmingham, mixed calcium oxalate whereas in women relative proportions of each constituent. United Kingdom these are just under half. The only case that gave a misleading result was ‘pure’ calcium phosphate stone in Introduction: Analysis of renal stones has P36 which the stone dust had also revealed been used for many years to identify risk Stone biochemical composition but 39% calcium oxalate. factors for renal stone disease. Current without a stone to analyse Conclusion: It was possible to accurately published data shows a male to female ER Ray, M Goldstraw, S Longhorn, S Choong, determine biochemical stone composition ratio less than previous publications of T Philp, G Rumsby, RD Smith from dust obtained at lasering of stone in 3 : 1 with calcium oxalate stones being the University College Hospital, London, United more than 80% of cases (provided an most common. We reviewed stones Kingdom adequate specimen could be obtained), analysed at our biochemistry laboratory representing 42% of procedures overall. which receives stones from 60 hospitals Introduction: Knowledge of stone Although work is required to standardise a across the UK to look at whether this has biochemistry is important for the reliable technique for specimen collection, changed. assessment of recurrent stone formers. this demonstrates a successful ‘proof of Method: Stones analysed over a 6 year However, stone basketing during principle’, and may offer a useful option period were reviewed. Data collected ureteroscopy is not always feasible or when a stone specimen cannot be retrieved included age, sex and stone constituents routinely practiced. In this pilot study we ureteroscopically for any reason. categorised as: Pure (100%) stones, mixed aimed to assess whether stone composition (>50%), and mixed (1–49%). can be determined from stone dust P37 Results: 5774 patients had stone analysis obtained during laser treatment. Diabetes in asian and caucasian patients over 6 years. 4204 were male (73%) and Patients and Methods: Urine/irrigant with nephrolithiasis 1570 were female (27%). In men the most containing dust was aspirated through the HS Fernando, A Gupta, R Devarajan common stones were calcium oxalate ureteroscope during/after stone lasering, City Hospital, Birmingham, United Kingdom (63%) followed by carbonate apatite and a stone fragment was also retrieved, in (12%). In women calcium oxalate stones 32 patients. Biochemical analysis of stone Introduction: Population-based studies were again the most frequent (44%) and dried, powdered material was carried support a genetic component to followed by carbonate apatite (28%). out by Fourier transform infrared nephrolithiasis (Thorleifsson, 2009). Magnesium ammonium phosphate stones spectroscopy. Evidence linking obesity and insulin were more common in women (7%) than Results: The dust specimen was suffi cient resistance with low urine pH and uric acid men (2%). In both sexes the proportion of for biochemical analysis in 17/33 (52%) of stones (Maalouf, 2004) as well as an

association between hyperinsulinemia and P38 regardless of the WCC, unless there is sepsis hypercalciuria (Nowicki, 1998) have been Signifi cance of white cell count in or urinalysis suggestive of an infection. reported. ureteric colic? 1. Sfoungaristos S, Kavouras A, Perimenis P. We aimed to identify whether diabetes was AIA Alleemudder, A Alleemudder, XY Tai, Predictors for spontaneous stone passage in more prevalent in the asian stone formers A Goyal, J Pati patients with renal colic secondary to compared to the caucasians. Further, the 24 Barts and the London NHS Trust, London, ureteral calculi. Int Urol Nephrol. 2011 May hour urinary excretion levels were United Kingdom 5. [Epub ahead of print] compared within the diabetic cohort. Methods: The race and the diabetic status There is usually a raised white cell count P39 of 121 patients who underwent a stone (WCC) in ureteric colic with a tendency to A multicentre UK-wide snapshot of retrieval procedure were identifi ed for this commence antibiotics when there are no current practice of stenting after case series. The 24 hour urine biochemical culture results or features to suggest ureteroscopy for stone disease analyse of these patients were analysed to infection. Information is lacking regarding MF Bultitude, T Thompson, J Masood, identify any signifi cant associations the use of antibiotics in this setting. Our RD Smith, S Irving, C McIlhenny, R DasGupta, between race and the diabetic status. SPSS aims were to correlate the haematological OJ Wiseman v16 software was used for the statistical fi ndings with microbiology results and to Guy’s and St. Thomas’ Hospital NHS analysis. justify the use of antibiotics. Foundation Trust, London, United Kingdom Results: The mean age of patients 49.7 Methods: We retrospectively analysed the years, of which 97 (80.2%) were males. data of 50 patients (28 male, 22 female) The use of JJ stenting after ureteroscopy is Forty (33%) patients were of Asian origin. presenting acutely with a solitary ureteric controversial. We set out to determine the Thirteen of the 40 asians were diabetic stone. incidence and reasons for stent placement while 10 out of 81 caucasians were diabetic Results: after ureteroscopy for stone disease. (p = 0.009). There was no signifi cant Seven stone units across the UK collected difference between the two races in the prospective data for a six week period from diabetic cohort for the urinary calcium (p = October 31st 2011. All patients underwent 0.09), uric acid (p = 0.4), oxalate (p = 0.25), rigid and/or fl exible ureteroscopy for stone phosphate (p = 0.08) and citrate (p = 0.18). disease by a specialised stone surgeon. Data was collected on standardised stone and Table for P38 operation related variables. Patients (n) 42 8 221 ureteroscopic procedures were performed (64 rigid, 129 fl exible, 28 a Mean stone size 7.2 mm combination), of which 203 were elective Urinalysis Haematuria only Nitrite positive operations. These were most commonly for Urine culture Negative 5-Coliforms lower pole stones (n = 66) followed by 2-Streptococcus lower (n = 41) and upper (n = 32) ureteric 1-Candida Mean WCC 11.5 (4–22.1) 10.5 (7.7–16.5), stones. The mean diameter of the largest Mean neutrophil count 8.75 (2.3–18.6) 8.4 (4.9–15.2) stone treated was 8 mm (range 2–24 mm). Mean C-reactive protein 15.9 (1–192) 40.7 (3–86) 68 (31%) had been pre-stented. 163 (74%) Sepsis No Pyrexia 1 patient had stents left in situ (27 with strings Antibiotic on admission (n) 34 8 attached) and 9 (4.1%) a ureteric catheter. There was no difference in post-operative stent rate between patients pre-stented Conclusion: The incidence of diabetes is Conclusion: The data shows a raised WCC (66%) versus those not (77%) (p = 0.10, higher in asian stone formers when is usually present in ureteric colic despite Fisher’s exact test). compared to the caucasian cohort. The fact urine cultures being negative in 84%. The main reason, in 119/156 (76%), for placing that there is no signifi cant difference in the Antibiotics were started on admission in a stent was due to concerns over oedema urinary excretion levels suggests that there 81% based solely on the raised WCC, or fragment passage post-operatively. In 28 may be other metabolic factors involved in causing an unjustifi ed use of antibiotics patients a stent was left as a repeat the increased incidence in diabetic Asians. when drug resistance is a growing concern. procedure was planned. Planned duration of This is the fi rst report in the literature The signifi cance and cause for the WCC rise stenting after a successful procedure varied describing an association of increased stone is unknown but could due to production of from 1–42 days (median: 14 days). formation in the diabetic asians. colony stimulating factor resulting from This multi-centre prospective study infl ammation caused by the stone rather indicates that stents are often placed after than infection. Interestingly, WCC is ureteroscopy for stones, whether the thought to be a more signifi cant predictor patient is pre-stented or not. The main for stone passage than size1. Based on this reason for stent placement was due to evidence, we conclude antibiotics are concern over ureteric oedema or passage of generally not required in ureteric colic fragments.

P40 P41 P42 Single-center analysis of complications of Strategies to reduce emergency admission The use of entonox analgesia during Holmium: YAG laser lithotripsy for upper after extracorporeal shockwave lithotripsy Extracorporeal Shockwave Lithotripsy tract calculi in 600 consecutive M Bolgeri, HM Alnajjar, E Eversden, (ESWL) using a Dornier Delta II procedures SJ Gordon, NA Watkin Lithotripter F Khan, F Anjum, H Marsh, IK Dickinson, Sutton Hospital, London, United Kingdom G Rogers, S Walker, N Suvakovic, A West, S Sriprasad B Gowda Darent Valley Hospital, Dartford, United Introduction: Haematuria and renal colic James Cook University Hospital, Kingdom after extracorporeal shockwave lithotripsy Middlesbrough, United Kingdom (ESWL) for urolithiasis can lead to Introduction: Ureterorenocopy and emergency consultations and admission to Introduction: Despite the prevalence of holmium laser fragmentation is the current hospital. ESWL there is limited data within the standard of management of ureteric and In a previous audit we reported that 5.6% literature regarding optimum analgesic small renal stones. The aim of this study of treatments resulted in attendance to the regimes. Entonox was recently introduced was to analyse the intra-operative and emergency department and 3.2% in to ESWL in our unit due to side effects of post-operative complications after holmium readmission, despite only 1.2% requiring strong opiates and inability of some laser lithotripsy in the treatment of Urinary intervention. patients to complete treatment due to pain. tract calculi. We prospectively re-audited emergency Our aim was to prospectively analyse this Materials and Methods: A review of all attendance and readmissions after treatment. consecutive patients who underwent implementation of a fl owchart with advice Methods: Data was collected prospectively ureterorenoscopy and laser lithotripsy for patients to follow after their treatment. on 183 patients receiving ESWL between between 17/11/2005 to 28/11/2011 as Methods: Between September 2010 and November 2010 and August 2011. 139 undertaken from a designated database. Six February 2011, patients were handed an patients received our standard analgesic hundred procedures were performed in 464 information sheet with a fl owchart on how regime and 44 patients received entonox patients. to manage pain/colic, haematuria and (introduced at various time-points) Results: 464 patients with 907 urinary systemic illness post-ESWL. Complication +/− reduced standard analgesia. Pain was tract stones were treated with laser and admission rates were recorded recorded using a visual analogue scale. lithotripsy in 600 procedures. Mean age prospectively. Results were compared with Unpaired and paired student T-tests were was 52.4 years (range 19–86) and mean the previous retrospective audit using a two used for analysis. size of stone burden measured at 10.6 mm sample z-test for proportions. Results: Groups were matched with regards (4–30 mm). 624 kidney stones (106 upper Results: 214 ESWL treatment episodes in to sex, weight, stone size, location, number calyx, 138 middle calyx, 274 lower calyx, 158 patients were included in the of shocks and treatment duration. Mean 29 within calyceal diverticulum, 77 renal prospective audit. In 82.7% of cases, pain score was reduced in patients pelvis) and 283 ureteric stones (104 upper patients developed at least one symptom, receiving entonox (2.4 vs 3.8, p = 0.0006). ureter, 63 mid-ureter, 116 lower ureter) most commonly haematuria (68%) and 13 patients would have stopped treatment were treated. 45 minor complications renal/ureteric pain (47%). due to pain if entonox had not been (7.5%) from 600 procedures were Emergency attendance (3.6% vs 5.6%, p = introduced and 6 patients who declined identifi ed: 3 regarding Sepsis (0.5%), 9 for 0.2) and admission rates (2.7% vs 3.2%, entonox failed to complete treatment due urinary tract infection (1.5%), 24 stent p = 0.6) did not change signifi cantly, to pain. In patients who had 2 sessions of symptoms and/or pain/colic (4%), 9 for however more patients who used the ESWL, where entonox was only used in the ureteric perforation. (1.5%). There were 6 fl owchart asked for medical advice second session, pain scores were reduced patients with damage to guide wire and (p < 0.001). (6.6 vs 1.2 p = 0.003) and numbers of broken laser tip which were removed. There No stented patient sought advice in either patients completing treatment increased (4 was silent obstruction with renal loss after audit. vs 6) with entonox. 12 months (1 major complication). Conclusions: Implementation of a Conclusion: This is the fi rst time that Conclusion: On the basis of these results fl owchart for patients and improving entonox use in ESWL has been reported in we determine that urinary tract stone post-treatment advice may not reduce the European literature. Entonox proved to ablation using the holmium: YAG laser is re-attendance and admission rates be an effective, safe adjunct to the both safe and reliable. Given the low post-ESWL. standard analgesic regime and allowed complication rate, follow-up imaging to There may be a fi nite rate of re-attendance reduction of strong opiates. Entonox was detect procedure-specifi c complications (around 5%) that cannot be avoided in straightforward to implement, with valuable would not be routinely indicated. non-stented outpatient-delivered ESWL. assistance from ‘pain team’ nurses. This evidence should be used in consent and post-treatment advice for patients. It may also have relevance in health care systems where readmission results in a fi nancial penalty.

P43 P44 Conclusions: Minimally invasive surgery is Is PCNL safe in solitary kidneys? Minimally invasive techniques for stone feasible with good stone clearance and A Sahai, K Wong, A Patel, M Bultitude, clearance in anomalous kidneys and in acceptable complication rates in anomalous K Thomas, J Glass patients with musculoskeletal kidneys and PMA. Guy’s Hospital and MRC Centre for abnormalities Transplantation, KCL, London, United AS Srivastava, J Kumar, A Yadav, MS Ansari, P45 Kingdom A Mandhani, R Kapoor Changing the gold standard in the Sanjay Gandhi Post Graduate Institute Of management of large renal calculi – the Introduction: Stones requiring Medical Sciences, Lucknow, India cost based argument percutaneous nephrolithotomy (PCNL) in H Sur, M Wills, A Blacker patients with solitary kidneys can pose Objectives: To study feasibility, safety and University Hospital Coventry and signifi cant anxiety to the urologist. We results of minimally invasive surgeries for Warwickshire, United Kingdom set out to review our experience in this stone clearance in anomalous renal setting. moieties. Introduction: Adopting new surgical Patients & Methods: A comprehensive Methods: This is a reterospective study techniques requires assessment of potential retrospective review of patient’s medical (January 2001 to December 2011) of 72 increased costs being justifi ed by records was performed who underwent anomalous renal moieties. Procedures improvement in patient care. PCNL and had either a solitary kidney or a performed were percutaneous At our institution it is regular practice to single functioning renal unit. Data was nephrolithotomy (PCNL), laproscopically manage large renal calculi (>2 cm) with collected on patient demographics, stone assisted PCNL (LA-PCNL), laproscopic ureterorenoscopy and laser fragmentation burden, outcomes and complications. pyelolithotomy, extracorporeal shock wave rather than PCNL. We decided to perform a Results: Out of a total of 378 PCNL’s lithotripsy (ESWL) and stented ESWL cost based analysis to determine if there is performed between January 2003 and (S-ESWL). Operative technique, any economic benefi t of selecting one September 2011, twenty-two were complications, stone clearance and ancillary method over the other. performed in 17 patients in patients with a procedures were analysed. Methods: Costs were obtained of single functioning kidney. Three patients Results: Mean age was 33.4 years (17–58). equipment routinely used during a had PCNL performed in a transplanted Mean stone size 24.9 mm (7–33 mm). ureteroscopic procedure versus a PCNL kidney. In those with a solitary calculus, the Anomalies studied were horseshoe kidney procedure. Average length of stay was longest mean length and stone surface area (HSK), pelvic and thoracic ectopic kidney approximately 3 days following a PCNL and was 37 mm and 825 mm2, respectively. (PEK), duplex kidney and patients with 1.5 days following a ureterorenoscopy. Stone free rate was 57%. Auxillary musculoskeletal abnormality (PMA). Number Results: The average cost of equipment procedures were required in 6 cases, of patients in each group was 35, 24, 3 and used during a ureteroscopic procedure was resulting in a stone free rate of 86%. 10 respectively. In HSK, PCNL, laparoscopic calculated to be £702 versus £586 for a Median inpatient stay was 4 days. Serum pyelolithotomy, ESWL and S-ESWL done in PCNL. The average cost per day of a creatinine values improved from 144 to 21, 4, 8 and 2 patients respectively. Stone surgical bed was determined as £400 per 126 umol/l pre- and post-procedure and clearance was more than 85% in PCNL day based on fi gures from the NHS mean eGFR improved similarly from 51 to group while the other modalities had 100% Institute for Innovation and Improvement. 59 mls/min respectively. Blood transfusion clearance. In PCNL blood transfusion was Based on these fi gures the average cost was required in 1 patient, sepsis developed needed in 11.5%. In PEK-PCNL, LA-PCNL, was £1386 for a PCNL, and £1302 for a in 3 and 2 patients required a stent for laparoscopic pyelolithotomy and ESWL in 1, ureteroscopic removal of a large renal obstruction. 3, 7 and 9 patients respectively. Stone calculus. Conclusions: PCNL in solitary kidneys is clearance was 100% in PCNL and ESWL Conclusion: The average cost for the two safe with an acceptable complication rate. group, while in LA-PCNL, laparoscopic procedures is similar. Reduced bed Outcomes are good, although auxillary pyelolithotomy clearance was noted in 88% occupancy following ureterorenoscopy procedures may be necessary. Renal and 66% respectively. No complication was enables further revenue to be generated by function remains stable or improves post noted in any of patients. In Duplex kidneys, increasing bed availability for additional procedure. PCNL was done the 3 patients stone procedures. Furthermore, when given the clearance was 100%. In PMA-PCNL done in choice, patients preferred to opt for a 8 patients and ESWL in 2 patients. Stone ureteroscopic approach making this the clearance was 100%. procedure of choice.

Wednesday 27 June 2012 BJUI Poster Session 5 SUPPLEMENTS 11:00–12:30 Alsh BLADDER CANCER Chairpersons: Ms Jo Cresswell & Mr Rik Bryan Posters P46–P57

P46 Muscle invasive BC (MIBC) (n = 29): 34% re-TURBT in high grade non-muscle invasive Snapshot of transurethral resection in the radiotherapy, 34% cystectomy, 32% other. bladder cancer (HGNMIBC) and recurrence UK audit (STUKA) Low, intermediate and high risk NMIBC 3 at 1 year (RR-1y). A Patel, S Fowler, D Rosario, J Catto, month recurrence: 16%, 21% and 21% Patients and Methods: Collaboration was T O’Brien respectively. 12 month mortality MIBC initiated between centres performing Guy’s and St Thomas’ NHS Foundation Trust, 34%; low/intermediate risk NMIBC 0% and Hexaminolevulinate PDD assisted bladder London, United Kingdom high risk NMIBC 2%. tumour surgery to combine prospectively Conclusions: Snapshot methodology has maintained and retrospective data. A Introduction: Despite transurethral proved a success. The quality of initial standard proforma based on bladder resection of a bladder tumour (TURBT) TURBT in the UK is high. mapping and tumour features was used to being the standard management of bladder Of note; Delays to TURBT are considerable; collect specifi c fi elds including tumour size, cancer (BC) there has been no national PDD is rarely employed; Re-resection of number, appearance, completeness of audit. A methodology, akin to NCEPOD, i.e. high risk NMIBC did not lead to upstaging. resection, grade & stage, presence/absence a snapshot, was tested as a means of Short term mortality of MIBC remains very of detrusor muscle in the resection determining the quality of TURBT across the high. specimen and surgeon experience. Patients country. underwent fi rst check cystoscopy at 3 Methods: Retrospective review of the fi rst P47 months, with early re-TURBT performed case of newly presenting BC undergoing Hexaminolevulinate (HEXVIX) within 6 weeks of initial resection in TURBT after midnight on 31st January 2010 Photodynamic Diagnosis Assisted HGNMIBC. Recurrence/residual disease was from every urologist in BAUS. 192 patients transurethral bladder cancer surgery defi ned as histologically proven cancer. were registered from June-August 2011. – multicentre experience of the UK PDD Logistic regression analysis was carried out. Results: 149 males, 43 females, median Users Group Results: A total of 929 patients were age 73 years (27–94). 81% visible P Mariappan, C Bunce, J Cresswell, recruited. The overall RRFFC was 9.6%, with haematuria. 29% current smokers, 37% A Shamsuddin, M Crundwell, R Donat, RRFFC being 2.7% and 4.4% for low and ex-smokers, 34% non smokers. A Zachou, S Stewart, LJ Hartley, RA Hurle, intermediate risk tumours, respectively. Diagnostic and surgical quality: Median H Mostafi d Residual disease was detected at early time to presentation 11 days. Median time Western General Hospital, Edinburgh, United re-TURBT in 16.9% of HG-NMIBC with to TURBT 27 days. 6% photodynamic Kingdom macroscopically complete resection. The diagnosis (PDD). 72% received single-shot overall RR-1y was 28.2%. Detection of cis mitomycin-C. 0.5% returned to theatre. Introduction: By improving tumour was signifi cantly higher with PDD when 16% no muscle in the specimen. detection and clearance, PDD assisted compared with white light cystoscopy. Planned Management: Non-muscle TURBT (PDD-TURBT) has been shown to Conclusion: In this large multicentre series, invasive BC (NMIBC) : low risk (n = 65); reduce recurrence. As part of a series of Hexvix PDD assisted bladder cancer surgery Intermediate risk (n = 35); High risk (n = analyses from a multicentre collaboration was associated with low risk of early 48). In high risk, initial management: 48% of centres performing Hexvix PDD assisted recurrence, residual disease in HGNMIBC re-resected, of which none were upstaged; bladder cancer surgery, we describe the and recurrence at 1 year. 29% BCG; 10% FC at 3 months, 4% group’s experience, particularly, early cystectomy 9% other. recurrence (RRFFC), residual disease at early

P48 P49 P50 The impact of early re-resection in Early re-resection of high grade non- Initial experience with sequential BCG/ patients with high grade non-muscle muscle-invasive urothelial carcinoma of Electro-motive drug administration invasive bladder cancer – an analysis of the bladder (NMIBC): a 5 year experience (EMDA) Mitomycin-C (MMC) as the 490 consecutive patients (2007–2011) of safety and quality standard intravesical regimen for high risk N Vasdev, J Dominguez-Escrig, E Paez, RJ Bryant, H Sandhu, A Birnie, J Bhatt, non-muscle invasive bladder cancer M Johnson, G Durkan, A Thorpe J Crew (NMIBC) Freeman Hospital, Newcastle upon Tyne, Oxford Radcliffe Hospitals NHS Trust, S Amery, K Chatterton, G Zisengwe, United Kingdom Churchill Hospital, United Kingdom A Mukwahuri, F Dickinson, S Khan, K Thomas, T O’Brien Aim: To evaluate the impact of early Introduction & Objectives: EAU guidelines Guy’s and St Thomas’ NHS Foundation Trust, re-resection on the incidence of tumour recommend patients with newly diagnosed London, United Kingdom recurrence and progression in patients with high grade NMIBC should undergo a second High Grade-Non Muscle Invasive Bladder resection (TUR) within 2–6 weeks due to Introduction: Whilst both MMC and BCG Cancer (HG-NMIBC). risks of tumour understaging and residual are effective treatments for NMIBC they Patients and Methods: From 1998 to tumour presence. We investigated the are rarely used in combination. Trials 2008, 490 consecutive patients were safety of early re-resection along with an suggest they may be synergistic and that diagnosed with HG-NMIBC. Retrospective analysis of up-staging in a contemporary MMC is more effective if delivered by data was collected which included patient patient cohort. EMDA. demographics, histological parameters Material & Methods: We performed In June 2009 we introduced sequential including the presence of detrusor muscle retrospective analysis of all early BCG/EMDA MMC as our standard induction at initial TUR and at re-resection, adjuvant re-resections performed over a 5-year regimen in high risk NMIBC. intravesical therapy and recurrence and period and investigated the associated Patients and Methods: 62 patients. Mean progression rates. Early re-resection was surgical complications. We also quantifi ed age 70 (range 42–85) (56 males/6 females). performed within 8 weeks of initial TUR. the rate of upstaging at early re-resection. 46/62 (74%) new diagnosis TCC. TNM: high Patients comprised those who underwent Results: 179 consecutive patients grade/pTa n = 21; high grade/pT1 n = 24; an early re-resection (Group-A, n = 172) underwent early re-resection for high grade pTis n = 12; secondary CIS n = 15; other and those who did not (Group-B, n = 318). NMIBC. Complication data was available in n = 5. Results: At initial TUR detrusor muscle was 141 cases. Most patients were male (n = Sequential BCG/EMDA MMC treatment present in 61% (n = 105) of patients in 145) and elderly (mean age 72 years, range administered over 9 weeks in 3 weekly group A and 76% (n = 244) of patients in 39–92 years). 159 patients underwent cycles repeated 3 times. Each cycle group B. At early re-resection detrusor re-resection following a new diagnosis of comprised 2 weeks BCG with single EMDA/ muscle was present in 77.9% of cases. urothelial carcinoma whilst 20 patients had MMC in the third week. Outcomes: Residual tumour was present in 54.6% of a previous history of recurrent NMIBC. tolerability, response rate, and recurrence. re-resected cases. Tumour upstaging Muscularis propria was obtained in 88.8% Check cystoscopies performed under occurred in n patients (12.7%). The overall of re-resections compared with 67% of general anaesthesia 8 weeks post- incidence of tumour recurrence was 35% in primary resections. Upstaging to muscle- induction. Complete responders offered group A and 42% in group B. During invasive bladder cancer was seen in 10 maintenance BCG. follow-up there was a signifi cantly higher patients (5.6%), all of whom had G3pT1 Results: January 2012, 12 patients still rate of tumour stage progression in patients disease at initial resection, and 5 had undergo induction, leaving 50 for who did not undergo early re-resection muscle included in the primary specimen. assessment. 40/50 (80%) completed full 9 (Group B 14.4% vs Group A 3.3%, p < Only 6.8% of re-resections were performed weeks; reasons for discontinuing – 4 LUTS/ 0.05). within 6 weeks (mean time to re-resection pain; 2 BCGosis; 1 pancreatitis; 1 unrelated Conclusions: Early re-resection facilitates 80 days). 15 complications (11 Clavien- illness, 1 rash and 1 refused. accurate staging and clearance of residual Dindo grade I, 3 grade II, 1 grade III) One awaits 1st check and one defaulted. 38 disease. Subsequent rates of tumour stage occurred including 6 bladder perforations (5 have completed 1st check; 31/38 (82%) had progression are signifi cantly improved. We extra-peritoneal and 1 intra-peritoneal). a complete response of whom 20 have advocate early re-resection for all patients Conclusions: This study indicates that early completed check at 12 months. 17/21 with HG-NIMBC. re-resection in patients with high grade remain clear. NMIBC identifi es and upstages a signifi cant Treatment of non responders; 4 cystectomy, number of patients and suggests the 4 maintenance BCG, 1 surveillance, 1 benefi ts of early re-resection outweigh the Synergo. One death unrelated to bladder risks associated with this procedure. cancer or treatment; no mets; no progression. Conclusion: Sequential BCG/EMDA MMC appears well tolerated and effective in the management of high risk NMIBC.

P51 P52 P53 BCG resistant high risk non muscle Can presence of granuloma act as a Prostatic urethral biopsy before invasive bladder cancer treated with marker of response to intravesical BCG in cystectomy: a service evaluation thermochemotherapy – two year non-muscle invasive bladder cancer? AW Nelson, AY Warren, AJ Colquhoun, follow-up data from a single institution S Jallad, P Hughes, A Gupta, S Goubet, WH Turner B Ayres, MJ Perry, R Issa, MJ Bailey, A Symes, T Larner, P Thomas Cambridge University Hospitals NHS S Mukhtar Brighton and Sussex University Hospitals, Foundation Trust, United Kingdom St George’s Hospital, London, United Royal Sussex County Hospital, United Kingdom Kingdom Introduction: Prostatic urethral involvement has been reported in up to Introduction: Management of high risk, Introduction: The mechanism by which 43% of patients with urothelial carcinoma non-muscle invasive bladder cancer intravesical Bacillus Calmette-Guerin (BCG) of bladder. The risk of urethral relapse (HRNMIBC) presents a challenge for exhibits its anti-tumour activity remains increases with prostatic urethral disease. urologists and their patients. The risk of poorly understood. Markers for response We biopsy the prostatic urethra before disease progression with bladder sparing have been evaluated, but until now no cystectomy to determine the need for must be weighed against the morbidity specifi c markers for response to intravesical urethrectomy, rather than using from cystectomy which may represent BCG have been identifi ed. There is intraoperative frozen section, as others overtreatment for some patients. confl icting evidence suggesting that the advocate. Patients failing to respond to BCG have presence of granulomata in histology Materials and methods: A retrospective little option but to undergo cystectomy. samples can act as a marker of response. service evaluation was conducted of Thermochemotherapy may provide an Materials and Methods: 194 patients with prostatic urethral biopsies (PUB) performed alternative bladder sparing therapy. non-muscle invasive bladder cancer between February 2008 and December Patients and Methods: We have treated 61 (NMIBC) treated with intravesical BCG over 2011. Patients were identifi ed from patients with BCG resistant HRNMIBC with a 5 year period were identifi ed. The electronic hospital records. PUB pathology mitomycin thermotherapy (Synergo therapy) presence of granulomata and/or was correlated with fi nal cystectomy at our institution since 2006. Patients have infl ammation on histopathology review was pathology. been followed up with regular cystoscopies correlated with disease recurrence and Result: One hundred and fi fty fi ve patients and VUC. Treatment was given weekly progression, with survival analysis with a median age of 69 years (range for 6 weeks with 6 weekly maintenance performed using the Kaplan-Meier method. 37–84 years) underwent PUB. Thirty four thereafter. Those patients with >2 year Results: Granulomata were identifi ed in 50 (22%) patients had positive PUB and 121 follow up are presented here. patients and infl ammation in 111. 14 (78%) were negative. Sixty seven patients Results: 34 patients have >2 year follow patients had no evidence of either, and subsequently underwent cystectomy, and 19 up (mean 36, range 24–66 months). tissue was unavailable in 19 patients, who others underwent cystourethrectomy. In 21 remain disease free. Three patients had were subsequently excluded. seven patients fi nal pathology results are a partial response and continue on The median recurrence free survival was pending. In the 79 patients with pathology treatment. Seven patients had a cystectomy signifi cantly higher in the granuloma group, results available, when the entire prostatic for persistent HRNMIBC and one for T2 60.2 months (95% CI: 54.3–66.1), than in urethra was sectioned, 16 (20%) had disease. One has had radiotherapy for T2 the infl ammation group (46.8 months, 95% cancer. Cancer was found in 14 (78%) of disease. One patient progressed to prostatic CI: 40.9–52.6. P = 0.003) and the normal 18 patients with positive PUB and in two stromal disease, but died from other causes. histology group (20.2 months, 95% CI (3%) of 61 with negative PUB. In all 79 One patient developed urethral tumours, 6.7–33.6. P < 0.0001). patients, the prostatic apical margin was but died of other causes. Two patients have The progression free survival was higher negative. died from metastatic bladder cancer (one in the granuloma group (65.5 months, Conclusion: Disease in the prostatic with only CIS in the bladder). 73% of 95% CI: 62.2–68.8. P < 0.0001) and urethra was common in our patient group patients treated are alive, with NED and an infl ammation group (64 months, 95% CI; and prostatic urethral apical margins were intact bladder. 60.1–67.9. P < 0.0001) in comparison with all negative. Intraoperative frozen section Conclusion: Mitomycin thermotherapy may the normal histology (24.1 months, 95% CI; would have missed cancer in the 16 provide an alternative to cystectomy for 9.9–38.2). patients with prostatic urethral cancer, patients with HRNMIBC unresponsive to Conclusion: The presence of infl ammation whereas our biopsies identifi ed 14 (88%) of BCG. Progression during this treatment has and specifi cally granuloma in histology the 16 patients with cancer in the prostatic been low, so the option of curative samples following intravesical BCG for urethra. This dataset validates the role of treatment with cystectomy is not lost. NMIBC could act as a marker of response. PUB before cystectomy in our patient In the absence of infl ammation or population. granuloma, the risk of recurrence and progression seems higher, perhaps necessitating a closer surveillance policy.

P54 P55 P56 UK Radical Cystectomy Audit 2011–2012 Serum beta human chorionic A comparison of survey results from 514 On behalf of BAUS Section of Oncology gonadotrophin; does it have a role as a pelvic surgeons – trends in robot-assisted L Patrick, JE McCabe, S Fowler marker of disease recurrence after radical surgery St Helens & Knowsley NHS Trust, Whiston cystectomy for bladder cancer? K Ahmed, AP Stegemann, NC duPont, Hospital, Prescot, United Kingdom T Drake, J Douglas R Chandrasekhar, A Hussain, GE Wilding, Southampton General Hospital, United KA Guru Background: UK Urologists have been able Kingdom Rosswell Park Centre, US to submit radical cystectomy data to the Guy’s Hospital, London, United Kingdom BAUS complex operations database since Introduction: Bladder cancer is the 9th 2004. In 2011 the datasets were overhauled most common cancer diagnosis worldwide Introduction: Institutional surgical volume and a web based system launched. We and like several other non-trophoblastic has been widely embraced as a surrogate present an analysis of this newly submitted tumours, has been associated with ectopic measure for surgical outcomes. Studies on data. It is hoped that by collecting this production of beta human chorionic the broad relationship between institution data we can gain a more meaningful gonadotrophin (βHCG). Previous studies volume and outcomes after robot-assisted perspective on the operations we do and have found an association between radical cystectomy (RARC) have been therefore make positive changes to patient pre-treatment serum βHCG levels and lacking. We aim to determine the management in the future. bladder tumour stage and grade, but as yet relationship between caseload and patient Methods: The data has been collected via little has been documented regarding selection as well as perioperative outcomes the web based system and an ongoing βHCG’s role as a marker for disease with RARC. analysis of all submitted data between April recurrence following radical cystectomy Methods: Using the International Robotic 2011 until March 2012 undertaken. Data performed with curative intent. Cystectomy Consortium (IRCC) database, was interrogated using Tableau software. Patients & Methods: We identifi ed a study 1118 patients who underwent RARC for Patients undergoing open and laparoscopic population of 96 patients treated surgically bladder-cancer at 18 institutions from (including robotic) procedures have been for recurrent or invasive bladder cancer at a 2003–2010 were evaluated. The institutions included in the data collection. single institution between 2000 and 2011. were divided into 2-groups according to Results: Up to October 2011, 193 Data was obtained from a previously their number of RARCs performed (cut-off: cystectomies were entered onto the created database containing patient 100 RARCs). database. These were performed in 31 outcome measures for all radical Results: 534 patients (48%) had their centres. Mean patient age was 68 years cystectomies performed at the institution surgery performed at institutions that had a and mean length of stay was 15.6 days. during this time period. Data was analysed caseload <100 RARCs and 584 (52%) had The majority of patients underwent open for correlations between serum βHCG their surgery performed at institutions with transperitoneal procedure 139 (72%). Post post-radical cystectomy and the presence a caseload of >100 RARCs. No signifi cant- operative complication rate for all of recurrent disease. difference was seen between groups for procedures was 15%. Results: Disease recurrence occurred in gender, previous-surgery, estimated Lymph node metastases were detected in 54% of the study population. Serum blood-loss, pathologic-stage, soft tissue only 23 (11%) of patients. concentrations of βHCG were elevated in surgical-margin positivity, lymph-node Discussion: This interim analysis suggests 51% of patients following radical metastasis and neo-adjuvant that there is a low yield of positive lymph cystectomy. Of these 84% had evidence of chemotherapy-administration. Institutions nodes for each given pathological T stage recurrent disease. The sensitivity of βHCG with >100 caseload operated on older- as compared to current literature. This may as a marker of recurrent disease post- patients (>75 years: 30% vs. 21%, p = be the result of inadequate pelvic lymph cystectomy was 83%. 0.001) with higher body mass index (p < node dissection. However, we need more Conclusions: An elevated βHCG post- 0.001) and higher ASA score (ASA ≥ 3: 7% data entries to analyse this accurately. Of cystectomy is a specifi c and sensitive vs. 41% p < 0.001). The institutions with note, the pathological data is more marker for disease recurrence. Regular >100 caseload were also more likely to complete than in the 2010 data, this is an measurement of serum βHCG levels perform an extended-lymphadenectomy early positive outcome of the re-launched post-radical cystectomy may be a useful (89% vs. 56%, p < 0.001), had a higher datasets. as an adjunct to current surveillance mean number of lymph-nodes removed programmes. Further studies are needed to (21 vs. 15, p < 0.001) and were more likely investigate how serum βHCG levels to perform continent-diversions (37% correlate with immuno-histochemical vs. 29%, p < 0.001). The patients at the expression on matched tissue samples, and >100 caseload institutions had shorter to see if this could allow personalised overall operative-time (mean-difference chemotherapy with anti-βHCG drugs. of 52 minutes, p < 0.001) and shorter length of hospital stay (median7 vs. 10days, p < 0.001). Conclusions: Higher-volume institutions perform a more thorough lymphadenectomy

and have shorter operating-time and Methods: From January 2010 to October LRC had signiﬁ cantly decreased blood hospital stay despite operating on sicker 2011, 70 consecutive patients underwent loss (597 vs 992 mL, p = 0.0009) and and older patients. Further follow-up is RC. Two surgeons performed ORC (n = 36), transfusion rate (14% vs 25%, p = 0.007), needed to assess the impact of these while two introduced LRC (n = 34). Patient but increased operative duration (297 ± 41 differences on morbidity and survival. demographics, operative and postoperative vs 265 ± 51 min, p = 0.006). Hospital stay variables, and pathological outcomes were (7 vs 10 days, p = 0.03) was shorter for P57 collected prospectively. LRC. The complication rate was lower for A comparison of open and laparoscopic Results: The mean age was 69.9 ± 8.7 LRC (29% vs, 56%). One patient died in cystectomy years for LRC and 67.8 ± 9.3 years for each arm (2.8%). GW Yardy, ETS Ho, V Kumar, RD Mills, ORC (p = 0.33). 79% in the LRC group The median number of lymph nodes MA Rochester were male compared with 83% of ORC. removed was similar in the open and Norfolk and Norwich University Hospital Three orthotopic bladder substitutes laparoscopic cohorts (13 vs 14, p = 0.4) NHS Foundation Trust, United Kingdom were performed in each group (8.5%) with no positive margins. – the remaining diversions were ileal Conclusion: LRC was safely introduced in Introduction: We prospectively compared conduits. The stage distribution was this department. The operating time was perioperative and pathological outcomes in similar in each group (ﬁ nal stage 22% prolonged, but there was decreased blood a consecutive series of patients undergoing T0, 28% Tis-T1, 49% T2–4 for LRC and loss, transfusion rate, complications and radical cystectomy (RC) by the open (ORC) 28% T0, 20% Tis-T1 and 51% T2–4 for length of hospital stay for LRC. or laparoscopic (LRC) approach. ORC).

Wednesday 27 June 2012 BJUI Poster Session 6 SUPPLEMENTS 11:00–12:30 Carron TECHNIQUES AND INNOVATION Chairmen: Mr Ghulam Nabi & Mr John McGrath Posters P58–P67

P58 Table for P58 Outcomes of emergency renal embolisation – 7 year single centre Post SAE Transfusion Av units Hosp stay creatinine analysis Indication/n Rate % transfused Median days change (μmol/l) RK Narahari, A Abroaf, S Patel, P Haslam, A O’Riordan, ST Hasan, TJ Dorkin Overall n = 61 67 2 8 +6 Freeman Hospital, Newcastle upon Tyne, Post partial nephrectomy 83 3.7 13 +4 United Kingdom = 12 Post PCNL = 13 69 1.8 13 +21 + Introduction: Acute renal haemorrhage is a Post renal biopsy for tumour 50 1.75 7.5 50 = 4 potentially life threatening condition. Post blunt loin/abdominal 62 3.2 13 −4 Surgical exploration is technically trauma = 8 challenging with low nephron salvage rates Bleeding renal tumours = 24 50 1.6 7 +2 even in specialist centres and consequent (13 RCC/TCC, 11 AML). long-term compromise of renal function. We present our data on all cause emergency selective renal arterial angio- embolisation (SAE) over the last 7 years. Conclusions: Emergency renal SAE is an tumours. The technique has evolved from This represents one of the largest series of effective and reliable way of arresting renal open to laparoscopic to robotic assisted embolisations performed in a single UK haemorrhage obviating the need for partial nephrectomy (RPN). We present a centre. exploratory surgery whilst also preserving prospective analysis of operative, Methods: All SAE performed on urological renal function. Our results compare perioperative and oncological outcomes of patients between January 2004 and June favourably to those published worldwide. a series of RPN. 2011 were identifi ed from the electronic Methods: Data was prospectively collected radiology database followed by a P59 across two institutes in 36 consecutive comprehensive case note analysis. Robotic assisted laparoscopic partial RPN’s. RPN was performed using = Results: A total of 61 patients (M : F 2:1) nephrectomy: a prospective analysis of transperitoneal approach and 3 arm, 4 port were identifi ed with mean age 58 years. feasibility, operative and perioperative technique. Patient demographics, tumour Overall successful embolisation was carried outcomes characteristics, intra and post-operative out in 93% of patients. 3 renal tumour A Hughes-Hallett, P Patki, M Nuttall, data, margin status and complications were patients required radiotherapy and an AML R Thilagarajah, M Sullivan recorded. patient eventually required a nephrectomy Broomfi eld Hospital, Chelmsford, United Results: Average age of patients was 60.7 for ongoing pain in a poorly functioning Kingdom years (range 42–87 years). Median tumour kidney. size was 2.8 cm (1–7.2 cm). Mean operative Introduction: Partial nephrectomy (PN) is time for RPN was 188.3 min. Overall mean the new standard of care for suitable renal warm ischaemia time (WIT) was 17.2 min.

Average blood loss was 518 ml. Surgical Table 1 for P60: Complications of LRC vesicovaginal fi stulae, two foreign body diffi culties (3) and equipment failure (1) removals and one endometriosis of the Clavien No of lead to RPN conversion to open. Mean bladder). Mean age was 43 years (14–83), Grade Patients % inpatient stay was 4.8 days (2–13 days). operative time 193 minutes (80–560), no Margin was positive in one with no 02435conversions to open surgery were necessary, recurrences at a mean follow up of 15.3 I68mean hospital stay fi ve days (2–8), all months (6–28). One urinoma and one II 25 37 patients had normal bladder function infective complication required additional III 10 15 without urinary incontinence at six weeks procedures. IV 2 3 and six months follow up. No recurrence of V 1 1.4 Conclusion: RPN is feasible, safe and has pathology, symptoms or post operative comparable operative, perioperative and complications were identifi ed at fi nal oncological outcomes to open and Conclusion: LRC appears to be a safe review. laparoscopic series in literature. Outcomes procedure with outcomes that are at least Conclusions: In our early experience of were similar amongst renal cancer surgeons comparable to open cystectomy, as assessed nine women undergoing vesicoscopic across two institutes suggesting the by the Clavien-Dindo classifi cation with surgery this novel techniques offers universally applicable nature of the satisfactory pathological results. Blood loss excellent visualisation and appears to be a technique. However in select cases and transfusion rates may be better in safe and reliable technique with minimal conversion to open may be required patients undergoing LRC. We support the morbidity and post operative pain enabling refl ecting the learning curve. continuing recruitment into the BOLERO a short recovery time and hospital stay. trial of open versus minimally invasive Structural and functional outcomes appear P60 radical cystectomy, which should eliminate equivalent to the established open Is laparoscopic radical cystectomy safe? selection and reporting bias and give a true approaches with superior recovery and – results from a high volume UK centre indication of the benefi ts or indeed risks of patient satisfaction. F Khan, M Jackson, GC Durkan, R Heer, these differing methods of radical NA Soomro, MI Johnson cystectomy. P62 Freeman Hospital, Newcastle, United Rectus sheath catheters – a novel Kingdom peri-operative pain control technique for P61 open pelvic uro-oncology surgery Introduction: Radical cystectomy is Transluminal Surgery (TLS) A series of T Dutton, M Daugherty, K Allman, RD Pocock, recognised as a morbid procedure. We vesicoscopic procedures in women R Mason, MC Crundwell, JS McGrath report the surgical and pathological F Lynch, P Grange, S Wali, M Vella, Royal Devon and Exeter NHS Trust, United outcomes from a large series of patients J Bidmead, D Robinson, N Marcus, L Cardozo Kingdom undergoing laparoscopic radical cystectomy King’s College Hospital, London, United (LRC) for bladder cancer. Kingdom Introduction: Epidural (EA) or spinal Methods: We prospectively collected anaesthesia (SA) has been the mainstay of data between May 2005 and August Introduction: The transvesical approach or post-operative analgesia in major open 2011 from patients undergoing LRC for vesicoscopy is an emerging technique in uro-oncology surgery (open radical muscle invasive or high risk superfi cial transluminal surgery. Employing standard cystectomy (ORC) and prostatectomy bladder cancer. The complications were laparoscopic surgical instruments and (ORP)). Rectus sheath catheters (RSCs) may recorded using the Clavien Dindo techniques direct access into the bladder offer an alternative, less invasive method classifi cation. can be achieved in order to perform a with potential for earlier mobilisation. Results: 68 procedures were performed variety of Urogynaecological procedures. Patients & Methods: 200 patients with no open conversions. The mean We report our initial prospective experience undergoing ORC and ORP (April 2008– operating time was 420 mins and mean of the technique in 9 women with various August 2011) had RSCs placed (94 ORC: blood loss was 600 ml. 19 (25%) patients pathologies. 106 ORP; 174 male: 26 female; mean age were transfused. Pelvic node dissection was Patients and Methods: Following 65 years (range 37–83)). Catheters were performed in 61 patients – mean count insuffl ation of the bladder with carbon placed under ultrasound guidance at – 11 (4–21). Male to female ratio – 4 : 1, dioxide through a urethral catheter three induction of anaesthesia between rectus Mean BMI – 27 (18–39). 2 (3%) patients 5 mm laparoscopic ports are inserted abdomini and posterior rectus sheath. Local had positive surgical margins. suprapubically and secured with stay anaesthetic boluses were given 6-hourly 44 patients (65%) sustained one or more sutures using an Endoclose device. A with ‘rescue’ analgesia as required. complications within 30 days, as listed in robotic camera holder, Freehand, can be Results: All RSCs were successfully placed Table 1. used to facilitate the technique. All patients and used for a mean of 2.8 days (range were prospectively followed up in order to 1–7). Post-operative pain scores per ensure accurate outcome data collection. 12-hour period were consistently low Results: To date 9 women have undergone (1.64, 1.52, 1.29, 1.53, 1.26, and 0.91 vesicoscopic surgery (three ureteric respectively). Problems with RSCs requiring reimplantations, three complex clinical review occurred in only 9% of

cases. RSCs usage was terminated early in admission has not occurred although in 1% can minimize service disruption. We have 5.5%. Mean time to mobilisation was urine infections occurred, associated with found a measurable fi nancial and clinical post-operative day 1 (POD) for ORP and bladder outfl ow obstruction benefi t to implementing a consultant- POD 2 for ORC. PCAS was used for the Conclusions: Transperineal sector biopsies delivered emergency service. initial 24 hours in 84 patients though this (TPSB) are safe. It allows stratifi cation of decreased with experience. patients, for Active Surveillance or active P65 Conclusions: RSCs offer a safe and intervention. The 3D geographical Development and validation of an iPad effective alternative to EA with low rates of information obtained may be used to plan based laparoscopic trainer complications. They avoid the rare but nerve sparing in radical prostatectomy, AN Bahsoun, MM Malik, O Elhage, K Ahmed, catastrophic complications of EA and allow deliver preferential loading in brachytherapy P Dasgupta early mobilisation. Additional analgesia may and potentially targeted treatments in focal Guy’s Hospital, United Kingdom be required to treat visceral pain in the fi rst therapies. post-operative 24 hours. RSCs may Introduction: Access to facilities that allow facilitate the aims of enhanced recovery P64 one to develop their laparoscopic skills is programmes and could therefore have an Consultant-delivered care – is it worth it? very limited in the hospital environment increasing role. A Russell, J Webster, V Izegbu, G Hellawell and courses can be very expensive. We set The North West London Hospitals NHS Trust, out to build a cheap yet effective trainer to P63 Northwick Park Hospital, London, United allow laparoscopic skill acquisition in the Transperineal sector prostate biopsy Kingdom home or classroom environment based on technique and morbidity using a tablet as a replacement for the L Vyas, R Popert, J Kinsella, H Yamamoto, Introduction: Reduction in trainee service laparoscopic stack and camera. P Acher, J Smith, S Duasko, A Chandra, activity via the EWTD and hospital fi nancial Methods: The cavity to train in was made D Cahill, B Challacombe pressures to reduce length of stay (LOS) has from a cardboard box and we left the sides Guys and St Thomas’ NHS Foundation Trust, led to a transition from consultant-led to and back open to allow for natural light to London, United Kingdom consultant-delivered care. Reduced elective fi ll the cavity. An iPad 2 (Apple inc.) was activity and consequential income loss are placed over the box to act as our camera Introduction: We describe our cited as barriers to implementation of a and monitor. We provided ten experienced transperineal sector biopsy (TPSB) consultant-delivered emergency service. We laparoscopic surgeons with a task of experience and complication rates. reviewed LOS for acute admissions before passing a suture needle through 3 hoops Material & Methods: The protocol and after the adoption of this service in and they fi lled in a questionnaire to assess developed from our dynamic brachytherapy order to quantify potential savings. Face (training capacity) and Content technique, with preferential peripheral Methods: Data was recorded prospectively (performance) validity. loading. A total of 24–32 cores are taken for average LOS for urology inpatients Results: On a 5 point Likert scale the (4/5 per sector). The prostate is divided into before and after the adoption of a tablet based laparoscopic trainer scored a 8 sectors; anterior, mid gland and posterior consultant-delivered acute service. Prior to mean 4.2 for training capacity (hand eye sectors bilaterally with additional basal September 2009 the daily care was middle co-ordination, development and sectors in glands larger than 30cc. grade led, thereafter the consultant of the maintenance of lap skills) the trainer and Geographical 3D distribution within each week undertook daily ward rounds of all for performance (graphics, video and sector, if required, can be determined by urology inpatients. lighting quality) it scored a mean 4.1. placing individual cores on to sponges laid Results: In the 12 months prior to Conclusion: The iPad 2 based laparoscopic from medial to lateral (a, b, c, d, e). The September, 2009 the LOS for emergency trainer was successfully validated for most medial core (a) is inked and fi xed at admissions was 3.1 days. The LOS in the training. It allows students and trainees to the basal end, allowing the pathologist to subsequent 12 months was 1.69 days. Dr practice at their own pace and on the go. report on the medial to lateral and apical Foster data for the consultant-delivered For the price of a laparoscopic stack and to basal distribution of the tumour within care period indicated an overall LOS that was camera we can buy around 150 iPad 2s for each sector. 50% of the national average. UK fi gures inexpensive training. Future ‘app’ based Results: 836 patients with known or estimate 650 emergency urology admissions skills are planned suspected prostate cancer have undergone per annum for an average district general TPSB. 205 have entered our AS program, hospital. Extrapolation of inpatient daily P66 288 have required active intervention (108 costs of £300 results in annual savings of Which resources do medical prostatectomy, 102 Brachytherapy, 16 £273,000 due to LOS reduction. undergraduates currently utilise in their radiotherapy with a brachytherapy boost, Discussion: The transition to a consultant- studies? 37 radiotherapy with hormones and 23 delivered model of care resulted in dramatic G Coleman, C May, AM Sinclair, I Pearce hormonal therapy. The remainder were LOS reduction that translates into Manchester University Medical School, benign and have been discharged to their measurable fi nancial savings. In addition United Kingdom primary physician. Complications include the 48-hour readmission rate dropped to retention in 2% and haematuria requiring zero. Service commitments may require Introduction: Over the past 20 years, due admission in 1%. Uro sepsis requiring reduction but planned staff redeployment to advances in technology, those in medical

education are no-longer confi ned to solely frequently. The vast majority of medical solutions. A brief/debrief system was using the traditional textbook for their students use and own a laptop to access introduced as part of the ‘team-working’ learning. We aimed to assess how popular information for medical studies, and many module and efforts to organise the work the medical textbook still is to what extent use a smart-phone. environment were introduced as part of the these new technologies are being used, and ‘well organised theatre’ module. ‘Measures in what form. workshops’ were conducted to monitor Materials and Methods: 124 fi nal year P67 effi ciency and audit start/overrun times and medical students in one university Can the productive operating theatre patient experience. attending a urology revision day were asked (Tpot) programme increase effi ciency in Results: Start Times: Measured from Sep’10 to complete an anonymous questionnaire urology operating theatres? to Jun’11 involving 1365 cases – there was regarding the learning resources they K Ahmed, N Khan, D Anderson, J Watkiss, a 39–41% increase in the percentage of currently use. 109 forms were returned, of MS Khan, P Dasgupta, D Cahill operating lists starting on time in Jun’11 which, 4 were excluded as a result of being Guy’s Hospital NHS Foundation Trust, compared to Sep’10. fi lled in incorrectly. London, United Kingdom Overrun Measures: Cost of monthly overrun Result: Students rated text books followed was reduced by £3,030.00 in theatre 1 and by a web search engine as their most Background: The productive operating £510.00 in theatre 2 between Sep’10 and preferable resources, with 59% and 32% theatre (TPOT) is a module based Jun’11. preferring them above all else respectively. programme designed by the National Patient experience: 54 urology patients On average, 84% and 68% of students had Health Service to improve value/effi ciency, returning for follow-up were surveyed. High used the internet to assist in their studies teamwork, patient experience, staff degree of satisfaction regarding level of within the last 48 and 24 hours well-being and the safety and reliability of care (77%), staff hygiene (71%) and respectively. 86% of the students had care in operating theatres. information provided (72%). Negative accessed a medical text book within the Aim: To evaluate the effectiveness of comments regarding staff shortages and last two days, the most popular being the introducing TPOT in urology operating environment/facilities. Oxford Handbook of Medicine. The most theatres and to identify obstacles to Conclusion: Introducing TPOT has shown popular device to own and use for study running an ideal operating list. improvements in effi ciency measures such was the laptop, followed by an iPhone or Method: TPOT was introduced in two as start and overrun times with high other smart phones. urology operating theatres in September patient satisfaction. Further work will Conclusion: Whilst the medical textbook is 2010. Multidisciplinary team discussions involve introducing new modules and still the resource of choice for most medical took place to identify obstacles to running implementing the programme in other students, web-based resources are used as an ideal operating list and implement specialties.

Wednesday 27 June 2012 BJUI Poster Session 7 SUPPLEMENTS 14:00–16:00 Alsh FEMALE UROLOGY AND LUTS Chairpersons: Mr Chris Harding & Miss Mary Garthwaite Posters P68–P82

P68 Conclusion: NICE guideline IPG267 quotes diverticulum, repair of urethral defect and Urological injury secondary to 2–7% risk of organ injury during anterior placement of a Martius fat pad. urogynaecology tape/mesh procedures mesh repair, producing symptoms with Results: Presenting symptoms were L Kerr, J Wilkens, K Guerrero, P Granitsiotis higher impact on quality of life than initial variable. Voiding symptoms (58%), storage Southern General Hospital, Glasgow, United stress incontinence. The number of symptoms (58%) and a swelling (58%) Kingdom urological injuries secondary to anterior predominated. A third were initially repairs with mesh is higher than misdiagnosed. Magnetic resonance imaging Introduction: Female incontinence surgery transvaginal tape, causing signifi cant and video Urodynamics (vUD) were highly has been revolutionised by mid-urethral comorbidity to patients. Due to risk of sensitive for identifying diverticulae. 6 tapes. Mesh repair of pelvic organ prolapse further surgery required, this study patients had vUD performed and using is increasingly popular. Most recent concludes cystoscopy should be part of Blaivas-Groutz nomograms, outfl ow mid-urethral tape procedures do not protocol for anterior repairs but is not obstruction was confi rmed in all (3 mild, 3 include cystoscopy. This retrospective required for transvaginal tapes due to lower moderate). Post repair, 60% had resolution review of urological injury, presenting to risk of urological injury. of symptoms and no complications. 10% of urogynaecology/urology tertiary referral storage lower urinary tract symptoms centre aims to determine if cystoscopy P69 persisted. There was no evidence of should be part of the procedure protocol. The effect of Urethral Diverticulae on dysplasia or malignancy in excised Method: Number of transvaginal tape (TVT, female voiding dynamics diverticulae. TVT-O and TOT) procedures and anterior G Rogers, C Harding, S Fulford Conclusion: No patients in our study mesh repair of pelvic organ prolapse were James Cook University Hospital, South Tees presented with the ‘classical triad’ of determined from theatre audit data over Hospitals NHS Foundation Trust, dyspareunia, dysuria and dribble. To the the period 2007–2011. Urological injuries Middlesbrough, United Kingdom best of our knowledge this is the fi rst study requiring surgical repair were determined to clearly demonstrate the obstructive by theatre logbook and casenote review. Introduction: Urethral diverticulae in nature of urethral diverticulae on voiding Results: Between 2007–2011, 2104 females are often misdiagnosed and there dynamics. Our operative results are in transvaginal tape procedures and 319 are few case series in the literature. keeping with the small number of studies anterior repair of pelvic organ prolapse Urodynamic characteristics are particularly to date, suggesting that where there is using mesh were performed. Five urological poorly defi ned. Therefore our aim was to already expertise in female and injuries following transvaginal tapes were review our 3 year experience in the reconstructive surgery, the learning curve referred (<0.2%). These required single management of these patients, focusing on for urethral diverticulectomy is acceptable. surgical procedure to repair. Two of fi ve voiding dynamics. required further management of stress Methods: A retrospective case note review incontinence. was undertaken for 12 consecutive patients Twelve anterior mesh related urological with urethral diverticulae treated by a injuries requiring surgery were referred. single surgeon between 2008–2011. Median Three of 12 required more than one surgical age was 39 (range 21–50) with mean procedure to remove eroded mesh. Injuries follow up of 8.6 months. Surgical treatment were not identifi ed during initial procedure. consisted of; cystoscopy, excision of

P70 P71 P72 The effect of urethral diverticulum MRI The effi cacy and safety of intravesical Reduced innate beta-defensin-2 response confi guration on the incidence of new sodium hyaluronate solution (cystistat®) in the bladder and vaginal epithelia onset urodynamic stress urinary installation in preventing recurrent increases suceptibility to fl agellated incontinence following excision Cystitis/Urinary Tract Infection in women E. coli infection R Kavia, I Rudd, J Jenks, R Hamid, J Ockrim, MS Vedanayagam, A Gordon-Dixon, ASM Ali, M Lanz, CL Townes, C Varley, J Shah, T Greenwell MG Salahia, MY Hammadeh B Suarez M-Falero, WA Robson, J Southgate, UCLH, London, United Kingdom Queen Elizabeth Hospital, Woolwich, London K Brown, P Hilton, J Hall, RS Pickard SE184QH, London, United Kingdom Newcastle University, United Kingdom Introduction: Excision of urethral diverticulum in females has been reported Objectives: Damage to the Introduction: Recurrent urinary-tract- to be associated with new onset glycosaminoglycan lining of the bladder infection (rUTI) affects 5% of women. urodynamic stress urinary incontinence may increase the possibility of bacterial Antimicrobial peptide (AMP) secretion (USUI) in up to 65%. We have assessed the adherence and infection. The aim of this following Toll-Like-Receptor (TLR) activation incidence of new onset USUI in all patients retrospective study is to assess the effi cacy is a key innate defence mechanism. A having urethral diverticulum excision with and tolerability of intra-vesical common heterozygous dominant stopcodon Martius fat pad interposition under the care administration of (cystistat)®, a bladder singlenucleotide-polymorphism in TLR5 of a single surgeon between 1/5/2007 and coating therapy, in female patients with a (TLR5392STOP) increases risk of rUTI. We 1/12/2011. The incidence of new onset USUI history of recurrent UTI. investigated AMP responses to fl agellated has been correlated with the pre-operative Method: A retrospective analysis of the E. coli in vitro and in clinical samples from MRI appearance of the urethral clinical data of 21 female patients who women with rUTI. diverticulum. failed previous management of recurrent Methods: In vitro, urothelial and vaginal Patents and Methods: All 33 patients UTI were treated with 40 mg/50 ml cell-lines plus fi nite cultured normal human (mean age 42) having urethral diverticulum intravesical Cystistat. All 21 patients urothelium from primary tissue were with Martius fat pad interposition had (100%) previously received fl uid challenged with E. coli and its fl agellin. prospective data tabulated on: management, lifestyle adjustment advice AMP expression, secretion and function demographics, pre-operative MRI and residual volume assessment. 14 were assayed by RTqPCR, ELISA and appearance and pre and post-operative (66.7%) had cystoscopy and urethral time-kill assays respectively. VCMG. dilatation for high post-void residual Clinically, 57 women with rUTI and 37 Results: Of the 33 patients 10 (30%) had volume. 18 patients (86%) had prophylactic controls were recruited. Volunteers provided pre-operative USUI and have been excluded antibiotics for at least 3 months without blood samples, urine, vaginal-washings, from this study. Other pre-operative any signifi cant improvement of recurrent bladder and vaginal biopsies. urodynamic fi ndings included IDO in 10 UTI. Follow up was every 3 months with Results: In vitro, fl agellin challenge (30%) and BOO in 5 (16%). urine examination and symptom assessment signifi cantly increased Beta-Defensin-2 The details regarding the incidence of new for up to one year. AMP (BD2) expression and secretion by onset USUI in the remaining 23 patients Results: 21 female patients aged 17–72 8-hours and 24-hours respectively and this are as tabulated: years (average 51.9) completed a full course was inhibited by antiTLR5 antibody. Media of intravesical cystistat. Over a period of from challenged cells reduced cultured Table for P70 one year post Cystistat installation, patients E. coli growth by 48%. (33%) had a recurrent UTI within 1 year, 14 Clinically, TLR5392STOP was found in 9 (16%) New MRI Confi guration Number Onset (67%) were UTI recurrence-free for one of rUTI patients but in no controls. of Diverticulum (%) USUI (%) year post Cystistat installation. Side effects 12-patients had infection at time of biopsy were experienced by 4 patients who (3 with TLR5392STOP). Infected women with Simple 2 (10) 0 (0) reported minimal bladder irritation and 1 TLR5392STOP showed signifi cantly lower mean Saddle 16 (73) 1 (6) case of right loin pain. BD2 peptides levels in urine (35.6 ± 16 pg/ Circumferential 5 (17) 1 (20) Conclusion: Intravesical Cystisat mL vs 87.4 ± 21 pg/mL; P < 0.05) and installation for recurrent UTI is effective, as vaginal-washings (11.9 ± 4.0 pg/mL vs 35.9 the majority (67%) of our female patients ± 7.6 pg/mL; P < 0.01). Conclusions: New onset USUI occurs in 9% showed an improvement in symptoms and Conclusion: We demonstrate that in vitro, of patients having excision of urethral remained UTI free up to 1-year post course TLR5 inhibition eliminates the BD2 response diverticulum with Martius fat pad completion. Cystistat is well tolerated clinically, the heterozygous stopcodon interposition. The incidence appears to without signifi cant side effects. TLR5392STOP SNP signifi cantly reduces it. BD2 increase with increasing complexity of is a potent component of defence against urethral diverticulum on pre-operative fl agellated E. coli. Reduced responses may MRI – rising from 0% following simple be pivotal for increased risk of rUTI urethral diverticulum excision to 20% amongst this common genotype. Future following circumferential diverticulum therapies inducing or supplementing excision. vaginal/bladder BD2 may reduce this risk.

P73 P74 P75 A novel, patient-managed Mixed growth of doubtful signifi cance is Patient treatment preferences for neuromodulation system (PMNS) that on the contrary wholly signifi cant in symptomatic refractory urodynamic uses a noninvasive sacral patch for patients with LUTS idiopathic detrusor overactivity (IDO) treatment of overactive bladder (OAB): O Pal, M Ghei, BH Maraj, J Malone-Lee I Rudd, R Kavia, J Jenks, R Hamid, J Ockrim, effect on urgency incontinence in a Whittington Hospital, London, United J Shah, T Greenwell prospective, multi-center, randomized trial Kingdom UCLH, London, United Kingdom AK Monga, R Dmochowski, D Miller Princess Anne Hospital, Southampton, Introduction: UTI, diagnosed by MSU Introduction: There is a multiplicity of United Kingdom culture depends on the 1957 Kass criteria treatments currently available patients with of 105 cfu ml−1 of a single species of a symptomatic refractory urodynamic IDO Introduction: A novel PMNS has been known urinary pathogen. The validation of (SRU IDO). We have assessed patient developed that transmits a transdermal this threshold was not rigorous and recent treatment preferences and their outcomes amplitude-modulated signal (TAMS) times have seen much criticism of its over a 12-month period between 1/1/2009 through a patch applied to the skin. The accuracy. This criterion dismisses ‘mixed and 31/12/2009. primary objective of this clinical trial was growth of doubtful signifi cance’. There is no Patients and Methods: A prospective to evaluate the PMNS for safety and evidence to exonerate mixed colonies and database of all patients with SRU IDO was effi cacy in reducing urgency incontinence. so this study tested the hypothesis. reviewed for patient demographics, Differences in effectiveness depending on Methods: Normal controls, and patients treatment preference and outcome. All whether the patch was applied by the with non-acute LUTS had symptoms patients attending for treatment in the investigator (Investigator Placement Group, measured and an MSU cultured. Fresh urine time period were offered treatment choices IPG) or the subject (Subject Placement specimen was examined microscopically to of; repeat bladder training +/− Group, SPG) were also evaluated. count pyuria. Four groups were compared, anticholinergic (BT +/− Ach), acupuncture, Methods: Male and female subjects with normal controls, LUTS no growth, LUTS intravesical botulinum toxin injection, documented symptoms of OAB for 6 mixed growth and LUTS positive culture. sacral neuromodulation (SNS) and clam months or longer were recruited. All Results: 43 control specimens (M = 10, F = cystoplasty +/− Mitrofanoff channel subjects had failed conservative treatment 33, Mean age 41 sd = 15) and 7517 LUTS formation. as well as treatment with at least one patients (M = 719 F = 6798, Mean age 56, Results: 217 patients (73 men) of whom anti-cholinergic drug. Subjects were sd = 17) provided data. 58% had storage 210 were new referrals with SRU IDO randomized to the IPG or SPG. Patches symptoms; 16% had stress incontinence; underwent primary treatment in this time were replaced every 7 days, with the new 20% had voiding dysfunction and 28% had period. Their treatment choices and patch placed on the contra-lateral side. non-dysuric pain symptoms. outcomes are as tabulated: Results: After 4 weeks of PMNS treatment, Urinary pyuria was markedly different in Table for P75 the number of urgency incontinence those with mixed growth compared to episodes was signifi cantly reduced by an ‘controls’ and ‘LUTS no growth’, on one side Patient Defi ned average of nearly 50%, with no difference and ‘LUTS signifi cant growth’ on the other Success between the IPG and the SPG. Symptoms (F = 30, p < 0.0001, df = 1). Similar Treatment N (%) N (%) improved by at least 50% in 62.5% of all patterns of difference were identifi ed in + − subjects (95% CI (50.6%, 74.4%). The measures of incontinence, urgency and Repeat BT / ACh 10 (3.5) 5 (50) Acupuncture 24 (8.5) 14 (56) majority of adverse events were mild dysaesthesia. In all analyses the mixed Intravesical Botulinum 70 (25) 49 (70) (90.6%), and no severe adverse events growth group differed markedly from the Toxin occurred. normal controls. Sacral Neuromodulation 71 (25) 35 (49) PNE Sacral Neuromodulation 35 (13%) 24 (68) Table 1 for P73: Change in urgency incontinence episodes after 4 weeks of PMNS defi nitive Clam Cystoplasty +/− 7 (2.5%) 6 (86) treatment Mitrofanoff Channel N Baselinea Week 4 Change % Change P value

Total 64 4.9 (3.2) 2.2 (2.5) −2.7 (3.1) −47.8 (60.6) <0.0001 Conclusions: The majority of patients opted for minimally invasive surgical Baselinea and Week 4 values are the mean (SD) over a 24-hr period. treatment with botulinum toxin and SNS with equivalent success rates in those patients having a successful PNE. A smaller Conclusions: A 4-week course of treatment Conclusion: Independent markers of number opted for non-surgical treatments with PMNS signifi cantly reduced the infl ammation, storage symptoms and with moderate success. The minority opted frequency of urgency incontinence episodes incontinence make it clear that ‘Mixed open surgery with clam cystoplasty in OAB subjects. growth of doubtful signifi cance’ has +/− Mitrofanoff – but appeared to have the considerable clinical signifi cance. most successful outcomes.

P76 Table 1 for P76: Outcomes of injecting OnabotulinumtoxinA 300U and 200U in patients Comparison study of OnabotulinumtoxinA with NDO and IDO 300U and 200U in patients with detrusor Parameter NDO 300u NDO 200u IDO 300u IDO 200u overactivity M Malki, A Mangera, SV Reid, RD Inman, % patients with 83.3% 93.7% 81.6% 78.5% CR Chapple subjective effi cacy Royal Hallamshire Hospital, Sheffi eld, United Median longevity 4–5 months 4–5 months 6–7 months 6–7 months Kingdom Need for catheter 93% 93% 42.9% 53.5% UTI 23% 37.5% 26.5% 32.1% Introduction: OnabotulinumtoxinA (Botox) Other complications 10% 6.2% 6.1% 7.1% remains off-licence for treating patients with detrusor overactivity (DO) in the UK. Regulatory approval is anticipated in many countries for 200U in patients with P77 were seen. Occult prostate cancer incidence neurogenic detrusor overactivity (NDO). The Can laser vapoenucleation and was 12.5%. Complication included UTI optimum dose for patients with idiopathic morcellation be the gold standard for 2.8%, urethral stricture 1.7%, urge detrusor overactivity (IDO) is still surgical treatment of symptomatic incontinence 1.4%, haematuria 1% and undergoing evaluation. prostatic obstruction? – initial UK incomplete morcellation 1%. Methods and materials: An earlier study experience using thulium laser Conclusion: We report a favourable initial was performed in our urology unit of all CL Chintea, J O’Dair, NJ Rukin, O Kenney, experience with ThuVEP. The procedure is the patients that had received 300U H Krasnowski, A Chakravarti safe, reproducible, effi cacious and onabotulinumtoxinA until June 2008 (n = The Dudley Group NHS Foundation Trust, demonstrates reduced length of stay with 79). Thereafter since July 2008 we began to United Kingdom minimal complications. ThuVEP is an inject Botox 200U in all patients with DO. attractive alternative option for We reviewed the case notes of patients Introduction: Laser enucleation of the vapoenucleation in the management of that had received both 200u and 300u to prostate is an established technique for the symptomatic prostatic obstruction. assess differences in outcomes. treatment of symptomatic prostatic Results: Forty four patients (36 female and obstruction. Pulsed Holmium : Yttrium- P78 8 male) had received both 300 and 200U Aluminium-Garnet (YAG) lasers (2100 nm) DAY-CASE GYRUS TURP – is it feasible? onabotulinumtoxinA, 28 for IDO and 16 for have traditionally been the laser of choice. IJ Raymond, SM Lloyd, SN Lloyd NDO. Of these; 37 patients reported The thulium : YAG laser (RevoLix®, 2000 nm) St James’s University Hospital, Leeds, United continued improvement with 200U emits a continuous wave mode which Kingdom onabotulinumtoxinA, 4 received no benefi t evaporates tissue without generating and 3 had worsening in their symptoms. pressure waves, enabling continuous Introduction/Aim: TURP impacts Percentage improvement in urgency and cutting, improved tissue penetration and signifi cantly on our over-stretched hospital urgency incontinence episodes per day were potentially shorter operative times. We services. This patient group is usually 82% and 72% in patients who were report our experience with Thulium non-cancer and invariably moves to the receiving 200U. Table 1 shows a comparison Laser Vapoenucleation of the Prostate back of the queue. Lasers prostatectomy of outcomes for onabotulinumtoxinA 300 (ThuVEP). and saline-TURP systems are recent and 200U in the same group of patients. Of Material and Methods: Over a 3-year innovations that have helped to reduce the 44 patients 39 continued to receive period, 287 consecutive patients who hospital stay and improve care quality. This 200U, 4 went back to 300U (decreased underwent ThuVEP were evaluated study evaluates the feasibility of day-case effect) and 1 did not attend after the 1st retrospectively. Data was collected via TURP. treatment. After switching to 200u three electronic records and notes review Patients/Method: We prospectively patients were commenced on CISC for de including demographics, perioperative collected data on Day Case TURP from novo voiding diffi culty. fi ndings, complications and follow-up data. 2001. Data was similarly collected on all Conclusion: 80% of patients were happy Results: Mean patient age was 71.7 years inpatient TURP between 2003–2005 to with their symptoms after switching form (range 39–96), with an ASA of 2. Median assess its impact on our inpatient facility. 300 to 200U onabotulinumtoxinA. Only 9% total operative time was 81 minutes (range Hospital stay and cost implications for both of patients (all with NDO) went back to 13–220) with mean enucleated tissue groups were compared. receiving 300U. This is the fi rst study to weight of 29.6 g (range 3–118). Mean Results: Total of 1253 patients (766 compare 200U and 300U post-operative stay was 2 days with 10% elective and 487 emergency) underwent onabotulinumtoxinA in the same patients of cases performed as a day case. There inpatient TURP. The average hospital stay and our results show similar effi cacy and were no signifi cant changes in mean (days) was signifi cantly more for emergency longevity in the majority of patients (90%) haemoglobin (13.9 g/dl to 12.9 g/dl) or (9.58 total; 5.5 pre-op) than elective (5.23 using 200U in both NDO and IDO. However sodium levels. Substantial improvement in total; 1.75 pre-op) cases. This difference is some patients may require the higher dose maximum urinary fl ow rates of 162.5% and attributable to delays in theatre availability of 300U especially with NDO. reduction in post-void residuals of 59% and medical reasons.

171 patients underwent day-case gyrus- hours) and hospital stay (2.4 versus 5.2 Introduction and Objectives: Holmium TURP by one operator over 11 yrs (157 days) were signifi cantly lower in the BPEP laser enucleation of the prostate (HoLEP) is under GA; 4 spinal; 33% ASA 3). 77% (n = group. At 1, 3, 6 and 12 months, no an established and durable treatment for 132) were discharged within 23 hrs; 90% statistically signifi cant difference was men with lower urinary tract symptoms (n = 153) had successful TWOC within 2 determined in terms of IPSS, Qmax, QoL (LUTS). The durability of HoLEP for retention days. 7% (n = 12) were re-admitted with and RV between the 2 study arms. At 6 and is unclear. We report 5 year outcome data sepsis (n = 4) and bleeding (n = 8). 12 months, equivalent prostate volume for a group of men in urinary retention Conclusion: Day-case gyrus TURP is decrease was established (88.3–88.9% treated with HoLEP. feasible and safe in our hands with versus 87.3–87.7%). Materials and methods: Prospective signifi cant advantages for patients and Conclusion: BPEP represents a promising analysis of 500 consecutive HoLEPs was provider. The electrodes cost £100 more, but endoscopic approach in large BPH cases, performed. 275 men (55%) had a HoLEP for savings in fl uid use and hospital stay characterized by good surgical effi ciency, retention. Perioperative outcomes were outweigh this. Our experience with more signifi cantly reduced complications, faster compared with men undergoing HoLEP for ASA 3 patients means we have increased postoperative recovery and satisfactory LUTS. 174 men with HoLEP for retention our pool of suitable cases including follow-up results when compared to OP. performed >3 years ago were identifi ed retentions. The good practice incentive of with 105 contacted (60%) for follow-up £300 for day-case TURP in 2011/12 should P80 (mean 61.3 months) make us all consider day-surgery Holmium laser enucleation of the prostate irrespective of which technology is used. in men with urinary retention – 5 year results P79 WJG Finch, S Tang, T Aho A prospective, randomized comparison Addenbrooke’s Hospital, Cambridge, United between the bipolar plasma enucleation Kingdom of the prostate versus open prostatectomy in cases of prostates over 80 ml B Geavlete, R Multescu, C Moldoveanu, D Georgescu, F Stanescu, M Jecu, P Geavlete Results: Saint John Emergency Clinical Hospital, Table for P80 Bucharest, Romania HoLEP perioperative outcomes Introduction: This prospective, randomized Retention group LUTS group p value trial evaluated the viability of the bipolar plasma enucleation of the prostate (BPEP) Mean Age at Surgery (yrs) 72.3 69.6 0.001 by comparison to open transvesical Fresh specimen weight enucleated (g) 66.5 51.5 0.0003 prostatectomy (OP) in cases of large Mean enucleation time (mins) 60.3 53.4 0.006 Mean morcellation time (mins) 16.4 12.8 0.004 prostates (over 80 ml). All complications within 30 days (%) 11.8 7.4 0.205* Patients and Methods: A total of 130 Successful initial trial without catheter (%) 76.0 86.0 0.007* benign prostatic hyperplasia (BPH) patients Overall successful trial without catheter (%) 98.4 99.5 0.389* with prostate volume over 80 ml, maximum * Fishers exact test fl ow rate (Qmax) <10 ml/s and International Prostate Symptom Score HoLEP for retention long-term outcomes ? mean follow-up 61.3 months (IPSS) >19 were randomized in the 2 study Mean score arms. All cases were evaluated preoperatively and at 1, 3, 6 and 12 months IPSS score out of 35 3.5 after surgery by IPSS, Qmax, quality of life Quality of Life score out of 6 0.8 score (QoL) and post-voiding residual urinary volume (RV). Percentage Results: The BPEP and OP series Haematuria 7.60% emphasized similar preoperative prostate Bladder neck Stenosis 0.9% volume (135.8 versus 133.2 ml). Similar Urethral stricture 3.8% operating times were determined for BPEP Acute Urinary Retention 2.9% and OP (89.8 versus 87.6 minutes), while Reoperation due to recurrent BPH 0.9% the mean hemoglobin drop (2.0 versus Remain catheter free 98.1% 3.3 g/dl), postoperative hematuria (3.1% versus 15.4%) and blood transfusion (1.5% versus 10.8%) rates were signifi cantly improved for BPEP. Also, the mean catheterization period (35.4 versus 98.3

Conclusion: HoLEP is a safe and highly Results: 1705 men aged between 70 and 1616–22). Little is known about the successful technique for relieving urinary 97 years underwent initial evaluation. 1367 prevalence and natural history of such retention despite these men being older men presented for follow-up. Baseline symptoms in ketamine users. and with a larger prostate size. Our 5 year median IPSS was 4, this was unchanged at Patients and Methods: A purposeful data demonstrates HoLEP for retention is two years. Median peak fl ow rate at sampling technique was used. Participants durable (98.1% of men remaining catheter baseline was 13.7 ml/sec, declining to completed an on-line questionnaire free at 5 years mean follow-up), with a low 10.5 ml/sec at two years. Peak fl ow rate promoted by a national dance-music complication rate and is well accepted by was lower in the older men (>90 years) magazine. Data regarding demographics patients. HoLEP may be the ideal surgical within the cohort compared to younger and illicit drug-use were collected. Amongst treatment for men with urinary retention. men (70–74 years) at baseline and two year respondents reporting recent ketamine use, review (p ≤ 0.001). Median post void additional information detailing urinary P81 residual volume was 35 ml at baseline and symptoms and use of healthcare services Voiding parameters in the elderly male: 45 ml at two years, with a clinically was obtained. the CHAMP study signifi cant difference only in the >90 years Results: 3806 surveys were completed. RC Esler, T Lobo, LW Chan, VW Tse, group. Increased total IPSS correlated with 1285 (33.8%) participants reported M Litchfi eld, V Naganathan, R Cumming reduced peak fl ow and increased post void ketamine use within the last year. 26.6% Concord Hospital, Department of Urology, residual, but not age. 63 (4.6%) men had (340) of recent ketamine users reported Sydney, Australia surgery for LUTS between baseline and two urinary symptoms, signifi cantly related to year review. both dose of ketamine used and frequency Introduction: To assess both symptom Conclusion: Urinary symptom scores and of ketamine use. Of 251 users reporting scores and voiding parameters in a group of voiding parameters remain stable over two their experience of symptoms over time, community-dwelling elderly men and to years in elderly men. 51% reported improvement in urinary determine whether there was any change in symptoms upon cessation of use with only either at two years. 8 (3.8%) reporting deterioration stopping Patients and Methods: 1705 men aged P82 use. over 70 years were enrolled to participate Prevalence & natural history of urinary Conclusion: Urinary tract symptoms are in the Concord Health and Ageing in Men symptoms in recreational ketamine users reported in over a quarter of regular Project (CHAMP), a population based study M Cottrell, A Winstock, L Mitcheson, ketamine users. A dose and frequency of men living in a defi ned geographical D Gillatt response-relationship has been area in Sydney, Australia. Men completed a Bristol Urological Institute, Southmead demonstrated between ketamine use and survey including International Prostate Hospital, United Kingdom urinary symptoms. Users and primary care Symptom Score (IPSS) and medical, providers need to be educated about medication and urological history, then Introduction: Ketamine is an anaesthetic urinary symptoms that may arise. A attended clinical assessment including agent increasing in popularity as an illicit multi-disciplinary approach promoting harm urofl owmetry and post void residual drug (Winstock et al. Eur Add Res 2007 31 reduction, cessation and early referral is volume measurement. Subjects are (1) 57–64). Case series have shown that needed to manage ketamine associated re-assessed at two and fi ve years. We recreational use can lead to severe urinary urinary tract symptoms to avoid progression report results at baseline and two year symptoms (Shahani et al. Urology 2007 69 to severe and irreversible urological follow-up. (5) 810–2, Chu et al. BJUI 2008 102 (11) pathologies.

Thursday 28 June 2012 BJUI Poster Session 8 SUPPLEMENTS 11:00–12:30 Alsh ANDROLOGY Chairmen: Mr Richard Pearcy & Mr Mike Foster Posters P83–P92

P83 category from our institution. Patients Conclusion: Though RCTs have shown Erectile dysfunction treatment by could obtain prescriptions both from the PDE5-I to be equally effective [1] our Schedule 2: the setup at a NHS trust trust and community pharmacies. real-life observational study shows that AR Mohee, L Bretsztajn, A Storey, I Eardley Results: 2159 patients referred to the most patients use tadalafi l (50.4%), owing St James University Hospital NHS Trust, andrology clinic, qualifi ed under the ‘severe to both patient choice and surgeons’ Leeds, United Kingdom distress criteria’. 226 patients were excluded preference. Medication switching is from further analysis owing to missing uncommon (12.3%), with most patients Introduction: Erectile dysfunction (ED) is a data. Patients were followed up on a yearly switching to Tadalafi l. 82% of patients diffi cult condition to treat owing to the basis. remain on the scheme long-term being stigma attached to the diagnosis. This study The mean age was 60.2 years (min 23, max compliant with their yearly appointment, aims to describe the setup for the 90) and mean follow up was 50.8 months showing good patient satisfaction. Our data management of ED in a large teaching (min 1, max 127). 25.0% of patients were shows a successful ED scheme in practice. hospital. not compliant with the setup, and 18.0% Patients and Methods: Basic demographics patients initially started on the scheme [1] Moore RA, Derry S, McQuay HJ. Indirect and data on ED management for patients stopped. 12.3% patients switched comparison of interventions using published treated from January 2000 to April 2011 treatment. Table 1 shows the different randomised trials: systematic review of were obtained from the ED-PMS database, drugs used, how patients switched between PDE-5 inhibitors for erectile dysfunction. which records patients who receive treatment regime and the reasons for BMC Urol. 2005: 5:18 medication under the ‘severe distress’ dropout from the scheme. P84 Table 1 for P83: Set up of the ED scheme The fi rst 20 months of a national audit of urethroplasty practice in the UK Number of patients n = 1933 SR Payne, D Andrich, AR Mundy Number of patients Sildenafi l Change from Sildenafi l Tadalafi l56Manchester Royal Infi rmary, United Kingdom started on treatment 696 (36.0%) 77 (11.1%) Vardenafi l15 (n = 1933) Alprostadil 6 Introduction: Urethroplasty has become an Tadalafi l Change from Tadalafi l Sildenafi l50increasingly early consideration in the 990 (51.2%) 94 (9.5%) Vardenafi l34 Alprostadil 10 management of men with urethral stricture Vardenafi l Change from Vardenafi l Tadalafi l17disease. The symptomology, pre-op 163 (8.4%) 32 (19.6%) Sildenafi l11evaluation, operative management and Alprostadil 4 Alprostadil Change from Alprostadil to tablets outcome from men presenting for, and 6 undergoing, reconstructive urethral surgery 84 (4.3%) (7.1%) Patients who stopped Deceased 25 has never previously been evaluated n = 347 (18.0%) DNA’d once 170 nationally. DNA’d more than once 35 Materials: This study reports the fi rst 20 Takeover by GP 38 Moved from area 18 months of national audit data using a Treatment ended 57 two-part database for men who progressed Unspecifi ed 4 with reconstructive urethral surgery. Data entrants chose from 228 and 55 potential

variables in the new/operative and (SWI) following radical retropubic conservative with catheter drainage. In our follow-up databases housed within the prostatectomy for prostate cancer. It’s role pelvic trauma centre there is a practice of BAUS Nuvola online system, embedded in after radiotherapy for prostate cancer is early orthopaedic pelvic stabilisation. This 40 and 13 questions respectively. Data were less clear. gives the potential opportunity for early analysed to determine modes of Our objective was to assess this role. surgical repair of the bladder. We reviewed presentation, preliminary management, Patients: P131 patients who were the outcome of early repair versus operative technique and post-operative implanted with an AUS for SWI after conservative management. outcome. treatment of their prostate cancer were Patients and Methods: Patient episodes Results: 812 and 601 patients were reviewed with a mean follow-up of 16 were captured from a prospective trauma entered into the new and follow-up months. Group 1: 97 patients had been database over 5 years. We identifi ed all database; 88.4% had stricture disease. treated by radical retropubic prostatectomy. patients with EBR in the presence of pelvic 13.8% presented in retention; 42% Group 2: 34 patients had been treated with fracture. had previous reconstructive surgery and external beam radiotherapy. We compared management plan with Injury 63% previous DIVU or dilatation. The Results: In Group 1: 88% of patients were Severity Score (ISS), nature of the pelvic aetiology of the stricture is shown in the dry and 12% were incontinent using 1–2 fracture (Tile classifi cation) and presence of table. pads per day. 4% developed malfunction complicating factors such as other pelvic during follow-up and 4% had device visceral injury. The outcomes of primary Table for P84 erosion/infection. repair and conservative management were There were no device infections (ie determined. Aetiology Incidence infection without erosion). Results: 21 patients were identifi ed Idiopathic 29.7% In Group 2: 87% of patients were dry and with EBR. The patients in each group Previous hypospadiac surgery 16.1% 13% were incontinent using 1–6 pads a (conservative/surgical repair) were similar Lichen Sclerosis 15% day. 6% developed malfunction during with respect to age, ISS, pelvic fracture and Post urological intervention 14.8% follow-up and 12% had device erosion/ complicating factors. Pelvic fracture 4.3% infection. Fall astride 2.2% 6% of patients had an infection of the Infection 2.2% device (ie infection without erosion).

55.7% had bulbar strictures, and 26.3% Table for P86 penile strictures, for which 25.3% underwent anastomotic urethroplasty, Mean Age Mean ISS Tile B1 Tile B2 Complicating Factors 46.2%, 24.7% and 4% augmentation Conservative 39.7 32 62% 15% 23% urethroplasty, staged reconstruction and (n = 13) perineal urethrostomy respectively. 75% Surgical Repair 40.0 35 63% 38% 38% had no post-op problems but post (n = 8) micturition dribbling and spraying were the commonest voiding issues with <10% having new sexual diffi culties. Conclusion: This audit shows that previous hypospadias surgery is a surprisingly large Conclusions: An AUS can indeed be In the conservatively managed group, 1 contributor to a urethral reconstructor’s successful for the treatment of SWI after perforation failed to heal requiring late workload and that the majority of radiotherapy but whereas the signifi cant repair, no clear cause for this was reconstructive urethral surgery demands complication rate of infection or erosion identifi ed. graft insertion. of the device is 4% in the post-surgical In the group undergoing repair, 1 repair group it is 18% in the post-irradiation failed to heal. 1 developed osteomyelitis of P85 group. the pubis. 1 patient developed a The role of the Artifi cial Urinary vesicovaginal fi stula. Sphincter (AUS) for Incontinence after P86 Conclusion: We have shown that radiotherapy for prostate cancer The management of extraperitoneal conservative management of EBR is E Zacharakis, S Bugeja, DE Andrich, bladder rupture in blunt pelvic trauma associated with high success. There is AR Mundy JJ Durrant, G Heron, M Perry, D Sharma, no clear need for early repair if patients University College Hospitals, London, United A Day, N Watkin are undergoing pelvic stabilization Kingdom St. George’s Healthcare NHS Trust, London, unless there are specifi c indications, United Kingdom such as bones spikes or bladder neck Introduction and Objectives: The AUS is injury. well established as the gold standard for Introduction: Traditional management of signifi cant sphincter weakness incontinence extraperitoneal bladder rupture (EBR) is

P87 Methods: 65 patients with BE were LS was identifi ed (Group A, 23.3%) and Does Clean Intermittent Self indentifi ed. A retrospective chart review compared with a group of patients without Catheterisation (CISC) pose a risk of was performed – data on renal function, synchronous LS (Group B, n = 171, 76.7%). infection/erosion of an Artifi cial Urinary imaging, urinary continence was collected. A subgroup of patients who underwent SSG Sphincter (AUS) in patients with Results: Mean creatinine levels at 20 years reconstruction was also identifi ed. The neuropathic bladder were 89 μmol/L (36 to 149), none required histology reports of graft biopsies obtained S Bugeja, E Zacharakis, DE Andrich, renal replacement. Abnormal renal during follow-up were reviewed and the AR Mundy ultrasounds were reported in 33%. 39 incidence of LS involving the graft was University College Hospitals, London United patients had available data, 26 had urinary recorded. Kingdom diversions and 13 emptied per urethra. Result: Mean age at diagnosis and mean 53.8% with, and 15.4% without diversions duration of follow-up were comparable Introduction and Objectives: To assess the had abnormal renal ultrasounds. between the two groups. No statistically long term results of an AUS ± augmentation Of the 65 patients, 35 had urinary signifi cant differences were noted between cystoplasty and ± CISC to provide bladder diversions, 15 drained the bladder per the two groups with respect to: tumour emptying – for the treatment of urethra (incomplete data for 15). Mean age grade (p = 0.091), stage (p = 0.697) and neuropathic bladder dysfunction. at diversion was 11.2 years (1.5 to 18). 84% presence of lymphovascular invasion (p = Patients: 192 patients were reviewed in required bladder augmentations. 44 0.333). In the subgroup of SSG two groups with a mean follow-up of 14 patients required CISC of which 29 (66%) reconstruction (188 patients), 41 patients years. Group 1 – 150 with an AUS and used a continent catheterizable stoma (21.8%) had histologically-confi rmed augmentation cystoplasty. Group 2 – 42 (CCS), 15 (34%) catheterized the urethra. synchronous LS. In this subgroup, 26 patients with an AUS alone. One patient achieved complete urinary patients (13.8%) underwent graft biopsy Results: 180 patients (94%) were continence with urethral voiding. 5 patients during follow-up. LS involving the graft was continent at a mean follow-up of 14 years. remained incontinent. identifi ed in 7 specimens. None of these There were 20 erosions and 9 device 42 patients had data available on number cases was associated with recurrence of infections all of which occurred in patients of bladder closures, ISC status and site, and PeScc. with a cystoplasty who were using CISC. of these 33 had one closure and 9 had >1 Conclusion: The presence of histologically- 35 of the 115 patients (30%) using CISC, closure. Of those that had one closure only confi rmed synchronous LS in patients whether or not they had a cystoplasty, had one patient did not use ISC to empty, and diagnosed with PeScc is relatively high but infection or erosion. of the remaining 32; 12 emptied per not associated with increased rates of None of the 43 patients with a cystoplasty urethra and 20 used a CCS. Of patients adverse pathological features. LS can who were not performing CISC developed with >1 closure 2 catheterized through the develop in extra-genital skin grafts and its infection or erosion and none of the urethra and 7 by CCS. association with the long-term risk for patients who were not performing CISC, Conclusions: At 20 years renal function is recurrent PeScc needs to be determined. whether or not they had a cystoplasty, preserved, 1/3 have abnormal renal developed infection or erosion. ultrasounds. Urinary diversion increases the P90 In other words, it was the use of CISC that risk of this. 85% of patients are continent Long-term oncological outcome following was the risk factor for infection or erosion – all but one require CISC drainage. conservative surgery for squamous cell of the AUS, not the presence of a carcinoma of the penis cystoplasty. P89 OJ Kayes, P Phillipou, H Goosen, R Nigam, Conclusions: Long term CISC carries a Genital lichen sclerosus in men with A Muneer, P Malone, D Ralph, S Minhas signifi cant risk of AUS infection or erosion. penile carcinoma – a critical analysis University College Hospital London, United This raises the possibility that a OJ Kayes, P Phillipou, H Goosen, R Nigam, Kingdom sphincterotomy might be better than CISC A Muneer, P Malone, D Ralph, S Minhas to provide bladder emptying when an AUS University College Hospital London, United Introduction: Organ-sparing surgery for is to be implanted for neuropathic bladder Kingdom penile carcinoma (PeScc) has been dysfunction ± cystoplasty. advocated as an alternative to penile Introduction: This study aims to assess the amputation. This study aims to assess the P88 incidence of Lichen Sclerosus (LS) in long-term oncological outcome of Bladder exstrophy in adults: a 20 year patients with penile carcinoma (PeScc). It penile-conserving surgery and identify follow up also reports the phenomenon of LS parameters predicting local recurrence. DN Wood, AD Gupta, G De Win, involving non-genital skin grafts in Patients and Methods: A total of 179 CRJ Woodhouse patients who underwent organ-sparing patients treated by organ-sparing surgery University College Hospitals, London, United surgery and split-skin graft (SSG) between 2002 and 2010 fulfi lled the study Kingdom reconstruction. criteria. Local, regional or distant recurrence Patients and Methods: Between 2002 and rates, time to recurrence and survival rates Introduction: This study reports 20 year 2010, 223 men underwent surgical were calculated. Logistic regression analysis outcomes following reconstruction for treatment for PeScc. A group of 52 patients was used to identify predictors of local bladder exstrophy (BE). with histologically-confi rmed synchronous recurrence, including distance between

tumour edge and nearest excision margin fi ne needle aspiration cytology (FNAC) in retrospective studies. EAU guidelines (≤5 mm versus >5 mm). our cohort of newly diagnosed patients and recommend follow-up for 5-years in all Results: Mean follow-up was 42.8 months to analyse any variation in sensitivity of the patients. We aimed to provide more (4–107). 16 (8.9%), 19 (10.6%) and 9 procedure. stratifi ed follow-up arrangements based on (5.0%) patients developed local, regional Patients and Methods: Prospective cohort risk of recurrence in a single supra-network and metastatic recurrence. Mean time to study over 6 years (2004 to 2010). Inclusion centre. recurrence was 26.1, 26.8 and 11.7 months criteria: New diagnosis SCCp, T1G2 or Patients and Methods: Prospective review for local, regional and metastatic disease greater defi nitive histology, non-palpable of all newly diagnosed primary SCCp respectively. The 5-year disease-specifi c nodes in inguinal basin. Exclusion: patient treated surgically from 2000–2011. Tumour survival after recurrence was 54.7% (95% with persistent/untreated local disease. recurrence was defi ned as local, regional, CI, 46.1%–63.3%). For patients with local Sensitivity of the procedure was calculated, distant at least 3 months after defi nitive recurrence, the 5-year disease-specifi c per node basin, per patient, DSNB alone, primary surgery. Inclusion criteria: all survival was 91.7%, compared to 31.6% for USS/DSNB combined. Minimum follow up patients regardless of tumour grade who regional recurrence. The overall 5-year local 12 months. had penile surgery leaving no residual recurrence-free rate was 86.3% (95% CI: Results: 500 inguinal basins in 264 glanular epithelium, clear local margins, 82.6%–90.4%). Tumour grade (p = 0.003), patients underwent USS +/− FNAC and fully staged regional nodes and pathological stage (p = 0.021) and lymphovascular DSNB. 70 (14%) positive inguinal basins in N stage pN0/pN1. invasion (p = 0.014) were identifi ed as 57 (22%) patients were identifi ed. 9 (2%) Results: 228 of 420 (54%) newly predictors of local recurrence on inguinal basins had no tracer uptake. 2 diagnosed SCCp patients met the inclusion multivariate regression analysis. A resection inguinal basins were confi rmed false criteria. All were fully staged and confi rmed margin of <5 mm did not jeopardise negative at 8 and 12 months. 2 inguinal to have N0/N1 nodal status. In the fi rst 12 primary oncological control. basins had positive USS + FNAC and months surveillance there were 5 local, 2 Conclusion: Penile conserving surgery is negative DSNB. Overall sensitivity of the regional and 2 distant recurrences (3.9%). oncologically safe and a surgical excision technique is reported in the table. 2/228 developed late local recurrence (17 margin of <5 mm is adequate. Higher rates and 29 months). Both had G1T1 lesions of local recurrence are associated with Table for P91 locally excised. No patient developed lymphovascular invasion and higher USS +/− FNAC DSNB recurrence after 12 months. The remainder tumour stage and grade. Local recurrence + DSNB alone of the patients remained disease free at a has no negative impact on long term mean of 44 months follow-up. survival. Technical (per 97% 95% Conclusion: For patients who have penile inguinal basin) surgery which removes all glanular P91 Clinical (per 97% 93% epithelium and have been staged N0 or N1, patient) Dynamic sentinel lymph node biopsy in there are few recurrences overall, and the patients with invasive squamous cell majority occur within 12 months of primary carcinoma of the penis: a prospective Conclusion: DSNB in combination with treatment. We recommend maximum study of the outcome of 500 inguinal USS has excellent performance follow-up of one disease-free year for this basins assessed in a single institution characteristics to stage patients with sub-group who represent 54% of all PWL Lam, HM Alnajjar, S La-Touche, clinically node-negative penile cancer with patients with invasive cancer. This will MJA Perry, C Corbishley, J Pilcher, S Heenan, a 3% false negative rate. USS improves reduce the burden of unproductive N Watkin performance by 4% over DSNB alone. There surveillance. All other patients should St George’s Hospital, London, United is no difference in performance of the continue to be followed up for 5-years. Kingdom combined technique if it is reported per node basin or per patient. Introduction: Dynamic sentinel node biopsy (DSNB) in combination with ultrasound scan (USS) has been the P92 technique of choice at our centre since Optimal follow-up arrangements for 2004 for the assessment of non-palpable invasive squamous carcinoma of the penis inguinal lymph nodes in patients with HM Alnajjar, MJA Perry, RW Rees, squamous cell carcinoma of the penis CM Corbishley, NA Watkin (SCCp). Sensitivity/false-negative rates may St George’s Healthcare NHS Trust, London, vary depending on whether results are United Kingdom reported per patient or per node basin and with and without USS. The purpose of this Introduction: Follow-up arrangements for study was to determine the long-term squamous cell carcinoma of the penis outcome of DSNB and ultrasound-guided (SCCp) are generally based on small

Thursday 28 June 2012 BJUI Poster Session 9 SUPPLEMENTS 11:00–12:30 Carron RENAL CANCER Chairmen: Mr Simon Williams & Mr Neil Barber Posters P93–P102

P93 solid lesions; 9 were suggestive of renal cell We retrospectively reviewed the details of Evaluating the role of contrast enhanced carcinoma (RCC) of whom 5 underwent 50 patients and correlated pre-operative CT ultrasound in the assessment of complex Nephrectomy. Three showed no scan imaging with fi nal pathology at renal lesions enhancement and were reassured they nephrectomy for predicting IVC wall P Hughes, R Nair, S Jallad, E Simpson, were benign. Only in one case was the invasion. T Larner lesion still felt to be equivocal necessitating Patients and Methods: Fifty patients with Brighton and Sussex University Hospitals, further imaging. Two cases were post RCC and IVC invasion underwent surgery at United Kingdom cryo-therapy ablation, of which one showed our institution (mean age: 59 years). recurrence not accessible on CECT. CEUS Pre-operative IVC involvement was Introduction: Although contrast enhanced aided clinical decision making in 90% evaluated with triple phase CT. Renal computed tomography (CECT) remains the (19/21) of cases. Tumour thrombus was infrahepatic/ standard imaging modality for renal lesion Conclusion: CEUS is an important adjunct level-I&II : N = 24, intrahepatic/level-III : N = characterisation, occasionally diagnostic to conventional imaging in delineating the 14, or suprahepatic/level IV:-N = 12. uncertainty remains. Contrast enhanced nature of complex solid and cystic renal Patients were classifi ed into those who ultrasound (CEUS) is safe, affordable and lesions, particularly in those in whom required a caval resection with equine non-ionising which can add diagnostic nephrotoxic and iodine based contrast pericardium patch (Group 1) (n = 10) versus value in the assessment of diffi cult cases. agents are contra-indicated. These results those who underwent a nephrectomy and We describe a UK centre case series are comparable with recent studies in other caval thrombectomy without caval experience of this emerging radiological international centres. resection (Group 2) (n = 40). technique. Results: Final histology was T3b = 34, Material/Methods: Between November P94 T3c = 10 and T4 = 6. Preoperative CT scan 2010–August 2011 patients in whom there Can pre-operative CT accurately predict reported IVC wall involvement in 40% (n = was diagnostic uncertainty about equivocal IVC wall invasion in cases with locally 4) [True positives] of patients in group 1. renal lesions or complex cystic lesions advanced renal cell carcinoma? All patients in group 1 had evidence of IVC underwent CEUS using sonovue N Vasdev, E Todd, A Ali, D Manas, D Thomas wall involvement on fi nal histology. The microbubbles. We evaluate how the Freeman Hospital, Newcastle upon Tyne, incidence of reported IVC wall invasion in presence of enhancement infl uenced United Kingdom patients in group 2 was 30% (n = 12) clinical management, along with [False positives] on the pre-operative CT histological correlation where surgery was Introduction: The Surgical management of Scan. performed. renal cell carcinoma (RCC) involving the Conclusion: In this series CT did not Results: 21 patients had CEUS with a inferior vena cava (IVC) remains a technical reliably predict IVC wall invasion median age of 68 years (range 35–89 years) challenge. Whereas CT and MR can identify (sensitivity-30% and specifi city-60%) in following conventional US and or CT the level of thrombus it can be more patients with RCC and IVC tumour imaging, in who diagnostic uncertainty diffi cult to predict caval wall invasion. In thrombus. There remains the possibility of existed. Six were complex cystic lesions, cases with IVC wall invasion, caval unpredicted caval resection and patching of which 3 demonstrated concerning resection and patching may be required and cases must be worked up with this in enhancement. Thirteen cases had equivocal which requires planning and preparation. mind.

P95 P96 P97 Factors predicting oncological outcome in BAUS renal cancer surgical audit 2011: A Cancer Network Audit on partial T3 renal cell carcinoma on behalf of BAUS section of oncology nephrectomy for tumours <5 cm BE Ayres, S Jeyabaladevan, Y Khan, R Issa, A Patel, S Fowler MC Ciuffreda, M Lau, VAC Ramani C Corbishley, CJ Anderson Guy’s and St Thomas’ NHS Foundation Trust, University Hospital of South Manchester, St George’s Hospital, London, United London, United Kingdom United Kingdom Kingdom Introduction: National audit of surgical Introduction: Incidence of RCC is Introduction: TNM classifi cation of T3 management of renal cancer in the UK has increasing, with approximately 60% of renal carcinoma changed in 2009. Renal been limited. The launch of the updated patients diagnosed with cT1 disease. After vein invasion was downstaged to T3a and BAUS cancer registry complex operations radical nephrectomy RN there is an adrenal invasion upstaged to T4. We audit, brings a timely opportunity to increased risk of cardiovascular death. analysed whether these and other capture current surgical management of Partial nephrectomy PN is now considered pathological factors in T3 disease are renal cancer in the UK. the gold standard, including patients with a associated with prognosis. Methods: Data was obtained from BAUS normal controlateral kidney. We wanted to Patients and Methods: Data on 611 renal cancer registry from April-November 2011. investigate the rate of PN and RN cell cancers was recorded prospectively in a Analysis was performed on patient (laparoscopic and open) for all RCCs, with database at our centre since 2000. We demographics and presentation, national particular emphasis to tumours <5 cm. analysed tumour type, size, grade, renal distribution, surgical characteristics and Materials and Methods: From 01/2009 to vein invasion, IVC invasion, adrenal gland outcomes. 12/2010, 454 patients underwent invasion, sinus fat invasion, capsular Results: 657 patients (378 Male, 272 extirpative kidney surgery in a major Cancer breach, tumour necrosis, microvascular female) with a median age 60 (20–90). 50 Network (8 centres). All data from the invasion and lymph node involvement in all institutions entered data with case numbers Pathology Department of each Trust were T3 patients and correlated with survival ranging from 1–56. analysed, and proformas with all the details using Cox proportional hazard statistics. Indication for surgery was malignancy in were completed by surgeons. Attention was Results: 109 patients had stage T3 renal 81%. 29% presented with haematuria. 32% focused on tumours <5 cm, and reasons for cancer. 7 of these had metastatic disease were incidental fi ndings. choice between treatments. and had cytoreductive nephrectomies and 67% of procedures laparoscopic assisted. Results: 441 patients with renal masses were excluded. 82 were male and median 18% of laparoscopic nephrectomies (LN) were treated with PN (191) and RN (250). age was 65 years (range 30–83 years). 24 performed for tumours less than 4 cm. 30% Tumour size was less than 5 cm in 191 pts: patients died of their disease with a median of partial nephrectomies (PN) performed 44% of them had a PN, with the most survival of 392 days. Adrenal gland invasion laparoscopically. common reason for RN being the central was signifi cantly associated with poorer Median length of stay for open (ON) and location (47%), followed by surgeon survival (p = 0.04). Capsular invasion LN procedures were 6 and 4 days opinion/unsure if suitable (27%). patients (p = 0.1), sinus fat invasion (p = 0.9) and respectively. Intraoperative complication declining PN (10%) and a normal renal vein invasion (p = 0.3) (all T3a rates for ON, LN and cytoreductive (CN) controlateral kidney. characteristics) were not associated were 7% ,4% and 14% respectively. There Conclusion: In our cancer network 44% of with survival outcome. Additional was only 1/325 perioperative death patients with tumours <5 cm underwent pathological factors also did not correlate recorded following an LN. PN. Although comparable to literature from with death. 14 patients had partial Median warm ischaemic time (WIT) during other centres, this is still a low rate. Central nephrectomies and, if excluded from the PN in the open and laparoscopic setting location/surgeon opinion were the analysis, adrenal gland invasion (p = 0.04) was 19 and 21 minutes respectively. commonest reasons, and it may be and tumour size (p = 0.04) were both Although WIT exceeded 30 minutes in 15% appropriate to restrict PN to one cancer associated with poorer survival. of laparoscopic and 0% of open PN. In the centre per network. Conclusion: Our fi ndings concur with the context of CN 17% had pre-operative TKi’s. new TNM classifi cation showing a poorer Conclusions: Laparoscopy has been widely P98 prognosis with adrenal gland invasion but and safely introduced in the UK, but Predicting oncological outcomes following not with renal vein invasion. Tumour size length of stay gains are not perhaps yet partial nephrectomy also correlates with poorer survival for as great as anticipated. There may be BE Ayres, O Abeywardena, E Anastasiadis, patients undergoing radical nephrectomies underutilization of partial nephrectomy for C Corbishley, P Le Roux, CJ Anderson for T3 renal cancer. the small renal mass. The goal remains for St George’s Hospital, London, United routine registration of all surgical cases. Kingdom

Introduction: The stage migration of renal cancer has resulted in increased use of nephron sparing surgery. We wanted to determine whether there are any prognostic indicators of oncological outcome following

partial nephrectomy, such as positive Methods: A retrospective analysis of the preference. Intra-operative, post-operative margins, tumour characteristics or effect of PN without hilar-vessel clamping and oncological outcomes were indications for surgery. on renal function and associated blood loss, prospectively collected and reported. Patients and Methods: We analysed our urinary leak and oncological outcomes. Results: Mean patient age was 60 years: prospective renal cancer database assessing Intra-operative haemostasis was by regional tumour size (mean +/− SD) was 29.94 ± whether positive margins, tumour size, type, soft clamp compression to isolate and 2.481 all cT1a-b stage; mean operative time grade and stage, necrosis and imperative or excise the tumour. 165 min; mean blood loss was 71.90 ml; elective indications for surgery were Results: 82 open PN were performed in 79 the average warm ischemia time was associated with recurrence, metastasis or patients (median age 65; range 16 to 85) 25 min. Median hospital stay was 1 night death following partial nephrectomy. between 2001–2011. 72 patients had an in the extraperitoneal group versus 2 nights Statistical analysis used Fisher’s exact test elective indication for PN and imperative in in the transperitoneal approach. 9.5% of and multiple regression analysis. 7 cases. The median tumour size was patients had limited intra-operative Results: 211 partial nephrectomies have 3.8 cm. Blood loss was 50 to 1840 ml and bleeding; all cases managed conservatively, been performed, 172 for cancer of which 14 patients required a blood transfusion. 2 patients were converted to total 157 had greater than 6 months follow-up No patient developed ARF requiring RRT in nephrectomy for bleeding during early and were analysed. 54 were for imperative the immediate post-operative period. dissection. As yet, there is no evidence of indications and 48 were for T1b, T2 or T3 Median percentage decrease in eGFR at one local recurrence nor perioperative morbidity tumours. 4 VHL patients recurred. An year was 9.1%, comparable to other or mortality. additional 3 patients suffered local studies. However, paired t-test for pre- Conclusion: RALPN is an emerging recurrence and a further 3 developed operative and long-term creatinine was not approach in treating small renal tumours metastases. In total, 14 patients died – 1 signifi cant (P > 0.05). Three patients (3.6%) apparently solving some of the technical with aspiration pneumonia following needed invasive intervention for post- diffi culties that were previously completion nephrectomy for recurrence, 11 operative complications. Four patients had encountered with the pure laparoscopy. It is due to non-renal cancer causes and 2 positive surgical margins but none has had possible to tailor the route of surgery to unknown. In particular, pT3 tumours, recurrence at follow-up of 2–6 years. the anatomy of the tumour; however, the papillary subtype and positive margins did Overall recurrence and mortality rate is extraperitoneal approach is possible in most not correlate with outcome. Tumour size 2.5% and 1.2% respectively. cases and is associated with a more rapid was the only variable associated with all Conclusion: PN can be safely performed discharge from hospital. cause mortality (p = 0.01) in a multiple without clamping the renal hilar-vessels regression model. None of the variables thereby minimizing risk of ischemic renal P101 correlated with recurrence once VHL injury. Our oncological outcomes and Zero ischaemia laparoscopic partial patients were excluded. complication rates are low and comparable nephrectomy Conclusion: In our series, partial to other regional and international series F Lynch, S Ahmed, A Rao, G Kooiman, nephrectomy is associated with a good where hilar vessels are routinely clamped. C Brown, P Grange oncological outcome. Tumour grade, stage King’s College Hospital, London, United and type are not associated with outcome, P100 Kingdom nor are positive margins. Patients with VHL Signatured approach to robotic assisted recur. However, larger tumours are laparoscopic partial nephrectomy based Introduction: Minimally invasive surgical associated with poorer overall survival. on tumour anatomy approaches for small renal masses are AM Emara, SS Kommu, A Fernando, considered valid alternatives to open partial P99 RG Hindley, NJ Barber nephrectomy (PN). Renal ischaemia during Aiming for zero ischemia partial Frimley Park Hospital, United Kingdom laparoscopic PN (LPN) is associated with nephrectomy (PN) – why clamp the hilar reduced post operative GFR. We report our vessels? Introduction & Objective: Partial prospective series of zero ischaemia LPN. Z Cheema, A Goyal, J Corr nephrectomy is the established treatment Patients and Methods: All patients had Colchester Hospital University NHS of choice for small renal tumours (<4 cm) pre-operative excision margin planning and Foundation Trust, United Kingdom with even higher demand on those with CT vascular reconstruction of the renal functional or anatomical single renal units hilum, where possible. A transperitoneal Introduction: Partial nephrectomy (PN) or bilateral pathology. The laparoscopic approach with intraoperative hilar remains the preferred treatment for approach is technically challenging and as dissection was utilised to expose renal localised exophytic masses. The a result use of the DaVinci Robot has arterial branches supplying the target area conventional operative technique involves become more widely spread worldwide. that were suture ligated if identifi ed. Intra clamping of hilar-vessels resulting in Materials and Methods: Since October operative laparoscopic ultrasound guided variable ischemic time. The safe duration of 2010 we have treated 30 patients using PN was performed using the Harmonic warm ischemia remains controversial. We this technique, in most of the cases (26/30) ACE™. Methylene blue via a ureteric present our PN series performed without an extraperitoneal approach was used; catheter identifi ed collecting system hilar-vascular clamping to maximize uniquely, the approach being dictated by breaches. The kidney was sutured to control preservation of renal function. tumour anatomy rather than surgeon’s haemorrhage and urine leaks.

Results: 67 LPNs have been performed percutaneous cryotherapy for the complications which were managed with a mean age of 57 yr (20–85) and management of small renal tumours. successfully with selective embolization, tumour size of 39 mm (9–100). 46 were Material and Methods: Prospective data one incisional hernia and one urinary leak. malignant tumours, all had clear margins. were collected on consecutive patients One patient (2%) had papillary necrosis Mean operative time was 307 s (145–540) undergoing renal cryotherapy between (Clavien IV). and blood loss 522 mls (0–2500) with December 2007 and November 2011. The Conclusions: Our data suggest that hospital stay of 6.1 days (2–22). Warm procedure was performed using 1 to 4 cryotherapy is a safe and effi cient ischaemia time was zero for all but 8 cases cryoprobes and involved standard double minimally invasive treatment option for with a mean of 17.9 mins (8–40). 8 cases freeze/thaw cycles. Patients without patients with small renal tumours at the had a segmental artery identifi ed and pre-operative tumour biopsy had immediate short- to intermediate-term follow-up. ligated. 5 cases were stented pre-cryotherapy biopsy. intraoperatively, 5 delayed stents for urine Results: A total of 60 tumours in 50 leaks and 4 Clavien III post operative patients were treated in 57 sessions; 47 complications. Mean pre-operative GFR was laparoscopically with laparoscopic 68 and GFR at 6 months was 64 (p = 0.4). ultrasound guidance and 10 percutaneously Conclusion: LPN with zero ischaemia time (3 ultrasound and 7 CT guided). Two is a reproducible and safe surgical approach patients were successfully treated with to PN with the benefi ts of minimally repeat cryotherapy. invasive surgery whilst reducing the global The mean tumour size was 26 mm ischaemic insult to the kidney. (9–52 mm) and operative time was 203 min (60–420 min). The median hospital stay P102 was 2 days (1–13 days) and no patient Percutaneous and laparoscopic required blood transfusion. Thirty six cryotherapy for small renal tumours patients had renal cell carcinoma (65%), 11 S Ahmed, M Lynch, D Huang, J Wilkins, benign (20%) and 8 equivocal (15%). C Brown, G Kooiman, P Grange At a mean follow-up of 19.4 months, there Kings College Hospital, London, United was one recurrence in a patient with prior Kingdom partial nephrectomy. He was treated sucessfully with radical nephrectomy. Introduction: We report our 4-year There were four Clavien III (7%) experience with laparoscopic and complications including two vascular