Paper Sessions

8 Table of Contents

BAUS Annual Meeting, 17–20 BJUI June 2013, Manchester Central Paper Sessions

Tuesday 18 June Paper Session A 1400–1530 Charter 1 PROSTATE CANCER DIAGNOSIS Chairs: Professor Martin Gleave & Mr William Cross Papers A1–A9

Wednesday 19 June Paper Session B 1330–1430 Charter 1 GENERAL UROLOGY Chairmen: Mr Peter Malone & Mr Toby Page Papers B1–B7

Tuesday 18 June BJUI Paper Session A 1400–1530 Charter 1 PROSTATE CANCER DIAGNOSIS Chairs: Professor Martin Gleave & Mr William Cross Papers A1–A9

A1 We then compared cancer yield in 50 Conclusion: Visualisation of each biopsy 3 D Visualisation of biopsy consecutive cases of positive prostate trajectory signifi cantly increases cancer trajectory and its clinical impact biopsies in the 2D vs. the 3D group (Part 2 detection rates and allows for a more in routine diagnostic TRUS guided of the study) through sampling of the prostate. Not only prostate biopsy Results : Th e results are tabulated as does this have a role in targeted biopsies K Narahari, A Peltier, R Van Velthoven follows but also in routine diagnostic biopsies. University Hospital of Wales, United Kingdom

Introduction and Aims: Transrectal ultrasound (TRUS) guided biopsy remains Part 1 the gold standard in prostate cancer Parameter 2D USS* 3D USS*** P value diagnosis however prostate remains n = 110 n = 110 Student’ s t test perhaps the only solid organ where biopsy Age in years 64 (46–90) 65 (46–84) NS is “blind”. Traditionally the surgeon would Mean (Range) prepare a “mental image” of the prostate PSA ng/ml 9 (0.5–70) 10 (0.5–59) NS and target his biopsy cores evenly to map Mean (Range) out the prostate as best as possible. Th is Prostate volume, cc 47 (16–160) 51 (20–145) NS method is not only random but also open Mean (Range) to signifi cant operator bias and no real way DRE positive 33 36 of checking for accuracy. Family history positive 10 13 In contrast, a 3D USS reconstruction of the Cancer detection rate 3450 0.04 prostate allows for visualisation of each biopsy core trajectory ensuring accuracy, *BK Medical systems, *** Sonoace X8, Medison/ Koelis completeness and most importantly brings quality control to the biopsy protocol. Th e aim of our study was to assess the P a r t 2 A2 impact of 3D USS in routine diagnostic Repeat prostate biopsy strategies prostate biopsy and its eff ect on cancer Parameter 2D USS 3D USS P after initial negative biopsy: detection rates. n = 55 n = 55 value meta-regression comparing Methods : We compared a case matched Gleason NS cancer detection of transperineal, cohort of all consecutive patients attending grade transrectal saturation and MRI for diagnostic prostate biopsies before and ≤ 6 61 56 guided biopsy aft er the introduction of the 3D USS 72832 AW Nelson, RC Harvey, RA Parker, A Doble, system (Part 1 of the study). All biopsies ≥ 8 11 12 C Kastner, VJ Gnanapragasam were performed by a single experienced % Of cores 8.6 35.66 0.03 Addenbrooke’ s Hospital, United Kingdom surgeon using the exactly the same involved standard 16 core biopsy protocol in both Introduction : Th ere is no consensus on cohorts. how to investigate men with negative

© 2013 The Authors BJU International © 2013 BJU International | 111, Supplement 3, 9–16 9 10 Papers Abstracts transrectal ultrasound guided prostate A3 A4 biopsy (TRUS-B) but ongoing suspicion of Repeat prostate biopsy after initial Could use of MRI in men referred cancer. Th ree strategies used are benign standard biopsies – for risk of prostate cancer result in transperineal (TP-B), transrectal saturation comparison of 3 advanced a reduction of biopsy related (TS-B) and MRI-guided biopsy (MRI-B). techniques; MRI / TRUS fusion morbidity when compared to the We compared cancer yields of these transperineal, transperineal sector, ERSPC and PCPT risk calculators strategies. extensive transrectal prostate for decision to biopsy? Methods : Systematic literature search biopsies (MD A nderson protocol) J Dockray, J Coe, V Abu, A Freeman, C Allen, identifi ed studies investigating biopsy RL Lombardo, AC Cantiani, THK Kuru, M Emberton, C Moore Royal Hampshire County Hospital, United diagnostic yield in men with at least one KSB Saeb-Parsy, AN Nelson, BK Koo, VG Gnanapragasam, AW Warren, AD Doble, Kingdom negative TRUS-B and ongoing suspicion of BH Hadaschik, CK Kastner cancer. Age, PSA, number of previous Addenbrooke’ s Hospital, Cambridge, United Introduction : Th e widespread use of PSA biopsy episodes, number of cores at Kingdom testing has increased referrals for suspected re-biopsy, cancer yield, and Gleason score prostate cancer with numerous strategies of detected cancers were extracted. Introduction : Large cohorts of men are proposed to more accurately predict clini- Meta-regression analyses compared these faced with uncertainty following previous cally signifi cant cancer. We compared the data. benign biopsy with ongoing concern due European Randomised Study of Screening Results : Forty-six studies were included rising PSA or changes suspicious for cancer for Prostate Cancer (ERSPC) and Prostate (4,657 patients). Th ere were no signifi cant in previous biopsies. We compared detec- Cancer Prevention Trial (PCPT) risk calcu- diff erences in PSA or number of previous tion rate of 3 prostate biopsy techniques lators with the use of MRI to aid the biopsy biopsy episodes. Th e mean number of performed in 2 centers: MRI/TRUS fusion decision. biopsy cores obtained by TP-B and TS-B transperineal prostate (MTTP), transperi- Methods : 217 men referred via the ‘2 were signifi cantly greater than MRI-B. neal sector (STP) and extensive transrectal week wait’ pathway were off ered a Cancer detection rates were 29·8%, 35·7%, prostate biopsies (MD Anderson protocol; multi-parametric MRI prior to a discussion and 37·6% for TS-B, TP-B, and MRI-B MDA) regarding biopsy. Th e ERSPC and PCPT respectively. Meta-regression analysis Materials and Methods : 738 patients were risk calculators were applied to compare showed that TP-B and MRI-B had similar identifi ed retrospectively: 201 patients how many patients would have undergone cancer detection but both performed better underwent MTTP biopsies, 188 patients biopsy using a calculator. Th e predicted than TS-B. In a sensitivity analysis STP biopsies and 349 MDA biopsies. biopsy-related morbidity was calculated incorporating previous biopsy episodes (36 Patients undergoing MTTP biopsies had a using data from the ProtecT study (Rosario studies) this was not maintained, resulting multiparametric MRI prior to the biopsy: et al, 2012.) in no diff erence in cancer detection suspicious lesions on MRI were contoured Results : Data for formal risk calculation between the groups. Th ere were no and the image was fused to a live was available for 167 men. Of these, signifi cant diff erences in median Gleason transrectal ultrasound image for guidance 104(52.2%) chose biopsy aft er a discussion scores detected. of lesion biopsies using BiopSeeTM; STP incorporating MR fi ndings into prostate Conclusions: In the re-biopsy setting, it is biopsies were taken dividing the prostate cancer risk assessment. 70/104(67.3%) had not clear which strategy off ers the highest into six sectors for guidance. MDA biopsy cancer, of which 49/70(70%) was clinically cancer detection rate. TP-B and MRI-B involved sampling of peripheral and signifi cant. Use of the PCPT or ERSPC may detect more cancers than TS-B. transition zones as well as standard sextant calculator to inform the biopsy decision MRI-B achieves this with fewer cores than biopsies. Low grade disease was defi ned as would have resulted in 166(99.4%) and ≤ + TP-B. Well–designed prospective cohorts Gleason 7(3 4) and high grade disease 147(88%) of men having a biopsy. ≥ + with standardised outcome measures are as Gleason 7(4 3). Use of MRI to inform the decision to needed to compare these three modalities Results : Th ere was no statistical diff erence biopsy resulted in fewer biopsies than and defi ne an optimum re-biopsy between the groups in relation to mean would have been suggested by either approach. age, mean PSA and mean prostate volume. calculator. Th e mean number of cores for MTTP was Th e reduction in biopsies using an MRI ± ± 27 5 and for STP 34 16. Cancer based approach is predicted to have detection rate in the MTTP group was avoided biopsy-related morbidity by the 107/201(53%), 79/188(42%) in the STP absolute numbers in the table below. group and 106/243(30%) in the MDA group (p = 0.0005). Detection rate of high grade disease was 40/107(37%), 22/106(21%) and 20/79(25%) respectively(p = 0.031). Conclusions: Our data suggests MTTP has a higher cancer detection rate and higher proportion of high grade disease compared to transrectal and transperineal biopsy techniques without MRI guidance.

Table (for A4) Patients & Methods: Patients who underwent anterior lobe prostate biopsies PCPT ERSPC following previous negative standard or Present Moderate/Severe Present Moderate/Severe saturation biopsies and multi-parametric Pain 27.0 4.5 18.7 3.1 MRI scans were identifi ed and their results Fever 10.9 3.4 7.5 2.4 analysed to determine detection rate of Haematuria 40.8 3.8 28.3 2.7 prostate cancer using these techniques. Haematospermia 57.4 16.5 39.8 11.4 Results : 35 patients who had anterior lobe Haematochezia 22.8 1.6 15.8 1.1 prostate biopsies and subsequently underwent multi-parametric MRI scans were identifi ed. 32 had a prostate tumour

Conclusions: Use of the risk calculators (p < 0.0001, X 2 trend test ). Relative to an detected on MRI in the anterior lobe. 26 of compared to pre-biopsy MRI would result MRI score of 3, the odds ratio of detecting these patients had positive histology on in signifi cantly higher numbers of men clinically signifi cant cancer for an MRI anterior lobe prostate biopsy. Th ese results undergoing prostate biopsy and increased score of 4 was 3.0 [95% CI 1.4–6.6] and for produced a sensitivity and specifi city of average numbers of cores taken. Th is leads an MRI score of 5 was 9.6 [ 95% CI 100% with a positive predictive value of to higher costs and a predicted increase in 3.9–23.8] (Table 1). 81.25%. 6 patients had negative anterior biopsy related morbidity. Conclusion: mpMRI is a useful imaging lobe prostate biopsies following positive modality for the detection of clinically MRI scans. 3 patients with normal MRI A5 signifi cant prostate cancer. Th e higher the scans also had negative anterior lobe Multiparametric MRI in the suspicion of prostate cancer on mpMRI, prostate histology. diagnosis of prostate cancer: the more likely clinically signifi cant cancer Conclusion : Th e combination of trans- a validation study of the is detected. perineal anterior lobe prostate biopsies and E uropean C onsensus M eeting R isk S coring S ystem Table 1 (for A5). Number of men with clinically signifi cant cancer based on V Kasivisvanathan, R Dufour, CM Moore, mpMRI score HU Ahmed, M Abd-Alazeez, SC Charman, MRI Score CSC No CSC Odds of Odds ratio of detecting CSC A Freeman, C Allen, A Kirkham, J van der Meulen, M Emberton detecting CSC relative to odds for MRI score 3 University College London, United Kingdom MRI score 3 13 32 0.4 1.0 MRI score 4 43 35 1.2 3.0 [95% CI 1.4–6.6] Background : A European Consensus MRI score 5 47 12 3.9 9.6 [ 95% CI 3.9–23.8] Meeting has recommended a 1–5 scoring = system for suspicion of prostate cancer on CSC Clinically signifi cant cancer multi-parametric MRI (mpMRI). Th is study A6 multi-parametric MRI scanning is a assessed whether greater suspicion of cancer The use of anterior lobe prostate valuable technique to diagnose prostate on mpMRI correlated with greater detection biopsies and multi-parametric MRI cancer in men with diffi cult to detect but of clinically signifi cant cancer. to detect prostate cancer in men highly suspected disease which can easily Methods : 182 men with clinical suspicion with negative standard or be implemented in any urology unit. of prostate, who scored 3 (‘equivocal’), 4 saturation biopsies and rising (‘likely tumour’) or 5 (‘very likely tumour’) PSA on the 1–5 scale of suspicion of prostate HJ Bekarma, M Mohammed, R Nairn, cancer on mpMRI, underwent G Hollins, R Clark, R Meddings, M Gurun A7 transperineal targeted biopsies of University Hospital Ayr, United Kingdom Does P rostate H istoscanning™ suspicious lesions. Th e linear trend accurately predict tumour volume between suspicion of prostate cancer on Introduction : Th e use of multi-parametric and position in men undergoing mpMRI (3, 4 or 5) and the detection of MRI scans has signifi cantly improved radical prostatectomy? clinically signifi cant cancer was assessed the detection of prostate cancer in men S Javed, E Chadwick, S Beveridge, S Bott, using Chi-squared trend test. Clinically with disease located in the anterior lobe C Eden, S Langley signifi cant cancer was defi ned by at least that has been undetected on previous Royal Surrey County Hospital, United Kingdom one biopsy core containing maximum standard trans-rectal ultrasound guided cancer core length 3 4 mm and/or Gleason prostate biopsies. We suggest the Objective: Prostate HistoscanningTM (PHS) Grade 3 3 + 4. combination of MRI and focussed anterior is a novel technology in which a transrectal Results : Population mean age was 63 lobe prostate biopsies as a valid tool ultrasound probe scans the prostate. PHS years old, median PSA was 6.7 ng/ml and for detecting cancer in men with rising soft ware characterises the 3 dimensional median number of targeted cores taken per PSA and previous negative histology. radiofrequency data and produces signa- lesion was 5. Anterior lobe prostate biopsies are tures for various tissue morphologies. Th e As the score of suspicion of prostate cancer performed under general anaesthetic objective of this independent study was on mpMRI increased, the detection of via the perineum with trans-rectal to evaluate the role of PHS in the preoper- clinically signifi cant cancer also increased ultrasound guidance. ative assessment of tumour volume and

© 2013 The Authors BJU International © 2013 BJU International | 111, Supplement 3, 9–16 11 12 Papers Abstracts pathological stage when compared to radical Objective: To assess the relationship A9 prostatectomy (RP) histology. between urinary Engrailed-2 (EN2) levels D ’ Amico risk stratifi cation Patients and Methods: 41 patients prior to radical prostatectomy with tumour outperforms published active scheduled for RP were screened for volume and pathological characteristics in surveillance selection criteria from recruitment between July 2011 and Jan radical prostatectomy specimens. EN2 is the USA as a way to identify 2012. 31 patients were eligible and 24 were homeodomain containing transcription patients with indolent prostate suitable for fi nal analysis. Th e index test factor secreted by prostate cancer cells and cancer in a relatively unscreened was PHS, immediately prior to scheduled not by normal prostate cells and belongs to UK population RP. Th e reference test was histological HOX genes family. GL Shaw, B Thomas, S Dawson, S Vowler, analysis of whole mount RP specimens. Materials and Methods : Early morning V Gnanapragasam, NC Shah, DE Neal Cambridge University NHS Trust, United Results : A total of 144 prostate sextants fi rst pass urine samples (10 ml) without Kingdom from 24 patients were examined (Pearson prior digital rectal examination were coeffi cient for all sextants 0.14). No collected from 57 patients and stored at Introduction : Eligibility criteria for active correlation was observed between PHS and –80°C. EN2 levels were measured using an surveillance are based on data from pathology for total cancer volumes enzyme-linked immunoabsorbent assay. screened populations where stage (Pearson coeffi cient of -0.099). Th e Tumour volume in the prostatectomy migration renders the patient cohort sensitivity and specifi city of PHS in specimens was determined histologically. dissimilar to UK patients. We evaluate the > detecting foci 0.5 ml were 37% and 71%, Results : 57 men undergoing RP in one performance of 6 diff erent methods to respectively. Th e Pearson correlation urological cancer network were evaluated. identify indolent disease in a UK cohort. coeffi cient for index lesion volume EN2 was detected in 85% of RP patients. Methods : 848 patients (including 445 identifi ed at pathology versus PHS was EN2 correlated with tumour volume (but patients with Gleason 3 + 3 prostate cancer -0.065. PHS failed to accurately locate EPE not total prostatic volume) in a linear on initial biopsy) underwent robotic with only 4.9% of the sextants matched for regression analysis, with increasing radical prostatectomy between July 2007 its presence. pathological T stage and margin positivity. and October 2011. Follow up data was Conclusions : Previous manufacturer Using three ‘cutoff levels’ of tumour available for 841. 5 published criteria to sponsored studies have shown positive volume (0.5 ml, 1.3 ml and 2.5 ml) to defi ne identify insignifi cant disease in candidates results in highly selective patients. Th is ‘signifi cant disease’, men with ‘signifi cant for active surveillance were identifi ed and independent study assessing the value of disease’ had markedly higher levels of the ability to predict insignifi cant disease < PHS in routine clinical practice reveals that urinary EN2 (p 0.001 for each cut off and low grade organ confi ned disease PHS fails to identify the total tumour level). compared with D ’Amico risk stratifi cation volumes, tumour volumes by prostate Conclusions: Urinary EN2 levels closely (Gleason score 6, no grade 4/5, PSA 2 10, sextants, the location and volume of index correlated with tumour volume in cT1/T2a) using univariable Cox regression. lesions, and the presence and location of prostatectomy specimens. Levels of AIC (Akaike information criterion) and EPE. urinary EN2 may be useful in predicting BIC (Bayesian information criterion) were tumour volume in men with prostate used to compare the ‘goodness of fi t’ of the cancer by potentially identifying men A8 six non-nested models. Area under the with small volume ‘insignifi cant’ disease. Urinary E ngrailed-2 (EN 2) levels curve (AUC) of the receiver operator Th is may help in critical decision making and their correlation with tumour characteristic curve was calculated. in the management of PC patients when volume and pathological tumour deciding between active surveillance vs stage in men undergoing radical radical treatment. Th is study justifi es a prostatectomy for prostate cancer S Javed, H Pandha, R Morgan, S Bott, C Eden, larger multicentre evaluation of urinary S Langley EN2 levels as a biomarker of PC Royal Surrey County Hospital, United Kingdom signifi cance.

Results (for A9): Approach Patients with Gleason Insignifi cant cancer, updated Organ-confi ned low-grade 3 + 3 on biopsy meeting defi nition cancer criteria for AS n(%) Sens Spec PPV NPV AUC Sens Spec PPV NPV AUC Tosoian 2011 46 (10.3) 0.17 0.94 0.28 0.89 0.55 0.14 0.95 0.52 0.75 0.55 Adamy 2011 157 (35.3) 0.45 0.76 0.21 0.91 0.60 0.43 0.79 0.43 0.79 0.61 Van den Bergh 2009 67 (15.1) 0.22 0.91 0.26 0.89 0.56 0.20 0.93 0.51 0.76 0.56 Whitson 2011 184 (41.4) 0.51 0.69 0.19 0.91 0.60 0.48 0.72 0.39 0.79 0.60 Soloway 2010 114 (25.6) 0.35 0.84 0.23 0.90 0.59 0.30 0.85 0.43 0.77 0.58 D ’Amico 1998 286 (64.3) 0.56 0.69 0.21 0.92 0.63 0.58 0.75 0.47 0.83 0.67 Any criteria 305 (68.5) 0.69 0.50 0.17 0.92 0.60 0.70 0.54 0.36 0.83 0.62 All criteria 45 (10.1) 0.14 0.96 0.33 0.89 0.55 0.12 0.97 0.62 0.75 0.55

Conclusion: D ’ Amico performs best at predicting insignifi cant (modifi ed defi nition) or Gleason 6 organ confi ned disease according to AIC, BIC and AUC, however, all 6 methods have a poor PPV. Our dataset included only 2 classically defi ned insignifi cant tumours of less than 0.5 cm3 rendering further analysis impossible. Th is refl ects diff erences between our UK cohort and screened USA and European cohorts in which these criteria were developed and validated. Low AUR values underline the need for a biomarker of indolent prostate cancer, and justify further investigation with confi rmatory transrectal biopsy, transperineal biopsy or MRI prior to embarking on an active surveillance program.

Wednesday 19 June BJUI Paper Session B 1330–1430 Charter 1 GENERAL UROLOGY Chairmen: Mr Peter Malone & Mr Toby Page Papers B1–B7

B1 and were more likely to result in increased 36(16%) were 1–5 mm, 144(65%) were 8 years experience of Holmium length of stay ( >2days). 5–10 mm, 28(12%) were 10–15 mm, 8(4%) enucleation of the prostate Conclusion: HoLEP appears safe and were 15–20 mm and 6(3%) were > 20 mm O Nehikare, M Goldstraw, S Michael, eff ective treatment for BPE. It appears to with a CR of 61%, 55%, 18%, 13% and A Zakarian, Y Beebeejaun, R Popert have a low retreatment rate. Age is not a 50%. 173(78%) were renal stones and Guys ’ Hospital, London, United Kingdom predictive of complications although it 49(22%) ureteric with a CR of 49% and does impact on length of stay. 51%. For kidney stones, 15(9%) were in the Introduction : Holmium enucleation of upper, 32(18%) in the mid, 75(43%) in the the prostate (HoLEP) is an established [Correction added on 4 June 2013 aft er lower pole and 51(30%) in the pelvis with surgical technique for men with bladder fi rst online publication: Th e author list has a CR of 52%, 59%, 49% and 41%. For outfl ow obstruction secondary to benign been updated to include O Nehikare.] ureteric stones, 32(65%) were in upper, prostatic enlargement (BPE). We present 10(20%) in mid and 7(15%) in lower ureter our experience of performing HoLEP over with CR of 47%, 70% and 43%. B2 an 8year period at a single institute. Conclusion : Our results demonstrated The effi cacy of a mobile lithotripsy Peri-operative variables were recorded that the mobile ESWL performance is service: A one-year review of including age, operation time, enucleation signifi cantly poorer than expected. Th is 222 patients weight and length of stay. A prospectively S Nafi e, JA Dyer, MA Khan, J Minhas, MA Khan may be related lack of clinical ownership. recorded database was maintained. We University Hospitals of Leicester NHS Trust, We believe such a service should be attempt to identify predictive factors for United Kingdom permanently placed on-site. complications and increased length of stay. Methods : Prospective data was collected Introduction : Extracorporeal shock wave B3 for patients undergoing surgery from 2004 lithotripsy (ESWL) is the management of The complications of ≤ – September 2012 with retrospective data choice for ureteric and renal stones 20 mm laparoscopic renal surgery, a ten analysis. All patients were operated on by a with stone clearance rate (CR) up to 89% year review. On behalf of the BAUS single surgeon experienced in this (EAU guidelines). We determined whether section of endourology technique and beyond the initial learning such a high success rate could be applied to MJ Fabricius, S Fowler, AJ Dickinson curve for this procedure. centres using mobile ESWL by reviewing Derriford Hospital, Plymouth, United Kingdom Results : Overall, 458 patients were treated the performance at our centre that provides by HoLEP surgery. Mean follow-up was 5.2 such a service. Introduction : Th e BAUS laparoscopic years (3–90 months). Mean age was 69.4 Patients and Methods: Between July 2011 nephrectomy database has been running years old and mean enucleation weight was and July 2012, 222 patients (mean age: 52.5 since the year 2001 and all UK Consultants 82 g (8–367 g). Overall complication rates years, range: 19–89) underwent 1–5 are invited to submit data prospectively. were acceptable at 15.6% with the urinary sessions of ESWL for ureteric and renal Th ese data provide a valuable insight into incontinence (5.2%), urethral stricture stones (mean size: 15 mm, range 4–22). complication rates for these commonly (3.0%) and infection (1.5%) most common. Stone clearance was regarded for residual performed procedures. Retreatment rates were low at 4.1%. Th ere fragment ≤ 2 mm aft er completion of Patients and Methods: Data were was no correlation with advancing age and sessions. obtained from the BAUS cancer registry increased risk of incontinence, of the 47 Result: A total of 110/222(49%) patients for laparoscopic renal surgeries completed patients over the age of 80 only 2 patients were stone clear. 198(89%) were between 1 st January 2002 and 31 December (4.2%) were incontinent. However, this radiopaque, 24(11%) were radiolucent with 2011. Prior to 2010, complications were subgroup were more likely to fail to void CR of 48% and 63%. Regarding sizes, recorded as free text. From 2010, only

© 2013 The Authors 14 BJU International © 2013 BJU International | 111, Supplement 3, 9–16 Papers Abstracts 15 limited defi ned complications were statistics and regression analyses were and 0–10 min post-procedure]. 15 ml of the recorded. All free-text complications conducted. blood was used for the ‘culture-method’ recorded were retrospectively classifi ed Results : Preliminary analysis from the and it was inoculated into BACTECª Plus according to the post-2010 system to allow fi rst 181 men are reported. Mean Aerobic and Anaerobic culture vials, for analysis of the entire data set. depression and anxiety scores were 3.31 incubated for 10 days and subcultured on Results : Data for 13,118 laparoscopic (SD = 3.569) and 4.63 (SD = 3.791), day 10. Bacterial identifi cation was done nephrectomies, carried out at 175 centres, respectively . 14.9% (n = 24) of cases met using 16 S PCR. Th e remaining 5 ml of were analysed. Th e median patient age was the HADS criteria (score ≥ 8) for clinical blood was used for the ‘molecular method’ 63. Th e median operating time was 155 depression and 22.36% (n = 36) for and it was used to extract bacterial DNA, minutes. anxiety. General population rates of using the MolYsis Complete5 kit by Th e overall complication rate was 18.2%. anxiety and depression for men aged over Molzym TM. Broad-range 16 S PCR Th is fell from 24% in 2002 to 14.3% in 65 are 8% and 6% respectively. Regression (Mastermix 16 S by MolzymTM ) and 2011. 30-day mortality was 0.6% (67 analysis showed that those who left school Multiplex PCR (Plex-ID by AbbottTM ) were deaths). before the age of 15 had higher depression performed. Sequencing and mass- Th e intra-operative complication rate was scores than those who completed spectrometry were respectively used for 2.9%. Intra-operative bleeding was secondary education (p = 0.022). Older bacterial identifi cation. A pre-procedure reported in 216 cases (1.6%), 36 bowel men had lower levels of anxiety (p = urine sample was also cultured. A injuries (0.3%), 25 splenectomies (0.2%) 0.069). Relationship status was a signifi cant follow-up telephone interview at 3 months and 9 liver injuries (0.1%) and 3 pancreatic predictor of anxiety (p = 0.05). was conducted. injuries were reported. Intra-operative Conclusion: Men on active surveillance Results : 50 patients were recruited with a complication rates pre- and post-2010 were are almost twice as likely to be depressed total of 276 blood samples. Th e mean age comparable. 6.2% of operations were and three times as likely to be anxious as was 71.1 years. 16 patients developed converted to open procedures. the general population of men aged over asymptomatic bacteraemia (32.0%), with From 2010 the most common post- 65. Given the high incidence of prostate 38 out of the 276 blood samples (13.8%) operative complication was chest-infection cancer and the increasing use of AS, these being positive. Th e main organisms (2.2%), followed by ileus (1.4%) and results suggest the need for a framework to detected were P. aeruginosa , E. faecalis and wound-infection (1.3%). Analysis of better identify and manage their S. agalactiae. Out of the 16 patients with post-operative complications prior to 2010 psychological distress to minimize bacteraemia, 12 had pre-operative is ongoing; complication rates pre- and unnecessary radical intervention. bacteriuria, with the main organisms being post-2010 appear to be comparable once P. aeruginosa and E. faecalis . 2 patients had reclassifi ed. B5 symptomatic bacteraemia ( S. epidermidis Conclusion: Laparoscopic renal surgery is Bacteraemia during TURP : and E. faecalis) in the immediate post- safe, and major complications are rare. is it more prevalent than operative period. 13 out 50 patients (26%) previously thought? required therapeutic antibiotics within 3 AR Mohee, D Gascoyne-Binzi, JAT Sandoe, months of the procedure. 8 of these I Eardley patients (61.5%) were bacteraemic during B4 The Leeds Teaching Hospitals NHS Trust, United Kingdom their procedure. The prevalence of depression and Conclusion : Th is study shows a higher anxiety in men undergoing active Introduction : Th e incidence of bacteremia incidence of bacteraemia peri-TURP than surveillance for prostate cancer post TURP with antibiotics prophylaxis is previously reported. Bacteraemia occured SD Watts, G Lewith, G Leydon, E Arden-Close, reported at 1%. In a separate study, we have B Birch, CM Moore, A Ridout, A Richardson in spite of the antibiotics prophylaxis Primary Medical Care, Aldermoor Health shown a statistical association between uro- regimen. Th is increased bacteraemia rate Centre, Southampton, United Kingdom logical procedures and infective endocardi- may be owing to the design of the study. tis. We therefore sought to investigate the Th e signifi cance of transient bacteremia in Introduction : Active surveillance (AS) is rate of bacteraemia during TURP in a relation to more serious infective an attractive treatment option for men diag- contemporary series, using contemporary complications like infective endocarditis is nosed with low risk prostate cancer. Th ese culture and molecular methods to detect not known. men commonly express concern about bacteraemia. living with an untreated cancer, and greater Methods : We conducted an ethically B6 anxiety and depression are associated with approved prospective cohort study of Histology following paediatric transfer to potentially unnecessary radical patients undergoing TURP. A focused circumcision for phimosis: Is treatments. We report the largest cross-sec- medical history was obtained. All patients this useful? received 160 mg IV gentamicin tional survey to date, completed in Decem- R Krishnan, AA Adeniran, E Bunova ber 2012, evaluating depression and anxiety prophylaxis. 20 ml of blood was obtained at Kent and Canterbury Hospital, United in AS. 5–6 diff erent time points [pre-procedure, Kingdom Materials & Methods: 338 men on AS when the urethral catheter was removed in completed the Hospital Anxiety and urinary retention patients, 5 minutes into Introduction : Th e foreskin is routinely Depression Scale (HADS) and a the procedure, 10 minutes into the sent for histology by Urologists performing demographic questionnaire. Descriptive procedure, 20 minutes into the procedure, circumcision in children at our institution.

Th ere are no guidelines to recommend the treatment of prostate cancer; this large this practice. Th is study was undertaken to observational study aimed to fi ll that void. assess: Patients & Methods: 34,515 men were a ) Th e pathology underlying phimosis in treated for prostate cancer throughout paediatric patients. Sweden with either surgery (n = 21,533) or b) Proportion of BXO as a cause and radiotherapy (n = 12,982). Th e dataset has correlation of clinical and histological >98% completion on age, PSA, year of diagnosis. treatment, clinical TNM stage, Gleason/ c) Usefulness of foreskin histology in this WHO grade, county of treatment, marital g r o u p . status, Charlson co-morbidity index (CCI), Materials and Methods : Th e clinical notes and educational/ socioeconomic status. and histology of the foreskin of all Patients were categorized by risk group, paediatric patients undergoing age, and CCI; cumulative incidence curves circumcision from 2008 to 2012 was for prostate-cancer-mortality (PCM) and reviewed retrospectively. other-cause-mortality (OCM) were Result: In the 5-year period from 2008 to derived. Competing risks regression 2012, a total of 212 paediatric patients hazard ratios for radiotherapy versus underwent circumcision for phimosis. Of surgery were computed with and without these, 180 (85%) had Chronic adjustment. Infl ammation, 21 (10%) had BXO, 5 (2%) Results : PCM became a larger proportion had Fibrosis without Infl ammation and 6 of overall mortality as risk group increased patients (3%) had a normal histology. for both the surgery and radiotherapy Twenty six (14%) patients thought to have cohorts; for localized prostate cancer BXO pre-operatively had chronic patients survival outcomes favored infl ammation only. BXO was clinically surgery, and for locally advanced/ diagnosed correctly in all cases. Although metastatic patients treatment results were BXO was clinically over diagnosed, it was similar. Th e only cohort in which not missed. Th ree patients (1%) of the 212 radiotherapy had superior PCM outcomes presented with meatal stenosis and was those aged 65–74 with non-localized required surgery. Two had BXO whilst one disease. did not. Conclusions: Surgery may be superior to Conclusion: BXO caused phimosis in 10% radiotherapy in terms of prostate cancer of our paediatric patients. Th e majority survival for the majority of men with (87%) had infl ammation or fi brosis only. localized prostate cancer. Radiotherapy In 3% of cases, the histology was normal. appears at least equivalent to surgery for Since the histology does not change the men with non-localized disease. Age and follow-up protocol or the management and co-morbidity also seem to play a part in since dysplasia or malignancy in children the comparative eff ectiveness of treatments is unknown, there is no merit in sending for prostate cancer. the foreskin for histology in paediatric patients.

B7 Comparative oncologic effectiveness of surgery and radiotherapy in prostate cancer: an analysis of mortality outcomes in 34,515 patients treated with up to 15 years follow-up P Sooriakumaran, L Haendler, T Nyberg, I Heus, M Olsson, S Carlsson, O Akre, MJ Roobol, G Steineck, P Wiklund Karolinska University Hospital, Stockholm, Sweden

Introduction & Objectives : No high quality data exists that compares survival outcomes of surgery versus radiotherapy in