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15-17 December 2016

Abstract Book

Dubai International Convention & Exhibition Centre | UAE

Case Based Abstracts

DAY 1 | 15 December 2016, Thursday | 08:30 – 09:30

CA - 1

Supracostal PCNL: An anatomic perspective

Dr Syed Mamun Mahmud 1Lifecare Hospital

Background and Purpose: PCNL is known to provide best stone free rate among all available treatment for Renal stones. And now it has been recommended as ‘standard’ for larger (>20 mm) renal stones. On most of the occasions, access into kidney is acquired Subcostally. However at times for better clearance of stones, because of multiplicity or load Pelvicalyceal System is accessed Supracostally. In Supracostal access, thoracic complications are the most concerning morbidity. The current presentation is aimed at sharing the experience through an audit of cases of PCNL with Supracostal access, literature review and a limited work on Cadaver Model emphasizing on anatomic perspective in access. Method: Records of all patients who underwent PCNL from June 2004 to August 2016 at the Kidney Centre Karachi, Pakistan and Lifecare hospital Abu Dhabi, UAE were reviewed. Patients where access was acquired through Supracostal Approach were identified. Data regarding demographic details, stone burden, clearance with primary PCNL, need for auxillary procedures like ESWL, Secondary PCNL or URS and complications were recorded and analyzed. Results: There were total of 425 patients who underwent PCNL. Sixty-nine out of 425 underwent PCNL through Supracostal Approach . One out of Sixty-nine had SupraXI access rest SupraXIIth only. Majority of the stone were multiple (70.1%). Clearance with Primary PCNL was 62% that

improved to 87.5% with ESWL combination for residual stone. The overall complication rate was 4.7% with 2.9% significant bleeding, 4.4% pleural effusion, 1.4% stone migration requiring URS and 2.9% persistent nephrostomy site leakage requiring DJS insertion. Conclusion: •Supracostal PCNL is a safe and effective approach for pelvicalyceal system having multiple stones. •Due anatomic consideration can decrease the complication rate. •Overall stone free rate can be improved with Flexible Nephroscopy and ESWL

CA - 2

Pheochromocytoma in Pregnant Women

Dr. Anvesh A1, Dr Rajendra Nerli1, Dr. Ranjeet Patil1, Dr. Musale A S1

1Kles Kidney Foundation

Background and Purpose: Pheochromocytoma is a tumor of the catecholamine- producing cells of the adrenal medulla. Pheochromocytoma occurring during pregnancy is potentially disastrous to the mother and fetus. Its ambiguous presentation is often mistaken for pre-eclampsia, although it may imitate other clinical conditions during pregnancy. Early diagnosis, timely and appropriate management reduces possible maternal and fetal complications. Methods: We report a series of three pregnant women diagnosed of hypertension secondary to pheochromocytoma. Results: Following removal of the tumor, all patients recovered from high blood pressure.

Conclusions:Multidisciplinary approach is of utmost importance, and essential during the management of this life threatening condition during pregnancy.

CA - 3

Efficacy of pharmacological neuromodulator therapy in the management of symptoms of chronic pelvic pain syndrome: a retrospective study (CB)

Dr. Mayank Mohan Agarwal1, Ms Mudelin Elsi Sy1

1Nmc Specialty Hospital

Background and purpose –We present descriptive data of a cohort of men diagnosed with chronic prostatitis-chronic pelvic pain syndrome (CP/CPPS) and efficacy of gabapentenoids for pain management. Material and methods: design – retrospective; setting – urology outpatient services of a secondary-tertiary care private hospital; inclusion criteria – men between 18-50y presenting with pelvic pain symptoms (lower abdomen, groin, scrotum, perineum, low-back, hip) with or without lower urinary tract symptoms for at least 3 months duration. Methodology – hospital database was searched using keywords for neuropathic pain in pelvic region/thigh and prostatitis. Clinical data was retrieved from physical patient record files, lab and radiology data from electronic database. Data was analyzed using SPSS version-19 using appropriate statistical methods. Results – Between 2013-2015, data of consecutive 99 patients with median age 33y (IQR 29-40) and symptoms for 6m (IQR 3-18m) was analyzed. Most common location of pain was scrotum / testis (52/99), followed by low back (25/99), suprapubic (20/99), groin (20/99), perineum (16/99), tip of penis (11/99), thigh (9/99), hip (6/99) and anus (2/99). Other symptoms included obstructive voiding (20/99), frequency-urgency (25/99),

dysuria (37/99) and ejaculatory pain (33/99). 24/93 patients had enlarged prostate, 54 tenderness in prostate. Semen culture was done in 66 patients of whom 21 showed infection. 73 patients received antibiotics based on culture or clinical picture. Baseline median Wong-Baker pain score was 2.5/5 (IQR 2.0-3.0) with 36/99 patients experiencing pain ≥3. With gabapentenoids with or without amitriptyline after a median follow up of 3 months (IQR 2-7) pain score improved to 1.0 (IQR 0.5 – 1.5). Gabapentin was significantly more effective in treating pain compared to pregabalin (≥50% improvement; gabapentin 75%, pregabalin 38%, p <0.01). Sedation was encountered in 18% patients mostly mild. Conclusion – gabapentin is effective and well-tolerated in the pain management of patients with CP/CPPS.

CA - 4

Camper's fascia graft in abdominal repair of Vesicovaginal fistula (VVF)

Dr. Ahmed Al-adhami1

1Alyarmouk Teaching Hospital

Camper's fascia graft in abdominal repair of Vesicovaginal fistula (VVF) Ahmed Al-Adhami,Hussain Lafta Hashim , Urology department ,Al-Yarmouk Teaching Hospital ,College of Medicine ,Al-Mustansyria University Purpose: the usage efficacy for graft taken from Camper's fascia that is superficial fatty layer of anterior abdominal wall as interposition layer between vagina and bladder in extraperitoneal retropubic transvesical surgical management of vesicovaginal fistula Patients and methods: between January 2011 and January 2014, 12 ladies with mean age of 34 years

old suffered from VVF developed as complications of gynecological procedures undergone transabdominal repair of VVF with using patches freely taken from superficial fascia of anterior abdominal wall. Patients were followed up to 6 months Results: all patients were successfully dry after surgery. 6 cases developed frequency and urgency and treated by anticholinergic medications. One lady developed deep venous thrombosis and managed accordingly Conclusion: interposition graft taken from camper's fascia in surgical repair of VVF is simple feasible and safe method to prevent recurrence of such fistula and to fasten operation.

CA - 5

Iatrogenic Obstetric Causes of Genito-Urinary Fistula, Increasing Prevalence

Dr. Ahmed Al-Badr1

1King Fahad Medical City

Introduction and Hypothesis: We aimed to evaluate the etiology and management of urogenital fistulas at a tertiary care referral center. Methods: In this retrospective cohort study, a total of 30 cases of urogenital fistula that were referred to King Fahad Medical City, Riyadh, Saudi Arabia, were collected from electronic charts and analyzed. The data collected included the patients’ age, parity, etiology, type of fistula, radiological findings, management, and outcomes. Results: Among the 30 cases of urogenital fistula, there were 17 (56.7%) cases of vesicovaginal fistula, 6 (20%) of vesicouterine fistula, 4 (13.3%) of vesicocervical fistula, and 3 (10%) of complex fistulas. The mean age was 41 (17–61) years, and the mean parity was 7.3 (0–15). Regarding the etiology, 20 (66.7%) cases were due to obstetrical surgical complications, of which 16 (53.3%) were complications of cesarean sections. Twenty-two of the 30 cases (73.3%) were cured after primary

surgical repair, 4 (13.3%) after second repair, and one after third repair. One case was cured after conservative management, and two cases are awaiting third repair. Conclusion: Most of the urogenital fistulas were of iatrogenic obstetric causes, mainly cesarean sections, with none of the cases due to obstructed labor, unlike the pattern of fistulae in developing and developed countries. Majority of cases were successful with first surgical repair.

CA – 6

The role of open partial nephrectomy in complex renal tumours management in the era of robotic surgery (CB)

Dr. Salah Albuheissi1, Dr Ahmad Mahrous1, Dr Mark Wright1, Dr Tim Whittlestone1

1Bristol Urological Institute

Partial nephrectomy (PN) is the gold-standard treatment for small renal tumours. In the recent years minimally invasive PN has emerged as an alternative surgical approach to open PN. Here we review our practice of open PN in the management of complex and large renal tumours in the era of minimally invasive surgery (MIS) Material and methods: We retrospectively reviewed all open PN performed in our hospital between 2014 and 2015. We report on patient and tumour characteristics, histopathological findings, perioperative complications and renal function. Results: A total of 31 patients underwent open PN. Median patient age 57 years (range 42-74). Median follow up was 12 months. Median tumour size was 4 cm (range 1.3-10). Overall 65% were T1b tumours or above, 25% were Hilar tumour and 3 (10%) in a solitary kidney. Preoperatively, CKD stage II and III was reported in 42% and 32% resprectively. Intraoperatively median cold

ischemia time was 30 minutes and blood loss was 200 ml. Median hospital stay was 6 days. Median drop in Hb and eGFR were 25 g/l (p&lt;0.5) and 7.7 respectively. Positive surgical margin was reported in 23% of cases. There was one recurrence treated with re-do OPN. Three CD grade 2 and 6 Grade I post operative complications were recorded. There was no increase in the overall morbidity compared to MIS.. Conclusion: Open PN is an effective treatment option in selected group of patients. Centrally located tumours, tumours in a solitary kidney, and multifocal lesions probably are best managed with OPN. Long-term advantage of better renal function associated with open PN make it an attractive surgical option in patients with complex renal tumours not suitable for MIS.

CA - 7

Vesico-urethral anastomosis (VUA) evaluation short and long term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome

Ms. Corinne Tillier1, MD PhD Henk van der Poel1

1The Netherlands Cancer Institute

Background and Purpose: The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot assisted laparascopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In 2 cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Methods: Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC ) was removed in the absence of VUA leakage or minimal leakage

on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow up and Quality of life (QOL) questionnaires at 6 months. Results: Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Conclusion: Selective cystogram in men with larger prostates and pre-operative Lower Urinary Tract Symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

CA - 8

Minimum intervention may save lives in urological dilemmas (CB)

Dr. Mohammed Aljumaili1, Dr. Samy Arafat1, Dr. Mustafa Al-badra1, Dr. Yosr Hassan1, Dr. Ayman Saleh2

1Sheikh Khalifa Hospital , 2Dubai Hospital

BACKGROUND AND PURPOSE: Patients may present to emergency department or to family physician office‘s with a variety of urologically related problems. Sometimes diagnosis and management can be easily made; whereas other times the primary health care physician needs to rule out serious causes for the presenting problem and overcome a guideline – recommended patient work up, to make a final diagnosis. When a physician believes that a patient may have a serious urological problem and he is unsure about the appropriate management strategy, then

he or she must quickly refer the patient to urologist. However, some cases need experts’ opinion and joint decision to optimize the medical target. In this presentation, I am describing two different cases with serious urological conditions and rare clinical scenarios managed conservatively in our hospital with a minimum follow up of 2 years. Case 1; 36 years old women presented emergency department with headache, diagnosed as multiple bilateral angiomyolipoma, tuberous sclerosis and Wunderlich syndrome. Case 2; 59 years old male presented to the primary health care facility with recurrent epigastric pain diagnosed with bilateral ureteroceles and bilateral hydronephrosis. Conclusions: Joint decision, patient preference and experts’ opinion were considered crucial for the patient best interest with preservation of renal function and overall quality of life should be a priority. Although the majority of patients presented with congenital abnormalities and renal malignancies require one or another surgical intervention. Conservative management may save lives in many urological dilemmas; we successfully helped both cases conservatively with minimum intervention and smooth follow up period for 2 years with stable general condition and renal function. Medical treatment followed by intervention versus emergency intervention (embolization; open or laparoscopic/robotic partial nephrectomy, endoscopic incision; reimplantation) remain the sole question to be answered.

CA - 9

Retrograde upper pole calyx access for PCNL of stones in the lower pole calyx

Prof. Khalid Alotaibi1

1University Of Dammam

Introduction: Percutaneous nephrolithotripsy (PCNL) is considered the most effective minimally invasive surgery for the management of lower calyceal stones. Percutaneous access is either directly to the lower calyx or is through an upper or middle calyx. This study outlines the results of upper calyceal access during PCNL for stones in the lower calyx. Materials and Methods: Seventy six patients with single (n=25) and multiple (n=20) stones in the lower calyx, as well as stones in the lower calyx plus renal pelvis (n=31) were included in this study. They were managed by PCNL by retrograde access through the upper pole calyx. Results: The average duration required for establishment of the retrograde nephrostomy tract was 14.4 minutes, and for completion of the procedure was 40 minutes. The average fluoroscopy exposure time was 3.2 minutes. Access from the upper calyx allowed easy and rapid advancement of the nephroscope to the lower calyx. The stones varied in size from 10-25mm. Stone clearance were complete in 70 out of the 76 patients (92%). Residual stone fragments 2-4mm were present in the remaining 6 patients (8%), and were considered insignificant. The stone-free rate was thus 100%. Complications occurred in 4 patients (5.3%) and were minor. They included pleural effusion (n=2), bleeding (n=1) and A-V fistula (n=1). Conclusions: Upper calyceal access for PCNL provides easy and effective clearance of stones in the lower calyx. This access should be considered for PCNL of single or multiple stones in the lower calyx as well as in other locations in the pelvicalyceal system.

DAY 2 – 16 December 2016, Friday

09:00 – 10:00

CB - 1

Photoselective vaporisation of the prostate using 120W HPS system: a prospective evaluation of results over 2 years.

Mr. Alper Eken1, Mr. Taner Arpaci2, Mr. Ergun Alma3, Mr. Durmus Alparslan Demirci3, Ms Meltem Acil4, Prof. Bulent Soyupak1

1Acıbadem University Urology, 2Acıbadem University Radiology, 3Adana Numune Teaching and Training Hospital Urology, 4Acıbadem University Anesthesiology

This study evaluated the safety and efficacy of Photoselective vaporization of Prostate using the 120-W High Performance System for management of symptomatic Benign Prostatic Hyperplasia. We obtained data from 229 patients who underwent PVP using the 120W HPS laser for BPH at our tertiary care hospital between January 2010 and December 2012.We evaluated PSA level, IPSS, prostate volume; Qmax and PVR in the patients at presentation,and on follow-up at 1,6,12 and 24 months after PVP.The mean duration of the surgery, energy used,time to removal of urinary catheter,duration of hospital stay,and intra- and post-operative complications were assessed. The mean age of the patients was 71.2 years,PSA value of the patients was 3.68 ng/mL and pre-operative size of the prostate was 59.41 mL.Majority of the patients had prostate volumes less than 80 cc.The mean duration of the surgery was 47.35 min. and energy use was 184.39 kJ .The mean time to removal of the urinary catheter was 21.45 hours,while duration of hospital stay was 24.82 hours.The IPSS declined, and Qmax measurements increased by over 2-fold within the first month after PVP,in all patient groups.The PVR also declined significantly in all groups up to 6

months after the surgery,and increased slightly thereafter.PVP also reduced the mean serum PSA levels by over 1.8 fold,12 months after the surgery.Urinary urgency and incontinence occurred in 2 patients between 1 to 6 months after the surgery,while 4 patients developed urinary strictures between 6 to 12 months after the surgery.Between 12 to 24 months after the surgery, 4 patients underwent repeat surgery.None of the patients required blood transfusion. Our findings show that PVP is safe and effective for the management of BPH,and resulted in few complications.It yielded improvements in IPSS, Qmax and PVR that were sustained even upto 2 years after the surgery.

CB - 2

In-Vivo Comparison of “V-Loc90 Wound Closure Device” with “Vicryl” and “Monocryl” In Regard to Tissue Reaction in a Rabbit Bladder Model

Ali Serdar Gozen, Dr, MD Serdar Yalcin1, Prof, MD Yusuf Kibar1, Rn, Msc, PhDs Elif Gezginci1, Asc. Prof, MD Armagan Gunal2, Prof. MD Ibrahim Yasar Ozgok3

1Gulhane Training And Research Hospital, Dept. of Urology/ Ankara, 2Gulhane Training And Research Hospital, Dept. of Pathology/ Ankara, 3Acıbadem Ankara Hospital, Dept. of Urology/ Ankara, 4Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany

Objective: This study is a prospective randomized trial that aims to compare the barbed suture with two commonly used conventional sutures, applied in the urinary collecting system, in terms of long-term

histopathological and macroscopic material features. Material and Methods Eight female and 6 male New Zeeland rabbits were included the study. Each animal served as its own control and was subjected to cystotomy. Watertight running cystorhaphies were performed utilizing three different sutures in a randomized fashion, namely MonocrylTM,VicrylTM,andV-LocTM90. Seven animals were sacrificed after the 3rd and seven after the 6th week. Following macroscopic examination, bladders were examined histopatologically in order to evaluate the tissue reaction like inflammation and fibrosis around the sutures. Results V-LocTM90 demonstrated a significantly shorter suture time in the 3rd and 6th week groups (p=0.005 and p=0.004 respectively), and no adhesion was recorded. However, in the 6th week group, stone formation was recorded on four V-LocTM90 threads and one VicrylTM thread, a difference being statistically significant (p=0.039). Additionally, one V-LocTM90 thread in the 3rd week group and three V-LocTM90 threads in 6th week groups migrated (p=0.368 and p=0.050 respectively). The histopathological analysis revealed less inflammation and fibrosis associated with the V-LocTM 90 thread in both the 3rd and 6th week groups (p=0.010 and p=0.002 respectively). Conclusion The V-LocTM90 wound closure appears to be superior to conventional sutures in terms of tissue reaction (wound inflammation and fibrosis). Nevertheless, suture migration and stone formation following collecting system closure could be potential predicaments of the above thread. To our knowledge, this is the first animal model study associating stone formation with collecting system suturing utilizing barbed sutures.

CB - 3

The effect of varicocelectomy on ARTs indications on base of Kruger strict morphology test

Dr. Ali Asghar Ketabchi1

1Kerman Medical Sciences University

Objective: The purpose of this study was to evaluate the efficacy of varicocelectomy on improving ARTs indications on base of Kruger strict morphology test. Method and materials: For assessing of improving ART (assisted reproductive technique) levels after varicocelectomy in a case control study we compared the results of sperm analysis parameters between 67 infertile operated patients with 71 matched no operated groups in one year duration. Results: The sperm analysis parameters in operating group was significantly better than controls (P<0.001). In a comparison of ART level selection on spermograms quality (on base of Kruger strict morphology test), we observed significant improving after varicocelectomy (P<0.05). Pregnancy rate (achieving full term pregnancy via natural cycle intercourse) in two groups was 53.84% and42. 25 % in operated and non operated groups consecutively (P­value=0.082) after one year. Conclusion: Although pregnancy rate is higher in study group but it is not different significantly from the control group after one year, but by improving sperm parameters after varicocelectomy, it will increase the ART level selection and so may improve pregnancy success rates(both via natural cycle intercourse andARTs procedures).

CB – 4

First kidney transplant in Dubai

Prof. Farhad Kheradmand Janahi1

1Mohammed Bin Rashid University of Medicine and Health Sciences

This presentation highlights the events and collaborations between all the government and

non-government organizations involved in the first case. This presentation illustrates how a team efforts could lead to success of the first kidney transplant surgery in Dubai. The first case became a milestone case for the future of Organ Transplantation in the country and symbol of hope for organ failure patients in the UAE.

CB - 5

Supracostal PCNL: An anatomic perspective

Dr Syed Mamun Mahmud 1Lifecare Hospital

Background and Purpose: PCNL is known to provide best stone free rate among all available treatment for Renal stones. And now it has been recommended as ‘standard’ for larger (>20 mm) renal stones. On most of the occasions, access into kidney is acquired Subcostally. However at times for better clearance of stones, because of multiplicity or load Pelvicalyceal System is accessed Supracostally. In Supracostal access, thoracic complications are the most concerning morbidity. The current presentation is aimed at sharing the experience through an audit of cases of PCNL with Supracostal access, literature review and a limited work on Cadaver Model emphasizing on anatomic perspective in access. Method: Records of all patients who underwent PCNL from June 2004 to August 2016 at the Kidney Centre Karachi, Pakistan and Lifecare hospital Abu Dhabi, UAE were reviewed. Patients where access was acquired through Supracostal Approach were identified. Data regarding demographic details, stone burden, clearance with primary PCNL, need for auxillary procedures like ESWL, Secondary PCNL or URS and complications were recorded and analyzed. Results: There were total of 425 patients who underwent PCNL. Sixty-nine out of 425 underwent

PCNL through Supracostal Approach . One out of Sixty-nine had SupraXI access rest SupraXIIth only. Majority of the stone were multiple (70.1%). Clearance with Primary PCNL was 62% that improved to 87.5% with ESWL combination for residual stone. The overall complication rate was 4.7% with 2.9% significant bleeding, 4.4% pleural effusion, 1.4% stone migration requiring URS and 2.9% persistent nephrostomy site leakage requiring DJS insertion. Conclusion: •Supracostal PCNL is a safe and effective approach for pelvicalyceal system having multiple stones. •Due anatomic consideration can decrease the complication rate. •Overall stone free rate can be improved with Flexible Nephroscopy and ESWL

CB - 6

Effect of coenzyme Q 10 and glutamine on methotrexate induced fertility changes in Wistar male Albino rats”

Dr. Balaji Ommurugan1, Dr Mohan Ambredkar2

1Post graduate ,Department of pharmacology,Kasturba Medical College, Manipal, 2Assosiate professor , department of pharmacology , KMC ,Manipal

BACK GROUND AND PURPOSE: Testicular toxicity of Methotrexate is a well known side effect causing subsequent infertility. Various hypotheses related to oxidative stress have been suggested. Of late the research has shown that Coenzyme q 10 and Glutamine administration attenuates oxidative stress and protects against chemotherapeutic agent induced organ injury. So in this study we are trying to evaluate the effect of coenzyme q 10 and L- glutamine on male fertility changes produced by methotrexate and can antioxidants we useful in reversing the methotrexate induced testicular injury.

METHODS: 5 groups of 30 male rats were used. Group 1(control) received saline, group 2,3,4,5 received single dose of 20 mg/kg methotrexate I.P. In addition, group 3 received orally coenzyme q 10 (400mg/kg), group 4 received orally l-glutamine 1000mg/kg and group 5 received coenzyme q 10 and l-glutamine orally. Animals were dosed for seven days and on day 8 they were sacrificed. Body weight, testicular weight, testicular index, epididymis weight, sperm count, sperm motility, sperm viability, histopathology of testis was documented and analyzed using One-way ANOVA. RESULTS: (a)Body weight- Group 5 showed significant reduction when compared to groups 1,3,4 and was comparable to group 2;(b) all other parameters - Group 3,4,5 showed statistically significant increase when compared to group 2 and group 3 alone was comparable to group 1;(c) histopathology- group 1,3,4 showed normal testicular architecture with maintained germ cell and interstitial cells , group 2 showed loss of germ cells with degeneration of seminiferous tubules, group 5 showed patchy loss of germ cells without seminiferous tubule degeneration. CONCLUSION: Coenzyme q 10 and Glutamine both show significant improvement in male fertility parameters and shows reversal of testicular toxicity induced by methotrexate, when Coenzyme q 10 and Glutamine were used alone as well in combination.

CB - 7

Urological application of Botulinum Toxin

Dr. Akos Pytel1

1DHA, Dubai Hospital

Background and purpose: Botulinum toxin is a potential lethal neurotoxin, with known 7 serotypes. Botulinum toxin subtype A (BoNT-A) selectively modulate neurotransmitter release from nerve endings, resulting in muscular paralysis, but might also act on sensory nerves. In recent years,

there has been an increased interest in the urological use of BoNT-A to treat conditions refractory to conventional treatment. The list of various urological condition have been treated by BoNT injections includes neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity (IDO), painful bladder syndrome (PBS), and lower urinary tract symptoms resulting from bladder outflow obstruction (BOO) or detrusor sphincter dyssynergia (DSD) Methods: A systematic review of the published literature on PubMed, Scopus, and Embase reporting on the urological application of BoNT-A was performed. An overview and evidence based recommendations was made. Also data, based on own experience with BoNT-A injections in 100 consecutive patients with detrusor dysfunction will be demonstrate. Preoperative and postoperative evaluation with urodynamics and voiding diary were performed. Investigated parameters included incontinent episodes, reflex detrusor volume, cystometric capacity and maximal detrusor pressure . Results. In all evaluated parameters we could demonstrate significant benefit of the treatment. Incontinent episodes reduced from 8/day to 3 /day, reflex detrusor volume increased from 66ml to 110 ml, cystometric capacity change was seen from 107 ml to 186 ml. Maximal detrusor pressure decreased from 49 H2Ocm to 25 H2Ocm. Conclusion: BoNT-A injection is well established, safe minimal invasive treatment optionts in various lower urinary tract dysfunctions.

CB – 8

Laparoscopic Pyeloplasty in infancy and early childhood-Single institute experience

Dr. Adel Aljneibi1

1SKMC

Abstract : Laparoscopic Pyeloplasty is the standard procedure done to treat older children with pelvic ureteric junction obstruction, however the advanced procedure is laparoscopic Pyeloplasty specially in infancy below 6months of age , SKMC started to preform the laparoscopic tansperitoneal Pyeloplasty since Dec.2012 , and around 55 cases done until present with excellent promising early outcome. Purpose : Feasibility and safety of the laparoscopic transperitoneal Pyeloplasty in Infancy and small Children Group . Early outcome of a series Infancy between 2-24 months with PUJ obstruction who underwent Laparoscopic transperitoneal pyeloplasty with Double J stent done in Single Institute Experience . Patient number : 55 cases. Method: laparoscopic tansperitoneal Anderson- Hynes Pyeloplasty with Double J stent insertion from Dec.2012 until June 2016 . All children were confirmed on renal US , diuretic Renogram preoperatively and most of them had Cystoscopy with Retrograde Pyelogram same sitting with pyeloplasty , Post-operative method of investigations are US and Isotope Renogram. Conclusion: -Laparoscopic transperitoneal pyeloplasty in infancy is safe procedure with high preliminary successful rate and comparable with older children who underwent same procedure . - Anatomy in situ , excellent cosmetic result and less surgical trauma are the main advantages of MIS.

CB - 9

New advances in penile reconstructive surgery

Dr. Dimitrios Borousas1

1Private Practice - Sava Perovic Foundation

Summary of our experience in reconstructive and cosmetic surgery of the penis, penile augmentation, penile bending ( curvature), buried penis, trapped penis, construction of new phallus ( total phalloplasty), at Sava Perovic Foundation

CB - 10

Effectiveness of retrograde intra renal surgery in treating renal stones ≥ 10 mm. Our experience at Al Ahli Hospital, Doha Qatar

Dr. Mohammad Dauleh1, Dr. Amjad Ali Siddiqui1, Dr. Mohamed Elsheikh1, Dr. Somar Lyaka1, Dr. Elfadil Elmalik1

1Al Ahli Hospital

AIMS: To assess the effectiveness of retrograde intrarenal surgery for the treatment of renal stones ≥10mm. MATERIAL AND METHODS: A retrospective study was conducted about retrograde intrarenal surgery (RIRS) which was performed between June 2014 and July 2016. Stone size, number, location & density in HU were measured by non-contrast CT. Stone burden was calculated as the total sum of the longest diameter of each stone. Total of 44 patients with stone burden ≥10mm were included .Stone fragmentation was done using holmium–YAG laser. Effectiveness of RIRS was defined as complete stone clearance or residual fragments ≤ 2mm .Post-operative Stone clearance status of the patients was assessed by plain X- ray films within a week. RESULTS: 44 patients were operated, 29 (66%) were male’s and13 (34%) were females. Median age was 40 years (20-63 year).The median stone burden was 15mm (10-47 mm). 23 patients (52%) had stone burden 10-15 mm, 11 patients (25%) had stone burden 16-20 mm and 10 patients (23%) had stone burden >20 mm. The most frequent location of stones was in the lower calyx 63 (60%), renal pelvis 20(19%), upper calyx 11 (11%) and middle calyx 10(10%) respectively. Stone density measured on

NCCT ranged from (340-1600) Hounsfield Units, with median stone density of 922 Hounsfield Units. 41 patients (93%) had complete stone clearance, of these, 34 patients (83%) were cleared in one treatment session while 7 patients (17%) needed two session.3 patients (7%) had unsuccessful stone treatments. Median time for surgery was 80 minutes (35-180 minutes). Post-operative stay was one day for all patients except one who stayed 3 days. Complication rate was (11%).Three patients (7%) developed UTI, one patient had neuorparexia and one patient developed steinstrasse. CONCLUSION: RIRS proved effective and safe in managing renal stones ≥10mm.

CB-11

Sacral Neuromodulation in Patients with a Cardiac Pacemaker

Dr. Mai Banakhar2, Dr. Abdullah Ghazi1, Dr Dean Elterman1, Prof Magdy Hassouna1

1University Health Network, Toronto Western Hospital, 2King Abdulaziz University , Faculty of Medicine

The objective of this study is to describe our experience using sacral neuromodulation for urinary urgency, frequency, urge incontinence and chronic urinary retention in patients with cardiac

pacemakers. With the wide spread use of InterStim™ for the bladder function restoration, we are increasingly seeing more complex patients with multiple comorbidities, including cardiac conditions. Herein, we report three cases of individuals with cardiac pacemakers who underwent InterStim™ implantation for urinary conditions. Study Design: This study is a case series of three patients with cardiac pacemakers who underwent subsequent sacral neuromodulation for refractory voiding dysfunction. Study Method: Initial patient screening for InterStim™ therapy involves percutaneous nerve evaluation (PNE), whereby a temporary untined lead wire is placed through the S3 foramen. Those patients who do not respond to PNE will proceed to a staged implant. All patients in this study had a greater than 50% improvement of their urinary symptoms during the test trial and underwent placement of the InterStim™ implantable pulse generator (IPG). Postoperative programming was done under ECG monitoring by a cardiologist. There was no noted interference between the InterStim™ IPG and the cardiac pacemaker. Conclusion: In this previously group of patients, sacral neuromodulation appears to be safe in the presence of a cardiac pacemaker.

Video Abstracts

DAY 1 – 15 December 2016, Thursday

14:00 – 15:40

VA - 1

Laparoscopic partial nephrectomy for a complex renal mass: Is it feasible?

Dr. Ahmed Alhadi1

1Armed Forces Hospital Southern Region

Background and Purpose: A 37 year-old man presented with a history of left loin pain with no hematuria or other significant medical or surgical history. Methods: Computed tomography (CT) scan confirmed a tumor mass located at the hilar region of the left kidney; however CT angiogram showed double renal arteries surrounding the hilar mass. Results: Operative time3 hrs, Ischemic time 22 min with insignificant blood loss.

First postoperative day drain nil which was removed and Patient discharged on the same day. Final pathological examination revealed renal cell carcinoma .Surgical margin, biopsy from the bed of the tumor as well as Lymph nodes were negative for malignancy…pT1aN0MO. Renal function and hemoglobin normal pre and post surgery. Follow-up after one year with C/T scan no local recurrence. Conclusions: The nephron-sparing surgery via minimally invasive surgical approach for a hilar mass with coexisting vascular abnormalities can be accessible and curative with the advantages of this approach which include preserving the remaining of the kidney, minimal blood loss, shorter hospitalization and more favorable cosmetic outcome

VA - 2

Is Laser lithotripter superior to pneumatic lithoclast for upper ureter in stones via rigid URS

Dr. Iqbal Shahzad1

1Liaquat National Hospital Karachi

Purpose: To compare the results of laser versus pneumatic lithoclast via rigid URS and to assess the feasibility in third world countries Methods:

Retrospective study conducted in 200 patients 100 patients underwent laser lithotripter and 100 patients were treated with pneumatic lithoclast for upper ureter stones.Stoe fragmentation, Retropulsion and stone clearance and need of auxilliary procedures were compared Results: Overall Laser lithotripsy had better results Conclusion: To be decided by the jury and fellow colleagues with respect to rebuttal and in accordance with economic conditions of third world countries.

VA - 3

Sliding Technics : Salvage surgery after penile implant in Peyronie's Disease for length and pain considerations

Dr. A Faix1, D Chevallier1, R Djinovic1, D Ralph1, C Bettocchi1

1Men’s health International Surgical Center

Background and purpose : The sliding technics for lengthening procedure in Peyronie’s disease (PD) with erectile dysfonction (ED) is an emerging surgical option for severe and specific cases. This technics is still in evaluation in Excellence Centers. We want to share our experience in one unusual case. Materiel : Decision of sliding procedure for a pain in the glans in erection after regular implantation 2 years before. A coronal approach was done with in the meantime a posthectomy. After liberation of neurovascular bundles and the corpus spongiusum, a circular incision with a complete section of the 2 corpus cavernosum. Lengthening of 1,5 cm with a circular graft (SIS 4 slices, Cook). No change of penile implant was necessary. The uretral catheter and drainages were removed after 2 days. Results : A man, 45 years old, diabetic for 11 years and a good balance, with a permanent pain at the tip of the glans in complete inflation after implantation of a 3 compartiments penile prosthesis in February 2012 with plication after failure of a modeling procedure. After full explanations, sliding technics with a circular graft without any complication. No complication was reported especially no glans dysesthesia, with a

functional implant after 4 weeks and a disparition of the pain in complete inflation. Conclusions : the sliding technics is still an unusual procedure even for well-trained surgeons. For very specific cases, it may be proposed to the patient, but with all the potential complications included glans dysethesia and vascular problems. Nevertheless, especially for lengthening problems after Peyronie’s disease with ED, it seems logical to think about this possibility in a sharing making process

VA - 4

Laparoscopic partial nephrectomy for renal mass – experience from a high-volume secondary hospital in UAE

Dr. Mayank Mohan Agarwal1, Dr. Rishikesh Pandya1

1Nmc Specialty Hospital

Introduction: to present technique and results of partial nephrectomy in a secondary care specialty hospital in the United Arab Emirates Methods: design - retrospective study; period – 2014-2016; inclusion – all adult patients having undergone partial nephrectomy at the index center. Methodology – review of case files, laboratory and radiology. Statistical analysis – descriptives only, using Microsoft Excel worksheet version 2010. Results – during the above period, 20 cases of partial nephrectomy were performed by two surgeons, 16 laparoscopic and 4 open. Mean age of the patients was 46.5y ± 10.6y; 16 were males and 4 females. Mean size of tumor was 41mm ± 20mm. standard operating technique was utilized - Renal artery and vein were clamped after renal mobilization, tumor excised with small renal

parenchymal margin / enucleated in solitary kidney or hilar tumors, defect in calyx, large venous tributary and arterial ends were ligated, renorrhaphy performed in 2 layers. Mean warm ischemia time was 23±20min; zero ischemia in 2 patients and cold ischemia in one. Duration of surgery – 214 ± 78 min, blood loss 118 ± 120 ml. no patient required any blood transfusion. Patients were discharged in mean 2.9 ± 1.4 days. No hemorrhage, collection or fever was encountered after discharge for a period of one month. Eighteen patients had conventional renal cell carcinoma (RCC), one chromophobe RCC and one chronic pyelonephritis. Conclusion – laparoscopic partial nephrectomy is safe and effective procedure for management of renal masses; surgeon’s experience and preparedness of hospital setup are the key factors for success.

VA – 5

Percutaneous retropelvic endopyelotomy for treatment of ureteropelvic junction obstruction

Prof. Khalid Alotaibi1

1University Of Dammam

Purpose: A new minimally invasive approach for endopyelotomy for the treatment of ureteropelvic junction obstruction (UPJO) is described. The results are compared with those of other lines of treatment.

Patients and Methods: Thirty-nine patients with UPJO underwent percutaneous retropelvic endopyelotomy. Retrograde percutaneous renal access, using the Lawson catheter and deflecting guidewire, was done for creation of the nephrostomy tract. Using holmium laser through a 28Fr nephroscope, a small window was made in the posterolateral surface of the renal pelvis. The nephroscope was advanced from the renal pelvis to the retropelvic space through that window. Crossing vessels were easily detected, and were either coagulated or avoided. The window incision was extended distally and the narrow ureteropelvic junction (UPJ) was incised using holmium laser. Results: The entire procedure was done in the supine position within 1 hour. Presence of secondary stones, hugely dilated renal pelvis, high insertion of the ureteropelvic junction, and whether UPJO was primary or secondary, did not alter the results. The only factor that affected the results was split function of the obstructed renal unit. The success rate was 100% when the split function exceeded 35%. When the split function was less than 35%, the success rate dropped to 56%. Conclusion: Percutaneous retropelvic endopyelotomy is a promising approach for the treatment of UPJO that gave favorable results. The use of the nephroscope provided a wide visual field. The wide field facilitated detection of crossing blood vessels with no incident of vascular injury. It also facilitated endopyelotomy with high precision. Ureteral injury was not a risk factor.

VA - 6

Laparoscopic Nephrectomy on Angiomyolipoma With Radiologic Appearance of Grawitz Tumor on The Left Kidney of 42 Years Old Woman: A Case Report (VA)

Ms. Astarin Ardiani1, Mr Kurnia Penta Seputra1, Mr. Besut Daryanto1, Mr Paksi Satyagraha1

1Department of Urology, Brawijaya University, Faculty of Medicine, Saiful Anwar General Hospital,

Background and Purpose: Angiomyolipoma, benign kidney tumor that account less than 10% of renal tumors, with autopsy series and ultrasound-screened populations showing incidences of 0.3% and 0.13%, respectively. While Renal cell carcinomas (RCC) accounts for 2% to 3% of all adult malignant neoplasms. Both of these renal tumor

looks similar from one another on an imaging study until proven to be different by pathology anatomy appearance. This case report aimed to report feasibility and outcome of laparoscopic approach in treating benign and malignant renal tumor at the same time. Methods: A 42 years old woman, referred patient from Nephrology Department came to Urology Department at Saiful Anwar General Hospital with chief complaint of abdominal discomfort since 2 years, the condition worsen for the last 6 months. She also complaint left flank pain that radiates to the lower abdomen. No history of hematuria, stone expulsion or flank mass. General state within normal limit, vital sign within normal limit. Physical examinations revealed left flank pain during percussion. Laboratory findings within normal limit. From abdominal ultrasound, revealed homogenous mass on the left suprarenal region

suspicious of neoplasm. CT Urography with contrast, revealed solid mass with fatty compound on the upper pole and middle kidney suspicious of angiomyolipoma with differential diagnosis of Grawitz tumor, multiple lymphadenopathy, with bilateral functional adnexal cyst and simple renal cyst on the left kidney. Patient then diagnosed with suspicious Grawitz tumor and underwent laparoscopic nephrectomy. Removal of dissected kidney from the abdominal cavity are done through pfannenstiel incision on the lower abdomen. Result: Pathology anatomy result revealed an angiomyolpoma. One week after the surgery, the patient can get back to her daily activity normally. Conclusion: Laparoscopic nephrectomy approached is feasible treatment on removing any operable renal tumor with good post operative outcome

VA - 7

Robotic repair of Vesicouterine fistula: feasibility of a novel tool.

Dr. Mai Banakhar 1King Abdulaziz university, Faculty of Medicine

Background and Purpose: Vesicouterine fistulas are uncommon type of genitourinary fistula which is starting to become more prevalent with modern obstetrical care. High index of suspicion of the diagnosis with history of urine leak with cesarean section is needed to diagnose. Their Surgical repair is challenging, but with Robotic facility the procedure becomes feasible, and easier to perform. We outline our robotic experience in repair of Vesicouterine fistula and patients outcome. Methods: In the duration January 2015-March 2016 we had two cases diagnosed as Vesicouterine fistula with history of caesarian section. Diagnosis

confirmed using CT cystogram. Patients underwent Robotic repair of the fistula after 2 month of delivery with preserving their uterus and intervening Omentum in between. Results: Both cases had uneventful procedure with smooth recovery. Catheters were kept in for 30 days. Repeated cystogram showed no evidence of fistula. Average procedure duration is four hours (4h) including duking. Robotic repair was associated with improved visualization of the operative field. The average in hospital stay is 5 days, with minimal blood loss. Conclusions: Robotic repair of Vesicouterine fistula is feasible, easier with better operative field visualization and cosmetic benefits

VA - 8

Laparoscopic repair of vesico-vaginal fistula

Dr. Sanjay Bhat, Dr. Deepak Janardhanan1, Dr Amgad Farouk

1Medeor Hospital

Background and purpose:To show that it is technically feasible to perform laparoscopic repair of even complex vesico-vaginal fistulae. Methods:A 65 year old Indian female presented with continuous leakage of urine for the last 3 months. She had undergone mesh repair of cystocele elsewhere 2 years previously. Abdominal hysterectomy had been performed 20 years previously. Cystoscopy revealed mesh erosion in the supratrigonal region. She was taken up for surgery. In lithotomy position initial excision of as much of the mesh was done and bilateral DJ stents were inserted. This was followed by laparoscopic O’Connor repair of the fistula. 3 ports were used (10mm+5mm+5mm). After taking down adhesions the Bladder was bivalve using harmonic scalpel. The incision was extended up till the fistula and additional excision of fibrous tissue embedded with prolene mesh was done till supple tissue was available for suturing. The vagina was closed with 20 v-lok suture, omental interposition was done. The bladder end of fistula was freshened and bladder was closed in one layer with running 20 v-lok suture. Suprapubic catheter was inserted and water tightness of the repair was confirmed. Drain was removed on day 2 and suprapubic catheter on day 5. Foley was removed after 3 weeks after CT cystogram confirmed healing. Stents were also removed. She is completely dry. Results:4 such patients were operated since April 2015. One patient had a combined ureteric and vesicovaginal fistula following hysterectomy which was managed by additional laparoscopic ureteric reimplantation. The operating time varied from 180 to 300 minutes depending on the complexity. All patients are fully continent. Conclusion:Laparoscopic repair of vesicovaginal fistulae are feasible although technically challenging. The ease of access to the pelvis is a definite advantage. It is a boon to women who have already gone through a lot of mental trauma.

VA – 9

Laparoscopic Anderson-Haynes Dismembered Pyeloplasty In Eight Years Old Boy with Ureteropelvic Junction Stenosis And Severe Hydronephrosis : A Case Report

Mr. Rudy Eka Putra1, Mr. Kurnia Penta Seputra2, Mr. Besut Daryanto3, Mr. Paksi Satyagraha4

1Department of Urology Of Brawijaya University, 2Department of Urology Of Brawijaya University, 3Department of Urology Of Brawijaya University, 4Department of Urology Of Brawijaya University

Background and Purpose: Ureteropelvic junction obstruction is defined as impaired urine flow from the renal pelvis into the proximal ureter with subsequent dilatation of the collecting system, it is also the most common cause of pediatric hydronephrosis. Overall incidence of UPJ are 1: 1500 with ratio of male to female are 2:1 in newborn. This case report aimed to report feasibility and outcome of laparoscopic approach in treating UPJ stenosis with severe hydronephrosis using. Methods: A 8 years old boy with chief complains of bilateral flank pain since 10 months ago and worsen in the last two months. General state within normal limit, From Urologic state, physical examination revealed pain during percussion of costovertebral angel. He had history of malnutrition and upper respiratory tract infection. Laboratory findings including kidney function test within the normal limit. Radiologic findings on IVU photo shows hydronephrosis grade III. Laparoscopic pyeloplasty was performed using Anderson-Haynes Dismembered technique to repaired the dilated pelvis and stenosis of the ureter, DJ stent was inserted afterward to rest the ureter and for the healing process. After the operation patients mobilized comfortably with less pain and discharged from the hospital 3 days later. Patient went home in a good condition and able to

do daily activity normally, scar made by the surgery are barely seen. Urologic ultrasound was performed during follow up to confirm the condition. From ultrasound imaging, there is left mild hydronephrosis and the kidney function test shows within normal limit. Conclusion: Laparoscopic pyeloplasty using Anderson-Haynes Dismembered technique, is a

feasible treatment as an alternative to open surgery in repairing UPJ obstruction. Laparoscopic pyeloplasty had many advantages in post operative care such as comfortable mobilization, shorter hospital stay and minimum post operative scar.

DAY 3 – 17 December 2016, Saturday

09:00 – 10:20

VB - 1

Robot-assisted Salvage Nodal Dissection in Prostate Cancer Patients who Experienced Nodal Recurrence after Radical Prostatectomy

Dr. Giorgio Gandaglia1, Dr. Nazareno Suardi1, Dr. Nicola Fossati1, Dr. Umberto Capitanio1, Dr. Andrea Gallina1, Dr. Alberto Briganti1, Prof. Francesco Montorsi1

1Università Vita-salute San Raffaele

Background and Purpose. Salvage lymph node dissection might represent a feasible treatment option for the management of prostate cancer (PCa) patients with nodal recurrence after radical prostatectomy (RP). The aim of our study was to report perioperative, pathologic, and early oncologic outcomes of robot-assisted salvage nodal dissection (RASND) in patients with nodal recurrence after RP. Methods. We retrospectively evaluated 7 patients affected by nodal recurrence following RP documented by positive PET/CT scan. Surgery was performed using DaVinci Xi system. A pelvic and

retroperitoneal nodal dissection that included lymphatic stations overlying the external, internal, and common iliac vessels, the obturator fossa, the presacral nodes, and all nodal tissue located between the aortic bifurcation and the renal vessels was performed. Perioperative outcomes consisted of operative time, blood loss, length of hospital stay (LoS), and complications occurred within 30 days after surgery. Biochemical response (BR) was defined as a PSA level <0.2 ng/ml at 40-day after RASND. Results. Median age at RASND was 69 years. Median operative time, blood loss, and LoS were 261 min, 20 ml, and 4 days. Overall, 3 (42.9%) patients experienced postoperative complications. Overall, 1 (14.3%) patient had an intraoperative complication (i.e., vascular injury) that was managed intraoperatively. Overall, 2 (28.6%) and 1 (14.3%) patients had grade I-II, and III complications according to the Clavien-Dindo classification. None of the patients included in the study required a postoperative transfusion. The median number of nodes removed was 26. Positive lymph nodes were detected in 2 (28.6%) patients. Overall, 25% of the patients with available data experienced BR after surgery. Conclusions. RASND represents a feasible procedure in men with nodal recurrence after RP and provides acceptable short-term oncologic outcomes.

VB - 2

Development of Robot assisted flexible ureteroscopic laser lithotripsy with Avicenna Roboflex

Prof. Dr. Anup Patel, Dr. Yasser Farahat, Prof.Dr. Remzi Saglam1, Dr. Abdul Qadir Al Zarooni2, Electronic Engineer Ahmet Sinan Kabakcı3, Prof. Dr. Jens Rassweiler4

1Medicana International Hospital, 2Sheigh Khalifa Hospital, 3Hacettepe University, 4SLK Hospital

OBJECTIVE: Robotic Flexible Ureteroscopy was first attemted by Desai at all. Saglam at all developed the first robot remotely controls the commercially available flexible ureteroscope. The advantage of

this new robot are the treatment of kidney stones precisely, better fragmentation and dusting, decreasing the tiredness of the user, protection from the radiation and protection of the device. It can treat the larger stones, with flexible ureteroscopy which the real indications are the percutaneous lithotripsy. METHOD: The manipulator of the Avicenna Roboflex can be controlled by two joystics. The right joystic is for the precise deflection. The precise deflection is very important. The left joystick controls rotation and in and out movement. When the tip of the endoscope reach to the renal pelvis, all calices navigated, During the insertion of laser fiber the tip must be in a straight position. Touching the zero button in the deflection part of the touch screen, provide this position

automatically. If the color in the laser section is blue, the software prevent the firing of laser. When the color become red, the user can use it safely. The user can control the laser fiber in and out. The foot pedals of laser and fluoroscopy can be controlled remotely by using the new universal remote pedal control unit. If necessary, the assistant can remove the laser fiber and use the basket catheter to remove the fragments. CONCLUSION: The development of the Roboflex provides better control of flexible ureteroscope without tiring and without the risk of radiation. It can provide a precise safety and effectivity and makes the life time of the device longer. The ergonomy of the user without radiation, provide the treatment of larger stones and the treatment of more patients in a day.

VB - 3

The Relevance of MAG-3 Renogram in Defining Laparoscopic Pyeloplasty Success Based on Ipsilateral Renal Function

Mr. Ali Thwaini1, Mr Mark Evans1, Mr Wesam El Baroni1

1Belfast City Hospital

Introduction: Pyeloplasty is the current gold standard treatment for pelvic ureteric junction (PUJ) obstruction. Clinical frustration can exist when symptomatic response does not mimic mercaptoacetyltriglycine renogram (MAG-3) appearance. The goal of this study was to investigate whether pre-operative ipsilateral renal function (IRF) <30% affected the MAG-3 resolution. Method: A retrospective review of all patients who underwent laparoscopic pyeloplasty at a single institution between 2008 and 2015 was performed. Success was defined as symptom

resolution with stable IRF. When pre-operative dimercaptosuccinic acid scan was not available the IRF was determined from MAG-3 data. Success rate and MAG-3 resolution were compared in patients with <30% and >30% IRF and a p-value obtained using the fisher exact test. Results: 68 patients were included. Median age was 32. Mean follow up was 2 years 10 months. Success criteria was met in 59 patients (86%). Within this group 50 had a resolved MAG-3 and 9 did not. 11 patients in the success group had an IRF <30 and of these 6 (54%) had non-resolved MAG-3. In contrast 48 patients had an IRF >30 and only 3 (6%) showed no MAG-3 improvement (p = 0.001). 9 patients symptoms did not resolve of which 5 had an IRF <30 (p=0.03). Conclusion: Kidneys with IRF >30% have a better success rate from laparoscopic pyeloplasty. The use of MAG-3 renogram in defining post-operative success becomes less relevant in poorly functioning kidneys. This information is useful in pre-operative patient counseling

VB - 4

Vaginal Extraction of Kidney in Laparoscopic Living Donor Nephrectomy

Dr. Ziting Wang1, Mr Kep Yong Loh2, Dr Yinchu Wang1, Dr Ho Yee Tiong1

1National University Hospital, 2Duke-NUS Graduate Medical School

Background: There has been increasing advocacy for optimising minimally invasive surgery to reduce living donor morbidity. We report our initial experience of vaginal extraction in laparoscopic living donor nephrectomy. Method: Preoperative patient preparation included use of flagystatin and lactacyd wash with intravaginal administration of misoprostol. After dissection of the kidney and preparation of the hilar vessels, the cervix was dilated and vagina douched with iodine. The uterus was anteverted and a posterior colpotomy performed. The left uterosacral ligament was then transected and pneumoperitoneum was maintained with Lina Tube. Initially, the kidney and divided ureter was placed into the endocatch bag with the vessels attached. We later modified the technique to dividing the vessels after securing the proximal ends with the EndoTA 30 stapler and hem o lok clips before placing them in the bag. After vaginal extraction of the kidney, benchwork was commenced. The colpotomy was then closed with absorbable continuous suture via the vagina. Results: Warm ischemic time was 7 minutes and mean operative time was 191 minutes. Mean intraoperative blood loss was 50mls. Post-operative analgesic usage was minimal. Both donors were discharged on POD 3 with good urinary output and renal function. The respective recipients had immediate graft function. The first donor was readmitted on POD 10 for ileus which resolved with conservative treatment. Both donors remained well with a mean period of 4.5 month. A sexual quality of life questionnaire revealed no significant changes in the quality of intercourse.

Conclusion: We report the first cases of laparoscopic donor nephrectomy with vaginal extraction in Singapore. In light of the altruistic nature of the nephrectomy and the likely good pre-operative health status of donors, preservation of wellbeing is of the utmost importance. Vaginal extraction of kidney is a technique that could help optimise outcomes in laparoscopic living donor nephrectomies.

VB - 5

Robot Assisted Radical Cystoprostatectomy with intracorporeal ileal Conduit: Kuwait's Initial Experience

Dr. Saad Aldousari1,2,3, Dr. Fawzi Abul1,2, Dr. Said Yaiesh1, Dr. Ahmad Alshammari1, Dr. Mohammad Khaja1, Dr. Narayanaswamy Arun1, Dr. Natarajan Sridharan1

1Sabah Alahmad Urology Center, 2Kuwait University, Faculty of Medicine, 3MD Anderson Cancer Center

Background and Purpose: Radical cystectomy is a major surgical procedure in urological practice which can be associated with significant morbidity and mortality. Advances in urology have focused on minimizing invasiveness of surgical procedures to decrease complications while maintaining oncologic principles. Robotic assisted radical cystectomy (RARC) is being performed increasingly worldwide. We hereby demonstrate our initial experience with RARC and intracorporeal ileal conduit using the da Vinci Si robot at Sabah Alahmad Urology Center. Methods: This video is for a 60 yeas old male Yemeni patient who was found to have muscle invasive urothelial carcinoma of the bladder without clinical evidence of distant metastases. He had no previous intra-abdominal surgeries and has no co-morbidities. He was counselled about his

options and decided to proceed with RARC and intracorporeal ileal conduit urinary diversion. Results: The patient had an uneventful intra-operative course. Total console time was six hours. Estimated blood loss was 100 mls. He was managed post-operatively according to the modified "Optimized Surgical Journey" pathway. He developed transient ileus which was managed conservatively. No other complications were reported. Histopathology revealed high grade urothelial carcinoma with lymphovascular invasion, pT4aN0. He was discharged on post-operative day seven in stable condition after removal of his drain and bilateral ureteric stents. He was referred to medical oncology for adjuvant chemotherapy. He was seen in follow up with a well functioning conduit and normal renal function tests. Conclusion: RARC can be a lengthy procedure requiring a learning curve. However, it has been shown in recent literature to be a feasible option with lower complications when compared to open radical cystectomy. By having a dedicated robotic team and developing a systematic operative approach, unnecessary intra-operative delays can be avoided. We have preformed under 5 cases and we need larger volume of cases to get shorter console time.

VA - 6

Early experience of Laparoscopic Retroperitoneal Lymph Node Dissection for metastatic Germ Cell Tumurs

Dr. Salah Albuheissi1, Dr Mark Wright1, Dr Hashim Hashim1, Dr Tim Whittlestone1

1Bristol Urological Institute

Introduction: Retroperitoneal peritoneal lymph node dissection (RPLND) is principally indicated for incomplete radiological remission of

retroperitoneal lymph nodes post chemotherapy metastatic nonseminomatous germ cell tumours (NSGCT). Open RPLND is associated with significant morbidity ; and laparoscopic (L-) RPLND is emerging as a safe alternative in selected cases. Patients & Methods: We prospectively collected data on patients undergoing L-RPLND after chemotherapy for Stage II NSGCT. Additionally, a single patient with a history of Stage I NSGCT underwent primary L-RPLND for low-volume retroperitoneal lymphadenopathy and negative markers without prior chemotherapy. Results: Twenty five patients underwent L-RPLND in total. Fourteen patients underwent unilateral (Left=14, Right=11) L-RPLND for marker negative Stage II post chemotherapy residual RP-nodes. A single patient with a history of NSGCT underwent a left L-RPLND for enlarged nodes with negative markers prior to chemotherapy. Mean operating time was 167 minutes. There were no intraoperative complications. One patient was converted to open because of bulky adherent nodes. Mean hospital stay was 1.1 days. two patients developed a lymphocele post operatively Which was treated conservatively. No retrograde ejaculation was reported. Histology from the post-chemotherapy group revealed differentiated teratoma in 11 patients, metatstatic NSGCT in 4, metastatic seminoma in 1 patient, fibrosis/necrosis in 8 patients, and lymphoma in 1 patient. The single patient who had not undergone chemotherapy had metastatic NSGCT and was referred for follow-up chemotherapy. Conclusion: L-RPLND is technically feasible and safe in selected cases of post-chemotherapy Stage II NSCGT. Long term follow up data is required to assess oncological results

VA - 7

Salvage procedure for intractable urine leak in renal transplant patient

Dr. Vineet Narang1, DR. Hardev Singh Bhatyal1, DR ANKUR ARYA1

1Blk Superspeciality Hospital

INTRODUCTION: Ureteral leak after renal transplant recipient although uncommon may be troublesome and may require complex urinary reconstruction especially in the scenario of a completely necrosed recipient ureter and diseased donor ureter where uretero-ureterostomy and uretero-neocystostomy are not feasible or failed. MATERIAL AND METHODS: An 18 year old young boy was diagnosed with renal failure for which he underwent renal transplantation in 2012.Second transplant was done in 2104 for graft rejection. On first post operative day, patient developed urine leak from drain site for which he underwent re-exploration with repair of Uretero-vesical anastomosis. On 3rd post op day he developed abdominal distension and urine leak. he was again re-explored and found to have a non viable transplanted ureter , the native ureter was anastomosed to the transplanted kidney renal pelvis. Post op recovery uneventful and patient was discharged on DJ stent. DJ stent was removed after 6 weeks. Post DJ stent removal he developed urinoma with transplanted kidney hydronephrosis and sepsis and graft dysfunction. Drainage of urinoma and PCN was done and his renal parameters stabilized. One month later he underwent salvage pyelo-vesicostomy to stop the urine leak. Post op at one month he is off DJ stent and is voiding well with a stable graft function. Results: Successful repair of post transplant intractable urine leak by salvage pyelo-vesicostomy Conclusion: Intractable urine leak in the post renal transplant setting may be associated with necrosed transplant and diseased native ureter . In these settings salvage pyelo-vesicostomy is an excellent alternative for urinary reconstruction.

VA - 8

Robot- assisted partial nephrectomy in zero ischaemia and tubeless pyelolithotomy. (VA)

Dr. Samer Schakaki1, Dr. Salahedein Alkeilani, Prof. Dr. Hermann van Ahlen1

1Klinikum Osnabruck

Introduction: Based on current available oncological and quality of life (QoL) outcomes, localised renal masses are better managed by NSS (PN) rather than RN. Benign renal tumor is very rare. Cystic hamartoma of the Kidney is the rarest tumor ever. Histogenesis of this tumor is still controversial. The robot- assisted surgery is not only a minimal invasive one, this technology is from our point of view the best choice to do a very complicated operations. Case presentation: A 36-year-old woman was found incidentally to have a left side hydronephrosis and a hug renal mass by abdominal ultrasonography. CT scan revealed a big stone in the left renal pelvis and a very big complex lesion in the left kidney hourglass shaped with dense septum. MRI of the abdomen showed a left renal complicated cyst with internal blood without any evidence of soft tissue component within the cyst. Result: We performed a robot- assisted partial nephrectomy with zero ischaemia and tubeless pyelolithotomy. Operation time was 118 minute without significant blood loos. Histologically, the tumor was composed of both mesenchymal and epithelial components. it showed a cystic tumor with a wall and mucosa of a large intestine. The final Diagnosis was a benign cystic hamartoma. Conclusions: A hamartoma is a benign tumor like malformation made up from abnormal mixture of cells and tissues. It is considered a developmental error and can occur at a number of sites. Renal hamartoma is a very rare manifestation. The preservation of

the renal function nowadays is a very important issue. The robot- assisted technology allows us to perform the complicated surgery in minimal invasive way. despite the size of the tumor, its

difficult location and the big size of stone in the renal pelvis the operation could be performed without any complications.

Poster Abstracts

Poster # 2

Evaluation of combined electro cutter with cold knife effect in the intractable anterior urethral stricture urethrotomy

Dr. Ali Asghar ketabchi1

1Kerman Medical Sciences University

Background and Purpose: Our aim in this study was to evaluate the efficacy of combined electro cutter as a more successful and less complications procedure in contrast to conventional Sachse cold knife in intractable anterior urethral strictures. Materials and Methods: Between May 2010 and Jun 2013, 112 men with proved intractable urethral stricture (≤ 2 time recurrent) were prospectively randomized to undergo internal optical electro cutter - cold knife urethrotomy (group A) or Sachse cold knife urethrotomy (B). Followup was scheduled at15, 30 and 180 post-operative days after surgery in outpatient department on. The Kaplan-Meier method was used to estimate survivor function for the treatment methods and the log rank test was used to compare the efficacy of two treatments. Results: Followup (range 15 to 180days) was available in 87 patients (77.67%). The success rates(stricture-free) in group A and B were 46.6% (21 out of 45 patients), and 23.80% (10 out of 42 patients) respectively (P < 0.05). The overall Complications were seen 11 % in group A and 45% in group B . The peak flow rates (PFR) were compared between the two groups on each follow up. At 180 days (6 month interval) the difference between mean of PFR for electro cutter -cold knife group and Cold knife group was statistically significant (P < 0.01).

Conclusion: combined electro cutter with cold knife urethrotomy modality are effective than conventional cold knife urethrotom in providing immediate relief in recurrent urethral strictures and had lesser complications in patients with intractable and recurrent urethral strictures.

Poster # 9

Radiological position of the electrode to predict the outcome of the InterStim therapy

Dr. Abdullah Ghazi1, Dr Mai Banakher2, Dr Dean Elterman1, Prof Magdy Hassouna1

1University Health Network, Toronto Western Hospital, 2King Abdulaziz University

OBJECTIVE: To find a correlation between the location of the electrode in the sacral foramen and the long-term outcome of sacral neuromodulation (SNM) therapy. Method: This was a retrospective study with patients who underwent SNM (InterStim™) by two surgeons at the Toronto Western Hospital, from July 2013 to March 2014. The electrode position in the sacral x-ray was placed at different angles (anteroposterior and lateral) to evaluate the impact on the long-term results of SNM therapy. Results: A total of 69 patients (61 female and 8 males) were included, with the median age of 55 years. 42 (60.9%) of patients had refractory overactive bladder (OAB), 21 (30.4%) suffered from chronic urinary retention (CUR) and 6 (8.7%) had chronic pelvic pain syndrome (CPP). Unsatisfied patients were defined as those who needed additional treatment for OAB and CPP, and those still using catheterization of CUR.

Conclusion: Our study did not show a correlation between SNM long-term response and the electrode position on sacral x-ray.

Poster # 11

Current management of Peyronie’s Disease amongst urological consultants in the United Kingdom National Health Service

Mr. Aza Mohammed1, Mr Zubair Al-Qassim2, Mr Duncan Summerton3

1Luton And Dunstable University Hospital, 2Kettering General Hospital, 3Leicester General Hospital

Objectives: To identify the current trends in the management of Peyronie’s Disease (PD) in the UK National Health Service (NHS) Hospitals Methods: A web-based questionnaire was emailed to consultant urologists practicing in the UK. Descriptive statistics and Fisher’s exact test were used for data analysis using Microsoft Excel. Results: 181 consultants responded with 53.6% working at UHs and 46.4% working at DGHs. Half of the respondents had 10 years or more experience as consultants and a third in both hospital groups had seen 10 or more new cases of PD in the 12 months prior to the survey. The majority used simple analgesia or vitamin E for acute phase PD. More patients with stable disease were treated in DGHs compared to UHs (47% vs. 53%). Methods to assess the degree of curvature included digital photography, patient’s own account and artificial erection. PD with higher degrees of curvatures (>60 degrees) for both dorsal and ventral deformities tend to be operated more in UHs Penile straightening procedures were the predominant operations performed with the tendency for incision of the corpora rather than simple plication in Nesbit’s operation. Synthetic

materials for grafting were used more frequently in DGHs compared to UHs (38.5% vs. 20%), while autologus materials are more used in UHs (52% vs. 38%). Inflatable implants were mostly used in UHs compared to malleable implants that were performed more in DGHs The majority of the consultants in both hospital groups would perform complex procedures (plague incision/excision and graft and implants) independently with minimal participation from urology specialist registrars Conclusions: The management of PD was similar between UHs and DGHs. The main differences seem to center around surgical operations for more complex deformities where the degrees of curvature are greater.

Poster # 12

Intracytoplasmic sperm injection outcomes by fresh ejaculated sperms and testis or epidedymal sperm extractions in idiopathic cryptozoospermia

Dr. Ali Asghar ketabchi1

1Kerman Medical Sciences University

Background and Purpose : To evaluate the fertility outcomes of patients with idiopathic cryptozoospermia treated with intracytoplasmic sperm injection (ICSI) by ejaculated sperms and testis or epidedymal sperm extractions. Methods: from 92 couples with idiopathic cryptozoospermia73 patientsundergoing their first Intracytoplasmic sperm injection (ICSI)were included in the study.They randomized to two groups ,group one (n=38) by sperm source of ejaculation,and group two (n=35) by sperm extraction from testis or epididym. Fertilization rate, cleavage rate, embryo quality, implantation rate, and clinical pregnancy rate were examined.

Results: There was significant difference in the fertilization rate, cleavage rate, implantation rate, and pregnancy rate in sperm extraction group inspite of natural ejaculate sperm group in conventional ICSI (P<0.05). The good quality embryo rate was also significant difference in sperm extraction group after ICSI (P<0.05). Conclusions: The quality sperm that extracted by PESA and TESE for ART procedures is better then the natural ejaculate spermin men with idiopathic cryptozoospermia.

Poster # 13

Fluoroscopy-free flexible ureteroscopy with Holmium: YAG Laser lithotripsy for removal of renal calculi

Prof. Hamdy Aboutaleb2

1Burjeel Hospital, 2Minoufiya University

Objective: To evaluate the feasibility of access sheath insertion and ureteral stent placement without image guidance in flexible ureteroscopic lithotripsy with Holmium: YAG Laser for renal stones. Materials and Methods: Between March, 2014 and October, 2015, 80 patients with renal stones treated with flexible ureteroscopic laser lithotripsy were evaluated. Indications of surgery were renal obstruction, failed SWL, stones in polycystic kidney and mal-rotated kidneys. Cobra flexible ureteroscope 6.5 Fr was used in all cases with access sheath of 12 inch, 35/45 cm dimensions. Fluoroscopy was not intended for use in all cases and postoperative double J stenting was optional. The perioperative complications were registered and the collected data was subjected to statistical analyses. Results: The study included 80 patients (66 male, 14 female), aged 28-54 (48.2±8), with the mean

stone burden of 13±3.5 mm (range 6-23). Stone burden > 15 mm was reported in 26 patients, while 48 patients had lower calyceal stones. The mean operative time was 71.5±20 minutes (range 25-130). Overall, 76 (95%) access sheath insertions were performed successfully without the use of fluoroscopy. Double J stenting was used in 22 patients (27.5%). Mean hospital stay was 10±8.5 hours (range 10-36). After one session, the stone-free rate of 87.5% was achieved (93.3% for stones < 15 mm). Single session was successful in 87.9% cases of lower calyceal stones, with 91.7% for post-SWL failure cases. Perioperative complication rate was 15%. Conclusion: Access sheath insertion without fluoroscopic guidance is feasible. This technique reduces radiation exposure in patients requiring flexible ureteroscopy.

Poster # 14

Management of upper ureteral stones exceeding 15 mm in diameter: shock wave lithotripsy versus semirigid ureteroscopy with holmium: YAG laser lithotripsy

Prof. Hamdy Aboutaleb2

1Burjeel Hospital, 2Minoufiya University

OBJECTIVES: We conducted a prospective randomized study to evaluate the efficacy and outcome of shock wave lithotripsy (SWL) versus semirigid ureteroscopy (URS) in the management of the proximal ureteral stones of diameter exceeding 15 mm. METHODS: During the 2009−2014 study period, 147 patients presenting with the proximal ureteral stones exceeding 15 mm in diameter were treated. Both SWL and URS with laser lithotripsy were offered for our patients. A 6 / 8.9 Fr semirigid ureteroscope was used in conjunction with a holmium yttrium-aluminum-garnet laser. The

stone-free rate was assessed at two weeks and three months post-treatment. All patients were evaluated for stone-free status, operation time, hospital stay, perioperative complications, and auxiliary procedures. RESULTS: Of the 147 patients that took part in this study, 66 (45%) had undergone SWL and 81 (55%) underwent URS. At the 3-month follow-up, the overall stone-free rate in the SWL group was 39/66 (59%) compared to 70/81 (86.4%) in the URSL group. URSL achieved a highly significant stone free rate (P=0.0002), and the mean operative time, auxiliary procedures, and postoperative complication rates were comparable between the two groups. CONCLUSIONS: In terms of the management of proximal ureteral stones exceeding 15 mm in diameter, ureteroscopy achieved a greater stone free rate and is considered the first-line of management. SWL achieved lower stone-free rate, and it could be used in selected case.

Poster # 19

Bladder histopathological changes due to ureteral double-J stenting in 30 patients. A prospective study

Assistant Professor Hamdy Aboutaleb1, Dr. Maher Gawesh2

1Minoufiya University, 2NMC Hospital

Objective: To study the histopathological changes in the urinary bladder associated with JJ stenting correlated to the period of stenting. Methods: In a two-year period, a prospective study was carried out in 30 patients indicated for JJ stenting. These patients were undergone cold cup cystoscopic biopsies from ipsilateral ureteric orifice before and after the insertion of JJ stents. Bladder pathological changes are found during stenting were excluded from the study. Pre-stenting biopsies are used as a controlled group.

Results: Total 30 patients were undergone JJ stenting. Mean age was 43.5±8.6 (Range 26-74). Stents size were used 4.7 & 6 Fr. Stent duration was 2 weeks in 2 patients, 4 to 6 weeks in 18 patients, 6-12 weeks in 6 patients and > 12 weeks in 4 patients. Stent placement was optimum in all patients. The histopathological study of 30 biopsies (30 patients) showed mild acute esinophylic inflammatory reactions with edema was reported in patients had stenting less than 14 days. Acute lymphocytic esinophylic cystitis with severe edema in patients had stents 2 to 6 weeks. Brunnes nests were reported in patients with stents more than 6 weeks. Cystitis cystica was seen in patients had stents more than 12 weeks. Conclusion: Our study shows that acute and chronic allergic inflammatory changes are seen around the coil of the JJ stents. It is of major importance for the urologist to limit the use of JJ stents to be used in highly indicated cases only.

Poster # 27

Effects of total hysterectomy versus subtotal hysterectomy on lower urinary tract functions

Dr. Tamer Abouelgreed1, Dr. Mohamed Abelaal2, Dr. Fayzah Abdelhakam2

1Gulf Medical University, 2Al-Azhar University

Objective: To assess the influence of abdominal hysterectomy on the lower urinary tract symptoms and functions using urodynamic studies. Patients and methods:Between March 2013 and October 2015 a total of 60 women ranging in age between 45-65 year old (with mean age of 56.40 year old) were enrolled in this study, divided into two equal groups (30 patients each) Group I:underwent total abdominal hysterectomy.Group II:underwent subtotal abdominal hysterectomy.All patients were subjected to urodynamic before and six months after surgery.

Results:Uroflowmetry results showed that total hysterectomy decrease maximum flow rate and increased voiding time insignificantly, whereas, subtotal hysterectomy had no effect on both.Average flow rate increased in subtotal group, while it decreased in total group.Residual volume increase insignificant after total hysterectomy (p=0.128) also the increase in residual urine after subtotal hysterectomy was insignificant (p=0.218).However all the changes were within the acceptable range. According to cystometry study, in the two groups volume at first sensation increased after surgery, with no difference between the two groups (P=0.363).Both total and subtotal hysterectomy did not change significantly maximum bladder capacity after surgery.All patient of both groups had no detrusor muscle over activity preoperative however after surgery over activity was observed in 6 cases in total group while only 2 cases in subtotal group.Again, all changes were within clinically acceptable range. Conclusions: Hysterectomy, whether total or subtotal, did not adversely affect urinary bladder function so we cannot depend on the effect of hysterectomy on bladder function as a matter of preference of total or subtotal type of the operation.

Poster # 28

Safety and efficacy of percutaneous nephrolithotripsy (PNL) in supine versus prone position

Dr. Tamer Abouelgreed1, Dr. Osama Elgendy2, Dr. Mohamed Abdelaal2, Dr. Salah Shebl2, Prof. Khaled Sabry2, Prof. Sayeda Ibrahim2

1Gulf Medical University, 2Al-Azhar University

Objective: To evaluate and compare the outcome of percutaneous nephrolithotomy (PNL) in both

supine and prone positions, with regards to; operative time, technical aspects, success rate, complications, safety and effectiveness of both approaches. Patients and methods: Between 2011 and August 2015 a total of 100 patients (ranging in age between 20 and 65 year with mean age of 42.7 year) were included in this study. Our study was designed on a randomized basis according to a 1:1 ratio and patients were randomly divided into two groups (50 patients each); Group A patients underwent standard prone position PNL while Group B patients underwent supine position PNL. All patients were evaluated by detailed clinical history, general and local examination, complete laboratory assessment. The radiological assessment comprised of KUB, IVP and or spiral CT examinations. Results: All preoperative, intraoperative and postoperative parameters, results and complications between both groups were comparable, except for the mean operative time for patients included (Group B) that was significantly less than the patients included (Group A) showing a statistical significance (p < 0.0001). We mainly attributed this to the time lost in turning the patient at the beginning and end of the procedure when it is done in the prone position. Conclusions: Supine position PNL is a safe and successful procedure with minimal complications and comparable results to the conventional prone position PNL with shorter operative time and being more suitable for compromised cardiopulmonary patients, morbidly obese patients and those with stature deformities.

Poster # 29

Preputial fascia flap as a secure layer in tubularized incised plate

(TIP) urethroplasty for repair of patients with distal hypospadias

Dr. Tamer Abouelgreed1, DR Ayman Altramsy2

1Gulf Medical University, 2Al-Azhar University

Objective: We report the efficacy of using the dartos fascia flap from the prepuce in different manners to protect the neourethra in tubularized incised plate urethroplasty (TIP) for distal hypospadias patients. Patients and methods: Between January 2012 and August 2015, a total of 102patients with distal penile hypospadias with age between 3 and 6 years (Mean3.2years) were included in this study. Patients were classified into 2 groups, 51 patients in each group; Group (A) underwent (TIP) urethroplasty using preputial dartos fascia flap in double layers as a vascularized secure layer between the neourethra and the outer suture line. Group (B) underwent (TIP) urethroplasty using preputial dartos fascia flap in a single divided layer as a vascularized secure layer between the neourethra and the outer suture line. Patients were followed regularly up to 12 months postoperatively. Results: The overall success rate was 100 (98.04%). The success rate shows no statistically significant difference between groups A 51(100%) and B 48(94.12%) and P value was (= 0.07). All successful patients have conical shaped glans with vertical slit like meatus at its tip which is consider a satisfactory cosmetic and function results. Conclusion: Preputial dartos fascia flap in conjunction with tubularized incised plate urethroplasty technique (Double layered or single layer) gives excellent functional and cosmetic results for repair of uncircumcised patients with distal hypospadias and so we advise it to be the procedure of choice in such patients.

Poster # 30

Evaluation of the Effect of Varicocelectomy on the Semen Parameters in Patients with Clinical Versus Subclinical Varicocele

Dr. Tamer Abouelgreed1, Dr. Mohamed Abdelaal2, Dr. Yasser Badran2, Dr. Elsayed Salih2

1Gulf Medical University, 2Al-Azhar University

Objectives: To evaluate the efficacy of varicocelectomy in patients with clinical versus subclinical varicocele as regards the seminal parameters. Patients and Methods: from June 2010 to May 2012, a total of 162 patients with varicocele (72 subclinical and 90 clinical) who presented at Al-Azhar University Hospitals seeking advice for infertility (primary or secondary) were included in the study. All patients subjected to history taking, clinical examination, semen analysis, color Doppler ultrasonography (scrotal). Patients with recurrent varicocele, azoospermia or have cause of infertility other than varicocele were excluded from the study. Semen analysis was done for all patients before and after 3 to 6 months of varicocelectomy. Improvements of seminal parameters were statistically significant in patients with clinical varicocele (P< 0.05). Bilateral and right side varicocele were relatively more common in patients with subclinical varicocele. Also the incidence of secondary infertility was higher in patients presented with subclinical varicocele compared with patients presented with clinical varicocele (P< 0.05). Results: In our study varicocelectomy have favorable results in patients with clinical varicocele. As regard, the effects of varicocelectomy in patients with subclinical varicocele, we recommend avoiding varicocelectomy in subclinical group of patients unless no identifiable causes of semen abnormality

Poster # 31

Role of Tamsulosin Oral Controlled Absorption System and Alfuzosin in Shock wave Lithotripsy for Renal and Upper Ureteric Calculi

Dr. Tamer Abouelgreed1, Dr. Yasser Badran2, Dr. Mohamed Abdelaal2, DR Hazem Deif2, DR Salah Shebl2

1Gulf Medical University, 2Al-Azhar University

Objective:To evaluate the effect of tamsulosin oral controlled absorption system 0.4 mg and alfuzosin 10 mg on clearance of stone fragments after ESWL in renal and upper ureteric calculi. Patients and Methods:A total of 200 patients with single pelvic renal or upper ureteric calculi 20 mm or less were enrolled in this study, underwent ESWL,divided into 3 groups, group (A) 65 patients received non-steroidal anti-inflammatory in the form of diclofinac Na 50 mg tds on demand with tamsulosin oral controlled absorption system 0.4 mg once daily.Group (B)66patients receiving diclofinac Na 50 mg tds on demand with alfuzosin 10 mg at night on bed time.Group (C) 69 patients received diclofinac Na 50 mg tds on demand as controlled group.All groups received 75 mg of diclofinac Na ampule intramuscular on demand. All patients were followed by KUB 2 weeks after each session of ESWL for clearance of stone fragments.Results:In our study the success rate after the end of study for stone size 10 mm or less was 28/28 patients 100% in group(A), 100% in group(B)and 93.3% in group(C).For stone size more than 10 mm, the success rate after 1st session of ESWL was higher in group(A)70.27% tamsulosin oral controlled absorption system and group(B) 71.4% extended release alfuzosin10 mg than group (C)35.89% controlled group.The overall success rate at end of study was higher in group(A)97.29% and group (B)94.28% than group(C)79.48%. No sever complication was observed in three groups A, B and C.

Conclusion: Medical expulsive therapy (tamsulosin oral controlled absorption system 0.4 mg) and alfuzosin 10 mg after ESWL for renal and ureteral calculi >10 mm increase stone expulsion rate, decrease the time for stone expulsion, amount of analgesia and number of colics episodes, in contrast, they failed to demonstrate a significant treatment effect after ESWL for stone less than 10 mm.

Poster # 32

Retrocaval Ureter with Hydronephrosis: Case report

Prof. Mohammed Elkady1

1Dar Alshifaa Hospital

Retrocaval ureter is one of the rare congenital anomalies. In this abnormality, right ureter deviates medially and passes behind the inferior vena cava (IVC), winding around and crossing in front of it from medial to lateral side. A 36 year old man presented with dull and intermittent right flank pain for 4 months, associated with vomiting and burning micturition. Physical examination showed tenderness & fullness in right renal angle. Complete evaluation done including laboratory, X-ray KUB and ultrasonography showed severe right hydroureteronephrosis with 7 mm calculus in the lower calyx of right kidney. Enhanced CT-KUB- mapped out the course of ureter and showed typical "S" shape deformity in the proximal dilated ureter with severe hydronephrosis. Preliminary cystoscopy & retrograde study was performed where we could detect whitish stenotic lumen at upper ureter then internal stent was fixed. The patient was then operated and subsequent surgical transection of the ureter near the renal pelvis along with ureteroureteral anastomosis and anteriorisation were performed.

Three weeks later stent was removed. Follow up done at 1 month & 6 months where we found improvement of the morphological hydronephrotic changes. In conclusion this type I retro caval ureter deformity is more is associated with obstruction at the pointof crossing. Marked hydronephrosis is seen in 50% of the patients. The standard repair of retrocaval ureter is open surgical pyelouretrostomy. The other modalities are per-cutaneous nephrostomy, ureteric stenting and retroperitonioscopic dissection of ureter.

Poster # 36

The efficacy of dutasteride and green tea combination towards angiogenesis and bleeding on BPH after TURP:Study the effect on VEGF,MVD,and haemoglobin

Dr. Nugroho Eriawan Agung1

1Department of Urology, Kariadi Hospital

Background and purpose : TURP is a standard procedure in BPH management,however,it may face with complication such as hemorrhagevthat may increase morbidity and mortality rate. The synergism effect angiogenesis combination of dutsteride and green tea on BPH has never been studied before.This study is designed to find the efficacy combination dutasteride and green tea in reducing hemorrhage on TURP patients and evaluate the anti angiogenesis effect. Methods:This study is double blind randomized controlled trial post test only,with 80 samples,randomized into 4 groups:one control group and three treatment group (P1 with 0.5 mg of dutasteride, P2 with a capsul of green tea, P3 with combination of 0.5 mg dutasteride and a capsul green tea at least 14 days before TURP procedure). We compared the hemoglobin value to evaluate the angiogenesis changes between

four groups. The difference is considered statistically significant p<0.05. Results:The result froo. Between subject effects showed sttistically significant differencess in hemoglobin (p<0.001), VEGF expression (p<0.001), and MVD count (p<0.001). Multivariate analysis showed that the combination of dutasteride and green tea significantly reduce the hemmorhage during TURP by decreasing MVD count. Conclusions:Administration of oral combination of 0.5 mg dutasteride and 725 mg of green tea,for at least 14 days prior to undergoing TURP signifacanty reduce the hemorrhage during TURP by decreasing MVD.

Poster # 42

Laparoscopic partial nephrectomy for renal mass in a patient with Autosomal Dominant Polycystic Disease

Dr. Deepak Janardhanan1, Dr Amgad Farouk, Dr Sanjay Bhat 1Medeor Hospital

Background and purpose:To show that it is technically feasible to perform laparoscopic partial nephrectomy in ADPKD and high light the steps. Methods:A 37 year old Indian male with ADPKD was evaluated for fever by MRI. His creatinine was 1.4mg%. MRI revealed classical features of ADPKD with a 4centimeter lower polar mass suggestive of RCC. 5 ports were used in lateral kidney position (10mm+10mm+12mm+5mm+5mm). Colon was mobilized medially and ureter and gonadal vein traced to renal hilum 2 arteries and one vein were isolated. Gerotas was opened preserving that overlying the tumour. Surrounding larger cysts were deroofed and the kidney was marked 5mm away from the mass with monopolar cautery. Bulldog was used to clamp the arteries and

satinsky clamp was used to clamp the vein after mannitol infusion. Cold shears was used to excise the mass. 30 V-lok suture was used to repair the PCS and ligate major vessels in the bed. 20 V-lok sutures was used to reapproximate the parenchyma. WIT was 27 minutes. On releasing the clamps some oozing from the site was repaired with additional 20V lok sutures over surgical. Specimen was extracted in an endobag by extension of one working port. RGP revealed some clots in the PCS with no leak. A 6/26 DJ stent was inserted. 14 Fr Foley catheter was placed. Results:Total operating time was 245 minutes and WIT was 27 minutes. Blood loss was minimal and did not require transfusion. Foley catheter was removed on day 2 and drain was removed on day 3 after renal Doppler confirmed good perfusion with no obvious AVM or collection. Histology revealed clear cell carcinoma with clear margins. His stent was removed after 3 weeks. He is awaiting follow up MRI. Conclusion:Laparoscopic partial nephrectomy is feasible in ADPD although technically demanding.

Poster # 45

Adrenal myelolipoma a rare benign tumour managed laparoscopically: case report

Dr. Rakesh Rajmohan1, Dr Mohammad Saheed,, Dr Abdul Jabbar Pirzada 1Lifecare Hospital Baniyas, VPS health care

INTRODUCTION: Adrenal Myelolipoma is a rare benign neoplasm composed of mature adipose tissue and a variable amount of haemopoietic elements. Most lesions are small and asymptomatic, discovered incidentally during autopsy or on imaging studies performed for other reasons. One case of right adrenal myelolipoma are presented here, which presented with flank pain and was managed by laparoscopic adrenalectomy

CASE REPORT: A 38-year-old male presented with complaints of intermittent, dull aching, vague pain right side of abdomen and lumbar area for few months duration. The physical examination was unremarkable.Radilogiclal investigations revealed a right suprarenal mass lesion of 71x56x55mm suspected of myolipoma or pheochromocytoma. Laboratory investigations revealed the non-functioning nature of the adrenal mass, Urinary VMA,Free Cortisol, metanephrines and normetanephrines were also within normal limits. Patient was posted for Right laparoscopic trans peritoneal adrenelctomy and the patient underwent the procedure with a smooth, postoperative recovery DISCUSSION: Myelolipomas are rare, benign tumours, usually found in the adrenal gland, although myelolipomatous foci can be present in other extra-adrenal locations. These tumours were initially described by Giercke in 1905, but Oberling coined the term ‘myelolipoma’ in 1929. They are composed of mature adipocytes and normal haematopoietic tissue,they contain precursors of white and red blood cells such as megakaryocytes. The incidence of adrenal myelolipoma is reported as being 0.08 to 0.4% at autopsy. More often than not, the male-to-female ratio is 1:1. They forms about 7% of all adrenal masses . Although most of indecently detected asymptomatic, there are few reported cases of large symptomatic lesions. The most well-recognised complication of adrenal myelolipoma is spontaneous retroperitoneal haemorrhage.They have no potential for maliganancy. Although small incidental lesions doen't need active surgical intervention symptomatic large lesions must be treated. With the advent of laparoscopic adrenalectomy connsiderably decreased the surgical morbidity as well as hospital stay and convalescence

Poster # 47

Improvement of Severe Baseline Lower Urinary Tract Symptoms Following Robotic Assisted Laparoscopic Prostatectomy

Dr. Seyed Behzad Jazayeri1, Dr. Dov Sebrow, Dr. Hugh Lavery, Adele Hobbs2, Dr. Adam Levinson2, Prof. David Samadi1

1Lenox Hill Hospital, 2Mount Sinai Medical Center

This study was designed to assess lower urinary tract symptoms following robotic assisted laparoscopic prostatectomy. Methods: In a single surgeon series, 938 patients underwent robotic prostatectomy and completed International Prostate Symptom Score surveys at baseline and after a minimum of 6 months follow-up. Patients preoperative lower urinary tract symptoms were categorized as mild, moderate, or severe according to the original International Prostate Symptom Score validation. Patient demographics, clinical and pathologic outcomes were recruited from an institutional board review approved database. Results: Preoperatively, 55.8% of patients presented with mild, 36.4% with moderate, and 7.8% with severe LUTS. Postoperatively, there was a shift toward milder lower urinary tract symptoms with 61.3%, 34.2%, and 4.5% of patients having mild, moderate and severe symptoms respectively. Increased prostate size trended with increased lower urinary tract symptoms severity (p<0.001). Patients who had severe preoperative lower urinary tract symptoms witnessed a 57% reduction in International Prostate Symptom Score (24.1 to 10.7, p< 0.001). Men with moderate preoperative lower urinary tract symptoms also witnessed a significant decrease in postoperative lower urinary tract symptoms (12.1 to 8.3, p<0.001). Conclusions: The majority of patients with moderate or severe lower urinary tract symptoms improved significantly following robotic prostatectomy, with the largest improvements

seen in the severe group. Prostate cancer patients with severe lower urinary tract symptoms should be counseled on the beneficial role of prostatectomy in helping to lessen their voiding dysfunction along with cancer treatment.

Poster # 48

Robotic Surgery in Young Men: Clinicopathological, Functional and Immediate Oncologic Outcome Assessment

Prof. David Samadi1, Dr. Dov Sebrow2, Adele Hobbs2, Dr. Adrien Bernstein2, Dr. Jonathan Brajtbord2, Dr. Hugh Lavery2, Dr. Seyed Behzad Jazayeri1

1Lenox Hill Hospital, 2Mount Sinai Medical Center

Background: Prostate cancer is the most common cancer in men. With wide spread use of PSA, men are diagnosed at earlier stages and earlier age. To define the pathologic and functional outcomes of men 50 years of age and younger with prostate cancer in a contemporary robotic cohort, this study was designed. Methods: Patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) (n=2,495) formed the base population for the current analyses. The patients were dichotomized according to their age: ≤50 (n=271) and >50 years old (n=2,224). Clinicopathological and health-related quality of life outcomes were recorded and analyzed for differences. Propensity score matching was used when assessing urinary and sexual function outcome. Results : Baseline PSA and clinical stage were similar between men older than 50 and those younger. Younger patients had less severe disease (D’Amico risk and Gleason scores) and smaller prostates. Young men had higher rates of erectile function at all time points, including baseline (94% vs. 83% at 12 months, p<0.01). Continence was

similar at all time points except for 6 months, where younger patients experienced a faster return than older patients and then remained constant, while older patients continued to improve (96% vs. 89%, p<0.1). After matching process, the difference in erectile function at 6 months follow up was lost. Conclusion: The majority of men aged 50 and younger who received RALP had clinically significant prostate cancer. While histopathologic and short-term oncologic outcomes were nearly identical when compared to older patients, younger men had a more rapid and superior return of erectile function.

Poster # 51

The role of PCA3 urine test in prostatic cancer diagnosis at repeat biopsy

Dr. Basheer Elmohamady1, Dr Mostafa Khalil1

1banha faculty of medicine

Objective:The primary objective of this study is to determine the performance characteristics and clinical utility of the PCA3 assay in detecting pCA at repeat biopsy. Patients and methods:78 patients with history of one or more negative TRUS prostatic biopsy result were enrolled in the study. All scheduled for repeat biopsy. The data of the patients with positive biopsy results were compared with negative ones. Evaluation of the diagnostic accuracy and efficiency of two different cut-off of PCA3 score (20 and 35) as an indication for repeat biopsy was carried out. Results:The mean age was 66.1 ± 3.9 years, the mean prostate volume was 66.5 ± 19.4 gram, 51.3% had one negative previous biopsy, and 48.7% had two previous biopsies, their mean PSA was 18.2 ± 8.1 ng/ml, and mean PCA3 scores was 36.3 ± 21.5.The mean PCA3 score was statistically

significant higher in the patients with positive results than those with negative results (54.2 ± 26.8 vs. 54.2 ± 26.8, P=.0.001).As regard score of 35 as PCA3 cut-off, the was statistically significant higher percent of patients with PCA3 scores more than 35 in the patients with positive result than with negative results (68.2% vs.31.8%, respectively, P=0.02). Sensitivity, specificity, PPV and NPV of PCA3 score cut-off of 20 vs 35 were 90.9 vs 63.4%, 27.8 vs 83.9%, 43.5 vs 60.9% and 83.4 vs 85.5%, respectively. Conclusions:PCA3 remained a good predictor of prostate cancer in patients scheduled for repeat biopsy, and could prevent unnecessary prostate biopsies if the value is low.

Poster # 52

Robot-assisted Removal of a Recurrent Retroperitoneal Leyomiosarcoma (PA)

Dr. Giorgio Gandaglia1, Dr. Andrea Gallina, Dr. Nazareno Suardi, Dr. Federico Dehò, Prof. Andrea Salonia, Prof. Alberto Briganti, Prof. Francesco Montorsi 1Università Vita-salute San Raffaele

Background and purpose. Surgery represents the treatment of choice of renal leiomyosarcomas. Nonetheless, a non-negligible proportion of patients with leiomyosarcoma would experience local recurrence during follow-up. Timely surgical resection of the recurrence represents one of the most effective options in these cases. Methods. We present the case of a 75 years old men who presented with a 45 x 42 x 2 mm para-aortic retroperitoneal lesion after a robot-assisted nephrectomy for a renal leiomyosarcoma. The patient underwent a robot-assisted surgical resection of the retroperitoneal lesion. The DaVinci Xi system was used in a four-arm configuration and the following robotic instruments were used: 30° down scope, ProGrasp

forceps, monopolar scissors, fenestrated bipolar forceps. The patient was placed in a 60° flank position. The recurrence resection was performed by an experienced high-volume surgeon at a tertiary referral center. Perioperative data including patient characteristics and postoperative complications were collected. Results. Operative time was 141 min. Console time was 75 min. Intraoperative blood loss was 50 ml with no need for blood transfusions. No peri or postoperative complications were recorded. The patient was discharged 4 days after surgery. The final pathologic report revealed a leiomyosarcoma with clear surgical margins. Conclusions. We describe a robot-assisted resection of a local recurrence in a patient with a renal leiomyosarcoma. Our video shows the surgical details of this technique and demonstrates that this approach might be safe and feasible.

Poster # 54

Prostate Cancer in African-Americans: Pathologic, Immediate Oncologic and Functional Outcome Following Robotic Prostatectomy

Dr. Seyed Behzad Jazayeri1, Prof. David Samadi1

1Lenox Hill Hospital

Purpose: To assess the clinical, pathologic, functional and immediate oncologic outcome of African American men undergoing robotic assisted laparoscopic prostatectomy (RALP) in a single series of patients this study was conducted. Patients and Methods: An institutional review board approved database of patients undergoing RALP was searched for patients with clinical and follow up data at 12 months after surgery. African American and white men were selected to compare the results of pathologic evaluation and

outcomes of surgery. A propensity match analysis was further performed to compare the outcomes in African American and white men. Results: Overall, 267 African American and 1913 white men were included in the analyses. In the preoperative evaluation African American men were younger (p<0.001) but had similar PSA level (p=0.21). Sexual function and urinary continence was similar between the two populations. At pathologic evaluation, African American men had more Gleason 3+4 or 4+3 (p=0.01) with higher tumor volume (p=0.01) but similar prostate weight (p=0.84) and index tumor size (p=0.05). Biochemical recurrence rate was similar in the two populations. In matched analysis, African American had lower rates of sexual function (p=0.01) but similar continence rate (p=0.44). Conclusion: In our series of patients in a referral setting, African American patients represented 10.6% of our database. There was no different in tumor characteristics of the two population. However, lower rate of sexual function after surgery in African American requires further investigation.

Poster # 56

Frequency and Predictors of Non-Muscle Invasive Bladder Tumour Recurrence on First Check Cystoscopy after Transurethral Resection of Bladder Tumour

Dr. Muhammad Farhan1, Dr Muhammad Nazim1, Mr Jibran Ahmed1, Dr Hammad Ather1

1Aga Khan Medical University Hospital

Background: Bladder tumor is the second most common genitourinary tract malignancy. 90% of bladder tumors are urothelial carcinomas of which 75% are non-muscle invasive. Trans-urethral resection (TURBT) is the standard treatment for

bladder tumours. 70% of non-muscle invasive UC recur and 25% progress to invasive form. Patient require check cystoscopy at three months after initial TURBT. Patients, who have recurrence at first check cystoscopy are at higher risk of recurrences as compared to those with no recurrence. Objective: To determine the frequency and predictors of non-muscle invasive bladder tumor recurrence on first check cystoscopy after transurethral resection of bladder tumor. Material and Methods: Patients with new bladder tumor underwent white light cystoscopy + Trans urethral resection of bladder tumor. Only patients with non muscle invasive disease who had complete resection were included. Patients received standard adjuvant intravesical therapy according to risk stratification and underwent check cystoscopy at 3 months to look for recurrence. Patients and tumor characteristics were recorded and data was analyzed. Univariate and multivariate logistic regression analysis was done to determine the association between clinico-pathological variables and recurrence at first cystoscopy Results: The study population included 84 patients. Mean age at presentation was 63.3 years with male preponderance (89%). On initial TUR, Majority of tumors were < 3cm in size and were single. Multiple tumors were seen in 39%. None of resected tumors were primary CIS and 39% were high grade. The overall recurrence rate at first check cystoscopy was 33.3%. On univariate and multivariate logistic regression analyses larger tumor, higher grade and tumor multifocality were factors associated with recurrence at check cystoscopy. Patient’s age, gender, smoking and tumor stage were not found to correlate with recurrence. Conclusions: Our limited data showed that number, size and grade of the tumor strongly correlated with recurrence at first check cystoscopy.

Poster # 58

PET/CT and PET/MRI for Localization and Grading of Primary Prostate Cancer

Dr. Ziting Wang1, Mr Kep Yong Loh2, Dr J Schaefferkoetter3, Dr Trina Kok3, Dr M Stephenson3, Dr Emile Schneider3, Dr E Niaf3, Dr J Totman3, Dr Lata Raman1, Miss Zin Mar Ma1, Dr Bertrand Ang1, Dr Thomas Thamboo1, Dr David Townsend3, A/Prof Edmund Chiong1

1National University Hospital, 2Duke-NUS Graduate Medical School, 3A*STAR-NUS Clinical Imaging Research Centre

Background: Prostate cancer is the most common cancer amongst men worldwide. Primary diagnosis relies on digital rectal examination, serum Prostate-Specific Antigen (PSA) measurement and histology from prostate biopsies. However, evaluations are limited by their low sensitivities and specificities. The prostate biopsy is hampered by its invasive and imprecise nature, and theunderestimation of the extent and grade of prostate carcinoma. We hope to develop new imaging techniques for global visualization of the prostate gland to aid in detection,localization and grading of prostatic carcinoma. Methods: We evaluated the models for quantifying uptake simultaneously with injection of 6mCi18F-Choline. The tissue time-activity data were analyzed using a 2-tissue model to estimate 4 compartmental rate parameters and blood volume fraction(Vb). Imaging data were correlated with histology from prostatectomy specimens tissue, and the corresponding perfusion-related parameter and tracer influx parameter for each were correlated with the 60-minute SUV and Patlak analysis collectively for all tissue groups. Tracer kinetic modelling was performed with a 4k, two tissue compartmental model.

Results: 10 patients were evaluated,yielding measured regions in 8 tumors, 9 healthy prostates, and 10 muscles. Typically, the PET data show highest accumulation of 18F-Choline in the tumor. The analyses for tumor versus healthy prostate tissue reflect good correlation between Choline influx parameters and SUV and Patlak slope for 3 tissue, with influx parameters of 0.078 and 0.082 for tumor and 0.017 and 0.018 for healthy prostate tissue, from compartmental fitting (R2=0.79, p<0.001) and Patlak, respectively (R2=0.69, p<0.001). Also, kinetic parameters could be accurately estimated with 20 minutes of data. Conclusions: We found that SUV and Patlak analyses did not accurately characterize Choline uptake in all tissue, and compartmental methods were needed. Fluorocholine is a relatively fast tracer and we were able to estimate kinetic parameters in less than half of the original duration of the PET study

Poster # 60

Grafting the incised urethral plate may improve the results of TIP repair in primary distal and mid-penile hypospadias

Dr. Mohamed Elsawy1, Dr AbdulNasser Alsaid1

1Ibn Sina Hospital

INTRODUCTION AND OBJECTIVES: To examine whether grafting the incised urethral plate using preputial skin graft in primary distal and mid-penile hypospadias cases improves the results of TIP repair. METHODS: An interventional comparative study was conducted from (1/2009-12/2013). All primary distal and mid-penile hypospadias cases before 8/2011 underwent TIP repair, while all after 8/2011 underwent grafting the tubularized incised

urethral plate (G-TIP) repair and the results of both groups were compared. Patients were followed up through clinic visits for a period of 2 to 5 years. In all cases urethra was closed in two layers, dartos was used as an interposing layer, and same sutures has been used. RESULTS: Each group comprised 33 consecutive patients. Mean age for TIP was 2.2 years and 2.3 years for G-TIP. The mean follow up period for TIP was 4.3 years and 3.1 years for G-TIP. In each group 8 cases with mild to moderate chordee were corrected using midline plication. The mean operative duration for TIP was 112 minutes while 136 minutes for G-TIP. Within the TIP group, the complication rate was 9.09% [fistula in 2 cases (6.06%) and glanular dehiscence in 1 case (3.03%)], while within G-TIP group the complication rate was 3.03% [only 1 case of fistula]. The difference in complication rate between both groups was statistically non-significant (P< 0.33). We had neither meatal stenosis nor residual chordee in each group. The results show that the success rate in TIP was 90.91% and 96.97% in G-TIP CONCLUSIONS: Urethral plate grafting, using a preputial skin graft when added to TIP repair for primary distal and mid-penile hypospadias, results in a lower complication rate compared to TIP repair.

Poster # 61 Clean Intermittent Vaginal Catheterization: Is an Alternative to Vaginostomy in Managing Hydrocolpos Associated with Urogenital Sinus

Dr. Mohamed Elsawy1, Dr AbdulNasser Alsaid1

1Ibn Sina Hospital

INTRODUCTION AND OBJECTIVES: Vaginostomy has been practiced as a standard procedure in drainage of hydrocolpos associated with

Urogenital Sinus. We herein emphasize the effectiveness of Clean Intermittent Vaginal Catheterization in drainage of hydrocolpos in patients with Urogenital Sinus. The advantage of this non invasive technique in facilitating reconstructive surgery by avoiding Vaginostomy and its related complications. METHODS: During 5 years period( from 2008 to 2013), a total of 9 patients of pure urogenital sinus (without ambiguous genitalia) presented during the first week of life with clinical and ultrasound findings suggestive of huge hydrocolpos. 5 patients underwent Genitoscopy to study the anatomy and vaginal orifice was seen stenotic on the floor of the common channel which was dilated with the scope and 10 Fr feeding tube was inserted for a week. After counseling the parents specifically regarding the advantage associated with avoidance of Vaginostomy related morbidity, clean intermittent vaginal catheterization was started and hydrocolpos was successfully drained every 8 hourly. In the other 4 patients clean intermittent vaginal catheterization could be performed successfully without need for Genitoscopy. Follow up period ranged from 17-62 months. RESULTS: The mean hydrocolpos volume at presentation was 120 ml. Serial ultrasound scan on regular follow up suggested that Clean Intermittent Vaginal Catheterization with no 8 French feeding tube was successful in managing hydrocolpos with daily drainage of 15-45 ml with optimum parents compliance and acceptance. All patients underwent reconstructive procedure successfully without complication. CONCLUSIONS: Clean Intermittent Vaginal Catheterization appears to be an easy, simple, effective non-surgical procedure in management of hydrocolpos associated with pure Urogenital Sinus till reconstructive surgery is performed. Awareness among treating physician may help in reducing the incidence of Vaginostomy thus facilitating reconstructive surgery and avoid long-term morbidity.

Poster # 62

Zero ischaemia time in partial nephrectomy with moderate to high RENAL nephrometry scores

Mr. Ali Thwaini1, Ms Karen Rhandawa1, Mr Wesam El-Baroni1, Mr Mark Evans1

1Belfast City Hospital

Introduction: Higher renal nephrometry score has been associated with increased blood loss, warm ischaemia time and length of hospital stay. Off-clamp partial nephrectomy has demonstrated advantages for long term renal function but requires careful patient selection. This study examines outcomes of off-clamp partial-nephrectomy in moderate to high RENAL nephrometry scores. Methods: Retrospective review of partial nephrectomy data between 2013 and 2016 was performed. Perioperative data and RENAL nephrometry score were collected. Tumours with intermediate(7-9) and high(10-12) RENAL scores were included. Only those with zero ischaemia-time(performed off-clamp) included in the study. Demographic and perioperative data was obtained, and postoperative oncological results and adverse events were analysed. Results : Of 99-patients, 23 with low nephrometry score(0-6) were excluded. 66 patients(Group I) had moderate nephrometry score and 10(Group II) had high nephrometry score. Patients’ demographics were similar in both groups. In groups I and II, 54(82%) and 8(80%) patients were performed with zero-ischaemia time respectively. In off clamp patients in group I, three conversions to open occurred in 3(5.5%) patients and 1(1.8%) had total nephrectomy, compared to one(8%) conversion to total nephrectomy, and none to open. For group II; one(12.5%) conversion to open occurred in the off-clamp group. In group I; urine leak occurred in

5,2 (9,16%) in the off clamp and warm ischaemia patients respectively. In group II; urine leak occurred in only 2 (25%) in the off clamp patients. Mean estimated blood loss in group I was 541, 176mls in the off-clamp and warm ischaemia patients respectively. Mean blood loss in group II was 540 and 250 mls in off clamp and warm ischaemia patients respectively. Positive surgical margins occurred in 8 (12%) and 2 (20%) patients in groups I and II respectively. Conclusion: Zero-ischaemia nephron-sparing surgery is oncologically safe and feasible in the management of selected cases of complex renal masses.

Poster # 63

Increasing intra-abdominal pressure and perioperative outcome in nephron sparing surgery: Initial Experience

Mr. Ali Thwaini1, Mr Osama Abu Sanad1, Mr Mark Evans1, Mr Bashar Mukhtar1

1Belfast City Hospital

Introduction: Nephron-sparing surgery(NSS) is the gold standard treatment of patients with pT1 renal tumours. We describe the impact of increasing intra-peritoneal pressure(IAP) values during laparoscopic NSS on the peri-operative blood loss and glomerular filtration rate(eGFR). Methods: Retrospective review of NSS patients between 2014-2015. Two groups were created according to IAP used at the time of dissecting the renal capsule, Group A 18mmHg, n=20) and Group B(12mmHg, n=20). The IAP was reduced back to 12mmHg once the first layer of renorrhaphy is performed. Demographic and peri-operative estimated blood loss (EBL) and eGFR changes were analysed.

Results: Median age for group-A was 55 years (37–75) and 59 years for group-B(42–72). Length-of-stay for group A and B was (5,4) days, respectively. Median EBL was (75,300)mls in Groups A&B, respectively. Median eGFR preoperatively for group A and B were (45, 42.5) mls/min/1.73m2, respectively. Postoperatively, eGFR values were (50, 40) mls/min/1.73m2, for group A and B respectively. Conclusion: Temporary increase in IAP during NSS resulted in reducing intra-operative blood loss, but most imprtantly no reduction on the renal function. To the best of our knowledge this numerical objective evaluation for the impact of IAP on EBL and eGFR has not been described in the literature of Laparoscopic NSS. We recommend long-term follow up with larger cohort to evaluate the results.

Poster # 65

Significance of Indwelling Time for Bacterial Colonization of Double J Stents

Dr. Muhammad Sheraz Javed1, Dr. Ghulam Mehboob Subhani1, Dr. Sana Tahir1, Dr. Safdar Hassan Javed1

1Allied Hospital, Faisalabad

Background and Purpose: Endoscopic surgery for urolithiasis is considered gold standard treatment. For Endo-urology, DJ stents have been designed to make surgery patient friendly. With passage of time, biofilm development around these stents and infectious complications are commonly encountered, causing patient’s morbidity. So study was conducted to determine the significance of indwelling time for bacterial colonization of DJ stents. Methods: Prospective study conducted from September 2014 to November 2015 (15 months)

in Department of Urology and Kidney Transplantation, Allied Hospital, Faisalabad. Study included 68 patients who undergone PCNL and URS for renal and ureteric stones respectively with DJ stenting. Urinary cultures were performed at 2-4 weeks, 5th week and more than 6th week of indwelling time and lower end of DJ stent cultures were performed. Characters of obtained data were observed for laterality, gender, age, and indwelling time. Student t and Chi-square test were applied for statistical analysis. Results: Mean age of 68 patients (38 male and 30 female patients) was 48.5 years (20-77 years age limits). Among 68, PCNL (n = 5) and URS (n =63) were the procedures. 36 patients undergone right sided and 32 undergone left sided ureteric stenting. Urine culture was positive in 1 (1.47%) while DJ stent cultures were positive for colonization in 4 (5.8%) cases. Detected microorganisms were Escherichia coli in three cases and Pseudomonas in one case. No statistical association found for gender, age and laterality while statistical significance found between indwelling time and colonization as the rate of colonization was 2.7% for less than 4 weeks, 4% for 5 weeks as compared to 28.5% colonization for more than 6 weeks indwelling time. Conclusion: Colonization rates increases when indwelling time increases and a sterile urine does not exclude an infected stent.

Poster # 66

Prevalence of Erectile Dysfunction in Patients on Hemodialysis

Dr. Muhammad Sheraz Javed1, Dr. Safdar Hassan Javed1

1Allied Hospital, Faisalabad

Background and Purpose: End stage renal disease (ESRD) is the most frequent illness of the medical floor having high incidence. Hemodialysis is

commonly available treatment option for ESRD and is associated with metabolic disorders affecting reproductive functions. Among these, erectile dysfunction is most commonly observed and psychologically disturbing morbidity as high as 83% worldwide. So, study was conducted to determine the frequency of erectile dysfunction in such patients. Methods: Cross sectional study conducted from November 2015 to April 2016 (6 months) in Department of Urology and Kidney Transplantation, Allied Hospital, Faisalabad. 60 patients for the study enrolled included indoor and Outdoor patients with ESRD presenting in Department of Urology, Allied Hospital, Faisalabad for AV fistula formation. Erectile dysfunction was assessed using International Index of Erectile Function (IIEF-5). Mean, standard deviation, frequency calculation and chi-square test were statistical tools being used. Results: Among 60 cases, 45 % (n=27) were of 25-35 years and 55 % (n=33) were of 36-45 years age with mean+ sd as 36.15 + 5.47 years. 81.67 % (n=49) had erectile dysfunction while 18.33 % (n=11) had no morbidity. Among 49 patients with morbidity, 32 patients were found with severe, 11 with moderate, 4 with mild to moderate and 2 with mild erectile dysfunction. Data stratification for age was done and was found that 24 out of 27 were between 25-35 years of age and 25 out of 33 were between 36-45 years of age with p value as 0.19. Data stratification for duration of the hemodialysis showed that 19 out of 27 were with 6-18 months duration while 30 out of 33 had >18 months of duration of dialysis with p value as 0.04. Conclusion: Study concluded that the frequency of Erectile Dysfunction is higher among patients on hemodialysis

Poster # 67

Prevalence of Urinary Tract Infection in patients with long standing indwelling Foley catheters.

Dr. Muhammad Saifullah1, Prof. Safdar Javed1

1Department Of Urology And Renal Transplantation, Punjab Medical College / Allied Hospital, Faisalabad

BACKGROUND AND PURPOSE: Catheter acquired urinary tract infection (CA-UTI) is one of the most common acquired health care infections. 70–80% of urinary tract infections are attributable to use of an indwelling urethral catheter. CA-UTI is the source of over 50% of episodes of bacteraemia in long-term care facilities. Indwelling catheters are called long-term when kept in situ for >30 days. The gold standard for diagnosing urinary tract infection (UTI) is the detection of the pathogen identified by midstream urine culture. The purpose of our study is find out the frequency of UTI in patients with long standing indwelling Foley catheters. METHODS: STUDY DESIGN: Descriptive cross-sectional study. SETTING: Urology Department, PMC/Allied Hospital, Faisalabad. DURATION: 01-12-2015 to 31-05-2016. METHODOLOGY: 100 patients were selected for the study. After taking informed consent, the indwelling Foley catheter was changed under aseptic measures and the cut tip end of the Foley catheter was removed and secured in a sterilized container. It was sent for culture to the Pathology Department of PMC/Allied Hospital. Diabetes Mellitus was ruled out on basis of history and blood sugar levels. The report was taken and data was collected on a proforma. RESULTS: In our study, out of 100 cases with Foley catheter in situ for >30 days, 53%(n=53) were between 15-50 years old while 47%(n=47) were

between 51-70 years, mean+sd was calculated as 46.45+12.39 years, 95%(n=95) were male and 5%(n=5) were females, frequency of UTI in patients with long standing indwelling Foley catheters was recorded in 18%(n=18). CONCLUSION: We concluded that the frequency of UTI is higher among patients with long standing indwelling Foley catheters, however, it is required that every patient with Foley catheter should be evaluated for CA-UTI.

Poster # 68

Epidemiologic pattern of Urolithiasis in Faisalabad: experience at a tertiary care hospital

Dr. Nabeel Ismail1

1Department Of Urology And Renal Transplant, Faisalabad, Pakistan

Background and purpose: Incidence of Urolithiasis has progressively increased in industrialized countries like Pakistan. This study updates on the epidemiology of urolithiasis in Faisalabad with a focus on the changing tendencies in stone disease, clinical spectrum currently encountered in practice and surgical interventions being employed. Methods: This was a prospective study of patients with urolithiasis irrespective of age and sex admitted in Department of Urology and Renal transplant, Allied Hospital Faisalabad between January1, 2015 and June 31, 2016. A total of 399 cases were reviewed for demographics, presentation and management. Results: Three nighty nine patients (276 males, 123 females; mean age 28.9 year) were assessed. One twenty eight (32%) had a family history of stones.248 patients (62%) belonged to rural areas. Flank pain (78%) was the most common presentation then Nausea/ vomiting (59%) and

Hematuria being third common at (47%). Fifty six Patients (14%) had history of stone passage. Kidneys (42%) were the most common site of urolithiasis. Both Renal (45%) and Ureteric (45%) stones were more common on Left side. Fifteen patients (3.75%) with ureteric and eight patients (2%) with urethral stones passed their stones spontaneously. 376 patients (94%) required surgical intervention. PCNL was the most common procedure (29%) performed for urolithiasis and patients undergoing Nephrectomy for Non-Functional kidneys were ten (2.5%). Conclusion: Urolithiasis is an important problem in our area. Stone distribution mostly resembles that of other countries but there are marked variations in the regional distribution of urolithiasis which had led to the identification of ‘stone belts’. By knowing the prevalence of area based urolithiasis, one can plan a better urological service for the nation.

Poster # 69

Correlation between International Prostate Symptom Score and Bladder Wall Thickness.

Dr. Moin Anwar1, Dr Safdar Javed1

1Allied Hospital (punjab Medical College) Faisalabad, Pakistan.

Background & Purpose: The International Prostate Symptom Score (IPSS) is a scoring system used to screen for and diagnose Benign Prostatic Hyperplasia (BPH) as well as to monitor symptoms and guide decisions about how to manage the disease. Calculation of IPSS is quite difficult as it depends on IQ level and intellectual level of patients. The Bladder Wall Thickness (BWT) due to detrusor hypertrophy occurs in response to bladder outflow obstruction caused by BPH. BWT can be precisely measured by ultrasound.

As IPSS is difficult to calculate, BWT measurement can be a reliable if there is correlation between IPSS score and BWT. OBJECTIVE: The objective of this study was to “determine the correlation between mean IPSS and mean Bladder Wall Thickness in patients of Benign Prostatic Hyperplasia. METHOD: A total of 70 male cases between 50 to 70 years with LUTS due to enlarged prostate diagnosed on ultrasonography were included in the study. Ultrasonography (USG) was done and reported by consultant Radiologist in Department of Radiology AHF to measure BWT, and IPSS was calculated. The data was entered in a proforma. RESULTS: In our study, out of 70 cases, 47.14%(n=33) were between 50-60 years of age while 52.86%(n=37) were between 61-70 years of age, mean+sd was calculated as 61.27+5.31 years, correlation between mean IPSS and mean bladder wall thickness in patients with benign prostatic hyperplasia was calculated as significant, mean Bladder Wall thickness was calculated as 3.64+0.72 while IPSS was calculated as 12.84+2.79, r value was r=0.9056 and p value=0.00 showing a significant correlation. CONCLUSION: We concluded a positive correlation between mean IPSS and mean Bladder Wall Thickness in patients of Benign Prostatic Hyperplasia.

Poster # 72

An unusual Urethral stone housing the Navicular fossa for years: A case Report

Dr. Nabeel Ismail1, Dr. Safdar Javed1

1Department Of Urology And Renal Transplant, Faisalabad, Pakistan

Background: Urethral stones are rarely encountered, accounting for 0.3% of overall

urolithiasis. They usually present with Dysuria, Hematuria, urinary tract obstruction and can also present rarely as a mass in Glans. Quite a few cases have been presented in the literature. Case Report: We are reporting an unusual case of huge urethral stone that was residing the navicular fossa for years with a unique presentation of hard swelling in Glans and intermittent retention. Patient had that stone for about seven years and was voiding by manually sliding the stone to one side with his hands since then. Plain X-ray KUB revealed a radiopaque shadow of 1.5 x 1.5 cm inside the glans. Stone can easily be seen inside the fossa on examination and on palpation it was like a hard swelling inside the glans. Meatotmy was done under general anesthesia and stone was removed using an artery forceps, incision site closed with vicryl. Clearance of the stone resulted in improvement of patient symptoms and patient was discharged home in satisfactory condition. Conclusion: Navicular fossa stones are extremely rare, and long standing stones can grow in size and be palpated as hard mass inside the glans. They can be easily removed by doing meatotmy with a symptom free follow-up.

Poster # 73

First 30 Focal One® prostate focal therapy : preliminary oncological results

Dr. Stefano Regusci1, Dr. Martina Martins Favre, Dr. Stephane Rohner, Dr Georges-Antoine De Boccard, Dr Alexandre Caviezel, Dr. Sao-Nam Tran, Dr Ildiko Szalay-Quinodoz, Dr Charles-Henry Rochat 1Sipc

Introduction and Objectives: In a retrospective way, we evaluated our first 30 cases of Prostate focal therapy by high-intensity focused ultrasound (Focal One® EDAP France) in term of oncological results by prostate biopsy.

Methods: Between october 2014 and november 2015 we treated 30 patients with localized Prostate cancer. Inclusion criteria were maximun PSA 15ng/ml, Clinical stage T2, Maximum Gleason 3+4. We performed focal therapy by Focal One Device. True focal, zonal or hemiablation were adopted depending on the grade and extent of the tumor. Short term PSA, MRI and biopsies results and complications rate were evaluated. Results: Mean age was 68 (53-74) years, median PSA was 9,1 (4,7-14,3) ng/, and the mean prostate volume was 43 (23-94cc). 15 patients harbored Gleason 3+3=6, and 15 Gleason 3+4=7. 16 patients underwent TURP or TUIP. All patients underwent contrast-enhanced ultrasound (SonoVue®). 12 immediate retreatments. In term of complications, one patient experienced severe incontinence for 3 months and 4 patients de novo erectile dysfunction. No fistula and urethral stricture were observed. PSA declined more than 50% of the initial value in 83,3% (25/30) patients. Biopsies performed between 8-12 months postoperatively were negatives in the lobe treated in 86,6% (26/30) patients. Conclusions: Short term results in our small serie, show that Prostate focal therapy by Focal One is a safe procedure with promising oncological results.

Poster # 75

Management of Male Urinary Incontinence

Dr. Akos Pytel1

1DHA, Dubai Hospital

Background and purpose: Worldwide there is rising elderly population and exponential increase of surgical intervention for prostate pathology. Even in the United Arab Emirates we can observe this trends. With evolving surgical procedures the incidence of male incontinence is rising as well.

Methods: A systematic review of the published literature on reporting male incontinence was performed. This review highlights the ethiology, evaluation, and management of post-prostatectomy incontinence. Effort is given to provide an algorithm to clinicians for the daily praxis. Different surgical techniques of commonly performed procedures and their outcomes are described. Also surgical tips and tricks, based on own experiences, are highlighted. Results: Male incontinence causes a significant impact on the patient's health-related quality of life. Although the majority of cases is caused by intrinsic sphincter deficiency, detrusor dysfunction or lower urinary tract obstruction can contribute to the pathologic conditions. Careful clinical evaluation, including voiding diary, incontinence questionnaire, urodynamic study, and urethrocystoscopy, are necessary to determine the appropriate treatment. The initial management is conservative treatment including lifestyle interventions, pelvic floor muscle training with or without biofeedback. An early start of conservative treatment is recommended. If the conservative treatment fails after the first year, a surgical treatment is recommended. Conclusions: With an increasing number of radical prostatectomies performed for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. It is necessary to improve our understanding of the pathophysiologic mechanisms of male incontinence, and to implement the evaluation and treatment of it in the daily urological practice.

Poster # 76

Androgenic Hypertrichosis , Androgenic Alopecia and Prostatic Cancer Association Assessment in Cauvery Delta TamilNadu

Population of Men who are a sample group of Dravidian Population. - A Case Control Study

Dr. Jayaprakash Narayanan1

1Frontline Hospital

Background and Purpose: The purpose of this study was to examine the relationship between Androgenic Hypertrichosis, Androgenic Alopecia and Prostatic Cancer in Cauvery Delta TamilNadu Men Population. Materials and Methods: We conducted an age stratified, population based case control study in Cauvery Delta Tamilnadu population of men who were diagnosed during 2010 to 2015 end with pathologically confirmed adenocarcinoma of the prostate. Controls were selected from the in patient registries of Thanjavur Medical College Hospital and FrontLine Hospital who were presented with lower urinary tract symptoms and diagnosed as Benign Prostatic Hypertrophy. The analysis was based on 117 and 123 controls of whom direct observations were made of their post pubertal excessive body hair growth and scalp hair loss during face to face interviews. Datas subjected to multiple discriminant analysis,one way anova and cross tabulation statistical analysis. Results: The result of Cramer’s V suggests that the relationship between Prostatic Cancer and Androgenic hypertrichosis is very weak and it is quantified as 1.1%, and the presence or absence of Androgenic hypertrichosis is independent at 5% level of significance. The result of Cramer’s V suggests that the relationship between Prostate Cancer and Androgenic Alopecia is very weak and it is quantified as 1.5%, and the presence or absence of Androgenic Alopecia is independent at 5% level of significance. Conclusion: We found that there is no statistically significant association between Androgenic Hypertrichosis and Prostate Cancer in our study. In contrast to the studies conducted in various ethnic(Australian , American and French)

populations, the Association between Androgenic Alopecia and Carcinoma Prostate is not statistically significant in Cauvery Delta Tamilnadu population of men who are a sample group of Dravidian Population.

Poster # 79

Comparison of effectiveness of pericatheter Retrograde Urethrography and cystography in detecting urethrovesical anastomosis.

Mr. kyung kgi Park1, Dr. Young Joo Kim1, Dr. Sung Dae Kim1, Dr. Jung Sik Huh1

1Jeju National University Hospital

Introduction and Objective: Urethro-vesical anastomosis (UVA) is a critical point of prostatectomy. UVA leaking can prolong catheterization. Properly evaluation of UVA leaking is important to remove the catheter. We evaluate both retrograde urethrography (RGU) and cystography as the method of confirming UVA leaking. Materials and Methods: we prospectively analyzed 90 patients who underwent robot assisted laparoscopic prostatectomy for prostate cancer at our instititute from march 2013 to February 2015. All patients underwent pericatheter RGU and cystography at postoperative days 7. The ability of detection of UVA leaking by minimal dye requirement to reveal leak, discomforts during procedure, urethral compressed length during kegel exercise. Patients discomfort was evaluated with visual analogue pain scale. Result: Among 90 patients, UVA leaking was observed in 16 patients. After postoperative 14 days, all patients could remove their urethral catheter without UVA leaking. Both methods let us figure out UVA leaking of 16 patients at postop 7 days. In this 16 patients, RGU could detect UVA leaking with small amount of dye rather than

cystography (mean 15.6cc (10-25cc), mean 83.3cc (50-120cc), retrospectively) (P < 0.001). However, patients complaint their urethral pain during proceeding RGU rather than cystograpy (mean 6.45 in RGU, 2.75 in cystography) (P <0.001). Cytography could let us identify compressed urethral length during pelvic muscle contraction. This also let us predict patient’s functional capacity and the presence of de-novo urgency after surgery. Conclusion: Cystography can help to more easily identify the severe postop urethral parameter such as compressed urethral length, bladder capacity and the presence of de-novo urgency without significant urethral pain rather than RGU. However RGU could let us detect the UVA leaking with less usage of dye filling and finely described the pattern of leaking flow than cystography.

Poster # 80

Role of Nurse/ESWL Technician in Management of Reno-Ureteral Calculosis

Mr. Laxman Magadum1, Dr. Rajendra Nerli1, (Dr.) Shridhar Ghagane2

1Department of Urology, KLE Kidney Foundation, Kles Dr. Prabhakar Kore Hospital & Mrc., 2Department of Biotechnology & Microbiology, Karnatak Univeristy, Dharwad

Urolithiasis and Nephrolithiasis is a common disorder and a significant problem because of the prevalence of the disease increasing worldwide. As the affected population is getting younger and recurrence rates are high, dietary modifications, lifestyle changes, and medical management are essential. Patients with recurrent stone disease need careful evaluation for underlying metabolic disorder. Major progress has been made recently in understanding the pathophysiological disturbances responsible for stone formation as well as in the techniques of stone removal. The

introduction of extracorporeal shock wave lithotripsy (ESWL) has considerably reduced the need for surgery. The lifetime risk of passing a stone is 8–10%. Men are twice as likely to develop stones, with the first episode occurring before 30 years of age. Stones are caused by the aggregation of crystalline mineral deposits in the urine. Investigations for stone disease include plain X-ray, X-ray with contrast media, ultrasound imaging, and computed tomographic (CT) scanning. Treatment of stones is dependent on the size and location, e.g. lithotripsy is used to break down stones in the ureter or kidney, whereas litholapaxy is used for stones in the bladder that are too large to be passed urethrally. Medical management should be used judiciously in all patients with urolithiasis and nephrolithiasis, with appropriate individualization. This study focuses on crucial role of Nurse/ESWL technician in medical management of urolithiasis and nephrolithiasis in assessment, management and provision of discharge advice for patients.

Poster # 81

Pre-Renal Transplant Counselling of Donor and Recipient

Mr. Laxman Magadum1, Dr. Rajendra Nerli1, (Dr.) Shridhar Ghagane2

1Department of Urology, KLE Kidney Foundation, Kles Dr. Prabhakar Kore Hospital & Mrc., 2Department of Biotechnology & Microbiology, Karnatak University, Dharwad.

Recent advances in the field of organ donation and organ transplant have introduced new hope for the treatment of serious diseases. A large number of factors can influence the clinical outcome of kidney transplant donor and recipients, but the active role of the nursing in-charge to prevent the possible complications related to transplant and its treatment is often neglected. Poor adherence to prescriptions is frequent in transplant recipients and represents a major contributor to the development of graft failure, cardiovascular disease, infection and/or malignancy. Thus,

nursing in-charge and transplant specialist should also consider values such as patient-doctor trust, respect for human dignity and presence of conflict of interest. The renal nurse needs to support and assist the patient and their relatives to cope with transplantation in the best way possible and to manage the pre- and post-operative care to maximise the success of the graft. Nurses caring for these patients require specialist knowledge to reduce problems in the early post-transplant period by prevention or anticipation and early intervention to maximise short- and long-term graft outcome. Patients (and relatives) who are engaged with the process are better equipped to care for themselves and this also contributes to the success of the graft.

Poster # 82

Roles & Complications of Substitution Urethroplasty, Systematic review

Mr. Abdulaziz Almujaydil1, Mr. Abdulmonem Alharbi1

1Department Of Medicine ,Qassim University

Background: Urethroplasty is the `gold standard' for treatment of urethral stricture infection; substitution urethroplasty is utilized as a part of long, perplexing, intermittent urethral strictures. Objectives: aim of this study is to discuss the roles and different surgical approaches that are used in substitution urethroplasty and also to demonstrate the most complications of this procedure according to evidence based trails. Methodology: A systematic review study of the literature was performed using Medline, Embase, the Web of Science, and the Cochrane Library were conducted databases through July 2016 using the search terms, `substitutional urethroplasty', `urethral obstruction', `urethral stricture', `sexual function', `erection' .

Conclusion: the results of the ventral and dorsal onlay of BM for bulbar urethroplasty are equivalent. Two-stage procedures are preferable in the penile urethra, except under certain circumstances when a one-stage dorsal onlay is feasible.

Poster # 85

The "Forgotten" Ureteral Stents- Are They Really Forgotten?!

Dr. Hamzeh Esmaeilpour1, Dr. Fariborz Bagheri1

1DHA- Dubai Hospital, 2DHA- Dubai Hospital

Purposes & Objectives :To evaluate the clinical presentation of forgotten ureteral stents, and targeting the predisposing factors leading to the condition, as well as the complications and the management options. Ureteral stents are often used in everyday urological practice. The spectrum of their use is wide and variable, depending on the given situations, Stents are used to bypass or overcome ureteric obstructions of intrinsic and extrinsic nature, used in pre and post operative phases ,anatomical abnormalities both congenital and aquired, as well as in iatrogenic injuries of the ureters. However, forgotten stents can lead to wide range of complications, from urinary tract infection until complicated and challenging issues, requiring major intervention.. Why do we use them? What goes wrong which leads to the above conditions? Who is to be blamed for it? What are the treatment modalities? What can be done to prevent it? Materials & Methods: Five cases of major complications of forgotten ureteral stent , which presented to our department over a period of 20 months (Jan. 2015-Aug. 2016) will be discussed here. Results: All patients needed to undergo surgical intervention, other than a simple stent removal, all

leading to stone-free, BUT not stent free condition, due to re-stenting! Procedures ranged from transurethral to percutaneous until open surgery. Conclusion: Not all the " forgotten" stents are forgotten, indeed! Communication barrier, vague & incomplete plans and patient compliance, are the major, however, preventable, influencing factors. A wide range of measures, from a simple informative discharge summary until more sophisticated stent registry and electronic data base are to be considered, in prevention.

Poster # 86

Metastasis to the penis secondary to invasive urothelial bladder carcinoma: a case report and review of the literature

Dr. Mohammed Wazzan1, Dr. Ziyad Alzahrani2, Dr. Abdullah Alahmari2, Dr. Mohamed Abdulwahab3

1Department of Radiology, King Abdulaziz University, 2Faculty of Medicine, King Abdulaziz University, 3Department of Urology, King Abdulaziz University

Metastases to the penis is a rare event, with a total of 370 cases reported since 1870. In more than two thirds of cases the primary source is the urogenital tract tumors. Prostate is the most common primary site. Retrograde venous route is the most common route for metastases. Penile Nodules were the initial presentation in half of patients. Thirty percent of patients presented either with priapism or urinary symptoms. MRI is the preferable modality in imaging of penile metastases. Prognosis is poor in bladder urothelial carcinoma associated with penile metastasis. We report a case of penile metastasis which is presented with painful penile mass, malignant priapism and bloody discharge from the meatus in a patient who is a known case of urothelial bladder carcinoma and underwent radical cystoprostatectomy nine months prior to his

presentation. Diagnosis of the metastasis was based on MRI and previous history of recurrent high grade urothelial bladder carcinoma. Palliative radiotherapy and chemotherapy were planned for the patient.

Poster # 87

Factors affecting urinary retention after transperineal template biopsy of the prostate (

Miss Francesca Kum1, Dr Adam Jones1, Mr Raj Nigam2

1Royal Surrey County Hospital, 2Royal Surrey County Hospital, Guildford. University College London Hospital, London

BACKGROUND: Transperineal template biopsy allows a more accurate mapping biopsy of the prostate gland in comparison with conventional 12-core Transrectal Ultrasound (TRUS) guided biopsy. Template biopsy of the prostate is associated with transient voiding impairment. Urinary retention is a recognised possible complication (1.6-11.4%), requiring catheterisation and a further hospital episode. We present potential patient and procedure-related factors, which influence occurrence of urinary retention after transperineal template biopsy. METHODS: Retrospective data collection of 244 consecutive cases of transperineal template biopsies at a single institution during 2015 were recorded and analysed. Median age was 67 years (range 41-80). The procedure was performed using a standard 5mm template with biopsies taken in sectors. Descriptive statistics and unpaired t-testing were used to analyse the data. RESULTS: 33 of the 244 patients (13.5%) developed urinary retention, defined as patient discomfort, inability to micturate and bladder scan of >500mls, this occurred <24hours post-procedure.

Prostate volume was significantly greater in the retention group, compared with the non-retention group (mean 75.6 vs. 57.0cc, P=0.0016). The number of biopsies taken was positively associated with development of urinary retention (median 35 vs. 32 biopsies, P=0.045) and unrelated to prostate size (R2=0.16). Patient age, presenting PSA, IPSS score, peak flow rate, post-void residual volume and histological outcome were not correlated with occurrence of urinary retention. 98.0% (239/224) patients were given prophylactic tamsulosin on the day of procedure, and 56/224 patients (23.0%) were already taking regular tamsulosin. CONCLUSIONS: A larger prostate size and a greater number of biopsies are significant independent factors conferring an increased risk of urinary retention. Targeted biopsies alone instead of the full template may avoid this complication, particularly in the at-risk groups identified above. Rates of urinary retention may have been greater without pre-procedural tamsulosin; however, a conclusion cannot be reached regarding its efficacy.

Poster # 91

Transperineal saturation/fusion biopsies integration in HIFU prostate focal treatment by Focal One

Dr. Stefano Regusci1, Dr. martina martins Favre1, Dr. Stephane Rohner1, Dr Georges-Antoine De Boccard1, Dr. Sao-Nam Tran1, Dr Alexandre Caviezel1, Dr Ildiko Szalay-Quinodoz1, Dr Charles-Henry Rochat1

1Sipc

Introduction and Objectives: Prostatic cancer focal therapy by FO (Focal One) is based on precise localisation of the target by MRI. Previous

Transperineal fusion and/or randomized biopsies (TP) can help to planify the treatment when the MRI can’t target precisely the tumor lesion. Methods: 1)In a retrospective manner we reviewed 30 cases of Localized Prostatic Cancer treated by FO, in which TP were performed previously. An mpMRI 3T was done before in every patient by the same radiologist. All patient underwent TP by the same operator under general anesthesia (BiopSee). Biopsies were taken from the lesion described on the MRI, and in the zones considered as normal. 2) Focal therapy was performed under general anestesia by FO. Precise Targetting relied on fusioning TP results with the live transrectal ultrasound of FO system. Peroperatively we performed a contrast US control followed by complementary treatment when necessary. Postoperatively 2 weeks after the procedure, an MRI was also performed. Results: Mean age was 67 (53-74) years, median PSA was 8,9 (4,5-14,1) ng/, and the mean prostate volume was 48 (23-94cc). 20 patients harbored Gleason 3+3=6, and 10 Gleason 3+4=7. 20 patients underwent TURP or TUIP. All patients underwent contrast-enhanced ultrasound (SonoVue®). In term of complications, one patient experienced severe incontinence for 3 months and 3 patients de novo erectile dysfunction. No fistula and urethral stricture were observed. Conclusions: In focal therapy performed by FO MRI is essential in targeting lesions. In situations where there is a discordant result between MRI imaging and fusion biopsies or when MRI is contraindicated, TP saturation/fusion biopses can help planning FO treatment.

Poster # 93

Staged Hypospadias Repair: Initial Experience

Prof. Mamdouh Ahmed1

1Ibn Sina Hospital - Pediatric Urology Unit Kuwait

Background: The majority of hypospadias patients can be successfully treated in single stage, where some cases require staged repair. This study was conducted to evaluate the initial outcome of single surgeon experience in staged hypospadias repair. Method: 27patients were included , 18 patients with proximal hypospadias with severe ventral curvature (group I) and 9 patients due to previously failed hypospadias repair (group II). During the first stage straightening of the penis is performed by excising the fibrous tissue and substitution of urethral plate by preputial graft in group I, in group II the scared urethral plate is excised and replaced by buccal graft in 8 patients and preputial graft in one patient. In the second stage tubularization of graft is done in 2 layers. Covering layer of tunica vaginalis flap in 24 patients or dartos flap in two patienwas is fixed . One patient in group II was done without covering layer. Results: No donor site morbidity was reported. Graft take was complete in 26 pts with normal healing (96.3%), in one patient there was partial contracture of the proximal part of preputial graft that required midline incision during second stage repair. One patient in group II developed glanular dehiscence with coronal meatus. In group I, two patients developed glanular meatus denoting partial distal glanular dehiscence (no patient required revision glansplasty). No meatal stenosis, stricture or diverticulum could be encountered. Functional success rate was 26 out of 27{96,3%),whereas cosmetic success rate was 24 out of 27 (88.9%). Conclusion: The staged repair is safe and reliable approach in selected patients in whom urethral plate could not be incorporated in repair and require substitution .. Preputial graft is the graft of choice in primary repairs whereas buccal graft in redo cases. Functional success rate was

96,3%,whereas cosmetic was 88.9%).Long-term follow-up is mandatory.

Poster # 104

Evaluation of anti-urolithiatic property of ethanolic extract of fennel seeds in male Wistar albino rats

Dr. Balaji Ommurugan1, Dr. shalini adiga2

1Post graduate , department of pharmacology ,KMC , Mnaipal, 2Head of department , department of pharmacology ,KMC ,Manipal

BACKGROUND AND PURPOSE: Urolithiasis affects 20% of human population with majority of urinary stones composed of phosphates, oxalates, cysteine and uric acid. Few studies have explored the diuretic property of Fennel (Foeniculum vulgare). So the aim of the current study was to evaluate the anti-urolilithiatic property of ethanolic extract of fennel seeds in male Wistar albino rats. METHODS: Prophylactic and curative urolithiasis models were used with 5 groups of 6 rats in each model. Ethanolic extract of roots of Fennel seeds in three doses 100, 200, 300 mg/kg were used. Cystone 750mg/kg was used as a standard drug. All drugs were administered orally. Zinc discs were surgically implanted in bladder. After recovery, rats in the prophylactic model received three different doses of ethanolic extract of Fennel seeds along with 1 % ethylene glycol for 2 weeks whereas the rats in the other model received 1% ethylene glycol for 2 weeks followed by ethanolic extract of Fennel seeds in three doses for the next 2 weeks. Both models had a control group receiving 1% ethylene glycol. At the end of study period, rats were sacrificed and vesical calculi collected, weighed and statistically evaluated using one-way ANOVA.

RESULTS: In both the models, all three doses of fennel seeds were effective in reducing stone formation as compared to control group with P value of <0.05. In the prophylactic model 100 mg/kg and 200mg/kg of test were comparable to standard Cystone but only 300mg/kg dose showed statistically significance (P value<0.05). In the therapeutic model all three doses of test drug were comparable to standard but there was no statistical significance. CONCLUSION: Fennel seeds can be used prophylactically as well as curatively in the treatment of urolithiasis. However, further studies and clinical trials are warranted to explore this property

Poster # 109

Complications of 411 laparoscopic urological procedures. A single surgeon experience

Prof. Khalid Alotaibi1

1University Of Dammam

Objectives: To review the complications of laparoscopic urological procedures performed by a single surgeon during a 12-year period. Methods: From June 2004 till May 2016, a total number of 411 abdominal urological procedures were performed by the author. They included 250 varicocele ligations, 94 nephrectomies (simple, partial, radical and nephroureterectomy), 34 adrenalectomies, 22 renal cyst ablation and 11 pelvic lymph node dissections. Operative and post-operative complications were reviewed and analyzed. Results: A total of 55 complications out of 411 procedures occurred in 26 patients with a total complication rate of 13.4%, 19 were major (4.6%) and 36 were minor (8.8%). Mortality occurred in 2 patients (0.5%). Conversion to open surgery was done in 5 patients (1.2%) to manage uncontrolled bleeding. Major intra-operative complications

included vascular injuries (2.2%), injuries to the diaphragm (0.5%), bowel (0.7%) and pancreas (0.5%). Major post-operative complications included urine leak (0.2%) and pelvic lymphocele (0.2%). Minor intra-operative complications included bleeding during trocar access (4.4%) and subcutaneous emphysema (0.7%), while minor post-operative complications included atelectasis (1.2%) and ileus (2.2%). Conclusion: Even though the complications rate in this series was comparable to those of other studies in the literature, yet it remains higher than that of open surgery. The continuing advances in laparoscopic techniques will reduce the complication rate and will pave the way for laparoscopy to replace most currently practiced open surgical urological procedures.

Poster # 111

Does high BMI protect against developing varicoceles?: A retrospective analysis

Dr. Said Yaiesh1, Dr. Abdullatif Al-Terki2, Dr. Tariq Al-Shaiji2

1Kuwait Institute For Medical Specialization, 2Urology Unit - Department of Surgery - Amiri Hospital

Introduction & Objectives: Incidence of varicoceles is associated with weight, height, smoking and long standing. Only a handful of studies address higher incidence of varicoceles in taller, heavier men. We aim to study the relationship between BMI and developing varicoceles, hypothesizing that patients with lower BMIs have a higher incidence of varicoceles. Material & Methods: We did a retrospective review of 178 patient files whom underwent varicocelectomies from January 2008 to March 2016 and another 178 “normal” patients with general complaints and no clinical or radiological evidence of varicoceles. Age, height and weight at diagnosis, location of the varicoceles and the

presenting complaint, infertility or scrotal pain, were collected. BMI was calculated and categorized according to WHO guidelines. BMI and age of both patient groups were compared, and against varicocele location and presenting complaints. Results: 97 (54.5%) of varicocele group patients had left while 76 patients (42.7%) had bilateral varicoceles; up to 66% complained of infertility. 59% of patients with left varicoceles were of ideal weight compared to 24 % of patients with bilateral varicoceles. Of those with infertility secondary to left varicoceles, 59% also were of ideal weight, compared to 81% of those with bilateral varicoceles. T-test assessment of the difference between mean BMI values of the normal group and those with lefts-sided varicoceles showed those with these varicoceles have a BMI value on average less by 3 kg/m2 (SD: 7.85, SE: 0.50, p = 0.001). Similar results were not showcased for bilateral varicoceles, nor were the results specific for any presenting complaint. Conclusions: Left unilateral varicoceles had lower BMI values than the average patient of the same age, irrespective of the presenting complaint. Expansion of the study’s patient base and a prospective follow-up would clarify the observed trend.

Poster # 112

Intradetrusal Botulinum Type A Injections For The Treatment of Bladder Pain Syndrome/Interstitial Cystitis: Recent Literature Evidence

Dr. Jameela Al-Qahtani1, Dr. Said Yaiesh1, Dr. Abdullatif Al-Terki2, Dr. Tariq Al-Shaiji2

1Kuwait Institute For Medical Specialization, 2Urology Unit - Department of Surgery - Amiri Hospital

Introduction: Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease of uncertain etiology. It is the combination of pelvic pain, pressure and discomfort attributed to one’s bladder as well as one of the following urinary symptoms: urgency, frequency, and nocturia. Though different medical modalities have failed to provide ultimate relief from this syndrome, intradetrusal botulinum type A (BoNT-A) injections have been showing promising results. This highly neurotoxic is not a new modality as it has been successfully used in the management of a variety of neurological and other conditions including cervical dystonia, cerebral palsy, chronic migraines, and urologically, in treatment of complex regional pain syndrome and a number of lower urinary tract symptoms. There is no consensus on the regimen of intradetrusal BoNT-A for BPS/IC, and thus, we embarked on a review of literature and publications that have employed these injections to treat this syndrome’s sometimes debilitating symptoms. Methods: We reviewed studies that employed BoNT-A in the treatment of BPS/IC from 2010 to a randomized double-blinded controlled trial in 2015, reviewing the criteria for selecting patients, treatment regimen including type, frequency and safety of injections, as well as outcomes with regards to symptoms or complications. Results: An extensive and comprehensive review of 11 prospective studies was performed. Though the modalities of intradetrusal injection and frequency differed, as well as techniques and protocols, the results have been consistent, if not highly promising, across all reviewed studies. Patients who have failed conventional treatment of BPS/IC, some assessed with high scores ICSI scores, underwent BoNT-A injections with variable improvements in symptoms. One critically reported side effect would be urinary retention requiring self-intermittent catheterization. Conclusion: BPS/IC is a debilitating urinary pain syndrome requiring extensive research into its etiology and management. BoNT-A intradetrusal

injections provide a possible line of treatment for BPS/IC with promising results.

Poster # 113

Conservative Management of Emphysematous Pyelonephritis: Short Series

Dr. Awad Thahir1, Dr. Said Yaiesh1, Dr. Tariq Al-Shaiji2, Dr. Abdullatif Al-Terki2

1Kuwait Institute For Medical Specialization, 2Urology Unit - Department of Surgery - Amiri Hospital

Introduction: Emphysematous pyelonephritis (EPN) is a severe infection of the renal parenchyma that causes gas accumulation in the tissue. It is common in diabetic patients, often has a fulminating course and can be fatal if not recognized and treated promptly. We review the outcome of conservative management of this condition over two years. Aim: A review of the clinical details, conservative management and the outcome of patients diagnosed with emphysematous pyelonephritis. Methods: A retrospective analysis and prospective follow-up of hospital data of patients diagnosed with EPN from September 2014 to date from our hospital and other hospitals around Kuwait treated conservatively. Results: A total of 16 female patients were involved. The mean age was 53 years. They were grouped according to CT to grade I, II, III and IV. All patients had loin pain and fever on presentation. Leukocystosis and acute renal impairment were positive for all. Urine culture showed E.Coli in 12 patients, Klebsiella pneumoniae in 3 patients and Pseudomonas aeruginosa in one. As for risk factors, all patients were positive for type II diabetes (poorly controlled) and 6 were hypertensive. Regarding the socio-economical status, they were citizens of developing countries of a working class. All patients were managed with

intravenous fluids, blood glucose control and parenteral broad-spectrum antibiotics. Eleven patients underwent minimally invasive intervention which resembled percutaneous nephrostomy (PCN), followed by stenting in 5 patients to overcome obstructive uropathy. One required percutaneous abscess drainage. None required open drainage or nephrectomy. Computed Tomography (CT) follow-up after 2 weeks showed total resolution of the pathology. One patient had recurrence of the same side. Conclusion: EPN is a serious life threatening pathology. However, early diagnosis, proper grading and conservative management of systematic illness and co-morbidities carry promising outcome on quality of life and can decrease the need of surgical intervention

Poster # 115

Robotic Partial Nephrectomy: Initial Experience from a Single Center

Dr. Saad Aldousari1,2,3, Dr. said Yaiesh1, Dr. Fawzi Abul1,2, Dr. Ahmad Alshammari1, Dr. Mohammad Khaja1, Dr. Narayanaswamy Arun1, Dr. Natarajan Sridharan1

1Sabah Alahmad Urology Center, 2Kuwait University, Faculty of Medicine, 3MD Anderson Cancer Center

Background and Purpose: Advances in urology have focused on minimizing the invasiveness of surgical procedures without compromising oncologic outcomes. We hereby present Kuwait’s initial experience with robotic assisted partial nephrectomy (RAPN) using the da Vinci Si robot. Methods: After IRB approval data was recorded for all patients who underwent robotic surgery at Sabah Alahmad Urology Center in Kuwait including demographics, RENAL Nephrometry score, and operative outcomes. Complications were graded

using the Clavien-Dindo system. Major complications were defined as ≥ Clavien grade III. Results: Between February 2014 and September 2016 a total of 82 cases were done robotically in our center. Of these, 12 were RAPN. Two additional cases were planned for RAPN, however, they got converted to radical nephrectomy and so not included as partials. Other cases included radical prostatectomy, adrenalectomy, pyelolithotomy, pyeloplasty, nephroureterectomy, radical cystoprostatectomy, and ureteric reimplantation. Mean age for patients who underwent RAPN was 48.83 years. Mean size of renal masses was 3.42 cm (IQR = 2.3 – 4 cm). Transperitoneal approach was utilized in all cases. Only one patient required a blood transfusion. Patients were subjected to either warm ischemia or zero ischemia partial nephrectomy. There was one grade III and two grade II complications. Median hospital stay for RAPN was 3.7 days. Mean estimated blood loss was 192 ml. Pathology included 11 malignant renal cell carcinomas (RCC) and one angiomyolipoma. All surgical resection margins were negative and none developed tumor recurrence over a mean follow up of 15 months. Conclusion: Our single center’s initial experience with RAPN show good patient and operative outcomes. The first minimally invasive uro-oncology unit in Kuwait has recently been established at our center and is continually growing. Establishing a robotic unit requires proper patient selection and continuous training of all members of the unit to ensure patient quality of care.

Poster # 116

Does a Standardized Algorithm for Managing Patients Post-Robotic-

Assisted Radical Prostatectomy Improve Recovery? Experience with the Optimized Surgical Journey

Dr. Saad Aldousari1,2,3, Dr. Fawzi Abul1,2, Dr. Said Yaiesh1, Dr. Ahmad Alshammari1, Dr. Mohammad Khaja1, Dr. Narayanaswamy Arun1, Dr. Natarajan Sridharan1

1Sabah Alahmad Urology Center, 2Kuwait University, Faculty of Medicine, 3MD Anderson Cancer Center

Background and Purpose: Prostate cancer is the most common cancer in Kuwaiti males according to 2011 statistics from Kuwait Cancer Control Center. A robotic-assisted radical prostatectomy (RARP) program was established in 2013 in Sabah Alahmad Urology Center. We examined the impact of implementing a standardized post-operative algorithm on recovery of RARP patients. Methods: We collected data prospectively on all robotic cases performed between February 2014 and September 2016. We used the Clavien-Dindo system to grade complications. Major complications were defined as grade ≥ III. Since April 2015, we adopted a modified “Optimized Surgical Journey” (OSJ) protocol as a standardized algorithm for managing our patients post-operatively. Results: A total of 82 cases were performed robotically in our center. Of these, 34 RARP’s were performed. Average age for robotic prostatectomy patients was 62.7 years. Mean prostate volume was 59.5 grams. Average estimated blood loss was 108 mls. Three patients (11.1%) had positive surgical margins. The first 12 RARP’s were managed with non-standardized postoperative orders. Mean hospital stay for this group was 4.83 days (median = 4). Since April 2015, 22 patients had the OSJ protocol implemented. For this group, length of hospital stay was reduced by 1.94 days with a mean hospital stay of 2.9 days (median = 3, p= 0.0091). Four patients in total had complications in our

series. All were minor (grade I and II) and were not significantly associated with the OSJ protocol. Conclusion: Following a standardized post-operative pathway has been shown to improve recovery of patients undergoing major surgical procedures like radical cystectomy. To show this is applicable for less morbid procedures we were able to decrease length of hospital stay after adopting the modified OSJ protocol without compromising outcomes. We realize limitations of our study with small number of patients and lack of randomization.

Poster # 119

Repair of Post Traumatic Recto-Urethral Fistula by Anterior Trans Anorectal Approach with Dartos Pedicle Flap

Dr. Vineet Narang1, DR. Hardev Singh Bhatyal1, DR ANKUR ARYA1

1Blk Superspeciality Hospital

BACKGROUND: Recto urethral fistula is an uncommon potentially devastating disease of diverse etiology. It may be acquired or congenital. There are various surgical approaches to manage these complex cases. We report successful management of a post traumatic recto urethral fistula by Anterior Trans Anorectal approach and dartos flap as tissue interposition between rectum and urethral anastomotic site. MATERIAL AND METHODS: A 25 year old boy with a history of Road traffic accident one and half years ago presented to us with leakage of urine per rectum .He had history of exploratory laparotomy with bladder injury and colonic injury one and half year ago and was on colostomy and SPC since last one year. Preoperative investigations revealed a large fistula between the post urethra and rectum. Patient underwent Trans Anorectal repair in which

incision was given in perineum through the anterior anal wall. The post urethra and the anorectum were separated the post urethra closed in two layers and the rectum also closed in two layers. A vascularised scrotal based dartos pedicle flap was interposed between the posterior urethra and the rectum. Wound closed over corrugated drain with SPC and Foleys catheter. Both catheters were removed after one month. Cystsogram done at one month showed intact bladder and post urethra with adequate caliber of urethra. Results: Successful repair of post traumatic recto urethral fistula by Trans Anorectal approach using dartos pedicle flap Conclusion: Repair of post traumatic recto urethral fistula is a challenging scenario with various surgical routes and options .One has to choose the correct approach depending upon the anatomy of the patient and the expertise and experience of the surgeon.

Poster # 120

Open Dismembered Tubularized Flap Pyeloplasty: An Effective and Challenging Operation for Failed Pyeloplasty with Upper Ureteric Stricture

Dr. Vineet Narang1, DR. Hardev Singh Bhatyal1, DR ANKUR ARYA1

1Blk Superspeciality Hospital

Backround: The procedure of choice has historically been dismembered pyeloplasty since decades. In recent years, management of ureteropelvic junction obstruction (UPJO) has been revolutionized by introduction of endoscopic and laparoscopic techniques. Here we describe open technique of dismembered tubularized flap

pyeloplasty (DTFP) for failed pyeloplasty with upper ureteric stricture and large extra renal pelvis. Materials & Methods: A 25 year old male with right UPJO had undergone Laparoscopic pyeloplasty 1 year back. Patient presented with recurrent right flank pain and intermittent fever since 6 month. Nephrostomy tube was inserted to drain the right kidney after failed attempt of double J stent insertion. Nephrostomogram and retrograde pyelogram revealed laterally placed ureteropelvic junction with patent 1.5 cm of proximal ureter beyond UPJ and upper ureteric stricture of 4 cm. CT Urography revealed right hydronephrosis with large extrarenal pelvis and patent 2 cm of proximal ureter with complete cut off beyond that. A wide base dismembered renal pelvis flap was created and tubularized to bridge 4cm of upper ureteric defect over Double J stent after excision of diseased upper ureteric segment. Patient was discharged with nephrostomy tube on 3rd post operative day. Double J stent was removed after 6 weeks. Result: Nephrostomogram revealed wide dependent UPJ with free flow of contrast. Patient was asymptomatic at 2 month follow up. Follow up excretory urography and renal scan confirmed a widely patent upper ureter with unobstructed drainage Conclusion: Dismembered tubularized flap pyeloplasty (DTFP) is a demanding procedure which is advocated in patient as a salvage procedure after failed previous pyeloplasty with long upper ureteric stricture. However the renal pelvis has to be of adequate size so that wide base pelvic flap can be tubularized with adequate caliber to bridge the upper ureteric defec

Poster # 121

Prospective Evaluation of Bilateral Same Session Renal Stone Surgery: (Tolerance & Outcome)

Dr Abdullah Alhumam1, Dr Hussam Alshubaili1, Dr Abdulrahman Almuhrij1, Dr Ahmed Alasker1, Dr. Saeed Bin Hamri1

1National Guard Hospital

Introduction: Saudi Arabia one of the highest upper urinary tract stone rates all over the world. Bilateral renal stone management can be controversial; therefore, we sought if bilateral same session retrograde intra-renal surgery (RIRS) with or without contralateral PCNL was properly evaluated. Thereby, it could be adapted as a practice that potentially reduces costs, length of hospital stay and the need for second intervention. Patients & Methods: In a prospective manner, from January 2015 – January 2016, we collected data of 20 patients (40 renal units) with bilateral renal stones who went for same session FURS or FURS + contralateral PCNL, these data were reviewed and analyzed. Patient’s characteristics as well as operative data were recorded. Outcome was determined at 6 weeks on renal ultrasound or Non-contrast CT scan (NCCT). Success rate was defined as stone free (SF) or remaining fragments (RF) less than 3 mm. Result: Mean stone size of renal unit was 26.4 mm (ranged from 3 to 55 mm) with a mean operating time of 81 minutes (range 35 - 177 minutes). Ten procedures (22.7%) were done as a day case procedure. Mean hospital stay of 1.6 days (range 0.5 -7 days). Of the 40 renal units (44 procedures), 90% (36/40) were stone free after a single session. 4 renal units were subjected to 2nd stage therapy. There were 2 pyelonephritis requiring intravenous antibiotics, 1 blood transfusion). Conclusions: Bilateral same session renal surgery is a safe and highly effective practice for bilateral renal stones patients with good clearance and minor complications and morbidities. However,

high stone volume centers should have the upper hand to practice such a technique.

Poster # 126

Medium term outcomes following focal HIFU for the treatment of non-metastatic prostate cancer: A UK registry analysis of 625 cases

Mr. Raj Nigam2, Ms Stephanie Guillaumier1

1University College London Hospital, 2Royal Surrey County Hospital

Background: Our UK prospective High Intensity Focused Ultrasound (HIFU) registry has collated over 2000 HIFU cases from 8 centers. We report on medium term outcomes in patients undergoing focal therapy using HIFU. Methods: 625 men with T1aN0MO to T3bN0M0 prostate cancer were treated with focal-HIFU. Disease was located using multi-parametric MRI followed by transperineal mapping biopsies and/or MR-targeted biopsies. Intermediate and high-risk cases underwent bone-scan and CT to exclude metastases. Focal-HIFU was performed involving hemi or quadrant ablation. Follow-up consisted of PSA, repeat MRI and biopsies. Results: 80 (13%), 491 (81%) and 39 (6%) had low, intermediate and high-risk disease, respectively. Median PSA was 7.1 (IQR 5.1-9.9). Median follow-up was 56 (IQR 33-70) months. 429 had baseline continence status recorded. At 1-2 years and 2-3 years after focal-HIFU, 305/314 (97%) and 241/247 (98%) were pad-free, respectively. At 1-2 years and 2-3 years after focal-HIFU, leak status was available in 251 and 195, at baseline and follow-up; 209 (83%) and 156 (80%) were pad-free, leak-free continent, respectively. 425 had baseline erectile function recorded. At 1-2 years and 2-3 years, erectile function status was available in 165 and 101, at baseline and follow-up; 138 (84%) and 87 (86%) maintained erectile function at 1-2 and 2-3 years following focal-HIFU, respectively. Two (0.8%) patients developed a recto-urethral fistula.

Median PSA nadir was 1.7 by 4.5 months. 222 underwent post-operative biopsies. 29 had in-field recurrence, 16 out-of-field de novo disease or progression and 11 had both. 122 (20%) had a further focal-HIFU treatment, whilst 44 (7%) transitioned to radical treatment (1% prostatectomy; 6% radiotherapy). Metastasis-free survival and overall survival (95%CI) at 5 years were 97% (95-98) and 99% (97-99), respectively. Conclusions: Focal-HIFU is a repeatable, ambulatory procedure that confers a low risk of side-effects with acceptable rates of disease control in the medium term.

Poster # 127

Intraoperative MRI-Guided Navigation of the Pelvic Floor During Exstrophy Closure

Dr. Heather Di Carlo1, Dr. Aylin Tekes1, Dr. John Gearhart1

1Johns Hopkins

Background: Radical dissection of the urogenital fibers and the thickened smooth and striated muscle fibers connecting the posterior urethra and bladder plate to the diastatic pubic rami is crucial for adequate placement of the posterior vesicourethral unit deep within the pelvis during classic bladder exstrophy (CBE) and cloacal exstrophy (CE) closure, as well as ensuring successful outcomes. Intraoperative magnetic resonance imaging (MRI) guided navigation of the pelvic floor offers a novel technique for identification of these critical anatomic landmarks. Methods: Institutional review board and Food and Drug Administration approval was obtained for use of Brainlab® (Munich, Germany) intraoperative MRI-guided navigation of the pelvic floor anatomy during closure of CBE at the authors’ institution. Pre-operative pelvic MRI was obtained one day prior to CBE closure in patients necessitating pelvic osteotomies. Intraoperative

registration was performed after pre-operative planning with a pediatric radiologist utilizing five anatomic landmarks immediately prior to initiation of surgery. Accuracy of identification of pelvic anatomy was assessed by three pediatric urologic surgeons and one pediatric radiologist. Results: 34 patients with CBE and 2 patients with CE closed at the authors’ institution have successfully utilized Brainlab® technology to navigate and guide the dissection of the pelvic floor intraoperatively. All patients had 100% accuracy in correlation of gross anatomic landmarks with MRI identified landmarks intraoperatively, and all have had successful closure without any complication. Conclusion: Brainlab® intraoperative MRI-guided pelvic floor navigation and dissection is an effective way to accurately identify pelvic anatomy during CBE and CE closure. Future assessment of real-time changes in pelvic floor anatomy comparing pre-closure to post-closure MRI will allow quantification of pelvic floor anatomy in these patients and may allow for intra-institutional telementoring in this most important first step of exstrophy reconstruction.

Poster # 128

Muscle Invasive Bladder Cancer (MIBC)- The gold Standard Radical Cystectomy or Bladder Preserving approach, YES or NO ?

Dr. Syed Mamun Mahmud1

1Lifecare Hospital Abu Dhabi

Background & Purpose: The urinary bladder cancer represents as fourth most common in men and twelfth in women in the United States and Europe. A total of around one fourth of bladder tumours are muscle-invasive are candidates for Radical Cystectomy. A large body experience with various level of evidences are now available suggesting the

scope of bladder preserving approaches. This include Partial / Segmental Cystectomy and Trimodality Therapy (TMT). Here the purpose is to share the scope of Bladder Preservation against Gold standard Radical Cystectomy in Muscle Invasive Bladder Cancer (MIBC) patients. Methods: Case is selected from prospectively maintained TURBT data from October 2004 to May 2014. All cases were performed at The Kidney Centre PGTI Karachi, Pakistan. The case under discussion underwent Cytoscopy as an evaluation for hematuria. Follow up included CBC, LFT, Urine Analysis, U/S Abdomen, Chest Xray, CT Abdomen with contrast and Cystoscopy. Results: The presentation is based on a case of 76 years old lady with Urothelial cell carcinoma recurrence as Muscle Invasive Bladder Cancer and was offered Partial cystectomy on grounds of tumour burden, age, quality of life(QoL) issues and socio-economic support. She did not have any recurrence over six (6) years of Follow up period following partial Cystectomy. Conclusion: There is no argument favouring Prospective Randomized trials to verify the findings in various systemic review and meta-analysis, defining the role of organ preservation and radical treatment for MIBC. However the debate for and against organ preservation is becoming more relevant with increasing octagenerians and QoL concerns. This presentation is intended to sensitize the urology fraternity with similar considerations and to have an insight on What should be done, What Could be done and WHAT IS DONE!

Poster # 138

Retroperitonoscopic approch by a rare tumor.

Dr. Samer Schakaki1, Dr. Salahedein Alkeilani1, Prof. Dr. Hermann van Ahlen1

1Klinikum Osnabruck

Introduction: Primary retroperitoneal cavernous hemangioma is a rare type of hemangioma, and is unique in that it is separated from the surrounding organs. This paper reports a case of PRCH Case presentation: A 52-year-old man presented with a 1-day history of akute left side renal colic. Imaging studies were carried out. In abdominal CT was as incidentally finding next to stone in the lower calyces stone a 50x52x20 mm paraortal node, Due to the KM - enhancement of paraaortal Node is probably a thinking primary of ectopic kidney tissue , which , however, appear untypical in this form . It could also scattered piece splenic parenchyma , but here the hyperdincity of Nodus speaks against that, DD Unusual located hemangioma . but no additional abnormalities of abdomenal organs. Surgical intervention with retroperoteneal laproskopic resektion were done. The post-operative period was not complicated, and the patient discharged home on day 3 after the operation. Result: The examination of the mass showed a16 g in weight fat soft tissue, of 5.5 x 5 x 2 cm . centrally with brown collerd mass of 2.5 cm size. histologically diagnosis was cavernous hemangioma. Conclusion: In this case, the tumor was separated from surrounding organs, thus it was diagnosed as a primary retroperitoneal CH . CH can mimic cystic neoplasm. Surgical resection is a curative treatment for PRCH, which reduces the risk of hemorrhage and for excluding the malignant tumors. the retroperitoneal minimal invasive surgery is the method of choice for resection of retroperitoneal tumors.

Poster # 140

Use of Co-Surgeon in the treatment of Bladder Exstrophy: Optimal management?

Dr. Heather Di Carlo1, Dr. Peter Stuhldreher1, Dr. Pokket Sirisreetreerux1, Dr. John Gearhart1

1Johns Hopkins

Background: Management of exstrophy is one of the most complex reconstructions facing pediatric urologists. Given the rarity of this spectrum, most see limited numbers of these patients yearly. To ensure excellent outcomes, some centers have combined experience and technical abilities forming consortiums. The authors present a novel approach to combining expert care in a single center while collaborating with the primary urologist for operative care. Methods: The authors retrospectively reviewed an IRB approved database of >1200 exstrophy patients for repairs done at their institution with the primary urologist participating. From 1998-2016 23 were identified. Results: 15 males and 8 females were identified. Of males, 4 were newborns, 5 were >1 month old, and all 9 were primary closures. Six were reclosures, of which 4 had complete primary repair of exstrophy, 4 were treated with spica casts, and 2 with “mummy wrap” immobilization. 3 males were treated with modified Cantwell-Ransley epispadias repair at the time of reclosure. Of the females, 4 were reclosures and 3 newborn primary repairs. All 4 reclosures had been immobilized in spica casts. Successful closure or reclosure was obtained in all. Complications included 2 superficial pin site infections, 1 premature dislodgement of SP, and 2 superficial penile skin separations with 1 requiring a subsequent skin graft. Conclusion: This novel approach to the management of exstrophy allows for excellent local follow-up by a surgeon actively involved in the primary operation, furthers education of urologists from low volume centers to maintain skills and be mentored by an experienced exstrophy surgeon, adds to educational and research collaboration, and maintains a close relationship between the local surgeon, family, and the exstrophy center. Co-surgeon approach to

the referral care of exstrophy closure allows for a continuing relationship between the referring urologist and exstrophy center while maintaining excellent local care of the patient.

Poster # 141

Elevated Serum PSA and Prostate Parenchymal Cysts: Association or Coincidence?

Dr. Rafayel Badalyan1, Prof. Sergey Fanarjyan, Dr. Gevorg Minasyan, Prof. Armen Muradyan 1Ysmu

Introduction: Cystic formations in the prostate gland parenchyma are usually found in patients with BPH; they vary in size and location, and can be scattered either in transitional zone or in the junction of central and peripheral zones. Current study was designed to evaluate the possible association of the presence of the cysts in prostate parenchyma (CPP) with elevation of the serum total prostate specific antigen (tPSA) level. Methods: From March 2012 to April 2015 one hundred and eighty patients at mean age of 68.2 with elevated serum tPSA level were enrolled. All the patients underwent transrectal ultrasound guided prostate biopsy with simultaneous scan in color coded duplex and power Doppler modes. Standard morphological evaluation was performed. Additionally, 60 symptomatic patients with LUTS (mean age of 65.4) with normal serum tPSA level underwent TRUS with the same protocol, but without biopsy. Patients were classified into CPP positive and CPP negative according to presence/absence of the cysts. Statistical analysis was carried out by means of Statistica 6.0. Results: In patients with total PSA more than 4 ng/ml in 33% CPP were detected, while in control group of patients with normal serum tPSA, only in 12% of cases CPP were described (p<0.001).

Prostate cancer was diagnosed by morphological evaluation in 60 cases out of 180 with tPSA >4 ng/dl, with median Gleason score of 7. In CPP positive group cancer was diagnosed only in 12 cases (20%), while in CPP negative group in 68 cases (56%). The table shows the comparative data for two groups. A significant negative correlation in between the presence of PCC and the morphologically diagnosed PCa was found (r=-0.34; p<0.0001). Conclusions: PPC can cause serum total PSA elevation without presence of malignancy. The above should be considered in repetitive prostate biopsies.

Poster # 143

CT Cavernosogrphy in penile trauma

Dr. Faiz Motiwala, Dr Ali Hassan1, Mr. Omer Karim1, Mr. Hanif Motiwala1

1The Princess Margaret Hospital

Background & Purpose: Routine cavernosography and MRI scan are helpful imaging modality in acute penile trauma. The difficulty arises when patient presents late having treated elsewhere with conservative treatment. There are no acute signs to pinpoint the issues. If patient continues to have persistent erectile dysfunction then further investigation are important. We present 3 cases of such nature where standard cavernosography and MRI scan were less than helpful but CT cavernosography identified site of injury and helped the cases being managed appropriately. Methods: Case 1: 32 years old man presented with erectile dysfunction 4weeks after sustaining penile trauma during sexual intercourse and history of acute oedema. Clinically no signs of injury or defect seen or palpable. Standard cavernosography normal(Fig1). CT cavernosography identified injury to right

crus(Fig2). Exploration revealed small haematoma and rupture of corpora (Fig 3 &4). Repair and reconstruction done (Fig 5) and patient regained erectile function 2 weeks later Case 2 : 35 year old man presented with erectile dysfunction with history of penile trauma sustained during sex 5 weeks before. No clinical signs or symptoms of acute trauma. CT cavernosography revealed site of injury to the right corpora.(Fig 6) Conservative treatment successful and patient having natural erections 3 months later Case 3 : 48 years old gentleman presented with penile pain and erectile dysfunction post sexual penile trauma sustained 3 weeks earlier. MRI scan failed to reveal significant changes.(Fig 7) CT cavernosography revealed small haematoma and site of injury to right corpora. (Fig 8). Conservative treatment and slowly regaining erections wit help of PDE5 inhibitors. RESULTS: All 3 cases were non acute, therefore were helped by CT cavernosograpphy in diagnosis and management Conclusion: CT cavernosogrphy is a useful tool in penile trauma in non acute setting or in follow up to understand erectile dysfunction in selected cases

Poster # 144

Abdominal Hair Lose As a Screening Symptom for Hypogonadism: a Pilot Prospective Study (AHLAS) (PA)

Dr. Rafayel Badalyan2, Prof. Segey Fanarjyan3, Prof. Mikael Manukyan3

1Ysmu, 2Urology and Men's Health Service, 3Erebuni Medical Centre

Serum testosterone declines as a function of age, as observed in both cross-sectional and

longitudinal studies on elderly men. However, screening for hypogonadism, specifically for late nset hypogonadism, is currently based on questionnaires and inventories, which are not always used by primary physicians. Current prospective study was designed to evaluate the power of periumbilical hairs lose as a specific symptom (PUHLS) and a screening sign for preliminary detection of men with late onset hypogonadism. Methods: Patients (N=145) presented with sexual dysfunction (age from 35 to 72; mean= 55,4) underwent complete evaluation by expert specialist. Total testosterone was measured in morning blood sample. In physical examination the presence of body abdominal hairs was checked. In 126 out of 145 it was possible to describe, while in other 19 cases abdominal hairs were not present according to body constitution type and they were excluded from the study. Patients were described as symptom-positive if periumbilical hairs lose was detected, otherwise they were considered as symptom-negative. Statistical analysis was performed to determine the sensitivity and specificity of the hairs lose symptom (PUHLS) (95% confidence interval) for hypogonadism. Results: The extent of abdominal hair lose was described from minimal (1.5cm in radius) to complete in 20 (15,8%) cases out of 126. In 12 (60%) cases out of 20, plasma total testosterone level was less then 3,5 ng/dl. In other 106 patients with no hair lose on the abdominal wall, testosterone deficiency was found in 7 (6,6%) patients only. The sensitivity for the described symptom for testosterone deficiency was 60% and specificity 93%. Limitations: PUHLS can be applicable for the men with some abdominal hairy body constitution. Conclusion: Periumbilical hair loses may become a specific and sensitive screening parameter for the consideration of hormonal check-up in primary care.

Poster # 148

Comparison of mean stone size, as measured on bone window versus standard soft tissue window on axial planes on multidetector computed tomography, in patients having single unilateral ureteric calculus

Dr. Hussam Uddin Soomro1, Prof. Hammad Ather1, Dr Basit Salam1

1Aga Khan University Hospital

Objective: To compare the mean difference of stone size, as measured on bone window settings (axial planes) versus standard soft tissue window settings (axial planes) on a multidetector computed tomography (MDCT) in patients with solitary ureteric stone. Material and Methods: A total of 60 patients presenting to Emergency and Outpatient department of Aga Khan University Hospital Karachi from May 2015 to October 2015, fulfilling the inclusion criteria were included in the study. 64-slice Multi detector Computerized Tomography was used to assess the locations and size of the ureteral stones. A consultant radiologist independently analyzed CT Scans of all those patients. Then mean difference in stone size was calculated between both window settings in axial planes. Results: The mean age of the patients was 37.13 ± 11.9 years. Males constituted about 68 % of the cohort while, 32 % were females. 85 % of the patients had left ureteric stones and 15 % had right ureteric stones. The mean stone size, as measured on soft tissue window settings was 6.68 ± 2.01 mm, and on the bone window settings mean stone size was 4.8 ± 1.9 mm. Mean difference of stone size between the two window settings was found to be + 1.85 ± 0.55 mm. The two means were

compared using Student T-test, and the difference was found to be statistically significant (P value < 0.05). The data was stratified according to age, gender and location of stone in the ureter and the mean difference was compared using Student T-test, and the difference was not found to be significant (P value > 0.05). Conclusion: The stone size measured on soft tissue window on a multidetector CT scan is significantly different from the measurement done on bone window setting.

Poster # 151

The Difference in the Position of the Urethral Cuff of the Artificial Sphincter (Ams800) after Abdominal and Vaginal Way of Implantation in Women.

Dr. Robert Grill1, Dr. Annett Gauruder-Burmester1, Dr. Michal Otcenasek1

1FNKV Urology

Introduction: The recurrent urinary stress incontinence might be treated with the help of the artificial urethral sphincter. In contrary to the situation in men, where the urethra is easily accessible, the female urethra might be difficult to prepare. Because the space of Retzius is often obliterated after previous surgical procedures, the transvaginal insertion might be an easier alternative. Objective: The aim of the study was to compare the position of the urethral occluding cuff of the artificial sphincter after classical abdominal and rare transvaginal insertion in women treated for recurrent stress urinary incontinence. Methods: We have compared the position of 8 women after abdominal and 6 women after transvaginal cuff insertion. Transversal and sagittal

T2-weighted magnetic resonance images were performed. Results: A detailed morphological analysis revealed that the position of the cuff is significantly different. The middle of the cuff was 1.2 cm closer to the external urethral meatus in the transvaginal group. The functional result was the same in all cases – the women were dry, the function of the kit was good. Some minor complications – temporary need to intermittent catheterization were encountered in one woman after abdominal and 2 after transvaginal approach. No protrusion and no infectious complication were seen in either group within 12 months after implantation. Conclusions: The transvaginal way of the cuff insertion of the is a possible alternative to the mostly performed transabdominal approach. The functional result in our series was the same. But, the position of the cuff varied significantly.

Poster # 152

Prevalence of Urinary Tract Infections in Women with Urinary Incontinence and Other Risk Factors

MD, FEBU Ali Furkan Batur1, MD, Associate Professor Metin Onaran2, MD, Professor İlker Şen2, MD Lokman İrkilata3, MD, Professor Nur Aksakal4, MD, Professor İbrahim Bozkırlı2

1Sincan State Hospital Urology Clinic, 2Department of Urology, Gazi University School of Medicine, 3Samsun Training and Research Hospital Urology Clinic, 4Department of Public Health, Gazi University School of Medicine

Background and Purpose: In this study, we aimed to determine the risk factors involved in urinary tract infections in women, especially focusing on the effects of urinary incontinence.

Methods: Medical records of 1,060 female patients who applied to the women’s urology department of Gazi University, School of Medicine, Urology Department were examined retrospectively. Datas about age, urinary incontinence types, parity, delivery history, hysterectomy history, constipation, postmenopausal symptoms, obstructive urinary symptoms, urinary tract infection history, presence of systemic diseases, and smoking history were obtained from the medical records of the patients. Results: In the univariate analysis getting older, higher post void residual urine, smaller Qmax, postmenopausal symptoms, diabetes mellitus, neurologic disorders, vaginal-urethral atrophy, and the abnormality of the uroflow graphic were found as the risk factors. In multivariable analysis only diabetes mellitus was found to be statistically meaningful. Conclusions: In light of our results and the literature, it would not be incorrect to assert that all of these factors increase the risk of urinary tract infections. Certainly, supplementary studies are needed to further identify the risk factors, mechanisms, and prevention strategies for this prevalent and chronic disorder affecting many women globally.

Poster # 153

Are the Neutrophil-to-lymphocyte ratio and Lymphocte-to-monosit ratio in accordance with EAU risk score tables in patients with non-muscle invasive urothelial carcinoma of the bladder ? (PA)

MD, FEBU Ali Furkan Batur1, MD Kerem Gençer Kutman1, MD,FEBU Mustafa Suat Bolat2, MD Ekrem Akdeniz2, MD Cem Şenol1, MD Kubilay YÜZÜNCÜ3

1Sincan State Hospital, 2Samsun Training and Research Hospital Urology Clinic, 3Private Samsun Atasam Hospital

Background & Purpose: We aimed to evaluate whether Neutrophil-to-lymphocyte ratio(NLR) and/or Lymphocyte-to-monocyte ratio(LMR) is associated with European Association of Urology(EAU) risk score evaluations. Methods: Medical records of 117, primarily diagnosed patients with non-muscle invasive bladder cancer(NMIBC) treated with transurethral tumor resection, between the years of 2013 and 2015 were reviewed. Pathological evaluation was made using the EAU guidelines, and 2004 WHO grading system and patients classified into groups. During the analysis T1G3 group was compared with the other NMIBC patients groups. Patients’ oncology working sheets were reviewed by one urologist (DR.AFB), and recurrence and progression scores were calculated and organized as four groups(0=1, 1-4=2, 5-9=3, and 10-17=4 for recurrence; 0=1, 2-6=2, 7-13=3, and 14-23=4 for progression) as defined by the EAU Guidelines in 2015. Low, intermediate, and high risk groups were organized as defined by the European Organization for Research and Treatment of Cancer (EORTC) risk tables. Independent sample t test, one way analysis of variances, Mann Whitney U test or Kruskal Wallis test were used to compare the continuous normal data, and non-normal data between/among groups. Results: The study cohort consisted of 81 men and 14 women with a median age of 64 years. High risk patients constitutes 63.2%(n=60) of all patients . On multivariate analysis, only LMR was found to be statistically significant at intermediate risk group compared with low – high risk tumors (5.67(3.93-7.18; p=0.013)were associated with disease progression. Conclusion: NLR and LMR were not found to be corraleted with EAU risk scores for recurrence and progression in our study. Prospective and larger studies are needed to validate the role of NLR and

LMR as prognostic markers in high risk of recurrence and progression in NMIBC.

Poster # 158

The Role of Transforming growth factor (TGFβ) in Erectile Tissue Alterations Following Complete Detachment of Urethra from Corpus Cavernosa

Dr. Heather Di Carlo, Dr. Ali Tourchi1, Dr. Mahsa Shabaninia1, Dr. John P. Gearhart1

1James Buchanan Brady Urological Institute,the Johns Hopkins University School Of Medicine

Background and Purposes: The purpose of our study was to determine the changes and underlying mechanisms of cavernosal structure alterations following complete detachment of urethra from the corpus cavernosa and to investigate the regulatory effects of TGF-β on cavenosal tissue fibrosis in this specific setting. Methods: 24 New Zealand White male rabbits were randomly allocated into three groups: Control group, complete disassembly model, and Cantwell-Ransley technique model. On weeks 2 and 4 post-op, rabbits were sacrificed with an overdose of pentobarbital and the penile tissue was harvested. Specimens were stained with hematoxylin and eosin and Masson’s trichrome. CD31 staining was used to assess endothelial cell content and vascular supply of corpora. To study apoptosis, apoptotic nuclei were identified with TUNEL technique using in situ cell death detection kit. Immunohistochemical staining for TGFβ was used to assess the expression of fibrosis-related factors in the corpus cavernosum. Results: One rabbit in the complete disassembly group had glanular necrosis at 4 weeks. Significant cavernosal fibrosis and decrease in smooth muscle/collagen ratio was observed in complete disassembly group. Content of endothelium (CD31+) in control group was significantly higher

compared to complete disassembly group, while no significant difference was observed between the Cantwell-Ransley and control group at 2 and 4 weeks follow-ups. The apoptosis indices were consistent between the Control and Cantwell-Ransley group, while the apoptosis index was significantly higher in the complete disassembly group compared with the Control group. Significantly higher expression of TGFβ was also noted in complete disassembly group. Conclusions: Our result suggest that up-regulation of TGFβ signaling after complete detachment of urethra from the corpus cavernosa might be the possible cause of fibrosis and decreased smooth muscle content of erectile tissue. This up-regulation of TGFβ signaling can be attributed to hypoxia induced by vascular and endothelial alterations following complete detachment.

Poster # 159

Autophagy, Apoptosis and Cell Proliferation in Extrophy-Epispadias Complex

Dr. Heather Di Carlo, Dr. Mahsa Shabaninia1, Dr. Ali Tourchi1, Dr. John P. Gearhart1

1James Buchanan Brady Urological Institute,the Johns Hopkins University School Of Medicine

Background: Very few pathophysiological mechanisms have been proposed as the etiology of bladder exstrophy (BE). Autophagy, or type II programmed cell death pathway, is an evolutionary conserved process involving intracellular degradation and recycling of cytoplasmic organelles. A basal level of autophagy is detected in most tissues, maintaining cellular homeostasis and viability through development and differentiation of eukaryotic organisms. Herein, the authors investigated the state of autophagy and its interactions with cells apoptosis and proliferation in patients with BE.

Material and Method: Primary cultures of bladder smooth muscle cells were established from patients with successful neonatal bladder closure (group 1, N=5), delayed closure due to small bladder template (group 2, N=5) and vesicoureteral reflux as control (group3, N=5). The myogenicity of the cultures was determined using anti-desmin antibody. Immunofluorescence staining for LC3 was used to detect autophagy. Cells apoptosis was assessed using TUNEL assay, 4′, 6-diamidino-2-phenylindole staining. Cellular proliferation was assessed by image analysis of immunofluorescence staining for Ki-67. Results: Immunohistochemical staining revealed consistent positivity (greater than 95%) for Desmin in all cultures that confirms the myogenicity of them. Apoptosis was significantly higher in delayed closure group compared to other groups. Autophagy marker (LC3) was more expressed in delayed closure group compared to the other groups. Cellular proliferation was significantly lower in delayed closure group compared with control and successful neonatal closure groups. Conclusions: Our results confirms that there are distinct differences in bladder smooth muscle cell function between control, successful neonatal closure and delayed closure cases due to small bladder template which persist in culture. Children with slower bladder growth and small bladder templates showed up-regulated autophagic process and increased apoptotic indices while experiencing a dramatic decrease in their bladder smooth muscle cells proliferation. Finally the concept of manipulating autophagy may lead to promising outcomes for BE patients in future.

Poster # 160

Is holmium laser lithoclast superior to pneumatic lithoclast in managing upper-ureteral stones?

Dr. Farhan Ahmed1

1Liaquat National Hospital

Abstract OBJECTIVE: To compare the results of holmium laser lithoclast over pneumatic lithoclast with the help of Uretro-renoscope in managing upper-ureteral stones. MATERIAL AND METHODS: We retrospectively analyzed the records of patients with upper-ureteral stone who underwent ureteroscopic lithoclast at our institution from January 2015 till august 2016. In our patients with proximal ureteric stones (mean stone size 12 mm). post operative follow up Ultrasound was used to see stone clearance. CONCLUSION: In our study, stone fragmentation was significantly better with holmium laser-assisted ureteroscopy. The need for auxiliary procedures and complications were significantly less for holmium laser-assisted ureteroscopy when compared with pneumatic lithoclast.

Poster # 166

Urethrocutaneous Fistula Repair (PA)

Dr. Iqbal Shahzad1

1Liaquat National Hospital Karachi

Purpose: To share our experience with urethrocuaneous fistula repair at our Institute Methods: Retrospective study, consisted of 30 patients Most of them were following failed hypo spadias repair Results: Initially had a success rate of 80% .Later with refinement in techniques success rate reached to 98% Conclusion: urethrocutaneous fistula repair poses heavy burden on surgeons because of higher failure

rate.Techical refinement results in high success rate

Poster # 168 Our early experience in shifting from open to laparoscopic donor nephrectomy

Dr. Tarek Mohammad Alzahrani1, Dr. Hossam Salah El-Tholoth1, Dr. Abdullah Al-Gadheeb1, Dr. Rafat Zahid1, Dr. Ahmad AlZahrani1

1Prince Sultan Military Medical City

Background and Purpose: Laparoscopic donor nephrectomy has become a gold standard for donor nephrectomy. We conduct this study to evaluate our shift from open to laparoscopic donor nephrectomy using two different laparoscopic methods. Methods: We prospectively collected data of all laparoscopic donor nephrectomy starting from our first case on 25-1-2016 till 1st august 2016 including warm ischemia, donor serum creatinine change, intra-operative and post-operative complications, blood loss, intra operative recipient difficulty and post-operative recipient serum creatinine, then analyzed this data . Results: Thirty seven Laparoscopic donor nephrectomy was done compared to 29 open cases in the same duration of the previous year. Thirty three male and 4 female with mean age 29 all left side kidney harvested, 27 done by total laparoscopy and 10 done with hand assisted technique. Four cases had intraoperative complications, two left renal vein injure one adrenal injury and one splenic injury laceration all managed laparoscopically without need for conversion to open nephrectomy and with a mean worm ischemia time of 2 min 56 sec and mean blood loss is 75 ml. Regarding Post-operative complication, one case developed post-

operative fever and another developed chest infection, both managed medically without consequences. Donors serum creatinine level remained within normal range in the first post operative month, only 4 cases shows mild elevated serum creatinine (127-133-144-150 mmol/dl). Regarding the recipients, no intraoperative difficulty has been reported regarding the artery, vein or ureter with post-operative mean serum creatinine of 95 mmol/dl in the recipients and only four (10.8 %) had mild elevated in creatinine level (122-162-204-143 mmol/dl) in the early postoperative follow-up. Conclusion: We support this shift to laparoscopic donor nephrectomy as there is no harm or significant complications noticed with good effect on both donor and recipient sides and encourage other centers to start this shift.

Poster # 169

Urdu translation and validation of urogenital distress inventory (UDI-6) in patients with urinary incontinence

Dr. Nuzhat Faruqui1, Dr. Novera Chughtaie1, Dr. Jamil Ahmed1

1Aga Khan University

Background and Purpose: Urdu is the national language of Pakistan and most people are unfamiliar with even the basic English language therefore In the Urdu language, there is no validated QOL instrument, which measures the impact of urinary incontinence. Therefore, the aim of our study was to validate the Urdu translated versions of the UDI-6 questionnaire for the use in Urdu-speaking female patients with urinary incontinence.

Methods: The linguistic translation of the questionnaire was performed through a multistep process: backward and forward translation coordinated by clinical investigators followed by pretest on ten patients. The final version was administered to a larger sample of female patients (n=200) presenting with urinary incontinence for last three months. To evaluate test-retest reliability, patients were rerated after two weeks. To test questionnaire capacity to discriminate between subjects with or without incontinence, cases and controls (n=54) were involved and assessed. Results: The correlation coefficient between ratings was ≥ 0.80 and the discriminate power between cases and controls was confirmed. The UDI-6 showed good internal consistency for all domains (Cronbach α = 0.695). Conclusion: The Urdu version of UDI -6 is a valid instrument, which can now be used reliably in daily practice and clinical research.

Poster # 172

Evaluation of Infective Complications After TRUS Guided Prostate Biopsy in Dubai Hospital

Dr. Abdulmunem Alsadi1

1Dubai Hospital

Background and purpose: Prostate biopsy (P-Bx) is currently an essential procedure for prostate cancer diagnosis - Antibiotic prophylaxis in transrectal P-Bx showed a significant reduction in the risk of bacteriuria, symptomatic (UTIs) and bacteremia. -guidelines recommend antibiotic prophylaxis, typically with an oral fluoroquinolone,prior to P-Bx. - An increased rate of infection following P-Bx recently reported

The aim of this study is to evaluate prospectively the incidence of infection after P-Bx in DH and identify the risk factors. Material and methods: All patients underwent P-Bx in DH from Jan 2014 to Jun 2016 were followed 2 wks after P-Bx. Patients with infective complications were compared with patients without infective complications. Patient factors: eg: Age, use of antibiotics in preceding 6 mo, history of UTI in preceding 6 months, Outcome of biopsy and results of urine culture. Results: 61 men underwent TRUS P-Bx, mean age were 60.25 years. 50.8% have been used fluoroquinolone in the preceding 6 months. 26% had a history of urogenital infection in preceding 6 months. 13% had urinary catheter at the time of biopsy. 31% had associated comorbidities. Histopathology results showed: Prostate adenocarcinoma in 34.4%. 23% prostatitis, BPH in 36% and 3% had normal histology. Antibiotic prophylaxis was given to all patient. Causative organisms were isolated in 13.7% cases with 71.4% resistant to fluorquinolones. Post operative urine culture was not done in 16.3% (Symptomatic (UTI) was seen in 5.8% men, 3.9% have Febrile UTI required hospitalization). Of the isolated cases 85.7% had a history of fluoroquinolone used in the preceding 6 months , Conclusions: Despite antibiotic prophylaxis, 5.8% of patients experienced an infective complication, while many factors we examined appeared not strongly correlated with increase this risk. This study confirms a high incidence of fluoroquinolone resistance in causative bacteria that is correlated with the preceding antibiotic use.

Poster # 174

Frequency and Predictors of TUR Syndrome for Patients Undergoing

Trans-Urethral Resection of Prostate (TURP).

Dr. Muhammad Nazim Syed1, Dr. Malik Aftab Younus1

1The Aga Khan University Hospital, Karachi- Pakistan

Aim: To determine frequency and predictors of complications in patients undergoing TURP. Introduction: Transurethral resection of the prostate (TURP) is a standard surgical treatment for BPH using non-conductive irrigation fluid. Transurethral resection (TUR) syndrome is usually defined as a serum sodium level of < 125 mmol/l combined with clinical cardiovascular or neurological manifestations. This study aimed to determine the risk factors for development of the clinical manifestations of TUR syndrome, and to investigate whether these clinical manifestations could be predicted by Hahn’s score. Methods: It is a retrospective study from January 2014 to December 2014. 131 patients were included with pre-operative ultrasound for prostate. All patients with incomplete data and with secondary or multiple procedures were excluded. TUR syndrome was diagnosed on basis of post-operative sodium level < 125 and intra- or postoperative cardiovascular or neurological abnormalities using Hahn’s score. Patients were divided into groups with and without clinical manifestations of TUR syndrome, and potential risk factors were compared between the two groups, that included patient’s co-morbids, duration of surgery, resected prostate weight, blood transfusion volume, and amount of irrigation fluid were seen. Results: In our study a total of 131 patients were included of which 9 (6.9%) developed TUR sydrome. There was significant difference in the pre-operative prostatic weight between patients with (85.7 +/- 35.3gm) and without (55.3+/- 29.4) TUR syndrome. There were significant differences in duration of surgery, resected prostate weight, irrigation volume and blood transfusion volume.

Conclusion: Pre-operatively risk of developing TUR syndrome should be communicated to patients with large prostatic size. Hahn’s score should be used prospectively to collect data regarding development of TUR syndrome. A prospective study with a larger sample size should be conducted.

Poster # 177

Simultaneous heart-kidney transplantation: Study of 9 cases in Imam Khomeini Hospital,Tehran

Dr. Mohsen Ayati Efin1, Dr. Mohsen Taheri Mahmoodi1, Dr. Farshad Sheybaee Moghaddam1

1Uro-oncology Research Center, Tehran University of Medical Sciences

Abstract Background: at the moment, there is an accession in renal failure and heart failure on the grounds of increment in the rate of chronic diseases such as diabetes mellitus and hypertension. We reported series of patients who underwent simultaneous heart- kidney transplantation from single donor in Emam khomeini hospital in Tehran and analysis their follow up data. Methods: this study was a retrospective review of collected data of 9 patients whom underwent simultaneous heart-kidney transplantation from January 2012 to July 2014. We performed heart transplantation and kidney transplantation simultaneously. Results: patient mean age was 28.5±10.32 years. Seven patients (77.78%) were male. Mean Follow up time was 30±10.9 months. All patients were on hemodialysis at time of transplantation. Mean serum creatinine level at discharge was 1.03±0.4mg/dl. No patients need hemodialysis after transplantation. Two patients were died. First patient was died at day 18 after transplantation because of ventilator associated pneumonia. Second patient was died 16 months after her transplantation because of respiratory failure. All other patients are now well and they have no symptoms related to kidney or heart

failure. Mean glomerular filtration rate was 88.38 ±25.98 ml/min. Mean ejection fraction was 50± 5.34%. There is an episode of cardiac allograft rejection in one patient which had been resolved. Conclusion: Our results after simultaneous heart-kidney transplantation indicate that this procedure is feasible option for patient with coexisting heart and kidney failure.in selected patients this procedure have satisfactory short and long term results, with a low incidence of allograft rejection.

Poster # 178

Prognostic factors for renal cell carcinoma: Have they predictive values today?

Dr. Emil Mukhtarov1, Prof.Dr. Ibrahim Cureklibatir2, Ass.Prof.Dr Adnan Simsir2

1Modern Urology Group, Mediland Hospital, 2Urology Department of Ege University Medical School Hospital

Aim: To investigate the incidence of different pathohistological sub-types in the unilateral, unifocal, non-metastatic, localized in organ in time of diagnosis sporadic renal masses suspicious for renal cell carcinoma, and to study different prognostic factors and results of treatment modalities. Material and Methods: The data of 106 patients with unilateral, unifocal, non-metastatic, localized in organ sporadic renal cortical masses, who were treated from 2001 to 2007 at the Urology Department of the Medical School of Ege University, Izmir, Turkey, were abstracted. There were divided four groups according to size of tumor: ≤4 cm, 4,1-7,0 cm, 7,1-10,0 cm, >10 cm. The age, gender, symptoms, TNM stage, Fuhrman nuclear grade, histological type, venous involvement, type of surgical extirpation, 5-year recurrence-free survival probability and real survive period, and also developed metastases were studied and analyzed using statistical modalities.

Results: Of the patients only 6 (5,66%) had benign tumors: ≤4 cm – 10,5%, >4 cm – 2,9%. Of the malign masses 67,92% were clear cell, 13,21% - papiller, 8,49% - chromophobe and 4,72% were other subtypes. None of 40 patients who underwent partial nephrectomy (≤4 cm – 25, >4 cm – 15 cases) had any local relapse or distant metastasis after primer nephrectomy. Every-one of 14 patients in whom metastasis developed had primer tumor larger than 4 cm, 71,5% had clear cell type of Tm, 78,6% - high grade Tm, 42,86% - major vena involvement, 42,86% - microvascular invasion. Conclusion: The most of suspicious masses were malign tumor. Malignancy raised according to tumor size rising. The size, stage, nuclear grade of tumor and venous involvement (major or microvascular) are the important prognostic factors. The effective method in small renal tumors, partial nephrectomy is applicable for larger tumors.

Poster # 179

Glyoxal—a pollutant, metabolite, and normal ingredient of diet: Why do we ignore its importance in genesis of oxalate and uric acid stones?

Dr. Jamil Ahmed Khan, Dr. Jamsheer Talati1, Dr. Raziuddin Biyabani1, Dr. Arif Mateen1, Dr. Saqib Qazi1, Dr. Ausha Habib1, Dr Farooq Ghani1, Dr. Quratulain Tariq1, Dr. Wajahat Aziz1, Dr. Hussamuddin Soomro1

1Aga Khan University

BACKGROUND Glyoxal (GO), a toxic aldehyde is rapidly converted by glyoxalases to glycolate; and by Aldehyde dehydrogenase to Glyoxalate. The latter is converted by Alaninglyoxylate aminotransferase to Glycine but when the Glyoxalate load exceeds capacity to reduce it or convert it to glycine, it is converted readily by cytosolic LDH to Oxalate. Additionally, GO forms

advanced glycation end products(AGE) which interfere with ammonias in the renal tubules, thus promoting acid urine and precipitation of uric acid and stone formation. METHODOLOGY: Literature search was done to understand oxalate metabolism and key sources of oxalate in body. The review was carried out as part of Oxalate group activities at Aga Khan University to develop a better understanding of oxalate metabolism and primary hyerpoxalurias. RESULTS: Glyoxal is a normal component of many foods including black tea, fermented foods and cookies. It is also used in preserved food. It is formed in the body by Schiff reaction where carbohydrates and aminoacids are transformed ultimately by Amadori process into AGE and GO. Diabetes promotes the formation of GO in this process. Glyoxal was mainly used in the textile industry, and in some household detergents, and so inhalation was infrequent except when aerosols were inadvertently inhaled. But it is now being added to petrol and aviation fuel, ostensibly to reduce carcinogenic products of combustion of these fuels. Satellite pictures now show significant GO aerial pollution. CONCLUSION The importance of glyoxal in formation of stones is yet undetermined, but it provides a link between diabetes, metabolic syndrome, and uric acid and oxalate stone formation. Could stones that are a combination of both, be the result of excess glyoxal? Glyoxal does not emerge in the normal conversations and research about stone, except for a fews studies. It should be central focus for future research. ( Acknowledgements, Oxalate group-AKU)

Poster # 181

Laparoscopic Pyeloplasty in Children with UPJ Obstruction

Associated with Crossing Renal Vessels

Dr. Srikanth Pentyala1, Dr. Rajendra Nerli1

1Kles Kidney Foundation

Ureteropelvic junction obstruction (UPJO) is usually intrinsic, however 15%-52% may be associated with crossing renal/lower pole vessels. Crossing vessels are usually located anterior to the UPJ. Investigators have demonstrated that the presence of crossing vessels decreased the success rate of antegrade endopyelotomy. We prospectively reviewed our series of laparoscopic pyeloplasty in children and analyzed as to whether crossing vessels affected the morbidity and outcome. Materials & Methods: Children < 18 years of age undergoing laparoscopic pyeloplasty for UPJO were prospectively included in the study. Pyeloplasty was performed anterior to the vessels and the anastomosis was placed adequately distal to the crossing vessel. Post-operatively the urinary catheter was removed after 48 hrs. Children were followed up in the post-operative period for urinary tract infection and a DTPA renogram was performed after 3 months in all. Results: Twenty (15.74 %) children had crossing renal/lower pole vessels associated with UPJO. In three of these children the crossing vessels were the main renal vessels, whereas in the remaining 17 children, the crossing vessels were the lower polar vessels. The mean age of these children was 11.0±3.37 years. The mean operating time was 96.15±12.54 mins as compared to 76.35±8.16 mins in children with UPJO alone. The mean blood loss was 31.50±6.03 cc as compared to 29.56±4.50 cc in children with UPJO alone. The mean post-operative hospital stay 51.50 hrs and 100% of the children showed improvement of renal function as well as drainage on the post-operative diuretic renogram done after 12 weeks of surgery. Conclusions: Crossing renal/lower polar are associated with UPJO in about 15% of children undergoing laparoscopic pyeloplasty. Presence of crossing vessels significantly prolonged operating time, however the blood loss, post-operative

hospital stay and short term outcomes were similar to children with UPJO alone.

Poster # 182

Umbilical only Access Laparoscopic Pyeloplasty in Children - Preliminary Report

Dr. Srikanth Pentyala1, Dr. Rajendra Nerli1, Dr. Abhijit Musale1

1Kles Kidney Foundation

Introduction: Over the past three decades laparoscopic surgery has become a well-established alternative to open surgery in the management of UPJ obstruction. Currently several efforts are being made, aimed at further reducing the morbidity associated with conventional laparoscopy. We report our experience with modified umbilical port laparoscopic pyeloplasty in children. Materials and Methods: Children presenting with hydronephrosis secondary to UPJ obstruction formed the study group. A 5 mm endoscopic port was placed on the inferior umbilical crease. The two 3 mm instruments were introduced through puncture sites created a few mm superior and lateral to the endoscopic port, under vision. Total operating time, time taken for insertion of double pig tail catheter, time taken for pyeloplasty anastomosis and complications were noted. Results: During the study period, 16 children underwent modified umbilical only access laparoscopic pyeloplasty. The Total operating time and the time for insertion of double pigtail catheter was significantly more in our earlier half of cases. Conclusions: Modified umbilical port laparoscopic pyeloplasty reduces the morbidity associated with conventional multiport laparoscopy without the need of expensive multichannel cannulas, curved laparoscopic instruments and longer laparoscopic endoscopes. Though crossing instruments is a factor which prolongs the duration of surgery, but it does not

hinder complex suturing needed during pyeloplasty.

Poster # 183

Metastases of Renal Cell Carcinoma to the Contralateral Adrenal Gland Managed by Laparoscopic Adrenalectomy

Dr. Abhijit Musale1, Dr. Rajendra Nerli1, Dr. Srikanth Pentyala1

1Kles Kidney Foundation

Introduction : Renal cell carcinoma (RCC) is the most lethal urological cancer . It is estimated that one thirds of the patients with localized cancer will develop distant metastasis after radical treatment. Adrenal metastasis of RCC are relatively rare and can be either synchronous or metachronous; ipsilateral, contralateral or bilateral; solitary or part of a massive metastatic spread. Since it was first described , laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions . We report our experience with laparoscopic management of contralateral, metachronous adrenal metastases from RCC. Materials & Methods : Patients undergoing radical/partial nephrectomy for RCC were prospectively followed and evaluated regularly for general health status , local recurrence of tumor and distant metastases . Patients identified to have had adrenal lesion/mass during the follow-up period were evaluated in detail both with imaging as well as endocrinal evaluation for assessment of functional status of these lesions. All these patients underwent laparoscopic adrenalectomy under general anaesthesia. Results: During the study period Jan 2006 - Dec 2015, 8 patients (7 male and 1 female) with a mean age of 57.8 years underwent laparoscopic adrenalectomy. The mean operating time was 111.2±32.5 mins, blood loss was 45±8.6 cc and postoperative stay was 37.5± 9.3 hours. None of

the patients had any major complications both early and delayed. The overall survival was 44.62 months. Conclusions: Metachronous, solitary and contralateral adrenal metastasis from RCC is an extremely rare clinical complication that can occur very late after the radical/partial nephrectomy. Increased use of imaging modalities has led to more efficient and early detection of these lesions. Aggressive surgery remains the treatment of choice in these cases. Laparoscopic adrenalectomy remains a good, safe option with minimal morbidity and short hospital stay.

Poster # 185

Why Position Matters: A Novel Percutaneous Nephrolithotomy (PCNL) Approach

Ms. Jaslyn Ju Lia Gan1, Jasmine Ju Hsien Gan1, Jonathan Gan2, Kim Tiong Lee3

1University College London, 2National Health Service England Trust, 3Puteri Specialist Hospital

Introduction: Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position to remove large renal calculi. However, there are anaesthetic limitations associated with the prone position. The supine position is associated with poorer ergonomics due to its awkward downward renal tract, smaller window for percutaneous puncture and higher

risks of anterior calyx puncture. The aim in this study is to demonstrate demonstrate the feasibility of lateral-PCNL in managing large renal calculi without the disadvantages associated with the prone and lateral position. Methods: A retrospective case series was conducted on 396 lateral PCNL cases by a single surgeon from July 2001 to July 2015. The lateral-PCNL was performed in a unique manner; the patient’s thorax, abdomen and pelvis were positioned over a bridge perpendicular to the ‘broken’table, creating an extended lumbodorsal space. The procedure was evaluated in terms of its learning curve, secondary stone clearance at 3 months post procedure, and complications. Results : Primary stone clearance was achieved in 82.7% of patients. Subsequent procedures were performed post primary procedure in 74 patients with residual stones. Secondary stone clearance was achieved in 91% of patients with non-staghorn stones, and 73% of patients with staghorn stones. The learning curve of this procedure was 15 cases. 2% of patients required post operative transfusion and 12.6% of patients had post operative fever. There were no cases of hydrothorax or bowel perforation. Conclusion: Our lateral-PCNL technique allows for effective stone clearance due to superior stone ergonomics, and is safe even in the most routine of procedures.