kss/london south regional meeting incorporating the annual ...€¦ · english cl, afshar m,...
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In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
KSS/LondonSouthRegionalMeetingincorporatingtheannualDerekPackhamMemorialMedialandinauguralBillChoiaward.
Tuesday20thNovember2018
PostgraduateEducationCentre,FrimleyParkHospital,SurreyGU167UJ.
Convenors:MrAhmedAli,MrMuddassarHussain,MrAndrewChetwood
Programme:
1000 ArrivalandCoffee:
1030-1230 KSSSTCmeeting(consultantsandtraineereps)
1230-1300 JointKSS/LondonSouthMeeting
1300-1400 Lunch(Includingsponsorsexhibits)
1400-1530 Traineepresentations,Session1(Uro-oncology)
1530-1600 Coffee(includingsponsorsexhibits)
1600-1730 TraineePresentations,Session2(Benignurology)
1730-1800 PresentationfromMrIanEardley,ConsultantUrologist,LeedsTeachingHospitalsandVicePresident,RoyalCollegeofSurgeons.
1800-1815 BAUSQ&AwithMrTimO’Brien,VicePresidentofBAUS
1815-1830 Trainingupdates,AwardofDerekPackhamMemorialMedal,PrizesandtheinauguralBillChoiaward
1830-1930 DrinksandcanapesinthePGECwithdinnerafterwardsatVillaBianca,FrimleyHighStreetGU167JF(5minswalkfromhospital)
WelookforwardtowelcomingyoutoFrimleyParkforagreatdayofpresentationsandacademicdiscussion.Eachpresentationwillbe7minswith3minsforquestions.Pleasecontactanyofuswithquestionsaboutthedayandpleasecontactoneofustoconfirmyourattendancefordinner.
Nearestmainlinestation:FarnboroughMain(35minstoWaterloo),Frimley(1hourstowaterlooviaAscot)
Hopetoseeyouonthe20th
Withbestwishes
Ahmed,MuddassarandAndrew.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
Session1–Uro-oncology
14.00 Oncological and Functional Outcomes following Salvage High-Intensity Focused Ultrasound(HIFU): A single centre evaluation 10 years later.Down C,Malthouse T, Sturch P,White E, Larner T.,Brighton&SussexUniversityNHSTrustPresentingauthor:ChrisDown
14.10Roboticassistedradicalprostatectomyafterfocaltherapy:oncological,functionaloutcomesandpredictors of recurrence. T. Stonier, L. Marconi, R. Tourinho-Barbosa, C. Moore, M. Emberton, HUAhmed, X. Cathelineau, R. Sanchez-Salas, P. Cathcart, Guy's and St. Thomas' NHS Foundation TrustPresentingauthor:ThomasStonier
14.20ConcordanceofclinicalT3stageasreportedonmulti-parametricmagneticresonanceimagingtofinalpathologicalstagingof radicalprostatectomyspecimen.MStanowski,MKQuraishi, IMorrison,EStreeterandBEddy,EastKentUniversityHospitalsNHSFoundationTrustPresentingauthor:MKQuraishi
14.30PSAScreeningTsunami-TheStephenFryEffect?MattStanowskiandBenEddy.EastKentUniversityHospitalsNHSFoundationTrustPresentingauthor:MattStanowski
14.40TREXIT-oneyearon.Canwemakeacleanbreakfromthetrans-rectalbiopsy?StromanL,NealeA, ElHageO, ChallacombeB, Cathcart P,O’Brien TS, PopertR,Guy's and St. Thomas'NHS FoundationTrustPresentingauthor:LukeStroman
14.50Longtermevaluationofqualityassuranceandlearningcurvefordynamicsentinelinguinallymphnode biopsy in penile cancer.Toomey, D, Yan S, Harrison J, AgerM,Heenan S, Ayres B, Horenblas S,WatkinN,StGeorge'sHospitalPresentingauthor:SylviaYan
15.00 Is Age an Independent Predictor for SurvivalOutcomes in Penile Cancer.English CL, AfsharM,Pickering L, Tree A, Ayres B, Watkin N., St George's Hospital, St George's University Hospitals NHSFoundationTrustPresentingauthor:DrCarolineLouiseEnglish
15.10 Retroperitoneal robotic-assisted partial nephrectomy in in patient with high BMI. RoxanneGeorgiou,ManarMalki,MuddassarHussain,NeilBarber.FrimleyHealthNHSFoundationTrustPresentingauthor:RoxanneGeorgiou
15.20 Specialist MDT for Upper Tract Urothelial Carcinoma – does it change anything? Tay LJ,ChattertonK,ColemeadowJ,AmeryS,PolsonA,ChandraA,PrezziD,RottenbergG,NairR,BultitudeM,ThomasK,Guy'sandSt.Thomas'NHSFoundationTrustPresentingauthor:JuneTay
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
Session2–Benignurology
16.00 Is vitamin B6 supplementation needed for cystinuric patients taking Penicillamine? NaeemaFarrah, LindaRoss,HayleyWells,DavidGame, Kay Thomas,MatthewBultitude.Guy's and St. Thomas'NHSFoundationTrust.Presentingauthor:NaeemaFarrah
16.10TotallyTubelessUltra-miniPercutaneousNephrolithotomyintheManagementofRenalCalculi:ASingleCentreUKExperience.GabrielJ,PaiA,WaiH,TheakerM,AliM,MackieS,WatsonG.EastbourneDistrictGeneralHospital.Presentingauthor:JosephGabriel
16.20Investigatinguretericcolic:aretheBAUSguidelinesfeasible?A.Brown,A.White,A.Sujenthiran,Dr R. Bendor-Samuel,N.Wijesekera, S.Dutta, F.Mugabe,Miss R. Singh. KingstonHospital.Presentingauthor:AndrewBrown
16.30Istheanswerintheirgenes?Phenotypeoffirst-degreerelativeswithcystinuria.F.Kum,K.Wong,R. Mein, M. Bultitude, K. Thomas. Guy's and St. Thomas' NHS Foundation Trust. Presenting author:FrancescaKum
16.40 Initial single centre experience of 4D prostatic Urethral lift (Urolift): A minimally invasivetechnique for symptomatic benign prostatic hyperplasia (BPH).Raghav Verma, Keng Ng, Neil Barber.FrimleyHealthHNSFoundationTrust.Presentingauthor:RaghavVerma
16.50BacterialProstatitisisasignificantfindinginpatientswithsymptomaticurethralstricturediseaseToomey D, Harrison J, Adimonye A, Bendig J, Patel P, Watkin N. St George's University NHS Trust .Presentingauthor:DeliaToomey
17.00 Patient satisfaction and service evaluation following post prostatectomy stress urinaryincontinencesurgery.YoussefChedid,KieranSheimar,ClaireTaylor,SachinMalde,ArunSahai.Guy'sandStThomas'NHSFoundationTrust.Presentingauthor:YoussefChedid
17.10IntravesicalBotulinumToxinAInjectionsinpatientsonanti-plateletandanticoagulationtherapy.ElsieEllimahMensah,BogdanToia,AndrewBrown,LinhTrangNguyen,RizwanHamid,MahreenPakzad,Roger Walker, Jeremy Ockrim, Davendra Sharma, Tharani Nitkunan, Tamsin Greenwell, Jai Seth . StGeorgesHealthcareNHSTrust.Presentingauthor:ElsieMensah
17.20 The Development of a Validated Patient Reported Outcome Measure (PROM) for PenileCurvatureSurgery.D.Akiboye,P.Patel,A.A.Campbell,N.Watkin.Epsom&StHelierUniversityHospitalNHSTrust,London.Presentingauthor:DejiAkiboye
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationOncologicalandFunctionalOutcomesfollowingSalvageHigh-IntensityFocusedUltrasound(HIFU):Asinglecentreevaluation10yearslater
AuthorsDownC,MalthouseT,SturchP,WhiteE,LarnerT.
InstitutionBrighton&SussexUniversityNHSTrust
PresentingauthorChrisDown
AbstractIntroductionBiochemicalfailurefollowingradicalradiotherapyforlocalisedprostatecancerremainshigh.Traditionallythesepatientsareofferedandrogendeprivationtherapywhichisnon-curativeandhasnotablesideeffects.SalvageHIFUisaminimally-invasivetreatmentoptionforthesepatientswithcomparableoncologicaloutcomestoradicaltreatments,withimprovedfunctionalresults.WeaimtoassesstheoncologicalandfunctionaloutcomesofsalvageHIFUinourcentreoverthepastdecade.MethodsSeventy-twopatientswithbiochemicalrecurrencefollowingradicalradiotherapyforprostatecancertreatedwithHIFUinasingleinstitutionwerefollowedupforfunctionalandoncologicaloutcomes.ResultsSeventy-twopatientswithameanageof73.1yearsunderwentsalvageHIFUforprostatecancerbetween2006-17.MedianPSApre-HIFUwas5.1(1.1–17.7)ng/ml.Patientswereclassifiedashavinglow-22.2%(16/72),intermediate-57.0%(41/72)andhigh-riskdisease20.8%(15/72).Themediantimetorecurrencefollowingradiotherapywas8(2-16)years.Medianfollow-upwas4years(1–10years).Regardingincontinence;15.2%,0%,and2.8%ofpatientshadGrade1,2,and3stressincontinencerespectively.6.9%experiencedurgeincontinence.Erectiledysfunctionaffected16.7%ofpatients.Complicationsincludedurinarytractinfections(8.3%),urethralstricture(5.6%),prostatenecrosis(2.8%)andbleeding(1.4%).MedianPSA(ng/ml)at1,3and5yearspost-HIFUwere0.77,1.02and1.27.Overallbiochemicalrecurrencefreesurvivalwas75%.DiscussionSalvageHIFUisanemergingminimally-invasivetreatmentoptionforlocalisedprostatecancer.HIFUofferslowerratesofmorbidity,withencouragingshort-tomedium-termoncologicaloutcomes.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationRoboticassistedradicalprostatectomyafterfocaltherapy:oncological,functionaloutcomesandpredictorsofrecurrence
AuthorsT.Stonier,L.Marconi,R.Tourinho-Barbosa,C.Moore,M.Emberton,HUAhmed,X.Cathelineau,R.Sanchez-Salas,P.Cathcart
InstitutionGuy'sandSt.Thomas'NHSFoundationTrust
PresentingauthorThomasStonier
AbstractBackground:FollowingprostateFocalTherapy(FT),aproportionofpatientswilldeveloprecurrentdiseaseand,someofthemwillultimatelyrequiresalvagetreatment.ThetoxicityofsalvageradicaltreatmentsafterFTisnotclearlyunderstood.RoboticAssistedRadicalProstatectomyafterFT(S-RALP)isoneoftheoptionsforthemanagementofrecurrentdiseaseafterFThoweververyscarcedataexistsconcerningtheperioperative,oncologicalandfunctionaloutcomesofthisprocedureObjective:Describethesurgicaltechniqueandcharacterizetheperioperative,oncologicandfunctionaloutcomesafterS-RALP.DeterminetheriskfactorsforS-RALPfailure.Design,Setting,andParticipants:Multi-centrecohortstudyof82patientssubmittedtoS-RALPpostFT.Weincludedpatientswithalifeexpectancyofatleast10years,prostatespecificantigen(PSA)<30ng/mlandhistologicalconfirmationofresidual/recurrentprostatecancer(afterFT)withinthesixmonthsprevioustoradicalprostatectomy.InallpatientsmetastaticdiseasewasexcludedwithapelvicMRI,bonescanand/orPET-CT.Intervention(s):S-RALPOutcomeMeasurementsandStatisticalAnalysis:TheprimaryoutcomewasProgressionFreeSurvival(PFS).Secondaryoutcomeswereperioperativeandfunctionaloutcomes.ResultsandLimitations:PFSwas73.9%,48%and36.2%at12,24and36months,respectively.Therecurrencerateinthehighandintermediateriskgroupswas64.3%and34.4%,respectively.Thecontinencerate-definedbytheuseofnopads-atmostrecentfollowupwas83.1%.Onmultivariateanalysis,onlyInfieldRecurrence(HR[95%CI]=4.88[1.3-18.34];p=0.019)andpT3bstage(HR[95%CI]=3.96[1.22-12.82];p=0.02)wereindependentpredictorsofrecurrence.Majorlimitationsaretheretrospectivedesignandabsenceofacomparativearm.Conclusions:RoboticRadicalProstatectomypostFTissafewitharguablyexcellenturinarycontinenceoutcomes.MenidentifiedashavinginfieldrecurrenceafterFTappeartohavephenoypicallyaggressivediseaseshouldbecounselledaccordinglyregardingthepotentialneedforamultimodaltherapeuticapproach.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationConcordanceofclinicalT3stageasreportedonmulti-parametricmagneticresonanceimagingtofinalpathologicalstagingofradicalprostatectomyspecimen
AuthorsMStanowski,MKQuraishi,IMorrison,EStreeterandBEddy
InstitutionEastKentUniversityHospitalsNHSFoundationTrust
PresentingauthorMKQuraishi
AbstractIntroductionandObjectiveMulti-parametricmagneticresonanceimaging(mpMRI)oftheprostatehasdevelopedintoavitalinstrumentinthearmamentariumoftheurologist.Itisincreasingbeingusedpre-biopsyfortargeting,andasanadjuncttoguideoperativetechniqueinordertoattainsafeoncologicalmargins.Weareretrospectivelycomparingtheconcordanceofpre-biopsympMRIsoftheprostatereportedasT3tothepathologicalstageofthefinalradicalprostatectomyspecimenfromourseries.MaterialsandMethodsWeundertookaretrospectiveauditof422mpMRIstudies(1.5or3T)performedatasingleinstitutionbetween2011and2018thatwerereportedashavingT3disease.ThesewerecomparedtothepathologicalTstagereportedforeachradicalprostatectomyspecimen.ResultsOf422mpMRIs,74.2%(313)hadpositiveconcordancecT3(all)topT3(all).Ofthe109mpMRIs(25.8%)whichhadnegativeconcordance,most(102)weredowngradedtopT2.DirectTstageconcordance(cT3atopT3a,cT3btoPT3b)waspresentin61.6%ofcases(260of422).ConclusionWehaveshownthatmpMRIoftheprostateatourcentreconveysareasonablelevelofaccuracywhenusedtopredictpT3disease.However,itislessreliableinpredictingtheexactpathologicalTstageofthedisease.Thisinformationcouldbeusedincounsellingpatientsinregardstotheirindividualisedoncologicalriskofnervesparing.WeaimtoprogressthisfurtherandlearnourpositivepredictivevalueforpT3diseasebasedonmpMRI.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationPSAScreeningTsunami-TheStephenFryEffect?
AuthorsMattStanowskiandBenEddy
InstitutionEastKentUniversityHospitalsNHSFoundationTrust
PresentingauthorMattStanowski
AbstractIntroductionInFebruarythisyear,thenewsthatStephenFryhadbeentreatedforprostatecancerwasmadepublic.Shortlyafterthis,BillTurnbullannouncedhehadbeendiagnosedwithmetastaticprostatecancer.WeaimtoassessandreporttheimpactofincreasedmediaattentionandawarenessofProstateCanceronatertiaryurologicalservice.MethodsWehaveassessedthevolumeofnewPSARapidAccessreferrals,DiagnosticInvestigations–PSApathologytest,multi-parametricMagneticResonanceImagingoftheProstate(mpMRI)andtransrectalultrasoundguidedbiopsyofprostate(TRUSBx),diagnosisofnewprostatecancers,volumeofRoboticAssistedRadicalProstatectomies(RALPs)andimpactoncancertargetsfromJanuary2017toAugust2018.Results:Followingtheincreasedmediaattentiontherewasasuddenriseof60%inthetotalvolumeofPSAtestsorderedacrosstheEastKentTrust.Thiswassustainedforaround2monthsandtherewereapproximately3000additionalPSAteststhanusualperformedinthisperiod.NewrapidaccessPSAreferrals,mpMRISandTRUSBxmorethantripledinthefollowingweeks.Therewasadoublingofnewprostatecancerdiagnosesinthisperiod.ConclusionsTherewasasharpriseinPSAtestingintheEastKentregionfollowingtheincreasedmediaawareness.Thisresultedina“tsunami”ofpatientsbeingreferredthroughtherapidaccesspathway.Theflowoneffectofthistsunamiwasrecordablethrougheachstepofthediagnosticpathway.ItislikelythattheEastKentexperiencewasmirroredinothercentresintheUnitedKingdom.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationTREXIT-oneyearon.Canwemakeacleanbreakfromthetrans-rectalbiopsy?
AuthorsStromanL,NealeA,ElHageO,ChallacombeB,CathcartP,O’BrienTS,PopertR
InstitutionGuy'sandSt.Thomas'NHSFoundationTrust
PresentingauthorLukeStroman
IntroductionOn1stSeptember2017atGuy'sHospitalinLondon,wedeclaredourintentiontomovetoaprostatebiopsypathwayinvolvingonlyTPapproaches.Wetermedthisday,TREXIT,viz,acomplete&cleandivorcefromtrans-rectalprostatebiopsy.Wehypothesisedthatourstrategymightbesuccessfulifwecouldminimisetheneedforgeneralanaesthetic(GA)andmaximiseutilisationoffreehandTPbiopsiesperformedunderlocalanaesthetic(LA)orIVsedation(IVS)doneineitherdaysurgeryoroutpatientclinic.PatientsandMethodsAllconsecutivepatientsundergoingTPbiopsyoveraoneyeartimeperiodwereanalysedformethodofanaestheticandlocation.TPbiopsiesweredoneeitherusingacognitivefreehandtechniqueorstepperwithorwithoutMRIfusiontechnology.Complicationsweregatheredretrospectivelyfromelectronicpatientnoterecords,morbidityandmortalitymeetingsandA&Eattendances.Results678menunderwentTPbiopsy1stSeptember2017–31stAugust2018.0menunderwentTRUSbiopsy.Medianagewas60.5(range44-88).LAbiopsieswereperformedin395(58%)ofwhich168(42%ofLA)wereperformedintheoutpatientclinic.GAwasusedin205(30%)andIVSin78(11%).Provenpost-operativeurinarytractinfectionwasseenintwopatients,ofwhichone(0.15%)wasadmittedwithpost-operativesepsiswhichsettledwithIVantibioticsandfluids.Onepatientwasadmittedforclotretentionandsettledwithirrigation.Urinaryretentionwasseenin4(0.5%)andallpassedTWOC.Vasovagalepisodeswhichselfresolvedwereseenin7(1%)patients.TherewerenoClavien3orabovecomplications.ConclusionAswitchtoaTPonlybiopsystrategyhasprovedfeasibleandhasbeendeliveredwithlowcomplicationrates.Usingmoderntechniques,nearly60%oftheseTPbiopsiescanbedeliveredunderLA.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationLongtermevaluationofqualityassuranceandlearningcurvefordynamicsentinelinguinallymphnodebiopsyinpenilecancer
AuthorsToomey,D,YanS,HarrisonJ,AgerM,HeenanS,AyresB,HorenblasS,WatkinN
InstitutionStGeorge'sHospital
PresentingauthorSylviaYan
AbstractIntroductionTheroleofdynamicsentinelinguinalnodebiopsy(DSNB)inthestagingofintermediateandhighriskcN0squamouscarcinomaofthepenis(SCCp)isestablished.However,variabilityinsensitivityandconcernoverfalsenegativestudieshaslimitedtheadoptionofthetechniqueworldwide.Thereisalsoaneedtoestablishanacceptablenon-visualisationrate(N-VR)fortraceruptakeforqualityassuranceofaunit.Forthesereasons,weevaluatedourprospectivecohorttodeterminewhetherthereisalearningcurveandestablishabenchmarkforN-VR.MethodsAprospectivestudyofDSNBinourunithasbeenundertakenfrom2003-2018.Regularreviewof(N-VR)ofinguinalbasinsandclosemonitoringoffalsenegativestudyoutcomeshasbeenperformed.Attheonsetofthestudy,theunithadnotperformedanymentoredproceduresbuthadadoptedthetechniqueofacollaboratinghighvolumeunit.ThenuclearmedicinedepartmenthadconsiderableexperiencewithothertumourDSNBprocedures.Themethodologyhasremainedunchangedwiththesamedosageandsiteofinjectionofnannocolloid,gammaprobe,imagereporting,surgicalapproach,surgicalteamandhistologicalreportingthroughout.WehaveanalysedtheincidenceofourfalsenegativeproceduresandanyvariationinN-VRinconsecutivecohorts.Results1500inguinalstudieswereperformed.Eachcohortof250casesconfirmedameanN-VRof0.4%,99%CI[0.16-0.5%];therewasnostatisticallysignificantdifferencebetweenanycohort.Thefalsenegativestudiesoccurredatrandomthroughoutthe15yearsobservationwithameansensitivityrateof99.1%(Range98.8-99.6%)ineachcohort.Inthefirstcohortthefalsenegativeprocedureswereno.15,98and201.ConclusionThisisthelargeststudyreportinglongtermoutcomeoftheperformanceofDSNBforSCCp.Wehavenotdemonstratedanylearningcurveandconsistentperformanceofthetestoverthelongterm.Wehaveconfirmedabenchmarkforqualityassuranceandseenoreasontopreventpenilecancerunitsadoptingthistechnique.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationIsAgeanIndependentPredictorforSurvivalOutcomesinPenileCancer
AuthorsEnglishCL,AfsharM,PickeringL,TreeA,AyresB,WatkinN.
InstitutionStGeorge'sHospital,StGeorge'sUniversityHospitalsNHSFoundationTrust
PresentingauthorDrCarolineLouiseEnglish
Introduction:Penilecancerismostcommonlybeingdiagnosedinmen>60years.However,thereisanon-validatedcommonlyheldpresumptionthatyoungerpatientshaveamoreaggressivephenotypewithhigherriskofprogressionanddeath.Methods:Aprospectivelycollecteddatabaseofpatientswithpenilecancerbetween2002-2017referredtooursupra-regionalcentre,wasinterrogated.Patientsweresplitintothreeagegroups:<55,55-74,and>74years,straddlingthemedianage.Survivalwascalculatedfromdateofindexsurgery/referraltodateofdeath.Causeofdeathwascollected,andcancerspecificmortalitycalculated.HazardratiosfordeathwerecorrectedforT-stage,gradeandlymphnodestatus.StatisticalanalysiswasperformedusingIBMSPPS25.TheKaplanMeiermethodwasusedtoanalysesurvival,andCoxregressiontablestoanalysehazardratiosfordeath.Patientswerefollowedupto5years.Results:900patientswereincludedinthestudy.Themedianagewas63(range19-91).270patientswereinGroup1,438patientsinGroup2,and192patientsinGroup3.Kaplan-Meiercurvesshowacleardisparityinsurvivalrates(LogRankp<0.027).Agreaterproportionofpatientsintheolderagegroupshadhigherstage/gradeofdiseaseandN2/N3disease.However,whencorrectedforstage,gradeandnodalstatus,thehazardratiofordeathbetweengroupswasstillsignificantat1.44(p=0.03)Discussion:Thisstudyshowsthatpenilecancerspecificsurvivalisincrementallyworsewithincreasingage,andfactorsotherthanrecognisedprognosticindicatorsareinvolved.Wepostulatethatwithincreasingageandco-morbidity,patientsmayhavelessaccesstoradicalandadjuvanttreatment.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationRetroperitoneal Robot-Assisted Partial Nephrectomy in obesepatientsAuthors
RGeorgiou,MMalki,MHussain,NBarber
Institution
FrimleyHealthNHSFoundationTrust
Introduction:Obesityhasastrongassociationwithan increasedriskofrenalcancer. Nephronsparingsurgery is thegold standard treatment for clinically diagnosed T1a tumours. There are a number of studies in theliterature reporting the outcomes of transperitoneal robot-assisted partial nephrectomy in obesepatients. However, there is paucity in the literature about the role retroperitoneal RAPN in obesepatients.Inthisstudy,wereportourexperiencewithretroperitonealrobot-assistedpartialnephrectomy(RAPN)inobesepatients.
Methods:Obesity isdefinedaspersonwithbodymassindex(BMI)≥30kg/m².FromApril2012toJuly2018,109patients with BMI ≥ 30 kg/m² underwent RAPN, of whom 96 patients has retroperitoneal RAPN. Wereviewed patients’ demographic, operative data, peri-operative and postoperative complications,postoperativehistology.
ResultsTheaverageBMIwas34.51kg/m² (range30 -56.02).Theaverageageof thepatientswas57.96years(range27-79).Themedianhistologicalsizeoftumourwas32mm(range8-65).Themediantotalsurgicaltimewas127.5minutes(range64-255)withmedianwarmischaemiatimeof22.0minutes.Thelocationofthetumourinmoreonethirdofpatientswasanterior.MedianR.E.N.A.Lnephrometryscorewas6.Themedianestimatedbloodloss(EBL)is20mL(range0-2000).Threecaseswereconvertedtoopenpartialnephrectomybecauseofbleeding(3.1%).Twopatientsneededperi-operativebloodtransfusionbecauseofbleeding.Themedianlengthofstaywas2days(range1-12).BMIdidnothavean impacton the totaloperating time (p=0.735),warm ischaemia time (p=0.5),post-operativecomplicationsandlengthofstay(p=0.178).Onunivariateanalysis,obesepatients(BMIclassIII,classIIandclassI)hadhigherestimatedmeanbloodloss(296.7mL,148.33mLand43mLrespectively)(p=0.036).Ourtotalsurgicaltime,estimatedbloodlossandpost-operativecomplicationratewerefavourablewhencomparedtotheoutcomesoftransperitonealstudies(table1).
Conclusions:RetroperitonealRAPNisfeasibleinpatientswithhighBMIandprovidesgoodsurgicalaccesstotreatnon-anteriorrenalmasses.RetroperitonealRAPNisassociatedwithlessbloodloss,shortersurgicaltimewhencomparedtotransperitonealRAPNstudies.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationSpecialistMDTforUpperTractUrothelialCarcinoma–doesitchangeanything?
AuthorsTayLJ,ChattertonK,ColemeadowJ,AmeryS,PolsonA,ChandraA,PrezziD,RottenbergG,NairR,BultitudeM,ThomasK
InstitutionGuy'sandSt.Thomas'NHSFoundationTrust
PresentingauthorJuneTay
AbstractIntroductionUpperTractUrothelialCarcinoma(UTUC)remainsachallengingconditiontotreatduetomultipleco-morbidity,radiologicaluncertainty,difficultywithbiopsytogradeandstage,concernaboutfalsenegatives,potentialforseedinganddelaystotreatment.Toimprovequalityofcare,wecreatedaspecialistUTUCmultidisciplinaryteammeeting(SMDT)withendourologistsanduppertractoncologicalsurgeonswithinourbladdercancerMDTatourtertiaryreferralcentre.MethodsDataofthepatientsdiscussedintheSMDTwasprospectivelyrecordedbetweenJanuaryandSeptember2018.Clinical,radiologicalandpathologicalfactorswereanalysed.ResultsOf893casesinthebladdercancerMDT,167cases(100patients)werediscussedinSMDT(mean4.4cases/meeting).Meanage67years(range28-92),with63men.FromtheSMDT,48patientswithsuspecteduppertractmalignancyhadeitheradiagnosticureteroscopyand/orbiopsy,ofwhich22(45.9%)werebenignand26(54.1%)weremalignant.Theremaining52patientshadtheirdiagnosisbasedonimaging(benignn=15;malignantn=22;previousUTUConsurveillancen=4)andurinetuberculosisculture(n=1).Nineareawaitingfurtherdiagnosticinvestigationsandonepatienthadanon-urologicalmalignancy.25patientsunderwent26radicalnephroureterectomy(RNU).Ofthese,weproceededwithoutpriorureteroscopyorbiopsyin12patientsbasedonMDTdiscussion.AllwhounderwentRNUhadmalignantpathology.Twopatientsunderwentureteroscopictreatmentandsurveillance.Fourunderwentdistalureterectomy:twohaduretericstrictures,twohaddistaltumourswithassociatedbladdermalignancy.Thirteenpatientsweremanagedexpectantlyforuppertractmalignancyduetodiseaseburdenandassociatedco-morbidities.Twopatientsareundergoingchemotherapy:oneformetastaticdiseasearisingfromarenalcarcinoma,andanotherforconsiderationofpalliativenephroureterectomy.Threepatientsdeclinedsurgery.ConclusionIntroductionofanSMDTforUTUChasledtostreamlinedcarewithlessresorttoureteroscopicconfirmationandtreatmentreducingtimetodefinitivesurgerywithoutcompromisingoncologicaloutcomesasnobenignpathologyonfinalRNU.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationIsvitaminB6supplementationneededforcystinuricpatientstakingPenicillamine?
AuthorsNaeemaFarrah,LindaRoss,HayleyWells,DavidGame,KayThomas,MatthewBultitude
InstitutionGuy'sandSt.Thomas'NHSFoundationTrust
PresentingauthorNaeemaFarrah
AbstractINTRODUCTION:
D-Penicillamineisacystinechelatorthatformsadisulphidecomplexwithcysteinetoincreaseitssolubility.StudieshavesuggesteditcancausevitaminB6deficiencyandsomerecommendroutinesupplementationwithpyridoxine.Weassessedourpatientcohorttoseeifsupplementationisrequired.
METHODS:
Weanalysedourprospectivedatabaseofpatientswithcystinuriaandidentifiedpatientsrecordedastakingorpreviouslytakenpenicillamine.Weanalysedbloodcountsrenal/liverfunction,vitaminB6levels,urinarydipstickforproteinuriaandprotein:creatinineratiowhereavailable.Werecordedside-effectsandreasonfordrugcessation.
RESULTS:
From175patientsinourdatabase,30patientshaveusedpenicillamine.Ofthese17arecurrentlystilltakingthemedicationforvariableduration(4for0-5years;4for6-10years;4for11-20years;5for>21years).Noneofthesepatientshaveexperiencedhaematologicalside-effectsorsignificantproteinuriaAllpatientshavehadtheirVitaminB6levelsassessedandonly1hadamildlyreducedlevel(27.4(nmol/L))andwasofferedsupplementation.NopatientsreportedsignsorsymptomsofvitaminB6deficiency.1patientreportschronicskinchangesafter30yearsofdruguse.
13patientsarenolongeronpenicillamine;8stoppedduetoside-effects;2hadonlytakentemporarilyduetotioproninshortage;3hadtakenpenicillaminehistoricallywithnoinformationavailable.Ofthese13patients,4nowtaketiopronin.
CONCLUSIONS:
Wehaveonly1patientfoundtohavereducedvitaminB6levels.Thuswefeelthisdoesnotjustifyroutinesupplementationforallpatientsandweadvocatetestingserumlevelsandonlyofferingsupplementsifrequired.Cessationofpenicllamineduetootherside-effectsiscommon.Patientsintoleranttopenicillaminecansuccessfullybetrialledontiopronin(andvice-versa).
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationTotallyTubelessUltra-miniPercutaneousNephrolithotomyintheManagementofRenalCalculi:ASingleCentreUKExperience.
AuthorsGabrielJ,PaiA,WaiH,TheakerM,AliM,MackieS,WatsonG
InstitutionEastbourneDistrictGeneralHospital
PresentingauthorJosephGabriel
AbstractIntroductionThereisemergingevidencethatminiaturisedtractsize,withan11-13Frtract,isassociatedwithreducedmorbidityandacceptableoutcomesinPercutaneousNephrolithotomy(PCNL).ThereishoweveranunderstandablereticencewithintheUnitedKingdomtosubjectpatientswithsmallerstoneburdentotheinvasivenatureofPCNL.OursinglecentrestudyevaluatestheoutcomesofUltra-miniPercutaneousNephrolithototmy(umPCNL)inthemanagementofsmalltomoderatevolumerenalcalculi.MethodsWeperformedaretrospectiveanalysisof44patientswhoweretreatedwithumPCNLatourinstitutionoverathreeyearperiod.AllpatientsunderwentumPCNLusinga3Frnephroscope,7.5Frinnersheathand13Froutermetallicsheath.WeusedaholmiumYAGlaserandusedabasketforstoneretrievalifnecessary.ResultsMedianstonesizewas9mm(range7to17mm).35patientsweretreatedinthesupineposition,with9prone.Stonefreerateswere98%(n=43).OnepatientintheumPCNLgroupwasleftwithapercutaneousnephrostomy;allotherpatientswerelefttubeless.Themeanoperativetimewas55minutes.Theminorcomplicationratewas15%.Therewerenomajorcomplications.Medianlengthofstaywasoneday.ConclusionumPCNLissafeandhasexcellentstonefreerates.Itisausefuladditiontothearmamentariumoftreatmentoptionsforsmallervolumerenalcalculi.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationInvestigatinguretericcolic:aretheBAUSguidelinesfeasible?
AuthorsA.Brown1,A.White1,A.Sujenthiran1,DrR.Bendor-Samuel2,N.Wijesekera3,S.Dutta3,F.Mugabe3,MissR.Singh1
InstitutionDepartmentofUrology1,EmergencyMedicine2andRadiology3,KingstonHospital,GalsworthyRoad,KT27QB
PresentingauthorAndrewBrown
AbstractIntroductionUretericcoliciscommon.BAUSguidelinesrecommendNSAIDsas1stlineanalgesia,thatcalciumanduratearemeasuredandaCTKUBisperformedwithin14hours.MethodsTheprimaryaimofthisauditwastoevaluatewhetherCTKUBwasperformedwithin14hoursofacutepresentationinourTrust.WeauditedtheuseofNSAIDanalgesiaandthemeasurementofcalciumandurate.RetrospectivedatacollectionandinitialauditJanuary-February2018.Therenalcolicpathwaywasupdatedandare-auditperformedJuly-August2018.AllpatientswhohadaCTKUBorganisedbyA&EtoaiddiagnosiswereincludedResults120patientswereincludedintheinitialaudit(30%confirmedurolithiasis)and164inthere-audit(50%confirmedurolithiasis).TheaveragetimetoCTKUBimprovedfrom1day,2hoursand23minutesto18hoursand46minutes.TimetoCTKUBwassignificantlylongerifpatientsweresenthometoawaitanout-patientscan,thisimprovedby10hours.Thenumberofpatientswithcalciumanduratemeasuredoninitialpresentationwaspoor(7.5%and15%)aswasNSAIDusage(32%and23%).ConclusionThetimetoCTKUBimproved,althoughtheaveragetimeisstilloutsidethatrecommended.Mitigatingfactorsmayincludeinabilitytocontactpatientsawaitingoutpatientinvestigationandprioritisingclinicalworkload.Giventhelowyieldofpositivescans,itwouldbemorecosteffectivetomeasurecalciumandurateonlyinpatientswithconfirmedstones.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
Titleofpresentation
Istheanswerintheirgenes?Phenotypeoffirst-degreerelativeswithcystinuria
AuthorsF.Kum,K.Wong,R.Mein,M.Bultitude,K.Thomas
InstitutionGuy'sandSt.Thomas'NHSFoundationTrust
PresentingauthorFrancescaKum
AbstractIntroduction:Thereare2genesresponsibleforthedifferentmodesofinheritanceofcystinuria;SLC3A1(autosomalrecessive)andSLC7A9(autosomaldominant,withincompletepenetrance).Over150mutationsareknown,henceanalyzingthegenotype:phenotypecorrelationischallenging.Studyingfirst-degreerelativesinisolationmayofferusabetterinsight.Methods:30first-degreerelatives,including3twinpairs(1identical)wereidentifiedfromourcohortof160genotypedpatientswithcystinuria.MutationsweredetectedwithDNAsequencing.Phenotypicdatawerecollectedprospectively.Results:Allfirst-degreerelativeshadthesamemutation.Medianagewas37years(18-73).ThegenderdistributionwasM:F2:1,whichisdifferentfromourentirecliniccohort(M:F,1:1).TherewasanequalsplitofSLC3A1andSLC7A9genes,unlikethe2:1ratioofSLC3A1:SLC7A9seeninourcliniccohortandreportedliterature.Amongstavarietyofmutations,c.1400T>Cp.(Met467Thr)andduplicationofexons5to9werethetwomostcommonlyfoundmutationsinSLC3A1.Noneofthepatientshadthesamephenotypeastheirrelativeforstoneformation,medications,surgicalinterventions,renalfunction,urinarycystinelevelsorkidneyloss.Conclusion:Thoughitseemslogicalthatsharingagenotypeinfirst-degreerelativeswouldleadtosimilardiseaseseverity,wewereunabletodemonstratethis,evenintheidenticaltwinpair.Thecomplexityofmultiplefactorsmayresultinthevariancesinstoneformation.Furtherresearchintodiseaseepigeneticsmayprovideabetterinsightintopredictingphenotypicdifferences.Thiscouldfacilitateindividualizedtreatmentbasedonapredictionofpatients’diseaseseverity.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofPresntation
Initialsinglecentreexperienceof4DprostaticUrethrallift(Urolift):Aminimallyinvasivetechniqueforsymptomaticbenignprostatichyperplasia(BPH).
Authors
RaghavVerma,KengNg,NeilBarber.
Institution
FrimleyHealthNHSFoundationTrust.
Presentingauthor
RaghavVerma
Contactemail:
Abstract
Introduction:
UroLiftisatransurethral,minimallyinvasiveprocedureusedtoholdtheprostaticlaterallobesawayfromurethrallumenforpatientssufferingwithsymptomaticBPH.IthasbeenshowntobeeffectiveinrelievinglowerurinarytractsymptomsinBPHwhilemaintaininggoodsexualfunction.4DUroliftisanewtechniqueinimplantdeliveryusedtomaximallywidentheprostaticurethraatbladderneck.
Methods:
Prospectiveandretrospectivedataoffiftypatientswhounderwent4DUroLiftfromSeptember2017toSeptember2018werecollected:preandpost-operativeInternationalProstateSymptomaticScore(IPSS)andQualityofLife(QoL)questionnaires,sexualfunction(IIEFandMSHQ-EjD)questionnairesandpreandposturoflowmetrydata.StatisticalanalysiswascompletedusingPairedt-test.
Results:
Therewas54%reductioninmeanIPSSfrom22.3+/-7.2to11.9+/-6.9(p<0.001).SignificantQoLscoresimprovedfrom4.6+/-1.1to2.1+/-1.8(p<0.001).ImprovementinQmaxfrom10.1+/-2.6to14.6+/-6.4mls/sec(p0.002)wasnoted.Therewerenoreportsofworseningsexualfunctionandretrogradeejaculation,withtheaverageMSHQ-EjDpost4DUroliftbeing11.5+/-3.7.Theseimprovementinresultswerecomparabletopreviousstudies(averageresultsat1year)–Graph1.
Conclusion:
Initialresultsfrom4DUrolifthasshowngoodcomparable,ifnotbetteroutcome,withimprovementoflowerurinarytractsymptomswithoutcompromisingsexualfunction.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationBacterialProstatitisisasignificantfindinginpatientswithsymptomaticurethralstricturedisease
AuthorsToomeyD,HarrisonJ,AdimonyeA,BendigJ,PatelP,WatkinN.
InstitutionStGeorge'sUniversityNHSTrust
PresentingauthorDeliaToomey
AbstractIntroductionUrinarytractinfectionsarecommonlyassociatedwithurethralstrictures,buttheevidenceforbacterialprostatitisislimitedtoonebriefreportover30yearsago.(1)Urethralstricturesymptomsandprostatitis-likesymptomsaresimilarandweconsideredthatundiagnosedbacterialprostatitismaybecontributingtothepatient’spresentation.MethodsA3yearprospectiveobservationalstudywasconducted.Malepatientswithsymptomaticpenileandbulbarurethralstrictures,whowerebeingassessedforurethroplasty,consentedtoprostateculturesusingthemodifiedMeares-Stameytechnique.Patientswithconcurrentpositiveurinecultureswereexcluded.Patientsunderwentcystoscopicassessment,stricturedilatation,cleancatchurineandprostatemassage.Prostatefluidwascollectedalongwithfirstvoidurine.Sampleswereindividuallyculturedbyadedicatedmicrobiologist.Resultswerecomparedwithculturesobtainedfromacontrolgroupofpatientswithprostatitis-likesymptomsoverthesametimeperiodwithnohistoryorevidenceofstricture.NIH-prostatitissymptomscoreswererecordedinbothgroups.Significanceofthecultureswasassessedbythemicrobiologistwhowasblindedfromthepatient’sclinicalpresentation.StatisticalsignificancewasassessedbyChisquare.Results100patientsunderwentthe3potculture.57(Group1)hadaconfirmedstricture(15%penile,56%bulbar,29%panurethral).43(Group2)hadnoevidenceofstricture.Meanprostatitissymptomscoreswere7forpain,5forurinaryand5forbotherinbothgroupsrespectively.InGroup1,47%ofpatientshadauniquelypositivebacterialculturewitharecogniseduropathogen.InGroup2,21%ofpatientshadpositivebacterialcultures.15%group1,and2.56%ofGroup2hadpositivecleancatchurine.Thefindingswerestatisticallysignificant(p=0.0087).ConclusionThisstudyhasshownforthefirsttimeincontemporarypractice,thatbacterialprostatitisispresentinalargenumberofsymptomaticpatientswithurethralstrictures.Itisalsoconfirmedtobeastatisticallysignificantlyhigherincidencethaninacohortofpatientswithclinicalprostatitisalone.Werecommendvalidationofourfindingsandsuggestthatpatientswithurethralstricturesshouldbescreenedforbacterialprostatitisbeforeanyurethralreconstructivesurgeryisundertaken.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationPatientsatisfactionandserviceevaluationfollowingpostprostatectomystressurinaryincontinencesurgery
AuthorsYoussefChedid,KieranSheimar,ClaireTaylor,SachinMalde,ArunSahai
InstitutionGuy'sandStThomas'NHSFoundationTrust
PresentingauthorYoussefChedid
AbstractAims:Toevaluatepatientexperienceandsatisfactionfollowingpostprostatectomystressincontinencesurgeryusingvalidatedpatientreportedexperienceandoutcomemeasures.Methods:Inthissinglecentrestudy,patientswhoreceivedtreatmentwithamalesling(MS;AdVanceXP™)orartificialurinarysphincter(AUS;AMS800™)withaminimumofa1yearfollowupwerecontactedandcompleted2questionnaires;theclientsatisfactionquestionnaire(CSQ-8),andtreatmentbenefitscale(TBS).HigherCSQ-8scoresindicatebetterserviceevaluation.LowerTBSshowedbetterpatientsatisfactionwithtreatment.Results:79procedureswereundertakenon78patients(34MS,45AUS)withatleast1yearfollowup.8patientswerelosttofollowup,leaving71procedures(31MS,40AUS)in70patients.Bothersomestressincontinencewasasaresultofradicalprostatectomyin92%ofcases.Themeanfollowupwas34months(range13to60).ThemeanCSQ-8scorewas29.8(S.D.3.70)outof32.ThemeanTBSscorewas1.55(S.D.0.86)outof4.Sixtypatients(85%)gaveascoreofatleast1or2showingthatthetreatmentimprovedorgreatlyimprovedtheircondition.Conclusion:Responserateswerehighat90%.MeanCSQ-8scoreswerehigh,alongwithindividualdomainsindicatingaveryhighserviceevaluationfromthestudycohort.TBSscoreswerelowindicatinghighpatientsatisfactionwithtreatment.Patientreportedexperiencemeasuresinadditiontopatientreportedobjectivemeasuresshouldbemorewidelyutilisedtofullycapturethepatientexperience.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationIntravesicalBotulinumToxinAInjectionsinpatientsonanti-plateletandanticoagulationtherapy
AuthorsElsieEllimahMensah1,BogdanToia3,AndrewBrown4,LinhTrangNguyen2,RizwanHamid3,MahreenPakzad3,RogerWalker4,JeremyOckrim3,DavendraSharma1,TharaniNitkunan4,TamsinGreenwell3,JaiSeth1
Institution1StGeorgesHealthcareNHSTrust.2StGeorges,UniversityofLondon.3UniversityCollegeLondonHospitals4Epsom,StHelierHospital
PresentingauthorElsieMensah
AbstractIntroductionThereislittleevidenceregardingthesafetyofIntravesicalbotulinumToxin-A(Botox)injectionsinpatientsonanticoagulant/anti-platelet(AC/ACP)medication.Thecessationofwhichmaypredisposetothromboembolicorischaemicevents.WereviewedsignificantbleedingeventsafterBotoxinjectionwithconcurrentAC/APuse.MethodsAretrospectivereviewofallpatientshavingBotoxin3LondonhospitalswasconductedbetweenJanuary2016-July2018toexaminethosewithcontinuedAC/APtherapy.Demographicdata,indicationforinjection,andside-effectsofsignificantbleedingrequiringinterventionwererecorded.Results532patientshadBotoxinjectionsduringthistime.63patients[meanage69years(range19-89),hadatotalof114separateroundsofBotoxinjectionswhilstontreatmentdoseAC/APtherapy.Eachpatienthadbetween1-7repeatBotoxinjections.AC/APuseincluded;aspirin44,clopidogrel37,warfarin19,NOAC(novel/non-vitaminKoralanticoagulant)14.PatientsonwarfarinwhohadpointofcaretestingallhadINR<3.Therewas1/114(0.88%)episodeofpost-injectionhaematuriarequiringovernightadmissionresolvingspontaneously,withcatheterisation.Thispatient,onrivaroxibanhad300UofBotoxinjectedthrough20sites,onabackgroundofpreviousprostateradiotherapy.Therewasnoreportofbladderwashoutunderanaesthesiaortransfusion.ConclusionsVeryfewsignificantbleedingeventsoccurreddespitecontinuationofAC/APtherapyduringintravesicalBotoxtreatment.Somepatientswithinthisgroupmayhaveotherfactorsthatfurtherincreasebleedingrisk.Thisisanimportantconsiderationduringpatientcounselling,andwhentreatingpatientswhohavehighriskofthrombosiswithAC/AP.
In partnership with the Ministry of Defence
Frimley Health incorporates Frimley Park Hospital, Heatherwood hospital and Wexham Park hospital Headquarters: Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ 01276 604604
TitleofpresentationTheDevelopmentofaValidatedPatientReportedOutcomeMeasure(PROM)forPenileCurvatureSurgery
AuthorsD.Akiboye,P.Patel,A.A.Campbell,N.Watkin.
InstitutionEpsom&StHelierUniversityHospitalNHSTrust,London.
PresentingauthorDejiAkiboye
AbstractIntroductionandObjectivesSubjectivemeasuresofsuccessfulpenilecurvaturesurgeryarepoorlydefined.Wedescribea6yearprospectivestudyofthedevelopmentofaPROMforpatientswithstablePeyronie'sdisease(PD)undergoingsurgeryinasinglecentre.MethodsStructuredinterviewsidentifiedfourdomainsforassessment-penileappearance(PA),erectilefunction(EF),sexualrelationshipsandgenericqualityoflife(GQoL).ARANDconsensusgroupofUKandrologistsdefinedPROM1.PAquestionswerecreatedde-novo.EFandGQoLquestionswerebasedonIIEFandEQ5-Dquestionnairesrespectively.PROM1waspilotedonallpatientsundergoingPDsurgerywithtest-retestdesign.AseconditerationPROM2wascreatedafterstatisticalanalysisandpatientfeedback,andretested.InternalconsistencywasassessedusingCronbach'salpha(CRα).WilcoxonSignedRanktestwasusedtoassesstestandretestconsistency.VariabilityandbiaswasassessedusingaBlandAltmanplot.ResultsPROM2wascompletedpre-operativelyby88menwithresponserates>90%.CRαforPAconstructshowedconsistency(0.66)omittinglengthandpainquestions.EDandsexualrelationshipconstructsshowedconsistency(CRα=0.86,1.46).GQoLconstructwasnotconsistent(0.56).GQolpain/anxietyquestionscoupledwitherectilepainquestionsfromPAconstructshowedconsistency(CRα=0.98).WilcoxonSignedRanktestforPAindicatednosignificantdifferencebetweentestandre-testscores(P>0.126).VariabilityremainedconsistentforincreasingPAscores.ConclusionsRelationshipandEDquestionswereansweredconsistentlyanddemonstratedcontentvalidityandreliability.Pain,lengthandGQoLquestionswereinconsistentlyanswered.Generalisedpain/anxietyaffectedpenilesensation.Interestingly,lengthisminimallybothersome.WearenowabletoconfirmafinalvalidatedPROM3forexternaltesting.