UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts 99mTc-Sestamibi Renal SPECT/CT in the Differentiation Between Malignant and Non-Malignant Renal Tumours: the Initial Experience at a Western Australian Centre. Pravin Viswambaram (1) (1) Fiona Stanley Hospital Introduction and Objectives: The incidental detection of small renal masses is increasing however standard imaging modalities remain unable to differentiate between benign andmalignant lesions. 99mTc-MIBI SPECT/CT is a form of nuclear imaging that is used extensively inmyocardial perfusion, breast and parathyroid scanning. There is limited experience with its use in the assessment of renal lesions however results from the few reported series is encouraging and so its utility was assessed in our unit in this prospective audit. The aim of this study was to assess the feasibility of using 99mTc-MIBI SPECT/CT in our department and to determine its sensitivity and specificity in differentiating between benign and malignant renal tumours. Methods: 99mTc-MIBI SPECT/CTwas offered to all patients referred to Fiona Stanley Hospital with newly identified small renal masses between 1 July 2018 and 1 October 2019. Nuclear medicine radiologists reported the scans and described lesions as either avid (suggestive of benign lesion) or non- avid (suggestive of malignant lesion). Results were prospectively collected and recorded. Patients subsequently underwent core renal mass biopsy and/or extirpative surgery after discussion with treating urologist. Results from 99mTc-MIBI SPECT/CT were compared to histopathology results to determine its sensitivity and specificity. Results: Of the 67 patients with new renal masses who have undergone 99mTc-MIBI scanning, 50 have histopathology available. 99mTc-MIBI demonstrated a sensitivity of 0.95 and a specificity of 0.85 in diagnosing malignant lesions. Conclusions: 99mTc-MIBI SPECT/CT has the potential to change the evaluation of renal masses by minimizing the role and complications associated with renal mass biopsy. Robotic-Assisted Laparoscopic Ureteral Re-Implantation: ASingle Center Experience Venkates Thuraiyur Kamaraj (1) (1) Sir Ganga Ram Hospital , New Delhi Introduction andObjectives: The open reconstructive surgery of lower ureter requires large incision and is associated with increased morbidity, whereas laparoscopic reconstruction is associatedwith steep learning curve, prolonged operative time and difficult . We report our single centre experience with robot-assisted laparoscopic ureteral reimplantation (RALUR). Methods: From 2014 to 2019 total 27 patients (age range 6-50 years) underwent RALUR for various underlying pathologic conditions. The da Vinci surgical systemwas utilized. We analyzed epidemiological characteristic of each patient, underlying pathology, unilateral or bilateral involvement, operative time, hospital stay and peri-operative or long term complication. Results: Total 27 patients underwent RALUR, out of which 8 were male and 19 were female. Inflammatory ureteral stricture was predominant underlying pathology with total 9 cases, followed by iatrogenic ureteral stricture (7 cases). Ureterovaginal fistula, obstructed megaureter and VUR contributed for 3 cases each. 2 cases were for ectopic ureter. Unilateral involvement was present in 21 cases with Bilateral involvement was present in 6 cases. Only ureteral reimplantation was sufficient in 17 cases, UR with psoas hitch was needed in 9 cases and 1 case required boari flap. Mean operative time, mean docking time and mean console time were recorded. Mean blood loss and mean hospital stay were 250 ml (range 50-500 ml) and 3 days (range 2-6 days), respectively. According to Clavien-Dindo classification, there were 4 grade 1, 1 grade 2 and no grade 3 complications. Conclusions: The robotic assisted ureteral reimplantation is not only technically feasible option but also give comparable outcome with minimal morbidity and better aesthetic. C-10097 C-10094 Is Multiparametric MRI (MP-MRI) Prostate Reliable in Detecting the Location of the Highest-Grade Lesion? A Western Australian Experience Pravin Viswambaram (1) (1) Fiona Stanley Hospital Introduction and Objectives: Transperineal prostate biopsy allows some degree of targeting during biopsy but is still invasive with complications. Some studies have suggested that MP-MRI prostate may allow up to 25% of men avoid prostate biopsy. The range of MP-MRI sensitivity and specificity is however wide, varying between 59-96% and 23-87% respectively. Hence, we aim to review the effectiveness of MP-MRI in detecting clinically significant prostate cancer in Western Australia. Methods: A retrospective study of patients who had template TP prostate biopsies at a single Western Australian centre and MP-MRI performed at a single respected radiology provider between 2015 and 2018 was done. Patient information was de-identified. Demographic data, PSA, prostate volume, the location of MRI PIRADS 3-5 lesions and the histopathology results were recorded. Standard methods were used to calculate sensitivity, specificity, positive predictive value and negative predictive value. Results: A total of 300 cases were analysed. MP-MRI demonstrating a clinically significant lesion (PIRADS 4/5) had a sensitivity of 92% [87-95], specificity of 83% [74-89], PPV of 91% [86-94] and NPV of 85% [76-91] in detecting clinically significant prostate cancer (Gleason 7-10). MP-MRI PIRADS 4/5 correctly identified the location of clinically significant prostate cancer in 91% of the cohort while it only correctly identified location of Gleason 6 cancer in 21% of cases. Conclusions: This study demonstrates that clinically significant lesions on MP-MRI corresponded to a high rate of clinically significant cancer being detected on biopsy at that same location, supporting the use of MRI target prostate biopsies. Who Dies of Localized Prostate Cancer? A Natural History Study in Singaporean Men Zhi Wei Law (1) (1) Singapore General Hospital Introduction and Objectives: Prostate Cancer (PCa), accounts for 13.0% of the cancers diagnosed in men between 2011-2015 . There is little data on the natural history of localized PCa, nor a clear definition of lethal PCa in this population. We aim to describe the natural history of men with clinically localized PCa. Methods: A clinical review of a prospectively collected prostate cancer registry in SingHealth was performed. 1679 patients were diagnosed with PCa between 2001-2008. Patients with non-adenocarcinomatous histology, metastatic disease, definitive local or systemic therapy, absent PSA/ histology/T-staging, and unknown cause of death were excluded. Results: 204 patients were analyzed. Median follow up was 10.11 years, 19 (9.3%) patients lost to follow up; 19 PCa and 84 non-PCa deaths. Cumulative incidence of overall mortality, PCa mortality (PCM) and NPCM was 64.2%, 11.7% and 52.5%.Age, comorbidities and CCI were statistically significant for NPCM. CCI had a higherAUC (73.1%) for NPCM compared to comorbidities (63.1%) and age (71.1%). sdHR of NPCM with CCI and DAmico was significant for CCI ≥ 4 (sdHR 3.21 CI 2.05-5.04, p<0.001). PCM of DAmico high-risk PCa patients with CCI 0-3 and ≥ 4 was 55.6% and 14.6% (p=0.026). sdHR of PCM in this population was significant for CCI 0-3 (sdHR 3.55 CI 1.08-11.7, p=0.036). Conclusions: Older menwith CCI ≥ 4 have a significant risk of NPCM, amore conservative approach should be. Men with high-risk PCa and CCI ≤ 3 are likely to die of prostate cancer and may represent candidates for aggressive treatment. CCI could serve as a better predictor for NPCM. C-10095 C-10092 9