UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 Contemporary Indications for Serial PSMA-PET in Prostate Cancer Patients Margaret Mansbridge (1) (1) Princess Alexandra Hospital Introduction and Objectives: PSMA-PET is a novel molecular targeting imaging modality that has been found to be useful in staging patients with biochemical recurrence. As facilities have become more readily available, the indications for imaging have widened to include primary staging and response to treatment. We investigate the contemporary indications for serial PSMA-PET in a large tertiary referral centre. Methods: We performed a retrospective review of all PSMA-PET studies completed from 2015 to 2019. Patients who had undergone more than one study were identified. Medical records, radiology, and pathology were reviewed to ascertain indications and outcomes of serial PSMA-PET studies. Results: We identified 35 patients in our 5-year study period. 48.6% (n=17) of patients underwent more than two PSMA-PET studies (range 2-9/patient). 14.3% of patients underwent an initial PSMA-PET study to assess response to systemic therapy, and 55.6% (n=10) of second PSMA-PET studies were to assess response. In patients who had undergone a third PSMA-PET study (n=17), 35.3% were performed to assess systemic therapy response and 50% (n=2) of fourth PSMA-PET studies were performed on patients post chemotherapy. Other common indications for serial PSMA-PET included assessing for site of recurrence in biochemical recurrence, or ongoing PSA progression post salvage treatment. Conclusions: The use of PSMA-PET as a tool to assess treatment response to systemic therapies has increasedwithout guidelines or long-termprospective studies to indicate the impact on patient outcomes. The use of serial PSMA- PET out of the multidisciplinary-team setting and without long-term studies assessing impact on patient outcomes comes at a potentially significant cost to the healthcare system. Management of Acute and Chronic Transplant Ureteric Complications Margaret Mansbridge (1) (1) Princess Alexandra Hospital Introduction and Objectives: Ureteroneocystostomy is routine practice at the time of renal transplantation. Rarely, it can be associatedwith anastomotic leak, breakdown or strictures that may require immediate or staged procedures. We review renal transplant ureteroneocystostomy complications, management, and outcomes in our transplant centre. Methods: The renal transplant database was used to identify all renal transplant recipients in our 10-year study period from 2009-2019. Patients who underwent further management of ureteric complications where identified. Management and outcomes were ascertained frommedical records, pathology, and radiology. Results: Mean age of patients was 49.8+/-14.4 years. In our 10 year study period, 13 patients were managed for obstructive ureteric pathologies, five patients with urine leak, and one patient for ureteric perforation. Obstruction was secondary to stenosis or stricture in six cases, pelvi-ureteric junction obstruction in five cases, urolithiasis in one case, and herniation in one case. Ureteroneocystostomy was routinely stented at time of transplantation. Time from transplant to ureteric complication ranged from 2 days to 6 years. Surgical repair techniques consisted of native ureteropyeloplasty (n=14), reimplantation (n=3), Boari flap pyeloplasty (n=1), and flap repair of renal pelvis (n=1). Two patients required a subsequent surgical procedure. Conclusions: Ureteric complications post renal transplantation are rare and can be varied. In cases that were amenable to native ureteropyeloplasty, surgical management was shown to be successful in our study population. Further research into other perioperative factors such as patient comorbidities, warm and cold ischaemic times, and other confounders should be considered in future studies assessing contributing factors to transplant ureter complications. C-10104 C-10101 One-Stage Dorsal Onlay Buccal Mucosa Graft Supplementedwith a Tunica Vaginalis Flap: a Novel Technique for Redo Bulbar Urethroplasty Bryan Geoffrey Arce (1) (1) Jose R. Reyes Memorial Medical Center Introduction and Objectives: Urethral stricture disease is an abnormal narrowing of the urethra resulting from fibrosis. This fibrosis may be caused by various risk factors and may include previous instrumentation, perineal trauma, and infections, among others. These primary strictures may be managed with urethrotomy, end-to-end anastomosis or outright open urethroplasty. Recurrent urethral strictures after initial correction, on the other hand, pose an even greater challenge for the reconstructive urologist. These wounds are highly complex due to the extensive tissue fibrosis and poor vascularity, rendering the urethroplasty more likely to fail. We aim to present a difficult case successfully managed by a novel technique not previously described in literature for urethral strictures. Methods: We present an 18-year-old male who previously suffered from severe trauma to the pelvis from a vehicular crash causing significant tissue loss. The patient initially underwent open urethroplasty with buccal mucosal graft. However, the initial repair failed few months after and a tube cystostomy was placed for diversion. During workup and imaging, a combined cystourethrogram revealed a 4.2 cm bulbar urethral defect. A surgical plan was formulated and the patient was scheduled for operation. The patient was then successfully managed with a one-stage dorsal onlay buccal mucosal graft with tunica vaginalis flap redo urethroplasty. Results: Post-operative course was unremarkable and the patient remains symptom-free nine months after surgery. A repeat urethrogram was performed and showed patency of the bulbar urethra after repair. Conclusions: We recommend this method to be considered a part of the reconstructive urologists armamentarium in the management of recurrent urethral strictures. Indications for Native Nephrectomy in Patients with Autosomal Dominant Polycystic Kidney Disease Margaret Mansbridge (1) (1) Princess Alexandra Hospital Introduction and Objectives: Manifestations of autosomal dominant polycystic kidney disease (ADPKD) include numerous large renal cysts leading towards end stage renal disease (ESRD), haematuria, pain, and urolithiasis. Multiple enlarging cysts, especially with concurrent liver cysts, can cause intra-abdominal compartment compromise leading to early satiety andmalnourishment. We assess patients who underwent native nephrectomy (NN) for ADPKD to determine indications and outcomes. Methods: A 9-year retrospective review from 1/10/10-1/10/19 identified 33 cases of NN for ADPKD. Retrospective chart review identified patient demographics, indications for surgery, histology, and perioperative details. Results: Average age at NN was 56.1+/-9.3 years. 45.5% (n=15) were male. 42%of patients were renal transplant recipients. The most common indication for NN was symptomatic abdominal compartment compromise in 36.4% (n=12). 24.2% (n=8) of patients underwent NN to create abdominal space prior to renal transplantation, and 6% (n=2) of patients underwent NN at the time of simultaneous liver-kidney transplantation. 15.2% (n=5) underwent NN due to infective pathologies, and 18.2% (n=6) due to a suspicious renal lesion. Two patients who underwent NN for abdominal compartment compromise, underwent subsequent contralateral NN for abdominal compartment compromise. Conclusions: ADPKD is an uncommon genetic disorder that can cause a constellation of conditions for patients. In our series, patients most commonly required surgery to relieve their symptoms from abdominal compartment compromise. Subsequently, it was associated with renal impairment with requirement for renal replacement therapy or transplantation. NN for ADPKD is a challenging procedure that balances the short-termquality of life improvement against the long-term implications of impending renal failure. C-10103 C-10099 10