UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 The Role of Telecommunications for Clinical Review of Patients with Haematuria - A Patient Perspective Jason Kim (1) (1) Queensland Health Introduction and Objectives: Macroscopic and microscopic haematuria is a common urological presenting complaint. Causes can be due to benign and malignant conditions. The investigations of haematuria is routinely completed with a urine cytology, imaging of the upper tracts, followed by cystoscopy for visual examination. In Australia, haematuria is a common presentation, and examination and investigations have put an increased burden on the health service in a tertiary hospital. To improve patient outcomes, patient waitlists and the burden on the public system, a streamlined telephone clinic was created to assess patients then book them for their appropriate procedure - likely a flexible cystoscopy. This study looks at the patient perspectives. Methods: A retrospective survey was completed of patients involved in the haematuria phone clinic. Patients were called or surveyed at time of follow up. Specific outcomes that were monitored included patient satisfaction in consults, wait times, as well as their health literacy and understanding of their condition and further investigations that was required. Results: Over a 3 month period, 94 patients were involved in the haematuria phone clinic. 82 of these patients participated in this study. Results showed that over 80% of patients were happy with the reduced wait time for review. However 28% of patients felt the consult was to brief. More concerning over 15% of patients were unsure why they were getting a cystoscopy. Conclusions: Telecomunication clinics can be used to improve the efficiency within a tertiary surgical system, however clinicians must be cautious to provide adequate care and thorough explanation for best patient outcomes. Predictors of Patient Anxiety during Flexible Cystoscopy: ASingle Tertiary Centre Experience Arsalan Tariq (1) (1) Royal Hobart Hospital, Tasmanian Health Service Introduction andObjectives: It is well documented that a flexible cystoscopy performed under local anaesthetic can provoke anxiety. The objective of this study was to provide a better understanding of the factors which underpin this. Methods: Consecutive patients undergoing flexible cystoscopies at Royal Hobart Hospital were prospectively asked to complete a questionnaire. Flexible cystoscopies were performed using local anaesthetic. Data collection included pre & post cystoscopy anxiety levels on a scale of 1-10 as well as a list of 30 standardized items. Univariate analysis and ANOVA testing were then conducted. Results: 70 males and 35 females (n = 105) completed the questionnaire. Across the cohort there was decrease in anxiety pre to post cystoscopy (3.05 vs. 1.69, p < 0.05). Patients with a gender preference had higher (4.64 vs. 2.81, p < 0.05) scores. Patients with mental health burden had higher scores (4 vs. 2.63, p < 0.05). ANOVAanalysis showed anxiety scores to be highest amongst those aged 40-70. FurtherANOVAshowed indication for cystoscopy, number of previous cystoscopies, education, income and rurality to be insignificant at p = 0.05. The remainder of our univariate analysis showed abuse, substance use, gown use & preference to be insignificant at p = 0.05. Conclusions: From this cohort, overall anxiety burden in cystoscopies remains low, however patients with mental health diagnoses, a gender preference for their urologist and those aged 40-70 are likely to have higher anxiety. Interestingly, our data also reflects that conventional socio-economic determinants including patient gender as well as reasons for and frequency of surveillance don’t significantly affect anxiety. C-10116 C-10114 Intranodal Lymphangio-Embolization as Treatment for Lymphocele after Kidney Transplantation : A Case Report Ee Jean Lim (1) (1) Singapore General Hospital Introduction and Objectives: Symptomatic lymphoceles after renal transplant requiring interventions are reported to be only at 5.6%. (1) Creation of a peritoneal window, frequently performed laparoscopically, is deemed the gold standard for management. However, in recent years, less invasive methods like instillation of various sclerosants have been described. We herin report a case of lymphocele post renal transplant treated with intranodal lymphangio-embolization, with a review of current literature of this uncommon procedure. Methods: Retrospective review of this patients electronic medical records. Results: We present a 43-year-old male with end-stage kidney disease secondary to chronic glomerulonephritis, having been on hemodialysis for seven years. He underwent a deceased donor dual kidney transplant, complicated post-operatively by renal vein thrombosis in one of the grafts resulting in early graft nephrectomy as well as a distal uretero-vesical leak requiring reimplantation. On re-implantation post-operative day 16, he was noted to have persistent high drain output with a normal drain fluid creatinine. Right intranodal lymphangiogram was performed and demonstrated active lymph leak around the transplanted kidney. 33% Glue (NBCA) - Lipodiol infusion was then injected at a rate of 0.2 ml/min intranodally under fluoroscopic guidance. He underwent another repeat embolization 5 days later for residual lymph leak with satisfactory results. Drain output subsequently decreased and was removed. Conclusions: This case suggests that intranodal lymphangiography and embolization may not only be a diagnostic tool but can be considered as an effective, minimally invasive and safe method for treatment of lymphoceles after kidney transplantation. ARare Case of Severe Vaginal Stenosis Causing Bladder Outlet Obstruction in a Post-Menopausal Female Patient Jun Jie Chew (1) (1) Changi General Hospital Introduction and Objectives: Bladder outlet obstruction (BOO) is an uncommon condition in women. In elderly women, genitourinary syndrome of menopause (previously also known as urogenital atrophy, vulvovaginal atrophy or atrophic vaginitis) is a common hypooestrogenic condition that affects close to 50% of postmenopausal women, resulting in a host of lower urinary tract symptoms (LUTS). In this case report, we describe a rare case of BOO in a female patient with severe vaginal stenosis and a retracted urethral meatus onto the anterior vaginal wall. Methods: We present a 69-year-old post-menopausal female patient that presented with LUTS. Results: The patients uroflowmetry voiding graph showed a stricture pattern with reduced peak urinary flow rate of 5 ml/s. Flexible cystoscopy was performed, showing what was initially thought to be a pinhole urethral meatus with a completely obliterated vagina. Serial dilatation via S-dilators was performed. Post-dilatation however, we realised that what was initially thought to be the pinhole urethral meatus was in fact the severely atrophied vaginal opening. The patients urethral meatus remained patent, and was merely retracted onto the anterior vaginal wall. Urine was therefore collected in the vaginal vault during voiding, prior to expulsion from the narrowed vaginal introitus. Vaginal dilatation showed significant improvement in urinary flow rate post-procedure. Conclusions: Genitourinary syndrome of menopause is a common condition. Post-menopausal women presenting with LUTS and/or BOO should be carefully examined for features of vaginal stenosis with a retracted urethral meatus onto the anterior vaginal wall. Dilatation of the vaginal stenosis is a safe and effective treatment option. C-10115 C-10113 12