UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts AReview of MRI Prostate Findings in a Tertiary Australian Hospital - Are we Using them Appropriately? Jason Kim (1) (1) Queensland Health Introduction and Objectives: Prostate cancer remains one of the more common malignancies in men in Australia and worldwide. In investigation of prostate cancer, a PSA blood test is followed by a physical examination. If there is any concern the next step is for an MRI prostate scan, followed by a transrectal ultrasound (TRUS) guided prostate biopsy. MRI scans have become more readily available with increased fundings. The question is whether MRIs are being over or under utilised in diagnosis of prostate cancer. This study looks at its use over a 12 month period in a tertiary hospital. Methods: A retrospective study was completed over a 12 month period in 2017. All MRI’s completed were reviewed, variables including family history, rectal examination, PSA and histology were recorded. Further statistical analysis was completed to review indication and findings. Results: A total of 318 MRI scans were undertaken at Gold Coast University hospital. 268 were completed for the diagnosis of prostate cancer. 191 went on to have a TRUS biopsy. 34.7% and 12.7%were scored PIRADS 4 and 5 lesions, and over 90% of these patients went to have a biopsy, resulting in 46.2% and 85.3% clinically significant prostate cancer diagnosis. Approximately 20% had non conclusive lesions, resulting in only 1 significant prostate cancer. An association with other risk factors was made in this study. Conclusions: The study concludes that MRI scans are being used appropriately in diagnosing prostate cancer. As a tool to assist in histological diagnosis, and a tool to assist in minimising invasive biopsies in patients. C-10118 Spontaneous Peri-Renal Haemorrhage of Renal Origin (Wunderlich Syndrome): Analysis of 5 Cases Ang Zhou (1) (1) Khoo Teck Puat Hospital Introduction and Objectives: Wunderlich syndrome is a rare condition where spontaneous non-traumatic haemorrhage occurs in the subcapsular and peri-renal spaces. It is classically characterized by Lenk’s triad: acute flank pain, flank mass, and hypovolemic shock. We report our experience in its surgical management. Methods: We performed a retrospective reviewof all patients who underwent emergency open nephrectomy at our institution from 2015 to 2019. Clinical variables (age, co-morbidities, presenting symptoms), radiological and histopathological results were reviewed. Results: We identified 5 patients (2 males and 3 females) aged between 35 to 68 (mean: 57.4) who presented with Wunderlich syndrome and were diagnosed on computed tomography scan with peri-renal haemorrhage. Significant co-morbidities included hypertension and diabetes mellitus (n=3), end-stage renal disease (n=2), and atrial fibrillation (n=1). Mean haemoglobin level on presentation was 9.96. One patient underwent immediate emergency nephrectomy. Four patients underwent immediate emergency angioembolisation which was initially successful, however 3 patients either became hypotensive or had downtrending haemoglobin levels and required emergency open nephrectomy. The last patient remained haemodynamically stable and underwent an interval elective radical nephrectomy subsequently 3 months later. Mean operative time was 168 minutes with a mean estimated blood loss of 470 mls. Mean hospitalisation stay was 14.8 days. Final histopathology revealed 2 renal cell carcinoma (both clear cell subtype), 1 angiomyolipoma, 1 ruptured renal cortical cyst and 1 perinephric abscess with secondary haemorrhage. Conclusions: While Wunderlich syndrome may be initially managed with angioembolisation, our experience has shown that most patients require surgical extirpation eventually, which can be safely performed with good peri-operative and functional outcomes. C-10120 C-10119 Is There a Role of Improving and Ongoing Education in our Workplace? - The Learning Curve of Guidewire Assisted Urethral Catheter Insertions Jason Kim (1) (1) Queensland Health Introduction andObjectives: The insertion of an indwelling urethral catheter is a vital skill which is taught in medical school in Australia and around the world. However due to decreased exposure, the skill of inserting a catheter is becoming more and more problematic, requiring specialty assistance. A safe technique which has been identified in previous studies to insert difficult catheters includes guidewire assisted insertions. This skill is not routinely taught or educated to other specialties, creating increased frustration and diminished patient care. This study pursued the role of ongoing inter departmental education, and analysed the learning curve required to confidently insert a urethral catheter. Methods: Education was provided with demonstrations on inserting a guidewire assisted urethral catheter, these were provided for those in other surgical specialties, critical care and emergency department. Post education after a trial period, a survey was conducted to determine whether other physicians felt comfortable using this technique to insert a catheter. Other variables including knowledge of anatomy, and concerns were also recorded. Results: Members of staff at a tertiaryAustralian hospital volunteered for the education. 74% of staff were muchmore confident in inserting a catheter post education, more importantly they felt that they could provide care to patients more efficiently. 60% were surprised at the technical ease of the guidewire. Conclusions: Ongoing education is critical in improving patient care in surgery. Urology is a subspecialty but simple skills can be translated to other members of staff. The methods of education is also a critical aspect of the learning curve. Pre-Stenting for Infected, Obstructed Kidney Secondary to Urinary Tract Calculi and the Risk of Urosepsis Post Ureteroscopy. Pravin Viswambaram (1) (1) Fiona Stanley Hospital Introduction and Objectives: The infected, obstructed kidney secondary to a ureteric calculus requires urgent decompression, most commonly with a ureteric stent. Studies have shown that pre-stenting increases the risk of urosepsis post-definitive stone treatment with ureteroscopy. Furthermore, a longer stent dwell time and prior stenting for sepsis have been associated with an increased risk of post-operative urosepsis. Our objective was to evaluate our rates of post-ureteroscopy urosepsis in patients who have been pre-stented for infected, obstructed kidneys secondary to urinary tract calculi. Methods: A retrospective study of patients who had ureteric stents placed for infected, obstructing urinary tract stones at a single Western Australian centre from 2017-2019 was performed. Data was collected from digital medical records and patient information was de-identified. The primary study endpoint was sepsis within 48 hours of ureteroscopy for definitive treatment of urinary tract stones while the secondary endpoint was sepsis within 10 days of ureteroscopy. Standard methods were used for analysis. Results: Between July 2017 and June 2019, 126 patients underwent ureteric stent insertion for infected, obstructed kidneys secondary to renal tract stones. 37 patients were lost to follow-up. 3 patients developed post-operative sepsis within 48 hours following definitive treatment of their urinary tract stone while 4 patients developed post-operative sepsis within 10 days after definitive treatment. Median stent dwell time in those who developed post-op sepsis within 48 hours was 78 days compared to 36 days in those who did not develop sepsis post definitive ureteroscopy. Conclusions: Longer stent dwell time was associated with higher rates of post-operative sepsis. C-10117 13