UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 Pathological Concordance Between Biopsy and Radical Prostatectomy in the Era of MRI-US Fusion Targeted and Saturation Prostate Biopsy Alvin Lee (1) (1) Singapore General Hospital Introduction and Objectives: MRI-targeted biopsy has been shown to increase the pathological concordance between prostate biopsy and radical prostatectomy (RP). We aimed to determine the rates of pathological upgrading betweenMRI-US fusion transperineal prostate biopsy (saturation and targeted) and RP. Methods: This ethics board approved prospective study included consecutive men with any suspicious lesion on mpMRI who underwent both saturation and MRI-US fusion targeted biopsy using our transperineal robot-assisted prostate biopsy platform between January 2015-January 2019. The gleason grade group at saturation and targeted biopsy was compared to that at RP to determine the rates of pathological upgrading. Results: 248 out of 433 men (57%) had prostate cancer detected on biopsy, out of which 117men (47%) underwent RP. Combined saturation and targeted biopsy had the lowest rate of pathological upgrading at RP compared to saturation biopsy and targeted biopsy alone (20% vs. 38%, p < 0.001 and 20% vs. 34%, p < 0.001 respectively). There were no differences in the pathological upgrading rates between saturation and targeted biopsy (38% vs. 34%, p = 0.627). Age, BMI, PSAdensity and previous biopsy status were not predictors for pathological upgrading. Men with PIRADS 3 were more likely to have pathological upgrading if only targeted biopsy was performed (OR = 16.1, 95%CI: 1.9-136.3, p = 0.011). Conclusions: Combined biopsy provided the lowest rates of pathological upgrading on radical prostatectomy and there were no differences in pathological upgrading between saturation and targeted biopsy. Lower PIRADS score was predictive of a higher rate of pathological upgrading if only targeted biopsy was performed. C-10123 Enhanced Expression of mRNAPDL-2 inMuscle Invasive Bladder Cancer: a Unique Model to Understand Cancer Immunity Said Alfin Khalilullah (1) (1) Division of Urology, Department of Surgery, Fakultas Kedokteran Universitas Gadjah Mada, Indonesia Introduction and Objectives: Programmed death ligand 2 (PDL-2) play an important role in the induction of immune tolerance in the tumor microenvironment. The aim of this study is to examine the mRNA PDL-2 expression in bladder cancer. Methods: mRNAPDL-2 expression was real-time polymerase chain reaction (RT-PCR) detected in paraffin-embedded specimens of primary tumors from thirty patients with bladder cancer. The sample is divided into two groups, muscle invasive and non-muscle invasive based on histopathological status. The mean differences between the two groups were analyzed using Mann- Whitney test. Results: Our data showed that mean patient age was 59.2 years with male more common than female. Mean range of mRNA PDL-2 expression was higher in the muscle invasive group, with 21,7. Non parametric analysis usingMann-Whitney test proves that there is a significant difference between mRNA PDL-2 expression in both groups (P = 0.000). Conclusions: We conclude that, these results indicated mRNA PDL-2 expression inmuscle invasive bladder cancer was increased significantly and may be the basis to understand the cancer immunity and also to development of anticancer immunotherapy of PDL-2 blockade. C-10126 C-10124 Acquired Phimosis as an Indicator of Diabetes Mellitus Chloe Ong (1) (1) Ng Teng Fong General Hospital Introduction and Objectives: Diabetes mellitus (DM) results in recurrent genitourinary infections and phimosis, and early identification would allow more effective treatment to prevent disease progression. The aim of this study is to assess the prevalence of DM in patients with acquired phimosis, and secondarily to compare the outcomes of conventional versus laser circumcision. Methods: EPIC was used to generate a list of circumcisions done by Ng Teng Fong General Hospital urologists from 1 January 2018 to 31 December 2018, excluding those with concurrent procedures done in the same session. Information including patient demographics, indication for circumcision, DM status, duration of procedure, and post-operative complications, was collected and analysed using Microsoft Excel statistics tool. Results: 82 patients were included; the mean age was 33.7 years (SD 15.3). 61%of circumcisions were done for phimosis, while other indications included recurrent infections and religious reasons. Among those with acquired phimosis, 83.3% had DM, 1 had impaired fasting glucose (IFG), and 1 did not have DM. In the group with congenital phimosis, 97.4% did not have DM, while only 1 had IFG. The mean operative time was 30.6 minutes (SD 6.1) for conventional circumcision and 21.1 minutes (SD 4.9) for laser circumcision. The rate of post-operative complications for conventional circumcisions was 6.1%, and 2% for laser circumcisions. Conclusions: There is a high prevalence of DM in patients with acquired phimosis, hence such patients should be routinely screened for DM for earlier detection and treatment of disease. Secondly, laser circumcisions are shorter operations, and at least as safe as conventional circumcisions. The Role of Streamlining Patients for Clinic Review - Howwill this Affect our System and our Patients? Jason Kim (1) (1) Queensland Health Introduction and Objectives: Acurrent problem in departments of Urology has been the increase in the burden of disease. With increased number of referrals for early and urgent reviews, public hospital stakeholders have found difficulty in satisfying the increased demand and providing timely medical care. Management of ureteric calculi is a common urological presentation that requires review of imaging and decision for intervention. At Gold Coast University Hospital these patients were waiting for loner than the recommended 6 weeks to intervention. A stones protocol was created and patients were streamlined to a clinic only for assessment of stones. The attempt was to improve patient outcomes and lessen burden on hospital resources. Methods: Apreliminary Stones Protocol was created at GoldCoast University Hospital. Patients would be called by a urology registrar 2 weeks after ED presentation, then liaised with the booking and radiology departments to create timely outpatient bookings with a scan. Outcomes that were monitored included wait times for category 1 waitlists, as well as subjective outcomes to determine patient and staff views within the hospital. Results: Over 3 months, the streamlined stones protocol clinic created a huge improvement in wait times of category 1 patients in urology (graph 1.) thus leading to improved patients care. Subjectively staff found it easier to run a streamlined clinic, as tasks were easier to follow when a team were focussed on one goal. Conclusions: Over a short period, the streamlined protocol at decreased wait times significantly and increased the likelihood of patients receiving more appropriately timed care. C-10121 14