UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts Ambulatory Robotic-Assisted Laparoscopic Radical Prostatectomy (RARP) With Extended Recovery Alvin WX Low (1) , Kenneth Chen (1) , Tze K Ng (1) , John SP Yuen (1) (1) Singapore General Hospital Introduction and Objectives: There were three recent negative feasibility studies of ambulatory RARPmainly due to transperitoneal approach-related post-operative ileus. This prospective study aims to evaluate the feasibility of performing RARP in an ambulatory surgery with extended recovery (ASER) setting by total extra-peritoneal (TEP) approach. Methods: From January 2017 to December 2018, thirty patients with low- to intermediate-risk prostate cancer were enrolled in the ASER arm. Forty patients (twenty each by TEP and transperitoneal (TP) approach) who opted for conventional inpatient surgery were recruited as a matched-pair group for comparison of peri- and post-operative outcomes with the ASER group. The objective discharge criteria were based on the post-anesthesia discharge scoring system (PADSS). Results: There were no statistically significant differences between theASER and inpatient groups in patient’s factors (age, Charlson co-morbidity, BMI), disease factors (cT-stage, Gleason grade), and peri-operative parameters. All ASER (30/30) and inpatient-TEP (20/20) patients met the PADDS discharge criteria within 24-hours postoperatively. The mean hospitalization stays were: ASER 20.6 hours, inpatient-TEP 47.8 hours, inpatient-TP 65.6 hours.Almost all (97%, 29 of 30) ASER patients were discharged within 24-hours of admission. The main reason for prolonged hospitalization for the inpatient-TEP group was social while for the inpatient-TP group was post-operative ileus. Conclusions: This study is the first prospective evaluation of ambulatory TEP-RARP which shows that the short-stay approach is safe, feasible and results in cost-saving with just overnight hospital-stay while achieving high patient satisfaction. TEP approach is critical to the success of the ASER protocol as it minimizes post-operative ileus. Real Time Experience of Neoadjuvant Chemotherapy (Gemcitabine + Cisplatin) in Muscle Invasive Urinary Bladder Cancer Sunny Goel (1) , Aditya Pradhan (1) , Yajvender Pratap Singh Rana (1) (1) BLK Super Speciality Hospital. New Delhi Introduction and Objectives: Muscle invasive bladder cancer (MIBC) is rapidly progressive disease with early metastases. Guidelines recommend neoadjuvant chemotherapy with radical cystectomy with urinary diversion to reduce micro-metastases, downgrade tumor burden and increase overall survival. We did a prospective study to evaluate real time trend of neoadjuvant chemotherapy in MIBC in terms of radiological and pathological response, tolerability of regimen and drop-out rates. Methods: This was a prospective observational study, included patients with MIBC aged 18 years, resectable disease at diagnosis, transitional cell carcinoma. We administered 4 cycles of neo-adjuvant chemotherapy (Gemcitabine + Cisplatin) followed by radical cystectomy with urinary diversion. Primary endpoint of the study includes radiological and pathological response. Secondary endpoints include tolerability of the combination using CTCAE criteria, drop-out rates of patients from the regimen in real world scenario. Results: We included 26 patients in our study. Mean age of patients was 53.1 + 11.79 years. There was radiological downgrading (complete + partial) in 47.8%, stable in 47.8% of patients. There was complete pathological response (T0) in 22.2%, pathological downgrading (T0,Ta,T1) in 44.4%. There was very few side effects mostly low grade in patients. There was a drop-out rate of 65% in patients. Conclusions: Although the response rate of neoadjuvant chemotherapy was found to be satisfactory, the drop-out rate from the study was very high. We need to do this study at a larger scale to extrapolate our results. C-10170 C-10162 The Feasibility of Tissue Adhesive for Wound Approximation in Pediatric Circumcision: A Meta-analysis of Randomized Controlled Trial Yufi Aulia Azmi (1) , Niwanda Yogiswara (2) , Johan Renaldo (1) (1) Department of Urology, Soetomo Hospital, Airlangga University School of Medicine, Surabaya, (2) Faculty of Medicine, Airlangga University, Surabaya Introduction andObjectives: Circumcision is one of themost common surgical procedure in men around the world. The wound approximation technique varies from sutures, plastibell to sutureless. Absorbable suture materials have been traditionally used for wound approximation in circumcision. However, the existence of stitch marks and sinuses, and irregularity in skin mucosa border usually occur those cause unsatisfactory cosmesis.Astudy reported that sutureless wound approximation with tissue adhesive has superior cosmetic result. However, the feasibility of tissue adhesive for circumcision in children has not been well established. This study aims to evaluate the feasibility of tissue adhesive for wound approximation in pediatric circumcision. Methods: A systematic search was conducted from the electronic database including PubMed, Clinicaltrial.gov, and Cochrane Library, published up to November 2019 following the PRISMAguideline. We screened RCTs with our inclusion criteria and assessed the quality with the Cochrane Risk of Bias tool. The primary outcomewas the complication and the secondary outcomewas the operation time. The meta-analysis was performed using ReviewManager 5.3. Results: Atotal of 5 RCTs, comprising of 629 children underwent circumcision were analyzed. Pooled analysis showed that compared to the suture group, tissue adhesive had no significant difference in total complication (OR 1.09 95% CI 0.54 to 2.21, p = 0.81), dehiscence, infection, and bleeding. The study showed a significant reduction in operation time (SMD -3.58 95% CI -3.83 to -2.52, p < 0.01), pain severity (SMD -3.58 95% CI -3.83 to -2.52, p < 0.01), and pain duration (MD -0.56 95% CI -0.8 to -0.32, p < 0.01). Conclusions: This study revealed that tissue adhesive has good feasibility in pediatric circumcision wound approximation as demonstrated by similar total complications compared to the suture group. Tissue adhesive is a good alternative and could reduce operation time, pain duration and pain severity in pediatric circumcision. Conservative Management of Methamphetamine Induced Testicular Torsion Mohammed Al-Zubaidi (1) (1) Royal Perth Hospital Introduction and Objectives: A 35-year-old man presented with acute left scrotal pain with ultrasound confirming left epididymitis. However, it incidentally showed a lack of vascularity of the right testicle despite being asymptomatic on the right hemiscrotum. He was known to use intravenous methamphetamine, admitting to his last usage only four hours prior to his presentation. The left epididymitis was treated with intravenous antibiotics, analgesia and scrotal support, while right testicle was treated conservatively with serial ultrasound under the impression of methamphetamine induced vasoconstriction rather than torsion. The return of normal vascularity of the right testicle was confirmed with ultrasound twenty hours later, confirming the former. The patient was discharged home three days later, upon clinical improvement, with a prescription of oral antibiotics for two weeks. No surgical intervention was required. The objectives are to confirm that methamphetamine can cause testicular ischemia, then to prove that the latter can be managed conservatively. Methods: We managed this young man conservatively by monitoring, serial examinations and ultrasounds to confirm resolution of ischemia. Results: The testis returned viable with normal vasculature upon repeating the ultrasound twenty hours later. Conclusions: Methamphetamine induced testicular ischemia can bemanaged conservatively without the need for surgical scrotal exploration. C-10164 C-10152 17