UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 Primary RIRS in Supine Position for a Patient with Limited Mobility (PRISM): A Case Report Wy Keat Tay (1) , Chloe Shu Hui Ong (1) , Sarvajit Biligere (1) , Vineet Gauhar (1) (1) Ng Teng Fong General Hospital Introduction and Objectives: Retrograde intrarenal surgery (RIRS) has now been established as a recommended option for treatment of renal calculi upto 2 cm. The safety and efficacy of this procedure has been well documented and is traditionally performed with patient in lithotomy position. We report our experience and outcomes of PRISM. Methods: An 82y male with a recent history of right subtrochanteric fracture on conservative management and a stiff left lower leg due to contracture from previous stroke, presented with recurrent UTI and sepsis due to a 1.6 cm left renal stone on CT scan. Arigid cystoscopy, RPG, left RIRS and ureteric stenting with UAS and Lithovue was performed in a complete supine, split leg “French” position. Results: No difficulty was encountered during each of the steps of RIRS. Maneuvering of the flexible ureteroscope was carried out effortlessly andwas similar to a traditional RIRS. Therewere no issues with vision and drainage via UAS. Stone fragmentation was effectively achieved post op CT KUB showed clinically insignificant residual fragments needing no intervention. Post op recovery was uneventful and DJ stent was removed on POD 6. Conclusions: This single case had a primary retrograde flexible ureteroscopy in complete supine position safely with the same effective outcomes. With this case we have proceeded to do more than 10 more cases and find this to be an easier alternative. Its attractiveness in elderly/ patients with flexion deformity/limb contracture or as part of combined bilaterally single side percutaneous procedure make it a feasible treatment option in the modern era of practice. C-10179 Review of Bacillus Calmette-Guerin Tolerability and Complications of Intravesical Therapy for NMIBC Over a 4 Year Period Venetia Hoe (1) , Mariolyn Raj (1) , Sue Wallace (1) , Frances Harley (1) (1) Western Health Introduction and Objectives: Intravesical bacillus Calmette-Guerin (BCG) has proven efficacy for prevention of recurrence and progression of NMIBC. There is limited data on it’s practical tolerability in an Australian patient cohort. We aim to assess the tolerability of BCG treatment and describe common complications experienced by patients treated at an experienced high volume centre in metropolitan Melbourne. Methods: From a prospectively collected database, we retrospectively analysed 114 patients treated with intravesical BCG during a 4 year period, with a minimum follow up of 12 months after the last instillation. Patients received induction and/or maintenance BCG regimens. Data collected included patient demographics, history of immunosuppression, history of prior treated TB, BCG regimen and number of instillations, as well as complications encountered. Results: 114 patients were identified. In total, 10 patients (8.8% of the cohort) were unable to complete their planned BCG treatment due to intolerance of side effects. The most common complications reported were LUTS (73.7%), haematuria (50.0%), fatigue (37.7%), suprapubic discomfort (36.0%), and recurrent UTI (21.1%). Systemic low-grade fevers were reported in up to 19.3%, with one patient (0.9%) experiencing BCG sepsis, which was successfully treated. Other complications less commonly reported in our population included penile pain/genital irritation, myalgias, nausea, flu like symptoms, rash, urinary retention, prostatitis and orchitis/epididymitis. Conclusions: 91.2% of patients tolerated their BCG treatment – 84.8% induction and 96.3% induction and maintenance. In 2.6%, treatment were discontinued at the patients’ request. The rates of tolerability in our institution is higher when compared to international literature. C-10177 C-10178 Cross Table Bulls Eye Puncture Technique in Supine Percutaneous Nephrolithotomy Helps in Identification of Posterior Calyx for Puncture Wy Keat Tay (1) , Sarvajit Biligere (1) , Pradeep Durai (1) , Chin Tiong Heng (1) (1) Ng Teng Fong General Hospital Introduction and Objectives: Based on anatomical studies by Sampaio et al, the ideal calyceal access is via the posterior calyx. Supine percutaneous nephrolithotomy (PCNL) presents challenges in terms of puncture technique, due to the limited window for puncture and lateral approach. Using the x-ray triangulation technique for puncture adds a concern that the anterior calyx is erroneously targeted. In this paper, we demonstrate that the cross-table bulls- eye puncture technique allows easy differentiation of the anterior and posterior calyces, with a more intuitive and reliable puncture of the planned calyx. Methods: Atourinstitution,patientsundergosupinePCNLwhichisperformed with the patient slightly rotatedwith gel pads appliedunderneath the ipsilateral rib cage and pelvis. After retrograde placement of ureteric catheter, calyceal puncture is done using cross-table bulls eye technique with the aid of C-arm fluoroscopy, usuallywithout breath hold. Subsequent guide wire and dilatation proceeds as usual, with the C-am in the normal, anteroposterior position. Results: For most urologists, the bullseye technique is more intuitive and easier to learn than the triangulation technique. Ultrasound guided puncture remains challenging to most urologists. Distinguishing anterior from the posterior calyx can also be challenging in prone position. Supine approach allows a lateral horizontal view of the pelvicalyceal system during cross-table fluoroscopy. This creates awider angle between anterior and posterior calyces. Gel pads also allow slight rotation of the kidney, which would further assist in differentiating the anterior and posterior calyx. X-ray images will be presented to illustrate accurate targeting of the planned posterior calyx, puncture and subsequent wiring, dilatation and sheath placement. Conclusions: From our experience with supine PCNL, we found that the posterior calyx could be easily differentiated from the anterior calyx during cross-table fluoroscopy, allowing easy and favourable puncture of the posterior calyx. This allowed optimal access to the renal collecting system resulting in less bleeding and better visualization and as a result more reliable stone fragmentation and clearance. The Perils of Penile Enhancement - A Case of Fulminant Penile Infection Ankur Dhar (1) , Nicole Khor (1) , Alistair Cameron-Strange (1) (1) Prince of Wales Hospital, Sydney, NSW, Australia Introduction and Objectives: Penile enhancement with injectable agents is a rising trend and yet has little scientific attention. We report a case of multi- organ failure from an infection in setting of penile fillers. Methods: 31-year-old man presented two days after unprotected sexual intercoursewith progressive pain and swelling of the penile shaft. Twomonths prior, the patient underwent subcutaneous hyaluronic filler injections for penile enlargement. Risk factors included self-administration of Prednisone 50 mg and regular testosterone injections, multiple sexual partners, heavy alcohol consumption, and previous tubularised hypospadias repair. Physical examination (HR 127, BP 90/50, temperature 40ºC) revealed gross oedema and erythema stopping at base of penis with small abrasion near glans. Results: Overnight patient was transferred to ICU due to hypotension and anuria. Repeat examination showed blistering of the penis over filler injection sites. Operative penile exploration revealed multiple pus stained fluid-filled fillers, which grew streptococcus pyogenes. He improved with intravenous antibiotics and was stepped down from ICU on day 4 and discharged on day 8 to complete total of 3 weeks of antibiotics. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, corresponding to the location of blistering, with healthy granulation tissue at the base. Three months post presentation he reports normal sexual and urinary function. Conclusions: The severity of the case is due to combination of behavioural factors, presence of foreign material and previous penile surgery. The case highlights the importance of evaluating social risk-factors and need for further research into complications of penile augmentation. C-10174 18