UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts C-10182 Percutaneous Renal Tumour Biopsy: a 10-Year Review of Complications and Outcomes at Royal Perth Hospital Ivan Thia (1) , Wilson Choi (1) , Emma Marsdin (1) (1) Royal Perth Hospital Introduction andObjectives: Percutaneous biopsy is an accepted diagnostic adjunct for patients with renal tumours that are suspicious for localised renal cancer. It is performed regularly at our institution, and we aim to review the outcomes associated with renal tumour biopsy at Royal Perth Hospital (RPH) over the past 10 years. Methods: A retrospective review was conducted on all image-guided renal biopsies performed between January 2009 to June 2019 by the Radiology Department at RPH. Data was collected on patient demographic, indication for renal biopsy, complication, hospital re-admission, biopsy finding, subsequent surgery or intervention, and final histopathology if surgery was performed. Patients who underwent renal biopsy for worsening renal function or possible transplant rejection were excluded from analysis. Results: 604 renal biopsies were performed over the last 10 years, with 308 (51%) for investigation of a renal mass. 1 patient (0.32%) developed a large retroperitoneal haematoma, and 1 patient (0.32%) developed life-threatening bleeding requiringemergency nephrectomy. Benign tumours were diagnosed in 59 of 308 renal biopsies (19.2%) and malignant tumours were diagnosed in 219 of 308 renal biopsies (71.1%). Normal renal parenchyma was detected in 18 of 308 biopsies (5.8%) and non-diagnostic biopsies occurred in 13 cases (4.2%). Concordance of tumour type between biopsy and surgical specimen was observed in 99 of 111 cases (89.1%). Relationship between concordance and number of biopsy cores and histopathology type was considered. Conclusions: Percutaneous renal tumour biopsy is associated with a low complication rate and a high positive predictive value at our institution. Outcome of Percutaneous Tibial Nerve Stimulation (PTNS) in Overactive Bladder (OAB) : A Prospective Study Ee Jean Lim (1) , Edwin JonathanAslim (1) , Tricia, Li Chuen Kuo (1) , Valerie, Huei Li Gan (1) , Lay Guat Ng (1) (1) Singapore General Hospital Introduction and Objectives: PTNS has been shown to be efficacious in treating overactive bladder (OAB), and is indicated in patients who fail conservative and medical therapy. It remains unclear if the efficacy differs between patients with and without detrusor overactivity (DO) on urodynamics study (UDS).We aim to investigate the outcome of PTNS in OAB patients with and without DO on UDS. Methods: Patients with OAB failing medical therapy were prospectively enrolled, with baseline UDS, bladder diary and validated overactive bladder questionnaire (OAB-q) taken before treatment and at week 13 ,after 12 weekly sessions of PTNS. The patients are dichotomised into 2 groups based on UDS findings: DO and non-DO groups. OAB-q scores were split into 2 domains: symptoms bother (SB) and health related quality of life (HRQL) scores. Results: Atotal of 14 patients completed treatment, of which n = 10 have (DO) and n = 4 do not have DO. In the DO group, there were mean improvements from baseline OAB-q-SB 10 and OAB-q-HRQL 18.5, frequency 1.65 and nocturia 0.73. In the non-DO group, there was no mean improvement from baseline OAB-q-SB at 0, with mean improvements in OAB-q-HRQL at 23, frequency at 3.83 and nocturia 1.08. GRA scores were similar in both groups (2-4), corresponding with no change to minimal improvements in terms of perceived degree of change in bladder symptoms and general health. Conclusions: The objectivemeasurements suggest minimally better response in non-DO group, with better reported improved symptoms in the DO group. Correspondingly, the patients perceived only minimal improvements in bladder symptoms or general health. C-10187 C-10184 The Interesting Case and Management of the ‘Screwed Bladder’ Marcus Chow (1) , Mon Mon Oo (1) , Weida Lau (1) (1) Khoo Teck Puat Hospital Introduction and Objectives: We present a unique case of an iatrogenic extraperitoneal bladder rupture secondary to a loose pelvic fixation screw post internal fixation and anterior pelvic plating. He required repeated bladder repairs and eventually underwent a pedicled right vastus lateralis flap reconstruction of the bladder. Methods: The patient was involved in a road traffic accident and suffered a pelvic open book fracture. Initial trauma CT revealed no bladder injury. He underwent an internal fixation with anterior pelvic plating by Orthopedics. Post-operatively, he had a high pelvic drain output that tested high for creatinine. A CT cystogram revealed an extraperitoneal anterior bladder perforation. He underwent an open bladder repair but needed a 2 further bladder repairs due to the internal pelvic plate screw. Results: He eventually underwent a pedicled right vastus lateralis flap reconstruction of anterior bladder wall injury.1 The pelvic plate was removed by Orthopedics, who agreed to stablise the pelvic fracture with external fixation in view of repeated bladder trauma from the plate. Intra-operatively, the surrounding bladder tissue was scarred; devoid of good muscular layer over the bladder dome. The primary repair was performed by Urology with vicryl 2/0 incorporating a periosteal flap. Plastic Surgery then performed a right vastus medialis flap (10 cm x 8 cm). Post-operative cystogram at 14 days revealed no contrast extravasation. Conclusions: A high index of suspicion for bladder injury post internal fixation of a pelvic fracture is required for early intervention and to prevent subsequent morbidity. The importance of a multi-disciplinary approach to clinical management cannot be underestimated. Optimising Clinical Decision Making in Trial of Void Patients Venetia Hoe (1) , Frances Harley (1) , Sue Wallace (1) , Janice Cheng () (1) Western Health Introduction and Objectives: Acute urinary retention (AUR) is a distressing and common urological presentation. Most cases occur inmales and are linked to benign prostate hyperplasia (BPH). Risk factors for AUR necessitating definitive surgery has been identified as: increased age, severe lower urinary tract symptoms, high postvoid residual, enlarged prostate and elevated serum prostate surface antigen (PSA). We aim to define and determine predictors for trial of void (TOV) failure, such that futile TOV attempts may be avoided and patients expedited towards early definitive care. Methods: All patients who underwent a TOV at our public hospital between April 2017 and September 2017 were included in our analysis. Univariate analysis was performed to determine predictors for TOV failure. Results: 210 TOV episodes involving 169 patients were identified. Median age was 71. The male to female ratio was 94:6%. Painless retention (p = 0.041), retention volume > 700 ml (p = 0.043), and history of urethral stricture disease (p = 0.038) were found to be risk factors for failing TOV.A lpha-blocker use in men, prostate size, history of neurological disease, history of diabetes mellitus, history of urinary tract infection and history of opioid use, were not independent predictors for failing TOV in our cohort. Conclusions: The success rate of TOV was 57.3%, largely comparable with international literature. Three main predictors of failure were identified in our cohort: painless urinary retention, retention volume > 700 ml and history of urethral stricture disease. This has assisted us in formulating TOV guidelines such that patients who are determined at high risk of TOV failure may be expedited towards early definitive care. C-10180 19