UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 Clinical Outcome of Localised Prostate Cancer Treated with Low-Dose- Rate Brachytherapy Thomas Chan (1) (1) Singapore General Hospital Introduction and Objectives: Low-dose-rate brachytherapy (LDR-BT) is an established treatment for low- to intermediate-risk localised prostate cancer. In the Southeast Asian region, LDR-BT represents a safe and valuable option for patients whose access to alternative modalities is limited. Methods: We retrospectively identified 105 patientswith low- to intermediate- risk localised prostate cancer treatedwith LDR-BT using 125-Iodine implanted seeds between July 2006 and March 2017 with at least a 2-year follow-up. Biochemical recurrence was defined by the American Society for Radiation Oncology Phoenix Criteria. Results: Our cohort comprised of 105 men with a median age of 65 (40-81) years and follow-up of 8.3 (2.2-13.2) years. Very low-, Low-, intermediate favourable- and intermediate unfavourable-risk disease represented 2.9%, 58.1%, 29.5%, and 9.5%, respectively (NCCN risk stratification). Forty-four (41.9%) patients received androgen-deprivation therapy before LDR-BT for prostate volume reduction. At the time of analysis, 97 (92.3%) patients were alive. One patient developed local recurrence after 6 years. Seven (6.7%) patients developed biochemical recurrence, 2 (1.9%) died from metastatic disease. Four (3.8%) patients had haematuria required hospitalisation. Six (5.7%) patients developed urethral stricture, half required surgical intervention. Six (5.7%) patients reported urinary incontinence. Nocturia ≥2 times per night were reported by 24.8% of patients. Eleven (10.5%) patients experienced new onset of erectile dysfunction, 4 (3.8%) maintained on phosphodiesterase inhibitors. Conclusions: Our results suggest that LDR-BT provides excellent oncological and functional outcomes and it should be considered for a selected group of patients in our region. C-10189 Allograft Nephrectomy - A Retrospective Review of Indications and Surgical Outcomes: Single Institution, 18 Years Experience Vincent Khor (1) , Valerie Gan (1) , Edwin Jonathan Aslim (1) (1) Singapore General Hospital Introduction and Objectives: Allograft nephrectomy (AN) is associated with significant morbidity and mortality. This study was conducted to review the indication and surgical outcomes of AN performed at Singapore General Hospital. Methods: Medical records of patients who underwent AN at our institution, between January 2000 and December 2018, were retrospectively reviewed, regardless of the institutionwhere the initial transplantations were performed. Patients were classified into 3 groups according to the timing of AN from their transplant: very early (within 30 days), early (within 1-12 months) and late (after 12 months). Descriptive statistics was used for this study. Statistical analysis performed using Fisher’s exact test and ANOVA test for categorical and continuous variables respectively. Results: 92 cases were identified within the study period. 2 cases were excluded due to incomplete data. The incidence of AN was 9.3%. Overall, the common indications for AN were graft infections (33%), persistent gross haematuria (24%) and renal infarcts (15%). Post-operative mortality rate was 4.4% (4/90) and major morbidity rate was 22.2% (20/90). The most common minor and major complications were blood transfusion and surgical site infection respectively. There was higher rate of perioperative blood transfusion in the late AN group (p = 0.025) and in patients who had subcapsular nephrectomy (as compared to extracapsular). Patients who underwent late AN had shorter survival after surgery as compared to the other two groups (p < 0.001). Conclusions: Majority of ANwere performed late at our institution. Patients who underwent lateANhad higher risk of complications and shorter survival after surgery. C-10191 C-10190 Is There a Role for Minimally Invasive Pyeloplasty in Children Less Than 20 kg? Sundaram Palaniappan (1) , Arvind Ganpule (1) , Abhishek Singh (1) , Ravindra Sabnis (1) , Mahesh Desai (1) (1) Muljibhai Patel Urological Hospital Introduction and Objectives: To assess if there is a difference in outcomes between open, laparoscopic and robotic pyeloplasty in children under 20 kg. Methods: A retrospective analysis of all pyeloplasties done for children of weight under 20 kg was carried out. Indwelling stents were the standard of care. However, in smaller children, a ureteric catheter was placed as splint. Patient demographics, duration of surgery, length of hospital stay, postoperative complications and re-intervention rates were collected. Success was defined as resolution of symptoms or absence of hydronephrosis during the follow-up Results: Atotal of 157 pyeloplasties was performed in children with a weight less than 20 kg between 2006 and 2018. Half of them were open pyeloplasty (OP, n = 78) procedures while laparoscopic pyeloplasty (LP, n = 52) and robotic pyeloplasty (RP, n = 27) made up the other half. Over the mean follow-up of 16.3 months, the success rates were comparable (98.7% vs. 96.2% vs. 96.3%) in the OP, LP and RP groups respectively. Mean operative time was significantly longer by 35 mins in both LP and RP groups when comparing with OP. Hospitalisation was significantly shorter in the minimally invasive groups (4 days) compared to the OP group (7days). Postoperative complications were not significantly different. Conclusions: In our series, LP and RP had equivalent outcomes to OP with a shorter hospital stay. The minimally invasive approach in children less than 20 kg of weight should be reserved to centres with expertise as the benefit is currently small. Open pyeloplasty remains the gold standard in these small children. Surgical Outcomes of Renal CancerwithLevel III-IVVenaCava Thrombosis with or without Pulmonary Embolism: A Single Centre Experience Vincent Khor (1) , Mohd Zainuddin Saiful Azli (2) , Mohd Ghani Khairul Asri (1) , AP Arunasalam (2) , Omar Fahmy (1) (1) Hospital Pengajar Universiti Putra Malaysia, (2) Hospital Serdang, Ministry of Health Malaysia Introduction and Objectives: Approximately 10% of all patients with renal cell carcinoma (RCC) have tumour thrombus in the inferior vena cava (IVC). Aggressive surgical resection is currently recommended for patients with non- metastatic disease. We present our early experience of radical nephrectomy and IVC thrombectomy performed at our centre. Methods: From 2017 to 2019, a cohort of 6 patients underwent open radical nephrectomy and IVC thrombectomy at our centre. The data of these patients were retrospectively reviewed. The level of thrombus was classified according to the Mayo Clinic classification. All patients with level IV thrombus underwent thrombectomy with cardiopulmonary bypass. Surgical complications were classified according to the Clavien-Dindo classification system. Results: Mean age of our patient were 49-years-old (33-63). The average tumour size was 11.1 cm (6-15.5). 3 patients had level III thrombus while the other 3 patients had level IV thrombus which extended into the heart. 2 of the patients with level IV thrombus also had nodal and distant metastasis. Mean operative time was 10 hours (8-12). Perioperative mortality was 33.3% (2/6, both patients had level III non-metastatic disease). Surgical complications among the surviving patients were minor (Clavien I-II). Histopathological examination of all tumours reported clear cell RCC except for one case with Ewing sarcoma. The 2 patients with metastatic disease survived for 3 months and 7 months after surgery. The 2 surviving patients with non-metastatic disease are currently doing well (after post-operative followup for 24 months and 5 months respectively). Conclusions: For patients with non-metastatic disease, radical nephrectomy with IVC thrombectomy offers survival benefits. C-10188 20