UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 C-10200 Impact of 5-Alpha Reductase Inhibitors on Prostate Health Index Daanesh Huned (1) , Yew Lam Chong (1) , Daniel Yong (1) (1) Tan Tock Seng Hospital Introduction and Objectives: 5-alpha reductase inhibitors (5-ARIs) will decrease prostate serumantigen (PSA) levels by roughly 50%within 6months. Studies suggest smaller reductions are associated with prostate cancer (PCa). The Prostate Health Index (PHI) has been shown to be useful in predicting PCa at initial biopsy. While PHI-testing is not recommended for patients on 5-ARIs, we aim to explore the effect on PHI and whether it may be used as a tool for PCa detection in the subset of patients on these medications. Methods: We retrospectively reviewed patients who had PHI tested between 2017 and 2019. Patient on 5-ARIs were identified and the diagnostic performance of PHI was assessed. Results: We identified 16 patients with a mean age and PSA of 69.8 years and 9.0 ng/mL respectively. N = 1 had biopsy-proven (Gleason3+3) PCa with a PHI of 24. N =3 had PHI tested before and after 5-ARI. At a mean of 12 months, both PSAand PHI were reduced (mean PSA:6.75 ng/mL (pre) vs. 3. 8 ng/mL (post), mean PHI:27 (pre) vs.17 (post)), p > 0.05. Overall a mean PSA reduction of 60.4% (p < 0.05) occurred after 22 months (mean) of 5-ARIs. This was associated with low (n = 10) to moderate (n = 6) risk PHI only. This was supported by MRI (PIRADS ≤ 3) in n = 7 and n = 8 with negative biopsies. Conclusions: Our data is limited as none of our patients had high risk PCa. While we cannot conclude that PHI can predict PCa despite 5-ARI, we can see it remains low to moderate in the context of 5-ARI associated PSAreductions typical of benign pathology. This may be extrapolated to consider that PCA is unlikely if PHI less than 40 (despite 5-ARI). Laparoscopic Adjustment and Insertion of Peritoneal Dialysis Catheters: A Single Institution Experience Jeffrey Leow (1) , Yee Mun Lee (1) (1) Tan Tock Seng Hospital Introduction and Objectives: Peritoneal dialysis (PD) as a means of renal replacement therapy is cost-effective, and has inherent advantages over haemodialysis. At our institution, peritoneoscopic insertion of PD catheters is routinely done by interventional nephrologists since 2012. Patients with non-functioning PD catheters or previous abdominal surgery are referred to urologists for laparoscopic adjustment or insertion. Methods: We retrospectively identified all laparoscopic adjustment and insertion of PD catheters between 2008 and 2019. Diagnostic laparoscopy was performed to identify the reason for malfunction. Using 2 working 5-mm ports, we routinely performed the following: (a) omentopexy with haemoloc clips to avoid future omental wrapping; (b) clearance of any intraluminal blockages to ensure patency; and (c) suture fixation of the PD catheter to prevent catheter migration. Perioperative outcomes and PD catheter survival rates were evaluated. Results: A total of 76 laparoscopic cases were identified - 26 (34.2%) were insertions, and 50 (65.8%) were adjustments. With a median follow-up period of 344.5 days (inter-quartile range [IQR] 160.5 to 671.5), the 1-month and 3-month PD catheter survival rates were 97.4% (n = 74) and 84.2% (n = 64) respectively. Overall, the median PD catheter survival duration was 344.5 days (IQR 160.5 to 671.5). Median operative time was 96.5 minutes (IQR 76 to 113.5). Mean length of stay was 1.57 days (± 1.27). Conclusions: Laparoscopic adjustment and insertion of peritoneal dialysis catheters had good short- and long-term functional outcomes with low perioperative morbidity. It is an excellent option to improve patients’ quality of life by delaying or avoiding the use of haemodialysis. C-10202 C-10201 Mammary Type Myofibroblastoma in Concurrent Bladder Tumour Yong Ai Roxanne Teo (1) , Yuyi Yeow (1) , Nathaniel Heah (1) (1) Tan Tock Seng Hospital Introduction and Objectives: Mammary-type myofibroblastoma (MTMF) is a rare benign mesenchymal neoplasm histologically identical to myofibroblastoma of the breast. We present a case of a 67-year-old male with MTMF with concurrent bladder carcinoma. Methods: A 67-year-old male presented to our department with painless gross haematuria. CT-urogram revealed a bladder tumour and incidental left inguinoscrotal lesion. MRI pelvis was performed to further delineate it and imaging characteristics were worrisome for liposarcoma. The mass was excised and histology findings was that of MTMF. Results: There have only been 153 cases of MTMFs reported thus far, and they are most commonly found in the inguinal region, with a predilection for middle-aged males. Most present with a slow growing painless mass, and surgical resection is curative. There is no significant risk of recurrence or metastases even with positive margins. There are no imaging characteristics specific to MTMFs, making it difficult to distinguish them solely on imaging. Atypical lipomatous tumour/ well-differentiated liposarcoma (ALT/WDT) can appear as a predominantly fatty mass with areas of non-fatty tissue that enhances following contrast administration, which is similar to our case of MTMF.Although rare, inguinal metastasis frombladder carcinoma could have been a possible differential as well. This poses a diagnostic conundrumwhich may result in a change in treatment approaches. Biopsy may be considered in the management of these patients to avoid aggressive resection given MTMFs’ benign nature. Conclusions: MTMF is rare but should be considered as a differential even in the context of co-existing tumour, as recognition can avoid excessively aggressive management. Drinking Mineral Water for Prevention of Calcium Oxalate Stones - A Prospective Randomized Controlled Study in An Asian Cohort Yadong Lu (2) , Palaniappan Sundaram (2) , HuiHua Li (2) , Natalia Liem (1) , Tsung Wen Chong (2) (1) Cancer Science Institute of Singapore, (2) Singapore General Hospital Introduction and Objectives: We compared the effect of taking bicarbonate rich mineral water with tap water in patients with known CaOx stones. Methods: This was a prospective RCT comparing the effects of a bicarbonate rich mineral water versus tap water on urine biochemistry in patients with proven CaOx stones. The mineral water group were instructed to consume at least 1.25L of mineral water per day at meal times, supplemented by other fluid intake up to 2.5L/day. Control group consumed tap water up to 2.5L/ day. 24h urine analyses were performed at baseline, 1, 4, and 8 weeks after starting protocol. Results: 58 patients were recruited for the study (27 randomized to the mineral water group and 24 to the tap water group). 7 patients dropped out. Baseline data and 24h urine analyses were comparable between the 2 groups. Over the course of 8 weeks, compared to patients drinking tap water, those drinking mineral water had overall higher urinary levels of Mg (difference = 1.869 mmol/day, 95% CI = (1.360, 2.378)), Cit (difference = 0.588 mmol/ day, 95% CI = (0.168, 1.007)), sodium (difference = 36.477 mmol/day, 95% CI = (16.9, 56.055)), calcium (difference = 1.080 mmol/day, 95% CI = (0.317, 1.842)) and pH (difference = 0.509, 95% C I= (0.317, 0.701)). There were no statistical difference in urinary Ox and Tiselius index between the 2 groups. Conclusions: Drinking bicarbonate richmineral water in CaOx stone formers increased urinary Mg, Cit, sodium and calcium; and alkalinized the urine compared to patients drinking tapwater. There were no significant differences in urinary Ox or Tiselius index. Consumption of bicarbonate rich mineral water may have benefits in urinary stone prevention. C-10198 22