UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 C-10209 Microcystic Stromal Tumour of Testes – An Extremely Rare Entity of Testicular Tumours and Its Impact on Subfertility Chia Jun Yang (1) , Irfan Sagir Khan (1) , Gregory Xiang Wen Pek (1) , Mervin Nathan Lim Han Hui (1) , Chua Wei Jin (1) (1) National University Hospital Introduction and Objectives: Microcystic stromal tumour (MCST) is a rare subset of stromal tumours which can be found in the ovaries. To date, there has only been a single case of testicular MCST published internationally. We present a case of MCST found in the testes with features of subfertility. Methods: Mr T is a 36-year-old man who presented with painless left testicular swelling. Ultrasound scrotum showed a left 4.8 cm well defined, solid intra-testicular mass of mixed echogenicity and disorganized vascularity. He had raised lactate dehydrogenase (LDH) of 612 units/L but alpha- fetoprotein (AFP) and beta human chorionic gonadotropin (bHCG) were otherwise normal. He was counseled for sperm banking and semen analysis revealed oligospermia with a sperm concentration of 4.7 million sperms/mL. Mr T underwent left radical orchidectomy. Histopathology showed a 3.7cm stromal tumour with benign features which stained positive for Vimentin, CD10, beta-catenin, cyclin D1 as well as weakly for WT-1, consistent with a microcystic stromal tumour. Interestingly, there was no normal spermatozoa throughout the testis, even in areas without compressive atrophy. Mr T recovered uneventfully. Conclusions: MCST is an extremely rare entity that is rarely found in the testes. We present the first case of testicular MCST with subfertility in a male. We postulate that there is an association between subfertility and MCST, although more studies will be needed to verify this. Genomic Interrogation of Collecting Duct Carcinoma and Potential Targeted Therapies Margaret Mansbridge (1) (1) Princess Alexandra Hospital Introduction and Objectives: Collecting duct carcinoma (CDC) is a rare and aggressive form of renal tumour associated with progressive metastatic disease at diagnosis and thought to be resistant to chemotherapy. There are only a handful of case reports of genomic interrogations performed due to its rarity. We assess whole exome sequencing (WES) results of a sample obtained from a 30-year-old patient with metastatic CDC and compare this with the limited literature. Methods: A 30-year-old patient with a 3 cm hilar tumour was treated with nephrectomy,and subsequent RPLND to remove two metastatic deposits. Soon, the patient developed widespread metastatic disease requiring immunotherapy. A sample collected from the primary tumour was used to perform WES. Results: AXL1 and NF2 somatic mutations were identified with variant allele frequencies of 29.3% and 48.4% respectively. CNV loss in CYP2D6 and SMARCB1were identified. Top canonical pathways generated from these four genes included DNAdamage response, AMPK signaling and glucocorticoid receptor signaling. These genes are linked through molecular pathways associated with TP53. Findings are similar to the limited published data where chromatin remodeling genes are more likely to be mutated in CDC. Somatic mutations in TP53, NF2, AXL3 and CNV loss of CDKN2A/p16 have most typically been published in association with CDC. Conclusions: CDC is a rare renal tumour with limited genomic characterization. Results suggest that there are multiple pathways that may be associated with CDCmechanism. Avariety of agents that may be effective in CDC include mTOR/TK inhibitors, EZH2 inhibitors, retinoic acid receptor agonists, quinidine, and aldose reductase inhibitors. T-10102 T-10078 The Sonic Hedgehog Link; Histopathology and ProteinAnalysis of Stented and Unstented Paired Porcine Ureter Wei Xiang Alvin Low (1) (1) Singapore General Hospital Introduction and Objectives: Pre-stenting of the ureter causes passive ureteric dilatation and better access to the urinary system during subsequent procedures. However, the pathophysiology of ureteral stenting disrupting peristalsis is currently unknown. In this study, we aim to elucidate the mechanistic pathway that leads to the involvement of multiple tissue layers in ureteric dilatation. Methods: Three pigs were stented unilaterally for 14 days and sacrified. Both stented and non-stented ureters were harvested and the degree of luminal dilatation was noted. Histological analysis was performed and the protein expression of transcription factor Gli-1 was assessed via immunohistochemistry. Results: Luminal dilatation occured in both stented and non-stented ureters in Pigs 1 and 2. Pig 3 showed luminal dilatation of the stented ureter with no significant histological changes on the contralateral non-stented ureter. Significantly, the muscularis propria layer of all 3 pigs in both stented and non-stented ureters showed smooth muscle thinning and hyperplasia with increased luminal diameter. Gli-1 proteinwas expressed in the smoothmuscle cells of the muscularis propria in all three pigs. The intensity of staining increased with increasing luminal diameter. These findings were similar in both the stented and non-stented ureters. Conclusions: Ureteral stenting results in dilatation of both stented and contralateral non-stented ureters with histological changes across all layers of the ureter, suggesting a systemic response was induced by the indwelling stents. This study is the first to show that increased luminal dilatation was proportionally correlated to increased Gli-1 protein expression Urolift in National University Hospital, Singapore – An Initial Experience Gregory Xiang Wen Pek (1) , Tsang Woon Chau (1) , Chua Wei Jin (1) (1) National University Hospital Introductions and Objectives: The Urolift® system has been shown to constitute a good therapeutic alternative for patients with symptomatic benign prostatic hyperplasia (BPH). We present our initial experience with this procedure in National University Hospital, Singapore. Methods: 9 patients with BPHunderwent Urolift procedure in our institution between September 2019 and January 2020. Preoperative parameters included prostate volume, evaluation of intravesical prostatic protrusion, uroflowmetry and completion of validated questionnaires including international prostate symptom score (IPSS) and international index of erectile function (IIEF). The number of staples used intraoperatively, length of stay and presence of complications were recorded. We analyzed uroflowmetry, IPSS and IIEF scores at 3 months post-procedure with pre-operative values. Results: The average age of our patients was 68 years. The mean prostate volume was 36.8 cc (range: 21.5-59 cc). All patients underwent general anaesthesia and the mean operative time recorded was 15.6 minutes. The median number of staples inserted were 4. 89% of patients went home on post-operative day 0 or 1. There was 1 patient re-admitted on post-operative day (POD-3) for gross hematuria with clot retention. There were no other reported complications. At the 3 month follow up, there was improvement of both mean IPSS score (19.0 to 9.1) and quality of life score (4.2 to 2.1). Mean max flow rate improved from 11.05 ml/s to 14.02 ml/s. There was no significant change in the IIEF score. Conclusions: Our initial experience with Urolift show promising results with significant symptomatic relief frombothersome urinary symptoms with preservation of sexual function. Longer term results are required. C-10208 24