UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts V-10028 Endoscopic-Assisted Transvesical Laparoscopy: A New Paradigm in Minimally-Invasive Bladder Surgery Yu Guang Tan (1) , Tze Kiat Ng (1) , John SP Yuen (1) (1) Singapore General Hospital Introduction and Objectives: Transurethral endoscopic surgery is limited by its incompatibility in bladder-defect repair that requires suturing. Technical reports of transvesical laparoscopy, employing the conventional three-port triangulation technique, resulted in multiple sizeable defects that predisposed to prolonged urinary extravasation. We present the first two- 5mm-port transvesical technique together with a transurethral resectoscope in performing resection of various bladder pathologies. Methods: A step-by-step of the technique is described: (i) Cystoscopy to identify the position of the bladder pathology in relation to the ureteric orifice. (ii) Insertion of two suprapubic transvesical 5mm self-retentive working ports under direct vision. (iii) Creation of pneumovesicum by exchanging irrigation fluid for CO2 (iv) Bladder pathology is resected by a combination of transvesical laparoscopic and transurethral resectoscopic manoeuvres. (v) Transurethral access provides illumination, visualisation, sutures and specimen passage. (vi) Repair of bladder defect via laparoscopic continuous suturing. Results: Three patients had undergone the described surgery for: (i) diverticulectomy; (ii) excision biopsy of trigonal nodule; and (iii) wide excision of urachal nodule. Mean operating time was 150 minutes (range 110180) with minimal blood loss. Mean hospital staywas 2 days (range 13).All patients had urinary catheterisation for 7 days postoperatively with cystograms showing no urinary extravasation prior to removal. No complications were reported. Conclusions: This is the first description of a 2-port transvesical laparoscopic technique for minimally-invasive bladder surgery, fully utilising the transurethral resectoscope as a natural-orifice access to provide illumination, visualisation, assistance, sutures passage and retrieval of specimen. It represents a safe, innovative and intuitive approach to resection of bladder pathology. Transperineal Aspiration of Prostatic Utricle Cyst Nathaniel H. E. Heah (1) (1) Tan Tock Seng Hospital Introduction and Objectives: Prostatic utricle cysts are a known cause of subfertility. Studies show that aspiration or transurethral deroofing of these cysts can improve semen volume and semen analysis parameters. Traditionally aspirations of utricle cysts are performed via the transrectal route, however the advent of transperineal prostate biopsy has provided the method and equipment to perform such a procedure via the transperineal route. We present a case of transperineal aspiration of a prostatic utricle cyst. Methods Mr LHLis a 33-year-oldmale, who presentedwith haematospermia. He was otherwise asymptomatic, with no symptoms of urinary tract infection. He had normal sexual function, with good erections and normal libido. Likewise, his physical examination was unremarkable, including a normal digital rectal examination. MRI pelvis showed a large 2 x 3 cm midline prostatic cyst, as well as a semen analysis with very low volume and no motility. Results He underwent a transperineal aspiration of his prostatic utricle cyst under local anaesthetic. A transrectal ultrasound was performed to identify the cyst. Subsequently, local anaesthetic was infiltrated to the perineum and the cyst was targeted and aspirated with a large bore (18G) needle via the transperineal needle guide until completely collapsed. He had no adverse events following the procedure. Conclusions: To our knowledge, this is the first demonstration of transperineal aspiration of a prostatic utricle cyst under local anaesthetic. Transperineal aspiration of prostatic utricle cyst is feasible and further studies should be conducted to determine its advantages over traditional transrectal aspiration. V-10048 V-10029 ‘Needle in the Haystack’: CombinationMRI-Fusion and Saturation Biopsy- Guided Focal Cryotherapy for Prostate Cancer Yu Guang Tan (1) , Alvin WX Low (1) , John SP Yuen (1) , Weber KO Lau (1) , Lui Shiong Lee (1) , Christopher WS Cheng (1) , Kae Jack Tay (1) (1) Singapore General Hospital Introduction andObjectives: Focal cryoablation has emerged as a promising alternative to conventional radical prostatectomy and radiotherapy for localized prostate cancer, with preservation of sexual function and continence. Preluding effective cryoablation lies in accurate tumour localization and estimation of volume. We describe the complementary role of MRI-fusion targeted and saturation biopsy in enhancing precision of tumour localization for effective cryoablation. Methods: We present a patient with intermediate-risk prostate cancer. Preoperative PSA was 8.4. MRI prostate revealed two PIRADS 4 lesions. MRI- fusion ultrasound guided transperineal targeted biopsy revealedGleasonGrade Group (GGG) 1 (3+3) disease in one lesion. Saturation biopsy complemented targeted biopsy in establishing the extent of index lesion. More importantly, two additional lesions were identified; one GGG 1 in the contralateral hemiprostate and another GGG 2 (3+4) in ipsilateral hemiprostate, which upstages the cancer profile. Conventional brachytherapy template guided focal cryoablation was modified to a freehand technique, which allowed better prostate tissues ablation andpreservationofneurovascularbundle.HydrodissectionofDenonvilliersfascia and insertion of urethral warming catheter minimized cold injury to rectum and urethra.Twofreeze-thawcycleswereperformed.RealtimecorrelationwithMRI- fusion and saturation biopsy template ensured accurate cryo probes placement. Results: Operating time was 75 minutes with no complications. Patient was discharged without need for indwelling catheter. PSA decreased to 1.2 (1st month) and 0.9 (3rd month). Quality-of-life survey demonstrated remarkable patient satisfaction with complete continence and preservation of sexual function. Conclusions: MRI-fusion, coupled with saturation biopsy, enhances tumour localization and volume estimation. This technique improves mapping precision for effective cyroablation. Evaluation of UBC® Rapid Assay in Detecting Asian Bladder Cancer Zhijiang Zang (1) (1) National University Hospital Introduction and Objectives: Bladder cancer is (BC) one of the costliest malignancies to treat. A good biomarker/assay of BC could improve clinic outcome and reduce financial burden. UBC® Rapid is a point-of-care ELISA test measuring cytokeratin fragments 8 and 18 in urine. Studies have shown a reasonable accuracy of UBC® Rapid in detecting BC. There are evidences suggesting different ethnic groups have different genetic variants of keratin 8 and 18. To date, however, UBC® Rapid has not been evaluated in Asian BC patients. Also very few papers have compared UBC® Rapid with urine cytology. Thus we aimed to evaluate UBC® Rapid in detecting Asian BC, in parallel with urine cytology. Methods: 83 patients were recruited at NUH Singapore, comprising 42 patients with BC, 13 patients with bladder benign lesions and 28 patients with normal cystoscopy and urinary upper tract imaging. All the BC and benign lesions were confirmed by histology. Voided urine was collected before urinary instrumentation. Fresh urine was used for UBC® Rapid assay. The results were compared with urine cytology. Results: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of UBC® Rapid in detecting BC are 53.6%, 90.4%, 88% and 65.5% respectively. The sensitivity, specificity, PPV and NPV of urine cytology in detecting BC are 42.8%, 97.6%, 94.7% and NPV of 63% respectively in our cohort. Conclusions: UBC® Rapid has higher sensitivity with relatively lower specificity in detecting BC compared to urine cytology. UBC® Rapid may partially replace urine cytology for BC surveillance to reduce the cost of BC treatment. T-10183 25