UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 V-10185 An Alternative Approach to Management of Ejaculatory Duct Stones Daanesh Huned (1) , Zhenbang Liu (1) , Yuyi Yeow (1) , Yee Mun Lee (1) (1) Tan Tock Seng Hospital Introduction and Objectives: Haematospermia is a common condition that can invoke a lot of anxiety in patients. Calculus obstruction of the ejaculatory duct is an unusual cause of haematospermia. We report a case of Haematospermia due to ejaculatory duct stones (EDS) diagnosed on imaging, and a subsequent successful and novel endoscopic approach to managing it. Methods: A 43-year-old male presented with intermittent haematospermia over 3 years. Initial investigations including a serumprostate specific antigen, urine and semen culture and prostate ultrasonography were normal. A MRI prostate however reported calcifications within the ejaculatory duct. The patient was counselled and planned for an endoscopic removal of the suspected EDS. Results: Using a 7.5Fr Ultra-Mini Nephroscope, the ejaculatory duct was accessed alongside a safety guidewire. After direct visual confirmation of the EDS, they were fragmented using laser lithotripsy and removed using a Zero Tip nitinol basket. The patient recovered well postoperatively with no complaints and remained asymptomatic. Conclusions: To date, other options have been described in literature such as transurethral resection of the ejaculatory duct (TURED), endoscopic laser- assisted resection of the ducts and antegrade seminal vesical lavage. However, we present an alternative approach, which has the benefit of the EDS being fragmented and removed under direct vision without the complications of bladder neck and external sphincter injury often associated with TURED. Using an Ultra-Mini Nephroscope is a promising option for management of such cases. Glansectomy and Split-Thickness Skin Graft Reconstruction for Penile Cancer Alex Lua (1) , Weida Lau (1) , Jeffrey Leow (1) (1) Khoo Teck Puat Hospital Introduction and Objectives: Penile cancer is a rare malignancy that is confined to the glans in majority of the cases. The aim of the video is to show the efficacy and safety of glanasectomy and split-thickness skin graft reconstruction. Though not widely performed, it is one of the recommended options in low grade (G1,2) T1 disease Methods: Our patient is a 42-year-old chinese gentleman with no significant past medical history. He presents to Khoo Teck Puat Hospital Urology Clinic with a growth on the glans penis for 2 months duration and was diagnosed with low grade penile squamous cell carcinoma on dorsal slit and incision biopsy. Pre-operative MRI did not reveal any involvement of corporal cavernosum. A decision was then made to proceed with glansectomy and split thickness skin graft reconstruction. Results: In this video, we show how glansectomy and split thickness skin garft was performed in our patient. Final histology revealed: pT2G1 squammous cell carcinoma, no lymphovascular invasion or perineural invasion; margins 3mm from proximal margins His pre-operative penile stretch length was 9 cm and post-operative stretch penile length was 7 cm indicating a 2 cm loss of length after surgery Conclusions: Glansectomy with split thickness skin graft can achieve good oncologic and functional outcomes, and can be considered in appropriate patients V-10206 V-10199 #TREXIT: Initial Experience with Transperineal Prostate Biopsy Under Local Anaesthesia in an Outpatient Setting Arianto Yuwono (1) , Rolando Salada (1) , Teck Wei Tan (1) (1) Tan Tock Seng Hospital Introduction and Objectives: There is evidence that compared to the traditional transrectal biopsy (TRUS), transperineal prostate biopsy (TPBx) significantly reduces the risk of infections. Our centre started the local anaesthetic (LA) TPBx service in September 2019. This video describes our technique and initial outcomes. Methods: We prospectively collected the data of men who underwent TPBx since the start of our service. All procedures were performed under LA in an outpatient setting utilising the PrecisionPoint device. Patients received only one dose of oral cefuroxime prior to the TPBx. Results: Between 19 September 2019 and 10 January 2020, 26 men underwent TPBx. Of the 26 biopsies, 22 (84.6%) were performed in biopsy-naïve men, two (7.7%) had previous negative TRUS biopsy but rising serum PSA, and two (7.7%) were confirmatory biopsies as part of active surveillance for low-risk prostate cancer. Cognitive-targeted biopsies were performed in five men with suspicious lesions on magnetic resonance imaging (one had a PI-RADS5 lesion, three had PI-RADS4 lesions, and one had a PI-RADS3 lesion), in addition to systematic biopsies. Median number of cores taken during systematic biopsies was 21 (range:12-24). Overall, 13 men (50%) were detectedwith prostate cancer, of which eight (30.8%) had clinically significant prostate cancer (Gleason grade group 2 or higher). Two men developed post-biopsy complications, both of which were acute urinary retention requiring temporary urethral catheter insertion. No patient had infectious complications after TPBx. Conclusions: TPBx under LAcan be performed safely in an outpatient setting with good cancer detection rates. In view of this, we are moving away from TRUS biopsy in our centre. Robotic Excision of Vaginal Pouch in Ovotesticular Disorder of Sexual Development PrashantSingh (1) ,SridharPanaiyadiyan (1) ,SanjayKumar (1) ,PremNathDogra (2) (1) Department Of Urology, All India Institute Of Medical Sciences, New Delhi, (2) Sir Ganga Ram Hospital, New Delhi, India Introduction and Objectives: Ovotesticular disorder of sexual development (DSD) is the rarest of DSDs with an incidence of 1:20000. Management of vaginal pouch in such cases is reserved for symptomatic cases such as urinary tract infections (UTIs), dysuria, pseudo-incontinence, and stone formation. Laparoscopy is considered the gold standard treatment. Robotic excision of a vaginal pouch in ovotesticular DSD has rarely been described in the literature. We report a rare case of robotic excision of a symptomatic large vaginal pouch in a 19-year-old boy with ovotesticular DSD. Methods: A 19-year-old boy with ovotesticular DSD (46XX) post hypospadias repair presented with complaints of recurrent UTIs, ballooning of urethra during micturition and post-void dribbling. Ultrasound, voiding cystourethrogram (VCUG) and magnetic resonance imaging established the diagnosis of vaginal pouch. Endoevaluation showed a vaginal pouch with rudimentary uterus opening into the posterior urethra. The DaVinci Xi Robotic Surgical System was used and the vaginal pouch was excised. The patient was discharged uneventfully on postoperative day one. Results: Follow up VCUG at 6 weeks did not show any evidence of residual pouch. Post void dribble has resolved and no episode of UTI in the follow-up period of 18 months has been reported. Conclusions: We were able to excise a large vaginal pouch without any unwanted intraoperative event owing to the high magnification, 3-D visualization, and ergonomics available in robot-assisted procedures. Robot assisted laparoscopy should be considered as a valid alternative to laparoscopy for the primary treatment of large vaginal pouch. V-10171 28