UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 C-10010 C-10013 KeepingonTrack-TheImplementationofanElectronicStentTrackingSystem Thomas Ahn (1) , Akshay Kothari (1) , Adrian Roe (1) (1) The Prince Charles Hospital Introduction and Objectives: Ureteric stents form an indispensable component of urological practice. However, they are associated with the forgotten stent which is classified as a never event given its entirely preventable and with significant consequential harm including increased morbidity, healthcare cost and legal issues. Here we present the implementation of an electronic stent tracking system across a health service district. Methods: Our electronic stent registry Stent Tracker was first developed in 2012 on a secure web application accessible via password on any hospital computer. The database operates within the electronic patient record, so all patient information and demographics are automatically imported facilitating data collection. It automatically interrogates stent records on a daily basis and identifies any stent that is overdue. Subsequently, an automated alert is highlighted on the home screen with patients contacted by staff via phone or mail. Results: There have been over 15,000 entries across five different hospitals since the inception of stent tracker. One recent example of an overdue stent occurred 6 months post-op. It involved a patient of non-English background who had a stent inserted for a ureteric stricture causing infected obstructed kidney with plans to be followed up privately. However, upon contacting the patient, stent was still in-situ due to inability to afford treatment. Consequently, patient was re-referred into the public systemand the forgotten stent was avoided. Conclusions: Stent tracker is a patient safety application that provides a secure and simplified interface. Aprospective study is needed for evaluation of its efficacy in preventing the forgotten stent. Prostate-Specific Membrane Antigen (PSMA) Expressed in the Neovasculature of an XP11.2 Translocation Renal Cell Carcinoma (RCC): Potential Role for PSMA-PET Staging? Thomas Ahn (2) , Simon Wood (1) , Keng Lim Ng (1) , Robert Ellis (3) , Sharon Del Vecchio (1) (1) Princess Alexandra Hospital , (2) QEII Jubilee Hospital , (3) UQ Introduction andObjectives: Renal cell carcinoma (RCC) represent the most common primary neoplasm of the kidney and encompass a heterogeneous group of tumours. XP11 translocation RCC is a distinct entity, most commonly associated with aberrations to the TFE3 gene located on chromosome Xp11.2. These tumours are associated with an aggressive disease trajectory in adults. PSMA is expressed in the neovasculature of clear cell RCC; however, its expression in XP11 translocation RCC has not been previously described. This report presents a case of XP11 translocation RCC in which PSMA expression was confirmed by immunohistochemistry. Methods: In 2013 a 68-year-old male underwent partial nephrectomy for an incidentally detected renal tumour. The patient had an extensive past medical history, including stage 3b chronic kidney disease with a solitary kidney, congestive heart failure, and controlled type 2 diabetes. The tumour was resected without complication and with clear surgical margins. Results: Morphological features were consistent with an XP11 translocation RCC. In 2017 disease recurrence was suspected based on follow-up imaging. The possibility of using Gallium-68 PSMA-PET to evaluate the extent of disease spread was discussed by the management team. Although not performed, primary tumour was evaluated immunohistochemically with PSMA identified in the tumour and limited to the neovasculature, which is concordant with findings in more common RCC subtypes such as clear cell, chromophobe and papillary RCC. Conclusions: PSMA is expressed in this tumour subtype, and given the aggressive nature of XP11 translocation RCC, PSMA-PET may present as a viable tool for the evaluation and staging of patients with this RCC subtype. C-10002 C-10012 A Clinical Study to Evaluate the Outcome of Early and Delayed Voiding Trial in Catheterised Patients of Acute Urinary Retention Due to Prostatic Enlargement Deepti Sureka Mummidi (1) , Nitin Pingale (1) (1) Bharati Hospital Introduction andObjectives: Voiding trial following acute urinary retention (AUR) after administration of alpha blockers is the traditional practice but the duration of catheter and alpha blockers is unclear, ranging from 1-32 days. Objectives: 1. To assess the feasibility of early voiding trial in catheterized patients of AUR due to BPH. 2. Compare the outcome of early and delayed voiding trial. Methods: Aim: To compare the result of voiding trial after 72 and 120 hours of administration of silodosin in patients presenting with AUR due to BPH. Sample size 50, prospective study, inclusion criteria: Men above 55 years in AUR due to BPH. Exclusion criteria AUR due to other causes(calculus, stricture urethra) & chronic retention. GroupAwas called for catheter removal and voiding trial after 72 hours of catheterisation or after 72 hours of 1st dose of silodosin taken, whichever is later. Group B was called for catheter removal and voiding trial after 96 hours of catheterisation or after 120 hours of 1st dose of silodosin taken, whichever is later. Results: Group A of 25 patients: 5 lost to follow up, 3 refused voiding trial and chose surgery, 8 patients had successful voiding trial and 9 had failed voiding trial. GROUP B of 25 patients: 3 lost to follow up, 2 refused trial, 15 had successful voiding and 5 failed to void. Conclusions: Our study concluded that Group B patients had a better voiding trial so far. Hence, we made it our standard protocol to give voiding trial after 120 hours. The Utilisation of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET) in Renal Cell Carcinoma (RCC) Staging: A Review of the Evidence so Far Thomas Ahn (2) , Ian Vela (1) , Simon Wood (4) , Handoo Rhee (1) , Marlon Perera () , Andre Joshi (1) , Aous Abjuljabar (5) , Matthew J. Robert (3) (1) Princess Alexandra Hospital , (2) QEII Jubilee Hospital, (3) Royal Brisbane Womens Hospital, (4) University of Queensland, (5) UQ Introduction and Objectives: Metastatic RCC (mRCC) is a disease with limited therapeutic options and portends poor prognosis. Early detection of small metastatic foci and intervention may have significant impact on patient survival. Accurate staging of mRCC is strongly desired however the traditional modalities of computed tomography (CT) and/or bone scan (BS) have exhibited limited sensitivity and specificity. In the search for better imaging modalities, PSMA-PET CT imaging in mRCC has been explored, given its recent well-established role in the staging of primary, metastatic and biochemically recurrent prostate cancer (CaP). Our aim was to assess the role of PSMA-PET CT in RCC patients. Methods: Given early encouraging reports, we performed a literature review on the available evidence, including the scientific basis for PSMAexpression in RCC, the role of PSMA-PET CT imagingwith potential clinical implications in mRCC, its limitations and future opportunities. Results: PSMA is a type II transmembrane glycoprotein highly expressed on prostate cancer epithelial cells. Recently, small molecules targeting the PSMA ligand, linked to radioactive isotopes have been developed for use with PET. Initial clinical experience has demonstrated superior sensitivity and specificity compared to standard of care imaging in primary, metastatic and biochemically recurrent CaP. PSMAhas also been found to be expressed in the neovascular of non-prostate cancers such as mRCC and hence PSMA- PET CT imaging has been proposed as an alternative staging modality (summarised table 1). Conclusions: Early pilot studies using PSMA-PET CT in mRCC has been encouraging with evidence of improved staging sensitivity which has directly led to changes in management. 2