Abstracts of the 44th Congress of the Société Internationale d’Urologie

1. Moderated Oral ePoster

1.1. Moderated Oral ePoster Session 01: Minimally Invasive Surgery Robotics, Renal Transplantation

• Thursday, October 24
• 0800–0900

1.1.1. MP-01.01: 3D Laparoscopy Is Better than 2D in Achieving Pentafecta in Nephron-Sparing Surgery for RCC

• Seregin A ¹, Loran O ², Pushkar D ¹, Kolontarev K ¹, Seregin A ¹ and Tarasov R ²

¹ 

Moscow Urology Center, S.P. Botkin City Clinical Hospital, Moscow, Russia

² 

Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Abstract: Introduction and Objectives: The technical evolution of partial nephrectomy (PN) nowadays is aimed at performing nonischemic sutureless minimal-margin nephron sparing surgery. The aim of our study was to evaluate possible advantages in performing three-dimensional (3D) laparoscopic partial nephrectomy with respect to functional outcomes. Materials and Methods: This study was a retrospective analysis of 180 patients underwent PN at a tertiary academic institution between January 2018 and December 2022 with minimal follow-up of one year. Consecutive consented patients were grouped into two cohorts: in group 1 standard two-dimensional (2D) high definition laparoscopic PN was performed (n = 100) and group 2, where 3D vision by Carl Storz was used during procedure (n = 80). Mean RENAL score was similar between groups (6.5 and 7.4, p = 0.4). All surgeries were performed by experienced laparoscopic (more then 300 PN cases) urologist. Primary outcomes assessed the benefits of application 3D technology in laparoscopic completely unclamped, minimal-margin PN; short-term changes in estimated glomerular filtration rate (eGFR); and pentafecta achievement (negative surgical margins, no postoperative complications, warm ischemia time ≤ 25 min, over 90% estimated glomerular filtration rate (eGFR) preservation and no chronic kidney disease stage progression 1 year after surgery). Results: Demographic data were similar among groups. The intended nonischemic sutureless minimal-margin nephron sparing technique was performed in 65% of 2D PN and 88% of 3D PN (p = 0.001). The rate of pentafecta was better in 3D PN (74%) vs. 2D PN (62%) (p = 0.01). In addition, 3D PN group had less blood loss (200 and 120 mL; p = 0.02), whereas transfusion rates, operative time and 30-d complication rates were similar. At 1-mo postoperatively, median percentage reduction in eGFR (10.4% and 5.6%; p = 0.3) and new-onset CKD stage > 3 (23% and 16%; p = 0.02) were similar. Study limitations included retrospective analysis, small sample size, and short follow-up. Conclusions: The addendum of 3D vision facilitates the performing of laparoscopic nonischemic sutureless minimal-margin nephron sparing surgery and may offer renal functional advantage.

1.1.2. MP-01.02: Clinical Experience and Outcomes of First 200 Uro-Oncology Cases with SSI Mantra: Single Centre Experience

• Khannanna A, Singh A, Pratihar S, Sourabh N, Kumar B, Khan M, Rawal S and Malla I
• Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Abstract: Introduction and Objectives: The objective of this study is to report our clinical experience and outcomes of the first 200 Uro-Oncology procedures conducted utilizing the SSI Mantra™ robotic surgical platform. Materials and Methods: Data of consecutive patients who underwent various robot assisted uro-oncology procedures using the SSI Mantra™platform at our institution between July 2022 and January 2024 were recorded. The specific surgical configuration employed with the SSI Mantra™ for these procedures were duly noted. We assessed the feasibility of these procedures with this novel robotic platform and reported the outcomes. Results: A total of two hundred patients were operated with the SSI MantraSSI Mantra™ system. The spectrum of procedures performed included robot assisted radical prostatectomy (RARP) with bilateral extended pelvic lymph node dissection (B/L ePLND) {n = 100}, RA radical cystectomy (RARC) with B/L ePLND with extra-corporeal urinary diversion {n = 50}, RA radical nephrectomy (RARN) {n = 39}, RA partial nephrectomy (RAPN) {n = 6}, RA Radical nephron-ureterectomy with bladder cuff excision (RARNU with BCE) {n = 1} and B/L RA video endoscopic inguinal lymph node dissection (RA-VEIL) {n = 4}. One RARP had to be converted to open in view of system malfunction. However, no system related intra-operative complications/injuries were encountered. Conclusions: The SSI Mantra™ system demonstrates significant promise as an innovative robotic platform. In this single centre experience, we have demonstrated the feasibility of a diverse array of surgical procedures using this platform. Further research, involving a larger cohort of patients, is imperative to refine the operative techniques and comprehensively understand the perioperative outcomes of the SSI Mantra system, particularly in comparison to other robotic surgical platforms.

1.1.3. MP-01.03: Direct Transmesocolic Pedicle Approach for Left Laparoscopic Partial Nephrectomy

• Karmakar S ¹ and Gopalakrishnan R ²

¹ 

B R Singh Hospital, E. Rly, Sealdah, Dum Dum Cantonment, India

² 

Fortis Institute of Kidney Disease and Research Centre, Kolkata, India

Abstract: Introduction and Objectives: Accessing the renal artery and vein is the prime step as a prelude to partial nephrectomy. Traditional approaches to the pedicle have been by mobilization of the splenic flexure and descending colon followed by elevation of lower pole of kidney to visualize the left renal pedicle. Herein we present a direct access to the left renal artery and vein through the root of the mesentery. This route has been used in quick and early pedicle control for treating left renal trauma. Extensive mobilization of the left colon and the left kidney is avoided. This has two major advantages, it saves laparoscopic time and second, it preserves virgin anatomical planes around the kidney for future renal surgery if becomes necessary. Materials and Methods: We present 10 cases of left laparoscopic partial nephrectomy using direct access to the renal vasculature. Results: The manoeuvre took 10 to 17 min (average 12 min). Following this, the anterior perinephric fat was taken down en masse with left colon thereby preserving the plane between these two layers. There were no cases of vascular damage or vascular catastrophes. Postoperative renal doppler done on postoperative day 2 in all cases was normal. Conclusions: Direct vascular pedicle access for left partial nephrectomy has clear advantages. It reduces operative time by early pedicle visualization. minimizing dissection of the perinephric tissues also reduces operative time and preserves anatomical planes around the kidney as much as possible.

1.1.4. MP-01.04: Early Endoscopic Realignment of Anterior Urethra in High Grade Traumatic Urethral Injury: A Rare Case Report

• Shuklakla V, Pattnaik P and Deshpande A
• Bombay Hospital Institute of Medical Sciences, Mumbai, India

Abstract: Introduction and Objectives: Injuries to anterior urethra are uncommon and are caused by blunt trauma, and rarely associated with pelvic fractures. Initial acute management is suprapubic cystostomy. Management of partial and complete disruptions remains controversial: suprapubic diversion only and secondary endoscopic or open surgical repair of the urethral stricture that occurs in the great majority of the cases. Materials and Methods: A 25-year-old otherwise healthy male, presented to the casualty after a history of fall from height over an iron rod with complaints of inability to pass urine and bleeding per urethra since injury. On examination bladder was palpable with suprapubic tenderness and blood at the tip of meatus. Single attempt of passing a glide wire per urethral was made which was unsuccessful hence supra pubic catheterization was done. CT KUB was suggestive of mildly displaced fracture of Ischiopubic ramus. RGU suggested of leakage of the dye and complete disruption at the bulbourethral region. Antegrade and retrograde cystoscopy guided urethral realignment with per urethral catheterisation with change of SPC was done, after 72 h of injury. Results: Patient recovered well and was able to pass urine well. Post op RGU suggested of urethral continuity and no extravasation of contrast. Follow up after two months post op on uroflowmetry showed Q-max—5.3 mL/s, voided volume—376 mL. He was re admitted in view of poor flow and cystoscopy showed narrowing of approximately 1.5 cms distal to mid bulbar urethra. Cystoscopic dilation and VIU was done. On one year of follow up patient has good flow rate with once a week clean intermittent self-catheterization. Conclusions: The above case report signifies the importance of early endoscopic intervention in transectional injury of urethra and may help avoiding the need for other major operative approaches. However chronic self-catheterisation and follow up might be required in such cases.

1.1.5. MP-01.05: Early Experience in Extraperitoneal Robotic Assisted Radical Prostatectomy with Novel Hugo RAS System: A Comparative Analysis with Three-Dimensional Laparoscopic Radical Prostatectomy

• Marques-Monteiro M, Vital J, Teixeira B, Mendes G, Madanelo M, Rocha M, Mesquita S, Carneiro D, Cabral J, Teves F and Fraga A
• Centro Hospitalar Universitário do Porto, Porto, Portugal

Abstract: Introduction and Objectives: The Hugo™ RAS system is a novel robotic platform recently implemented in our department. Our primary aim is to compare perioperative, early functional, and oncological outcomes of extraperitoneal robot-assisted radical prostatectomy (eRARP) with this new system with the standard three-dimensional extraperitoneal laparoscopic radical prostatectomy (eLRP). Materials and Methods: We conducted a retrospective analysis, comparing men diagnosed with localized prostate cancer who underwent either eRALP or eLRP. These procedures were performed by the same surgeon’s team between 2022 and 2023. Urinary continence was defined as no pads used and was assessed up to 3 months post-surgery. Oncologic outcomes were determined by evaluating the positive surgical margin (PSM) rate and PSA levels ≥ 0.1 ng/mL at 6 weeks. Secondary outcomes included the number of pads used at 3 months post-surgery and perioperative outcomes. Complications within 3 months post-surgery were classified according to the Clavien-Dindo system. Statistical analysis was conducted with significance set at a two-sided p value < 0.05. Results: Patients who underwent eRALP (n = 50) and eLRP (n = 59) were analyzed and compared. Baseline characteristics and pathologic results were represented in Table 1. Postoperative continence rates at 6 weeks and 3 months after surgery were 52.0% and 70.0% for eRALP and 42.4% and 64.4% for eLRP, respectively (p > 0.05). At the 3-month, 60.0% and 90.5% of non-continents patients who underwent eRARP and eLRP respectively, only required one pad per day (p < 0.05). PSA persistence was observed in 16.7% and 23.7% for the eRALP and eLRP, respectively (p = 0.37). There was also no statistically significant difference in the rates of PSM between the two surgical modalities. Perioperative results and oncologic results were resumed in Table 2. The only intraoperative complication registered was mechanical failure of one robotic arm, which required conversion to laparoscopy. There was also no statistically significant difference in 90-days complication rates (eRALP 10.0% vs. eLRP 10.2%, p = 0.46). Conclusions: We were unable to demonstrate a discernible difference between the two surgical modalities concerning urinary continence and oncological outcomes. eRARP with the Hugo™ RAS system seems to prove to be safe and feasible, allowing for a seamless transition into robotic surgery.

1.1.6. MP-01.06: Endovascular Complication of DJ Stent

• Agrawal P, Kolsawala H, Bhatt N, Goyal A, Shrivastava P, Maheshwari P and Harne S
• Fortis Hospital, Mulund, Mumbai, India

Abstract: Introduction and Objectives: DJ stent placement is a commonly performed endourological procedure. Although stent placement is a safe procedure, it can have complications like infection, encrustation, migration and stent fragmentation. Stent migration is often antegrade or retrograde in the pelvi-calyceal system. Rarely migration can be extrarenal in the vascular system. Materials and Methods: A compilation of all case reports published about the endo-vascular complication of DJ stent was performed. A total of 22 case reports were identified between 2002 till date in English literature. Results: Endovascular complications happened in 10 men and 12 women between the age range of 29 to 75 years. In 19 patients (86%) this complication happened during management of urolithiasis. Nine patients (40%) had associated infection and needed stenting in emergency. Nearly 80% (17 out of 12) happened on right side and only 22% on left. More patients (15 of 22) had endovascular migration on retrograde stent attempt. In most patients (18 of 22) fluoroscopy was not used to monitor stent placement. Only two patients (9%) presented with a vascular emergency while the rest were all diagnosed on a pre-stent removal radiologic evaluation. Management of the migrated stent was by open surgery in four patients, endourologic removal 13 (four were also controlled with endovascular means), endovascular removal in four & one patient needed laparoscopic removal. There are no reports of renal or life loss due to endovascular migration of the stent. Conclusions: Endovascular migration of a DJ stent is a rare complication. This commonly happens when the stent placement is performed in an emergency for an obstructed stone with infection without access to fluoroscopic control. Interestingly this complication is more common on the right side. Usually this complication is diagnosed on pre-stent removal evaluation and most patients can be managed by endourologic management often controlled with endovascular means.

1.1.7. MP-01.07: Enhancing Neurovascular Bundle Dissection in Robot-Assisted Radical Prostatectomy Through Intraoperative Angiography: Initial Clinical Insights

• Amaraara N ¹, Hlodec I ¹, Séjourné C ¹, Massa A ¹, El Khoury E ¹, Ait Kaki A ¹, Al Youssef T ¹, Deswarte C ², Gutierrez P ³ and Patel B ⁴

¹ 

Department Urology/Oncology Dunkirk Center Hospital, Dunkirk, France

² 

Anesthesia Department Dunkirk Hospital Center, Dunkirk, France

³ 

Radiology Dunkirk Hospital Center, Dunkirk, France

⁴ 

Scott & White Hospital, Temple, United States

Abstract: Introduction and Objectives: Leveraging contemporary insights into prostate surgical anatomy, this study aimed to assess the utility of intraoperative angiography employing indocyanine green (ICG) and near-infrared fluorescence during robot-assisted radical prostatectomy (RARP) for improved dissection and preservation of the neurovascular bundle (NVB). Materials and Methods: Between June 2016 and June 2023, 387 patients with localized prostate cancer underwent RARP using the Da Vinci Xi^® system (Intuitive Surgical). Among these, 291 patients underwent RARP with intraoperative angiography utilizing the Firefly^® fluorescence imaging system. The study evaluated the bilateral identification (%) of NVB to optimize dissection and assessed any ICG-related complications. Patients were followed up at 3, 6, 9, and 12 months post-surgery to assess erectile function using Sexual Health Inventory for Men scores (SHIM Score). Results: Bilateral identification of NVB was achieved in 100% of cases without difficulty. No ICG-related complications or allergies were observed. Real-time intraoperative angiography facilitated precise visualization and microdissection of the NVB by seamlessly integrating fluorescence with standard light. Postoperative erectile function significantly improved in patients undergoing nerve-sparing RARP with fluorescence imaging assistance. Conclusions: Fluorescence-guided surgery emerges as a straightforward and promising non-invasive technique, aiding in the identification of crucial anatomical landmarks to optimize micro-preservation of the NVB and preserve erectile function.

1.1.8. MP-01.08: Laparoscopic Radical Cystectomy at a High-Volume Tertiary Center: Analysis of Pentafecta Criteria and Its Relationship with Survival

• Marques-Monteiro M, Carneiro D, Fraga A and Oliveira M
• Centro Hospitalar Universitário do Porto, Porto, Portugal

Abstract: Introduction and Objectives: Our objective is to employ the radical cystectomy pentafecta criteria (PC) to assess the outcomes of laparoscopic radical cystectomy (LRC) and the effects of surgical experience on perioperative and oncologic outcomes. Materials and Methods: Between 2017 and 2023, we gathered data on patients who underwent LRC with pelvic lymph node dissection and extracorporeal urinary diversion for non-metastatic bladder cancer. The surgeries were conducted by a dedicated surgical team. We assessed consecutive patients into time-associated groups according to the operation order. Process efficiency was assessed by evaluating operative time and perioperative outcomes, while the achievement of pentafecta served as the primary endpoint. Overall survival (OS) and recurrence-free survival (RFS) comprised further endpoints. We also evaluated the impact of surgical experience on surgery proficiency and quality. Statistical analysis was conducted using SPSS Statistics 28^®, with significance set at a two-sided p value <0.05. Results: Out of the 155 patients analyzed, 41.3% achieved all five criteria of the pentafecta and the mean pentafecta score was 4.1 ± 1.0 (95% CI 4.0–4.3). Negative surgical margins, removal of ≥16 lymph nodes, absence of complications beyond Clavien-Dindo grade 3–5 within 90 days, the absence of clinical recurrence within 12 months, and absence of urinary diversion complications were observed in 91.0%, 69.1%, 78.6%, 78.6%, and 85.2% of patients, respectively. For LRC with ileal conduit, operative times and the number of lymph nodes improved with increasing case numbers. The proportion of pentafecta attainment did not statistically change across consecutive operation order groups (Group 1: 33.3%; Group 2: 41.9%; Group 3: 50.0%; Group 4: 40.0%; Group 5: 46.7%; p > 0.05). Higher Charlson Comorbidity Index, extravesical disease, and positive lymph node status were independent predictors of non-attainment of pentafecta in both uni and multivariable analysis. The three and five-year OS rates were 66.5% and 54.7%, respectively. Patients who achieved all 5/5 PC showed higher OS and RFS compared to those who did not attain all criteria (log-rank p < 0.001). Conclusions: LRC demonstrated a satisfactory level of proficiency and surgical quality, and PC achievement was associated with improved RFS and OS. Nonetheless, only operative time and number of lymph nodes yielded were improved with increasing experience.

1.1.9. MP-01.09: Partial Nephrectomy on Hugo RAS Platform: Real World Experience

• Pradhan A, Antony A and Kumar A
• Venkateshwar Hospital, New Delhi, India

Abstract: Introduction and Objectives: We present our experience in performing partial nephrectomies of all complexities in an unselected cohort, using the Hugo RAS platform. Materials and Methods: We performed partial nephrectomy on 10 patients between Nov 22 to Dec 23. There were 9 female and 1 male with age range 36–83 years. All patients had a normal contralateral renal unit and normal GFR. All patients except 3 had comorbidities. The RENAL score was 8–11 except 1 case of 4. We used a standard 4 arm approach 3 from behind the patient and 1 from front. 2 assistant ports were used and on the right side an additional 5 mm port was used for liver retraction. The initial dissection was with 3 arms with fenestrated bipolar forceps and shears. After colonic mobilization and initial hilar dissection the 4th arm was docked and Cadierre forceps was used to manipulate and retract the kidney as needed. This approach reduced the internal clashes of instrument experienced at colonic mobilization. In all cases we used a 30 degree telescope. An intraoperative ultrasound was used when needed. After the entire tumor was delineated the renal artery only was clamped. In most cases a resection was done on the surface and cortical area and enuceloresection at the tumor base. Renorraphy was in 2 layers. A stent was used in those cases where the pelvicalyceal system needed repair. The docking time was 18 to 25 min. The post operative recovery in all patients was normal. All were discharged on 3rd post operative day. Results: The 2 conversions to radical nephrectomy were from patient factors unrelated to the robot. Conclusions: This robot can be used across all complexities of renal tumors for partial nephrectomy.

1.1.10. MP-01.10: Pathological Upstaging and Upgrading After RARP in Clinically Localized Prostate Cancer and Its Impact on Biochemical Recurrence: A Third World Country Experience

• Kharade M, Mohan A and Sharma R
• Basavatarakam Indoamerican Cancer Hospital and Research Institute, Hyderabad, India

Abstract: Introduction and Objectives: Incidence of localized prostate cancer is increasing due to increase in PSA (prostate specific antigen) based opportunistic screening in third world countries. Robot assisted radical prostatectomy (RARP) is an important modality for the management of clinically localized prostate cancer. Significant number of localized prostate cancer patients experience tumor upstaging and upgrading between prostate biopsy and radical prostatectomy (RARP) specimens. The aim was to study the incidence of upgrading and upstaging in final radical prostatectomy specimen and its impact on biochemical recurrence and need of adjuvant/salvage treatment in post operative period. Materials and Methods: Ours is a retrospective study and data was retrieved through electronic hospital medical system. The patients who underwent robot assisted radical prostatectomy between August 2017 to 15th March 2024 were studied. Data regarding Gleason score and Gleason grade in prostate needle biopsy specimen, clinical staging was obtained. This was compared with the final histopathology of radical prostatectomy (RP) specimen. Upgrading, upstaging was noted. The effect of upgrading and upstaging on biochemical recurrence was noted. Results: Around 234 patients underwent robot assisted radical prostatectomy (RARP) between August 2017 and 15th March 2024. Pathological upgrading in final specimen was noted in about 62 patients (26.49%), pathological upstaging to locally advanced stage (i.e., T3a/T3b/T4 stage/nodal involvement) was noted in around 92 patients (39.31%). BCR in upstaged patients was noted in around 38 patients (41%). In our study only 3 patients that were upstaged had positive surgical margins in final specimen (3.2%). 54 patients (58.69%) upstaged to locally advanced stage were successfully treated with only RARP (serum PSA—0.01 ng/mL) and none required any form of additional treatment. Mean time to biochemical recurrence was 18 months. BCR patients required additional treatment with radiotherapy (adjuvant/salvage) and hormonal therapy. Conclusions: Pathological upgrading and upstaging are associated with early biochemical recurrence (BCR). RARP is a good modality for the management of clinically localized prostate cancer. Patients upstaged to locally advanced stage requires additional adjuvant treatment.

1.1.11. MP-01.11: Percutaneous Transvesical Laparoendoscopic Single-Site Surgery (T-LESS) for Bladder Diverticulum: A Thirteen-Year Clinical Experience

• Roslan M ¹, Borowik M ¹, Przudzik M ¹ and Markuszewski M ²

¹ 

University of Warmia and Mazury, Olsztyn, Poland

² 

Medical University of Gdańsk, Gdańsk, Poland. Funded by the Minister of Science under “The Regional Initiative of Excellence Program”

Abstract: Introduction and Objectives: Various single-incision techniques have been developed to decrease morbidity after laparoscopic/robotic port placement and to improve cosmetic results. One widespread single-port procedures is laparoendoscopic single-site surgery (LESS). We present our clinical experience of this approach for transvesical bladder diverticulectomy. The objective of this study is to present a series of laparoendoscopic single-site surgeries for transvesical excision of symptomatic bladder diverticula. Materials and Methods: From March 2011 to March 2024, we operated on 32 patients (31 males, 1 female) aged 48–76 yr (mean 66 yr) for symptomatic bladder diverticula using the T-LESS approach. The total number of diverticula removed was 37 (three pts with 2 diverticula, one pt with 3 diverticula). Patients were placed in the lithotomy position and were under general anesthesia. The size of a single diverticulum was of 6 cm (range, 4–12 cm) in diameter. The procedures were performed transvesically (percutaneous intraluminal approach) with a single-port device (Tri-Port+, Olympus, Germany) via a 1.5 cm incision made 3 cm above the pubic symphysis. Standard 10 mm optic and straight laparoscopic instruments were used. The diverticula were dissected and removed from the bladder with a combination of standard laparoscopic and endoscopic instruments introduced through the TriPort+ and the urethra. The bladder wall openings were closed by running absorbable 2/0 polyglactin sutures. An 18F Foley catheter was left in place for 6–9 days. Results: The average operative time was 95 min (range, 45–170 min) and the estimated blood loss was 20–50 mL. The hospitalization time after the operation was 44 h (range, 18–76 h). No intra- or post-operative complications were observed. During the mean six-year follow-up (range, 0.1–13 yr) patients presented significant reduction of post-void residual volume, decrease of lower urinary tract symptoms and improvement of flow rate. Eight patients (25.8%) underwent surgery for BPH. Conclusions: The T-LESS procedure can be considered as a valuable option for diverticulectomies in either male or female patients because of its minimal invasiveness, short hospital stay, fast recovery time and good long-term results.

1.1.12. MP-01.12: Pfannenstiel Incision versus Iliac Fossa Incision for Retrieval of Resected Specimen After Laparoscopic Nephrectomy: A Prospective Randomized Parallel Arm Study

• Barik K, Dheeroo D, Tarigopula V, C S, Das M, Mandal S, Tripathy S and Nayak P
• All India Institute of Medical Sciences, Bhubaneswar, India

Abstract: Introduction and Objectives: Although laparoscopic nephrectomy is the standard of care for benign and malignant renal masses, the location of the incision for kidney retrieval remains a point of debate, and no clear-cut guidelines exist. We aimed to assess the outcomes of kidney specimen retrieval after laparoscopic nephrectomy using Pfannenstiel incision vs. Iliac fossa incision. We present the analysis of our data in this CTRI Registered trial (CTRI/2022/03/041075). Materials and Methods: This is an open-labelled, parallel-group, randomised control trial. The calculated sample is 52 (26 in each arm). The primary endpoint was the surgical site pain in the immediate postoperative period (measured by VAS score fourth hourly till 48 h). Secondary endpoints were total operative time, incision length, blood loss during specimen retrieval, length of postoperative hospital stay, wound site cosmesis (Manchester scar scale) at three months postoperatively, or wound complications in the early postoperative period between groups. Results: Demographic characteristics were comparable in both groups. Postoperative pain demonstrated a significant difference in favour of the Pfannenstiel incision group. There were no significant differences between groups on other parameters. Conclusions: The Pfannenstiel incision has significantly less operative site pain. However, other parameters don’t show any significant difference between the two groups.

1.1.13. MP-01.13: Deceased Donor and Live Related Renal Transplantation: A Initial Single Centre Experience

• Mohd Ziauddin S and Munjewar C
• AIIMS, Nagpur, India

Abstract: Introduction and Objectives: A successful renal transplantation program was started at our tertiary care institute. We discuss the relevant surgical and follow up outcomes of the renal transplant patient population with continued service being provided to the needy population. Materials and Methods: Between May 2023 to March 2024 a total of 19 ESRD (end stage renal disease) patients underwent renal transplantation. From the total, 5 received kidney from live related donors while remaining 14 had a deceased donor transplantation. Of the 14 deceased donor recipients, 2 received organ from DCD (donation after cardiac death) while rest 12 were the recipients of BSD (brain stem death) donors. Results: The mean age of deceased donor recipient cohort was 39.9 years range (20–55 year), while that of live related donors was 30-year range (23–33 year), all from the parents to the children. In LRRT (live related renal transplantation) 4 patients received left kidney while 1 received right kidney for transplantation. In DDRT (deceased donor renal transplantation) again 1 patient received right kidney while 13 patients got the left kidney as an allograft. The immunosuppression protocol for the recipients was induction with antithymocyte globulin (ATG) along with methylprednisolone intraoperatively, maintenance with triple immunosuppression (tacrolimus, MMF & steroids). There were no major surgical complications in live donors postoperatively. Postoperatively no recipient had any major surgical event except one who developed perigraft clot with renal graft compromise requiring re exploration with open clot evacuation. Postoperatively 5 (26%) patients had laboratory documented urinary tract infections 3 (15.7%) amongst which progressed to epididymoorchitis, one of whom required right simple orchidectomy due to non resolving epidymo orchitis. The average graft implantation time was 165 min. The mean cold ischemia time (CIT) for LRRT was 60 min and that for DDRT was 150 min and the warm ischemia time was 3 min. There was 1 acute rejection (cell mediated) managed by IV methylprednisolone. None of the transplanted grafts were lost until the last follow up. Conclusions: Our results show that renal transplantation is a viable mode of renal replacement therapy in ESRD patients with near normal quality of life in the long run.

1.1.14. MP-01.14: Robotic Marvels in Kidney Transplants: Multi-Vessel vs. Single Vessel Grafts—Our Experiences Unveiled at a Tertiary Care Centre in a Developing Nation

• Mitratra S, Kumar A, Maheshwari R, Chaturvedi S, Khan U, Kushwaha S and Gupta R
• Max Super Speciality Hospital, New Delhi, India

Abstract: Introduction and Objectives: The aim is to compare outcomes of robot-assisted kidney transplants in graft with multiple vessels vs. single vessel at a single high-volume tertiary care centre by a single surgeon. Materials and Methods: Patients undergoing robot-assisted kidney transplant from living donors using graft multiple vessels (GMVs) were reviewed from retrospectively collected data. Kidney transplants using graft single vessel (GSVs) (one artery and one vein) were used as controls, termed as group I. GMVs were defined as those with greater than or equal to two renal arteries, termed as group II. 25 patients underwent kidney transplant with GMVs and were compared to 50 patients with GSVs in a propensity match of 1: 2. In group II, specific ex-vivo vascular reconstruction techniques were used before introducing the graft into recipient. Reconstruction was done according to vascular anatomy: (1) side-to-side arterial anastomosis (in a pantaloon fashion), (2) end-to-side anastomosis of polar artery into the main renal artery, or (3) combination of these techniques, in case of greater or equal to three renal arteries or complex vascular anatomy. Functional outcomes and complications at post-operative days 1, 7 and at 3 months were analysed. Results: Mean warm ischaemia time in group I and group II was 4.94 ± 1.25 min and 5.24 ± 1.42 min respectively. Mean cold ischemia time in group I and group II was 56.62 ± 21.98 min and 63.32 ± 15.33 min respectively. Rewarm ischemia time and duration of surgery time was higher in group II (50.92 ± 3.49 and 272.12 ± 29.86 min) respectively vs. 48.44 ± 8.29 and 265.60 ± 45.05 min in group I. These differences were not statistically significant. No statistically significant difference was seen in the mean value of serum creatinine at 3 months’ follow up (1.19 ± 0.38 in group I vs. 1.30 ± 0.26 in group II). No complications were seen in patients with GMVs. Conclusions: With increasing experience, renal grafts with multiple vessels can be accepted safely for kidney transplant with good outcomes. In experienced hands, this procedure is technically feasible and achieves optimal perioperative and functional outcomes comparable to kidney transplant using grafts with conventional vascular anatomy.

1.1.15. MP-01.15: Salvage of Short Right Renal Graft Vein Tear with Saphenous Vein: A Case Report

• Saurav N, Maheshwari R, Gupta R, Mitra S, Khan U and Kushwaha S
• Max Super Speciality Hospital, New Delhi, India

Abstract: Introduction and Objectives: We report a case of live donor renal transplantation, during which inadvertent graft renal vein shortening occurred while handling leading to bleeding. We used the recipient’s great saphenous vein as a free graft to reconstruct the graft renal vein after explanting the graft kidney, to achieve adequate length and re-anastomosed the graft vessels and ureter. Materials and Methods: A 46-year-old underwent ABO-compatible renal transplantation in July 2023. Right donor kidney was harvested by transperitoneal laparoscopic technique as left kidney had multiple vessel complexity. Graft vein was anastomosed with right external iliac vein & artery with internal iliac artery followed by ureteric anastomoses. After clamp release there was significant bleeding from a small veinous tributary which could not be controlled with hemolok clip. Renal vein was paper thin and suture repair led to shortening and obliteration of lumen. Hence the kidney was explanted. Recipient great saphenous vein was harvested, de-tubularised and re-configured along the horizontal axis. This free graft was used to reconstruct the renal vein using 7–0 polypropylene sutures. Graft kidney was re-anastomosed as before. Results: Brisk diuresis (~700 mL) was noted after re-anastomosis. Post-operative doppler study showed good perfusion with resistive index of 0.6. Lower limb doppler study was normal. Serum creatinine level dropped from 5.7 to 4.1 on post-operative day 1 and nadir serum creatinine was 0.9 on post-operative day 5. Conclusions: Great saphenous vein can be used as a potential free graft to reconstruct renal vein in case of short length either during retrieval or during similar vascular complications. Timely decision making with surgical expertise is the key.

1.1.16. MP-01.16: The Dual Renal Transplant: A Rare Case Report

• Mohare S, Vaddi S, P L, Naidu Koneni B, Sampathi Rao G, Kadam A and G S
• Yashoda Hospital, Somajiguda, Hyderabad, India

Abstract: Introduction and Objectives: To provide optimal nephron mass, two pediatric diseased kidneys can be transplanted into a single adult recipient. The procedure permits converting two pediatric kidneys into one en-bloc graft, which then can be transplanted into a single iliac incision, using only single arterial and venous anastomosis. Materials and Methods: 8 years male child, history of fall from height brought to hospital as brain dead. The consent taken of parents for organ donation and liver and kidneys harvested. A 32-year-old male who had been on maintenance hemodialysis was found fit for transplantation as per recipient waitlist. In view of two small cadaveric kidneys decided to transplant both the kidneys to the same recipient. Results: The kidneys harvested en-bloc along with aorta, IVC and ureters. Benching done and upper ends of aorta and IVC were closed. Lower end of aorta anastomosed to EIA end to side and IVC anastomosed to EIV end to side. The right kidney was placed on psoas muscle in right iliac fossa and left kidney in pelvic cavity avoiding any kinking of the vessels. After releasing the clamps good urine output started. Both the ureters spatulated anastomosed by Wallace technique and then anastomosed to the bladder by modified Lich Gregoir technique. Post operatively creatinine was 0.7 mg/dL on POD-3. USG doppler showing both kidneys with good vascularity and graft well perfused with normal RI values. DTPA renogram done after 1 month showing good renal function. Conclusions: The dual kidney transplant is a good option of renal replacement therapy when the cadaveric donor is a pediatric age group and recipient is an adult. The present report demonstrates the surgical steps involved in en-bloc dual kidney transplant from a pediatric donor into an adult recipient to provide optimal nephron mass.

1.1.17. MP-01.17: The Renal Artery Injury in a Donor Nephrectomy. How We Managed It!

• Mohare S ¹, Vaddi S ¹, P L ¹, Naidu Koneni B ¹, Sampathi Rao G ¹, Kadam A ¹, G S ¹ and Elgamal M ²

¹ 

Yashoda Hospital, Somajiguda, Hyderabad, India

² 

Yashoda Hospital, Somajiguda, Hyderabad, Egypt

Abstract: Introduction and Objectives: The laparoscopic donor nephrectomy has become the standard of care in most of the transplant centers all over the world. The renal artery injuries can happen in laparoscopic donor nephrectomy. Immediate on table management of such vascular mishaps are important to avoid graft related morbidity. Materials and Methods: 63 years female, VKD for her son who was a 45 years male patient known CKD on MHD planned for live related donor renal transplant. The donor planned for laparoscopic left donor nephrectomy. On CT renal angiogram, the donor has early branching of the left renal artery (2.7 cm from the origin). Normal venous anatomy. DTPA—Equal function on both sides. Results: Intraoperatively the main renal artery accidentally transected along with its posterior branch and upper polar branch near to the hilum. The renal arteries fall short of length for recipient anastomosis. Hence internal iliac artery graft from the recipient was harvested along with its anterior and posterior branches with adequate length. While benching these anterior and posterior branches of the internal iliac artery anastomosed with anterior and posterior division renal artery. And then the common stump is anastomosed to the external iliac artery end to side with 6.O prolene. The upper polar artery anastomosed to the external iliac artery separately. Post operative US doppler was showing normal RI values and good blood flow. Conclusions: Even after careful evaluation of renal CT angiogram vascular injuries can happen in donors. How we overcome this situation is important. As mentioned above one can use internal iliac arterial graft to act as rescue.

1.2. Moderated Oral ePoster Session 02: Reconstruction

• Thursday, October 24
• 0800–0900

1.2.1. MP-02.01: Analysis of Appendicular Interposition for Stricture Ureter

• Mallarapu A, Coelho V, Pathak N, Singh A, Ganpule A, Sabnis R and Desai M
• Muljibhai Patel Urological Hospital, Nadiad, India

Abstract: Introduction and Objectives: Segmental ureteric strictures in upper and mid ureter present a unique management challenge. If a thin lumen is present augmentation ureteroplasty can be done, if completely obliterated replacement needs to be done. Replacement options include ileal, buccal mucosal graft. In right upper and mid ureteric strictures appendix presents a unique opportunity for reconstruction. Here in we describe our experience of segmental replacement using appendicular interposition. Materials and Methods: This is a retrospective review of all patients with ureteral stricture disease that elected to undergo ureteral appendiceal interposition (UAI) from February 2020 to August 2022 at our institution. Patient demographic and clinical information, stricture characteristics, perioperative parameters, surgical approach and posthospitalization follow-up data were collected using the electronic medical record. Stricture size and characteristics were determined by retrograde pyelogram and contrast CT. All patients underwent right open appendicular interposition, appendix along with mesoappendix was separated from caecum, spatulated over antimesenteric border and anastomosed in anti-peristaltic fashion to ureter. Postoperatively parameters such as post-op hydronephrosis, re-intervention, post op creatinine, length of hospital stay were evaluated. Results: Five patients underwent right open appendiceal interposition. Mean age of the patients was 35 yrs. Average length of stricture was 5.4 cm. One patient had B/L ureteric stricture. Median follow up was 17 months. All patients had minimal hydronephrosis postoperatively. Out of the five patients one patient had to undergo reintervention. Average index creatinine was 1.105, average postoperative creatinine was 0.8. Average length of hospital stay was 14.5 days. 8/26 stent was placed in all except one patient in whom 6/26 stent was placed. Conclusions: Appendicular interposition is a safe and feasible option in segmental replacement of right sided upper and mid ureteric strictures. It is associated with minimal gastrointestinal morbidities and medium outcomes of renal preservation were good. A large multicentre trial is required to further establish this technique.

1.2.2. MP-02.02: Erection Function and Bother in Transgender Women Taking Gender Affirming Hormone Therapy and After Pre-Vaginoplasty Bilateral Orchiectomy

• Dadashian E ¹, Sandhu S ¹, Mallavarapu S ¹, Stelmar J ², Smith S ¹ and Garcia M ¹

¹ 

Cedars-Sinai Medical Center, Los Angeles, United States

² 

University of California San Diego School of Medicine, San Diego, United States

Abstract: Introduction and Objectives: Gender-affirming (GA) hormone therapy (GAHT) and bilateral orchiectomy (GABO) reduce gender dysphoria in transgender women (TW). A key source of dysphoria are erections. No studies describe erectile function (EF) among TW pre-vaginoplasty. We aimed to: (1) Evaluate EF in TW only taking GAHT >6 months, and GAHT+ >6 months post-GABO; (2) Determine the incidence of erections among TW based upon using their penis for sexual activity; (3) Query interest for any treatment to reduce/eliminate erections pre-vaginoplasty. Materials and Methods: Pre-vaginoplasty TW on GAHT were surveyed anonymously. Participants were grouped based on GABO status. We queried EF using the Sexual Health Inventory for Men (SHIM) questionnaire pre-GAHT, >6 months on GAHT, and >6 months post-GABO. We also queried the incidence of any erections in these three states, and, whether patients would undergo a procedure to reduce/eliminate erections. Results: 50 participants participated (29 GAHT-only; 21 GAHT + GABO). Median age was 36.5 years (IQR 23.8 years) and median years on GAHT was 5 years (IQR 5 years). 35/50 (70%) reported they do not use their penis for sexual activity. TW on GAHT and GAHT + GABO showed reduced SHIM scores, with lowest scores in TW not using their penis for sex (Figure 1a). Spontaneous erections were significantly reduced in GAHT + GABO women not using their penis during sex, but both groups reported high incidence of erections with sexual arousal and activity (b). The majority of TW showed a high interest in any procedure which could reduce/eliminate their erections (c). Conclusions: Our study is the first to show that GAHT reduces SHIM scores, with greater reductions in TW who do not use their penis for sexual activity. GAHT + GABO significantly reduced spontaneous erections vs. GAHT, but did not impact erections with sexual arousal/activity. The majority of women reported an interest in surgically reducing/eliminating their erections. Further study with larger numbers is warranted.

1.2.3. MP-02.03: Failed Hypospadias Repair in Adulthood: Transitional Urology

• Kojovic V, Marjanovic M, Ilic P, Cvetinovic A, Cvetinovic S and Cico E
• Institute for Health Protection of Mother and Child of Serbia ‘Dr Vukan Cupic’, Belgrade, Serbia

Abstract: Introduction and Objectives: The exact incidence of failed hypospadias repair in adult patients is unknown, but the number of cases is increasing rapidly. Our study aims to evaluate the most common issues in adult patients who require additional surgical treatment due to failed primary hypospadias repair. Materials and Methods: The study evaluated 57 patients who had undergone a hypospadias repair in childhood and additional surgery in adulthood between January 2015 and January 2024. The research recorded the most common complications, the number of surgical procedures performed, and the duration between childhood and adulthood surgery. Follow-up evaluations were conducted one, three, and six months after the surgery and then annually. Results: Fifty-seven patients with a mean age of 26 years were treated, with 49 (86%) undergoing one-stage repair and 8 (14%) receiving staged repairs. The most common reasons for surgical repair were urethral stricture in 8 (14%) patients, failed urethroplasty with abnormal meatal position in 10 (17.5%) patients, residual curvature or deformity in 10 (17.5%) patients, and a combination of several complications in 29 (51%) patients. Buccal mucosa graft (BMG), penile skin flap, or a combination of BMG and skin flap were used for urethral repair. Plication procedures were used to correct penile curvature and deformities. The mean interval between the last surgical procedure in childhood and the definitive correction in adulthood was 16 years. Among the 57 patients, 25 (43.9%) underwent one surgical procedure in childhood, while the remaining 32 (56.1%) underwent two or more. The mean number of operations required for final repair was 4. The mean postoperative follow-up period was 18 months. The overall successful outcome was achieved in 52 (91.2%) patients, while 5 (8.8%) patients required additional procedures to achieve satisfactory results. Conclusions: Surgical treatment of failed hypospadias repair is challenging due to the poor quality of available tissue and excessive scar formation. Regular and long-term follow-up after primary repair is crucial to identify and treat potential complications promptly. Due to the complexity of multiple surgeries and possible severe psychosexual consequences, patients with such conditions should be referred to a center of excellence.

1.2.4. MP-02.04: Flap-Related Complications in Musculocutaneous Latissimus Dorsi Free Flap Phalloplasty

• Bencic M ¹, Bizic M ¹, Pusica S ², Djordjevic M ³ and Stojanovic B ¹

¹ 

School of Medicine, University of Belgrade, Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia

² 

Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia

³ 

School of Medicine, University of Belgrade, Belgrade, Serbia and Icahn School of Medicine at Mount Sinai, New York

Abstract: Introduction and Objectives: Total phalloplasty is one of the most challenging tasks in gender affirmation surgery, representing the creation of a neophallus using extragenital tissue. There is not an ideal technique to fulfil all functional and esthetical goals of neophalloplasty. We evaluated flap-related complications after gender affirmation phalloplasty using a musculocutaneous latissimus dorsi-free flap phalloplasty technique (MLD). Materials and Methods: Between January 2007 and December 2022, 180 transmen, with the mean age of 23 years (18–53 years) underwent total phalloplasty using latissimus dorsi free flap technique. The data about perioperative flap-related complications were obtained from medical records. Results: The mean follow-up period was 82 months (ranged from 12 to 190 months). Neophalloplasty with MLD flap was a primary procedure in 131 (72.8%) patients, while secondary operation after metoidioplasty was done in 49 (27.2%) patients. The average length and girth of the neophallus was 14.3 cm (ranged from 12 to 18 cm) and 12.2 cm (ranged from 12 to 14.5 cm), respectively. In the early postoperative period, 6 (3.3%) patients had flap-related complications. There were three partial and three total fap necrosis. Partial necrosis was limited to the distal and lateral parts of the neophallus and healed spontaneously in two cases with minimal loss of length, while in one case skin graft was used to cover the defect. In three patients with total necrosis due to vein thrombosis, a new phalloplasty was performed using an anterolateral thigh flap or latissimus dorsi flap from the opposite side with a satisfactory outcome. One case of total necrosis occurred on fifth postoperative day. Conclusions: Total neophalloplasty with musculocutaneous latissimus dorsi-free flap is a safe and feasible option in gender affirmation surgery. A low flap loss rate with a good phallus size and volume presents a good solution for achieving a good esthetical and functional outcome.

1.2.5. MP-02.05: Identifying Stricture Urethra Using Machine Learning: A Proof of Concept Evaluation of Convolutional Neural Network Model

• Lekkalaala U and P A
• Sri Satya Sai Institute of Higher Medical Sciences, Puttaparthi, India

Abstract: Introduction and Objectives: Urethral stricture disease is a prevalent ailment that can be quite debilitating. Recurrence of strictures following urethrotomy or dilation is a common occurrence, with the effectiveness of treatment influenced by factors such as the length and location of the stricture. The primary focus of medical AI research and development is to leverage the capabilities of AI to assist in the diagnosis, prediction, treatment, and overall management of patient care. This study puts forth a technological framework that utilizes artificial intelligence in improving the precision and effectiveness to identify urethral stricture using the retrograde urethrogram (RUG) images. Materials and Methods: A total number of 346 RUG data set of patients who underwent treatment at our institute from the year 2014 to 2023 was reviewed. Among these 168 cases were stricture positive and 178 cases were negative. Data splitting 70–20–10%. A total of 242 cases were selected for training (118 stricture positive, 124 negative) and 69 (34 positives, 35 negatives) were selected for validation. Test data 35 (16 positive, 19 negative). Results: We used Keras high level API of the TensorFlow platform. AI model detecting stricture in RUG images and site of stricture. Results of segmentation model Validation: Dice coeff. = 89.35%, Iou = 80.78%, accuracy = 99.51% precision: 93.16 recall: 90.80 Test: Dice coeff. =87.17%, Iou = 77.26%, loss = 0.215, accuracy = 99.47%, precision: 88.45, recall: 87.58. Results of classification model Validation: Dice coeff. = 90.91%, Test: Dice coeff. =87.88%, precision: 84.429, recall: 81.21. Cross validation = 82.48%. Conclusions: Our study investigates the contemporary use of artificial intelligence in the diagnosis of stricture urethra, examining the types of AI algorithms employed, the accuracy of these models, and the potential benefits and limitations of their application. The study findings indicate that AI shows promise in enhancing the accuracy and efficiency of stricture urethra diagnosis. However, additional research is required to fine-tune algorithms and verify their effectiveness in real-world clinical settings.

1.2.6. MP-02.06: Impact of Vaginectomy Technique on the Safety and Outcomes of Transmasculine Gender Affirming Surgery

• Ho P ¹, Schmidt-Beuchat E ¹, Sljivich M ¹, Nyein E ¹, Djordjevic M ², Purohit R ¹ and Stojanovic B ²

¹ 

Mount Sinai Hospital, New York, United States

² 

University of Belgrade, Belgrade, Serbia

Abstract: Introduction and Objectives: The optimal approach for vaginectomy in transmasculine surgery has not been well-defined. One common technique is to perform sharp excision of the vaginal epithelium, whereas another includes complete electrocautery fulguration of the vaginal mucosa prior to vaginal closure. An incomplete vaginectomy risks various post-operative complications including formation of vagino-cutaneous fistulae, urinary fistula, or persistence of vaginal remnant. This study aims to compare the outcomes of both vaginectomy approaches in patients undergoing transmasculine surgery. Materials and Methods: We performed a retrospective review of patients who underwent transmasculine surgery from 2021 to 2023 at a single institution. All had concomitant metoidioplasty with vaginectomy, with or without a simultaneous hysterectomy. Based on vaginectomy technique, the incidence of post-operative vagino-cutaneous fistulae, recurrence of vaginal remnants, and rates of re-operation were measured. Estimated blood loss (EBL) and operating room (OR) time were also compared between the two techniques. Results: Of the 70 patients included in this study, 50 patients (71%) had vaginectomy by epithelial excision and 20 patients (29%) by fulguration of the vaginal mucosa. The rates of post-operative vagino-cutaneous fistulae were identical (10%) between the two cohorts. In the epithelial excision group, 4 patients (8%) had recurrence of a vaginal remnant compared to one patient (5%) in the fulguration group (p = 0.67). One patient (2%) in the epithelial excision group had to undergo repeat vaginectomy compared to one patient (5%) in the fulguration group (p = 0.50). In patients undergoing vaginectomy without hysterectomy, mean EBL was 254 mL in the epithelial excision group compared to 88 mL in the fulguration group (p < 0.01). For the same patients without hysterectomy, mean OR time was 290 min in the epithelial excision group compared to 183 min in the fulguration group (p = <0.01). Conclusions: Vaginectomy technique is not standardized in transmasculine surgery. Our data suggest that a complete fulguration approach, when compared to an epithelial excision approach, reduces blood loss and OR time without compromising rates of vagino-cutaneous fistulae or vaginal remnants requiring re-operation.

1.2.7. MP-02.07: Long-Term Outcomes After Surgical Repair of Peyronie’s Disease

• Bencic M ¹, Bizic M ¹, Pusica S ², Djordjevic M ³ and Stojanovic B ¹

¹ 

School of Medicine, University of Belgrade, Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia

² 

Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia

³ 

School of Medicine, University of Belgrade, Belgrade, Serbia and Icahn School of Medicine at Mount Sinai, New York

Abstract: Introduction and Objectives: Peyronie’s disease is a condition where the penis becomes deformed and shortened. Surgical repair which includes penile lengthening with incision/excision of fibrotic plaque and grafting is reserved for patients with a curvature greater than 60 degrees, shortened penis, and complex hourglass deformity. The aim of the study is to evaluate the surgical outcomes and patient satisfaction following repair. Materials and Methods: From January 2013 until January 2018, a total of 68 patients who underwent surgical correction of deformity were retrospectively analyzed. All patients underwent corporoplasty, plaque incision, and defect grafting with a bovine pericardium patch. The surgical treatment data were collected from medical records and photo documentation. We analyzed the functional outcomes of surgical treatments for penis size and deformities. Erectile function was analyzed with the International Index of Erectile Function (IIEF) questionnaire. Results: The mean follow-up period was 7.2 years (5 to 10 years). In long-term follow-up, two patients (2.9%) had moderate curvature recurrence, while complications in subcutaneous deformities or major length reduction were not observed. Erectile dysfunction occurred 6 months after surgery in one case, and penile prosthesis was implanted. A total of 85% of patients reported satisfaction with the surgical outcome. Erectile dysfunction was satisfactory in 25 patients who accepted to answer the IIEF questionnaire, with the mean IIEF score of 27.4. Conclusions: Corporoplasty involving plaque incision and bovine pericardium grafting is a viable option for treatment of Peyronie’s disease with satisfactory long-term outcomes.

1.2.8. MP-02.08: Mucosal Sparing Augmented Non-Transecting Urethroplasty (msANTA): Game Changer in the Management of Non Traumatic Bulbar Urethral Strictures

• Bafnafna S, Jain N, Ragavan N, Ganesan T and V K
• Apollo Hospitals Chennai, Chennai, India

Abstract: Introduction and Objectives: Urethroplasty has progressed towards minimal transection and more tissue sparing to preserve vascular supply to the urethra and spongiosum. Our technique aims to preserve the native vascularity of the urethral mucosa by enlarging the native urethral plate with direct anastomosis at the level of the stricture and without the need for resection in bulbar urethral strictures. To report our experience of msANTA for non-traumatic bulbar urethral strictures. Materials and Methods: Between March 2022 and December 2023, patients with near obliterated long (>4 cm) bulbar strictures, who required msANTA were considered for this study. The bulbar urethra was accessed through a perineal incision, one-sided urethral dissection was done. Grafts were harvested from cheek, lingual, or preputial skin and quilted over the corpora to reconstruct the dorsal plate of the neourethra. The narrowest segment of the ventral wall of the urethra up to 15 mm was reconstructed and widened without transecting mucosa. Any need for instrumentation after surgery was defined as the primary failure. Obstructive symptoms or maximum flow rate (Qmax) below 10 mL/s, with or without a need for instrumentation, was defined as a secondary failure. Results: Our results were limited to a cohort of 128 patients. The median (interquartile range [IQR]) age at surgery was 48.3 (31–66.3) years. The median (IQR) stricture length and length of the most significant narrowest portion of the stricture were 4 (3.5–6.5) cm and 1 (08–1.1) cm, respectively. The median (IQR) operative time was 95.5 (88.2–123.2) min. The median (IQR) follow-up was 10.5 (6.3–13.4) months. The median Qmax at catheter removal was 23 mL/min (IQR 21.5–26 mL/min). After surgery, no perioperative complication of Clavien–Dindo Grade ≥III was recorded in the subsequent 30 postoperative days. To date, no patient has undergone redo surgery. The USS PROM questionnaire was used in all patients and 84% of patients reported post micturition dribble. Success was achieved in 87.5% of patients. Conclusions: Our technique doesn’t increase morbidity in the patient and will improve urethral plate caliber and improve post-surgery results. This is a non-inferior technique and can be done by any reconstructive urologist in his urethroplasty surgeries.

1.2.9. MP-02.09: Narcotic Free Perineal and Urethral Surgery

• Damm T, Hudson C and Monn M
• Southern Illinois University School of Medicine, Springfield, United States

Abstract: Introduction and Objectives: Reducing opioid use following surgeries is gaining traction as a means to address the opioid epidemic. The objective of this study was to evaluate the impact of transitioning to no narcotics following perineal and urethral surgeries on patient outcomes and interactions with clinic staff. Materials and Methods: Beginning 1/1/2024, all male patients undergoing urethral or perineal surgeries by a single surgeon were counseled and granted no narcotics following surgery. Prior to this shift in practice, patients were given between six and ten tablets of oxycodone 5 mg and counseled to use these along with scheduled acetaminophen. Solifenacin 5 mg daily was provided to all patients. Diazepam 5 mg nightly was offered to males with erectile function. A retrospective review was performed to compare patients after 1/1/2024 to the patients in five months previously. Patients were excluded if they had less than four weeks of follow-up. Demographics, post-operative medications, number of calls to the clinic, and the reason for calls to the clinic were examined. Fisher’s exact test and unpaired T-test were used to compare between the cohorts. IRB exempt status was granted for conduct of this study. Results: Twenty patients were in the no narcotics cohort compared with 21 in the pre-intervention group. Full details including surgeries, use of buccal grafts, prescription of valium, and calls to the clinic are available in Table 1. The most common reason for calling the clinic was to address bladder spasms. One patient in the narcotics cohort called the clinic to request additional pain medication. One patient in the no narcotics group had an adverse event requiring a trip to the emergency room to stop a venous bleed from the buccal graft harvest site after he restarted anticoagulation and antiplatelet therapy. Conclusions: A no-narcotic policy is achievable for perineal and urethral surgery when appropriate adjunct medications and counseling is provided.

1.2.10. MP-02.10: Outcome Analysis and Management Algorithm of Obliterated Nontraumatic Urethral Strictures

• Kore R
• Warana Institute of Uro-Surgery, Kolhapur, India

Abstract: Introduction and Objectives: The obliterated strictures in the anterior urethra are not uncommon. We describe a case series of 45 patients of obliterated strictures, their outcome analysis and postulate a management algorithm. Materials and Methods: Urethral reconstruction was done in all 45 patients from February 2015 to March 2019. They were evaluated with symptom score, uroflowmetry, post-void residue (PVR) and urethrogram. The lumen size, length of stricture, and degree of spongiofibrosis were assessed. The strictures were subclassified into nearly obliterated strictures (NOS) and completely obliterated strictures (COS) based on the urethral lumen size. A silicon catheter was left in place for 4 to 6 weeks, followed by check urethrogram. The patients were followed initially quarterly, and yearly after. Any intervention needed was considered a failure. Results: The average age was 49 years (range 31 to 68). The etiology was iatrogenic in 30 (67%) and LS in 15 (33%). There were 12 (27%) NOS and 33 (73%) COS. Seven management categories are described in Table 1. A management algorithm is shown in Figure 1. The average follow-up was 34 months (range 12 to 58). Overall average symptom score, flow rate, and PVR improved from 21 to 7, 6 mL/s to 19 mL/s, and 210 mL to 20 mL, respectively. Complications and recurrences were seen in 6 (13%) and 7 (16%) patients, respectively. Conclusions: Obliterated strictures are complex and challenging. A systematic approach, as described, may be taken to manage them for a successful outcome with a reasonable complication and recurrence rate.

1.2.11. MP-02.11: Perineal Urethrostomy as a Feasible and Effective Urinary Diversion for the Urethral Stricture Porcine Model

• Landerer E ¹, Gomez R ², Velarde L ², Lillo F ³ and Paredes R ³

¹ 

Clínica Insida; UNAB, Santiago, Chile

² 

Hospital Del Trabajador Santiago; Clínica Indisa, Santiago, Chile

³ 

UNAB, Viña Del Mar, Chile

Abstract: Introduction and Objectives: Establishment of a reliable animal model is essential for the study of urethral stricture disease. While in the process of developing a porcine model, we realized that obtaining adequate urinary diversion is problematic. Options like indwelling urethral catheter, catheter suprapubic cystostomy or cutaneous vesicostomy were not satisfactory, so a perineal urethrostomy was constructed. We describe our results with this diversion, which to our knowledge has not been reported before in the porcine model. Materials and Methods: Four male adult swine were diverted using a perineal urethrostomy as part of a urethral stricture study. The animals were anesthetized and kept in supine position. Normal urethral anatomy was revealed by retrograde urethrogram and cystoscopy. Parallel to the team working in the urethral stricture (US) procedure, a second team performed an arcuate skin incision at the perineum, exposing the bulbar urethra caudal to the distal flexure, between both ischial bones. A 2 cm ventral longitudinal urethrotomy was performed and the urethra was sutured to the skin with interrupted 4/0 Monocryl^® stitches. No catheter was used and the animals were maintained in standard environmental conditions for up to 4 weeks. Results: The average surgical time was 69 min (55–101). No immediate complications occurred, and all animals voided normally between 1 and 3 h after recovery from anesthesia. No medical or surgical complications were recorded in the follow up period. This urinary diversion allowed for the conduction of the baseline urethral stricture study. Conclusions: Perineal urethrostomy resulted as a safe, technically feasible and efficient catheter free urinary diversion for the urethral stricture porcine model.

1.2.12. MP-02.12: Quality of Life and Sexual Satisfaction After Metoidioplasty in Transmen

• Stojanovic B ¹, Bizic M ¹, Bencic M ¹ and Djordjevic M ²

¹ 

School of Medicine, University of Belgrade, Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia

² 

School of Medicine, University of Belgrade, Belgrade, Serbia and Icahn School of Medicine at Mount Sinai, New York

Abstract: Introduction and Objectives: The surgical goals of metoidioplasty are male appearance of genitalia, with good cosmetic and functional outcome, achieved in a one-stage surgery. However, the ultimate objectives are patients’ satisfaction and improved quality of life, which we evaluated in this study. Materials and Methods: Between December 2016 and December 2022, 243 transmen underwent one-stage metoidioplasty with urethral lengthening. Out of them, 165 transmen with the mean age of 28 years (ranged from 18 to 58 years) participated in the study. Two questionnaires were used. One is designed for transmen in our center and includes 17 questions to evaluate surgical and psychosexual outcomes. A WHOQOL-BREF was used preoperatively and postoperatively, measuring 4 health domains (physical, psychological, social relationship and environment). Results: Follow-up ranged from 12 to 84 months. Length of the neophallus ranged from 4.8 cm to 10 cm. Urethral fistula and stricture occurred in 20 (12%) and 4 (2.5%) cases, respectively. Other complications included testicular implant rejection in 5 (3%), testicular displacement in 7 (4.25%) and vaginal remnant in 18 (11%) cases. Erogenous sensitivity and quality of erection are preserved in all cases, and only 1 patient reported possibility for penetrative sexual intercourse. Regarding postoperative overall sexual satisfaction, 115 transmen (69.7%) are very satisfied, 37 (22.4%) somewhat satisfied, and 13 (7.9%) dissatisfied. Grading overall sexual satisfaction from 1 to 5, mean postoperative grade of 3.64 was significantly higher than preoperative of 2.21. Results of WHOQOL-BREF revealed improvement in postoperative compared to preoperative scores in all domains: I—80.4:80.2; II—70.5:57.5; III—72.2:62.3; IV—79.0:74.0. Statistically significant difference (p < 0.001) is determined in every domain comparing preoperative and postoperative scores, and the biggest improvement is registered in domain of psychological health. There were no regrets after surgery. From 165 transmen, 28 (17%) requested total phalloplasty after metoidioplasty, wishing to achieve more natural male appearance and better sexual function. Conclusions: One-stage metoidioplasty has very good aesthetic and functional outcomes, with low rate of complications. Sexual satisfaction and quality of life are significantly improved after surgery. However, up to 20% of transmen after metoidioplasty require total phalloplasty to improve sexual function.

1.2.13. MP-02.13: Specificity of Static MR-Urethrography for Assessment of Urethral Strictures Length and Spongiofibrosis Grade

• Bogdanov A ¹, Katibov M ², Goncharuk D ¹, Veliev E ¹, Sokolov A ¹, Ivkin E ¹, Akhverdieva G ³, Tulinov M ¹, Vardanyan V ⁴, Loran O ⁵ and Pushkar D ¹

¹ 

Moscow Urological Center, S.P. Botkin’s State Clinical Hospital, Moscow, Russia

² 

Makhachkala City Clinical Hospital, Makhachkala, Russia

³ 

N.N. Blokhin National Research Center of Oncology, Moscow, Russia

⁴ 

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

⁵ 

Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Abstract: Introduction and Objectives: The fundamental factor for ensuring the effectiveness of anterior urethral stricture correction is to obtain the information about its length and degree of spongiofibrosis, which allows us to choose the optimal treatment tactics. From this point of view, magnetic resonance imaging (MRI) has greater sensitivity and specificity than the currently available methods of diagnosing this disease. Thus, the aim of the study is to demonstrate the capabilities of MRI in the diagnosis of bulbous urethral stricture length and spongiofibrosis degree. Materials and Methods: The prospective research included 6 men aged 36 to 64 years with bulbous urethral strictures of various etiologies, that underwent the non-transecting anastomotic urethroplasty without complete intersection of the spongiosal body using the ventral technique by one surgeon. Before the operation all patients were examined with standard, MRI urethrography. Stricture length obtained with standard urethrography and MRI were compared with intraoperative data. Among other the extent of spongiofibrosis by MRI urethrography was compared with intraoperative data too. Results: The average stricture length according to retrograde urethrography—11.5 ± 6.3 mm, by MRI urethrography data was 17.8 ± 10.9 mm, and during intraoperative evaluation—16.7 ± 9.1 mm. Comparison of the mean of stricture length determined by MRI was matchable to the results of intraoperative measurement (p = 0.085). The results obtained by retrograde urethrography revealed a significant difference with intraoperative measurements (p = 0.028). The mean MRI spongiofibrosis length was 15.8 ± 13.6 mm and intraoperative measurement was 16.7 ± 12.9 mm. When comparing the mean values of spongiofibrosis length according to MRI and intraoperative data, no significant differences were found (p = 0.092). Conclusions: Usage of MRI to obtain key preoperative information on the nature of urethral stricture is superior to traditionally used diagnostic approaches, providing more accurate and valuable information: stricture length, the extent of scarring in the spongy body very close to intraoperative data. Taking into account the obtained data of the study, noting the objective advantages of MRI diagnostics in the form of absence of ionizing radiation and independence on the operator, this technique is promising for further study and wider application in urethral surgery.

1.2.14. MP-02.14: Testicular Implant Complications After Transmasculine Gender Affirming Surgery

• Ho P ¹, Schmidt-Beuchat E ¹, Sljivich M ¹, Nyein E ¹, Djordjevic M ², Purohit R ¹ and Stojanovic B ²

¹ 

Mount Sinai Hospital, New York, United States

² 

University of Belgrade, Belgrade, Serbia

Abstract: Introduction and Objectives: Complications from testicular implantation in transgender men can cause significant distress, repeat visits to the emergency department, and require reoperation for explantation. Outcomes and risk factors for testicular implants have not been well described in the literature. This study compares patient and surgery specific factors, including implant size, with complications from testicular prosthesis implantation in transgender men. Materials and Methods: We performed a retrospective review of patients who underwent metoidioplasty with implantation of testicular prostheses at a single institution. Testicular prosthesis insertion was standardized across patients with placement through incisions at the top of the labia majora or medially during metoidioplasty. Rates of complications, including infection, erosion, migration, and pain requiring removal was compared with patient factors, including body mass index (BMI), smoking status, and implant size. Logistic regression was used to determine if these factors were predictive of removal of testicular implants. Results: Of the 116 testicular implants, 14 implants (12%) had a complication requiring removal. The most common reason for post-operative removal was erosion of the prosthesis, which occurred in 6 instances (5%). Migration was a relatively frequent complaint, with 10% of patients noting relocation of one or more of their prostheses. However, only 4 implants (3%) ultimately underwent reoperation for migration. Four implants (3%) caused significant enough pain to require reoperation. On univariable logistic regression of BMI, age, smoking status, and immunocompromised state on post-operative removal of prosthesis, no factor was found to be a significant predictor of removal. Increasing implant size was not associated with an increased likelihood of removal. Conclusions: Complications after implantation of testicular prostheses in transgender men are not uncommon events. Although there appears to be a growing trend toward smaller prostheses in the literature, our data suggest that implant size is not a significant predictor of complications requiring prosthetic removal.

1.2.15. MP-02.15: The Trials and Tribulations of a Combined Uro-Plastic Clinic

• Omar A, Shokrollahi K and Floyd M
• St Helens and Knowsley Teaching Hospital NHS Trust, Prescot, United Kingdom

Abstract: Introduction and Objectives: In the comorbid patient with severe genito-perineal skin conditions treatment is challenging. Obesity, poor skin quality and erratic diabetic control causing BXO, hidradenitis suppirivata and penoscrotal ptosis require elaborate staged reconstruction techniques following detailed counselling and weight management. Improving quality of life, maintaining sexual function and improved cosmesis are important concerns. In 2019 a new bimonthly dedicated combined uro-plastic clinic was started in Whiston Hospital specifically aimed at treating such conditions. Materials and Methods: The purpose of the study was to analyse the workload and case mix of the uro-plastic clinic from 2019 till 2023. The referral source and nature of pathological condition were recorded. Additionally, the use of medical photography and recording of baseline BMI where applicable were recorded. Results: A total of 72 patients were seen in the uro-plastic clinic over 4 years with the following conditions: buried phallus (25), genital hidradenitis suppurativa (10), scrotal lymphoedema (5), penoscrotal webb (3), post Fournier’s defect (3), perineal pyroderma gangrenosum (1), genital BXO (13), post circumcision concerns (10) and penile paraffinoma (3). All patients had baseline BMI scores recorded and baseline medical photography performed. A total of 35 patients had been referred from other hospitals. Those who had undergone joint procedures were satisfied with their outcome. Conclusions: For some genital conditions such as hidradenitis suppurativa and buried penis there is no specific standard of care and expertise is limited nationally. Consequently, the formation of a joint clinic involving a Consultant Plastic Surgeon, Consultant Reconstructive Urological Surgeon and specialist nurse has led to increased referrals and optimization of care. The future need for bariatric surgery input, dietician advice in addition to psychological support is anticipated. Managing patient expectations, use of dedicated questionnaires, restoration of functional capacity and cosmetic appearance remain important concerns when treating these complex patients.

1.3. Moderated Oral ePoster Session 03: Pediatric Urology, Infections and Inflammatory Diseases, Basic Science—Benign Disease

• Thursday, October 24
• 0800–0900

1.3.1. MP-03.01: Anti-Inflammatory Effect of Hippophae Rhamnoides in a HCL-Induced Interstitial Cystitis/Bladder Pain Syndrome Model

• Yoon H ¹ and Yoon H ²

¹ 

Ewha Womans University Mokdong Hospital, Seoul, South Korea

² 

Department of Urology, Ewha Womans University, Seoul, South Korea

Abstract: Introduction and Objectives: The mechanism of IC/BPS is unclear but some studies suggest oxidant stress is related to IC/BPS. Hippophae rhamnoides L. (sea buckthorn, SB) contains various compounds with antioxidant effect. This study aimed to evaluate the anti-inflammatory effect of sea buckthorn using IC/BPS rat model. Materials and Methods: Twenty 8-week-old female Sprague-Dawley rats were instilled with hydrochloric acid into the bladder to make IC/BPS model. Daily oral feeding of distilled water (DW, control, n = 4) or concentrated SB (n = 8) or pentosan polysulfate (PPS, n = 8) was done to 3 groups. Histologic inflammation grade (hematoxylin-eosin staining) and number of mast cells per square millimeter (toluidine blue staining) of bladder tissue samples were compared among groups. Area of fibrotic change (Masson trichrome staining) and apoptosis (Tunel staining) were also compared. Results: Compared with the control group, the SB group and PPS group showed reduced edema score (5.25 ± 0.96 vs. 2.25 ± 0.46 vs. 2.50 ± 0.54, p = 0.004, 0.005, respectively) and smaller number of mast cells (12.5 ± 3.6 vs. 6.8 ± 1.9 vs. 6.6 ± 1.8, p = 0.010, 0.002, respectively), ratio of fibrotic submucosal tissue (63.9 ± 7.0 vs. 43.6 ± 9.9 vs. 40.5 ± 5.2, p < 0.001, <0.001, respectively) and ratio of apoptotic nucleus (40.7 ± 11.7 vs. 7.7 ± 6.5 vs. 5.1 ± 4.9, p < 0.001, < 0.001, respectively). Significant difference between SB group and PPS group was not seen. Conclusions: Sea buckthorn showed comparable anti-inflammatory effect with PPS on IC/BPS model.

1.3.2. MP-03.02: The Mechanism of Big Conductance Voltage- and Ca²⁺-Activated K⁺ Channel on the Phenotypic Change of Bladder Smooth Muscle Cells Under Mechanical Stress

• He Q and Zhuo H
• The Third People’s Hospital of Chengdu, Southwest Jiaotong University, Chengdu, China

Abstract: Introduction and Objectives: In order to explore the role of large-conductance voltage- and calcium-activated potassium channels (BK channels) in the phenotypic changes of bladder smooth muscle cells under biological stress, we investigated the effects of biological stress and BK channel on the expression of human bladder smooth muscle cells (HBSMCs) contraction-related proteins and related mechanisms. Materials and Methods: HBSMCs were seeded into a cell culture flask and subjected to 200 cmH₂O hydrostatic pressure for 0 h (control), 2 h, 6 h, or 24 h. DNA microarrays were used to explore the genes expression of cell contraction associated proteins and BK channels. The changes of transcription and translation were confirmed by quantitative real-time polymerase chain reaction (RT-PCR) and western blot (WB). Specificity of BK channels was determined with inhibitor Paxilline and agonist NS1619. In addition, the Cell Contraction Assay detected the cell contraction function. Results: In DNA microarrays, genes of cell contraction associated proteins and BK channels were remarkably induced under hydrostatic pressure. Both RT-PCR and WB determined that the expression of contraction associated proteins (α-Actin, SM22α, Myosin Heavy Chain and Calponin) and BK channel subunits (α, β1, and β4) was highest in 200 cmH₂O pressure for 2 h. The hydrostatic pressure significantly promoted the contraction of HBSMCs, and the cell contraction index was highest in 2 h group (66% ± 2.82%, p < 0.0001). Paxilline increased the expression of α-Actin (RT-PCR: p = 0.0089; WB: p < 0.0001), Myosin Heavy Chain (RT-PCR: p = 0.0002; WB: p < 0.0001) and Calponin (RT-PCR: p = 0.0002; WB: p < 0.0001), but NS1619 lacked this facilitation effect. However, Cell Contraction Assay determined NS1619 inhibited contraction of HBSMCs under hydrostatic pressure (cell contraction index = 53.67% ± 2.82%, p = 0.045). Conclusions: Hydrostatic pressure enhanced the contraction function of HBSMCs. The functional status of BK channels can also affect cell contraction function, indicating that BK channels are expected to be a therapeutic target for BOO.

1.3.3. MP-03.03: Antibacterial Prophylaxis with Fosfomycin at the Time of the Urethral Catheter Removal After Radical Prostatectomy (Prospective Randomized Trial)

• Sokolov E, Metelev A, Aliev E and Veliev E
• Moscow Urological Center, S.P. Botkin’s State Hospital, Moscow, Russia

Abstract: Introduction and Objectives: We evaluated the effectiveness of antibacterial prophylaxis (ABP) using fosfomycin during the removal of a urethral catheter after radical prostatectomy in relation to the development of episodes of urinary tract infection (UTI), severity of leukocyturia and bacteriuria, as well as the severity of lower urinary tract symptoms (LUTS). Materials and Methods: A single-center, non-blind, prospective, randomized controlled trial was conducted. The main group included 38 patients, and the control group included 35 patients. Patients of the 1st group (study) took two doses of fosfomycin 3 g: in the evening on the day of catheter removal (the first dose) and 48 h after catheter removal (the second dose); patients of the 2nd group (control) did not receive any ABP before or after urethral catheter removal. The endpoints of the study were confirmed clinical episodes of UTI within 1 month after catheter removal, laboratory results (leukocyturia and bacteriuria in urinalysis/urine culture) and severity of LUTS in accordance with the IPSS questionnaire. Results: In the control group, UTI developed in 6 (17.1%) patients, in the study group—in 1 (2.6%) patient (p = 0.032). Leukocyturia and bacteriuria in the urinalysis were significantly less common in the group receiving ABP with fosfomycin after catheter removal: 18.4% and 48.6%, respectively (p = 0.006). Positive urine culture was observed in 7.9% in the study group and in 25.7% in the control group (p = 0.035). Four weeks after removal of the urethral catheter, the average IPSS score was significantly higher in the group that did not receive ABP (13.2 and 9.5; p = 0.002). No cases of allergic reaction and no cases of pseudomembranous colitis associated with C. difficile were observed in both groups. Conclusions: Antibacterial prophylaxis using two oral doses of fosfomycin 3 g on the day and 48 h after urethral catheter removal after radical prostatectomy appears to be an effective scheme that reduces the incidence of UTI and the severity of LUTS, and is characterized by a minimal risk of adverse events. It is necessary to conduct further research and develop uniform recommendations for ABP in urological interventions requiring prolonged bladder catheterization.

1.3.4. MP-03.04: Does the Brain Weep? Post Hysterectomy Leak PV May Not Always Be Urine!

• Hegde A
• Father Muller Medical College, Mangalore, India

Abstract: Introduction and Objectives: Post hysterectomy urine leaks secondary to urinary fistulae are known and commonly encountered in practice. I present a unique experience with a seemingly common problem. Materials and Methods: A 65-year-old lady presented to the outpatient department with recent onset of leak per vagina. There was no stress or urge incontinence. She had on and off fever, nausea and was culture positive, treated outisde for UTI. Past history was positive for a laparoscopic hysterectomy and salphingo oophorectomy done 3 months back. A VP shunt for aqueductal stenosis was done 8 years before. She underwent a CT IVU and a collection with suspected communication with the vaginal vault was seen at the terminal end of the VP shunt. A dye test confirmed leak from the shunt and the shunt was removed by the neurosurgery team following which she had no further complaints. Conclusions: While it is common to find post hysterectomy urinary fistulae, presence of unusual symptoms should alert the clinician to possibility of alternate diagnoses outside the realm of urology sometimes. Complete, unbiased evaluation of the patient considering the previous history is important to reach the final diagnosis.

1.3.5. MP-03.05: Features of Infection Prevention in the Surgical Intervention Area Prior to Radical Cystectomy: A Systematic Review and Meta-Analysis

• Berkut M, Zaozersky O and Nosov A
• FSBI N.N. Petrov NMRC of Oncology MH of Russia, Saint-Petersburg, Russia

Abstract: Introduction and Objectives: The high frequency of postoperative infectious complications (ICs) within 30 days after radical cystectomy (RC) raises questions about the effectiveness of existing antibiotic prophylaxis (AP) recommendations. The aim of this study was to conduct a systematic review and meta-analysis of literature data to assess the impact of different AP approaches on the frequency of ICs. Materials and Methods: The meta-analysis protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO): ID-CRD42023480525. A systematic search of studies published in the last 10 years (November 2013-November 2023) was conducted in PubMed and Cochrane Library by two independent researchers. The final statistical analysis included 7 full-text articles (data from 90,935 patients). The analysis was conducted along three dimensions: comparing the effectiveness of antibiotic prophylaxis duration (24 h or more), the impact of the type of antimicrobial agent, and the application of Enhanced Recovery After Surgery (ERAS) principles on the overall frequency of infectious complications, the development of surgical site infections, and infections of soft tissues and upper urinary tract (UTI). Results: The median overall frequency of infectious complications was 31.78% (23.8%–58.8%), surgical site infections were 16.46% (6.25%–35.41%), and UTI was 25.11% (3.86%–35.7%), including cases leading to urosepsis. The meta-analysis did not reveal a statistically significant influence of antibiotic prophylaxis duration (24 h or more) on the risk of developing infectious complications: for the overall frequency of infectious complications, the risk was OR 1.11 (95% CI 0.92–1.33; p = 0.27), for surgical site infection OR 1 (95% CI 0.87–1.15; p = 0.97), and for UTI OR 0.96 (95% CI 0.84–1.10; p = 0.59). However, the overall frequency of infectious complications was statistically significantly higher in the standard perioperative management group, i.e., without ERAS principles (OR = 3.02 [95% CI 2.07; 4.39], p < 0.001, I² = 93.1%). Conclusions: The results of this study suggest that existing AP may be ineffective in reducing the frequency of ICs within 30 days after RC. Prolonged AP beyond 24 h, as well as the standard regimen, did not show an impact on reducing the risk of infections, emphasizing the need for a revision of clinical recommendations in this area.

1.3.6. MP-03.06: Flexible Cystoscopy for Recurrent Urinary Tract Infections, Is It Necessary? Time to Redefine Indications

• Gaur A, Naushad N and Mahmood T
• University Hospitals of North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, United Kingdom

Abstract: Introduction and Objectives: Flexible cystoscopy (FC) is one of the commonest endoscopic diagnostic tools in use for more than 20 years for a number of urological problems. It is currently recommended for multiple lower urinary tract problems mainly non visible and visible haematuria, LUTS, dysuria in the absence of infections, follow up for bladder cancers, botox to bladder, removal of stents and foreign bodies and also for recurrent UTIs. FC carries 18.18% risk of UTI post procedure in patients where indication is recurrent UTIs. This was proven on prospective audit carried out locally in our department. This study was done to identify the risk of finding bladder cancer in such category. Materials and Methods: Prospectively kept data of all patients who underwent FC for various indications between Jan 2018 till December 2021 was reviewed retrospectively. Data of all patients was reviewed on the hospital clinical portal TrakCare and imaging and urine culture reports were reviewed on ICE. Results: 4431 patients underwent FC for a number of urological problems. In 735/4431 (16.5%) indication was recurrent UTIs. Of these males were 277 and females 458. Mean age was 64.19 ± 16.14, range (19–96 yr). 37/735 (5.03%) were found to have red patch in bladder needing GA cystoscopy and biopsy, none were found to have bladder cancer, only inflammation. 16/735 (2.17%) were found to have urethral stricture, however the uroflowmetry could have suggested that. 1/735 (0.1%) had bladder stone which was also visible on the ultrasound scan. 1/735 (0.1%) patient was found to have low risk bladder tumor in the absence of any visible haematuria, however ultrasound showed some echogenic material in the bladder pre FC. 100/735 (13.6%) had visible haematuria with recurrent UTIs, only one was found to have ureteric TCC with hydronephrosis clearly visible on the CT scan. Conclusions: Risk of finding bladder tumor is minimum in patients with history of recurrent UTIs. Non invasive tests in the form of ultrasound urinary tract, uroflowmetry and if necessary CT urogram with contrast is sufficient in these patients. FC in this category should be considered only if indicated following noninvasive investigations.

1.3.7. MP-03.07: Human Herpesviruses as a Potential Etiology of Nonbacterial Chronic Cystitis and Interstitial Cystitis/Bladder Pain Syndrome

• Kosova I ¹, Gundorova L ², Kolbasov D ², Loran O ¹, Pushkar D ³ and Barsegian V ¹

¹ 

Russian Medical Academy of Continuous Professional Education, Moscow, Russia

² 

Demikhov City Clinical Hospital, Moscow, Russia

³ 

Russian University of Medicine, Moscow, Russia

Abstract: Introduction and Objectives: Despite extensive research in the past, the etiology of nonbacterial chronic cystitis (NCC) and interstitial cystitis/bladder pain syndrome (IC/BPS) is still unclear. Some histological findings on the bladder specimens isolated from patients with NCC and IC/BPS (e.g., focal inflammatory infiltrates and vacuolization of cells) suggest the presence of viral infection. In this study, we aimed to assess the possible role of human herpesviruses in the pathophysiology of NCC and IC/BPS. Local ethics committee approval has been obtained. Materials and Methods: Bladder specimens were obtained from 65 patients with NCC and 10 patients with IC/BPS. These samples were tested for the presence of HSV-1, HSV-2, EBV, and CMV by real-time PCR. Additionally, an immunoassay for anti-EBV antibodies (anti-EA IgG, anti-VCA IgM, anti-VCA IgG, and anti-EBNA IgG) was performed. Results: Human herpesviruses were detected in 41.5% of NCC (n = 27) and 20% of IC (n = 2) by PCR. In NCC bladder specimens were positive for EBV in 26.2% (n = 17), for CMV—in 10.8% (n = 7), and for HSV—in 9.2% (n = 6). The simultaneous presence of 2 or more viruses was found in 6.2% of NCC bladder specimens (n = 4). Serology in NCC patients demonstrated that 83.1% (n = 54) had past EBV infection, 13.8% (n = 9) had primary (new or recent) EBV infection, and 3.1% (n = 2) were susceptible to infection. In IC/BPS bladder specimens were positive for EBV in 1 case and for CMV in 1 case. Serology in IC patients revealed that 90% (n = 9) had past EBV infection and 10% (n = 1) had primary (new or recent) EBV infection. Conclusions: Our study indicates a possible role of human herpesviruses, especially EBV, in the pathogenesis of nonbacterial chronic cystitis. Further research is required to confirm our findings.

1.3.8. MP-03.08: Negative Pressure Wound Treatment for Surgical Site Infection in Oncourology

• Berkut M, Krotov N and Nosov A
• FSBI N.N. Petrov NMRC of Oncology MH of Russia, Saint-Petersburg, Russia

Abstract: Introduction and Objectives: Negative pressure wound therapy (NPWT) is a widely accepted advanced treatment for surgical site infections (SSI), addressing issues such as wound suppuration, postoperative peritonitis, or open abdominal conditions. However, its application in complications arising from oncological surgery lacks substantial evidence. This study aims to evaluate the 30-day outcomes of NPWT in the treatment of SSIs following oncological surgery. Materials and Methods: Conducted as a retrospective cohort study adhering to the STROBE protocol, the research involved 446 patients who underwent radical cystectomy with uroderivation (RC) at the Oncourology department between January 2012 and December 2021. Out of these, 62 cases with complete data were analyzed, divided into two groups: Group A (n = 36) received standard SSI management, while Group B (n = 26) underwent NPWT with VivanoTec^® S042 device in constant negative pressure mode (85–110 mmHg). Data analysis was performed using MS Excel and StatPlus:mac (2022). Results: SSIs were identified in 57 men (91.93%) and 5 women (8.07%), with no significant differences in age or BMI between the groups. Group B exhibited a statistically significant increase in C-reactive protein (CRP) at the time of SSI detection—233.72 ± 139.67 mg/mL (p = 0.011), corroborated by severity assessment via the APACHE scale and correlation analysis (r = 0.318, p = 0.011). Hospitalization mortality rates did not differ between groups. One-way analysis of variance did not yield convincing data on the impact of NPWT on mortality (F = 2.68, p = 0.106). Conclusions: NPWT dressing demonstrated no adverse effects on postoperative mortality, intestinal fistulas, or wound edge lateralization. Despite including cases with more severe inflammatory processes (90% of patients with APACHE II scale > 20 points), the method yielded comparable results to the standard approach.

1.3.9. MP-03.09: PD-L1 Expression in Nonbacterial Chronic Cystitis and Interstitial Cystitis/Bladder Pain Syndrome

• Kosova I ¹, Gundorova L ², Kolbasov D ², Loran O ¹, Pushkar D ³ and Barsegian V ¹

¹ 

Russian Medical Academy of Continuous Professional Education, Moscow, Russia

² 

Demikhov City Clinical Hospital, Moscow, Russia

³ 

Russian University of Medicine, Moscow, Russia

Abstract: Introduction and Objectives: Upregulation of the inhibitory PD-1/PD-L1 pathway is observed not only in malignant diseases but also in several persistent inflammatory conditions. In the meantime, some viruses (e.g., EBV, HBV, CMV) evade the host immunity by taking advantage of the PD-1/PD-L1 pathway. In this study, we aimed to assess the PD-L1 expression in bladder tissue in patients with nonbacterial chronic cystitis (NCC) and interstitial cystitis/bladder pain syndrome (IC/BPS) and its association with the presence of viral pathogens. The study was approved by the local ethics committee. Materials and Methods: All patients involved in the study underwent cystoscopy with hydrodistension. A total of 25 bladder specimens were obtained: 15 from NCC patients, 7 from patients with IC/BPS without Hunner lesions, and 3 from Hunner-type IC/BPS patients. The degree of inflammatory infiltration of the bladder wall was assessed on slides stained with H&E. Viral pathogens (HSV, EBV, CMV, and high-risk HPVs) were detected with PCR analyses of the bladder specimens. Immunohistochemistry was performed to examine the PD-L1 expression. Immune cell score ≥1% was considered positive. Results: The PD-L1 positivity rate in NCC patients was 53.3% (8/15). Viral pathogens were detected in 9 NCC bladder samples (60%) with EBV being the most common (5/15, 33.3%). The simultaneous presence of two or more viruses was found in 3 bladder specimens (20%). In IC/BPS PD-L1 expression was observed only in 1 patient (10%). Viral pathogens were detected in 3 IC/BPS bladder samples (30%), in 1 case EBV and CMV were found simultaneously. Overall, the immune cell score strongly correlated with the degree of inflammatory infiltration of the bladder wall (r = 0.84, p < 0.01) and the presence of viral DNA in bladder tissue (r = 0.76, p < 0.01). Meanwhile, the degree of inflammatory infiltration of the bladder wall correlated significantly with the presence of viral DNA in the bladder tissue (r = 0.69, p < 0.01). Conclusions: PD-L1 expression was observed in a group of NCC patients. PD-L1 positivity has been associated with persistent inflammatory infiltration of the bladder wall and the presence of viral pathogens in bladder tissue.

1.3.10. MP-03.10: Urologists’ Take on Effectiveness, Uses & Place in Therapy of Oral Fosfomycin in Urinary Tract Infection: A Large Pan-India Survey

• Patel A ¹, Nabar A ², Panda M ² and Kundaikar P ²

¹ 

Endoskopik Klinik & Hospital, Mumbai, India

² 

Cipla Limited, Mumbai, India

Abstract: Introduction and Objectives: EAU 2023 guidelines recommend fosfomycin trometamol among 1st line treatments for acute uncomplicated UTI (uUTI). However, data on its effectiveness, uses & place(s) in therapy in real-world Indian settings are lacking. Therefore, such an assessment on pan-India scale is required to better understand these aspects. Materials and Methods: In this cross-sectional survey, a 20-item questionnaire was administered to 865 urologists (uros) across India. Results: Among 1st line antibiotics for treating UTI, fosfomycin was preferred by ~1/5th doctors after nitrofurantoin (~38%) & fluoroquinolones (~31%); single dose regimen of (by ~56% uros) & lower antimicrobial resistance to fosfomycin (by ~46%) were top reasons for the choice. As 2nd line therapy, fosfomycin was most preferred over nitrofurantoin & fluoroquinolones (by ~47%, ~18% & ~17% uros respectively), top reasons for preference being resistance to & lower efficacy of 1st line antibiotics (by ~51% & ~15% uros respectively). ~59% uros reported patients getting symptomatic relief within 1–2 days of fosfomycin use with 34% reporting it within 3–4 days. ~58% urologists prefer to use fosfomycin empirically, with 46% recommending it as a stat dose (1 sachet for 1 day) & 21% advising 3 sachets given over 1 week. While ~65% uros prescribe fosfomycin for uUTI, 51% & 34% also prescribe it for treating complicated (cUTI) & multidrug resistant (MDR) UTI respectively. ~17% urologists prescribe fosfomycin as 1st line antibiotic prophylaxis for UTI, second only to nitrofurantoin (~65%). Preferred dosing regimens for prophylaxis were 1 sachet every 10 days (59%), 3 days (~21%) & 2 weeks (~20%). ~7% urologists state no side effects to fosfomycin while 37% report them in up to 10% cases. ~33% state no resistance to fosfomycin while 47% state it to be only in 1–5% patients. Conclusions: About one-fifth of urologists prefer fosfomycin as 1st line treatment while nearly half use it as 2nd line. Top reasons to prescribe are its single-dose regimen & low/no antimicrobial resistance. It is also useful to treat cUTI and MDR UTI.

1.3.11. MP-03.11: Hypospadias Management in Senegal: Complexity, Challenges, and Outcomes in the Urology Department of Idrissa Pouye General Hospital

• Ndoye M, Gassama C, Jalloh M, Mbodj M and Niang L
• UCAD, Dakar, Senegal

Abstract: Introduction and Objectives: Hypospadias surgery practice is not well codified in West Africa. In the absence of formal training in pediatric urology, and a well-prepared environment, patient and family needs are not fully addressed with a high rate of redo cases. Here we aim to present hypospadias management challenges and outcomes at Idrissa Pouye General Hospital of Dakar over two years. Materials and Methods: A total of 43 cases were selected from January 2022 to January 2024. Clinical parameters such as patient age, number of surgeries, surgical techniques used, and postoperative complications were reviewed from the patient‘s file record. Patient and family satisfaction was evaluated postoperatively every month for three months and every three months after. Results: The average age of patients was 6 years, with a predominance of patients under 5 years old (51.2%). Our patients were referred from all over the country with a high rate of complex redo cases. At clinical presentation, distal hypospadias was found in 28% of cases, with an important chordee over 30 degrees for all patients. On average, each patient underwent 2 surgical interventions resulting in 40% of patients experiencing complications. Duplay urethroplasty technique was the most utilized one (47.6%) with orthoplasty in all cases. The use of a flap was necessary for 58% of patients, and the preputial flap was the most frequently used one followed by the Snodgraft technique. The majority of patients had satisfactory voiding (88.4%), with a normal stream and a straight penile. Conclusions: Hypospadias management at Idrissa Pouye General Hospital in Dakar demonstrated overall satisfactory outcomes despite challenging work conditions related to the absence of fine sutures, adequacy of instrumentation, and lack of well-trained specialists. A formal fellowship training in pediatric urology is a sine qua non condition to improve hypospadias care management and other complex congenital urological abnormalities at large.

1.3.12. MP-03.12: Minimally Invasive Treatment of Urinary Stones in Pediatric Population

• Král M, Vrana J, Smakal O, Skotak H, Hradil D and Sarapatka J
• University Hospital Olomouc, Olomouc, Czech Republic

Abstract: Introduction and Objectives: Similarly to adult population, in children extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous stone extraction (PCNL) can be indicated with respect to size and location of urinary stones. It is necessary to assess the effectivity, the need to repeat the treatment and its potential long-term risks. Our work aimed to evaluate the success of ESWL and URS and to assess predictive factors of treatment effectiveness. Materials and Methods: During the years 2008–2024, we retrospectively analyzed data from 109 pediatric patients treated with ESWL and 42 patients treated by URS. We assessed the stone-free rate after the 1st ESWL period, the number of ESWL repetitions to achieve a stone-free state, the duration of the procedures, a comparison of the effectiveness of lithotriptors Medilit and Sonolith, the necessity of using auxiliary methods (change of strategy to ureteroscopy) and a comparison of the effectiveness of ESWL and URS. Results: 55 patients (50.4%) were stone free after the 1st ESWL period, 22 patients (21.1%) after the 2nd ESWL period, and another 3 patients (2.7%) during the 3rd ESWL period. Even at the cost of repeating ESWL (1–3×), the overall efficiency was 73.3%. The effect was not found in 19 patients, therefore URS was performed in 13 patients and observation was chosen in 6 patients. The CT stone density did not correlate with the stone free rate (SFR) (p = 0.83). No statistically significant difference in the effectiveness of lithotriptors was found. In 42 patients after ureteroscopy, a SFR was achieved in 83%; five patients were indicated to observation and in two cases open surgery was indicated. The average time of URS was 42 min. Comparison of the effectiveness of treatment methods showed significantly better results in favor of URS (p = 0.002). Conclusions: Ureteroscopy proved to be more successful, among other things, because it is a one-step solution. Contrary to adult patients, we did not demonstrate the effect of CT stone density on the effectiveness of ESWL. When indicating a treatment procedure, it is necessary to assess the technical equipment of the department as well as the experience of the surgeon with the treatment of pediatric patients.

1.3.13. MP-03.13: Parental Guilt and Depression After the Child’s Unilateral Orchiectomy for Torsion Testis

• Harne S ¹, Mulawkar P ², Bhatt N ¹, Maheshwari P ¹, Sharma G ³, Kanbur A ⁴, Gupte D ¹, Kolsawala H ¹, Agrawal P ⁵, Goyal A ¹ and Shrivastava P ¹

¹ 

Fortis Hospital, Mulund, Mumbai, India

² 

Tirthankar Hospital, Akola, India

³ 

Chitale Clinic, Solapur, India

⁴ 

Jupiter Hospital, Mumbai, India

⁵ 

Fortis Hospital, Mumbai, India

Abstract: Introduction and Objectives: Torsion testis is a common emergency often afflicting young children. Most often the diagnosis gets delayed and quite a few boys land with orchiectomy for management of gangrenous testis. One of the reasons for delay is a delay on part of the parents in recognizing the problem and postponing definitive treatment for the next day by giving home remedies (painkillers) to these kids. Materials and Methods: This is a multi-centric study where a Diagnostic and Statistical Manual of Mental Health-5 based questionnaire was submitted to parents of 24 children who underwent unilateral orchiectomy for torsion testis. The questionnaire looked at various domains like depression, mania, anxiety, self-harm, psychosis, obsessive-compulsive symptoms, sleep and substance abuse. Results: Most fathers (18) self-blamed themselves for their child’s orchiectomy and had an extreme sense of guilt. There was a sense of anxiety regarding the future sexual and married life of their son. Five fathers needed medications for anxiety and depression. About five complained of sleep disturbances more than half of them (three) had thoughts of self-harm. Seven fathers had recent onset alcohol abuse. Conclusions: Need for orchiectomy in a child is a matter of severe anxiety and stress for the parents. As some of them felt they neglected the symptoms and delayed treatment there is an extreme sense of guilt associated with this emergency. Quite a few parents land in depression and substance abuse and may need psychiatric support. Proper explanation to the parents that loss of single testis may not impact the sexual life and chances of future paternity, and when needed, help by psychiatrist and psychologist would go a long way in allaying the anxiety and guilt.

1.3.14. MP-03.14: Treatment Options for Pediatric Urethral Strictures

• Marjanovic M, Kojovic V, Ilic P, Cvetinovic A and Cvetinovic S
• Institute for Health Protection of Mother and Child of Serbia ‘Dr Vukan Cupic’, Belgrade, Serbia

Abstract: Introduction and Objectives: Pediatric urethral strictures (US) are rare, and published studies usually involve a small number of patients with a short follow-up. This study aims to present the surgical approaches used to treat pediatric US. Materials and Methods: From January 2007 until January 2024, 19 boys with urethral strictures, aged between 2 and 18 years, were treated. Ten patients had US due to trauma (straddle injury or pelvic fracture), seven underwent harmful iatrogenic procedures, and two had a stricture of unknown cause. Patients with urethral strictures due to complications of hypospadias repair were not included in the study. Stricture or complete urethral obstruction was presented on the anterior urethra in 16 and the posterior urethra in 3 patients. Patients were treated with endoscopic intervention (2), by augmentation using buccal mucosa graft (BMG) (10) or urethrorrhaphy (7). The surgical technique was chosen according to the stricture’s severity and localization. Very short strictures of the bulbar urethra were treated endoscopically (internal urethrotomy). More extensive bulbar strictures and obliterative posterior urethral disruption were treated by excision and primary anastomosis. The treatment method for the anterior US was urethral augmentation with BMG. Results: The patients were followed for 12 to 180 months (mean 49 months). Patients or their parents reported the quality of the urinary stream and the presence of urinary tract infections or dysuria. If any disturbances were reported, further exams were performed, including uroflowmetry, urethrography, and urethroscopy. Seventeen patients (89.5%) had good outcomes, while two (10.5%) underwent a redo procedure. One patient with urethral stricture relapse was treated with an endoscopic incision, and another one with BMG augmentation. Complications such as penile curvature, urethral fistula, or diverticulum were not reported. Conclusions: Pediatric urethral strictures can be successfully treated by open surgery, similar to the approach for adults. Repeated urethral dilatation and endoscopic treatment should not be preferred treatment methods due to their low success rate, the possibility of additional injuries, and pediatric patients’ non-compliance. An individualized approach is required for the successful outcome of the urethral stricture surgery.

1.3.15. MP-03.15: Ureteroscopy in Children About 120 Cases

• Bouhnik A, Brahmi M, Benrabah R and Azli M
• Kouba Hospital, Algiers, Algeria

Abstract: Introduction and Objectives: Minimally invasive treatment has become the gold standard for the management of urolithiasis in children. The incidence of urolithiasis in children varies across the globe however it is estimated at 1–2% of all cases of urolithiasis. While the incidence is low compared to the adult population there is a documented increase in the last two decades. We evaluated the results of fragmentation of urolithiasis in children using ureteroscopy and highlighted its role in the treatment of urolithiasis in children by evaluating feasibility, safety and effectiveness. Materials and Methods: The study involved 120 children performed at the Dr Mohamed Seghir Nekkache Hospital in Algiers between September 2016 and December 2019. The children were treated by ureteroscopy after a nephro-pediatric consultation in order to rule out any metabolic or anatomical abnormalities. Our patients were followed up by a multidisciplinary team. The chronology of this follow-up was at 1, 3, 6 and 12 months and then annually. Results: The average age of patients was 7 years, with extremes ranging from 1 to 17 years. The average stone size was 14.33 mm a range of 10 to 20 mm and an estimated density of 1104 HU ranging from 550 to 1600 HU. The average operating time was 53 min ranging from 28 to 110 min. All the children were treated with ureteroscopy as follows: 49% by SRURS (semi rigid ureteroscopy) and 51% by FURS (flexible ureteroscopy). The immediate success rate was 92.5%. We identified 5.8% of cases with surgical complications which were minimal. The recurrence rate after a mean follow-up of 16 months was 22.5%. Conclusions: The minimally invasive treatment of urolithiasis in children is an effective and safe option to minimize the operating time and the duration of convalescence with rapid reintegration of the child in their school environment. The results are encouraging both in terms of the stone free rate and in terms of complications, which were mostly minimal. Additional efforts must be made to improve the prevention component. The generalization and demystification of minimally invasive techniques is essential to achieve optimal care for children with urinary stone.

1.4. Moderated Oral ePoster Session 04: Prostate Cancer—Clinical Advanced, Prostate Cancer—Clinical Localized

• Thursday, October 24
• 0800–0900

1.4.1. MP-04.01: Da Vinci™ vs. Hugo™ for Robot-Assisted Radical Prostatectomy: A Prospective Comparative Single-Center Study

• Brime Menendez R, García Rojo E, Hevia Palacios V, Feltes Ochoa J, Justo Quintas J, Lista Mateos F, Fraile A and Romero Otero J
• Hospital HM Sanchinarro, Madrid, Spain

Abstract: Introduction and Objectives: Robot-assisted radical prostatectomy (RARP) has emerged as the preferred approach for the treatment of prostate cancer. As new robotic platforms like Hugo RAS™ emerge, we seek to understand their potential in achieving similar outcomes as the established Da Vinci™ system. Materials and Methods: In this prospective study, we compared the outcomes of 150 consecutive patients with prostate cancer treated by RARP using either the Hugo or the Da Vinci system. We conducted a comprehensive comparison, including operative and postoperative outcomes, as well as pathological and functional results. The study involved the participation of 2 experienced surgeons. Results: 75 Da Vinci and 75 Hugos were included. Baseline characteristics and tumor features were comparable between the two groups. Intraoperative outcomes showed a shorter docking time for Da Vinci (10.45 vs. 18.62 min, p = 0.02) but similar total operative time (145.34 vs. 138.95, p = 0.85). The Hugo group had advantages in neck dissection and lymphadenectomy times (22 vs. 13.67 min, p = 0.027 and 37.82 vs. 45.77 min, p = 0.025 respectively). Postoperative outcomes, including length of stay, catheter time, and complications, were not significantly different. Functional outcomes, measured with IPSS and IIEF5, did not significantly differ between groups. Six patients (8%) in the Da Vinci group and nine (12%) in the Hugo group presented with social incontinence (p = 0.072). Pathological outcomes, including T stage, Gleason Score and number of nodes removed, were comparable, but the Hugo group had a higher rate of positive surgical margins (20% vs. 10.67%, p = 0.034). Conclusions: In our initial experience, RARP perioperative outcomes with the new Hugo RAS™ robotic platform are comparable to those obtained with the Da Vinci™ system. Further investigations and long-term follow-up are needed to assess their long-term oncological and functional outcomes.

1.4.2. MP-04.02: Is Pelvic Lymph Node Dissection Necessary in Radical Prostatectomy? Results from the MICAN Study

• Atagiagi Y, Tada K, Kouno R, Minato R and Hashine K
• NHO Shikoku Cancer Center, Matsuyama, Japan

Abstract: Introduction and Objectives: Radical prostatectomy (RP) has become a common procedure and the mainstay of local prostate cancer treatment. We reviewed and examined the necessity of lymph node dissection in detail on the database of all cases of RP in the database of the Medical Investigation Cancer Network (MICAN) study. The MICAN study was a retrospective cohort study in which all medical institutions in Ehime Prefecture participated to analyze the treatment outcomes and prognostic factors of patients who underwent RP. Materials and Methods: The MICAN study enrolled 3463 patients, including 292 open RP (ORP), 938 laparoscopic RP (LRP), and 2233 robot-assisted RP (RARP). The analysis of PSA recurrence included the extent of lymphatic dissection, number of dissected lymph nodes, number of positive lymph nodes, and each clinicopathologic factor. The limitted lymph node dissection was defined as the obturator area plus the external iliac region, and the extended lymph node dissection was defined as more than limitted area. Results: Limitted dissection was performed in 1669 cases and extended dissection in 274 cases. RARP accounted for 81.8% of cases of extended dissection, while ORP and LRP were rarely performed. The median number of lymph nodes dissected in limitted dissection was 5, and 15 in extended dissection. Lymph node metastases were found in 73 patients, 1.2% with limitted dissection and 19.3% with extended dissection (p < 0.001). Cox regression analysis showed that pT, resection margins, Gleason score, and pN were associated with PSA recurrence, while extent of dissection was not a significant factor. However, the 5-year PSA recurrence-free survival rate in pN1 subgroup tended to be better with extended dissection, although there was no significant difference (extended: 20.8% vs. limitted: 14.8%). There was a trend toward better the 5-year PSA recurrence-free survival rates in the group with up to two positive lymph nodes compared to the group with three or more (21.2% vs. 10.5%, p = 0.063). Conclusions: The MICAN study showed that although extended lymph node dissection allowed for an accurate pathology diagnosis, it did not contribute to the PSA-free survival rate and increased operative time and complications. Since even extended dissection showed no benefit, pelvic lymph node dissection cannot be uniformly recommended for radical prostatectomy.

1.4.3. MP-04.03: Trans-Perineal Prostate Biopsy Under Local Anaesthesia with Pre-Biopsy mpMRI Scan—Way Forward in Prostate Cancer Diagnostics

• Ahmed I, Waqas M, Godil F and Chaudry A
• Bedford Hospital, Bedford, United Kingdom

Abstract: Introduction and Objectives: The technique of trans-perineal biopsy of prostate under local anaesthesia has evolved in the last decade and has now been shown to be a technique which is more accurate and significantly safer compared with the traditional TRUS biopsy technique. We have demonstrated the efficacy of this biopsy technique using the precision point device mounted on BK TP biopsy probe. Published data on this techniques suggest an accuracy of up to 98% in detecting clinically significant prostate cancer in the population biopsied (1). Materials and Methods: Patients referred with suspected prostate cancer i.e elevated PSA and/or abnormal DRE in age range of 40–75 years included in this study. 1684 patients referred meeting the above criteria. Data was recorded on prospective manner. 1558 underwent pre-biopsy mpMRI scan and were included. Patients without the mpMRI were excluded. Pirad scoring, prostate vol, PSA density recorded. Histology results recorded along with antibiotic prophylaxis used and any complications reported were recorded. Patients undergoing the biopsy had 6 sector biopsies (3–6 cores from each sector) + target biopsies (2–4) using cognitive fusion—Guys hospital protocol. 10 mL of Lignocaine 1% with adrenaline used for perineal skin and 20 mL of Lignocaine 1% plain used for periprostatic block. Results: Total patients included = 1558 (28 under GA). Pirad scores: Pirad 0–2—310, Pirad 3—467, Pirad 4—578, Pirad 5—203. Patients found to have cancer = 964 (61.8%). Gleason 3 + 3 = 206. Gleeson 3 + 4 = 316. Gleeson 4 + 4 = 282. Gleeson 4 + 5 = 135. Gleeson 5 + 5 = 25. Complications recorded: (all Clavien-Dindo grade 1) visible haematuria = 67 (4.3%), UTI requiring antibiotics = 38 (2.4%), sepsis requiring hospital admission = 0, acute urinary retention = 26 (1.6%). Conclusions: The data presented for the last 04 years indicates that the TP biopsy technique using precision point device is effective and yields high diagnostic accuracy with minimal complications. It compares well with the published data. This technique must be popularised to assist in early diagnosis of prostate cancer with increased accuracy and minimal complications. We believe this technique is the way forward.

1.4.4. MP-04.04: A Comparative Study on the Reporting Quality of PSMA-PET in the Staging of Prostate Cancer

• Li T ¹, Chang P ², Ahmadi N ¹, Doeuk N ¹ and Woo H ¹

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

University of New South Wales, Sydney, Australia

Abstract: Introduction and Objectives: PSMA PET has superior accuracy in detecting lymph node metastasis compared to MRI and helps in mapping sites of pelvic lymph node dissection during prostatectomy or planning radiation fields. Reporting is performed by a nuclear medicine specialist that, in Australia, may be trained through either a radiologist or physician pathway. This means that the reporting quality of these scans may vary based on the nuclear medicine specialist’s background. This study aims to compare and examine the differences in reporting characteristics between these two providers. Materials and Methods: A retrospective review of records for all patients presenting to a urology clinic was performed in 2023. Inclusion criteria considered all men diagnosed with prostate cancer that had a PSMA-PET performed. Reporting details of clinical history, radionuclide characteristics, tracer uptake and reporting qualifications were extracted from PSMA-PET reports. Results: 77 patients were included in the review. The mean number of days to report was 3.89 days (95% CI 2.57–5.21 days) and mean uptake time was 62.4 min (95% CI 59.2–65.5 min). A fluorine-based tracer was used in 39 studies (50.6%), a gallium-based tracer was used in 35 studies (45.5%). Radiologists were more likely to provide comparative information on PSA (p = 0.003) and MRI lesions (p < 0.001). They were more likely to report on bony lesions (p = 0.03) and other significant CT findings (p = 0.012). Conclusions: The reporting of PSMA-PET demonstrates significant differences in some areas that are useful in pre-operative planning and prognostication. Radiologists provide better information on clinical data, comparative results and bony lesions. This study highlights key areas of improvement required to maximise the utility of PSMA-PET in staging prostate cancer.

1.4.5. MP-04.05: A Diagnostic Significance of Prostate Health Index (Phi)-MRI Sequence Flow in Patients with PSA Below 10 ng/mL

• Ito K ¹, Oki R ¹, Magari T ¹, Furuya Y ¹, Baba K ¹, Ogura H ¹, Kurosawa I ¹ and Kaji Y ²

¹ 

Kurosawa Hospital, Takasaki, Japan

² 

Shimane University, Izumo, Japan

Abstract: Introduction and Objectives: Prostate health index (phi), which is more cancer specific serum index than PSA, has been available in Japan since November 2021. However, an optimal diagnostic flow for prostate cancer (PC) using phi has not been established, so far. The present study is aimed to investigate diagnostic significance of phi-MRI sequence flow in PC and clinically significant PC (CSPC) detection. Materials and Methods: Between April 2022 and February 2023, 357 patients having PSA reflex range from age-specific cut-offs to 10 ng/mL followed by phi testing were retrospectively enrolled. Those with phi above the cut-off at 27.1 recommended multi-parametric or bi-parametric MRI (reviewed by one expert radiologist, YK), then carried out systematic biopsy (SB) for men with PI-RAD<3 or SB+ MR-guided targeted biopsy (MRI-TB) for men with PI-RADs 3–5. Positive predictive value (PPV) for subgroups stratified by phi range and MRI findings were investigated. Results: Median age, PSA and phi was 65 years, 5.25 ng/mL and 31.8, respectively. A total of 242 (67.8%) patients had phi above 27.1 and those of 164 (67.8%) underwent MRI and scored by PI-RADs at which 1–2, 3, 4 and 5, respectively, was in 100 (61%), 8 (5%), 40 (24%) and 14 men (8%), and other 2 men was suspicious for mucinous tumor. Then 149 men were biopsied, 67 (45%) were detected PC, which Gleason grade group (GG) 1, 2, 3, 4 and 5 was in 16 (24%), 17 (25%), 18 (27%), 12 (18%) and 4 patients (6%), respectively. PPV for men with phi from 27.2 to 36.0, 36.1 to 55.0, 55.1, respectively in SB and SB+MRI-TB group, was 6.3% and 66.7%, 36% and 68%, 13% and 91%. GG 1 and GG 2–5 distribution in the above subgroup is shown in the figure. Among 17 PC patients with phi above 36.0 and normal MRI findings, 12 patients (71%) were diagnosed CSPC with GG 2 or higher. Conclusions: PPV was low in men with phi from 27.2 to 36.0 and normal MRI. On the other hand, men with normal MRI, but with phi above 36.0 had a high likelihood of having CSPC. Therefore, phi and MRI may have a complementary role in CSPC detection.

1.4.6. MP-04.06: Development and Validation of a Risk Assessment Tool to Predict Clinically Significant Prostate Cancer Among Asian Men

• Chiu P ¹, Lam T ¹, Yi Y ¹, Yip B ¹, Wong S ¹, Ng A ¹ and Sung J ²

¹ 

The Chinese University of Hong Kong, Hong Kong, China

² 

Nanyang Technological University, Singapore

Abstract: Introduction and Objectives: Risk-based prostate cancer (PCa) screening is proposed to minimize unnecessary biopsies while enhancing the detection of clinically significant prostate cancer (csPCa). We aimed to develop and validate a prediction risk score to identify Asian men who are at a higher risk of developing csPCa. Materials and Methods: 2582 Chinese men of screening age (50–75 years) who underwent diagnostic transrectal ultrasound-guided prostatic biopsy were recruited. csPCa was defined as ISUP grade group ≥ 2. 1550 (60%) subjects were randomly assigned as the training cohort. The odds ratios for significant predictors identified by ordinal logistic regression analysis were used to formulate a prostate cancer risk score for risk-stratification (“average-risk” [AR] vs. “high-risk” [HR]). The remaining 1032 (40%) subjects formed an internal validation cohort to assess the performance of the score. External validation was assessed by a cohort of 3923 asymptomatic Chinese men who participated in a prostate cancer screening program which consisted of prostate surface antigen (PSA) testing, followed by prostate health index testing and MRI-prostate if PSA > 4 ng/mL, and MRI-guided biopsy if indicated. Results: Old age (≥60 years), family history, obesity (body mass index ≥25 kg/kg²), and smoking were independent significant predictors of csPCa (Table 1). They formulated a risk score, ranging from 0–6, divided into AR (0–2) and HR (3–6). Applying the risk score in the internal validation cohort, 424 (41.1%) and 608 (58.9%) were categorized as AR and HR, respectively. The corresponding prevalence of csPCa was 10.1% and 16.6%. The sensitivity and specificity are 70.1% (95% CI:62.7–77.6%) and 42.9 (95% CI:39.7–46.2%), respectively. Men in the HR tier had 1.6-fold (95% CI:1.2–2.3) increased prevalence of csPCa than the AR tier (Table 2). In external validation cohort, 2563 (65.3%) men were categorized as AR and 5 (0.2%) had csPCa, while 1360 (34.7%) were HR with 17 (1.3%) of them having csPCa. The sensitivity and specificity are 77.3% (95% CI:59.8–94.8%) and 65.7 (95% CI:64.1–67.1%), respectively. High-risk men had 6.3-fold (95% CI:2.3–16.9) increased prevalence of csPCa than the low-risk men (Table 2). Conclusions: The risk score based on age, family history, obesity and smoking, is useful in stratifying Asian men to different risk groups to prioritize PCa screening.

1.4.7. MP-04.07: Dosing, Safety, and Pharmacokinetics of Combination Therapy with Darolutamide (DARO), Androgen-Deprivation Therapy, and Docetaxel in Patients with Metastatic Hormone-Sensitive Prostate Cancer in the ARASENS Study

• Hammerer P ¹, Kalebasty A ², Tombal B ³, Hussain M ⁴, Saad F ⁵, Fizazi K ⁶, Sternberg C ⁷, Crawford E ⁸, Zhang W ⁹, Ploeger B ¹⁰, Li R ⁹, Kuss I ¹⁰, Zieschang C ¹⁰ and Smith M ¹¹

¹ 

Academic Hospital Braunschweig, Braunschweig, Germany

² 

University of California Irvine, Orange, United States

³ 

Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium

⁴ 

Northwestern University, Feinberg School of Medicine, Chicago, United States

⁵ 

University of Montreal Hospital Center, Montreal, Canada

⁶ 

Institut Gustave Roussy, University of Paris-Saclay, Villejuif, France

⁷ 

Englander Institute for Precision Medicine, Weill Cornell Department of Medicine, Meyer Cancer Center, New York-Presbyterian Hospital, New York, United States

⁸ 

UC San Diego School of Medicine, San Diego, United States

⁹ 

Bayer HealthCare Pharmaceuticals Inc., Whippany, United States,

¹⁰ 

Bayer AG, Berlin, Germany

¹¹ 

Massachusetts General Hospital Cancer Center, Boston, United States

Abstract: Introduction and Objectives: Darolutamide in combination with androgen-deprivation therapy (ADT) and docetaxel significantly reduced risk of death vs. placebo in patients with metastatic hormone-sensitive prostate cancer (mHSPC), with similar incidences of TEAEs (ARASENS [NCT02799602]). We report dosing, safety, and PK of coadministration of darolutamide and docetaxel with ADT. Materials and Methods: Patients with mHSPC were randomized 1:1 to darolutamide 600 mg twice daily or placebo, plus ADT and docetaxel (75 mg/m² q21d for 6 cycles). The effect of darolutamide on docetaxel PK was assessed by noncompartmental analysis from the first 25 patients with dense PK data and by population PK (PopPK) for all patients. Darolutamide PK data from ARASENS and ARAMIS (NCT02200614; without docetaxel) were compared to evaluate docetaxel impact on darolutamide PK. Results: 1305 patients were included in the analysis (darolutamide, n = 651; placebo, n = 654). Median treatment duration was longer with darolutamide vs. placebo (41.0 vs. 16.7 months). More darolutamide-treated patients (45.9% vs. 19.1%) were receiving treatment at data cutoff (Oct 25, 2021). Most patients completed 6 cycles of docetaxel (darolutamide, 87.6%; placebo, 85.5%). A comparable proportion of patients required dose modification (interrupted/delayed/reduced [darolutamide, 60.0%; placebo, 62.9%]). TEAEs led to discontinuation/reduction of docetaxel in 8.0%/19.9% of darolutamide and 10.3%/19.5% of placebo patients. PopPK analysis indicated that docetaxel PK in ARASENS was generally consistent with literature. A slight numeric increase in docetaxel exposure was observed in the darolutamide arm, with 15% higher maximum plasma concentration (geometric mean, 1.93 vs. 1.68 µg/mL) and 6% higher area under the concentration-time curve (AUC0-tlast within an 8-h sampling interval, 2.10 vs. 1.99 µg·h/mL) vs. placebo, which is likely not clinically relevant given the variability in docetaxel exposure (coefficient of variation, 23%–54%). PK meta-analysis of ARASENS and ARAMIS, which considered patients’ characteristics as covariates (eg, age/body weight/region), indicated 10% lower AUC0–12ss of darolutamide in docetaxel-treated patients vs. those not receiving docetaxel, which is not considered clinically relevant. Conclusions: In patients with mHSPC, darolutamide can be effectively and safely combined with docetaxel, with no observed drug-drug interactions between darolutamide and docetaxel, and no clinically relevant changes in the PK of either agent.

1.4.8. MP-04.08: Effect of Urethrovesical Anastomotic Leakage After Robotic Radical Prostatectomy on Postoperative Continence

• Kiliç M ¹, Eden A ², Tekkalan F ¹, Koseoğlu E ², Balbay M ² and Madendere S ¹

¹ 

VKV American Hospital, Istanbul, Türkiye

² 

Koç University School of Medicine, Istanbul, Türkiye

Abstract: Introduction and Objectives: In this study, we aimed to evaluate the effect of urethrovesical anastomotic leakage (UAL) on continence in patients undergoing robot-assisted radical prostatectomy (RARP). Materials and Methods: 86 patients who underwent RARP were evaluated retrospectively. On the seventh postoperative day, cystography was performed to determine whether patients had UAL. Anastomotic leakage was categorized according to Han’s classification. The foley catheters of those with no or mild leakage were removed on the 7th day, while those with moderate and extensive UAL were removed on the 14th day or later. Any level of involuntary urine leakage was considered urinary incontinence (UI), according to the recommendation of the International Continence Society. The effects of UAL, as well as patient and operative factors, on UI were evaluated. Results: The mean follow-up period was 36 (±22) months. Cystography detected UAL in 28 patients (32.5%); 14/28 (50%) were mild, 9/28 (32%) were moderate, and 5/28 (18%) were extensive. Postoperative long-term UI was detected in 28 (32%) patients. Among these, only 11/28 (39%) used pads, and the remaining 17/28 (61%) patients had mild UI and did not use pads. The patients with and without UI were compared, and no correlation between UAL and postoperative development of UI was observed (p = 0.479) (Table 1). A repeat analysis where mild UI was added to the full continent group also confirmed no correlation between UAL and UI (p = 0.743). Conclusions: UAL was shown to have no long-term effect on UI. However, in patients with moderate and extensive UAL, prolonged catheter duration may have had a positive impact on urinary continence. Based on this, further randomized studies comparing patients having UAL whose catheters were removed on the seventh day and those who were removed afterward may contribute to this issue.

1.4.9. MP-04.09: Half of the Prostate Cancers Detected in South Korea During the 2010s were High-Risk Diseases; an Interim Report from a National Investigation

• Ko Y, Song P and Moon K
• Yeungnam University, Daegu, South Korea

Abstract: Introduction and Objectives: To report the interim results of a nationwide investigation to investigate the change in prostate cancer (PCa) risk stratification in South Korea from 2010 to 2020. Materials and Methods: From the 61 general hospitals with a urology department of 300 beds or more, the clinicopathologic features of prostate cancer at the time of detection were summarized in 2010, 2012, 2014, 2016, 2018, and 2020. The NCCN (ver. 2023) defined the high-risk as having one of the following: PSA 20 ng/mL, T3a stage, and Gleason Grade 4 or higher, and low-risk as having PSA < 10 ng/mL and T2a or lower stage, and GG 1 or lower. Results: Data from 24,170 PCa patients were collected, representing 33.8% of the total 71,403 patients registered in the National Cancer Statistics for the years covered. In all years, the most common group was high-risk (50.7%), which slightly increased from 50.4% in 2010 to 52.0% in 2020, while low-risk decreased from 8.2% in 2010 to 3.0% in 2020 (Linear-by-linear association, p < 0.001, Figure 1). In 17 administrative provinces, high-risk was the most common risk group at detection time in 10 provinces (Figure 2). In comparing rural and urban areas, the number of high-risk individuals was higher in rural areas (56.1% vs. 48.8%, p < 0.001). Conclusions: In the 2010s, high-risk PCa was the most common type of cancer in South Korea. It was a nationwide phenomenon but particularly severe in rural areas.

1.4.10. MP-04.10: National Robotics-Assisted Radical Prostatectomy Database: A Unified Clinical-Research Model

• Jevoor V ¹, Lawrentschuk N ¹ and Chengodu T ²

¹ 

Royal Melbourne Hospital, Melbourne, Australia

² 

E.J Whitten Prostate Cancer Centre, Epworth Healthcare, Melbourne, Australia

Abstract: Introduction and Objectives: Generating high quality evidence for surgical techniques is challenging as most studies conducted are non-randomised, retrospective small-scale studies. Outcomes from these studies are not generalizable to population at large. Rigorous studies are needed to generate solid evidence. Patient data stored in electronic medical records (EMR) holds the potential to generate high quality evidence for surgical approaches. Integrating clinical workflow from EMR into a research database is an idea which has not been explored. To address the above-mentioned issues, the present study presents a comprehensive framework for setting up a database tailored specifically for robotics-assisted radical prostatectomy (RARP) procedures. The objective of the present study is to generate high quality evidence for RARP procedure by evaluating surgeons’ learning curves along with patient reported outcome measures (PROMS) and integrating these outcomes into REDCap database. Materials and Methods: The Royal Melbourne Hospital (RMH) and other major, tertiary hospitals in Australia will collaborate to recruit participants both retrospectively and prospectively. Participation eligibility requires individuals to: (a) consent, (b) be within the age range of 16–90 years, (c) diagnosed with localized (PCa) and (d) receive medical care at engaged hospitals. Ethical approval is obtained from the Royal Melbourne Hospital Human Research Ethics Committee (RMHHREC) and the study is registered on clinicaltrials.gov (NCT06279260). The datapoints will include patient demographics, preoperative characteristics, surgical details including learning curves of surgeons, interoperative outcomes, postoperative complications, oncological outcomes and patient reported outcome measures (PROMS) using Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaire. Data will be entered into an electronic data capture form via the REDCap platform. Results: Findings from the database are anticipated to provide insights into surgical, oncological and patient reported outcome measures along surgeons’ learning curves. Conclusions: RARP holds the potential as a standard of care procedure for localized PCa. Lack of quality evidence and associated costs hinder the widespread adoption of RARP. The database aims to facilitate research collaborations to generate high quality evidence necessary for clinical decision making and improve patient care for RARP procedures.

1.4.11. MP-04.11: Preventive Effect of the Hydrogel Spacer System on Acute Proctitis After Hypofractionated Intensity-Modulated Radiotherapy for Localized Prostate Cancer

• Hagiwara K, Horiguchi Y, Nakasuka S, Narita S, Shimizu T, Kawano Y, Sakamoto N, Tsukuda F and Koga S
• Edogawa Hospital, Tokyo, Japan

Abstract: Introduction and Objectives: There is a risk of severe proctitis after local radiation therapy for prostate cancer. Among 1210 patients treated with intensity-modulated radiation therapy (IMRT) (76 Gy/38 fr) in our hospital between 2007 and 2013, 15 (1.2%) developed Common Terminology Criteria for Adverse Events (CTCAE) Grade 3 ≤ proctitis. On the other hand, the SpaceOAR hydrogel spacer system, which was approved in the Japanese ministry of Health in 2017, is expected to reduce the volume of the exposed rectum and the absorbed radiation dose, thereby preventing radiation proctitis. The interim results of this system, introduced in our hospital in January 2021, on the preventive effect on acute proctitis were evaluated. Materials and Methods: We investigated the incidence of acute proctitis in 103 localized prostate cancer patients who underwent hypofractionated IMRT (60 Gy/20 fr) after insertion of SpaceOAR hydrogel spacer in our hospital between January 2021 and April 2023. Results: Median age and PSA of the 103 subjects were 77 years and 10.44 ng/mL. SpaceOAR hydrogel was inserted a median of 2 months after transperineal prostate targeted biopsy. The insertion procedure was difficult in only one patient, and no serious complications occurred. During the post-IMRT follow-up period (1–23 months, median 7 months), CTCAE Grade 3 > proctitis was observed in 11 patients (10.7%), but Grade 3 ≤ proctitis did not occur. Conclusions: In hypofractionated IMRT for prostate cancer, the combined use of the SpaceOAR system was suggested to be useful in reducing Grade 3 ≤ acute proctitis in the early post-treatment period. The efficacy of radiation proctitis prophylaxis should be further investigated with a longer follow-up with more patients.

1.4.12. MP-04.12: Prognostic Value of MR Visibility/Invisibility in Men on Active Surveillance

• Klotz L ¹, Vesprini D ² and Loblaw A ²

¹ 

University of Toronto, Toronto, Canada

² 

Sunnybrook HSC, Toronto, Canada

Abstract: Introduction and Objectives: We sought to determine, in a large prospective long term active surveillance cohort, the prognostic value of negative MR imaging with respect to upgrading and need for intervention. The primary hypothesis was that MR invisible prostate cancers have a significantly lower rate of upgrading and need for intervention than MR visible cancers. Materials and Methods: A long term prospective single centre study of men on active surveillance with MR imaging. Primary outcome was upgrading on biopsy and rate of intervention. Results: Of 1415 patients in the AS cohort, 1210 (86%) were GG 1 and 193 (14%) GG 2. 530 patients had at least one MRI after study registration. At baseline, 39 patients (7.4%) had negative MRIs (PiRADS 1–2), 161 (30%) equivocal (PiRADS 3), and 330 (62%) had a positive MRI (PiRADS 4–5). 229 patients were upgraded; 5% of those with invisible lesions, 34% with PiRADS 3, and 52% with PiRADS 4–5. 229 (43%) of the 530 men were eventually treated. No patients with negative PiRADS were treated, vs. 36% with PiRADS 3 and 52% with PiRADS 4–5 (p < 0.001). Since 2013 when MRIs were incorporated into the AS protocol, no patient has progressed to metastatic disease. In 331 men with serial MRIs, upgrading occurred in 46% of men with stable or improved MRI, and 57% in those with MRI progression. In the 70 patients whose MRI improved from PiRADS 4–5 to 3, 46% were upgraded. No patients who transitioned from PiRADS 3–5 to 1–2 were upgraded. Time to grade progression was highly inversely correlated with PIRADS score. Conclusions: MRI invisible cancers demonstrated dramatically reduced rates of progression and no patient required intervention. This suggests that, in men on active surveillance, image guided management, restricting biopsies to targeted biopsies of regions of interest, is sufficient to identify clinically significant cancers.

1.4.13. MP-04.13: Rectal Wall Infiltration with Hyaluronic Acid Based Rectal Spacer and Its Reversal

• Hong A ¹, Bolton D ¹, Ramani S ², Ischia J ¹, Lim Joon D ³, Foroudi F ³, Jack G ¹ and Chao M ²

¹ 

Austin Health, Melbourne, Australia

² 

GenesisCare, Brisbane, Australia

³ 

Olivia Newton John Cancer Centre, Melbourne, Australia

Abstract: Introduction and Objectives: Radiation therapy for prostate cancer may cause gastrointestinal (GI) toxicity as the rectum is an organ at risk. Stabilized hyaluronic acid (sHA) has recently been approved for use as a rectal spacer and reduces GI toxicity. It has several advantages, including its reversibility using hyaluronidase. This is beneficial in cases of rectal wall infiltration (RWI). As such, we aim to assess the outcomes of inadvertent RWI by sHA rectal spacers. Materials and Methods: A retrospective analysis of patients who had inadvertent RWI following the use of sHA rectal spacers was conducted in Australia. More than 5000 patients have had sHA rectal spacing with the majority undergoing magnetic resonance imaging (MRI) simulation. Patients with RWI were identified based on post-procedural MRI. Data collection included patient demographics, delays in radiation therapy, grade of the RWI, symptoms, and management of the RWI. The patients were followed up during and post radiation therapy and assessed for rectal complications. Results: A total of 16 patients were identified to have RWI after sHA spacer insertion. The grade of RWI (as defined by Fischer Valuck criteria) were: Grade 1, n = 5; Grade 2, n = 6; and Grade 3, n = 5. The median volume of misplaced sHA was 2.8 cc. No post procedural complications were reported. A sigmoidoscopy was performed in 12 patients and all showed intact rectal mucosa. Seven patients underwent targeted reversal procedures while 9 patients were monitored. Of those who underwent reversal procedures, the median (and mean) volume of misplaced hyaluronic acid is 4 mL (3.8 mL), compared to 1.5 mL (2.1 mL) in those who did not undergo reversal (Mann-Whitney U test, p = 0.1). Initiation of radiation therapy was delayed in 11 cases by a median of 3.2 months. All patients completed their RT and no acute grade 2 or higher GI toxicity was reported. Conclusions: This case series presents the first evidence for the safety of sHA rectal spacer in cases of RWI, with an event rate of less than 0.03%. We have proven the efficacy of hyaluronidase in reversal of RWI with hyaluronidase. No severe adverse complications were reported.

1.4.14. MP-04.14: The Addition of Peri-Procedural Gentamicin with Ciprofloxacin Reduces Infection and Sepsis Rates Post TRUS Biopsy

• Guduguntla A ¹, Satasivam P ², Benn K ³ and Xu D ³

¹ 

Northern Health/Austin Health, Melbourne, Australia

² 

Northern Health, Melbourne, Australia

³ 

University of Melbourne, Melbourne, Australia

Abstract: Introduction and Objectives: Despite the advent of transperineal biopsy, TRUS biopsy is still widely performed worldwide. The accepted peri-operative antibiotic is usually a single agent fluoroquinolone, for which there is growing resistance. At Northern Health, patients have been getting single agent ciprofloxacin or ciprofloxacin + gentamicin depending on consultant preference at time biopsy. The aim of this study was to assess whether the addition of gentamicin reduced infection and sepsis rates post TRUS biopsy over the last 5 years. The primary outcomes that were measured were sepsis and UTI rates post TRUS biopsy for single agent ciprofloxacin versus ciprofloxacin and gentamicin combination therapy. Secondary outcomes assessed included whether there was an association between infection and possible risk factors—number of cores taken, BMI, diabetes, time of ciprofloxacin administration and prostate size. Materials and Methods: 658 TRUS biopsy patients were identified over the last 5 years (2017–2022) and 648 were analysed via the hospital paper and electronic records; 10 patients for which there was inaccurate documentation required for analysis were omitted from the dataset. Patients were recorded as having sepsis if they had an admission (either at Northern, or at another hospital) following the biopsy for which they required intravenous antibiotics. Patients were recorded as having a UTI if they had a documented growth on urine culture but did not require hospital admission. Results: A Fisher’s exact test was done for Table 1 with a p value of 0.01. When considering sepsis without UTI the same statistical analysis has a p value of 0.03. No association between infection and risk factors were found. Given the data is limited by low amounts of patients with sepsis, this was not unexpected. Conclusions: The addition of at least 160 mg or 2 mg/kg gentamicin with oral ciprofloxacin reduces infection and sepsis rates post TRUS biopsy.

1.4.15. MP-04.15: The Role of Stockholm-3 Test in Patients Under Active Surveillance on Deciding Confirmation Biopsy

• Madendere S ¹, Kiliç M ¹, Palaoğlu E ¹, Vural M ¹, Tilki D ², Esen T ³ and Balbay M ³

¹ 

VKV American Hospital, Istanbul, Türkiye

² 

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

³ 

Koç University School of Medicine, Istanbul, Türkiye

Abstract: Introduction and Objectives: We investigated if the Stockholm-3 test results correlate with multiparametric MRI and confirmation biopsy outcomes in patients under active surveillance (AS) due to prostate cancer (PCa). Materials and Methods: Twenty patients aged 53 to 78, under AS due to Gleason Grade Group (GG) 1 or 2 PCa were included. A repeat MRI and confirmation biopsy following Stockholm-3 test were recommended in all. We considered Stockholm-3 score > 15 as high risk for clinically significant PCa (csPCa). Results: Eighteen (90%) patients had repeat mpMRI, nobody had a Stockholm-3 score above 15. Among 14 (70%) who underwent confirmation biopsy, GG 1 was confirmed with targeted biopsy following PIRADS 4 lesions on new MRI and Stockholm-3 scores of 12–13 in 2 patients. One patient with GG 1, Stockholm-3 score of 11 and PIRADS 2, underwent radical prostatectomy and final pathology detected GG 2+cribriform pattern (15%) PCa. Another patient with GG 1, PIRADS 4 and a Stockholm-3 score of 8, underwent radical prostatectomy after GG 3 was detected on confirmation biopsy. Final pathology revealed a GG 2 PCa. In 12/14 (85.7%) patients with Stockholm-3 ≤ 15, confirmation biopsy results did not show upgrading. In 2/9 (22%) patients with PIRADS 4, clinically significant PCa was detected. In 9/9 (100%) patients with PIRADS 4, Stockholm-3 was ≤15. Conclusions: In the majority of the patients on AS with Stockholm-3 ≤15, confirmation biopsy remained as GG 1+BPH. In such patients, confirmation biopsy may be omitted. However, we continue to advocate confirmation biopsy when patients have a Stockholm-3 >15 and PIRADS 4 simultaneously which suggest aggressive disease.

1.4.16. MP-04.16: Weakly Supervised Deep Learning for Diagnosis of Prostate Cancer After Radical Prostatectomy: A Population-Based, Multicenter Study

• Mai Z ¹, Yan W ¹, Qin C ² and Zeng J ²

¹ 

Peking Union Medical College Hospital, Beijing, China

² 

Wuyi University, Jiangmen, China

Abstract: Introduction and Objectives: The pathological diagnosis of prostate cancer after radical prostatectomy (RP) is a challenging and time-consuming process. Artificial intelligence has the potential to enhance this situation significantly. Our study aimed to assess the efficacy of weakly supervised deep learning, specifically focusing on practical diagnostic tasks for RP specimens. Materials and Methods: We obtained slices from clinical centers across four regions in China. The model was developed based on a multiple instance learning framework. We evaluated the model’s predictive accuracy, covering both slice-level and lesion-level diagnoses. Additionally, we investigated lesion localization using attention visualization. Slice-level diagnosis included prostate cancer detection and Gleason grading, while lesion-level diagnosis involved recognizing index lesions and non-index lesions. Results: The study involved 13,245 slides from 304 patients. The area under the curve values in four validation sets ranged from 0.921 (95% CI 0.913–0.930) to 0.964 (95% CI 0.959–0.968). Regarding Gleason grading, the model demonstrated quadratic weighted kappa values of 0.748 and 0.720 for internal and external validation, respectively. The model predicted 1683 (35.3%) positive and 3081 (64.7%) negative slices in all validation sets. The median area of index lesions and non-index lesions was 92.6 mm² (IQR: 54.2–130.0 mm²) and 3.5 mm² (IQR: 1.4–10.9 mm²) (p < 0.001), respectively. The model accurately predicted index lesions in all cases for the validation sets from Peking Union Medical College Hospital (PUMCH), Zhongshan City People’s Hospital, and Clinical Medical College, Yangzhou University (CMCYU). Furthermore, the model achieved 100% accuracy in predicting slides with the maximum tumor area for index lesions in PUMCH and CMCYU validation sets. In visual assessment, 200 randomly selected slices predicted as true positive demonstrated that the model could identify 97.5% (195/200) of the index lesions. These findings supported that our attention can be directed towards the slices predicted as positive, constituting only about one-third of the total burden. Conclusions: The weakly supervised deep learning model demonstrated remarkably high diagnostic and localization capabilities in identifying index lesions within RP specimens. This targeted approach would effectively alleviate the diagnostic workload associated with pathology assessments for prostate cancer.

1.5. Moderated Oral ePoster Session 05: Penis/Testis/Urethra: Cancer—Clinical, Bladder Cancer—Basic Science, Kidney & Ureteral Cancer—Basic Science, Adrenals, Miscellaneous

• Thursday, October 24
• 0800–0900

1.5.1. MP-05.01: Surgical and Functional Outcomes of Adrenalectomy by Urologists: A 15-Year Cohort Review

• Agarwal K, Kumar R, Ramachandaran R and Tandon N
• All India Institute of Medical Sciences, New Delhi, India

Abstract: Introduction and Objectives: Incidental adrenal masses are found in up to 5% of all patients undergoing abdominal imaging and around 10% of these may be functional. Data from the ACS-NSQIP suggests that over 90% adrenalectomies are performed by general surgeons even though urologists are facile in minimally invasive surgery. We reviewed adrenalectomies performed by us in the last 15 years with a focus on functional tumors and bilateral surgeries to assess the surgical and functional outcomes. Materials and Methods: In an IRB approved study, we reviewed our prospective database of patients who underwent adrenalectomy between 2008 and 2023. Clinical parameters were recorded for all patients and, those who underwent bilateral surgeries were followed up either in-person or telephonically and analysed for resolution of symptoms, quality of life using the WHO-QoL BREF questionnaire and complications of chronic steroid intake. Results: During the study period, 333 patients underwent 394 procedures including bilateral surgeries in 61 (18.3%). 286 patients (86%) had functional tumors with 63% being pheochromocytomas, 14% Cushing’s syndrome and 8% Conn’s syndrome. 32 patients had paragangliomas outside the adrenal gland. 87% cases were sporadic. 261 (78%) were hypertensive and 81 (24%) had diabetes (Table 1). The overall complication rate was 6.6%, the majority being minor and 4 conversion to open surgery. Among 61 patients with bilateral surgery, 58 had synchronous procedures; 37 for pheochromocytomas and 21 for Cushing’s syndrome including 7 requiring urgent surgery for severe hypercortisolism. All 43 who were available for follow-up had resolution of symptoms and BMI changes with only two requiring one antihypertensive medication each. Episodes of steroid deficiency occurred in 7 patients while steroid excess occurred in 3 patients. QoL scores were satisfactory in all patients in all domains. Conclusions: Adrenalectomy, including bilateral synchronous surgery, is a safe procedure that can be performed by urologists with excellent outcomes, most often using a minimally invasive approach.

1.5.2. MP-05.02: 5-Year Review of BCG Practices and Outcome for Intermediate- and High-Risk Bladder Cancer at a Tertiary Centre

• Karmakar A
• Alfred Health, Melbourne, Australia

Abstract: Introduction and Objectives: Current EAU guidelines recommend BCG instillation in intermediate risk tumours for 3, 6, and 12 months, and high-risk tumours at 3, 6, 12, 18, 24, 30 and 36 months. Anecdotally, not many patients reach three years of BCG maintenance as per many urology clinicians. This prompted a review of a tertiary centre’s completion rate of BCG maintenance and patient outcomes. Materials and Methods: A retrospective review of patients who had received BCG between 1st January 2016 and 31st December 2020 was conducted, with follow-up until 31st December 2023. Their initial diagnosis, BCG history and outcomes were recorded. Results: 43 high-risk patients were identified. Of these, only one completed three years of BCG. Five progressed to cystectomy. Four patients did not tolerate further maintenance BCG. Two patients had follow-up outside the health network. Eight patients did not continue BCG due to comorbidities or patient choice. The remaining 23 patients had a variation of induction-only or some maintenance ranging from three months to two years. Of those that did not reach three years, three patients had recurrence; one patient did not wish to have any further treatment, another patient had recurrence of CIS who proceeded to have gemcitabine, and the third patient had LGTa recurrence after induction BCG for HGT1. Five intermediate risk patients had induction BCG and one patient had maintenance to 12 months. One patient had follow-up outside of the health network. Of the remaining four patients, only one intermediate risk patient had recurrence after five y ears from initial diagnosis. Conclusions: A retrospective review over 5 years reflects different practice to the guidelines, which could be explained by BCG shortage, COVID-19 impact, or local practice. Of note, there was a low recurrence rate for high-risk patients despite not receiving the recommended three years of maintenance BCG, which raises the question of risk-benefit and resource allocation in the space of growing demand for bladder cancer management.

1.5.3. MP-05.03: Diagnostic Value of Aquaporin 3 as a Marker of Progression of Urothelial Cancer

• Pavlov V, Galimzianov V, Kutliyarov L, Danilko K and Ishemgulov R
• Bashkir State Medical University, Ufa, Russia

Abstract: Introduction and Objectives: Aquaporins are well known water channel proteins. Increasing evidence strongly suggest that Aquaporin 3 plays a pivotal role in cancer progression and metastasis. Aquaporin 3 is not a specific marker for benign or malignant epithelial neoplasms and changes in its expression can be multidirectional in the tissues of various forms of cancer. But the role of this protein in urothelial carcinoma of the bladder has been investigated only in one patients cohort. The objective of this study was to investigate the pattern of expression of Aquaporin 3 in neoplastic and benign tissues of bladder. Materials and Methods: Fresh tissue samples of the 77 patients with urothelial carcinoma following transurethral resection or radical cystectomy were collected. Gene expression profile of Aquaporin 3 mRNA transcript in 53 tumor tissues samples or 24 visually normal tissue samples were determined using real-time PCR (RT-PCR). The differences in mRNA expression between neoplastic and benign bladder tissues was assessed using Mann-Whitney U test and GraphPad Prism v.6.0 software. Results: Method ΔΔCt was used to compere the mRNA expression levels in cancer and benign bladder tissues of 39 urothelial carcinoma patients using RT-PCR. MRNA expression of Aquaporin 3 gene was significantly lower in tumor tissues than in benign tissues (Mann-Whitney U = 173.0, p = 0.0274). Conclusions: Aquaporin 3 is expressed significantly lower in bladder cancer tissue than in normal tissue. This finding can be used to improve the early diagnostic of urothelial carcinoma.

1.5.4. MP-05.04: NSUN2 and Methyl-5-Cytosine Promote Homologous Recombination Repair via Regulating DNA:RNA Hybrid Metabolism

• Wu Y, Ying Y, Zheng X and Xie L
• First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

Abstract: Introduction and Objectives: Bladder cancer is one of the common urinary tumors with a high incidence. Clinically, cisplatin is often used as the main chemotherapy drug for bladder cancer, which can lead to DNA damage, including double-strand DNA breaks (DSBs). The formation of DNA:RNA hybrids at DSB sites influences homologous recombination (HR)-mediated repair efficiency, with methylation on the hybrid potentially affecting its stability and metabolic processes. NSUN2 and YBX1 have been reported as key proteins in methyl-5-cytosine (m5C) modification. Thus, we aim to investigate the correlation between NSUN2/YBX1 and DNA:RNA hybrids in bladder cancer cells treated with cisplatin. Materials and Methods: In both the control and cisplatin-treated UM-UC3 bladder cancer cell lines, co-immunoprecipitation (CoIP) coupled with mass spectrometry using S9.6 antibody identified NSUN2 and YBX1 as key regulatory proteins involved in DNA:RNA hybrid metabolism. Further investigation into their regulation of DNA:RNA hybrids was conducted through DNA:RNA hybrid immunoprecipitation and sequencing. Site mutagenesis experiments validated the m5C-dependent regulation of DNA:RNA hybrids by NSUN2 and YBX1. Immunofluorescence confirmed that DNA:RNA hybrids facilitate the recruitment of downstream repair proteins. A series of in vivo and in vitro experiments confirmed the impact of NSUN2 and YBX1 on cell sensitivity to cisplatin. Results: CoIP and mass spectrometry revealed the involvement of NSUN2 and YBX1 in DNA:RNA hybrid metabolism in cisplatin-treated bladder cancer cells. NSUN2, acting as an m5C methyltransferase, contributes to m5C formation on hybrids, while YBX1 recognizes and stabilizes this structure. Consequently, the NSUN2-m5C-YBX1 axis regulates the accumulation of DNA:RNA hybrids at DSB sites, facilitating the recruitment of BRCA1 to DSBs sites for HR-mediated repair. Conclusions: Knockdown of NSUN2 and YBX1 in bladder cancer cells diminishes HR-mediated repair capability, thereby enhancing cancer cell sensitivity to cisplatin. These findings elucidate the functional role of the NSUN2/YBX1 m5C axis in HR-mediated DSB repair, offering a new avenue for bladder cancer treatment.

1.5.5. MP-05.05: To Study Urinary Let-7c Cluster Expression as a Diagnostic Marker in Urinary Bladder Cancer

• Kumar L ¹, Jain G ², Kural S ¹ and Das P ²

¹ 

Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

² 

Institute of Science, Banaras Hindu University, Varanasi, India

Abstract: Introduction and Objectives: Urinary exosomal miRNAs have emerged as promising non-invasive diagnostic markers for bladder cancer (BCa). This study aims to evaluate the expression of Let-7c-5p miRNA, along with miR-99a-5p and miR-125b-5p, in urine samples from patients undergoing transurethral resection of bladder tumors (TURBT). Materials and Methods: Quantitative Real-Time-Polymerase-Chain-Reaction (qRT-PCR) was used to analyze Let-7c-5p, miR-99a-5p, and miR-125b-5p cluster expression in 30 urine samples from BCa patients. Sixteen urine samples were collected and analyzed as healthy controls (HC) for comparative analysis. Results: Let-7c-5p (p = 0.2441) exhibited similar values in healthy controls and BCa patients, with an AUC of 0.62 for HC vs. BCa, indicating modest discrimination (Figure 1). Of these, only miR-99a-5p was significantly increased in BCa samples (p = 0.0026) with an AUC of 0.83, outperforming Let-7c-5p, while miR-125b matched Let-7c-5p at 0.65. While comparing high and low-grade tumors, Let-7c-5p, miR-99a-5p, and miR-125b showed limited diagnostic capability with AUCs of 0.39, 0.56, and 0.44, respectively (Figure 2). Conclusions: Urinary exosomes have unique miRNA profiles in BCa. Our study proposes that urinary miR-99a-5p has the potential to serve as a novel non-invasive diagnostic marker. This study contributes valuable insights into the potential of miR-99a-5p as a diagnostic tool, emphasizing its significance in the early detection and management of bladder cancer.

1.5.6. MP-05.06: Enhancing Surgical Planning for Complex Renal Tumors with 3D Renal Reconstruction: A Case-Based Interactive Survey

• Agrawal S, Menon A and Kumar G
• Amrita Institute of Medical Sciences, Kochi, India

Abstract: Introduction and Objectives: Surgical planning for minimally invasive partial nephrectomy (PN) is intricate, requiring consideration of various patient and tumor characteristics, particularly the tumor’s relationship with renal hilar anatomy. Virtual three-dimensional (3D) models is a promising technology that creates specific 3D printed models based on routine CT or MR imaging data. The purpose of the present study is to identify the role of 3D reconstruction as part of the preoperative planning process for complex renal tumors. Materials and Methods: Four patients with complex renal tumors were retrospectively chosen based on RENAL nephrectomy score and diverse anatomical characteristics from their pre-operative computed tomography (CT) datasets. Interactive virtual 3D models were created for each dataset using image segmentation software and made accessible for viewing and manipulation. A well-planned structured questionnaire was distributed among the attending urologists at an international meeting held in Kochi. The survey questionnaire inquired about demographic data, surgical experience, imaging clarity concerning the arterial, venous, and calyceal system, the feasibility of performing partial PN, surgical approach, time of ischemia, estimated blood loss after viewing CT scans, and their respective 3D models. Results: Sixty urologists participated in the study and most of them (86%) were consultants. The overall feasibility of performing PN after viewing the 3D reconstructions significantly increased (p < 0.05). Preference for the open approach significantly decreased (p < 0.05) along with a decrease in warm ischemia time and estimated blood loss. Surgical decision change was significantly associated with several partial or radical nephrectomies performed annually. Conclusions: 3D reconstruction models play a significant role in modifying surgeons’ strategies and surgical planning for patients with renal tumors.

1.5.7. MP-05.07: A Rare Case of Seminal Vesicle Adenocarcinoma

• Muralidhar A, Jain S, Bhushal I abnd Aggarwal N
• All India Institute of Medical Sciences, New Delhi, India

Abstract: Introduction and Objectives: Adenocarcinoma of the seminal vesicle is an extremely rare tumor of the genitourinary system. Usually presenting in older individuals with hematospermia, this is a presentation in a young male of 16 years with vague constitutional symptoms along with a systematic review of literature of all similar reported cases. Materials and Methods: In Feb 2023, a 16-year-old male presented with hematuria underwent an open exploration for a large pelvic, cystic mass compressing the rectum and bladder with its origin of origin still in doubt. Radiology review suggested either an unascended kidney with RCC or a prostatic utricle cyst with a secondary malignancy. Post surgery the same was reported to be seminal adenocarcinoma after extensive IHC use. Owing to the unusual age and presentation of the same as a large palpable pelvic mass with hematuria, a search through PubMed, and google scholar revealed that there are approximately 60 cases reported. Results: The patient underwent surgery and was discharged after 7 days after a normal post operative period. The patient is on regular follow up and is currently asymptomatic. Conclusions: Since primary SV adenocarcinoma was first described, only about 50 cases have been reported in the literature. Despite improvements in imaging modalities, the diagnosis remains primarily one of exclusion. Symptoms do not typically develop until late in the clinical course and are non-specific. Given the rarity of the condition, non-specific symptoms, and aggressive nature of the disease, SV cancers remain a challenging clinical entity for the practicing urologist. Early diagnosis and aggressive extirpative therapy offer the best chance at a durable response.

1.5.8. MP-05.08: A Scoping Review Suggests Post-Pubertal Potentially Reversible Germ Cell Atrophogenic Events Are Part of the Cause of Germ Cell Tumours and Could Justify Further Study of Testis Conservation

• Oliver T
• Queen Mary University of London, London, United Kingdom

Abstract: Introduction and Objectives: There is no doubt that testicular germ cell neoplasia (TGCN) is part of testicular dysgenesis syndrome and an oestrogenic/xeno-oestogenic exposure during intra-uterine development is the initiating event. Less clear is whether this event is sufficient to lead to the variation seen in post-puberty tumour development and this abstract will review a series of post pubertal events that result in a different frequency germ cell tumour. Materials and Methods: Post-pubertal events reviewed are: 1. Trauma and surgery for cryptorchid testis increase frequency of non-seminoma over seminoma (NS > S). 2. Cryptorchidism no surgery have increased S > NS. 3. Azothiaprine immunosuppression have increased NS > S. 4. Drug addict HIV have increased NS>S. 5. HIV (other) have increased S > NS. Results: These “atrophogenic” events after puberty acts on in utero exposed diploid germ cell precursors at the beginning of post-pubertal meiosis. They form the tetraploid pachytene spermatocyte before completing meiosis, explaining the high ploidy level found in TGCN. These “atrophogenic” events damage both germinal epithelium and Leydig cell function. The Leydig cell effects result in the need up to 40% of TGCN survivors requiring testosterone supplementation patients with bilateral TGCN have sperm precursors capable of salvage by chemotherapy and producing offspring is proven from limited studies, though the recovered function is poor. Tumours that develop after chemotherapy induced testis conservation develop relapse (up to 40 years). This is later than metastatic disease and are usually stage 1 seminomas and to date have not as yet led to drug resistant cancer. A hypothesis to explain the late recurrence after treatment is that they might require re-induction of tetraploidy post-puberty from in-utero primed diploid precursors that survive chemotherapy. Conclusions: Possible treatment strategies to be considered as ways of reducing this late re-induction of TGCN-tumour intraepithelial neoplasia (TIN) include: treat testis anaerobe microbiome associate infertility & viral orchitis with immunotherapy study spermatogenesis in males after HPV vaccination verses unvaccinated a placebo controlled randomised trial of testosterone in those with elevated FSH and LH as prevention of late events (both cardiac and 2nd germ cell testis tumours).

1.5.9. MP-05.09: Analysis of 30-Day Complications in 300 Post-Chemotherapy RPLNDs for Testicular Germ Cell Tumors over a Decade: A Single Centre Experience

• Arora A, Sampath S, Thimiri Mallikarjun N, Garg V, Gujela A, Joshi A, Prabhash K, Noronha V, Menon S, Katdare A, Bakshi G, Godse S, Misra A, Shirke A, Pal M and Prakash G
• Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India

Abstract: Introduction and Objectives: In advanced GCT patients with residual nodal disease, a post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is the mainstay of management. This is a challenging surgery and outcomes vary widely, largely dependent on the centre’s experience. We aimed to evaluate the incidence of 30-day major complications in PC-RPLND. Materials and Methods: We retrospectively analysed 300 patients with GCT who underwent a pc-RPLND at our centre from 2012 to 2023. We perform pc-RPLND for all residual nodal masses (with normalised tumor markers) larger than 8–10 mm in size. Data was collected for clinic-pathological characteristics. Complications were graded as per the Clavien Dindo Classification (CDC) and divided into low grade (CDC I, II) and high grade (CDC > II). Results: Of the 300 patients 23.8% had stage II disease while 16%, 27% and 30.2% had IIIA, IIIB and IIIC disease respectively. Good risk patients constituted 35% and poor risk patients accounted for 31%; thus, the majority of our patients had advanced disease. A bilateral template RPLND was performed in 92.4% patients. The median duration of surgery was 360 min (IQR 300–390) and the mean blood loss was 750 + 120 mL. A vascular surgeon’s assistance was required in 19 (8.4%) patients. The mean size of the nodal burden was 7.1 + 3.3 cm. The incidence of post-operative 30-day complications for CDC grades 0, I, II, IIIa, IIIb, IVa, IVb and V were 66.2%, 15.1%, 9.8%, 6.2%, 1.8%, 0.4%, 0% and 0.4% respectively. The types of complications are summarised in Table 1. Conclusions: The incidence of CDC low-grade complications is acceptable while that of CDC high-grade complications is quite low when PC-RPLND is performed in an experienced centre. Our low rates of complications despite a high burden of disease re-emphasizes the importance of centralised care for this rare cancer.

1.5.10. MP-05.10: Assessment and Outcome of Intraoperative Frozen Section Examination of Surgical Resection Margins in the Management of Penile Cancer from a Tertiary Centre

• Pang K ¹, Yunis M ², Haider A ³, Freeman A ³, Hadway P ⁴, Nigam R ⁵, Rees R ⁶, Muneer A ³ and Alnajjar H ³

¹ 

The University of Hong Kong, Hong Kong, China

² 

King’s College London Medical School, London, United Kingdom

³ 

University College London Hospitals NHS Foundation Trust, London, United Kingdom

⁴ 

Royal Berkshire NHS Foundation Trust, Reading, United Kingdom

⁵ 

Royal Surrey NHS Foundation Trust, Guildford, United Kingdom

⁶ 

University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom

Abstract: Introduction and Objectives: Frozen section examination (FSE) of the tumour and its margins is important during penile-preserving surgery (PPS) in penile cancer. Positive surgical margins will impact on how much penile or urethral tissue is excised. We aim to evaluate the outcomes of intraoperative FSE of resection margins in PPS. Materials and Methods: A retrospective analysis of patients who underwent a penile FSE for assessment of margins between 2010 and 2022 was conducted. Patients with penile squamous cell carcinoma (SCC) diagnosed in FSE and/or final histopathology were included. FSE were grouped into positive and negative margins. The FSE were compared with the final histopathological analysis and the Diagnostic Testing Accuracy (DTA): sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. Survival analysis was performed using the Kaplan-Meier survival curve and log-rank test. Results: A total of 137 FSE were performed. The median (IQR) age was 65 (53–75 years). 118 (86.1%) patients had negative FSE margins, 16 (11.7%) had positive FSE margins and 3 (2.2%) had equivocal (atypical cells) results. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of penile FSE was 100%, 100%, 100%, 100%, and 100%, respectively. 18 patients underwent further resection due to a positive or equivocal FSE and 12 (66.7%) achieved negative margins. Kaplan-Meier estimated survival rates for the whole cohort were: RFS (recurrence-free survival) 79.2%, MFS (metastasis-free survival) 77.7%, OS (overall survival) 65.9%, DSS (disease-specific survival) 66.8%, at 2 years; and RFS 73.3%, MFS 75.4%, OS 54.2%, DSS 59.9%, at 5 years. Conclusions: Intraoperative FSE performed at our centre for the assessment of penile SCC margins is 100% specific and sensitive. FSE remains an essential diagnostic tool in minimising over-treatment during PPS.

1.5.11. MP-05.11: Comprehensive Assessment of Perioperative Morbidity After Retroperitoneal Lymph Node Dissection in Metastatic Germ Cell Cancer Patients Leveraging the EAU Guidelines of Standardized Complication Reporting

• Klemm J, Schulz R, Stelzl D, Janisch F, Fisch M, Seidel C, Bokemeyer C, Dahlem R and Vetterlein M
• University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Abstract: Introduction and Objectives: Retroperitoneal lymph node dissection (RPLND) is crucial in managing metastatic germ cell tumors (GCTs), particularly postchemotherapy. There is a notable scarcity of data regarding the perioperative morbidity of this procedure based on predefined reporting standards. We aimed to present findings from our institution involving men undergoing RPLND for GCTs, aligning with the updated EAU guidelines for standardized complication reporting. Materials and Methods: Retrospective analysis of patients who underwent RPLND for GCTs between 2010–2022. A detailed extraction of 30-day complications from digital charts was performed using a procedure-specific predefined catalog. All complications were graded according to the Clavien Dindo classification (CDC), and the Comprehensive Complication Index (CCI) was calculated for each patient, reflecting cumulative morbidity on a scale from 0–100. Results: Overall, 71 men underwent RPLND at a median age of 32 yr (IQR 25–38). Median BMI was 24 (IQR 22–27). A significant majority— 63 patients (89%)—had a primary diagnosis of non-seminoma, and 56 patients (79%) fell within the good prognosis group according to the International Germ Cell Cancer Collaborative Group (IGCCCG). Prior to RPLND, chemotherapy was administered to 66 patients (93%), and 48 patients (68%) had negative tumor markers. Median tumor diameter was 53 mm (IQR 35–83) and the median operative time was 198 min (IQR 128–262). Unilateral template removal was carried out in 55 patients (79%). In total, 163 complications were reported among 68 patients (96%), primarily related to bleeding (37%), gastrointestinal issues (23%), and miscellaneous reasons (18%). Nevertheless, 8 individual “major” complications (CDC grade ≥ IIIa) were observed in 6 patients (8.5%; Table 1). The median CCI was 12 (IQR 9–23). When using the CCI to capture cumulative morbidity, the proportion of patients with most severe complication burden (CDC grade IIIa or corresponding CCI > 26.2) increased to 14% as compared with 8.5% when considering only the highest grade complication according to the CDC. Conclusions: An in-depth assessment of complications following RPLND highlights that nearly all patients encounter some form of postoperative complication. Nevertheless, severe complications are relatively uncommon. The CCI, offering a comprehensive evaluation of cumulative postoperative morbidity, indicates higher rates of “major” complications compared to the more restricted CDC.

1.5.12. MP-05.12: Impact of Scrotal Violation on Presentation and Outcomes of Patients with Non-Seminomatous Germ Cell Tumors

• Shirke A, Thimiri Mallikarjun N, Prakash G, Misra A, Godse S, Menon S, Joshi A, Pal M and Arora A
• Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India

Abstract: Introduction and Objectives: High inguinal orchiectomy is the standard initial treatment for suspected testicular cancer. Inadvertent orchidectomy or a biopsy through a trans-scrotal route is considered an oncological violation. In this study, we aimed to determine the oncological outcomes of our non-seminomatous germ cell tumor patients who had a history of scrotal violation and then later underwent stage-dependent treatment of their testicular cancer at our centre. Materials and Methods: We retrospectively reviewed our institutional database of patients with germ cell tumors for those who had a history of scrotal violation from 2014–2023. For stage 1 patients, a scrotal scar excision and inguinal cord revision was done. Stage 2 and 3 patients underwent the same procedure at the time of the post-chemotherapy retroperitoneal lymph node dissection (RPLND). Data was collected for the pattern of metastatic disease in stage 2 and 3 patients, presence of disease in the cord revision specimen and the oncological outcome for all patients. Results: We identified 57 patients who had a history of scrotal violation and were then managed further at our centre. Of these, 8 (14%) had presented with Stage 1 disease. In them, the cord revision had identified residual tumor in 5 (63%) patients. The stage at presentation of the remaining 49 patients was as follows: 6 with Stage IIB (12%), 6 with Stage IIC (10%), 10 with Stage IIIA (18%), 15 with Stage IIIB (26%) and 12 with Stage IIIC disease (21%). Of these 49 patients who underwent post-chemotherapy RPLND with scrotal scar excision and cord revision, only 1 patient (2%) had scrotal scar involvement and 2 patients (4%) had residual disease in the cord. Conclusions: Stage I patients who have had a scrotal violation should undergo a scrotal scar excision and inguinal cord revision. In patients with stage II or III disease and a history of scrotal violation, the incidence of post-chemotherapy residual disease in the scrotal scar or the inguinal cord is very low.

1.5.13. MP-05.13: Is Histology of Retroperitoneal Lymph Node Dissection a Guide for Surgical Management of Extra Retroperitoneal Metastatic Site in Testicular Germ Cell Tumor—Implications in Clinical Practise

• Thimiri Mallikarjun N, Pal M, Misra A, Godse S, Shirke A, Menon S, Joshi A, Prakash G and Arora A
• Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India

Abstract: Introduction and Objectives: Post-chemotherapy residual disease resection (RDR) is a crucial part of treatment in patients with metastatic non-seminomatous germ cell tumor (NSGCT). However, only limited data is available regarding the concordance of histologies of the different disease sites. In this study, we analysed whether the histology after a retroperitoneal lymph node dissection (RPLND) could indicate the histology of the extra retroperitoneal site of disease. Materials and Methods: We retrospectively analysed 153 patients from 2012 to 2023 with metastatic NSGCT who had post-chemotherapy residual disease in the retroperitoneum and at least one other site. All of these patients underwent a RPLND while the decision to resect or observe the extra-retroperitoneal site was based on a multi-disciplinary discussion. We compared the histologies of the retroperitoneal RDR with the extra-retroperitoneal RDR and calculated the concordance between them. Results: Patients were classified as good (19%), intermediate (35%) and poor (46%) prognostic groups according to IGCCCG. The sites of the extra-retroperitoneal disease were lungs (32%), mediastinum (7%), supraclavicular node (7%), liver (3%) and multiple sites (49%). Of the 153 patients who underwent a RPLND, 62 (40%) patients also had resection of their extra-retroperitoneal site, while in the remaining 91 (60%) patients, the extra-retroperitoneal disease was observed. The RPLND histology showed necrosis, teratoma and viable tumor in 36%, 38% and 26% respectively. The histologies of the retroperitoneal and extra retroperitoneal disease are depicted in Table 1. Among 91 patients in whom the extra-RP disease was observed, a recurrence/progression occurred in 12%. Of these, 50% had necrosis and rest 50% had teratoma or viable disease in their RP histology. Conclusions: Our results underline that treatment of residual disease after chemotherapy at all sites is mandatory, as the rate of discordance of histology is around 26.3% (ranging from 21–31% depending upon the RP pathology). Necrosis on retroperitoneal histology does not exclude a teratoma or viable disease in the extra-RP disease. Thus, extra-RP residual disease should always be addressed if technically feasible.

1.5.14. MP-05.14: Oncological and Functional Outcomes with Nerve-Sparing Retroperitoneal Lymph Node Dissection for Testicular Non-Seminomatous Germ Cell Tumor

• Pal M, Thimiri Mallikarjun N, Arora A, Misra A, Godse S, Shirke A, Menon S, Joshi A, Bakshi G and Prakash G
• Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India

Abstract: Introduction and Objectives: Retroperitoneal lymph node dissection (RPLND) is integral in the armamentarium to manage non-seminomatous germ cell tumors (NSGCT). Preservation of fertility is of significant concern when treating this young population, most of whom have long disease-free survival. A nerve-sparing RPLND (NS-RPLND) helps in maintaining antegrade ejaculation in these young males, but requires surgical expertise. We report our oncological and functional outcomes with NS-RPLND in patients with NSGCT. Materials and Methods: We retrospectively reviewed our NSGCT patients who had undergone an NS-RPLND from Jan 2020 to Dec 2022. All surgeries were performed by three surgeons. The decision for a unilateral vs. bilateral nerve sparing technique depended on the location of the nodal masses and also on the intra-operative tissue planes. Data was collected for stage of disease, template of dissection, unilateral/bilateral nerve preservation, antegrade ejaculation function at 6 and 12 months post-op and for any disease recurrence. Results: During the study period, 43 patients underwent a NS-RPLND. Of these, 5, 13 and 22 patients had stage I, II and III disease respectively. The median age of the patients was 24 + 4 years. Of the 43 patients, 7 (16.2%) underwent a bilateral NS-RPLND while in the rest, only one-sided nerves could be preserved. Four patients had a robotic NS-RPLND. The median blood loss was 400 cc (IQR 300–450) with a median operating time of 270 min (IQR 240–330). The median length of hospital stay was 6 days (IQR 5–8). There were no major intra and peri-operative complications. Over a median follow-up period of 12 months, none of the patients had an in-field recurrence. Of the 43 patients, 25 (58%) had achieved antegrade ejaculation by 6 months post-operatively, which improved to 29 (67.4%) patients by 12 months. The median time to first antegrade ejaculation after the RPLND was three months. Conclusions: NS-RPLND, when possible depending upon the location of nodal masses, is feasible and safe and allows for preservation of antegrade ejaculation in the majority of patients without compromising oncological outcomes.

1.6. Moderated Oral ePoster Session 06: Stones—Surgical Treatment

• Thursday, October 24
• 0800–0900

1.6.1. MP-06.01: Combined Open and Endourological Management of Broken-Complex-Encrusted Forgotten Double-J Ureteral Stents Causing Renal Failure

• Kalathia J ¹, Patel K ², Vala G ³, Agrawal S ⁴, Joshi P ¹, Khetarpal A ⁵, Aggarwal K ¹ and Khant S ¹

¹ 

Fortune Urology Clinic, Botad, India

² 

Nephron Kidney Hospital, Anand, India

³ 

KIMS, Ahmedabad, India

⁴ 

Bansal Hospital, Bhopal, India

⁵ 

Khetarpal Hospital, New Delhi, India

Abstract: Introduction and Objectives: Forgotten double-J (DJ) stents cause a spectrum of complications including encrustations, obstruction and eventually renal failure if timely not removed. These neglected indwelling stents often fragments with large encrusted stones creating a urological dilemma in its management. We prospectively evaluated combination open and endourological approaches in managing these complex stentoliths in patients with renal failure due to forgotten double-J ureteral stents. Materials and Methods: Between October 2013 to October 2023, 48 patients (34 males and 14 females) were diagnosed with forgotten DJ ureteral stents. On average indwelling time was 3.8 years (range 1–8 years). Pre-operative radiological investigations included X-rays, CT-scans and renal scans to evaluate the encrustations, stone burden, fragmentations and assess the renal functions. Primary diversions were accomplished in patients with obstructive uropathy. Definitive open or endourological or combined management were carried out to render stone free status. Perioperative parameters, stone free rate, blood loss and length of hospitalization were prospectively evaluated. Results: Mean age of the patients was 52.4. minimum indwelling time was 1 year whereas maximum was 8 years. Average stone burden was 38.6 mm (22.8–97.2). Initial percutaneous drainage was performed in 14 (26.16%) patients with obstructive uropathy. Open, endourological (percutaneous nephrolithotomy, cystolithotripsy, ureterolithotripsy) and combined approach was carried out in 6 (12.5%), 37 (77.1%) and 3 (6.3%) of patients respectively to render stone free status. 40 (83.3%) patients were stent free in same sitting but 8 (16.7%) required a staged procedure. The mean operating time was 80.44 ± 28 min with stone free rate achieved 88.4%. Average length of hospitalization was 3.5 ± 2 days. Despite aggressive management 5 (10.4%) patients could not recover from renal failure. No other significant postoperative complications occurred. Conclusions: In the minimally invasive era, often due to substantial stone load conventional open or combined with endourological approach is needed especially in forgotten encrusted stentoliths for a successful outcomes ultimately preventing renal failure.

1.6.2. MP-06.02: Could Selective Use of Single-Use Digital Flexible Ureteroscopes Reduce Annual Costs Associated with Reusable Ureteroscopes? A Local Economic Evaluation in a High-Volume Center

• Simard F, Cloutier J and Turcotte B
• Université Laval, Québec, Canada

Abstract: Introduction and Objectives: Breakages and repairs related to flexible digital reusable ureteroscopes (flURS) are expensive. Thus, we aimed to assess the cost-effectiveness of single-use flexible digital ureteroscopes (SUDFU) in our Canadian high-volume center. Materials and Methods: We collected local data over a year in 2017–2018 and conducted an economic evaluation by cost minimization, comparing head-to-head SUDFU and flURS related costs in our center. For reusable scopes, we considered the purchase costs of Karl-Storz and Olympus devices, which are the available models in our centers. Regarding single-use, we considered the purchase costs of LithoVue and Uscope devices. Also, by generating different flURS breakage reduction scenarios, we aimed to demonstrate the budgetary impact that would have SUFDU introduction in our center. Results: Over a year, we performed 328 ureteroscopies. Our data collection reported 21 breakages with an incidence of 6.4% and the mean number of cases before breakage was 12. By combining the costs related to the purchase, repairs, reprocessing, and sterilization of our 5 reusable URS, we estimated total annual costs of around 115,000$ with a mean cost per procedure of 350$. More than 80% of the mean cost per intervention was related to scope repairs and the average repair cost per breakage was around 5000$. The annual number of ureteroscopies for which SUDFU would become profitable stands between 11 and 26, depending on the chosen device. Furthermore, we illustrated in custom graphs how selective use of SUFDU in selected cases can reduce annual costs by avoiding breakages in different hypothetic scenarios. Conclusions: The mean cost per intervention with SUDFU is usually higher than with flURS in high-volume centers and exclusive use of single-use becomes cost-ineffective from a low number of cases per year. However, a hybrid approach in selected high-risk cases could have an interesting annual budgetary impact.

1.6.3. MP-06.03: Damage Control Electrocoagulation of Arterial Bleeders in PCNL: Description of a Low Cost Modification

• Rewari H, Wadhwa P, Singh A, Talwar H, Rathi D and Ahlawat R
• Medanta, The Medicity, Gurugram, India

Abstract: Introduction and Objectives: Renal haemorrhage after percutaneous nephrolithotomy (PCNL) is a dreaded complication. Venous bleeding is the predominant type and can be controlled by tamponade in most instances. Arterial bleeding occurs due to pseudoaneurysms, arteriovenous fistula or segmental arterial injury and is treated by selective renal angioembolization. We present our experience in the use of electrocautery for controlling arterial hemorrhage as a damage control procedure. Materials and Methods: We describe 3 cases of intraoperative arterial bleeding during PCNL managed by electrocoagulation. Case 1 was a diverticular stone, which had an arterial bleeder from the parenchymal tract. Case 2 was an inferior calyceal calculus. Bleeding occurred from the calyceal wall, which eroded during use of pneumatic lithotripter. We used thin bugbee electrodes through the Alken guide rod covered by a 10Fr infant feeding tube as insulation cover to perform point electrocoagulation. The distal knob of the rod was left uncovered, providing a larger surface area for coagulation and proximal end allowed transmission of current via cautery pencil. This was inserted through the working channel of 20Fr nephroscope. Case 3 was a left solitary kidney with previous pyelonephritis secondary to cystine stones. While fragmenting, the hard stone eroded into the still inflamed calyceal bed, causing profuse arterial bleeding from base of the anterior calyx. A slender resectoscope with a ball electrode was used for fulguration. Patient was stabilized and emergent renal angiography confirmed good coagulation of 2 subsegmental vessels. Results: Hemostasis was achieved satisfactorily allowing completion in 2 cases with an uneventful recovery. Case 3 underwent RIRS after 3 weeks. Conclusions: Electrocoagulation of arterial bleeders is feasible in case of arterial bleeding during PCNL. It affords interim hemostasis till angiography can be undertaken. Our ‘modified ball electrode’ is low cost, easily accessible and may prove life-saving, especially in situations where immediate access to angioembolization is unavailable.

1.6.4. MP-06.04: Effect of Different Irrigation Rates on Intrarenal Temperature During Laser Lithotripsy: An Experimental Study on Ex Vivo Model

• Malkhasyan V, Sukhikh S, Gritskov I, Kindarov I, Shamaev D and Pushkar D
• Russian University of Medicine, Moscow, Russia

Abstract: Introduction and Objectives: Currently, the use of laser systems for lithotripsy of ureteral and renal stones is widespread. It is relevant to study critically high temperatures in the renal system when using laser lithotripsy to provide safety and minimize complications. Materials and Methods: This prospective study was conducted ex vivo on a kidney model (made using 3D modeling) with and without a stone in different tulium fiber laser modes and irrigation rates. Temperatures of 43C and 56C were taken as measurement reference points. Results: The temperature in the renal pelvis increases significantly with higher laser power and is in direct correlation with the irrigation rate. When the laser was used continuously in the renal system without stone and without irrigation, temperatures of 43C and 56C were achieved at 25 W power after an average of 27 and 96 s, respectively, and at 40 W power after 29 and 93 s, respectively. At 15 mL/min irrigation demonstrated that the 43C at 25 W was not reached. Under the same conditions, 40 W heated the liquid to 43C in 68 and 56C was not reached. At an irrigation rate of 40 mL/s, none of the critical temperature points were reached when running at 25 W and 40 W. The following results were obtained with laser lithotripsy of kidney stones: without irrigation 25 W–28 and 107 s, 40 W–14 and 56 s (for 43C and 56C respectively), with irrigation 15 mL/s 25 W–76 s to 43C (56C was not reached), 40 W—in 26 to 43C and (56C was not reached), with irrigation 40 mL/s 25 W and 40 W—critical points were not reached. Conclusions: Analysis of the results showed that lithotripsy at irrigation rate 15 mL/min and power of 25 W appears to be a safe procedure but is limited by the continuous laser operation time of 76 s. The safest irrigation mode is 40 mL/min, at which critical temperature was not reached at any selected laser lithotripsy power, however, the possible increase in intrarenal pressure should not be forgotten, studies in this aspect should also be planned in the future.

1.6.5. MP-06.05: Endoscopic Stone Surgery in Patients with Bacteriuria

• Malkhasyan V ¹, Gadzhiev N ², Sukhikh S ¹, Maltsev E ¹, Kindarov I ¹ and Pushkar D ¹

¹ 

Russian University of Medicine, Moscow, Russia

² 

N.I. Pirogov Clinic of High Medical Technologies at St. Petersburg State University, St. Petersburg, Russia

Abstract: Introduction and Objectives: A study was conducted to compare infectious complications in patients with sterile urine and bacteriuria who underwent the endoscopic treatment of upper urinary tract stones. Materials and Methods: There was a cohort, retrospective study of patients who underwent endoscopic stone treatment between January till July 2023. 211 patients were selected for analysis. Patients were given different antibiotic prophylaxis according to the urine culture results. In case of initially sterile urine culture, antibiotic prophylaxis was prescribed a few hours before surgery, in case of clinically insignificant bacteriuria—3 days before surgery, in case of clinically significant bacteriuria—7 days before surgery, with control urine culture and selection of antibiotic prophylaxis in the following. Results: A preoperative sterile urine culture was diagnosed in 152 patients (72%), whereas 59 patients (28%) had bacteriuria in urine culture. Of these, 31 (14.7%) patients had bacteriuria with a titer < 105 CFU/mL, and 28 (13.3%) patients had bacteriuria with a titer ≥ 105 CFU/mL. After antibiotic therapy of patients with clinically significant bacteriuria—sterile urine cultures were obtained in 22 (78.6%) patients. Accordingly, 37 (17.5%) patients with different titers of bacteriuria underwent endoscopic surgery. In the postoperative period, hyperthermia was noted in 17 (8.1%) patients. Hyperthermia was more frequently noted in 6 (16.2%) patients with bacteriuria compared to 11 (6.3%) patients with sterile cultures (p = 0.087). The results of multivariate logistic regression parameter estimation revealed statistically significant associations between the odds of hyperthermia and bacteriuria before surgery. Bacteriuria increased the odds of hyperthermia by 4.75 times (OR = 4.75, 95% CI [1.222; 18.803], p = 0.023). No statistical significance was found for the association of hyperthermia with other model parameters such as sex, age, BMI, diabetes mellitus, volume and size of the stone and operation time (p > 0.05). Conclusions: A positive urine culture is a significant risk factor for infectious complications after endoscopic surgery. Patients with stones and bacteriuria are indicated for extended antibiotic therapy with a duration of 7 and 3 days, depending on the titer of the bacterium, which will reduce the risks of infectious complications in the postoperative period.

1.6.6. MP-06.06: How Common Is Non Papillary Puncture During PCNL and Does It Have Inferior Outcome Compared to Papillary Puncture?

• Sistla B, Mahajan V, Myilsamy A and Sangampalayam K
• Vedanayagam Hospital & PG Institute, Coimbatore, India

Abstract: Introduction and Objectives: Papillary punctures are considered anatomically more safe due to less incidence of hemorrhage than nonpapillary punctures. The incidence of unintentional non papillary punctures is not well documented. We intend to study the incidence of unintentional nonpapillary punctures during PCNL and see is there any difference in the outcomes. Materials and Methods: This is a single institution prospective observational study of PCNLs done over one year period. Visualisation of torn papilla during the entry or withdrawal of nephroscope is defined as papillary puncture (Group A) and if the entire papilla was seen adjacent to the tract then it is called non-papillary puncture (Group B). Serial co-axial metal dilators were used in standard PCNL followed by 30–32 Fr Amplatz (Cook) and in miniperc after initial screw dilation 15–21 Fr dilator were used with appropriate sheaths (Stortz). Video recording of all the cases was done irrespective of patient or findings. Data was analysed for preoperative, operative and postoperative parameters. Data was presented in proportions and percentages. Student’s t-test was used for comparison of variables. Chi square test was used for qualitative data. Results: A total of 171 patients had PCNL during the study period. Male:Female = 2:1 (135 vs. 65). 50% were in 4th to 6th decade. 29 had multiple punctures. Of 200 punctures, papillary and NP punctures were 106 (53%) and 94 (47%) respectively. There was no difference between papillary and non papillary puncture with respect to intra or post op bleeding, drop in Hb, need for transfusion, and post op intervention in form of redo or angio-embolisation. (Table 1). Conclusions: Nearly 50% of PCNLs are non papillary punctures. Non papillary punctures are safe and incidence of complications are same as in papillary punctures.

1.6.7. MP-06.07: Inner Diameter of Narrow Ureter and Dilating Effect of Preoperative Ureteral Stent Placement

• Kawazu T ¹, Kato Y ¹, Kumagai M ¹, Maeda K ², Miura K ², Furuno T ², Ameda K ² and Seki H ²

¹ 

Saka Urological Hospital, Sapporo, Japan

² 

Hokkaido Memorial Hospital of Urology, Sapporo, Japan

Abstract: Introduction and Objectives: During transurethral lithotripsy (TUL) procedures, some patients present with narrow ureters and difficult-to-access stones. The most common practice in these patients is the two-phase surgery with preoperative stenting; however, the lack of reports on ureteral diameter measurements regarding actual dilation and the efficacy in patients with severe stenosis remains uncertain. Therefore, this study aimed to establish the prevalence of narrow ureters, identify associated risk factors, and assess the dilation effect of preoperative stenting, with a focus on the inner diameter of the diameter. Materials and Methods: A retrospective analysis was conducted encompassing 607 patients undergoing initial transurethral lithotripsy procedures from January 2018 to December 2022. Patients were categorized into two groups: the narrow ureter (12-Fr dilator could not be inserted) and the non-narrow ureter (using standard TUL techniques). Results: Among the 607 patients, 67 (11.0%) were classified as the narrow ureter group: a 10-Fr. the instrument was successfully inserted in 33 (5.4%), 8 Fr. in 30 (4.9%), and 6 Fr. in 4 (0.7%). Multivariate analysis revealed a significant association with younger age in patients with narrow ureters. All 47 patients undergoing preoperative stenting exhibited dilation of the ureteral diameter up to 12-Fr. or larger after stent placement, with no instances of intraoperative ureteral injury or postoperative ureteral stricture. Conclusions: Narrow ureters, where 12-Fr. sheaths could not be inserted, constituted 11% of patients undergoing transurethral lithotripsy procedures. Preoperative stenting demonstrated substantial dilation, thereby ensuring the safety of surgical procedures, even in patients with severe stenosis.

1.6.8. MP-06.08: Optical or Visual Tract Dilatation in Percutaneous Nephrolithotomy: A New Technique with Its Safety, Efficacy Assessments

• Karuppaiah J
• K A P V Government Medical College, Tiruchirapalli, India

Abstract: Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is gold standard technique for the treatment of renal calculi larger than 2 cm or complex renal calculi. Establishment of nephrostomy tract is the important step during PCNL. A newer technique of tract dilatation under vision using ureteroscope has been defined and executed. In this study, we aimed to evaluate the safety, efficacy of this innovative optical or visual tract dilatation in percutaneous nephrolithotomy procedures. Materials and Methods: This is a single centre study, conducted in patients who underwent PCNL using optical or visual tract dilatation between January 2017 and December 2022 were included in this study. Demographic details, operative time, tract dilatation time, number of per and post operative blood transfusions, retroperitoneal fluid collection needs intervention, pleural fluid collection needs ICD, peritoneal fluid collection needs drainage, vascular injury needs intervention, pelvic calyceal injury needs intervention, other organ injuries need intervention, the day of PCN tube removal and number of post-operative days in admission were recorded. Data were analysed and reported using summary statistics. Results: A total of 117 patients datas were analysed in this study. The mean (SD) age was 47.5 years and 84 patients were male. Overall, the mean (SD) operative time was 103.5 min, tract dilatation time was 12.5 min, blood transfusion was required in 14 patients, 4 patients required USG guided percutaneous needle aspiration for retroperitoneal fluid collection. 2 patients required ICD for pleural fluid collection, one patient required peritoneocentesis for peritoneal fluid collection. No one required angio embolisation or nephrectomy. 11 patients developed urine leak after nephrostomy closure and settled with conservative managements. No one developed other organ injury. The mean (SD) day of PCN tube removal was 3 rd POD. The mean (SD) number of post-operative days in admission was 5. No other major complications were reported during post-operative period. Conclusions: Optical or visual PCN tract dilatation technique is a safe, economical and feasible technique, unlike C arm guided blind procedure this is done under direct vision with added advantage of nil radiation exposure, lesser chance of arterial injuries, reduced blood transfusions and complication rates.

1.6.9. MP-06.09: Outcomes of Percutaneous Nephrostomy in the Pregnant Cohort, in Melbourne, Australia

• Khanna Y, Wei G and Ranasinghe W
• Monash Health, Melbourne, Australia

Abstract: Introduction and Objectives: Management of obstructive uropathy in pregnancy is complex, requiring consideration of urologic, obstetric and technical factors such as radiation and general anaesthetic exposure. Options include retrograde stent insertion, primary ureteroscopy (for calculi), or percutaneous nephrostomy. Early encrustation/blockage of nephrostomy tubes in the pregnant cohort has been described, due to metabolic changes and glomerular hyperfiltration of calcium. Some authors have described shorter interval schedules (i.e., every 3 weeks), with average dwell time of ~3 weeks in the pregnant cohort and ~6 weeks in the non-pregnant age-matched cohort. This study aims to evaluate outcomes of pregnant patients undergoing nephrostomy insertion in a large quaternary centre in Melbourne, Australia. Materials and Methods: 17 patients were identified over the last 10 years as having undergone percutaneous nephrostomy insertion during pregnancy, in a quaternary health service in Melbourne, Australia. Data was collectively retrospectively, including demographics, indication for nephrostomy, radiation exposure (if fluoroscopic), dwell time of nephrostomy, issues warranting replacement (i.e., blockage, dislodgement), urological and obstetric outcomes. Results: Of 17 pregnant patients, indication for nephrostomy included ureteric calculus (n = 13), hydronephrosis of transplant kidney (n = 1), infected obstructed bilateral system without calculus (n = 1), obstruction from cervical malignancy (n = 1), and infected PUJO (n = 1). Mean age was 32.5 years (SD 5.7 years), whilst mean gestation stage was 25.0 weeks (SD 9.4 week, range 4–38 weeks). With regards to radiation exposure (of initial nephrostomy)—mean DAP was 2196.6 mgycm² and mean air kerma was 33.6 mGy). Mean dwell time for nephrostomies was 37.45 days (SD 25.1 days). A total of 24 nephrostomies were inserted during pregnancy (21 fluoroscopic, 3 sonographic), with 7 blockages and 3 dislodgements. There were no major obstetric complications (1 patient entered labour shortly after nephrostomy insertion). Conclusions: In our albeit small cohort of pregnant patients, mean time dwell of nephrostomies was substantially greater than described in the literature for pregnant patients—and mirrored that described for age-matched non-pregnant women. Larger volume data is required to establish an appropriate interval schedule for nephrostomies amongst pregnant patients to balance risk of early encrustation/blockage against radiation risk.

1.6.10. MP-06.10: Pharmacological Thromboprophylaxis in Percutaneous Nephrolithotomy (PCNL): A Preliminary Study

• Shakiba B ¹, Torabi N ¹, Maghsoudi R ¹ and Faegh A ²

¹ 

Iran University of Medical Sciences, Tehran, Iran

² 

Alborz University of Medical Sciences, Karaj, Iran

Abstract: Introduction and Objectives: European Association Urology (EAU) suggests against pharmacologic venous thromboembolism (VTE) prophylaxis in any patient undergoing PCNL. They recommend only mechanical prophylaxis for those at high risk of VTE after PCNL. However, these recommendations are based on low quality studies. On the other hand, some studies have demonstrated that PCNL is safe in patients under anticoagulant-therapy. In these patients, anticoagulant agent was started 6 h after PCNL. We decided to investigate the safety and effectiveness of a prophylactic dose of heparin after PCNL. Materials and Methods: In this study, we compared the results of two cohorts: 106 patients who received unfractionated heparin after PCNL as pharmacologic VTE prophylaxis (group A) and those of a control group of 182 patients who underwent PCNL along with early mobilization as VTE prophylaxis after surgery (group B). Based on Caprini risk stratification, in moderate, high and highest risk groups, subcutaneous heparin is administered 6 h after surgery. Patients with a Hb drop more than 2 units, those needing transfusion during surgery, subjects with heparin sensitivity or with a history of heparin-induced thrombocytopenia and severe haematuria were considered as ineligible for heparin administration. Results: In basic characteristics of patients, solely the mean age and BMI in group A were significantly higher than group B. Regarding PCNL outcome, the stone-free rate and the overall postoperative complications were similar in both groups, revealing no statistically significant difference. In group B, one case of Symptomatic VTE and one case of PE were reported. Conclusions: Present study showed that the use of heparin as a VTE prophylaxis is safe and may decrease the risk of thromboembolic events after PCNL. Due to our small sample size the results of this study cannot yet be generalized for clinical practice purposes. Nevertheless, based on the findings of the present study, it seems reasonable to recommend heparin as prophylaxis after PCNL surgery at least in patients with multiple risk factors for thromboembolism. Furthermore, the present study can be used as a basis for designing future clinical trials in this field.

1.6.11. MP-06.11: Postoperative Renal Functional Changes Assessed by 99mTc-DTPA Scintigraphy and Predictive Factors After miniaturized Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery: An Observational 3-Year Follow-Up Study

• Lee H ¹, Sharapatov Y ², Park H ¹, Castillo C ³, Alharthi M ⁴, Mesadef Z ⁵ and Cho S ¹

¹ 

Department of Urology, Seoul National University College of Medicine, Seoul, South Korea

² 

Department of Urology, Astana Medical University, Astana, Kazakhstan

³ 

Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines

⁴ 

Department of Urology, King Fahd General Hospital, ministry of Health, Jeddah, Saudi Arabia

⁵ 

Department of Urology, Prince Mohammed bin Nasser Hospital, Jazan, Saudi Arabia

Abstract: Introduction and Objectives: This study aims to investigate changes in relative renal function three years after mini-PCNL and RIRS, assessed using 99mTc-DTPA, and identify significant predictors associated with renal function deterioration. Materials and Methods: All 93 patients who underwent miniaturized percutaneous nephrolithotomy (mini-PCNL) or retrograde intrarenal surgery (RIRS) from August 2014 to October 2020 underwent preoperative monitoring using 99mTc-DTPA scintigraphy. Postoperatively, patients with abnormal renal function were monitored from 3 to 36 months. Logistic regression analyses were performed to identify predictors associated with aggravated renal function. Results: The difference in preoperative renal function between the contralateral and the operative side was >10% in 79 patients (84.9%). Among those with abnormal renal function, 42 (53.2%) showed stability, 31 (39.2%) aggravation, and 6 (7.6%) improvement at postoperative 3 years. Functional changes did not differ according to the type of surgery. Surgery methods (RIRS versus mini-PCNL), preoperative creatinine, preoperative hydronephrosis, and S-ReSC (Seoul National University Renal Stone Complexity) > 3 were significant predictors of aggravation in renal function. Conclusions: RIRS and mini-PCNL had similar effects and favorable outcomes on renal function during a 3-year follow-up period. Clinicians should pay more attention to renal function in patients undergoing mini-PCNL or with higher preoperative creatinine levels, presence of preoperative hydronephrosis, and S-ReSC >3.

1.6.12. MP-06.12: Retrograde Intrarenal Surgery (RIRS) vs. Super mini PCNL (SMP) for Lower Pole Calyceal Calculi of 10–20 mm Size: A Randomized Controlled Trial

• Pathak N, Singh A, Ganpule A, Sabnis R and Desai M
• MPUH, Nadiad, India

Abstract: Introduction and Objectives: Primary objective: To compare stone free rates (SFR) at 1 month after surgery (no stone or stone less than 4 mm). Secondary objectives: To compare perioperative complications, operating times (1st puncture to wound closure or insertion of endoscope in urethra to completion of stent placement), postoperative pain score, auxillary procedure, Hb drop, hospital stay duration. Materials and Methods: Prospective, randomised, single center, parallel assignment, open label study. Done in 70 patients, 35 in each arm. Patients had lower pole calyx calculi of 1–2 cm in size. Results: With a median age of 48 years in RIRS (retrograde intrarenal surgery) group and of 44.5 years in SMP (suction miniPCNL) group, stone size was comparable in both the groups. Post operative haemoglobin drop was more in SMP group (Median, IQR in g/dL = 1 (0.7–1.2) vs. 0.3 (0–0.8), p < 0.001). Operative time was more in the SMP group (Median, IQR in minutes = 80 (65–90) vs. 45 (36.2–60), p < 0.001). Hospital stay was more in the SMP group (Median, IQR in hours = 72 (66–96) vs. 40 (36–48), p < 0.001). Immediate post operative pain VAS scores were higher in the SMP group (Median, IQR = 3 (2–4) vs. 2 (2–2), p—0.002). Postoperative pain VAS scores at 48 h were more in the RIRS group (Median, IQR = 1 (0–1) vs. 0 (0–1), p—0.018). Stone free rates were similar in both groups at 1 month. Conclusions: SMP for lower calyceal calculi results in more blood loss, has more operative times, hospital stay duration and higher immediate postoperative pain scores, lower delayed postoperative pain scores and similar stone free rates as RIRS.

1.6.13. MP-06.13: Role of Anatrophic Nephrolithotomy for Complex Staghorn Renal Calculi in the Minimally Invasive Era and Its Impact on Renal Function: A Prospective Study

• Kalathia J ¹, Vala G ², Khetarpal A ³, Valiya A ⁴, Aggarwal K ¹, Agrawal S ⁵ and Patel K ⁶

¹ 

Fortune Urology Clinic, Botad, India

² 

KIMS, Ahmedabad, India

³ 

Khetarpal Hospital, New Delhi, India

⁴ 

Valiya Urology Hospital, Bhavnagar, India

⁵ 

Bansal Hospital, Bhopal, India

⁶ 

Nephron Kidney Hospital, Anand, India

Abstract: Introduction and Objectives: The last two decades have observed the edge of endoscopic surgeries over the open procedures for managing staghorn calculi. Large complex staghorn calculi are an exception where anatrophic nephrolithotomy (ANL) has been critical in rendering kidney completely stone free with minimal negative long term sequalae of renal dysfunction. Materials and Methods: The study included 18 patients who underwent ANL for large complex renal calculi with normal functioning kidney between November 2018 to June 2023. In this prospective study we observed the difference in demography, stone characteristics, intra-op parameters, stone clearance, post-operative blood transfusion, length of stay and long-term effects on renal function in patients who underwent ANL. Results: Mean age was 46.2 years with 9 male and 5 female patients. The average length of the complex staghorn calculi was 9.6 ± 2 cm occupying all of the calyces. Baseline mean haemoglobin and serum creatinine were 10. 6% and 1.18 mg/dL respectively. 8 (57%) patients were operated under regional while 4 required general anaesthesia. The mean cold ischemia time was 38. 26 min with average blood loss around 120 mL. Mean operative time was 135.4 min. Post-operative average drop in haemoglobin and rise in creatinine were 1.4% and 0.12 mg/dL respectively. 14 (78%) patients were completely cleared of calculi while remaining 4 (22%) with residual calculi required ancillary procedures. Sepsis secondary to urinary tract infection was seen in 3 (21%) patients. The average length of hospital stay was 8.2 days with no peri-operative mortality. Conclusions: In the treatment of large complex staghorn calculi ANL is non-inferior and should be considered a reasonable alternative to endoscopic lithotripsy which requires multiple sittings. This study also supports that ANL is safe with minimal peri-operative complications such as acute renal failure or sepsis.

1.6.14. MP-06.14: Serial Manual Bolus Irrigation Leads to Critical Intrarenal Pressures During Pyeloscopy

• Hong A, Browne C, Jack G and Bolton D
• Austin Health, Melbourne, Australia

Abstract: Introduction and Objectives: Uretero-renoscopy has become mainstay of managing urolithiasis. Various methods of irrigation can be utilized to maintain clear views. One such method is the manual bolus irrigation, whereby a bolus of fluid is delivered from a chamber or syringe in the irrigation system. Raised intrarenal pressures (IRPs) will logically ensue from such fluid instillation, and this is of concern due to associated post-operative complications. Deaths have been reported as a consequence of sepsis related to uretero-renoscopy. We aim to characterize the fluctuations and maximal IRPs produced by manual bolus irrigation used during uretero-renoscopy. Materials and Methods: A pressure guidewire was used for intrarenal pressure measurement during routine flexible ureterorenoscopy for management of renal stone disease, including manual bolus irrigation when required to maintain vision. The fluid bolus was either as a solitary manual bolus or a series of manual boluses in quick succession. The baseline, maximal and difference between intrarenal pressures were calculated. Results: 50 procedures in 46 patients were analyzed. 68 solitary manual boluses and 38 serial manual boluses were observed to have been undertaken during these procedures. After a solitary manual bolus, the median increase in IRP was 22.4 mmHg (range 0.1–160.8; SD 34.0), and the mean maximum IRP was 46.1 mmHg (range 15.8–190.0; SD 41.7), with elevated IRPs persisting for a median duration of 19 s (range 4–66 s). After serial manual boluses, the median rise in IRP was 58.4 mmHg (range 10.2–242.84, SD 64.7) and the mean maximum IRP reached was 100.8 mmHg (range 34.3–303.5, SD 69.7). The elevated IRPs endured for a median of 42 s (range 9–121 s) (p value < 0.01 in all comparisons), suggesting a much greater elevation of intrarenal pressure with instances where serial bolus irrigation was undertaken. Conclusions: Manual bolus irrigation—both solitary but particularly serial boluses—produces significant rises in IRPs and could logically result in pyelovenous backflow and sepsis. We suggest that this maneuver should be avoided to reduce complications during ureterorenoscopy.

1.6.15. MP-06.15: Totally Tubeless Mini-Percutaneous Nephrolitotomy Practice. How Common Are Complications?

• Kretzmer L, Saleem M, Awil A, Shanker D, Rajagopal R, Dhanoya G, Quraishi M, Mackie S and Watson G
• Eastbourne District General Hospital, Eastbourne, United Kingdom

Abstract: Introduction and Objectives: Totally tubeless (TT) percutaneous nephrolithotomy (PCNL) has gained popularity recently due to improvements in post-operative pain and faster recovery. These benefits however come at the potential cost of post-operative renal drainage, which may have safety implications. The primary aim of this study was to determine the safety profile and complication rate associated with TT mini-PCNL, with a secondary aim to identify variables that may cause surgeons to digress from the default TT mini-PNCL approach to large renal/ureteric stone burden. Materials and Methods: A retrospective review of medical records of all PCNLs performed at a tertiary endourology unit during the study period 2022–2023. Parameters recorded include patient demographics, stone burden, operative factors and complications. Guys Stone Score, American Society of Anaesthesiologist and Clavien-Dindo scoring systems were utilised for standardisation. Results: 95% (n = 138/146) of PCNLs were performed using a mini- or ultra-mini track (15/16Fr or 11/12Fr One Step Storz MIP-M/MIP-S). 60% (n = 87/146) were TT. A complication rate (Clavien-Dindo 3 or greater) of 5.7% (n = 5/87) was identified in the cohort. Three patients warranted a post operative ureteric stent, a single patient needed a ureteroscopy for residual fragments, and a further single patient underwent radiological embolization of a renal pseudoaneurysm. Blood product transfusion and mortality incidence was identified at 0.7% and 0% respectively. Nephrostomies or ureteric (antegrade/retrograde) stents were placed intra-operatively during the PCNL in 40% of cases (n = 59/146). The most cited reasons for their placement included concerns about residual fragments (52%), patient complexity (19%), operative complexity (17%), and hostile ureteric anatomy (17%). Conclusions: Our cohort demonstrates the safety of TT mini-PCNL with a low complication rate in well triaged patients. To maximise safety, a degree of caution and discretion is required by surgeons to insert a nephrostomy/stent. This would take bespoke case-by-case decision making intraoperatively, rather than a generalised practice protocol. Despite an institutional acceptance of TT mini-PCNL, two fifths of patients had drainage tubes placed intra-operatively, potentially reflecting the complexity of the case load. We would recommend placement of drainage tubes in cases surrounding concerns with residual fragments, infection, impaired drainage, or patient/anaesthetic factors/complexity.

1.6.16. MP-06.16: Transurethral Pneumatic Cystolithotripsy Under Local Anaesthesia as a Day Care Procedure

• Sailo S and Wann C
• NEIGRIHMS, Shillong, India

Abstract: Introduction and Objectives: We review the safety, effectiveness and tolerability of transurethral pneumatic cystolithotripsy under local anaesthesia as a day-care procedure. Materials and Methods: Between June 2022 and January 2024, 34 patients (33 men and one woman) with symptomatic urinary bladder stones underwent transurethral pneumatic cystolithotripsy under local anaesthesia as a day care procedure. Ten minutes after instillation of 10 mL of 2% lignocaine jelly into the urethra, pneumatic energy was delivered using 9.5 Semi-rigid ureteroscope (Karl Storz, Germany). Analgesic injection (Diclofenac 75 mgs, intramuscular or Paracetamol 1 gm, intravenous infusion) was given on demand. Pain during the procedure was assessed using visual analogue scale (VAS). At the end of the procedure, the patients passed out the fragmented stones along with urine. No Foley catheter was placed. Tablet Tamsulosin 0.4 mg to be taken at night for ten days, Tablet Flavoxate 200 mg, three times a day for five days and Tablet Aceclofenac, 100 mg to be taken as required, were prescribed. Complete clearance was defined as absence of residual stones at KUB X-ray done at 10th post operative day. This study was approved by our Institutional Ethics Committee. Results: Mean patient age was 38 years (range 20 to 70). The mean stone size was 13.9 mm (range 5 to 30). The mean operating time was 15.4 min (range 5 to 60). Complete stone fragmentation and clearance was achieved in 30 patients (88.2%) with mean VAS score of 2.5 (range 1 to 6). All patients who had successful procedure had stones ≤20 mm. 25 patients (73.5%) had mild haematuria which subsided with conservative treatment within 48 h. There was no bladder perforation and no mortality. The procedure failed in four patients (two patients with stone sizes, 30 mm and two patients, 20 mm and 17 mm). These patients later underwent cystolithotripsy under spinal anaesthesia. Conclusions: Transurethral pneumatic cystolithotripsy under local anaesthesia as a day care procedure is safe, effective and well tolerated by adult patients with urinary bladder stones of size ≤ 20 mm.

1.7. Moderated Oral ePoster Session 07: Reconstruction

• Friday, October 25
• 0800–0900

1.7.1. MP-07.01: A Comparison of Primary Gender-Affirming Vaginoplasty Outcomes: Penile Inversion Versus Robotic-Assisted Peritoneal Flap

• Purohit R ¹, Sljivich M ¹, Kahan D ², Allan C ³, Palese M ¹, Wiklund P ¹, Djordjevic M ¹ and Stojanovic B ⁴

¹ 

Mount Sinai Hospital, New York, United States

² 

Albert Einstein College of Medicine, Bronx, United States

³ 

University of Alberta, Edmonton, Canada

⁴ 

University Children’s Hospital, Belgrade, Serbia

Abstract: Introduction and Objectives: Robot-assisted peritoneal flap vaginoplasty (PFV) for feminizing gender affirmation surgery is an alternative to penile inversion vaginoplasty (PIV) for transgender females (TF). There is little data on comparative outcomes, complicating pre-operative discussions to help direct patient choice. We compared operative outcomes in patients undergoing PFV vs. PIV at a single institution. Materials and Methods: 41 TF who underwent primary PIV were compared to 41 TF who underwent PFV at our institution. Retrospective data was collected to compare pre-op penile length, vaginal depth, operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), perioperative complications, 30-day emergency department visits, and late complications requiring surgical revision. Variables were directly compared using parametric t-tests. Results: PFV and PIV groups were similar in age, BMI, and circumcision (61% vs. 58%, respectively). PFV group had shorter penile length (7.0 cm [1.0–11] vs. 9.0 cm [6.0–13]), less EBL (250 cc [150–500] vs. 300 cc [150–700]), and similar LOS (3 d [1–18] vs. 3 d [2–6]) and OT (339 min [269–447] vs. 365 min [249–524]) compared to PIV. There were 3 rectal injuries (RI) during PIV and 0 during PFV. PFV group had lower risk of transfusions than PIV (2.44% vs. 9.75%). Both groups had similar 30-day ED visits (17.1 vs. 17.1%), hospital readmissions (7.32 vs. 7.32%), and late complications requiring surgical revision (12.2 vs. 14.6%). The PFV group had deeper vaginal depth at 1 month (18 cm [13–20] vs. 15 cm [4.0–23]) and 6 months (18 cm [7.6–20] vs. 15 cm [2.5–19]). Conclusions: In this cohort, PFV led to improved vaginal depth compared to PIV, despite shorter pre-operative penile skin length. These findings suggest PFV may be advantageous in TF with limited genital tissue pre-operatively. PFV may also confer an advantage in operative time, blood loss, and risk of rectal injury compared to PIV. Further studies are needed to determine long-term outcomes of vaginal depth. The comparable safety profile in this study supports the use of primary PFV as an alternative to PIV.

1.7.2. MP-07.02: Cod This Be the One: Fish Skin Xenograft (Kerecis™) for Primary Gender-Affirming Vaginoplasty

• Drozd A ¹, Abou Zeki J ², Kim E ³, Yang E ¹, Patel A ¹, Sun H ¹, Pope R ¹, Scarberry K ¹, Mishra K ¹ and Gupta S ¹

¹ 

Case Western Reserve University—University Hospitals, Cleveland, United States

² 

University Hospitals, Cleveland, United States

³ 

Case Western Reserve University, Cleveland, United States

Abstract: Introduction and Objectives: Gender-affirming vaginoplasty (GAV) is a surgical option for transgender male-to-female (MTF) patients who are experiencing gender dysphoria. Regardless of GAV technique genital hypoplasia is a common problem. Kerecis is an intact fish-skin xenograft that can act as a scaffold for epithelialization and has emerged as a novel on-the-shelf tool in wound management. We hypothesize that the incorporation of Kerecis graft at the time of primary GAV will provide durable outcomes. Materials and Methods: We conducted a retrospective analysis of 11 patients who underwent primary robotic peritoneal pull-through GAV using Kerecis. Outcomes of interest included surgical and subjective patient outcomes, complications, the ability to perform post-operative dilation, as well as need for subsequent vaginal canal revisions. Results: All patients underwent robotic peritoneal pull through GAV incorporating Kerecis xenograft in the neovaginal canal. 71.4% satisfaction rate in post-operative period. 18% (2/11) complication rate requiring a return to OR within 30 days of index GAV; including post-operative bleeding from the urethral plate, and dehiscence. No complications were associated with the vaginal canal itself. 36.4% vaginal canal revision rate within first 8 months following index GAV. Of those requiring canal revision, patients required on average 1.5 revision surgeries. Conclusions: Utilization of Kerecis xenograft in primary GAV is safe and effective. In our short-term follow-up, we have observed comparable rates of vaginal canal stenosis requiring revision, compared to rates reported in the literature. Longer follow-up will be required to determine the durability of treatment.

1.7.3. MP-07.03: Comprehensive Long-Term Patient-Reported Outcomes Following Female Urogenital Fistula Repair: A 15-Year Experience from a Reconstructive Referral Center

• Klemm J ¹, Schulz R ¹, Stelzl D ¹, Shariat S ², Fisch M ¹, Dahlem R ¹ and Vetterlein M ¹

¹ 

University Medical Center Hamburg-Eppendorf, Hamburg, Germany

² 

Medical University of Vienna, Vienna, Austria

Abstract: Introduction and Objectives: Urogenital fistulas (UGFs) in western countries primarily stem from iatrogenic procedures and significantly affect quality of life. However, a paucity of long-term and patient-reported outcome measures (PROMs) exists for UGF Repairs. This study aims to explore both long-term surgical and patient-reported outcomes following UGF repair. Materials and Methods: We included women undergoing UGF repair at our center between 2010–2023. UGFs were stratified by surgical approach (transvaginal vs. transabdominal). Etiological, fistula, and surgical characteristics were reported by descriptives and compared between the groups. Cross-sectional follow-up was performed by phone and electronically via a web-based survey. We assessed both objective (fistula closure rate and reinterventions for SUI) and subjective outcomes using validated questionnaires (ICIQ-FLUTS, ICIQ-FLUTSsex, ICIQ-Satisfaction). Results: Of 50 patients, 17 (34%) had urethrovaginal fistulas (UVFs) and underwent transvaginal surgery, while 33 (66%) had vesicovaginal fistulas (VVFs) and were treated with transabdominal surgery. Of the fistulae, 23 (46%) were classified as complex, and 18 (36%) were redo cases. In VVF cases, peritoneal flaps were used in 76%, while 59% of UVF repairs employed Martius flaps for tissue interposition. The median operative time was 130 min (IQR 88–148). Median follow-up in censored patients was 44 months (IQR 16–90). Fistula closure rate was 94% and 100% after 3 redo UGF repairs. All 7 (14%) reinterventions for SUI (6 autologous fascial sling, 1 midurethral sling) were performed in women who had undergone transvaginal UGF repair. Median time to assessing PROMs was 50 mo (IQR 16–90) and complete PROM questionnaires were available in 35 patients (70%). Median (IQR) ICIQ-FLUTS score was 5 (3–7), 1 (0–2), 4.5 (1–9), and 3 (1–5) for filling (0–16), voiding (0–12), incontinence symptoms (0–20), and ICIQ-FLUTSsex (0–14), respectively. Median (IQR) ICIQ-S outcome (0–24) and satisfaction scores (0–10) were 22 (18.5–23.5) and 10 (8.5–10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. The surgical approach did not significantly affect the outcomes (all p > 0.2). Conclusions: At a tertiary referral center, urogenital fistula repair shows excellent outcomes and patient satisfaction. However, patients with UVF face a higher risk of stress urinary incontinence, likely due to the initial trauma’s site causing the fistula.

1.7.4. MP-07.04: Evaluating Long-Term Success and Patient Satisfaction: One-Stage Buccal Mucosal Graft Urethroplasty in Women

• Klemm J, Schulz R, Stelzl D, Marks P, Fisch M, Dahlem R and Vetterlein M
• University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Abstract: Introduction and Objectives: Female urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcome measures as endpoints for assessing treatment success are crucial, yet data, particularly regarding sexual function and treatment satisfaction, are scarce. We aimed to provide insights from a reconstructive referral center. Materials and Methods: We conducted a retrospective analysis of women treated with one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009 and 2023. We assessed both objective (retreatment-free survival, ΔQmax) and subjective outcomes (validated patient-reported outcomes). Results: Of 12 women, 83% had iatrogenic and 17% had idiopathic strictures. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25% and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm. At a median follow-up of 66 months, 33% of the patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate (ΔQmax) was 10 mL/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction. Conclusions: Buccal mucosal graft urethroplasty for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are essential to further assess its efficacy, especially regarding patientreported experiences and sexual function.

1.7.5. MP-07.05: Experience of Colovaginoplasty in Adults with Disorders of Sex Development

• Mungadi I, Umar A, Muhammed U, Ahmed Y and Khalid A
• TETFUND Center of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University, Sokoto, Nigeria

Abstract: Introduction and Objectives: Colovaginoplasty may be indicated in individuals with Disorders of Sex Development (DSD) and during sex reassignment or gender affirmation. Individuals with congenital defects of the female reproductive tract resulting from failure in the proper embryological development and fusion of the Müllerian ducts may also require colovaginoplasty We reviewed colovaginal reconstruction performed for various intersex conditions presenting in adulthood. Materials and Methods: This was a 16-year retrospective study conducted at Institute of Urology and Nephrology, Usmanu Danfodiyo University, Sokoto between January 2007 to December 2024. There were 25 cases of colovaginoplasty for various intersex conditions over the period that were reviewed, and the data obtained was analysed using Statistical Software for Social Sciences (SPSS) version 25. Results: Their ages ranged from 14 years to 35 years with a mean of 21.0 ± 5.0 years. All patients presented due to primary amenorrhoea or failure to function in the assigned sex. There were 12 (48.0%) cases of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, 7 (28%) cases of androgen insensitivity syndrome, 3 (12.0%) were cases of perineal hypospadias reared as females, 2 (8%) were true hermaphrodites, and 1 (4%) was secondary procedure in a case of Turner’s syndrome. All patients were raised as females and opted to remain in female gender. The prevalence of renal agenesis amongst MRKH patient was 33.3%. Procedures performed consisted of colovaginoplasty or colovaginoplasty with gonadectomy, clitoroplasty and vulvoplasty as indicated. In all cases, 8 to 10 cm of sigmoid colon segment was used. Two patients (8%) had intraoperative rectal injury that were recognised and closed on table, 8% developed introital stenosis requiring operative revision. Seven (28%) patients required initial dilatation before coitus. Overall, 18 cases (72%) reported satisfactory coitus. Conclusions: Colovaginoplasty is a viable option for patients with DSD desirous of normal sexual life. It is applicable to female assigned genetic males and true hermaphrodites choosing female assignment.

1.7.6. MP-07.06: Long Term Complications of Female Genital Mutilation and Their Surgical Management

• NDOYE M, Jalloh M, Mbodj M and Diaw J
• UCAD, Dakar, Senegal

Abstract: Introduction and Objectives: Female genital mutilation/cutting (FGM) comprises all procedures that involve partial or total removal of female external genitalia for non-therapeutic reasons. Estimations based on the most recent prevalence data show that in Africa, 91.5 million women and girls over the age of 9 years are currently living with the consequences of FGM. These medical and sexual consequences are underreported and not always treated, leading to physical and psychological suffering. Below, we report two cases of complications of this cultural practice in women who had genital mutilation in early childhood and discuss broadly the problems of this children’s rights violation. Materials and Methods: We report on two cases of female genital mutilation performed on women at the age of three and the complications that arose several years later. All patients were seen in our urology clinic at adulthood while starting sexual and reproductive life. After a thorough clinical examination, we proceed to the surgical management of the cases and present the results of the treatment. Results: The first case was referred to our clinic for the treatment of a vulvar swelling after being seen at a community outreach event on vesicovaginal fistulas in Southern Senegal. The mass had been present for several years and had been slowly enlarging. The sexual mutilation was done at age three. Histology was done after the excision of the mass. The second patient,19 years old, recently married, was referred to our clinic for the management of a closed vaginal opening discovered at the beginning of her honeymoon. There was a previous history of sexual mutilation during childhood. The urogenital examination demonstrated an extremely stenotic vaginal orifice with a stenosed urethral meatus and a continuous urine leakage. Her examination demonstrated an infibulation. For both cases, successful surgical management was performed with excellent clinical and functional results. Conclusions: Long-term complications can occur at any time in the life of a woman who has been mutilated; Lack of sexual education and knowledge of sexual rights results in complications of FGM being hidden under barriers in culture and communication ignoring the chance to be cured with surgery despite his encouraging outcomes.

1.7.7. MP-07.07: Not so Koi: Fish Skin Xenograft (Kerecis™) for Revision Gender-Affirming Vaginoplasty

• Drozd A ¹, Patel A ¹, Abou Zeki J ², Yang E ¹, Sun H ¹, Pope R ¹, Scarberry K ¹, Mishra K ¹ and Gupta S ¹

¹ 

Case Western Reserve University—University Hospitals, Cleveland, United States

² 

University Hospitals, Cleveland, United States

Abstract: Introduction and Objectives: Many patients require revision surgery for loss of depth or caliber of the vaginal canal after a gender-affirming vaginoplasty. In these cases, lack of local skin necessitates the use of flaps, autologous grafts, allografts, or xenograft. Kerecis is an intact fish-skin xenograft that can act as a scaffold for epithelialization and has emerged as a novel tool in wound management. Here, we assessed outcomes of revision vaginoplasty (RV) utilizing Kerecis fish-skin xenograft material for canal deepening in the setting of inadequate remnant tissue in transgender patients at our institution. We hypothesize that incorporation of Kerecis graft into the revision will provide durable outcomes after RV. Materials and Methods: We conducted a retrospective analysis of 12 patients who underwent RV using Kerecis with or without autologous flaps for vaginal stenosis and/or canal deepening. The time from index vaginoplasty to revision and revised vaginal depth were recorded. Other outcomes of interest included surgical and subjective patient outcomes, complications, as well as the ability to perform post-operative dilation. Results: The median time from index vaginoplasty to revision with Kerecis was 275 days. Three patients underwent a robotic peritoneal pull-through revision vaginoplasty. The mean vaginal depth prior to revision was 3.45 cm. Mean revised vaginal depth in the operating room was 13.55 cm. All patients were able to dilate at their initial post-operative visit. All were satisfied with their outcomes. Only one patient required additional revision due to lack of compliance with dilation four months after RV. There were no operative complications following RV in this group of patients. Conclusions: Kerecis, an intact fish-skin xenograft, is an efficacious tool in surgical wound management by acting as a scaffold for epithelialization. In this group of patients undergoing RV, incorporating Keresis into the revision improved vaginal depth while providing durable patient outcomes, notably the ability to dilate at follow-up. Moving forward, Kerecis may serve as an effective means to improve long-term outcomes after RV in patients with inadequate native tissue.

1.7.8. MP-07.08: Novel Technique of minced Buccal Mucosal Graft Endourethral Urethroplasty: A Pilot Study

• Barik K, Tarigopula V, C S, Ambade S, Gaur A, Das M, Mandal S, Tripathy S and Nayak P
• All India Institute Of Medical Sciences, Bhubaneswar, India

Abstract: Introduction and Objectives: While visual internal urethrotomy (VIU) is the preferred treatment for short bulbar urethral strictures, its long-term success rate is dismal and varies from 9–30%. Urethroplasty has higher success rates than VIU. However, due to its steep learning curve, longer operative times, bleeding, risk for erectile/ejaculatory dysfunction, wound infection, incontinence, it is typically used for long and complex urethral strictures. Our technique, minced buccal mucosal graft endourethral urethroplasty (MBGEU), is based on a similar principle, albeit in humans for the first time. MBGEU combines the advantages of buccal mucosal grafting with VIU. This pilot study aimed to measure the success rate of MBGEU. The primary outcome was success rate at six months. The changes in AUA symptom score, peak flow rate, and post-void residue at three and six months were secondary outcomes. Materials and Methods: This pilot study was IEC-approved and CRTI-registered (CTRI/2021/09/036651). Males with primary bulbar urethral strictures <2 cm underwent MBGEU. A 1 × 1 cm BMG was harvested, minced, centrifuged and suspended in fibrin glue. After a cold knife visual internal urethrotomy, 12-Fr foley was placed. An 11-Fr cystourethroscope was passed by the side of the catheter, and the minced graft suspension was instilled via a 5-Fr ureteric catheter over the urethrotomy site. Results: Thirty men underwent MBGEU. The median stricture length was 1 cm (1.0–1.5). The stricture recurred in two patients at 3 and 6 months respectively. The success rate of MBGUE was 93.33%. The median pre-operative AUA score was 18.00, and the post-operative AUA score at three, six and 12 months were 3.00 (2.00v4.00), 2.00 (1.00–3.00) and 2.00 (1.00–2.00) (p < 0.05). The median pre-operative Qmax was 6.00, and Qmax at post-operative three, six months and 12 months were 24.00 (20.00–27.00), 22.00 (20.00–25.00) and 23.00 (20.00–28.00) (p < 0.05) respectively. The median pre-operative PVR (mL) was 88.00 (IQR 66.25–150.50), and PVR at post-operative three, six and 12 months were 16.00 (10.75–39.00), 15.00 (9.70–22.25) and 15.50 (10.700–22.00) (p < 0.05) respectively. Conclusions: The short-term success of MBGEU is encouraging and could revolutionize the surgical outcomes of VIU. However, a longer follow-up and further studies with more participants are required. This is a very simple and inexpensive technique.

1.7.9. MP-07.09: Patient-Reported Functional Outcomes and Treatment Satisfaction Following Perinealurethrostomy in the Salvage Treatment of Complex Anterior Urethral Strictures

• Klemm J ¹, Schulz R ¹, Stelzl D ¹, Shariat S ², Fisch M ¹, Dahlem R ¹ and Vetterlein M ¹

¹ 

University Medical Center Hamburg-Eppendorf, Hamburg, Germany

² 

Medical University of Vienna, Vienna, Austria

Abstract: Introduction and Objectives: Definitive perineal urethrostomy (PU) is a crucial therapeutic option in the management of complex anterior strictures. Although it’s increasing adoption, information regarding the impact on patient-reported functional outcomes is scarce. Our objective was to comprehensively assess long-term outcomes and patient-reported outcome measures (PROMs) subsequent to definitive PU. Materials and Methods: Retrospective study of patients undergoing definitive PU at a tertiary referral center from 2009–2023. Comorbidities, initial stricture etiology, characteristics, and previous interventions were assessed. Co-primary endpoints were retreatment-free survival (RFS) with recurrence being defined as any reintervention for PU stenosis as well as validated PROMs (Figure 1). Follow-up and PROMs assessment was performed by meticulous chart review, by phone and an online-based survey. RFS was evaluated by Kaplan-Meier estimators and PROMs were reflected by scores as indicated in the respective scoring manuals. Results: Of 76 patients undergoing PU, 55% had iatrogenic strictures and 82% had received prior urethral interventions. 37% presented with a stricture > 8 cm, median stricture length and operative time were 3 cm (IQR 2–6) and 36 min (IQR 28–46), respectively. 13 patients (17%) were lost to follow-up. At a median follow-up of 37 mo, 12 of 63 patients (19%) recurred, translating into RFS rates of 89% and 83% at 2 and 5 yr, respectively. PROM scores are depicted in Figure 1. Overall, 41 patients (54%) completed the PROMs, 8 (11%) had died and 6 (7.9%) had dementia and were not able to complete the questionnaires. Lower scores on LUTS score and ICIQ-UI sum score correlate with reduced symptom burden. Conversely, higher scores on the IIEF-EF, MSHQ-Ej, and ICIQ-Satisfaction outcome score signify effective symptom management and satisfaction. Conclusions: PU demonstrates efficacy in addressing complex anterior urethral strictures, resulting in restored voiding function, continence, and notable patient satisfaction. Variability in sexual function outcomes may stem from significant variations in baseline conditions. It has the potential to be a preferred option for older individuals with comorbidities, particularly following comprehensive counseling.

1.7.10. MP-07.10: Positioning the Elusive Clitoris: A Novel Technique to Properly Position the Neoclitoris in Transgender Women Undergoing Vaginoplasty

• Sandhu S ¹, Mallavarapu S ¹, Smith S ¹, Stelmar J ² and Garcia M ¹

¹ 

Cedars-Sinai Medical Center, Los Angeles, United States

² 

University of California San Diego School of Medicine, San Diego, United States

Abstract: Introduction and Objectives: The clitoris is an integral structure to female anatomy. Located anteriorly on the vulva, it plays an integral function for sexual sensation. Specific to transgender women undergoing genital gender-affirming vaginoplasty, the neoclitoris is fashioned from the glans penis to provide erogenous sensation. To date, gender-affirming surgeons have anchored the neoclitoris to the superior aspect of the penile stump during vaginoplasty. We sought to determine the correct position of the clitoris in natal female anatomy and describe our technique for appropriately situating the neoclitoris. Materials and Methods: Magnetic resonance imaging scans of the natal female pelvis were reviewed to determine the position of the glans clitoris in the sagittal plane in relation to the bony pelvis. We describe our technique for anchoring the neoclitoris in transgender women undergoing vaginoplasty in the correct anatomic position. Results: The glans clitoris was identified on MRI in the sagittal plane and was found to be approximately 1.5 cm from the inferior aspect of the pubic symphysis (Figure 1). After liberating the neurovascular bundle from the penis, we fashion the neoclitoris from the glans penis. To anchor the neoclitoris to the correct anatomic position, we bluntly dissect the neurovascular bundle in the midline using a Kelley clamp at the level of the pubic symphysis, 1.5 cm anterior to the pelvic ring. The neoclitoris is anchored to the periosteum of the pubic symphysis absorbable sutures. The remaining folded neurovascular bundle is then anchored without tension to the mons with absorbable sutures. Conclusions: Our novel technique for anchoring the neoclitoris to the pubic symphysis is more anatomically correct, and optimizes cosmesis. We recommend using the bony landmark of the pubic symphysis, approximately 1.5 cm cephalad to the pelvic ring in the midline as a landmark for surgeons to correctly position the neoclitoris for women undergoing gender-affirming vaginoplasty.

1.7.11. MP-07.11: Postauricular Skin Grafts in the Treatment of Bulbar Urethral Stricture Disease

• Chandra S, Bokare A and Ghagane S
• KLE Academy of Higher Education and Research, Belagavi, India

Abstract: Introduction and Objectives: Chewing tobacco, betel nut, or pan masala leads to several changes in the oral cavity, making harvesting of healthy buccal mucosa next to impossible. In such patients with a long bulbar urethral stricture, the choice of the substitute material for urethral reconstruction is a challenging problem. The objective of our study was to assess the feasibility and efficacy of postauricular skin in the repair of such strictures and also to assess the outcome of such repairs 12 months later. Materials and Methods: All male patients with long bulbar urethral strictures were prospectively included in the study. Patients who were either circumcised or had unhealthy genital skin and whose oral mucosa was considerably damaged by the continuous use of tobacco and other substances were offered an option to undergo urethroplasty using postauricular skin. Results: During the study period a total of 22 patients with long bulbar strictures underwent substitution urethroplasty using postauricular skin grafts. The mean length of the stricture was 5.84 ± 1.29 cms. The mean operative time was 135.23 ± 12.58 min and the mean blood loss was 120 cc. Following catheter removal all patients voided with a good urinary stream (mean Q max was 22.41 ± 2.63 mL/s). Conclusions: Postauricular skin is a good substitute material for urethral reconstruction in patients with long bulbar urethral stricture and having neither healthy buccal mucosa nor genital skin for harvesting a graft.

1.7.12. MP-07.12: Prospective Comparative Study of Patient Reported Outcomes of Direct Visual Internal Urethrotomy with Heinke Mikulicz Urethroplasty and Augmented Urethroplasty in Non-Traumatic Short Segment Bulbar Urethral Stricture

• Chawla A, Vishwanath K, Pillai S and Hegde P
• KMC Manipal, Manipal Academy of Higher Education, Manipal, India,

Abstract: Introduction and Objectives: Bulbar urethra is the most common location for urethral strictures, with DVIU being the most commonly performed treatment, but with high recurrence rates (25–53%). Non-transecting urethroplasty is reported with 80–90% success rates over 5 years. Our study compared DVIU with Heinke Mikulicz (HM) urethroplasty, and augmented urethroplasty (AU) outcomes for short segment bulbar strictures in a three-arm trial. Materials and Methods: A prospective comparative study on primary short segment bulbar stricture patients (≤ 2 cm) divided into three groups: DVIU (Group 1), HM urethroplasty (Group 2), and AU (Group 3). Assessments included uroflowmetry, RGU/MCU, modified USS PROM, PREM forms (pre-procedure, 1st, 3rd, and 6th month follow-up), and validated questionnaires (IPSS, LUTS Score, CLSS Score, MSHQ, and SHIM) for subjective outcome measures. Results: Out of 86 patients, 7 were excluded for > 2 cm intra-op stricture length, leaving 79 (n = 79). DVIU group had shorter mean stricture length (1.53 cm ± 0.4) than HM (1.64 ± 0.22) and AU (1.9 ± 0.06) (p < 0.001). Inter-group comparison showed improved Mean Qmax/LUTS/IPSS/CLSS scores in HM and AU groups vs. DVIU group. MSHQ (Erectile) and SHIM (Ejaculatory) scores improved in DVIU at 3rd month but not in HM and AU groups. One HM patient had Clavein Dindo grade 1 surgical site infection. Post void dribbling was seen in 22.22% (AU), 14.2% (HM), and 12.9% (DVIU) at 1 month. Recurrence rates were higher in DVIU (25.8%) vs. HM (4.76%) and AU (7.4%). Conclusions: There is significantly improved patient satisfaction noted with HM technique and AU as compared to DVIU along with reduced recurrence rates.

1.7.13. MP-07.13: Resurgence of Preputial Graft—Dorsal Onlay Single Stage Spiral Preputial Graft for Pan Urethral Strictures

• Bafna S, Ragavan N, Jain N, Ganesan T, V K and Tiwary M
• Apollo Hospitals Chennai, Chennai, India

Abstract: Introduction and Objectives: Management of pan urethral stricture (PUS) is challenging. Single-stage dorsal onlay with Kulkarni technique is a preferred approach. Buccal mucosa graft (BMG) is used by most surgeons for substitution urethroplasty (SU). Spiral preputial graft (SPG) can negate the chances of having anastomotic stricture between grafts in PUS. The study aimed to evaluate the outcome of SU with spiral preputial graft for non-LS PUS. Materials and Methods: Between March 2022 and December 2023, patients with non-LS PUS, who required pan urethroplasty were considered for this study. Perineal incision, penile invagination, and dorsal onlay approach performed. An outer circumcision incision was made just deep into the skin. The prepuce was harvested with dissection above the dartos. An inner circumcision incision was made. The prepuce was harvested like a cylinder. Spiral incision was made and a long continuous 1.5 cm wide and 20 cm long graft was made. This graft was applied as dorsal onlay like Kulkarni technique from the meatus to proximal bulbar urethra. The catheter was removed after 4 weeks. Any need for instrumentation after surgery was defined as the primary failure. Obstructive symptoms or maximum flow rate (Qmax) below 10 mL/s, with or without a need for instrumentation, were described as a secondary failure. Results: Our results are limited to a cohort of 16 patients. The median (interquartile range [IQR]) age at surgery was 58 (46–68.3) years. The median (IQR) stricture length 12 (10–15.3) cm. The median (IQR) operative time was 173 (162–210) min. The median (IQR) follow-up was 11.4 (8.2–13.4) months. The median Qmax at catheter removal was 21 mL/min. After surgery, no perioperative complication of Clavien–Dindo Grade ≥ III was recorded in the subsequent 30 postoperative days. One patient had poor flow of Qmax 10 mL/s. To date, no patient has undergone redo surgery. The USS PROM questionnaire was used in all patients and 92% of patients reported post micturition dribble. Success was achieved in 91.6% of patients. Conclusions: In Asian subcontinent, many men have an intact prepuce. By harvesting a spiral-long graft, we avoid junctional strictures. There is no oral morbidity. We also preserve the preputial dartos, which preserves the neurovascular supply.

1.7.14. MP-07.14: Surgical Correction of Penile Curvature with Autologous Graft Material

• Bajramovic S, Spahovic H, Aganovic D, Alic J and Sabanovic Bajramovic N
• Clinical Centre University Sarajevo, Sarajevo, Bosnia and Herzegovina

Abstract: Introduction and Objectives: Our aim was to evaluate penile lengthening procedure with autologous graft material used in correction of penile curvature due to Peyronie’s disease. In the absence of other grafting material, autologous grafting material was used, such as buccal mucosa, rectus fascia, fascia musculus tensor fasiae late, saphenous vein. Materials and Methods: Subjects of this study were male patients diagnosed with penile curvature due to Peyronie’s disease at the Department of Urology at the Clinical Centre University of Sarajevo from (2018–2023). Penile Doppler ultrasound examination, degree of penile curvature, measurement of flaccid penile length were performed on all patients. All patients were interviewed on the International Index of Erectile Dysfunction (IIEF-5). All patients had stable disease for more than 12 months. Results: A total of 62 men were selected to participate in the survey, in Group 1, rectus fascia group 12 pts, Group 2, musculus tensor fasciae late group 6 pts, Group 3, saphenous vein group 16 pts, Group 4, buccal mucosa group 28 pts, respectively. The mean duration of follow-up was 25 months (18–30) for Groups 1 and 2 and 40 months (38–48) for Groups 3 and 4. Groups 3 and 4 had better functional and cosmetic results after surgery (p < 0.05). There were no significant differences of adverse events between each group (p > 0.05). Penile curvature recurrence was more noticed in Group 4 but without significant difference (p > 0.05), and penile shortening was more noticed in Groups 1 and 2 (p < 0.05). Patients achieved better results of postsurgical IIEF-5 survey in Group 3 and 4. According to patient satisfactory survey patients choose more buccal mucosa graft than other autologous grafting material. Conclusions: In the case of a lack of extracellular matrix as grafting material, an alternative option of curvature correction with an autologous graft can be offered to patients with Peyronie’s disease who require surgical treatment. The buccal mucosa or the saphenous vein graft should be taken into account.

1.7.15. MP-07.15: Urethroplasty with Autologous Ultra-Purified Adipose Graft: First Experience for Treatment of Recurrent Anterior Urethral Strictures

• Berdondini E ¹, Silvani M ¹, Ferretti S ², Eissa A ² and Gacci M ³

¹ 

Center for Urethral and Genital Surgery, Torino, Italy

² 

University of Modena & Reggio Emilia, Modena, Italy

³ 

Univerisity of Florence, Florence, Italy

Abstract: Introduction and Objectives: To report the first use of ultra-purified adipose graft (NANOFAT) for the treatment of recurrent anterior urethral strictures (RAUS). Adipose tissue as regenerative material is an attractive perspective. This is a monocentric study to assess the use of NANOFAT in RAUS. Materials and Methods: Ethics Committee approval (CET-0104113) Clinical Trials.gov NCT05451732 We enrolled 11 men with RAUS between 2021 and 2022. Inclusion criteria were: male patient with RAUS. Exclusion criteria: obstructive urethral stricture, posterior urethral stenosis. Preoperative data: age, urethral stricture characteristics (etiology, length, site, number), previous treatments. Symptoms, uroflowmetry peak flow (Qmax), abdominal ultrasonography with evaluation of postvoid residual urine (PVRU) data were collected before and after surgery. After liposuction we pass the adipose tissue into filters to obtain nanofat. All patients were followed up every 3 mo for the first year and every 6 mo for the second year, after one time per year. Qmax at 3, 6, 9, 12 mo was planned during the first year and then every 6 mo, while abdominal ultrasonography with evaluation of PVRU was made one time per year. In case of suspect of recurrence, a urethroscopy was made with 15 Fr cystoscope. Results: Stricture site: bulbar (5), peno-bulbar (4), penile (1), penile plus bulbar (1). Double urethral stricture was in 3 pts. Median stricture length: 1.9 cm (range 1–4 cm). Stricture cause: 5 unknown, 2 lichen sclerosus, 2 iatrogenic, 1 fayled hypospadias repair. Mean operative time: 60 min (50–90). Median quantity of NANOFAT: 23 mL (range 15–35). A 14 or 16Ch Foley catheter was left in place for 4 weeks, after a voiding cystourethrography of control was made. No periop or postop complications occurred. Median follow-up was 24 mo (range 13–45). Median postop Qmax at 6 mo was 16,3 mL/s (range 14–28) with median PVRU of 20 mL (range 0–40). At 3 and 16 mo follow-up one pt developed RAUS of 1 cm and was treated with second NANOFAT and one pt with perineostomy. Conclusions: Our experience revealed that NANOFAT is feasible, repeatable and there is no limit to harvest. The regenerative potential represents the peculiarity of NANOFAT. Larger prospective series with longer follow-up are expected to confirm its efficacy.

1.7.16. MP-07.16: Urogenital Complications of Pelvic Trauma: A Report on 48 Cases from Douala City (Cameroon)

• Frantz Guy E ¹, Edouard Herve M ² and III A ¹

¹ 

Douala General Hospital, Douala, Cameroon

² 

Douala Laquintinie Hospital, Douala, Cameroon

Abstract: Introduction and Objectives: Describe the epidemiological, clinical and therapeutic aspects of urogenital complications associated to pelvic trauma in the Douala General Hospital (DGH) and Douala Laquintinie Hospital (DLH). Materials and Methods: This was a descriptive retrospective study involving all cases of urogenital complications of pelvic trauma in the Departments of Urology and Orthopedic Surgery of the DGH and DLH. It covered a period of six years nine months (2014–2019). Tile’s classification was used to classify pelvic fractures. Results: A total of 48 (38.71%) patients with complications of pelvic trauma were selected out of the 124 cases with pelvic fractures. Males were more involved with a sex ratio of 5, and the mean age was 33 years (range 20–55 years). The presenting symptom was essentially hemorrhage, hematuria and urethrorragia (35.44%), and pelvic and/or perineal pain (30.95%). Tile B fractures were the most frequent. Posterior urethra lesions were the most common urinary complications observed (45.84%). Emergency management was done on a case-by-case basis: surveillance, urethral catheterization, exploratory laparotomy or diverting cystostomy. Seventeen cases were deferred on which end-to-end anastomotic urethroplasty was performed for urethral rupture. As functional outcome, 6 patients operated developed dysuria requiring urethral dilatation, and 4 complained of erectile dysfunction after a follow-up of 24 months. Conclusions: Urogenital complications of pelvic trauma are common in the city of Douala. Their gravity depends on the degree of instability of the fractures (Tile B and C). They are responsible for important sexual and urinary sequelae. Training of nonsurgical medical personnel would ensure proper initial management of the patient before any specialized multidisciplinary treatment.

1.8. Moderated Oral ePoster Session 08: Female Urology, Voiding Dysfunction

• Friday, October 25
• 0800–0900

1.8.1. MP-08.01: A Randomised Controlled Trial Comparing Intravesical Instillation of Cocktail vs. Intravesical Injection of Onabotulinumtoxin A for Treatment of Interstitial Cystitis/Bladder Pain Syndrome

• Pathak N, Singh A, Ganpule A, Sabnis R and Desai M
• MPUH, Nadiad, India

Abstract: Introduction and Objectives: Primary objective: To compare changes in O’Leary Sant questionnaire scores from baseline between bladder instillation and intradetrusor onabotulinumtoxin A injection groups (baseline, 6 weeks, 6 months). Secondary objectives: To compare: changes in pain—visual analog scale, changes in Female Sexual Distress Scale-Revised (FSDS-R), changes in 12-Item Short Form Survey (SF-12), changes in bladder capacity via 1 day bladder diary, incidence of adverse outcomes, re-treatment incidence, patient perception of treatment convenience and satisfaction (Scale 1–5). Materials and Methods: Prospective randomised controlled single center trial with open label parallel assignment over a 6-month period. 60 patients total, 30 in each arm of intravesical cocktail instillation (6 monthly cycles) and Botox injection (single cycle) (Group 1 and Group 2). Study population were patients with IC/BPS and refractory/poor response to medical therapy. Patients with poor response to oral medication and with good bladder capacity and no Hunner lesions on cystoscopy were included. Results: With mean age of 51.8 and 50.4 years in Groups 1 and 2. Mean visual analog scale (defense and veterans pain rating scale with 0–10 points) at 6 weeks and 6 months was lower for the Group 1 than Group 2 (6 weeks mean 2.73 ± 1.26 vs. 3.47 ± 1.33, p = 0.032 and 6 months mean 2.14 ± 1.19 vs. 2.9 ± 1.37, p = 0.027). Patient convenience (1–5 points) was also different for both groups (Mean 2.76 ± 1.4 vs. 3 ± 2.1, p = 0.001). Patient satisfaction was also different for both groups (Mean 2.73 ± 0.27 vs. 3 ± 0.4, p = 0.019). Conclusions: Intravesical cocktail instillation has less pain relief, has lower patient convenience and patient satisfaction than intravesical Botox injection.

1.8.2. MP-08.02: Application of Single-Layer Vaginal Flap in Transvaginal Repair for Vesicovaginal Fistula

• Meng X, Tang M and Li P
• The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Abstract: Introduction and Objectives: Only few studies have reported the success rates of transvesical versus transvaginal approaches for vesicovaginal fistula (VVF) repairs. Here we retrospectively reviewed the information on VVF and operative characteristics of transvaginal and transvesical closures for 68 simple VVFs repair in our centre from 2007 to 2022. This study is to compare the first-time success rate and prognosis of repairing vesicovaginal fistula (VVF) by transvaginal and transvesical approaches, and to highlight a modified transvaginal repair technique which only require single layer closure of an annular vaginal flap. Materials and Methods: Retrospective analysis of 68 consecutive patients who underwent VVF repair between 2007 and 2022. Fistula characteristics, operative factors, post-surgical complications and outcomes were analyzed. Results: A total of 68 women with a median age of 52.1 (27–75) years were included. The history ranged from 7 days to 8 years, with an average of 18.4 months. 67 cases (98.5%) of VVFs were caused by pelvic surgery, and only one resulted from difficult labour. 15 cases (22.1%) had a history of surgical repair failure. All 68 cases of surgery were smoothly completed. Among them, 28 patients underwent transvaginal repair, whereas 40 (58.8%) women had transvesical repair. Transvaginal approach had a significantly shorter operative time, less intraoperative blood loss, reduced postoperative hospital stay, less hospitalization cost and lower minor complication rates than transvesical group (p < 0.05). No serious complications occurred in the two groups. No cystostomy was performed in the transvaginal group, but 12 cases (30%) in the transvesical group. The average follow-up time was 17.4 (3–48) months. The first-time success rates of transvaginal and transvesical techniques were 89.3% and 75%, respectively. Conclusions: VVF repair with single layer closure of an annular vaginal flap is a technically feasible, simple and successful approach with significantly better operative parameters and lower complications rates.

1.8.4. MP-08.04: Approaches to Reduce the Risks of Mesh Exposure After Midurethral Slings: A Retrospective Long-Term Study of Erosion with a Single Type of Mesh

• Cadilhe J, Leitão J, Coelho H and Maia E
• ULSAM—Viana do Castelo & Universidade do Minho—Braga, Viana Do Castelo, Portugal

Abstract: Introduction and Objectives: The current gold standard of care for the treatment of urodynamic stress incontinence (USI), midurethral tapes, carries a small but significant and concerning risk of erosion and extrusion of the synthetic material into the vagina and urethra (1.4% at 1 year to 2.7% at 5 years according to literature) [1,2]. In a nationwide cohort study of 6706 women in Denmark, Ferm Eisenhard et al. found a significantly reduced risk of mesh exposures if perioperative antibiotics are administered [3]. This study aimed to evaluate the feasibility and safety of the trans obturator procedure (TOT) with this particular SERASIS^® Tape, as well as documenting the post-operative long term sling erosion/extrusion. Materials and Methods: We retrospectively evaluated 860 patients who underwent TOT using SERASIS^® systems by the same surgeon between January 2006 and December 2019 for the cure of USI, and required surgical review for tape problems. All patients received perioperative antibiotic prophylaxis and all post-menopausal women, if they have no contraindications, received post-operative vaginal estrogens for at least 4 months. When vaginal erosion occurs, the patient usually manifests persistent vaginal discharge, postcoital bleeding, and pain during intercourse or male partner discomfort. The diagnosis was confirmed by visual inspection or palpation of the tape in the vagina. Care must be taken to exclude urethral and bladder erosions, as such we perform urethocystoscopy whenever dysuria or UTIs appear. Results: In our series, the rate of midurethral mesh sling removal was 0.5% (4/860: 95%CI, 0.4%–0.5%). The majority of the erosions developed within a few months (5–16 m) therefore they were addressed by partial removal of the eroded sling. Only one had urethral and vaginal extrusion corrected 8 years after the procedure. We also report 0.6% patients (5/860) who underwent urethrolysis with tape section due to obstructive voiding complaints. Conclusions: The use of SERASIS^® MR, along with the significance of perioperative antibiotic prophylaxis and the postoperative vaginal estrogens in postmenopausal women, may result in an approach to reduce the risk of less tape extrusion into the urethra or vagina. The encouraging findings of this study might also help surgeons to be more accurate when choosing tapes.

1.8.5. MP-08.05: Autologous Fascial Slings in Women with Stress Urinary Incontinence: Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Kasyan G, Grigoryan B and Pushkar D
• Botkin’s Hospital Moscow Urological Center, Moscow, Russia

Abstract: Introduction and Objectives: The purpose of this study is to evaluate the efficacy and safety of autologous fascial slings (AFS) compared with other surgical methods for female stress urinary incontinence (SUI). Materials and Methods: The systematic review and meta-analysis were registered in PROSPERO and performed in PICO format using the PRISMA checklist. A systematic search was performed from the Cochrane Library and PubMed until July 2023 using keywords: “autologous”, “sling”, “incontinence”. The data were pooled in meta-analysis using RevMan software 5.4. Authors independently assessed included studies for risk of bias using the Cochrane tool. Inclusion criteria: adult female patients with SUI, only randomized controlled trials (RCT). Exclusion: pregnancy, lactation. Results: Out of 860 studies 20 were included in synthesis, 10 in meta-analyses. The first meta-analysis focused on cure rate between AFS and standard midurethral slings (SMUS) and showed no statistically significant difference (Risk Ratio (RR) = 0.97, 95% Confidence Interval (CI): 0.92 to 1.03, p = 0.32, Heterogeneity (I2) = 0%). The next meta-analysis compared AFS vs. SMUS and has a statistically significant difference—SMUS has more long-term postoperative complications (RR = 0.12, 95% CI: 0.03 to 0.50, p = 0.004, I2 = 0%). The third one assessed AFS vs. SMUS in de novo urgency with a statistically significant difference—in favor of SMUS. (RR = 2.84, 95% CI: 1.13 to 7.10, p = 0.03, I2 = 0%). The fourth meta-analysis showed a significant difference in SMUS vs. AFS—operation time was lower in SMUS (RR = 2.87, 95% CI: 2.56 to 3.19, p < 0.00001, I2 = 97%). The last meta-analysis compared SMUS vs. AFS. Hospital stay duration in SMUS was lower (RR = 1.92, 95% CI: 1.44 to 2.41, p < 0.00001, I2 = 96%). Conclusions: AFS showed the same effectiveness and safety with SMUS and significantly fewer long-term postoperative complications. However, SMUS has shorter operative time and hospital stay, as well as less de novo urgency.

1.8.6. MP-08.06: Correlation of Clinical, Laboratory and Endoscopic Phenomena in Interstitial Cystitis

• Karasev A, Stroganov R, Pushkar D and Kasyan G
• Federal State Budgetary Educational Institution of Higher Education “Russian University of Medicine” of the Ministry of Health of the Russia, Moscow, Russia

Abstract: Introduction and Objectives: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a serious disease that affects the patient’s quality of life. We assessed the mutual influence of clinical symptoms, the influence of endoscopic phenomena on clinical and diagnostic parameters, and presented a prognostic model of Hunner’s lesions (HL). Materials and Methods: At the Department of Urology of the Russian University of Medicine in Moscow, a cohort prospective study was conducted. We examined 60 patients diagnosed with IC/BPS. After screening based on inclusion/exclusion criteria, 34 patients with HL were included in the study. An analysis of urination diaries, pain parameters, diagnostic scales and questionnaires (VAS, ICSI, ICSI), results of laboratory and instrumental diagnostics was performed. A correlation analysis and pairwise comparison of the studied parameters were performed. A multivariate logistic model was obtained to predict the number of HL. A statistically significant level was considered at p < 0.05. Results: Correlation analysis noted a relationship between the number of HL and the presence of urge incontinence (r = 0.36). Permanent pain is accompanied by higher scores, according to VAS, than with sporadic pain (r = 0.43). ICSI scores correlate with ICPI (r = 0.42), VAS (r = 0.42), the presence of urge incontinence and persistent pain (r = 0.39 and 0.57, respectively). ICSI score do not have a statistically significant correlation with urination frequency, urination volume, nocturia (p > 0.05). ICPI score correlate with the presence of permanent pain (r = 0.36), but there is no statistically significant correlation with nocturia, urination frequency, the presence of imperative urinary incontinence, VAS (p > 0.05). Patients with 2 HL or less differ from patients with 3 HP or more in terms of urination volume and positive urine culture. A logistic model with a sensitivity of 80.0% and a specificity of 64.3% was obtained. According to the obtained model, the maximum volume of urination of 100 mL or less increases the probability of having 3 or more HL by 85.2%. Conclusions: The ICSI and ICPI questionnaires are not relevant for the cohort of patients with IC with HL. Urinary tract infection does not exclude the diagnosis of IC, but is an associated condition. Our prognostic model highlights the importance of assessing functional bladder capacity in patients with IC/BPS.

1.8.7. MP-08.07: Nomogram for Predicting the Presence of Hunner’s Lesion

• Karasev A, Pushkar D and Kasyan G
• Federal State Budgetary Educational Institution of Higher Education “Russian University of Medicine” of the Ministry of Health of the Russia, Moscow, Russia

Abstract: Introduction and Objectives: We created a nomogram to predict the presence of a Hunner’s lesion (HL) without the use of cystoscopy in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Materials and Methods: At the Department of Urology of the Russian University of Medicine, Moscow, a cross-sectional cohort study was conducted. From 2021 to 2023, 213 patients with urological diseases were examined. Patients were allocated to one of two groups based on clinical diagnosis: the experimental group consisted of patients with IC with HL, the control group consisted of patients with dysuric manifestations caused by diseases other than IC/BPS. After assessing patients for inclusion/exclusion criteria, each group included 34 patients. A comparative analysis of groups was carried out based on anamnestic, clinical, laboratory parameters, followed by the construction of a classifier based on statistically significant differences. A nomogram for the probabilistic assessment of the presence of HL is presented. Results: A naive Bayes classifier with sensitivity and specificity of 97.1% and 98.5%, respectively, was used to develop the nomogram. The studied parameters are sorted in order of “diagnostic importance” for identifying IC/BPS. Each parameter can be assigned a score from a minimum of −100 to a maximum of +100. The calculated parameters are summed up to form the resulting score. The maximum nomogram score, which corresponds to a probability of 97.1% is 100 points. The probability of having a Hunner lesion is as follows: −100 points—2.9%, 0 points—50%, 100 points or more—97.1%. Conclusions: The presented prognostic tool may be useful for doctors, especially in cases where cystoscopy is difficult or impossible. Early diagnosis of Hunner’s lesions ensures timely treatment, having a significant impact on the patient’s quality of life.

1.8.8. MP-08.08: Prospective Randomised Controlled Trial to Evaluate the Importance of Pre-Procedure Video Counselling for Patient Undergoing Invasive Urodynamic Study

• Shetty R, Pathak N and Singh A
• Muljibhai Patel Urological Hospital, Nadiad, India

Abstract: Introduction and Objectives: Urodynamic Study involves a palette of test to evaluate the lower urinary tract function. Cystometry and pressure flow studies are invasive tests and therefore considered stressful. It is well known that the goal is to mimic the patients symptom complex at the time of urodynamics. For a test such as the one being evaluated in the study requires patient understanding and co-operation. It is more important that the patient understands the procedure well. So our objective is to study the importance of pre-procedure video counselling for patient undergoing pressure flow urodynamic study. Primary objectives were to assess patient anxiety and secondary objectives were to assess patient comfort, operator ease, events of overactivity, need for repeat procedures, patient perception of usefulness of video counselling, impact of patient personality on benefit of video-counselling. Materials and Methods: Randomised single centre experimental comparative study over a period of 6 months. Done in total 60 patients with 30 in each arm of those with pre procedure video counselling and with routine verbal counselling as group 1 and group 2. Parameters studied were demographic details, presenting complains, education status of the patient, indications of UDM, patient personality, UDM findings, patient satisfaction questionnaire, Spielberger six item short form state trait anxiety inventory, operator ease based on patient cooperation on Likert type system and need for repetition. Results: With a median age of 61 years in group 1 and 68 years in group 2, bladder capacity was higher in the group with video counselling (median 454.5 mL, IQR = 373.5–581 vs. median 358.5 mL, IQR = 265–438, p = 0.007). In the patient satisfaction score consisting of 10 questions, there were significant differences for four questions with p value < 0.05, favouring the group 1. Conclusions: Video counselling helps in allaying patient anxiety and facilitates the performance of a urodynamic study, reflecting as a higher bladder capacity and higher patient satisfaction scores.

1.8.9. MP-08.09: Robotic-Assisted Mesh Sacrocolpopexy for Pelvic Organ Prolapse: Functional and QoL Outcomes with at Least 5 Years and up to 9 Years Follow-Up

• Tse V ¹, Oze V ² and Yeow S ³

¹ 

Macquarie University, Sydney, Australia

² 

University of Sydney, Sydney, Australia

³ 

Khoo Teck Puat Hospital, Yishun, Singapore

Abstract: Introduction and Objectives: Robotic assisted sacrocolpopexy (RASC) has become a minimally invasive option for treating pelvic organ prolapse. Many studies have been published evaluating clinical outcomes, but there is paucity of regional and longer term outcome data. This study presents functional and quality of life (QoL) outcomes of a local patient cohort with at least 5 years, up to 9 years, follow-up. Materials and Methods: A retrospective analysis on prospectively collected data of all women undergoing RASC at a single centre was undertaken. Demographic variables were collected, and preoperative functional evaluation undertaken using the Pelvic Floor Impact Questionnaire (PFIQ) and post-operatively also the Patient Global Impression of Improvement (PGI-I). Postoperative outcomes were assessed in terms of POP recurrence, defined as either further POP surgery, pessary use or sensation of vaginal bulge postoperatively. Telephone interview was used for PFIQ and PGI-I at time of abstract submission. Results: 20 consecutive patients with at least 5 years follow-up between 2014–2018 were included. Mean surgical time 142 min (range 81–211). Mean console time was 112 min (68–188). 12 of 20 underwent sacrocolpopexy and 8 sacrohysteropexy. All patients underwent mesh RASC. There were no Clavien-Dindo 2 or higher complications. 2 patients developed a cystocele (8%) and 1 an apical recurrence (4%) at time of last follow-up, however none were symptomatic. On the PFIQ, 95% (n = 19) of patients had both decreased total scores post-operatively and 95% (n = 19) had decreased bladder symptom scores. With regards to bowel and vaginal symptoms, 90% (n = 18) and 65% (n = 13) of patients had decreased scores respectively across these domains. Overall, the average pre-op PFIQ and post-op scores were 94.05 and 12.14 respectively. There was a statistically significant decrease across each individual PFIQ domain as well as the total score (p < 0.0001). With PGI-I, 70% of patients reported very much better or much better (n = 14), 15% a bit better (n = 3), 5% no change (n = 1) and 5% as a bit worse (n = 1). Conclusions: This is the first Australian study on RASC originating from a urology department. It shows that RASC is safe and effective in the longer term, with good patient satisfaction and low recurrence rates.

1.8.10. MP-08.10: Sexual Function in Real Life Urogynecological Practice: A Cross-Sectional Prospective Study

• Ausheva B, Pushkar D and Kasyan G
• Russian University of Medicine, Moscow, Russia

Abstract: Introduction and Objectives: Pelvic disorders involve a variety of different conditions such as bladder and bowel dysfunctions along with pain or sexual problems. The problem of sexual dysfunction is one of the symptoms associated with pelvic organ prolapse that motivates women to seek medical attention. The objective of this study is to assess the severity and prevalence of sexual dysfunction in patients with pelvic floor disorders. Materials and Methods: A study was conducted from March to October 2023 in the female urology department of a tertiary public University center. A total of 150 patients admitted for the pelvic surgery were screened, data of 105 patients were collected and analyzed. All patients completed questionnaire PISQ 12 (Pelvic Organ Prolapse Incontinence Sexual Questionnaire) prior to surgery. Results: The total number of patients operated was 105, with an average age of 55.7 years (± 12.6). The mean value of the PISQ 12 questionnaire was 31.6 ± 6.85 with a maximum value of 48.0. Patients who completed the questionnaire were diagnosed with stress urinary incontinence (44.8%), a mixed (41.0%) and pelvic organ prolapse (26.7%). 9.2% of women with pelvic dysfunction “never” experienced sexual desire, 18.4% experienced sexual desire “seldom”. Pain during sexual intercourse was frequent—3 points. 2.7%—“always” experienced pain during sexual intercourse, 2.7%—“usually”, 28.0%—“sometimes”, 29.3%—“often”, 37.3%—“never”. Episodes of loss of urine during intercourse were observed on average-often (3 points; 5.3%—“always”, 16.0%—“often”, 17.3%—“sometimes” lost urine during intercourse), but urinary or fecal incontinence rarely affected sexual activity. The genital prolapse in 66.7% of women was always considered the primary reason for avoiding sexual intercourse. The percentage of women with negative emotions during sex was 36.0%. As sexual abstinence is recommended for all patients to reduce the risk of dyspareunia in the postoperative period, a long-term follow-up study of the sexual function in postoperative female patients at least 2–3 months after surgery is necessary. Conclusions: Patients with pelvic disorders most often experienced pain during sexual intercourse and urinary incontinence. Sexual dysfunction increases with age and pelvic disorders such as urinary incontinence and pelvic organ prolapse.

1.8.11. MP-08.11: Symptoms of Pelvic Floor Dysfunction in Real Life Urogynecological Practice: A Cross-Sectional Prospective Study

• Ausheva B, Pushkar D and Kasyan G
• Russian University of Medicine, Moscow, Russia

Abstract: Introduction and Objectives: Pelvic disorders involve a variety of different conditions such as bladder and bowel dysfunctions along with pain or sexual problems. Urinary incontinence is one of the most common manifestations of pelvic disorders. The aim of this observational study was to analyze patient’s profile and the structure of surgical interventions in these patients in real life practice. Materials and Methods: A study was conducted from March to October 2023 in the female urology department of a tertiary public University center. A total of 150 patients admitted for the pelvic surgery were screened, data of 105 patients were collected and analyzed. All patients completed questionnaires prior to surgery. Results: The total number of patients operated was 105, with an average age of 55.7 years (±12.6). Coital urinary incontinence was reported in 41.7% cases, 17.1% had difficult voiding, 42.3%—intermittent urination, and 31.4% experienced constipation. Stress urinary incontinence was detected in 44.8% of the patients during the examination, while 41.0% had a mixed incontinence. 26.7% of the patients had pelvic organ prolapse: 13% with rectocele, 65.2% with cystocele, 7.1% with a combination of cystocele and rectocele. In 46 patients (43.8%) frequency of urination was more than 7 times. A total of 85 patients (80.9%) had urge to urinate at night, and 44 women (51.7%) had urge to urinate 2 or more times per night. The urge to urinate was not felt by 16 patients (15.2%). In 83 patients (79.0%), urine was not delayed due to strong urge to urinate. Suburethral sling operations (n = 77.73%) and combined surgical interventions (n = 19.18%) were most often performed. Transobturator approach was most commonly used for sling urethropexy (n = 54, 70%), while retropubic approach was used in 26% of patients (n = 20). Conclusions: Pelvic disorders limit female patients in their choice of professional activities, force them to leave their workplaces, and significantly restrict them in daily activities. Surgeons should take into account the patient’s expectations and lifestyle, her age, which is a determining factor in choosing the optimal approach, as well as risk factors for relapse.

1.8.12. MP-08.12: Artificial Urinary Sphincter Complications and Revision Surgery: 20 Years Single Center Experience

• Tomilov A, Golubtsova E and Veliev E
• Botkin’s Hospital, Moscow, Russia

Abstract: Introduction and Objectives: Despite the favorable results in reduction of urine loss, AUS implantation is associated with relatively high rate of complications. We evaluate AUS implantation long-term results in terms of safety and opportunity to recover its functioning. Materials and Methods: From 2004 to 2024 in our center AUS AMS 800 was implanted in 62 patients with severe urinary incontinence. The use of ≤ 1 pad per day (“social continence”) was considered as success. The quality of life was assessed using the IPSS QoL scale and the ICIQ-UI SF questionnaire. Complications were described according to the Clavien-Dindo classification. Results: The mean patient age at the time of implantation was 67.4 ± 8 years. The most common cause of severe stress urinary incontinence was radical prostatectomy (61.3%), followed by transurethral resection of the prostate (21%), simple prostatectomy (8.1%) and other interventions (9.7%). The proportion of irradiated patients was 14.5%. Median follow-up was 73.5 months (IQR 14.8–118.3 months). Twenty-eight grade 2 and higher complications according to the Clavien-Dindo classification were noted in 22 (35.5%) patients. More than a third of patients (35.7%) experienced complications more than 5 years after implantation. The spectrum of complications was: urethral erosion (35.7%), fluid deficiency (32.1%), mechanical failure (10.7%) and other (21.4%) with 32.1% of all complications were iatrogenic. The median time to first complication was 41.5 months (IQR 5–60.4 months). Nineteen (30.6%) patients underwent 32 revisions, 10 of them repeated. The AUS was partially or completely removed in 18 (29%) patients. Eleven (57.9%) patients underwent revision surgery and achieved recover of AUS functioning. Conclusions: With a long follow-up period a significant number of patients developed complications, including those requiring removal or replacement of AUS or its components. Great part of complications requiring revision surgery were iatrogenic. Healthcare professionals should be familiar with the specifics of providing care to patients with AUS, while patients with an AUS require regular long-term follow-up.

1.8.13. MP-08.13: Baseline Anti-Cholinergic Burden Increases Risk of Urological Complications After Antimuscarinics: A Propensity Score Matched Analysis

• Liu A, Chan B and Ng C
• The Chinese University of Hong Kong, Hong Kong, China

Abstract: Introduction and Objectives: Antimuscarinics for overactive bladder (OAB) is associated with adverse anti-cholinergic effects, which are further exacerbated by accumulated anti-cholinergic burden from concomitant polypharmacy. Higher anti-cholinergic burden score increases risks of cognitive impairment, falls, and mortality. This study aims to explore the association between anti-cholinergic burden and complications, with primary interest in urological outcomes, in patients newly started on antimuscarinics. Materials and Methods: All adult patients who were newly started on antimuscarinic monotherapy under the public healthcare system in Hong Kong from 2017 to 2021 were included. After exclusion of confounders, a total number of 13,947 patients were eligible for analysis. The Anticholinergic Cognitive Burden (ACB) score is utilised, which is the most widely used scale that measures anti-cholinergic burden, covering 88 drugs with anti-cholinergic properties. The ACB score of all patients were calculated based on prescription records. Patients with ACB ≥ 1 are compared to the control group with ACB = 0. Propensity score matching is performed in a 1:1 manner to balance co-variates including demographic factors and co-morbidities. Complications, including urological outcomes are compared between the two groups. Results: After propensity score matching, a total of 9854 patients were analysed. The two groups showed balanced co-variates after matching. Regarding urological outcomes, statically significantly higher incidence of acute retention of urine (AROU) in observed in the group with baseline ACB ≥1 compared to control (4.5% vs. 3.6%, p = 0.028), with a relative risk of 1.24 (95% CI 1.02–1.50). ACB ≥1 is also associated with statically significantly higher urinary tract infection (UTI) incidence (9.4% vs. 6.3%, p < 0.001), with a relative risk of 1.50 (95% CI 1.30–1.72). There is no statistically significant difference in haematuria or bladder stone incidence between the two groups. Statistically significant incidence of other complications such as atrial fibrillation is also seen in patietns with baseline ACB ≥1. Conclusions: This is the first study reporting that baseline ancholinergic burden is associated with higher incidence of urological complications of AROU and UTI after initiation of antimuscarinics, with a clinically significant relative risk of 1.24 and 1.50 respectively. Additional care and counselling is needed before initiating antimuscarinics in patients with baseline anticholinergic burden.

1.8.14. MP-08.14: Comparison of Clinical and Urodynamic Characteristics of Anatomical and Functional Obstruction in Females with Nonneurogenic Voiding Dysfunction: A Single Center Experience

• Pal A ¹, Kalra S ², Narayanan Dorairajan L ², Thakor P ², Narkhede V ² and Kodakkattil Sreenivasan S ²

¹ 

Medanta—The Medicity, Gurugram, India

² 

Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India

Abstract: Introduction and Objectives: The objective of this retrospective analysis was to evaluate the different clinical and urodynamic parameters of the women presented with nonneurogenic anatomical and functional obstruction and comparison between two groups. Materials and Methods: We analyzed a total of 53 female patients who presented with nonneurogenic voiding dysfunction due to bladder outlet obstruction over a period of three years. Patients who presented with urogenital prolapse (cystocele, enterocele, rectocele; n = 9), extra-urinary tract obstruction (carcinoma, urethral diverticulum; n = 8), urethral stricture disease (n = 10), and obstruction post-sling surgery (n = 2) were included under ‘anatomical obstruction’ (AO). Patients who presented with primary bladder neck obstruction (n = 20), dysfunctional voiding (n = 3), and Fowler’s syndrome (n = 1) were categorized as ‘functional obstruction’ (FO). Results: Of 53 female patients, the AO and FO group had 29 and 24 patients, respectively. The mean age was significantly less in the FO group (55.7 ± 17.7 and 36.6 ± 12.8 years, respectively, p < 0.05). The distribution of storage symptoms was comparable in both groups except for frequency, which was seen more in the FO group (AO vs. FO, 44.8% vs. 75%, respectively; p < 0.05). Except for acute retention of urine (AUR), all other voiding symptoms and International Prostate Symptom Score (IPSS) were equivalently distributed. AUR was seen more in the FO group (AO vs. FO, 24.1% vs. 37.5%, respectively, p < 0.05). On uroflowmetry, Qmax was significantly less in the AO group (AO vs. FO, 6.8 ± 4.79 vs. 9.7 ± 5.3 mL/s, respectively; p < 0.05). In urodynamic study (UDS), the parameters of the filling phase, including compliance, were comparable in both groups, while during the voiding phase, Qmax was significantly less and bladder contractility index (BCI) was significantly more in the AO group (AO vs. FO, Qmax 6.3 ± 4.6 vs. 8.9 ± 5.4 mL/s, BCI 112.4 ± 22.2 vs. 94.5 ± 33.6 respectively; p < 0.05). (Table 1). Conclusions: Except for a few clinical and urodynamic parameters, female bladder outlet obstruction, when categorized into anatomical and functional groups, had similar findings.

1.8.15. MP-08.15: Long-Term Prospective Evaluation of Patient Reported Outcome and Quality of Life in Patients with Intermittent Self Catheterization

• Telle J ¹, Manka L ², Schiffmann J ³ and Hammerer P ⁴

¹ 

Klinikum Wolfsburg, Wolfsburg, Germany

² 

Klinikum Braunschweig, Braunschweig, Germany

³ 

Praxis Wolfsburg, Wolfsburg, Germany

⁴ 

Dept. Urology, Braunschweig, Germany

Abstract: Introduction and Objectives: Intermittent catheterization (IC) is the recommended technique for bladder emptying in patients with chronic retention resulting from different causes. In this study, quality of life (QoL) and different patient reported outcome (PRO) and infection rates in patients with intermittent self-catheterization (ICS) were examined prospectively. Materials and Methods: 72 patients with an indication for ICS with a maximum follow-up to 10 years were included. Validated QoL questionnaires, Kings Health Questionnaire (KHQ) and questionnaire on general health status SF 12 at the start of treatment, after 3, 6, 9, and 12 months with a follow-up up to 10 years were used. Symptomatic urinary tract infection rates, antibiotic treatments, comorbidities, dysuric complaints, consultations and visit frequency of the treating physicians and the nursing services and the personal subjective experiences of the patients. Results: All 72 patients included in our study performed ISC in home care. The most common hydrophilically coated single-use catheters were adapted to patients in accordance with their needs and anatomical conditions, regardless of the manufacturer. The instruction was carried out by nurses 1–5× in the first quarter and later once in the quarter. Most of the patients (> 65%) stated that their QoL was good (1–3 of 5). However, the bladder emptying disorder and the necessary ISC lead in many patients to a serious influence on the partnership through the bladder problem (7–10 out of 10). 8% of the patients do not want any further visits from the nursing staff after therapy periods > 1 year. 51/72 patients developed symptomatic urinary tract infection within the first year. Conclusions: This study shows the acceptance and quality of life with ISC on a long-term perspective. The initial explanation and instruction in the handling as well as the selection of the best-adapted catheter can be carried out by trained employees. Symptomatic urinary tract infection are seen in up to 71%.

1.8.16. MP-08.16: MI-CRONS: A Novel Practical Classification for Male Urinary Incontinence

• Kasyan G, Grigoryan B and Pushkar D
• Botkin’s Hospital Moscow Urological Center, Moscow, Russia

Abstract: Introduction and Objectives: The objective of this study is to develop a new simple and practical classification of male urinary incontinence based on the clinical features and type of urinary incontinence. Materials and Methods: MI-CRONS classification is a system based on two estimations: (a) severity of incontinence and (b) patients’ characteristics that would play a role in management and further prognosis. Clinical evaluation of incontinence severity is based on preservation of self-voiding, proportion of void/lost urine, absorbable device usage, level of physical efforts that causes urine loss and nocturnal incontinence. Following patients’ characteristics of patients were included in the classification system: history of radical prostatectomy, history of pelvic radiation, surgery for prostatic obstruction, neurogenic incontinence, and urethral stricture. This classification system uses five uppercase Latin letters as follows: Male Incontinence—Cancer, Radiation, Obstruction, Neurogenic, Stricture. (Figure 1) We presume that the MI-CRONS classification could be used for stress (SUI), urgency (UUI), and mixed (MUI) incontinences. Results: A single institution longitudinal observational study (2020–2023) included 86 male incontinent patients (~67 yo.). Patients were classified by MI-CRONS in order to estimate an inclusiveness and complicity of proposed classification. Only one patient could not be classified using the MI-CRONS classification due to the fact that the patient has a history of bladder exstrophy, augmentation cystoplasty. Conclusions: The MI-CRONS has demonstrated prompt potential for classifying male incontinence of any type. It is a valuable tool for daily practice and clinical trials. A multicenter trial and Delphi consensus would be proposed with international experts for the further development of MI-CRONS.

1.8.17. MP-08.17: Urinary Continence and Quality of Life After Artificial Urinary Sphincter Implantation: Long-Term Single Center Outcomes

• Tomilov A, Golubtsova E and Veliev E
• Botkin’s Hospital, Moscow, Russia

Abstract: Introduction and Objectives: Implantation of artificial urinary sphincter (AUS) is the main treatment method in patients with intrinsic sphincter deficiency. We present the results of long-term follow-up of patients who have an artificial urinary sphincter implanted in our center. Materials and Methods: From 2004 to 2024 AUS AMS 800 was implanted in 62 patients with severe urinary incontinence in our center. The use of ≤ 1 pad per day (“social continence”) was considered as success. The quality of life was assessed using the IPSS QoL scale and the ICIQ-UI SF questionnaire. Results: The mean patient age at the time of implantation was 67.4 ± 8 years. The causes of severe stress urinary incontinence were the following interventions: radical prostatectomy (61.3%), transurethral resection of the prostate (21%), simple prostatectomy (8.1%) and other interventions (9.7%). The median time after the intervention that caused urinary incontinence was 24 months (IQR 13–36 months), 48.4% of patients had vesicourethral anastomosis/urethral stricture correction before AUS implantation and 16.1% of patients had prior antiincontinence surgery. The effectiveness of implantation was evaluated in 53 patients, 8 patients had complications preventing the use of AUS and 1 patient has not reached device activation time. Median follow-up was 73.5 months (IQR 14.8–118.3 months). There was a statistically significant decrease in the median urine loss from 900 mL (IQR 700–1100 mL) to 7 mL (IQR 0–35 mL), p < 0.05. There was also a statistically significant reduction in pad use from 7 (IQR 6–8) to 1 (IQR 0–2) pad per day, p < 0.05. Twenty-seven patients did not use pads. Overall, 69.4% of patients met the criterion of success. Median IPSS QoL scores decreased from 5 (IQR 4–5) to 1 (IQR 0–2), p < 0.05. There was statistically significant reduction ICIQ-UI SF questionnaire score from 21 (19–21) to 6 (IQR 1–9), p < 0.05. Conclusions: With long-term follow-up AUS implantation leads to statistically significant reduction in urine loss and quality of life improvement in patients with activated device.

1.9. Moderated Oral ePoster Session 09: Prostate Cancer—Detection, Miscellaneous

• Friday, October 25
• 0800–0900

1.9.1. MP-9.01: Prevalence of Multimorbidity in Genitourinary Cancer in Chile: A Population-Based Study

• Eltit I ¹, Juri D ², Cáceres C ³, Delgado I ⁴, Astudillo M ⁴, Bustamante A ¹ and Fernandez M ¹

¹ 

Clínica Alemana, Santiago, Chile

² 

Posta Central, Santiago, Chile

³ 

Universidad San Sebastian, Santiago, Chile

⁴ 

Universidad Del Desarrollo, Santiago, Chile

Abstract: Introduction and Objectives: Multimorbidity, defined as the coexistence of two or more chronic conditions, presents a complex challenge in healthcare, impacting patient outcomes and healthcare costs. This study aimed to characterize multimorbidity and determine its impact on patients with genitourinary cancer (GUC) in Chile. Specifically, the study sought to identify the most frequent comorbidities, their combinations, and their association with hospitalization modalities in this population. Materials and Methods: A retrospective descriptive population study was conducted using data from the Fondo Nacional de Salud (FONASA) in Chile. The study included patients with GUC (bladder, prostate, kidney, and testicular cancer) between 2019 and 2021. Diagnosis-related group (DRG) databases were used to assess comorbidities and associated costs. Comorbidity prevalence, hospitalization modality (elective vs. emergency), severity (moderate/major vs. minor/none), and length of stay were analyzed. The costs associated with each hospitalization were determined by multiplying the Diagnosis-Related Group (DRG) weight assigned to the specific hospitalization by the corresponding basal cost of the healthcare institution. Results: Of the 4,028,597 hospital events analyzed, 11.6% were related to GUC, with a total of 18,792 patients. Multimorbidity was present in 67.3% of patients, with hypertension and diabetes mellitus being the most prevalent conditions. Patients with multimorbidity accounted for 69.1% of the total cost of GUC care. Hospital mortality was higher in patients with multimorbidity (7.5% vs. 3.7%; p < 0.001), who also had longer hospital stays (mean of 8 vs. 5 days). Most patients were admitted electively (60.3%), while 39.7% were admitted through the emergency room. Patients with multimorbidity had a significantly higher proportion of moderate/major severity hospitalizations compared to those with no multimorbidity (56.1% vs. 32.5%; p < 0.001). Patients admitted through the emergency room had a significantly higher prevalence of each comorbidity (p < 0.001). Conclusions: Multimorbidity in GUC patients in Chile is associated with increased hospitalization costs, longer stays, higher mortality rates, and higher severity of hospitalization. These findings underscore the importance of comprehensive care strategies addressing multimorbidity to improve clinical outcomes and reduce the burden on healthcare systems. Future research should focus on interventions that effectively manage multimorbidity in GUC patients.

1.9.2. MP-09.02: A Genome-Wide CRISPR Screen Identified FABP5 as a Key Driver for ARSI Cross-Resistance in Prostate Cancer

• Yu Y, Qu F, Gu Z, Ding J, Dong K, Chen H, Qian Y, Liao H and Cui X
• Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Abstract: Introduction and Objectives: The next-generation androgen receptor signaling inhibitors (ARSIs) enzalutamide (enza) and darolutamide (daro) are effective initially for treating advanced prostate cancer (PCa) and castration-resistant prostate cancer (CRPC). However, drug resistance is an inevitable cause of mortality associated with CRPC, as patients often relapse and develop resistance. The present study sought to investigate the role of the fatty acid-binding protein 5 (FABP5) in the ARSI cross-resistance in prostate cancer and explore the potential related pathway mechanism. Materials and Methods: Long-term treatment of hormone-sensitive prostate cancer LNCaP cell line with enzalutamide or darolutamide resulted in an acquired cross-resistant cell line. Based on the CRISPR/Cas9 knockout library and GEO datasets, the key gene FABP5 in the top 1% of resistance was screened, and the drug-resistant cells were verified by open-access chromatin sequencing (ATAC-seq) after treatment. Single-cell RNA sequencing (scRNA-seq) assay identified the differential activation of the NF-κB/Wnt/β-catenin axis between FABP5 positive (FABP5+) and FABP5 negative (FABP5−) PCa cells in CRPC tissue. In vitro and in vivo experiments highlighted the important role of FABP5 in conferring ARSI resistance. Results: The expression level of FABP5 in ARSI-resistant PCa cell lines was significantly higher than that in parental cells. An increase in the RefSeq transcriptional start sites (TSSs) in the existence of enza indicated that ARSI treatment up-regulated the chromatin accessibility of the FABP5 gene in LNCaP-resistant cells. ChIP assay confirmed the transcription regulation of NF-κB on the FABP5 promoter in PCa cells. The FABP5 overexpression upregulated the activation of the NF-κB signaling pathway. In vitro and in vivo experiments highlighted the role of FABP5 in conferring ARSI resistance to LNCaP cells. The GO and GSEA analysis results of scRNA-seq indicated significant activation of NF-κB/Wnt/β-catenin axis in FABP5+ PCa cells. Moreover, combining the use of orlistat with daro in 22Rv1 suppressed tumor growth more dramatically than any ARSI treatment alone in vitro and in vivo. Conclusions: Our results established that ARSI treatment activates FABP5 and mediates ARSI resistance via the FABP5/NF-κB/Wnt/β-catenin axis, whereas the FABP5 inhibitor orlistat induces synthetic lethality with ARSI as an effective strategy for advanced PCa progression.

1.9.3. MP-09.03: A Large Cohort Study of Metformin and Dipeptidyl Peptidase 4 Inhibitors for Prostate Cancer Incidence Using Japanese Claims Database

• Sakaguchi K, Waki M, Usui A, Noda T, Tanaka M, Hayashida M, Oka S and Urakami S
• Toranomon Hospital, Tokyo, Japan

Abstract: Introduction and Objectives: Metformin, a drug for the treatment of type 2 diabetes, has been shown to inhibit tumor growth by activating adenosine monophosphate (AMP)-activated kinase and its effects on cancer stem cells. With regard to prostate cancer, its effects on reducing morbidity and inhibiting tumor progression have been reported, but the results have been inconsistent and inconclusive. Recently, dipeptidyl peptidase 4 (DPP4) inhibitors, which are also used to treat type 2 diabetes, have been reported to be effective in prostate cancer incidence. Using the present claims data, we analyzed the anti-tumor effect of diabetes drugs in the Japanese population. Materials and Methods: Twenty-year-old or older males with newly diagnosed type 2 diabetes between December 2009 and December 2019 were divided into three groups: metformin treatment group (Met group), DPP4 treatment group (DPP4 group), and other drug treatment groups (other groups). The endpoint was the incidence of prostate cancer (persons/100,000 person-years). Covariates were age, duration of observation, hypertension, medications of aspirin, statins, insulin, BMI, HbA1c, smoking, and alcohol use. Statistical analyses included intergroup incidence of prostate cancer diagnosis (persons/10,000 person-years), COX regression analysis, and log-rank tests. Statistical significance was set at p < 0.05. Results: Of the total 49,445 patients, Met group n = 11,272, DPP4 group n = 2304, and other group n = 15,132; median (IQR) age (years) were 50 (44–56), 53 (47–59), and 51 (45–58), respectively. Prostate cancer incidence rates were 121.8, 182.2, and 147.0, respectively. Kaplan-Meier curves analysis and the log-rank test showed p = 0.003. In multivariate analysis, metformin use and DPP4 use were not associated with the incidence of prostate cancer (Hazard ratio 0.93; 95% confidence interval 0.83–1.29, p = 0.673 and HR 1.06; 0.82–1.37, p = 0.681). BMI and HbA1c levels correlated with the incidence of prostate cancer (HR 0.92; 95% CI 0.89–0.94, p < 0.001 and HR 0.83; 95% CI 0.77–0.90, p < 0.001). Conclusions: Multivariate analysis showed that metformin and DPP4 inhibitors were not statistically associated with the prostate cancer incidence. Low BMI and HbA1c levels were more likely to be risk factors for prostate incidence than medication factors. Further subgroup analyses and future prospective studies are warranted.

1.9.4. MP-09.04: Active Surveillance in Low-Risk Prostate Cancer; the Role of Multiparametric MRI and Cancer Progression Predictors

• Simforoosh N ¹, Hamidi Madani M ² and Dadpour M ²

¹ 

Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Nikan Hospital, Tehran, Iran

² 

Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract: Introduction and Objectives: To evaluate the outcomes of active surveillance (AS) strategy for low risk prostate cancer (PCa) and identify multiparametric MRI role and PCa progression predictors. Materials and Methods: This was a 5-year follow-up cohort study which enrolled 153 low-risk PCa patients in an AS program from April 2017 to February 2023. Patients were included in this study based on AS protocol inclusion criteria. MpMRI was also a part of this protocol. Active surveillance outcomes such as adherence to AS treatment strategy and the oncologic outcomes were assessed. Results: During the 4.23 ± 0.5 years follow-up, 39 of 153 patients left the AS protocol by their own decision (14 patients) or other physicians’ advice (25 patients), due to the concern of cancer progression; 5 of 153 died from another cause other than PCa; 9 of 153 revealed cancer progression and underwent radical prostatectomy; The remaining 100 patients stayed on the AS protocol during the follow up. Adherence to AS strategy protocol was 60.55% in our study. Older age, positive family history for PCa, initial clinical stage, higher total PSA, greater PSA density, more positive cores, and greater core involvement were the predictors for progression. The sensitivity, specificity, positive predictive value, and negative predictive value of mpMRI for cancer progression detection were 55.55%, 97%, 62.25%, and 96%, respectively. Conclusions: AS can be a suitable protocol for low-risk prostate cancer to avoid the probable complications of definitive treatment. MpMRI is valid and reliable for identifying PCa progression and provides useful information when combined with biopsy.

1.9.5. MP-09.05: Comparative Analysis of Perioperative, Oncological and Functional Outcomes of Robotic vs. Open Radical Prostatectomy for Prostates More than 100 cc

• Sokolov E ¹, Poliakova A ², Veliev E ¹ and Pushkar D ¹

¹ 

Moscow Urological Center, S.P. Botkin’s State Hospital, Moscow, Russia

² 

Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Abstract: Introduction and Objectives: The aim of this study was to evaluate safety and efficiency of robotic (rRP) vs. open retropubic (oRP) approach in patients with prostate cancer and prostate volume (PV) ≥100 cc. Materials and Methods: The study groups comprised 97 patients with prostate cancer and PV ≥ 100 cc who underwent rRP (n = 56) or oRP (n = 41) from 2014 to 2022. There were no differences between the groups in the main preoperative clinical characteristics. Median PV was 124 cc in rRP group and 130 cc in oRP group; mean IPSS score—12.8 and 12.5; mean Qmax—9.5 mL/s and 9.6 mL/s respectively (p > 0.05). Cystostomy tube was placed preoperatively due to urinary retention in 9 (16.1%) patients in rRP group and 12 (29.3%) in oRP group (p = 0.06). Results: Mean surgery time was shorter with the open approach (185 min vs. 230 min; p < 0.05), while the estimated blood loss was significantly lower in rRP group (140 mL vs. 370 mL; p < 0.05). Grade II-III complications were more common in open approach (22% vs. 7.1%; p < 0.05). Positive surgical margins were found in 5.4% and 12.1% in rRP and oRP groups, while biochemical recurrence free survival after 12 months was 92.8% and 87.8% (p > 0.05). Total urinary continence recovery was faster in rRP group during first three months (44.6% vs. 31.7% at 1 month/58.9% vs. 43.9% at 3 months; p < 0.05) with no significant differences at 6 and 12 months (76.7% vs. 67.3%; 87.5% vs. 82.9%; p > 0.05). Significant improvement in quality of life due to urinary symptoms score (IPSS) was noted in the group of patients with cystostomy tube or severe LUTS (IPSS score ≥ 20) prior to RP regardless of the type of surgery (4.7 before RP vs. 1.9 after RP; p < 0.05). Conclusions: Robotic access is associated with fewer perioperative complications and better early functional results after RP in large prostates. Patients with severe LUTS or preoperative cystostomy could experience a significant improvement in the quality of life after RP, which makes it a method of choice regardless of risk group stratification.

1.9.6. MP-09.06: Correlation of 68 Ga—PSMA PET—CT/MRI with Histopathology Characteristics in Carcinoma Prostate Patients Undergoing Radical Prostatectomy

• Taur P and Ragavan N
• Apollo Main Hospital, Chennai, India

Abstract: Introduction and Objectives: 68Ga-PSMA PET is being progressively used in PCa patients for staging and detection of lymph node metastases, despite a lack of prospective, validating facts. Therefore, we intended to study the correlation of PSMA findings (SUVmax values) with respect to final histopathology findings (Gleason grade and lymph node positivity) in patients undergoing radical prostatectomy. Materials and Methods: We did a single centre, prospective, observational study. We evaluated the data from 63 consecutive eligible patients in specified time. Patients underwent 68 Ga- PSMA PET CT with fusion MRI for staging and then a standard TRUS-guided biopsy as per the established standard protocol. All patients underwent robotic-assisted radical prostatectomy, with EPLND as a standard. Clinical parameters and SUVmax values were collected and data analysis was performed. Results: The preoperative median PSA was 15 ng/mL (IQR 9.4–28). Median SUVmax uptake of 4.8, 6.1, and 12.9 in the PSA groups of 20 groups respectively. A statistically significant correlation was seen between PSA values and SUVmax uptake (p 0.001). The median SUVmax of PCa lesions was 3.7, 5.4, 10.2, 13.5, and 12.6 for GG 1, 2, 3, 4, and 5 respectively. The correlation between SUVmax of the prostatic lesion and GG of radical prostatectomy specimens reached a significant level (p 0.025). A similar correlation was also observed between SUVmax of LN and LN involvement (p < 0.001). 0.94 as cut-off as per the ROC curve, Calculated PSMA PET scan Sensitivity, Specificity, PPV and NPV for the detection of involved lymph nodes were 77.8%, 88.7%, 53.8%, and 95.9% respectively. Conclusions: SUVmax of PCa lesion and Gleason Grade Group on final histopathology correlates significantly. There is increased SUV uptake in 8, 9 GS tumours as compared to GS 6 and 7. PSMA PET is valuable in detecting LN metastases and SUVmax of LN correlates with LN positivity. The SUVmax value may have prognostic significance.

1.9.7. MP-09.07: Cytoreductive Radical Prostatectomy in Patients with Advanced Prostate Cancer and Multiple Bone Metastases: Result of Feasibility and Local Symptoms Control

• Simforoosh N ¹, Dadpour M ², Mofid B ², Poorsalimi S ² and Siavashpour M ³

¹ 

Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Nikan Hospital, Tehran, Iran

² 

Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

³ 

Medical school, Iran University of Medical Sciences, Tehran, Iran

Abstract: Introduction and Objectives: Traditionally, systemic therapy (ST) beside palliative measures such as pain management and preventing pathologic fractures is the standard treatment for advanced prostate cancer and multiple bone metastases. The local benefits of cytoreductive radical prostatectomy in oligo-metastases patients has been proved, previously. Herein, we designed a study to evaluate the local benefits of cytoreductive surgery in patients with prostate cancer and multiple bone metastases. Materials and Methods: Prospectively, 88 patients with newly diagnosed of advanced prostate cancer and multiple bone metastasis were enrolled in this study and divided into two groups: 47 patients in ST group received systemic therapy alone and 41 patients in CRP group underwent cytoreductive radical prostatectomy, extended lymphadenectomy and bilateral orchiectomy alongside systemic therapy (similar to ST group). Exclusion criteria included patients older than 75 years, visceral metastasis and those with prior treatment. Results: The two groups were comparable in terms of mean age (p = 0.26), pre-operative PSA level (p = 0.16), Gleason’s grade of prostate biopsy (p = 0.42) and mean follow up time (p = 0.33). During the mean follow up of 26 months, all patients in CRP group maintained continent and voided well while 5 patients in ST group required channel TURP, 6 patients needed permanent Foley catheter that they were not candidate for TURP due to their medical condition and 2 of them needed bilateral nephrostomy due to tumor progression and involvement of ureteral orifices. 11 patients in group CRP and 14 patients in group ST died because of cancer during the follow up (p = 0.18). Conclusions: Cytoreductive radical prostatectomy has the potential to decrease symptoms resulting from tumor progression and may prevent patients from experiencing disabilities due to additional surgeries and catheters in case of advanced prostate cancer with multiple bone metastases. Further studies are needed to prove our results and at present it is recommended to be performed only in designed investigational trials.

1.9.8. MP-09.08: Initial Experience of Radical Prostatectomy in CRPC State of Disease

• Shah R, Rajyaguru K and Shah P
• SVP Hospital, Ahmedabad, India

Abstract: Introduction and Objectives: All available systemic treatment for CRPC (castrate resistance prostate cancer) do not have effect on prostate itself, we present our initial experience of palliative RP in CRPC. Materials and Methods: From December 2023 to Feb 2024, seven patients with CRPC state of disease, having lower tract symptom without rectal involvement by DRE, who has good performance status and willing to undergo surgery studied retrospectively. Current disease status identified by PSMA PET scan before surgery: three patients had avid lesion in prostate, one had in Prostate and trigone, two had systemic disease, one had no PSMA avid lesion. Apart from hormonal therapy, one patient had taken radiation to pelvic area and one had undergone TURP before palliative RP. Mean age 70.86 ± 6.70 and mean pre-op PSA 2.47 ± 3.81. Results: Mean operative time was 140 ± 9.13 min. whereas intra operative blood loss was < 100 mL. One patient had wide resection (prostate trigone and B/L VUJ resection) with B/L ureteric re-implantation, one had unilateral ureteric re-implantation. Three patients had a positive surgical margin, while four had a negative. Six patients had undergone pelvic lymph node dissection (PLND), in one patient PLND not done due to high systemic volume of disease. Average lymph node yield was 9.34 ± 2.16 and average prostate weight was 45.60 gms. Average hospital stay was 4.28 ± 0.79 days. Per urethral catheter was kept for 3 weeks in all patients. At post operative one month mean PSA declined from 2.47 ± 3.81 to 0.86 ± 1.12 ng/dL. No 30 days mortality noted. Conclusions: Radical prostatectomy is feasible and safe even in mCRPC, might have therapeutic benefit in advance stage of disease. Further study in this regards might involve palliative RP in management of CRPC.

1.9.9. MP-09.09: MRI-Based Risk Calculators for High Grade Prostate Cancer Underperforms in Transperineal Prostate Biopsy in Argentinian Cohort

• Bujaldon J, Rios Pita H, Ochoa E, Ringa M, Blas L and Vitagliano G
• Hospital Alemán, Buenos Aires, Argentina

Abstract: Introduction and Objectives: Prostate cancer screening has reduced its mortality in 21%. However, this has also led to an increased number of biopsies to establish diagnosis, many of them unnecessary. In recent years, the use of prostate MRI for diagnosis has improved the prediction of clinically significant cancer. We aimed to evaluate the performance of the risk calculator for MRI-guided biopsy (PCRC-MRI) and The Rotterdam European Randomized Study of Screening for Prostate Cancer risk calculators (MRI-ERSPC-RCs) in predicting the risk of presenting clinically significant prostate cancer (csPC) in a cohort from an Argentine hospital. Materials and Methods: We retrospectively analyzed patients who underwent transperineal prostate biopsy at Hospital Aleman, Argentina between October 2020 and December 2023. The probability of having high-grade prostate cancer was calculated with the two calculators separately and then the results were compared to establish which of the two performed better. For this, areas under the curve (AUC) were analyzed. Results: From 560 patients, 274 met selection criteria. One hundred and thirty-eight (50.36%) patients were diagnosed with csPC (ISUP 2 or more), 45 (16.42%) ISUP 1 and 92 (33.57%) had a negative biopsy. The patients who presented csPC were older, had a lower prostate-specific antigen (PSA) value, had a smaller prostate size, and had a greater proportion of positive digital rectal examinations. The AUC to predict the probability of having clinically significant prostate cancer was 0.59 and 0.56 for PCRC-MRI and MRI-ERSPC-RCs respectively (p = 0.0084). To predict the risk of developing cancer was 0.74 for MRI-ERSPC-RCs. Conclusions: In this cohort of patients, neither of the two risk calculators showed effectiveness in predicting the risk of developing a clinically significant tumor. This shows the need to develop a risk calculator in our population that uses magnetic resonance imaging and transperineal biopsies.

1.9.10. MP-09.10: Next-Generation Sequencing: The Mutational Analysis of Genes Associated with Prostate Cancer

• Umarane P ¹, Chamanmalik S ¹ and Nerli R ²

¹ 

KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India

² 

KLE’s Dr. Prabhakar Kore Hospital & MRC, Belagavi, India

Abstract: Introduction and Objectives: Genetic alterations are one of the important known risk factors of prostate cancer. The family predisposition of breast and ovarian cancers may cause the severe progression of familial prostate cancer in some men. Approximately 40–50% of cases of prostate cancer are believed to have an inherited cause. Hereditary prostate cancer (HPC) occurs when a person has a pathogenic (disease causing) variant that increases the risk of cells turning cancerous. This study focused on the analysis of mutations in a gene panel containing 20 different genes which are known to cause prostate cancer. The research of specific mutations associated with tumor outcomes might help the urologist to identify the best therapy for PCa patients such as surgical resection, adjuvant therapy or active surveillance. Materials and Methods: Blood samples were collected from the patients attending urology clinic. Genomic DNA was extracted and whole exom sequencing was performed using illumine sequencer to generate fastq files. Then the quality control of fastq files was done using FASTQC tool, sequence alignment was performed using Burrows-Wheeler Alignment BWA-MEM Tool, post-alignment processing is performed (MarkDuplicates), then the variant calling files were generated (Freebayes). There vcf files were uploaded in illumina platform for annotation and the list of mutations were analysed. Mutation significance was processed by Genomic Evolutionary Rate Profiling, ClinVar, and Varsome tools. NGS results were then analysed using RFLP technique by designing the appropriate primers and the restriction enzymes. Results: A total 72 samples were collected in which 32 were prostate cancer samples and 40 were controls. NGS successfully identified all sequence alterations in ATM, BRCA1, BRCA2, CHEK2, HOXB13, TP53 and PALB2. In which 2 intronic variants were found common i.e., c.442–34CT and c.7806–14TC for BRCA1 and BRCA2 respectively in most of the prostate cancer samples and the mutations were identified for rs799923 and rs9534262. Conclusions: The study showed that there is a significant relationship associated with the ATM, BRCA1, BRCA2, CHEK2, HOXB13, TP53 and PALB2 gene mutations which not only be the major risk for developing hereditary and sporadic prostate cancer, it also helps to know the prognosis of the disease.

1.9.11. MP-09.11: Oncological and Functional Outcomes of Hemi Ablation versus Focal Ablation for Localized Prostate Cancer Using Irreversible Electroporation (IRE)

• Suberville M ¹, Woillard J ², Zhang K ³, Laguna P ⁴, Herafa I ⁵, Ducoux D ⁶, Nachef R ⁷, Teoh J ⁸ and De La Rosette J ⁹

¹ 

Pôle Saint Germain Centre Hospitalier de Brive, Brive, France

² 

INSERM CHU de Limoges, Limoges, France

³ 

Beijing United Family Hospital, Beijing, China

⁴ 

Istanbul Medipol University, Istanbul, Türkiye

⁵ 

CHU de Limoges, Limoges, France

⁶ 

CHU de Limoges, Limoges, France

⁷ 

Centre Hospitalier de Brive, Brive, France

⁸ 

The Chinese University Hong Kong, Hong Kong, China

⁹ 

Istanbul Medipol University Hospital, Istanbul, Türkiye

Abstract: Introduction and Objectives: IRE is used for focal therapy of localized prostate cancer. We examine the risk-benefit ratio when enlarging the treatment zone when using IRE for prostate cancer: Hemi Ablation versus Focal Ablation. Materials and Methods: From 2016 to 2023, a total of 106 patients underwent IRE in a single center by a single surgeon: 40 Focal Ablation and 66 Hemi Ablation. The diagnosis was confirmed by 3–6 targeted MRI-US fusion plus 18 systematic transperineal biopsies. Oncological follow up was monitored by MRI studies, PSA and transperineal biopsies. Safety was monitored by complication registration, changes in urinary (IPSS) and sexual (IIEF-5) scores. The study was IRB approved and data collected retrospectively. Results: Table 1 depicts baseline data. There was no statistically significant difference between both groups except for PSA. The patients had minimal voiding symptoms and good quality of life with minimal sexual dysfunction. Following treatment, the cancer free survival was superior in the Hemi Ablation group as presented in Figure 1 (Hemi vs. Focal, HR [95%CI] = 3.03 [1.37–6.67]; p = 0.00666). The complications were similar and minimal and mainly caused by temporary urinary retention in favour of Focal Ablation (Focal 2.6 versus Hemi 13.6 days). IPSS score and sexual function remained stable and were not impaired by the extended ablation. Conclusions: Hemi Ablation has a three times better overall cancer free survival than focal ablation without compromising on functional or sexual outcomes.

1.9.12. MP-09.12: Predictive Factors of Locally Advanced Disease in a Cohort of Argentine Patients Undergoing Radical Prostatectomy

• Bujaldon J, Rios Pita H, Ochoa E, Blas L and Vitagliano G
• Hospital Aleman, Buenos Aires, Argentina

Abstract: Introduction and Objectives: Identifying preoperative predictive factors for locally advanced disease in patients diagnosed with prostate cancer who underwent surgical treatment, including extraprostatic extension (T3a) and seminal vesicle invasion (T3b). Materials and Methods: We conducted a retrospective review of all patients undergoing radical prostatectomy (N: 376) at our department between October 2013 and October 2023. All procedures were performed via laparoscopy. Locally advanced disease was defined as those with extraprostatic extension (T3a) or seminal vesicle invasion (T3b) on final pathology. Mann-Whitney test was used for continuous variables, and the Chi-square test for categorical variables. Results: Of the total 376 patients, the analysis was divided into two groups: pT2 (N: 222) and pT3 (N: 154). Age, PSA level, prostate volume, multiparametric prostate MRI with PIRADS 4–5 or presence of extracapsular extension, and PSA density were not significantly associated with extraprostatic extension or seminal vesicle invasion. Patients with positive digital rectal examination (DRE), ISUP grade 3 to 5 associated with 7 or more positive biopsy cores, and high risk according to NCCN classification showed significantly higher rates of pT3a and pT3b in final pathology. Additionally, this group had a higher percentage of upgrade (55.84%) and upstage (81.16%) associated. This patient group showed a clear difference in the need for subsequent adjuvant treatment (50.64% vs. 12.61% p < 0.001). Conclusions: Considering digital rectal examination, histological grade (ISUP), and the number of positive biopsy cores can help identify patients at higher risk for advanced disease. Based on these data, we can anticipate and inform patients about the high probability of needing adjuvant treatment.

1.9.13. MP-09.13: Preoperative mpMRI in Surgical Planning for the Highly Aggressive Ductal Prostate Cancer

• Ranasinghe W ¹, Troncoso P ², Wang X ², Andrews J ², Elsheshtawi M ², Zhang M ², Adibi M ², Chery L ², Gregg J ², Papadopoulos J ², Pettaway C ², Pisters L ², Ward J ², Davis J ², Chapin B ² and Bathala T ²

¹ 

Monash Health, Austin Health and Monash University, Melbourne, Australia

² 

University of Texas, MD Anderson Cancer Centre, Houston, Texas, United States

Abstract: Introduction and Objectives: Ductal prostate cancers (DAC) are an aggressive histologic subtype, often clinically under-staged with high rates of nodal disease and high positive surgical margin (PSM) rates. We aimed to determine the accuracy of mpMRI in predicting extraprostatic extension (EPE) and pathologic N1 disease in patients undergoing radical prostatectomy (RP) for DAC and to explore the feasibility of nerve-sparing (NSS). Materials and Methods: All patients with biopsy-proven cT≤3, cN0/1 DAC between 2011–2018, who also had mpMRIs before RP and without neoadjuvant therapy, were retrospectively identified. Patient and tumor characteristics, mpMRI images and RP pathology were reviewed. Sensitivity analyses were performed for detection rates of EPE, PSM status, and lymph node positivity on mpMRI. Results: Forty-nine DAC patients met inclusion criteria. Although 61% had <cT1 disease, at RP, 49% of forty-nine percent of men had pT3a/b disease and 58.3% had multiple sites of EPE. Pre-operative mpMRI had a 54.2% sensitivity, 60% specificity, 56.5% positive predictive value (PPV) and 57.7% negative predictive value (NPV) in identifying EPE but missed EPE of > 1 cm in 50% patients with DAC. Twenty-four percent had PSM, 54.5% occurring at the apex and 38.4% in men undergoing bilateral NSS. Of the 46 men who had extended lymph node dissections for DAC, 10.9% had pN1 disease, but mpMRI only had 20% sensitivity, 85.4% specificity, 14.3% PPV and 89.7% NPV in detecting nodal disease. Our results are limited by the retrospective study design. Conclusions: Although pre-operative mpMRI can increase detection of EPE in DAC compared to clinical staging, its detection of multifocal EPE and pN1 disease was poor. Caution is advised with any degree of bilateral NSS and lymph node dissection is needed.

1.9.14. MP-09.14: Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer

• Alaverdyan A ¹, Govorov A ², Vasiliev A ², Skrupskiy K ² and Pushkar D ²

¹ 

Botkin Hospital & ROSUNIMED, Moscow, Russia

² 

Department of Urology A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia

Abstract: Introduction and Objectives: To treat prostate cancer, our medical center performs robot-assisted radical prostatectomy (RARP), radical retropubic prostatectomy, cryoablation, brachytherapy and HIFU. This allows us to accurately stratify patients when choosing the best treatment for prostate cancer (PCa). We have very strict selection criteria for patients for HIFU. Here are our treatment results. The aim of our trial was to assess treatment of localized PCa using HIFU with «Focal One» device (with the possibility of fusion technology combining intraoperative ultrasound and preoperative MRI data). Materials and Methods: From November 2019 to December 2023, HIFU using the “Focal One” device was performed in 145 patients with PCa. Total ablation was carried out in 95 cases, focal ablation in 50 cases. The mean age of the patients was 62.7 (51–80) years, total PSA level 9.3 (3.2–15.5) ng/mL, prostate volume 32.0 (11–55) cc, Qmax 13.3 (6.3–36) mL/s, total IPSS score 7 (3–25), IIEF-5 18 (4–25). Clinical stage T1cN0M0 was established in 118 patients, T1bN0M0 in 10 and T2N0M0 in 17 patients. In 49 cases transurethral resection of the prostate was performed 4–6 weeks before total HIFU. Results: In all cases HIFU was performed under general anesthesia. The average operation time was 96 (56–147) minutes. The course of the postoperative period was without any serious (Clavien-Dindo > 2) complications. After urethral catheter removal on the 4th day, natural urination was restored in all patients. Twenty five patients required an additional single catheterization during 24 h after Foley removal. One year after HIFU 102 patients were fully examined: mean total PSA level in patients who underwent total ablation (n = 67) was 0.96 ± 0.11 ng/mL, IPSS score was 6.9 ± 0.6 points (no difference from the initial level), at control biopsy the prostatic adenocarcinoma was revealed in 10 patients; in the remaining cases the prostatic tissue fibrosis was revealed. Sexual function was not preserved in men who underwent total HIFU and the median IIEF score remained the same in those after focal therapy. Evaluation of other results is ongoing. Conclusions: For 3 years we have achieved a high recurrence-free survival rate. This has been possible as a result of accurate patient selection and the variety of available prostate cancer treatments that we can offer at our medical center. Treatment of localized prostate cancer using HIFU with the «Focal One» robotic complex is promising and safe minimally invasive type of therapy, which has demonstrated good oncological results and functional outcomes for a certain patient group after a short follow-up period.

1.9.16. MP-09.16: The Early Screening of Serum Biomarkers and the Establishment of Prediction Model for Prostate Cancer: Utilizing Artificial Intelligence-Assisted Multiplexed Nanomaterial-Assisted Laser Desorption/Ionization for Cancer Identification (MNALCI) Technique

• MAO S ¹, Zhang H ², Xu C ¹ and Zheng P ¹

¹ 

Huashan Hospital, Fudan University, Shanghai, China

² 

Fudan University, Shanghai, China

Abstract: Introduction and Objectives: This study aimed to give us suggestions whether to do prostate biopsy or not among elevated PSA patients by utilizing a novel technology integrating high-throughput mass spectrometry based on nano-materials with machine learning. Materials and Methods: A total of 200 patients, including 100 cases of prostate cancer and 100 cases of benign prostatic hyperplasia (BPH) needed prostate biopsy all, were enrolled from the biological specimen banks of our center, Shanghai, China. Serum samples were collected before prostate biopsy and subjected to analysis using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF-MS) with novel nanomaterials. The training set to validation set ratio is 9:1. Subsequently, a diagnostic model for prostate cancer was established and validated using a machine learning algorithm. Furthermore, a clinical diagnostic model and a prognosis risk prediction model for prostate cancer were developed by combining prostate specific antigen (PSA) levels, demographic data, and imaging data of patients. Results: A total of 228 patients who underwent prostate biopsy were enrolled, from March 2019 to October 2022, among which 102 cases were diagnosed with prostate cancer. The eventual study cohort consisted of 76 prostate cancer and 72 BPH patients after sample quality control. 119 patients assigned to the training set and 29 patients to the validation set through random allocation. The accuracy of diagnostic model achieved 90.8% in distinguishing between the two groups. Furthermore, the accuracy increased to 98.2% after combining serum metabolic spectrum features with clinical features such as PSA and imaging examinations. The AUC of ROCcurve was 0.84 in the nomogram constructed with serum metabolic spectrum features, PSA, imaging results, and family history. The prediction model was constructed using serum metabolic spectrum features, PSA, and imaging results. When utilizing the model to predict the post-biopsy prostate cancer Gleason score (low-risk group: 6–7 points; high-risk group: 8–10 points), the sensitivity, specificity and AUC reached 82.9%, 51.6% and 0.86, respectively. Conclusions: The MNALCI analysis based on mass spectrometry technology, novel nano-materials, and big data artificial intelligence algorithms can improve the accuracy of non-invasive diagnosis of prostate cancer, provide guidance for patients undergoing prostate biopsy, and predict prognosis risk of the patients.

1.10. Moderated Oral ePoster Session 10: Bladder Cancer—Clinical

• Friday, October 25
• 0800–0900

1.10.1. MP-10.01: Diffusion-Weighted Magnetic Resonance Imaging for Assessment of Tumor Response in Muscle-Invasive Bladder Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Prospective Study

• Mahdavi A ¹, Razzaghdoust A ², Mofid B ², Jafari A ², Simforoosh N ² and Basiri A ²

¹ 

University of Washington School of Medicine, Washington, United States

² 

Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract: Introduction and Objectives: This prospective study tested the hypothesis that the apparent diffusion coefficient (ADC) value measured in diffusion-weighted magnetic resonance imaging (DW-MRI), as well as tumor volumes (TV) before, during, and after the treatment are independent imaging markers to assess tumor response in muscle-invasive bladder cancer (MIBC) patients undergoing neoadjuvant chemotherapy (NAC). Materials and Methods: Multi-parametric MRI was prospectively done for MIBC patients at 3 time points. Pre-treatment ADC value, pre-treatment tumor volume (TV), as well as, percent of changes in these parameters at mid- and post-treatment relative to baseline (ΔADC%, and ΔTV%) were calculated and compared between the patients with and without clinical complete response (CR). Also, further analysis was carried out based on the groups of patients with and without partial response (PR). Two different methods of ADC estimation including single-slice ADC measurement (ADCsingle-slice) and whole-lesion ADC measurement (ADCwhole-lesion) were used. Pearson’s correlation coefficient was used to evaluate the strength of a relationship between the two ADC estimation methods. Non-parametric Mann-Whitney U test was used to compare the continues variables between the clinical CR and non-CR groups. Results: From 63 recruited patients, a total of 50 eligible patients were included in our available-case analysis. Of these, 20 patients (40%) showed clinical CR to treatment, while 30 (60%) did not. Our results showed that although there was no significant difference between the two groups of patients with and without CR in terms of mid-treatment ΔADC% and mid-treatment ΔTV%, significant differences were observed in terms of the pre-treatment ADCsingle-slice/whole-lesion (p < 0.01), pre-treatment TV (p < 0.001), post-treatment ΔADC%single-slice/whole-lesion (p < 0.05), and post-treatment ΔTV% (p < 0.05). The results of PR-based analysis were in line with the CR-based results. There was also a strong and significant correlation between single-slice ADC measurement and whole-lesion ADC measurement (r > 0.9, p < 0.001). Conclusions: Pre-treatment ADC, pre-treatment TV, post-treatment ΔADC%, and post-treatment ΔTV% are noninvasive imaging markers of tumor response in MIBC patients undergoing NAC. Moreover, mid-treatment ΔADC% and mid-treatment ΔTV% should not be considered as predictors of tumor response in these patients. Further larger studies are required to confirm these results.

1.10.2. MP-10.02: Divergent Experiences of Bladder Cancer Patients: A Focus on Advanced and Metastatic Disease Stages

• Filicevas A ¹, Makaroff L ¹, Hensley P ², Myers A ³ and Kamat A ³

¹ 

World Bladder Cancer Patient Coalition, Brussels, Belgium

² 

University of Kentucky, Lexington, KY, United States

³ 

MD Anderson Cancer Center, Houston, TX, United States

Abstract: Introduction and Objectives: Bladder cancer (BC) patients encounter a diverse range of challenges across different stages of diagnosis and treatment. This study investigated the specific experiences of patients with advanced or metastatic BC, highlighting the disparities in diagnosis, treatment accessibility, psychological impact, and quality of life. Materials and Methods: Data were extracted from the World Bladder Cancer Patient Coalition Survey, focusing on responses from patients across different stages of BC, with a particular emphasis on those with advanced/metastatic disease. Variables analysed include time to diagnosis, treatment modalities and side effects, financial impact, support systems, and expectations for the future. Results: People with advanced/metastatic BC face challenges in diagnosis and understanding their condition. Key findings include: 48% of metastatic patients who delayed seeing a doctor did so because they did not think their symptoms were serious, compared to 33% of people with non-muscle invasive BC. Only 50% felt the diagnosis was communicated in a way that was completely understandable, compared to 65% of people with non-muscle invasive BC. Daily activities were severely impacted for 17% (non-muscle invasive) to 57% (advanced/metastatic) of respondents. Only 14% (advanced/metastatic) felt they could live a full life post-diagnosis, compared to 39% of non-muscle invasive. A lack of needed support was reported across all bladder cancer stages for diet and nutrition (29–52%), exercise and activity (26–49%), and more critically, mental health aspects such as depression/anxiety (38–58%) and stress (40–55%). Financial/employment issues support was insufficient for the majority of people affected by bladder cancer (48–68%). Conclusions: The findings underscore the urgent need for tailored interventions to address the multifaceted challenges faced by patients with advanced/metastatic bladder cancer. Improving diagnostic pathways, expanding treatment options, enhancing patient support systems, and offering psychological counselling are critical to ameliorating the burden of this disease. Additionally, this study calls for further research into the experiences of this patient cohort to inform policy and practice in oncology care.

1.10.3. MP-10.03: Evolution of a Rapid, Simple Urine Test for Detecting Volatile Organic Compound (VOC) in Urine by a High Performance Portable Device (NABIL) for Detection of Urinary Bladder Carcinoma

• Karmakar S
• B R Singh Hospital, Kolkata, India

Abstract: Introduction and Objectives: Diagnosis of urinary bladder cancer by the presence of volatile organic compounds (VOC) in the urine has been employed for the past decade. Current clinical diagnostic approaches suffer from many limitations including issues related to accuracy, invasiveness and cost. The use of biomarkers in clinical practice can range from screening of at risk population, risk stratification following diagnosis to prognostication following therapy. We have done this study jointly in collaboration with Dr. S N Bose National Centre for Basic Sciences in Kolkata to develop a portable, non-invasive, real-time, low cost method of detection of bladder carcinoma by detecting urinary biomarkers. Materials and Methods: Urine samples from 218 patients and 56 normal volunteers have been taken. 177 patients were reported to have confirmed urinary bladder cancer, 29 subjects revealed to have fresh haematuria and 15 subjects were reported to have other types of cancers. The samples have been kept in a warm chamber for 15 min while they will be exposed to indigenously developed sensor strips which change color on exposure to the specific urinary VOC. The data collected from the strip is then analysed by the in-house device (NABIL), and the machine learning algorithms being trained using the parameters, to create a model that could estimate the probability of cancer in the urine sample under test. The result has been compared with the histopathological reports. Results: When we analyze the data in the algorithms, the probability of cancer in normal control population was found to be 0%. On the other hand probability of cancer in known bladder tumor cases was 85–88% and probability of cancer among patients who were on BCG was 16%. Conclusions: Our present work demonstrates the development of a cost-effective sensitive sensors and rapid detection device which has great potential applicability in rapid and non-invasive diagnosis of urinary bladder cancer which can be extremely helpful in screening of at risk population.

1.10.4. MP-10.04: Intraoperative ICG Fluorescence as a Method of Prevention of Postoperative Strictures of Uretero-Ileoanastomoses During Robot-Assisted Radical Cystectomy

• Pavlov V, Urmantsev M, Gilmanova R and Akinyemi S
• Bashkir State Medical University, Ufa, Russia

Abstract: Introduction and Objectives: Radical cystectomy with urine diversion is recognized as the “gold standard” treatment of muscle-invasive bladder cancer. One of the dangerous complications in the postoperative period is the stricture of uretero-ileoanastomosis. One of the factors of the development of anastomosis stricture is its ischemia. Intraoperative assessment of perfusion of ureteral and intestinal segment tissues using ICG fluorescence is a promising direction. Materials and Methods: We selected 56 patients who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion between January 2021 and March 2022. Before anastomosis between ureters we used ICG. The patients were divided into two groups: ICG (22 patients) and non-ICG (34 patients). The median follow-up was 14 months. The comparison criteria were demographic indicators, perioperative results (including 30- and 90-day complications and repeated hospitalizations) and the frequency of uretero-enteric strictures. Results: There were no statistically significant differences between the patients of both groups in terms of surgical duration, estimated blood loss and duration of hospitalization. There were no significant differences in the frequency of 30- and 90- day complications and the number of repeated hospitalizations among patients of the first and second groups (p = 0.477 and p = 0.089, respectively). There was a statistically significant decrease in the incidence of uretero-enteric strictures in ICG group compared with non ICG (0/22 [0%] and 3/34 [8.9%], p = 0.020). Conclusions: The use of ICG fluorescence to assess the vascularization of the distal ureter during robot-assisted radical cystectomy with intracorporeal urinary diversion may reduce the risk of postoperative ischemic strictures of uretero-ileoanastomosis.

1.10.5. MP-10.05: Intravesical Gemcitabine and Docetaxel in Patients with High Risk NMIBC: Our Experience

• Krishnappa D
• HCG cancer care, Bangalore, India

Abstract: Introduction and Objectives: Gemcitabine and Docetaxel (Gem/Doce) has emerged as an alternative to BCG for high risk NMIBC (non-muscle invasive bladder cancer). The recurrence rate of BCG is up to 40% with serious side effects, low tolerance with diminished immunologic response in immunocompromised individuals, but studies have demonstrated single agent chemotherapy regimes are inferior to BCG. In view shortage of BCG many institutions have adopted Gem/Doce. Hence here in, we report our outcomes of 29 patients with high-risk NMIBC treated with Gem/Doc. Materials and Methods: The Institutional Board approval was obtained and we retrospectively reviewed all patients confirmed high-risk NMIBC who were treated with Gem/Doce between January 2021 to January 2023. Risk stratification was as per EAU guidelines. A total of 29 patients received Gem/Doce, 6 weekly intravesical instillations of sequential 1 gm gemcitabine and 37.5 mg docetaxel of induction followed by maintenance for 2 years. The primary outcome was recurrence-free survival. Results: The 29 patients were followed up for 24 months. Out of 29 patients, 8 were prior BCG recurrance or intolerance, 4 had received Gem 2 gm and had recurrance, 17 patients had not received any prior treatment. The high grade disease was seen 23 patients T1 (15), Ta (8) and 2 had CIS T1. Patients at end of 24 months follow up none had recurrance. The adverse events were seen in 6 patients and were less than grade 2. Conclusions: The combination intravesical therapy Gem/Doce none of our patient recurred at 24 months. When compared with BCG the tolerability and grade 2 side effects and above were low. The limitations were financial burden, longer hours of day care admission.

1.10.6. MP-10.06: On Block Robot-Assisted Radical Cystectomy: New Method for Bladder Cancer

• Pavlov V, Urmantsev M, Gilmanova R and Akinyemi S
• Bashkir State Medical University, Ufa, Russia

Abstract: Introduction and Objectives: The utilization of robot-assisted radical cystectomy (RARC) has seen a significant rise in the past decade, yet reports on intracorporeal diversion remain scarce. Our center established standardized procedures for RARC with entirely intracorporeal diversion, and we present the perioperative, oncologic, and functional outcomes based on 250 cases. Materials and Methods: Between February 2021 and February 2024, 250 patients underwent RARC with intracorporeal diversion using our patented method. We assessed perioperative variables, pathological data, early and late complications, overall recurrence-free and cancer-free survival as outcome measures. Results: All surgeries were successful without open conversion. Median operative time, estimated blood loss, and postoperative hospital stay were 176 min (±86 min), 286 mL (±91 mL), and 8.1 days (±5.1 days), respectively. No positive surgical margins were observed, and lymph node involvement occurred in 9%. Complications were noted in 35 patients in the early (0–30 days) period and 16 in the late (>30 days) period. Median follow-up was 17.1 months (range, 1.0–36.0 months), with 33 patients succumbing to metastatic disease. Conclusions: RARC with intracorporeal diversion proves to be an intricate yet technically feasible procedure, demonstrating acceptable oncologic and functional outcomes. Our patented technique enhances the speed and safety of the operation.

1.10.7. MP-10.07: Oncological Outcomes with the 80 mg Dose of the Moscow Strain of Intravesical BCG for Non-Muscle Invasive Bladder Cancer: Implications for Global Shortage

• Arora A ¹, Misra A ², Bakshi G ², Thimri N ², Shirke A ², Godse S ¹, Pal M ¹ and Prakash G ¹

¹ 

Tata Memorial Hospital, Mumbai, India

² 

Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India

Abstract: Introduction and Objectives: BCG with Moscow strain in being used in India since 2016. Concerns of higher rates of toxicity and alarming discontinuation rates have been published. Studies comparing Moscow strain with those available in the west have been undertaken with the aim of overcoming the global shortage. In this study we present the contemporary outcomes of 80 mg of intravesical BCG with the Moscow strain. Materials and Methods: We performed a retrospective search of our prospectively maintained institutional database of patients started on intravesical-BCG therapy at 80 mg dose from Jan 2020 to Dec 2021. BCG was administered as per the Lamm protocol. Adverse effects were graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Recurrence was defined as histologically proven Ta/T1 high-grade urothelial cancer and/or carcinoma-in-situ. End points included recurrence-free survival (RFS) in the overall cohort and also stratified by whether the patients could receive adequate BCG or not. Results: We identified 166 patients during the study period, of which 33 (19.8%) were intermediate-risk, and 133 (80.2%) were high-risk. The median follow up was 19 months. Of these, 128 (77.1%) received adequate BCG. In this ‘adequate BCG’ group, 10 (7.8%) patients had disease recurrence and 2 (1.5%) progressed, while in those who could not receive adequate BCG (38 patients), there were 14 (36.8%) recurrences and 6 (15.7%) disease progressions. The RFS in the overall cohort was 91.7%, 85.3% and 82.9%, at 12, 18 and 24 months respectively. In the ‘adequate BCG’ group, the RFS was 94.9%, 91.9% and 88.8% at 12, 18 and 24 months which fell to 80.3%, 62.1% and 56.9% in the ‘inadequate-BCG’ group. CTCAEv5.0 grade 3 and 4 adverse events were seen in 29 (17.4%) patients. Conclusions: Moscow strain at the 80 mg dose has excellent oncological outcomes in those patients who are able to receive adequate BCG. This strain however is also associated with high rates of discontinuation and toxicity. Research focused at re-evaluating the optimum dose and schedule for this strain to retain these oncological outcomes and reduce the toxicity rate could help bridging the on global BCG shortage.

1.10.8. MP-10.08: Outcome of Robot-Assisted Radical Cystectomy with Intracorporeal Creation of Heterotopic Neocystis

• Pavlov V, Urmantsev M, Gilmanova R and Akinyemi S
• Bashkir State Medical University, Ufa, Russia

Abstract: Introduction and Objectives: Bladder cancer is the 10th most common diagnosed malignant tumors. Currently, the established gold standard for treating aggressive forms is radical cystectomy with pelvic lymphadenectomy. The development of minimally invasive technologies has played a vital role in integrating robot-assisted interventions into surgical practice. Robot-assisted cystectomy stands as a contemporary and pertinent approach for addressing muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. Over the past years, numerous studies have gathered, illustrating the efficacy of robot-assisted cystectomy with intracorporeal urine removal. Purpose of the study. Investigation of the outcome of complications classified according to Clavien-Dindo after robot-assisted radical cystectomies with intracorporeal heterotopic urine removal on the basis of a single center. Materials and Methods: Within the period 2021 to 2024, a broad retrospective study was conducted at the clinic of the Bashkir State Medical University focused at studying complications after robot-assisted radical cystectomies. The experimental group consisted of 270 male and female patients with an established diagnosis of bladder cancer. All patients had radical cystectomy by Bricker with pelvic lymphadenectomy. Surgical intervention was performed using the DaVinci^® Xi robot-assisted system. Results: 35 patients (12.9%) had 30-day complications, represented by grade I-III. 14 patients (5.2%) had 90-day complications having II and III degrees. Patients with grade III or II and III complications that occurred during the first 30 days after surgical treatment subsequently had 90-day complications (p < 0.05). There were no statistically significant differences between the types of 30-day complications of II and III degree and the subsequent 90-day complications (p < 0.05). Conclusions: Robot-assisted radical cystectomy is an efficacious and technologically advanced way of treating patients with aggressive forms of bladder cancer. Our study showcase low rates of complications after this surgical intervention.

1.10.9. MP-10.09: Proposed Novel Surveillance Schedule Using Cx Monitor for Patients on Annual Bladder Cancer Surveillance

• Guduguntla A ¹, Gyomber D ², Chandler L ² and Whish-Wilson T ²

¹ 

Northern Health/Austin Health, Melbourne, Australia

² 

Northern Health, Melbourne, Australia

Abstract: Introduction and Objectives: Cx Bladder Monitor (CxM) is a test that has a proven high sensitivity and negative predictive value in bladder cancer surveillance. At Northern Health, we have transitioned non-muscle invasive bladder cancer patients on yearly cystoscopic surveillance as per the EAU guidelines to an alternating CxM and flexible cystoscopy schedule. The aim of this study is to report on the outcomes of patients on this regime in 2022. Primary outcomes were measured as incidence and types of recurrences (if any) that patients had at the time of next cystoscopy (+ upper tract imaging if indicated) after negative (low-risk) Cx, as well as PPV of patients who had a positive (high-risk) Cx. Secondary outcomes assessed were patient satisfaction, wait-list reduction and costs involved. Materials and Methods: In 2022, 111 of 114 on annual surveillance opted into the alternating surveillance schedule, with 19 of these excluded from data as they have been subsequently discharged from surveillance. If clinically indicated, upper tract imaging was performed. If a patient had high-risk Cx, they proceeded to flexible cystoscopy and up-to-date imaging if required. If a patient had low-risk Cx, they were booked for a flexible cystoscopy in 12 months. Patient satisfaction was assessed during clinic and cystoscopy, with costs and numbers assessed via the hospital’s audit team. Results: Of the 2022 cohort still under surveillance—84 patients had a negative Cx test and 8 patients had a positive Cx test. 3 of these 8 were true positive, correlating to PPV 0.375. Of the negative patients, 70 of these have had no recurrence at the time of the next cystoscopy/imaging, 11 patients had recurrences, and 3 patients have declined cystoscopy and opted for repeat Cx. Importantly, only non-invasive and low tumour volume recurrences were found—therefore it is unlikely that any clinically significant cancer was missed at the time Cx was performed instead of cystoscopy. Overall patient satisfaction was high. The hospital surveillance flexible cystoscopy waitlist was reduced by approximately 65%. CxM was approximately 850 Australian dollars cheaper than a cystoscopy. Conclusions: CxM can be safely used in an alternating schedule with flexible cystoscopy for patients on annual bladder cancer surveillance.

1.10.10. MP-10.10: Quality of Primary TURBTs for Non-Muscle Invasive Bladder Cancer Patients

• Verma S, Pouzi A, Boreddy N, Mustafa M, Banka S, Suraparaju L, Gupta S and Suresh K
• James Paget University Hospital, Great Yarmouth, United Kingdom

Abstract: Introduction and Objectives: A transurethral resection of bladder tumour (TURBT) is both an investigative and therapeutic intervention. Its primary goal is to confirm the diagnosis, grading and staging of bladder cancer. To ensure appropriate staging of tumour, detrusor muscle needs to be present in the histology specimen. Furthermore, to ensure reduced recurrence it is imperative in suspected cases of non-muscle invasive bladder cancer that a single post-operative installation of Mitomycin C is given. We will review the quality of TURBT according to these requirements in a single urology unit. Materials and Methods: 100 patients with confirmed bladder cancer were identified from the Somerset Cancer Register. Their operation notes and histopathology specimen reports were reviewed to see whether Mitomycin C was given and whether detrusor muscle was present in the bladder cancer specimens. Results: 68 patients were identified to have primary non-muscle invasive bladder cancer. Exclusions involved patients under going re-resection, ureteric tumour, not having a TURBT (due to mortality) and muscle invasive bladder cancer. 53% cases were performed by consultants, 40% of cases were performed by middle grades and the remaining 7% of cases were performed jointly. Overall, 41.18% of patient were given Mitomycin C following their TURBT. 48.53% had detrusor muscle presenting in their histopathology specimen. In consultant lists, 39% of TURBTs were given a single post operative dose of Mitomycin C and 53% of specimens collected had detrusor muscles. In middle grade lists, Mitomycin C was given in 40% of cases and detrusor muscle was only found in 37% of specimens. National targets for instillation of Mitomycin C in primary TURBTs for non-muscle invasive bladder cancer is 60% and presence of detrusor muscle in histopathology specimen should be 70%. Conclusions: Targets for single post-operative instillation of Mitomycin C and presence of detrusor muscle in histopathology specimens in primary TURBT for non-muscle invasive bladder cancer patients are not being met. Barriers identified include: logistics for giving and handling Mitomycin C, the degree of consultant supervision and awareness of alternative TURBT techniques.

1.10.11. MP-10.11: TAR-200 in Patients with Bacillus Calmette-Guérin-Unresponsive High-Risk Non-Muscle-Invasive Bladder Cancer: Results from the SunRISe-1 Study

• Cutie C ¹, Jacob J ², Daneshmand S ³, Simone G ⁴, Xylinas E ⁵, Morris D ⁶, Spiegelhalder P ⁷, Zainfeld D ⁸, Kang T ⁹, Matulay J ¹⁰, Belkoff L ¹¹, Decaestecker K ¹², Arentsen H ¹³, Hampras S ¹, Sweiti H ¹⁴, Stromberg K ¹, Martin J ¹⁴, Shukla A ¹, Van Der Heijden M ¹⁵ and Necchi A ¹⁶

¹ 

Clinical Oncology, Janssen Research & Development, Lexington, United States

² 

Department of Urology, Upstate Medical University, Syracuse, United States

³ 

Department of Urology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, United States

⁴ 

Department of Urology, ‘Regina Elena’ National Cancer Institute, Rome, Italy

⁵ 

Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris Cité, Paris, France

⁶ 

Urology Associates, Nashville, United States

⁷ 

Urologie Neandertal, Gemeinschaftspraxis für Urologie, Mettmann, Germany

⁸ 

Urology San Antonio, San Antonio, United States

⁹ 

Department of Urology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea

¹⁰ 

Atrium Health Levine Cancer Institute, Charlotte, United States

¹¹ 

MidLantic Urology/Solaris Health, Bala Cynwyd, United States

¹² 

Department of Urology, AZ Maria Middelares, Ghent, Belgium

¹³ 

AZ Sint-Jan Hospital Brugge-Oostende, Bruges, Belgium

¹⁴ 

Janssen Research & Development, Spring House, United States

¹⁵ 

Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands

¹⁶ 

IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

Abstract: Introduction and Objectives: Patients with bacillus Calmette–Guérin (BCG)-unresponsive high-risk non–muscle-invasive bladder cancer (HR NMIBC) are at high risk of disease progression and have limited bladder-sparing treatment options. TAR-200 is a targeted releasing system designed to provide sustained release of gemcitabine in the bladder over 3 weeks. SunRISe-1 (NCT04640623) is a randomized phase 2b study assessing efficacy and safety of TAR-200 + cetrelimab (Cohort 1 [C1]), TAR-200 (C2), or cetrelimab (C3) in patients with BCG-unresponsive HR NMIBC with carcinoma in situ (CIS) ineligible for or refusing radical cystectomy. TAR-200 alone is also being assessed in patients with papillary disease only (C4). We report results from C2. Materials and Methods: Eligible patients aged ≥ 18 years had histologically confirmed CIS ± papillary disease (high-grade Ta, any T1) after adequate BCG, with last BCG dose ≤12 months prior to CIS diagnosis, and ECOG performance status 0–2. TAR-200 was dosed every 3 weeks through Week 24, then every 12 weeks until Week 96. Response was assessed by cystoscopy and centrally assessed urine cytology, CT/MRI, and bladder biopsy (at Weeks 24, 48, and as clinically indicated). The primary end point was overall complete response (CR) rate. Secondary end points included duration of response (DOR), overall survival, safety, and tolerability. Results: At data cutoff (Jan 2, 2024), 85 patients (median age, 71 years; range, 40–88; 33% with concurrent papillary disease) received TAR-200 monotherapy. 58 patients were efficacy evaluable. Centrally confirmed CR rate was 83% (95%CI, 71–91) by urine cytology and/or biopsy. The estimated 1-year DOR rate is 75% (95%CI, 50–88); median follow-up in responders was 30 weeks (range, 14–140); 85% remain in CR at data cutoff. 98% of CRs were achieved at first disease assessment at Week 12. CR rate by investigator assessment (86%; 95%CI, 75–94) correlated with central results. 61 patients (72%) had treatment-related adverse events (TRAEs). 7 patients (8%) had grade ≥ 3 TRAEs; 4 (5%) had TRAEs leading to discontinuation. No treatment-related deaths were reported. Conclusions: In SunRISe-1, TAR-200 monotherapy is associated with a clinically meaningful, high, centrally confirmed CR rate, durable responses, and a favorable benefit-risk profile in patients with BCG-unresponsive CIS.

1.10.12. MP-10.12: Timeline Analysis of Muscle Invasive Bladder Cancer Patients

• Verma S, Mustafa M, Pouzi A, Suraparaju L, Hicks N and Manson-Bahr D
• James Paget University Hospital, Great Yarmouth, United Kingdom

Abstract: Introduction and Objectives: Bladder cancer is the 11th most prevalent type of cancer in the UK. Muscle invasive bladder cancers are associated with significant morbidity and mortality and therefore these patients need to be identified and managed appropriately in a timely manner. Materials and Methods: Patients with histologically proven muscle invasive bladder cancer (T2) from January 2022 to December 2023 were retrieved from the Somerset Cancer Register. A timeline analysis of these patients was conducted. This included dates of: initial referral, initial contact with a urologist, flexible cystoscopy, imaging, TURBT and MDT discussion. This was compared to the national cancer waiting time targets. Results: 184 bladder cancers were initially identified in the register. 38 of these patients had muscle invasive bladder cancer confirmed on histology. 78% of GP referrals were assessed within 14 days. Roughly 66% of patients underwent flexible cystoscopy as the remaining patients had TURBT either due to a mass identified on imaging or for haemodynamic control. 78% flexible cystoscopies were performed within 28 days from initial referral. Approximately 79% of TURBT were within 62 days of initial referral (median time 50 days). Conclusions: Waiting time targets are not being met. Key factors identified on process mapping has been: patient refusal for treatment, lack of co-ordination with imaging and failure of making the appropriate referral. Considerations for an integrated pathway needs to explored to ensure swift diagnosis and staging to enable early initiation of radical treatment.

1.10.13. MP-10.13: Transurethral Resection of Bladder Tumour (TURBT) Operative Notes: How to Improve Their Quality

• Verma S, Pouzi A, Boreddy N, Mustafa M, Suraparaju L and Suresh K
• James Paget University Hospital, Great Yarmouth, United Kingdom

Abstract: Introduction and Objectives: Keeping clear, accurate and legible records is a cornerstone of good medical practice. Within the context of urology, accurate and comprehensive previous operation notes orientate surgeons when performing cystoscopic procedures. Complete operative notes enable safe surgical practice. We will be reviewing the accuracy with which transurethral resection of bladder tumours (TURBT) operational notes and comparing this to the standards recommended by the European Association of Urology. Materials and Methods: 100 bladder cancer patients were taken from the Somerset Cancer Register. Their operation notes were assessed and compared to the TURBT checklist made by the EAU bladder cancer guidelines. This includes: tumour size, tumour appearance, tumour focality, presence of ureteric orifice, completeness of resection, depth of resection, visual evaluation of perforation and whether an examination under anaesthesia (EUA) is performed. A standardised proforma has been introduced and comparisons before and after introduction of this proforma will be analysed. Results: 76 patients from the initial 100 patients had a primary TURBT. A large proportion of these operation notes had tumour appearance (86.84%) and completeness of resection (78.95%) documented. 56.58% of operation notes had depth of resection documented. 68.42% had tumour size and focality documented. 63.16% had ureteric orifice presence documented. Documentation of visual evaluation of perforation (30.26%) and preoperative EUA (52.63%) has also been noted to be lower. Result following the introduction of the proforma are under review. Conclusions: TURBT is a core urological procedure. For bladder surveillance, it is important to known what was found on previous operations to help orientate the urologist. Operation notes are currently at an unsatisfactory standard, therefore a standardised proforma has been introduced that will help alleviate any inconsistencies in TURBT operation note quality.

1.10.14. MP-10.14: Trial in Progress: Pivot-006- a Phase 3, Randomized Study of Adjuvant Intravesical Cretostimogene Grenadenorepvec versus Surveillance for the Treatment of Intermediate-Risk Non-Muscle Invasive Bladder Cancer Following Transurethral Resection of Bladder Tumor

• Svatek R ¹, Kim J ², Keegan K ², Bivalacqua T ³, Shore N ⁴, Jayram G ⁵, Josephson D ⁶ and Daneshmand S ⁷

¹ 

University of Texas, San Antonio Health Center, San Antonio, Texas, United States

² 

CG Oncology, Irvine, California, United States

³ 

University of Pennsylvania, Philadelphia, Pennsylvania, United States

⁴ 

Carolina Urologic Research Center, Myrtle Beach, South Carolina, United States

⁵ 

Urology Associates, Nashville, Tennessee, United States

⁶ 

Tower Urology, Los Angeles, California, United States

⁷ 

University of Southern California, Los Angeles, California, United States

Abstract: Introduction and Objectives: Guidelines for intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) recommend adjuvant intravesical (IVE) therapy or surveillance. However, these recommendations lack level-1 evidence and despite therapy, up to 60% of patients experience recurrence. Therefore, there is a considerable gap in knowledge and an unmet medical need for improved therapies in the adjuvant setting. Cretostimogene Grenadenorepvec is an oncolytic adenovirus designed to preferentially replicate in and lyse cancer cells. Cretostimogene recently received both US FDA fast track and breakthrough designations in the high-risk, BCG-unresponsive NMIBC indication. PIVOT-006 is a multi-national, randomized Phase-3 study designed to assess the efficacy and safety of intravesical Cretostimogene after TURBT versus TURBT alone. Materials and Methods: Eligibility criteria: Histologically confirmed IR-NMIBC diagnosis within 90 days of randomization, as defined by AUA-SUO guidelines. Participants will be stratified by receipt of single-dose perioperative chemotherapy and tumor grade. Patients (n~364) will be randomized 1:1 to receive intravesical cretostimogene (Cohort 1) adjuvant to TURBT or TURBT alone (Cohort 2). If IR-NMIBC recurrence is noted in Cohort 2, participants will be eligible to receive intravesical cretostimogene. In Cohort 1, intravesical cretostimogene will be instilled for 6 weekly doses during the induction phase, followed by 3 weekly maintenance cycles at months 3 and 6, and culminating in single intravesical doses at months 9 and 12. Primary disease assessments include serial cystoscopy, urine cytology, axial imaging, and centralized review of pathologic samples. The primary outcome measure is recurrence free survival (RFS). Secondary and exploratory outcome measures will be assessed. Results: This clinical trial is in progress. Data will be summarized and displayed graphically, where appropriate. It is hypothesized that 364 patients will be sufficient to test a 10% absolute improvement in RFS at 12 months in the treatment group with 90% power. Conclusions: IR-NMIBC represents a heterogeneous disease state, with limited level-1 evidence and high rates of clinical recurrence. Cretostimogene may provide a highly effective and well-tolerated treatment to address these critical clinical and knowledge gaps. 90+ clinical sites have been selected in North America. Enrollment has been initiated. The trial has received Society of Urologic Oncology-Clinical Trials Consortium and Bladder Cancer Advocacy Network support. NCT06111235

1.10.15. MP-10.15: URO17^® Urine Test for Bladder Cancer—Meta Analysis

• Vasdev N ¹, Ibrahim M ¹, Cucci J ², Matthews M ², Porten S ³, Gholami S ⁴, Jahanfard S ⁵ and Kim N ⁵

¹ 

Lister Hospital ENH NHS Trust, Stevenage, United Kingdom

² 

Acupath Laboratories, New York, United States

³ 

University of California, California, United States

⁴ 

Urology Associates of Silicon Valley, CA, United States

⁵ 

KDx Diagnostics Inc, San Jose, CA, United States

Abstract: Introduction and Objectives: URO17^® is a non-invasive urine biomarker test that detects presence of the oncoprotein Keratin 17, which is involved in the replication cycle of malignant cells. Due to high sensitivity and specificity reported in the literature, URO17^® has a potential to transform the diagnosis of urothelial cancer (UC) and reduce the need for invasive procedures such as cystoscopy. Numerous studies have been conducted to evaluate the performance of URO17^® in detection in UC. This study presents an overview and meta analysis of all available data on the URO17^® for the detection of urothelial cancer (UC) in both recurrent UC and hematuria populations. Materials and Methods: Data from eight studies on URO17 urine tests on recurrent UC and new UC in hematuria populations conducted between 2018 and 2023 were used for the analysis. Data from each studies were queried and summarized for analysis. Samples from all studies showed a total of 3401 samples, and the number of true positives, true negatives, false positives, and false negatives were determined from the total number of samples to calculate overall sensitivity, specificity, NPV, and PPV. Results: In the full cohort consisted of 3401 samples, there were 506 UC and 2895 benign samples and URO17 test showed overall sensitivity of 94%, specificity of 83%, NPV of 99%, and PPV of 49%. Relatively low PPV number was driven mainly by one study that relied on urine cytology results to determine the sample categories. Individually, the sensitivity of each study ranged from 87% to 100%, specificity ranged from 56%–96%, NPV ranged from 93%–100%, and PPV ranged from 23%–97%. URO17 was able to detect both high-grade and low-grade UC in both recurrent UC and hematuria populations. Conclusions: Current data on multiple independent studies confirms that URO17^® is a highly sensitive NMIBC urine detection test that could help screen patients for bladder cancer in the community with minimal resources required. This can improve diagnostic capabilities in primary care and reduces the number of unnecessary invasive investigations. URO17^® exhibits a high level of sensitivity and specificity in both recurrent UC and new UC in hematuria populations.

1.10.16. MP-10.16: Usefulness of UF-5000 Automatic Screening System in Urothelial Carcinoma Diagnosis

• Kikugawa T, Miura N, Watanabe R and Saika T
• Ehime University, Toon, Japan

Abstract: Introduction and Objectives: Urine cytology is a useful test for detecting urothelial carcinoma, but it involves problems such as detection time and accuracy. The UF-5000 is a fully automated analyzer that uses fluorescence flow cytometry technology. The UF-5000 provides a new parameter, “Atyp.C,” which uses the side fluorescence signal waveform area to differentiate between atypical and non-atypical cells, based on differences in the fluorescent staining of nucleic acids in urothelial cells. In this study, we evaluated the usefulness of Atyp.C for patients with a suspected diagnosis of urothelial carcinoma. Materials and Methods: We analyzed 1517 urine specimens from patients with suspected urothelial carcinoma using the UF-5000 and evaluated its performance on identifying malignant urothelial cells. All consecutive urine samples were registered from February 2020 to January 2022. Results: Of the 1517 cases, 723 were positive for hematuria (794 negative) and 73 were diagnosed with urothelial carcinoma (1444 negative). The optimal Atyp.C cut-off value determined by receiver operating characteristic curve analysis was 0.1/µL. Patients with Atyp.C of ≥ 0.1/μL were found in 404 cases, and 44 patients were diagnosed with urothelial carcinoma. Regardless of the presence or absence of hematuria, the cancer-positive rate was higher in the group with an Atyp.C of ≥ 0.1/μL (11% vs. 3%). In the group with no hematuria and positive Atyp.C, 5 of 7 cases contained high grade urothelial carcinoma. Conclusions: Urinalysis is frequently performed in both symptomatic and asymptomatic patients. Our results suggest that Atyp.C from urinalysis measured with the UF-5000 may be a useful screening parameter for the detection of urothelial carcinoma.

1.10.17. MP-10.17: Validation of Novel ddPCR Bladder Cancer DNA Mutation Panels in Liquid Biopsies

• Karmakar A
• Monash University, Melbourne, Australia

Abstract: Introduction and Objectives: The increasing burden of bladder cancer places additional pressure on the healthcare system. While liquid biopsy samples of patient plasma and urine offer an accessible investigation for cancer biomarkers, a consensus on the optimal biomarker and detection method is lacking among researchers. In contrast, other hollow organ cancers, such as bowel cancer, have successfully advanced tumour DNA (tDNA) mutation detection into clinical practice, inspiring optimism for a similar progression in bladder cancer research. tDNA mutation panels, developed and validated in both MIBC and NMIBC groups, were prospectively monitored in patients with bladder cancer. Using droplet digital PCR (ddPCR), these novel panels in liquid biopsies represent the first of their kind in current literature. Materials and Methods: ddPCR assays for MIBC and NMIBC panels, each consisting of ten common mutations, were previously validated against archival tissue reporting detection rates for MIBC and NMIBC panels of 96.1% and 98.6%, respectively (Nandurkar, 2023). These panels were assayed against tissue and liquid biopsies of the current study, analysing baseline and prospective samples detection rates for correlation with results at various clinical timepoints. Results: The mutation panels successfully detected tDNA mutations in liquid biopsies, which typically contain low levels of cell-free DNA (cfDNA). Mixed concordance and discordance were observed in detected mutations within baseline tissue and liquid biopsies. Additional prospective tissue samples detected mutations regardless of histological diagnosis, and comparison with baseline tissue reported mixed concordance and discordance. Liquid biopsies correlated with the patient’s disease status in half of the assayed timepoints, with urine outperforming blood samples. Conclusions: Our study has demonstrated a potential assessment assay capable of detecting tDNA mutations associated with bladder cancer in liquid biopsies. Further research will provide valuable insights into the implications of this test and the discordant results in guiding clinical decision making for patients with bladder cancer.

1.11. Moderated Oral ePoster Session 11: Kidney and Ureteral Cancer—Clinical

• Friday, October 25
• 0800–0900

1.11.1. MP-11.01: Advancing Kidney Cancer Treatment: Embracing Partial Nephrectomy for T1B and T2 Tumors

• S L, Sharma R, Mohan A and Reddy B
• Basavatarakam Indoamerican Cancer Hospital and Research Institute, Hyderabad, India

Abstract: Introduction and Objectives: Renal cell carcinoma (RCC) treatment has evolved, with robotic-assisted partial nephrectomy (PN) offering a kidney-sparing alternative for larger T1B and T2 tumors, traditionally managed by radical nephrectomy. This study evaluates the feasibility, surgical success, and outcomes of PN in these cases, aiming to shift the paradigm towards preserving kidney function without compromising oncological safety. Materials and Methods: A retrospective analysis was conducted in our Hospital, spanning 2017–2023. Patients with T1B (4 to 7 cm) and T2 renal tumors undergoing PN were assessed against trifecta (negative margins, no postoperative complications, minimal warm ischemia time) and pentafecta (additionally, postoperative renal function preservation) criteria. Results: Among 80 T1B and 7 T2 tumor patients, trifecta achievement was significant, with 91.25% (73/80) in T1B and 85.71% (6/7) in T2 cases. Pentafecta success rates were 43.75% (35/80) for T1B and 42.86% (3/7) for T2. Chi-Square analysis indicated no significant difference in achieving these outcomes between T1B and T2 tumors, demonstrating PN’s potential across a broader spectrum of renal tumor sizes. Conclusions: The study underscores the viability of extending PN to T1B and T2 renal tumors, challenging the traditional surgical approach with radical nephrectomy for larger tumors. High rates of trifecta and pentafecta criteria achievement support PN’s effectiveness in preserving kidney function while ensuring oncological safety. These findings advocate for a more individualized approach to RCC treatment, emphasizing the need for further research to confirm these outcomes across diverse patient populations and settings.

1.11.2. MP-11.02: 68Ga FAPI 4 PET CT Scan for Renal Mass Staging—Initial Experience

• Patel R, Gandhi S and Thakkar S
• Zydus Cancer Hospital, Ahmedabad, India

Abstract: Introduction and Objectives: In staging of renal cell carcinoma (RCC), FDG PET CT has limitation due to FDG non-avid nature of RCC. With literature supporting its role, we routinely perform 18F FDG PET CT (FDG scan) for RCC staging. Occasionally, we use 68Ga FAPI 4 PET CT (FAPI scan) for solid tumour staging instead of FDG scans in view of unavailability of FDG, poorly controlled diabetic status & inadequate fasting status. FAPI stands for Fibroblast activating protein inhibitor, which detects cancer associated fibroblasts (CAFs) in tumour microenvironment. Like many solid tumours, CAFs are expressed in RCC which can be of diagnostic & theranostic help. We present our experience with FAPI scan for RCC staging. Materials and Methods: We retrospectively assessed PET CT scan data of last 2 years & found 3 cases (see table) of RCC with FAPI scan. For the scanning, 3.5 mCi of 68 Ga FAPI 4 was injected IV followed by whole body PET—CT images & corresponding contrast enhanced CT images. Results: In all patient, FAPI scan showed tracer avidity (see table). Higher tracer avidity corresponds with higher grade (case 1). Absence of nodal/distant metastases and long-term recurrence free survival may suggest good specificity. In case 1, Tracer avidity in part of IVC thrombus gave us a fair idea about extent of tumour thrombus—bland thrombus. Conclusions: 68Ga FAPI 4 PET CT scan showed good sensitivity and specificity in our initial experience. With proven superiority of FAPI scan over FDG scan in many solid cancers, large sample size is required to prove its superiority in RCC. FAPI scans have better target to background ratio than FDG scans. The logistic advantages of FAPI scan worth mentioning: minimum fasting status, favourable usage in diabetics, early scan time (20 min versus 60 min for FDG scan) & local production with gallium generator versus cyclotron production.

1.11.3. MP-11.03: A Wildcard for Bosniak Scoring: Role of Contrast-Enhanced Ultrasound for Follow up of Bosniak IIF Cysts and Further Evaluation of Bosniak III Cysts

• Adhami M ¹, Narayan A ², O’Brien J ³, Keating J ³, Wang W ³, Sim K ³, Simkin P ³, Gibson R ³ and Lawrentschuk N ³

¹ 

Monash University, Melbourne, Australia

² 

The University of Melbourne, Melbourne, Australia

³ 

The Royal Melbourne Hospital, Melbourne, Australia

Abstract: Introduction and Objectives: The incidence of cystic renal masses has increased exponentially with the expanding access to abdominal imaging. The Bosniak renal cyst classification system provides a standard framework for assessing imaging features and stratifies the suspicion of malignancy. It performs well for Bosniak I, II, IV lesions using contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (CEMR). However, confidence dwindles for Bosniak IIF and III cysts. Recently, contrast-enhanced ultrasound (CEUS) has emerged as a promising adjunct to enhance the accuracy of renal cyst diagnosis. It is a superior modality compared with conventional imaging techniques due to higher spatial resolution, increased sensitivity to signal enhancement, and continuous assessment of the whole enhancement period. This presentation aims to discuss the indications, procedural techniques, and current data on clinical applications of CEUS for follow-up of Bosniak IIF cysts and further evaluation of Bosniak III cysts. Materials and Methods: A narrative review was conducted to summarise the evidence related to CEUS. MEDLINE and EMBASE were searched with the keywords “Bosniak Score,” “Bosniak III,” “Bosniak IIF,” “Renal Cyst,” and “Contrast-enhanced Ultrasound”. In addition, to ascertain real-world expertise, senior CEUS sonographers were interviewed regarding procedural techniques for optimising imaging. After obtaining informed consent, we recorded high-definition video demonstrations of patients undergoing CEUS. The imaging protocol included an initial B-mode ultrasound scan to get an overview of the lesion and the surrounding parenchyma and Doppler imaging to assess vascularisation. DEFINITY^® (Lantheus, Massachusetts, USA) microbubble contrast agent was subsequently administered and contrast harmonic imaging mode with a low mechanical index was utilised for image acquisition. Results: Here we present tips and tricks on the following: indications and contraindications for CEUS, procedural techniques for optimising imaging, interpreting CEUS images and advice for integrating CEUS into clinical practice. Conclusions: CEUS can identify fine septations and faint nodular wall enhancement. This improved accuracy may result in more reliable data to inform the decision for intervention when conventional CECT or CEMR are inconclusive or contraindicated. Although CEUS is not standard practice yet, our presentation will highlight its clinical utility and potential to aid urologists in managing cystic renal lesions.

1.11.4. MP-11.04: Clinicopathological Feature that Influence Efficacy Treated by Nivolumab Plus Ipilimumab in Patients with Metastatic Renal Cell Carcinoma

• Ohba K, Nakanishi H, Mukae Y, Kawada K, Nakamura Y, Araki K, Mitsunari K, Matsuo T, Mochizuki Y and Imamura R
• Nagasaki University Graduate school of Biomedical Sciences, Nagasaki, Japan

Abstract: Introduction and Objectives: Nivolumab plus ipilimumab is a recommended first-line therapy regimen for metastatic renal cell carcinoma (mRCC). However, it is not clear which patient characteristics are associated with its effectiveness. In this study, we aimed to investigate the specific patient profile associated with effective treatment using nivolumab plus ipilimumab, and to assess the relationship between changes in paraneoplastic symptoms and outcomes. Materials and Methods: We retrospectively examined 67 mRCC patients treated with nivolumab plus ipilimumab as a first-line therapy in multiple institutions from September 2018 to August 2022. Nivolumab plus ipilimumab was administered every three weeks for four doses, after which nivolumab alone was administered. We analyzed the relationships between survival outcomes and patient-related variables, such as patient age, sex, prior nephrectomy, metastatic sites, clinicopathological features, International Metastatic RCC Database Consortium (IMDC) risk classification, paraneoplastic symptoms, and inflammatory parameters. We also analyzed the relationships between changes in symptoms and parameters and outcomes. Results: Of the 67 patients, 32 patients had paraneoplastic symptoms. Fifty patients were able to receive four doses of ipilimumab. The median progression-free survival (PFS) was 14.9 months and median overall survival was 43.3 months. The objective response rate was 49.25% (33 patients), including two patients with complete response. Patients with cytoreductive nephrectomy (CN), bone metastasis, high C-reactive protein (CRP) levels, and paraneoplastic symptoms were significantly correlated with PFS in the univariate analysis. Multivariate analysis of these factors showed that the presence of paraneoplastic symptoms at treatment initiation remained an independent predictor of short PFS. Of the 32 patients with paraneoplastic symptoms at treatment initiation, 12 patients had symptomatic improvement and 20 did not. The 1-year PFS rates were significantly longer in improved patients compared with those with no improvement. Conclusions: Patients without CN and with bone metastasis, liver metastasis, high CRP levels, and paraneoplastic symptoms were significantly correlated with shorter PFS. The presence of paraneoplastic symptoms was an independent predictor of PFS. Improvement of paraneoplastic symptom improvement may reflect the treatment efficacy of nivolumab plus ipilimumab.

1.11.5. MP-11.05: Cutting Through Complexity: Long Term Outcomes of IVC Resection Without Reconstruction in RCC with IVC Thrombus

• Pradhan R ¹, Narasimha S ¹, SK D ², Adhikari K ², Toari R ² and Mohan A ¹

¹ 

Sri Shankara Cancer Foundation, Bengaluru, India

² 

HCG Hospitals, Bengaluru, India

Abstract: Introduction and Objectives: RCC has a unique tendency for venous migration into venous system in the absence of metastasis. Aggressive surgical resection is considered as the primary curative treatment. Rarely the tumor thrombus infiltrates the IVC wall requiring excision of IVC segment. Graft reconstruction has high incidence of thrombosis in low flow venous system. IVC resection without reconstruction is a feasible surgical procedure due to development of collaterals in an already obstructed IVC. Long term outcomes on morbidity, renal function, survival have been sparse. Materials and Methods: From 2016, we report a retrospective analysis of 19 cases of IVC resection without reconstruction with long term outcomes performed at two high volume UroOncology Centres at Bangalore, India which as per our knowledge is the only reported series from India. Out of the 19 cases, 11 cases had level II and 8 cases had level III IVC thrombus. All renal tumors were right sided. 6 patients had undergone preoperative angioembolization and 8 patients had an IVC filter placed. 16 cases were open surgery, 2 cases attempted robotic converted to open, and one case was completed robotic assisted. Results: The average intraoperative blood loss was 733.3 mL with one patient having massive haemorrhage. All patients had a R0 resection and all margins reported negative of final pathology. Two patients had node positive disease. The mean preoperative serum creatinine was 1.16 mg/dL which rose by 0.47 mg/dL at the time of discharge. One of the patients developed transient AKI. The mean hospital stay was 6.3 days. Their renal functions at 15 days, 1 month, 3 and 6 months were comparable. 3 patients developed DVT which was managed conservatively. The follow up period ranged from 17 months to 8 years. Adjuvant treatment was started in 7 patients as a joint decision between the patient and clinician. 4 out of 19 patients developed recurrences (3 in the lungs and 1 in had a nodal recurrence) 3 out of the 4 patients with recurrence eventually died because of the disease whereas 1 patient has a stable disease with IO therapy. Conclusions: IVC resection without reconstruction is a safe and feasible option with good long term outcomes.

1.11.6. MP-11.06: Da Vinci and Hugo RAS Platforms for Robot-Assisted Partial Nephrectomy: A Preliminary Prospective Comparative Analysis of the Outcomes

• Hevia Palacios V, Feltes Ochoa J, García Rojo E, Brime Menendez R, Duque Ruiz G, Justo Quintas J, Lista Mateos F and Romero Otero J
• Hospital HM Sanchinarro, Madrid, Spain

Abstract: Introduction and Objectives: Robot-assisted partial nephrectomy (RAPN) has emerged as the preferred approach for T1 renal-cell-carcinoma. As new robotic platforms like Hugo RAS emerge, we seek to understand their potential in achieving similar RAPN outcomes as the established Da Vinci system. Materials and Methods: A prospective single-centre comparative study was conducted and 50 patients selected for RAPN were enrolled (25 Da Vinci Xi; 25 Hugo RAS). The choice of robotic system was based solely on hospital logistics criteria. Surgeries were performed by expert surgeons. Demographic data, tumor characteristics, operative details and postoperative outcomes were collected. SPSS version 22.0 was used for statistical analyses. Results: The average age of patients was 62.52 ± 9.47 years, with no significant differences in median age, sex, and nephrometry scores between groups. Da Vinci group showed a significantly shorter docking time (12.56 vs. 20.08 min; p < 0.01), while other intraoperative measures like console time and warm ischemia time were similar. The Hugo RAS group had a shorter renorraphy time (14.33 vs. 18.84 min; p = 0.024). Postoperative outcomes and surgical margin positivity showed no significant differences. Each group had one patient (4%) who developed major surgical complications (Clavien IIIa). Trifecta rates were comparable between both groups (Da Vinci 88% vs. Hugo RAS 84%; p = 0.93). Conclusions: Initial findings suggest similar perioperative outcomes for RAPN when using Hugo RAS compared to the Da Vinci system. Further research with long-term follow-up is necessary to evaluate oncological and functional outcomes.

1.11.7. MP-11.07: Do Nephrometry Scores Predict the Occurrence of Positive Surgical Margins in Robotic Partial Nephrectomy?

• Khan M, Nambi Rajan T, Kumar M, Al-Gburi S and Amirhassankhanni S
• Wirral University Teaching Hospital NHS Foundation Trust, Upton, United Kingdom

Abstract: Introduction and Objectives: We retrospectively review a two surgeon database of robotic partial nephrectomy experience to assess whether pre-operative nephrometry scores predict a positive surgical margin. Materials and Methods: Between July 2014 and October 2023, all robot assisted laparoscopic partial nephrectomies performed in a single centre are analysed where pre-operative imaging was available for independent assessment. Nephrometry scores are calculated using the three standardised scoring systems: RENAL, SPARE and PADUA. These are correlated against the presence of a positive margin to determine which scoring method on average most reliably predicts a post operative positive surgical margin. Results: A total of 280 patients are included in the study who underwent a robotic partial nephrectomy in the allocated time period. Of these, 32 had a post-operative positive margin (11.4%). Each of the three nephrometry scores demonstrated increased complexity of tumour for the patients who had a post-operative positive margin, with a similar absolute discrepancy between the three scores. The results are depicted in Table 1. The simplicity of the SPARE scoring system provides this system with the greatest utility if a whole number threshold is used to predict a positive margin. Interestingly, the presence of a hilar tumour (irrespective of nephrometric complexity) was a strong predictor for a positive margin. 23% of patients with a hilar tumour had positive margins compared with 10% in patients with a non hilar tumours. Conclusions: Our study supports nephrometry scores being a valid predictor for a post operative positive margin, with the SPARE scoring system providing the simplest algorithm. Furthermore, a hilar tumour location alone was strongly associated with an increased risk of a positive margin. These factors should be taken into consideration in the pre-operative workup for patients undergoing robotic partial nephrectomy to aid case selection, surgical technique and oncological planning.

1.11.8. MP-11.08: Does Long Warm Ischemia Time Have Always Adverse Effect on Renal Function in Post Partial Nephrectomy Patients in Long Term—What Is the Limit?

• Imran Q, Baid A, Patel K, Ranjan A, Singh S, Sureka S and Singh U
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: Maximum safe warm ischemia time in partial nephrectomy is largely been questioned. Our aim was to evaluate long term GFR outcomes with warm ischemia time > 50 min with higher nephrectomy scores (RENAL nephrometry score > 10). We evaluated the effect of long warm ischemia time on functional outcome in form of GFR at follow up on 1 year in post partial nephrectomy patients. Materials and Methods: Total of 162 robotic and laparoscopic partial nephrectomy were performed for renal masses at our institute from 2018 to 2022. Out of these, 21 patients had WIT more than 50 min who underwent partial nephrectomy during this period. Serum creatinine and GFR were estimated preoperatively and at 3 months, 6 months and 1 year. Serum creatinine and GFR were represented as Mean ± SD, pair wise comparison was done using paired sample t test. Results: Mean pre operative creatinine was 1.24 ± 0.45, significantly lower than 3 month and 6 month post operative values of 1.38 ± 0.47 and 1.39 ± 0.45 respectively with p value < 0.001. On follow up at 1 year serum creatinine was estimated to be 1.28 + 0.43 with p value of 0.042. Mean pre operative GFR level was 93.19 ± 8.42 mL/min and post operative GFR at 3 month and 6 months were 87.48 ± 9.17 and 87.57 ± 9.18 mL/min respectively were significantly different from baseline GFR (p value < 0.001) while GFR at 1 year 92.81 ± 8.53 mL/min was not significantly different from pre operative GFR with p value of 0.057. Conclusions: Our study showed that longer warm ischemia does not have significant adverse effect on GFR after partial nephrectomy with higher nephrometry scores. Similar functional outcomes can be achieved irrespective of long warm ischemia time in these group of patients.

1.11.9. MP-11.09: Evaluating the Concordance Between Gross Intraoperative Evaluation of the Tumor Bed Margin with Permanent Section Analysis in Partial Nephrectomy Patients—Preliminary Results of a Prospective Study

• Basiri A, Amani-Beni A, Masoumi N, Sabzi S, Parvin M and Gharib A
• Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract: Introduction and Objectives: With ever increasing trend toward partial resection of renal masses, irrespective of tumor size, the issue of margin status after resection had gained more attention. In this prospective study, we aimed to compare the concordance between intraoperative gross evaluation of tumor bed and permanent section analysis of biopsies taken from tumor bed. Materials and Methods: Patients undergoing partial nephrectomy in two university hospitals were prospectively enrolled in this study. No size limit was considered for partial resection and it was decided at surgeons’ discretion. After performing mass resection and ensuring gross satisfaction of complete resection and negative margin, four samples, one from each corner of the tumor bed, was taken and sent for permanent section analysis. The concordance between surgeons’ decision and permanent pathology was analyzed. Results: To date, 44 consecutive partial nephrectomies were enrolled for this study. All surgeries were performed by experienced urologists. Only one mass was resected laparoscopically and the rest were open partial nephrectomies. Thirty-one cases were performed with safety margin and 13 tumors were enucleated. Warm ischemia time was under 30 min in all cases. Two masses were benign and the remainder were renal cell carcinomas. None of the biopsies taken from tumor bed reported positive which indicated 100% concordance rate between surgeons’ gross inspection and final pathological analysis. Conclusions: Our study suggests that surgeons’ visual inspection of the tumor bed is justified regarding negative margin and oncologic efficacy and random biopsies from tumor bed for confirmation of negative margin may not alter the treatment plan.

1.11.10. MP-11.10: Impact of Smoking on Postoperative Complications Following Partial Nephrectomy

• Nolazco J ¹, Tang Y ², Chang J ³, Melnick K ¹, Nayan M ¹, Filipas D ⁴, Przewoźniak K ⁵, De Cássio Zequi S ⁶, Alkhatib K ⁷, Mossanen M ¹, Chung B ⁸ and Chang S ¹

¹ 

Brigham and Women’s Hospital, Harvard Medical School, Boston, United States

² 

Beijing Tsinghua Changgung Hospital, Beijing, China

³ 

Harvard T. H. Chan School of Public Health, Boston, United States

⁴ 

University Medical Center Hamburg-Eppendorf, Hamburg, Germany

⁵ 

Maria Skłodowska Curie National Research Institute of Oncology, Warsaw, Poland

⁶ 

Fundação Antônio Prudente, A.C. Camargo Cancer Center, Sao Paulo, Brazil

⁷ 

University of Pennsylvania, Philadelphia, United States

⁸ 

Stanford University School of Medicine, Palo Alto, United States

Abstract: Introduction and Objectives: Some studies have shown an association between tobacco smoking and postoperative surgical complications. However, this relationship remains largely unexplored in the context of partial nephrectomy. Therefore, we aim to examine the association between tobacco smoking and the incidence and severity of 90-day postoperative complications in patients who underwent partial nephrectomy. Materials and Methods: A cross-sectional study was conducted using data from the Premier Healthcare Database (2010–2019). Our primary outcome was the occurrence of 90-day postoperative complications according to the Dindo-Clavien Classification. We used a multinomial logistic regression model adjusted for confounding factors to estimate the association between tobacco smoking and the risk of postoperative minor complications, major complications, and mortality. Further, predicted probabilities for postoperative complications were calculated based on the regression model. Results: A total of 44,392 patients (median age, 56.3; 66.1% males) who underwent elective partial nephrectomy were included. From this cohort, 16,048 participants (36.15%) were identified as tobacco users. Compared to non-tobacco users, tobacco smokers were generally younger, less often married, more frequently belonging to white ethnicity, and had higher Charlson Comorbidity Index scores. The multivariable regression analysis revealed a significant association between tobacco smoking and an increased risk of minor and major complications, as well as mortality (OR 1.19, 95% CI 1.14–1.24), (OR 1.41, 95% CI 1.31–1.52), (OR 1.51, 95% CI 1.01–2.24), respectively. Conclusions: This study revealed a significant association between tobacco smoking and an increased risk of minor and major complications and mortality in patients undergoing partial nephrectomy. These outcomes underscore the need for implementing effective preoperative smoking cessation interventions tailored to this patient group.

1.11.11. MP-11.11: Incidence and Risk Factors for Urinary Fistula in Patients Undergoing Partial Nephrectomy: Results of a Single-Center Cohort Study (UroCCR N°170)

• Margue G, Klein C, Geshkovska A, Alezra E, Estrade V, Capon G, Robert G, Bernhard J and Bladou F
• Bordeaux University Hospital, Bordeaux, France

Abstract: Introduction and Objectives: Partial nephrectomy (PN), when technically feasible, is the gold standard treatment for localized renal cell carcinoma. However, the morbidity of this surgery remains significant, and one of the most dreaded complications is the development of a postoperative urinary fistula. The aim of this study is to assess the incidence of urinary fistulas after PN in our high-volume center and to determine their risk factors. Materials and Methods: We conducted a monocentric retrospective study including all patients operated for PN. Clinical data were collected prospectively after written consent in the French kidney cancer research database UroCCR (CNIL DR 2013–206; NCT03293563). Patients’ and tumors’ characteristics as well as intra- and postoperative results were collected. Risk factors for postoperative urinary fistula were evaluated using uni- and multivariate logistic regression models. Results: From 2012 to 2023, 1269 PN were performed, 32 (2%) of which were complicated with a urinary fistula. Univariate analysis is displayed in Table 1. In multivariate analysis, sex, tumor complexity and surgical approach were independent predictors for postoperative urinary fistula. Thus, compared to low complexity, surgery for a tumor of moderate complexity (OR = 6.32 [1.24–115.49]) or of high complexity (OR = 21.6 [4.33–390.0]) is more at risk for urinary fistula. On the contrary, PN in women seems to be less at risk than in men (OR = 0.38 [0.12–0.95]) and the robotic approach appears to cause fewer urinary fistulas than the open approach (OR = 0.25 [0.01–0.63]). Conclusions: In our large monocentric cohort, post-operative urinary fistula was a rare event. Male gender, high tumor complexity and open approach appeared to be the risk factors.

1.11.12. MP-11.12: Is Single Layer Renorrhaphy Safe in Robotic Assisted Laparoscopic Partial Nephrectomy?

• Khan M, Nambi Rajan T, Kumar M andAmirhassankhanni S
• Wirral University Teaching Hospital NHS Foundation Trust, Upton, United Kingdom

Abstract: Introduction and Objectives: We retrospectively review a two surgeon database of robotic partial nephrectomy where single layer renorrhaphy was routinely used where possible to determine the presence of any significant differences in operative outcomes. Materials and Methods: Between July 2014 and October 2023, all robot assisted laparoscopic partial nephrectomies performed in a single centre are analysed. The two surgeons use their individual discretion in the choice between a single and double layer renorrhaphy but in general aim to perform a single layer renorrhaphy where possible. The patient electronic record is evaluated to contrast simple post procedural metrics including creatinine rise, Hb drop along with intra-operative factors such as warm ischaemia time. Results: Our results are summarised in Table 1. There are no significant differences demonstrated between the two groups on any of the basic metrics calculated, supporting the safety of a single layer renorrhaphy where possible. The advantages demonstrated in our series for a single layer renorrhaphy include a reduction in average clamp time along with a reduced average complication rate. When analysing the surgical experience prior to performing single layer renorrhaphy, our chronological data suggests increased uptake of the technique once 50–75 partial nephrectomy procedures were performed by each surgeon. However, single layer renorrhaphy is a reproducible technique and should be considered for all partial nephrectomy where possible. Conclusions: Single layer renorrhaphy is a safe technique for robotic assisted partial nephrectomy that has a potential benefit of reducing clamp time and post operative complications. Utility of the technique requires a baseline competence in robotic partial nephrectomy and an experience of at least 50 cases based on our results.

1.11.13. MP-11.13: Novel Nomogram Development and Internal Validation for Predicting Risk of Pathological T3a Upstaging from Clinical T1 Mass Following Robot-Assisted Partial Nephrectomy: A Multicenter Study on the Indian Population

• Agrawal S, Menon A and Kumar G
• Amrita Institute of Medical Sciences, Kochi, India

Abstract: Introduction and Objectives: Renal cell carcinoma (RCC) patients with clinical T1 (cT1) disease who are upstaged to pathological T3a (pT3a) have reduced survivals after partial nephrectomy. The objective of this study was to identify pre-operative risk factors linked to pT3a upstaging in clinical T1 RCCs and create a novel nomogram capable of accurately identifying patients at an increased risk of possessing occult pT3a features. Materials and Methods: A retrospective study was conducted on 782 patients with cT1 RCC who underwent robot-assisted partial nephrectomy (RAPN) across 14 centers in India from September 2010 to September 2022. Among them, 80 patients were upstaged to pT3a. After screening, a total of 312 patients were enrolled, comprising 78 in the pT3a upstaging group and 234 in the pT1 subgroup. Univariable and multivariable logistic regression analyses identified predictors for cT1 to pT3a upstaging, and significant risk factors were then used to construct a nomogram. Results: The multivariate logistic regression analysis revealed that older age (OR\\: 1.04, CI = 1.02–1.07, p = 0.001), comorbidities (OR: 2.5, CI = 1.38–4.50, p = 0.002), BMI (OR: 0.94, CI = 0.87–1.01, p = 0.094), symptoms (OR: 2.37, CI = 1.16–4.84. p = 0.017), larger tumor size (OR: 1.22, CI = 1.03–1.52, p = 0.04), and renal rim location (OR: 2.39, CI = 1.21–4.71, p = 0.12) were independent risk factors for upstaging to pT3a. A nomogram predicting pT3a upstaging was developed based on these factors and internally validated in a separate cohort of 66 patients. Using a probability cut-off of 0.29, the nomogram predicted tumor upstaging with a sensitivity of 79%, specificity of 81%, positive predictive value of 52%, and negative predictive value of 93%. Conclusions: Our model effectively predicts occult pT3a disease in patients with cT1 renal lesions, aiding urologists in making informed management decisions.

1.11.14. MP-11.14: Perioperative and Oncological Outcomes of Robotic and Laparoscopic Nephroureterectomy as Management Option for Urothelial Carcinoma of the Upper Tract: A Five-Year Experience from a Single-Center

• Pal A, Gupta P, Bodduluri S and Ahlawat R
• Medanta—The Medicity, Gurugram, Haryana, India

Abstract: Introduction and Objectives: The objective of this study is to compare the perioperative and oncological outcome variables of the two minimally invasive approaches for management of upper tract urotheilal carcinoma (UC), robotic and laparoscopic nephroureterectomy (NU). Materials and Methods: Sixty-one patients underwent NU between 2018–2023, 31 and 30 patients undergoing robotic and laparoscopic NU, respectively. The clinic-demographic data, medical comorbidities, Charlson Comorbidity Index (CCI), site, side, size, and stage (TNM) of the lesion, associated carcinoma-in-situ (CIS) changes, bladder growth, hydroureteronephrosis (HUN) were recorded. Mean surgery duration, hemoglobin drop, blood transfusion, bladder cuff excision status, lymph node yield, Clavien-Dindo complication, follow-up duration, recurrence, and survival data were analyzed. Results: The mean age, body mass index, and CCI were 65.8 ± 16.2 vs. 64.1 ± 9.2 years (p = 0.303), 24.8 ± 2.3 vs. 25.1 ± 2.3 kg/m² (p = 0.323) and 4.6 ± 1.4 vs. 4.6 ± 1.2 (p = 0.484) in the laparoscopic and robotic group respectively. The tumor location of the TCC and their T and N stage distribution were comparable in both groups. The associated HUN and CIS were seen in 32.3% vs. 33.3% and 32.2% vs. 23.3% in the laparoscopic and robotic groups, respectively. The mean size of the tumor was 3.16 ± 0.74 vs. 3.32 ± 1.4 cm, respectively. The mean duration of surgery was significantly less in the robotic group (295.3 ± 35.4 vs. 264 ± 61.6 min, p = 0.008). The haemoglobin drop (0.7 ± 0.4 vs. 0.5 ± 0.2 gm/dL, p = 0.051), blood transfusion rate (9.7% vs. 6.7%, p = 0.126), mean hospital stay (4.06 ± 1.4 vs. 3.73 ± 1.01 days, p = 0.156) and Clavien-Dindo complication grade were similar in the laparoscopic and robotic group. Bladder cuff excision rate (p = 0.0012) and lymph node yield (p = 0.0006) were significantly better in the robotic approach. The catheter indwelling time was significantly less in the robotic group (p = 0.007). The mean follow-up duration was 30.6 ± 16.4 vs. 31.4 ± 15.4 months, respectively. The intravesical recurrence and distant metastasis were seen in 29% vs. 40% and 19.4% vs. 16.7% patients, respectively. The duration of recurrence-free survival and overall survival were similar (23.3 ± 14.2 vs. 25.1 ± 16.7 months and 30.3 ± 16.8 vs. 33.1 ± 15.4 months, respectively) in both groups. Conclusions: Robotic nephroureterectomy provides better bladder cuff excision rate, lymph node yield, and less catheter indwelling time in a shorter operative duration without increasing complications and similar survival outcomes compared to the laparoscopic approach.

1.11.15. MP-11.15: Role of Diffusion Weighted MRI as a Diagnostic Tool for Renal Pseudotumours in CKD Patients: A Future Way Forward

• Imran Q, Patel K, Raj H, Sureka S, Singh U and Hussain A
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: Pseudotumours are benign lesions which may mimic like a malignant tumour on conventional imaging. They are frequently seen in kidneys which are scarred and deformed by chronic pyelonephritis, glomerulonephritis, trauma, or infarction specially in the setting of chronic kidney disease. DW MRI is one modality which can characterize renal infections and focal parenchymal lesions but very few studies are there to suggest the role of DW-MRI in differentiating renal pseudotumours from neoplasm. Our study demonstrates that DW-MRI can distinguish CKD pseudotumors from RCCs and offers a non-contrast non-invasive alternative. Materials and Methods: Our study retrospectively evaluated 20 CKD patients with 32 pseudotumors, who were > 18 years of age and having clinically or on USG suspicious renal lesion with CKD who required further imaging. All such patients were subjected to MRI with DWI, and ADC values were calculated for pseudotumor and diseased parenchyma in CKD patients. All patients were followed by routine USG every 3 monthly for 1 year for change in characteristics of the pseudotumor. These findings were extrapolated for comparison with the findings of renal tumour on MRI, so as to clear the diagnostic dilemma, hence avoiding unnecessary resections in CKD patients. Receiver operating characteristic (ROC) curves were drawn to find out area under the curve (AUC) for differentiation of groups and cut-off ADC values calculated to achieve highest average sensitivity and specificity. Results: CKD pseudotumours remained indeterminate after conventional MRI. On DW-MRI, none of them showed restricted diffusion and thus malignancy could be ruled out in 100% of the lesions. Mean ADC-value for CKD pseudotumor was significantly higher than RCCs and surrounding diseased parenchyma [2.30 vs. 1.56 (×10⁻³ mm²/s) (p < 0.0001) and 2.04 (×10⁻³ mm²/s) (p = 0.0001) respectively]. ROC analysis for differentiating CKD pseudotumor and RCC yielded high sensitivity (91.7%) and specificity (100%) for cut-off ADC-value of 2.04 (×10⁻³ mm²/s). Conclusions: DW-MRI can diagnose CKD pseudotumors and can differentiate between pseudotumors and RCC hence avoiding unnecessary resections in already compromised CKD patients.

1.11.16. MP-11.16: The Role of Tc 99 m Sesta MIBI SPECT CT Scan in the Characterization of Renal Masses

• G A T, Kumar M, Sachan A and Tripathi M
• All India Institute of Medical Sciences, New Delhi, India

Abstract: Introduction and Objectives: Renal MIBI scan can be used for characterization of small renal masses and also for differentiation of oncocytoma with malignant renal mass as lipophilic cation accumulates in the mitochondrion. This study is needed as up to 30% of cases are benign and partial nephrectomy can be overtreatment in these benign cases which cannot be identified even on biopsy. This comparative study evaluated the utility of MIBI single-photon emission computed tomography-computed tomography (SPECT-CT) in the assessment and risk stratification of renal masses. Materials and Methods: A total of 57 patients with renal mass were included in the study from January 2021 to February 2024. Patients were managed as per the departmental protocol and only renal MIBI scan was done in addition prior to surgery/biopsy. Both the pathologist and nuclear radiologist were blinded. All data of patients were recorded and the post-operative histopathological report was correlated with the SPECT scan. Results: This study included 44 males and 13 females with a mean age of 48 years. Fifty-four patients underwent surgery while 3 patients underwent biopsy. Partial nephrectomy was performed in 39 patients while 15 patients underwent radical nephrectomy. All patients of clear RCC were found to be MIBI negative, 1 patient of angiomyolipoma and 3 patients of chromophobe were found to be MIBI positive. The most commonly identified single histologic type was clear cell RCC (44/57; 77%). Chromophobe RCC was present in 3 patients, papillary in 2 patients, 1 patient each of Ewing and mucinous and tubular spindle, and MITF family tRCC with 4 patients of angiomyolipoma. Conclusions: Renal MIBI SPECT scan can be used as a non-invasive tool in predicting the histology of renal masses and further multicenteric studies are required to define the beneficial effect of MIBI scan in the assessment of renal masses.

1.11.17. MP-11.17: Utility of Contrast-Enhanced Ultrasound Compared with Conventional Imaging in the Evaluation of Renal Masses

• Adhami M ¹, Narayan A ², O’Brien J ³, Keating J ³, Wang W ³, Sim K ³, Simkin P ³, Gibson R ³ and Lawrentschuk N ³

¹ 

Monash University, Melbourne, Australia

² 

The University of Melbourne, Melbourne, Australia

³ 

The Royal Melbourne Hospital, Melbourne, Australia

Abstract: Introduction and Objectives: Contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance (CEMR) are the current mainstay imaging modalities for investigation of renal masses. However, they have several limitations including risk of anaphylaxis, nephrotoxicity, radiation exposure, and high costs. Recently, contrast-enhanced ultrasound (CEUS) has emerged as a promising tool. This study aimed to evaluate the diagnostic accuracy of CEUS and its influence on patient management. Materials and Methods: Data was collected from electronic medical records for patients who underwent CEUS at the Royal Melbourne Hospital over the past three years. Data collected included prior imaging, CEUS results, tissue diagnosis and management details. Sensitivities and specificities were calculated to assess diagnostic accuracy, and Fischer’s exact test was utilised to analyse the significance of categorical data. Results: A total of 81 patients underwent CEUS, 34 (42.0%) had malignant, 41 (50.6%) benign, and 6 (7.4%) indeterminate lesions based on combined histopathology and follow-up. CEUS had a sensitivity of 91.2%, specificity of 100.0%, PPV of 100.0%, and NPV of 93.2%. CEUS showed greater diagnostic accuracy than CECT, US and CEMR collectively (p < 0.0001). The qualitative diagnosis obtained from CEUS examination amended patient management in 46.9%, resulted in no change in 46.9%, and had an unclear effect in 6.2% of cases. Conclusions: CEUS performs at least as well as or better than CECT or CEMR in the evaluation of renal masses. Its higher diagnostic accuracy may result in more reliable data to inform the decision for intervention when conventional imaging is inconclusive or contraindicated. Further research is needed to validate our findings.

1.12. Moderated Oral ePoster Session 12: Training and Education, Miscellaneous

• Saturday, October 26
• 0800–0900

1.12.1. MP-12.01: Impact of Intraoperative Cephalic Vein Dilatation on Short Term Outcomes of Radiocephalic Arteriovenous Fistula

• Kumar N ¹ and Raman A ²

¹ 

All India Institute of Medical Sciences Patna, Patna, India

² 

Jayprabha Medanta Hospital, Patna, India

Abstract: Introduction and Objectives: Patients with kidney failure pose a significant healthcare challenge for whom hemodialysis is a standard therapeutic option. Radiocephalic arteriovenous fistula (AVF) is considered the initial and most frequently created access for hemodialysis in patients with kidney failure. This study investigates the impact of intraoperative cephalic vein dilatation on short term outcomes of radiocephalic AVFs in patients with kidney failure. Materials and Methods: A prospective study was conducted on patients undergoing radiocephalic AV fistula surgery. Intraoperative venous dilatation was performed by pushing saline into cephalic vein through a cannula using tourniquet proximally. Data on demographics, surgical details and postoperative outcomes were collected. Preoperative and postoperative duplex ultrasound parameters were recorded. Patients were followed up for 6 weeks after surgery. Results: 95 patients were included in the study. The fistula maturation rate at 6 weeks was 94.73% (90/95). The mean blood flow of the radial artery increased from 207 ± 83 mL/min to 962 ± 346 mL/min at 6 weeks after surgery (286 to 1980 mL/min) (p < 0.05). The mean diameter of the vein increased to 5.09 ± 0.96 mm 6 weeks after surgery from 2.43 ± 0.74 mm before surgery (p < 0.05). There were no Clavien Dindo grade II-III complications. Conclusions: Cephalic vein dilatation during radiocephalic AV fistula surgery in kidney failure patients is associated with AVF maturation. For patients with small veins, intraoperative venous dilatation may also help in technical feasibility of radiocephalic AVF surgery with excellent outcomes.

1.12.2. MP-12.02: Artificial Intelligence-Based Chatbots Analysis in Urology: Current Opportunity and Perspective

• Arutyunyan P, Govorov A, Vasilyev A, Kim Y and Pushkar D
• Moscow State University of Medicine and Dentistry named after A.I. Evdokimov and Botkin Hospital, Department of Urology, Moscow, Russia

Abstract: Introduction and Objectives: Language model-based chatbots can generate text-based content and are poised to become a major information source in medicine. The accuracy and completeness of the information obtained by AI-based chatbots for urological queries is unknown. The aim of our study is to analyse the accuracy and reliability of the responses of three different chatbots (ChatGPT, YaGPT, Chat Sonic) to ten urological queries made by urologists. This will provide data on the reliability of chatbots in terms of providing correct and valid information. This study will identify the shortcomings and evaluate the limitations of urological information provided by artificial intelligence based chatbots. Materials and Methods: Twenty-five urologists generated 10 urological questions that required a detailed response. Experts then evaluated the chatbot generated answers to these questions using two validated tools for assessing the accessibility of textual medical information quality: DISCERN (an instrument for judging the quality of written consumer health information on treatment choices) and PEMAT-P (Patient Education Materials Assessment Tool for Printable Materials). A five-point Likert scale (1 = none to 5 = high level) was used to detect misinformation. Evaluators were blind to the type of AI-based chatbot used. Results: Amidst the entirety of AI chatbot responses, it is evident that the quality of information was reasonably elevated (median DISCERN score 4 out of 5). Understandability was moderate (median PEMAT-P score 66.7%) and actionability was low (median PEMAT-P score 40%). There was no misinformation in any chatbot responses (median Likert score 1) and the median readability level was fairly difficult. Written responses were brief (median word count 100 words). AI-generated responses frequently employ medical terminology and are predominantly composed at a moderately elevated reading complexity. All AI chatbots do not offer visual aids to elucidate intricate medical concepts, thereby resulting in diminished understandability scores as assessed by PEMAT-P. Conclusions: Based on assessments conducted by urologists, it is observed that AI-driven chatbot systems generally furnish predominantly precise information pertaining to diverse urological inquiries, albeit with notable constraints. Further investigations and refinement of models are imperative to mitigate inaccuracies and ascertain validation.

1.12.3. MP-12.03: Artificial Intelligence (AI)-Based Decision Making in Urology Oncology: A Comparative Assessment of AI-Based Tools for Appropriateness and Quality of Information

• Garg H ¹, Bhasin S ¹, Gupta A ¹, Nakra V ¹, Saini G ¹, Goswami V ¹, Chaturvedi H ¹, Kandhari P ², Anand G ¹ and Thombare B ¹

¹ 

Max Institute of Cancer Care, Vaishali, Delhi, India

² 

Max Superspeciality Hospital, Delhi, India

Abstract: Introduction and Objectives: Artificial intelligence-based tools such as ChatGPT3.5, ChatGPT4.0, Google Bard, and Microsoft Bing are easily available and accessible. This study aims to assess the quality of information and appropriateness of responses generated by various AI-based tools for patients of urological cancers discussed in our multidisciplinary tumor (MDT) board. Materials and Methods: A cross-sectional study of consecutive patients of urological cancers presented to authors’ MDT from Aug 1, 2023 to Sept 30, 2023 were included. The clinical case summary submitted to MDT was uploaded on four AI-based platforms: ChatGPT3.5, ChatGPT4.0, Google Bard, and Microsoft Bing. The appropriateness of responses was assessed using a 5-point Likert Scale on the domain of accuracy, comprehensiveness, and clarity. A score of 4 or 5 indicates appropriate response for each domain. The DISCERN tool (Section 2) was used to assess the quality of information in the response. Higher score represents better quality. The Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKRGL) were used to assess ease of readability of responses. Higher FRE and lower FKGL indicate easier readability. Results: Twenty-five patients were included. The mean age (SD) was 57.8 (16.1) years and 84% were males. Of 25 clinical scenarios, ChatGPT3.5, ChatGPT4.0 and Microsoft Bing responded to all the clinical scenarios while Google Bard failed to generate any response in 12% (3/25) of cases. ChatGPT3.5 and ChatGPT4.0 performed better in all the three domains of accuracy, comprehensiveness and clarity as compared to Google Bard and Microsoft Bing (p < 0.001) (Figure 1). Similarly, the mean DISCERN score was highest for ChatGPT4.0 (29.8), followed by ChatGPT3.5 (26.3) while lowest for Microsoft Bing (21.7) (p < 0.001). However, ease of readability was best for Google Bard followed by Microsoft Bing while worst for ChatGPT3.5 as assessed using FRE and FKRGL scores. (p < 0.001). Conclusions: AI-based platforms have the ability to provide appropriate and quality response in patients with urological cancer. ChatGPT3.5 and ChatGPT4.0 performed better as compared to Google Bard and Microsoft Bing in terms of quality of response, however, was associated with lower ease of readability.

1.12.4. MP-12.04: Pain and Anxiety Associated with Diagnostic Flexible Cystoscopy in a Middle Eastern Cohort

• Almazeedi A ¹, Alenezi S ¹ and Almarzouq A ²

¹ 

Jaber Al-Ahmed Hospital, South Surra-Kuwait City, Kuwait

² 

Jaber Al-Ahmed Hospital & Sabah Al-Ahmed Urology Center (SAUC), South Surra-Kuwait City & Kuwait City, Kuwait

Abstract: Introduction and Objectives: Cultural and ethnic differences exist in all aspects of clinical medicine. It has always been hypothesized that Middle Eastern patients have lower pain thresholds. The aim of this study was to measure the levels of peri-cystoscopy anxiety as well as post-cystoscopy pain in bedside flexible diagnostic cystoscopy with intra-urethral local analgesic gel preparation using pain and anxiety scores. Materials and Methods: Between January 2024 and March 2024, patients of Middle Eastern descent between the age of 18 and 80 years old were included. They all underwent bedside diagnostic flexible cystoscopy with the application of intra-urethral local analgesic gel. Visual analogue pain scale and anxiety scale were recorded peri-procedure. They were asked to mark the level of their anxiety peri-operatively using the Spielberger State-Trait Anxiety Inventory (STAI), 20 questions, scoring range from 20–80, each question has a 4 points, (20–40) mild anxiety, (41–60) moderate and (61–80) severe. Their level of pain post-operatively was also assessed using a visual analogue scale (VAS). Post cystoscopy questionnaire to the urologist performing the cystoscopy was also filled about the perceived pain, anxiety levels as well as difficulty of the procedure. Results: Sixty patients were collected of which 70% were males and mean age was 42.7 years. The mean anxiety score pre-procedure STAI levels was 42.37, which indicates a moderate baseline anxiety. Mean post-procedure anxiety score was 35.05. Mean post-procedure visual analogue scale pain levels was 3.42. Neither training level nor perceived difficulty of the case by the performing urologist had any association with pain level of the patient. Conclusions: Our data shows low pain and moderate anxiety levels and does not suggest any increased level of pain or anxiety pre, peri or post diagnostic flexible cystoscopy in a Middle Eastern cohort. Pre-procedure anxiety decreases post-procedure in 90% of the patients. Training level and perceived difficulty of the performer does not impact pain levels during and after procedure.

1.12.5. MP-12.05: E-POSSUM & Charlson Health Index: Scoring Systems to Predict Morbidity After Major Uro-Oncological Surgeries in Geriatric Patients

• Misra A, Pal M, Arora A, Godse S, Thimiri N, Prakash G and Shirke A
• Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India

Abstract: Introduction and Objectives: The geriatric population is unique as management depends not only upon the stage of cancer but also on the individual’s health status, age-related co-morbidities, and life expectancy. Only a little research has been done in this subset with the morbidity predictor tools in uro-oncology. The study’s primary objective was to determine the clinical factors in the elderly that influence the 30-day morbidity and mortality. Variables were measured per the Charlson Health Index (CHI) and Elderly-POSSUM (E-POSSUM) scores. The secondary objective was to validate the existing Charlson and E-POSSUM scores in Indian patients. Materials and Methods: All patients equal and above the age of 60 years who underwent open or minimally invasive, major uro-oncological surgeries (MUs) from 1st January 2014 to 31st December 2020 were included. MUs included radical nephrectomy, nephron-sparing surgery, partial cystectomy, radical cystectomy, retroperitoneal lymph node dissection, nephroureterectomy, and radical prostatectomy. Logistic regression was used to calculate the risk of complications. Charlson score and postoperative complications were compared using the Chi-Square test. For validation, the linear analysis method was used to calculate the predicted mortality risk obtained from the Charlson and E-POSSUM scores. AUC was drawn for both scoring methods, and the accuracy was calculated. Results: Four hundred twenty-six patients underwent MUs, including 382 male and 44 female patients. There was a significant association between cardiac complications and the Charlson score, with a p value of 0.017. A higher E-POSSUM score also had an association with cardiac complications, deep abdominal complications, and hypotension/collapse post-operatively, and it was statistically significant with p < 0.05. Post-operatively, cardiac complications increased by 11% per unit increase in the E-POSSUM score (p = 0.004). The deep abdominal complications increased by 6% per unit increase in E-POSSUM score (p < 0.006). Hypotension complications increased by 12% per unit increase in the E-POSSUM score (p < 0.001). Conclusions: E-POSSUM and CHARLSON scores may help select the suitable patient when urological cancer in the elderly has equivalent treatment options other than surgery and can be used to predict 30-day morbidity and mortality.

1.12.6. MP-12.06: How Much of the Genital Area Can People Actually See Directly with Their Own Eyes? An Assessment of Genital Visual Fields Important for Cisgender and Transgender People

• Sandhu S ¹, Smith S ¹, Mallavarapu S ¹, Stelmar J ², Yuan N ¹ and Garcia M ¹

¹ 

Cedars-Sinai Medical Center, Los Angeles, United States

² 

University of California San Diego School of Medicine, San Diego, United States

Abstract: Introduction and Objectives: Many conditions such as infections, genital pain and wound care require patients to assess their genitalia. Urologists assume that patients can see this area clearly. However, no literature to date assesses how much of the genital area is commonly visible. We aimed to ask individuals with natal anatomy and transgender individuals post-gender-affirming surgery the extent of genital visibility on their bodies. We also query whether patient age and BMI predict visibility in genital sub-fields. Materials and Methods: 195 individuals completed an anonymous survey (82 cisgender women; 89 cisgender men; and 12 transgender women; 12 transgender men) for this study. No subjects had visual or ambulation deficits. Each was shown an anatomic illustration with genital anatomy subdivided into various subfields (Figure 1a,b). Subjects identified each field they are able to see with their own eyes, on their body, without the aid of a camera or mirror. Age and BMI were recorded. Logistic regression was performed for visibility by age and BMI. Results: Average visibility decreased more posteriorly on the visual field for all genders. A majority of men were able to see to the level of their scrotum, and visibility precipitously decreased posterior to the clitoris for women. For cisgender women, 44–91% could not see their vulva below their clitoris. For cisgender men, 23–82% could not see below their scrotum. With increased BMI, visibility significantly decreased starting at the penile glans for men. Interestingly, BMI was not a significant predictor of field-visibility for women (Figure 1c,d). Conclusions: Visibility of the genital area is limited posterior to the clitoris among women and posterior to the lower half of the scrotum among men respectively. BMI is only noted to be significant in cisgender men. This is the first study to describe how much of the genital area is directly visible to patients.

1.12.7. MP-12.07: Optimal Tilt: The Search for Perfect Angle for Robot Assisted Pelvic Surgeries

• Sharma G ¹ and Sahay S ²

¹ 

Aakash Healthcare Superspeciality Hospital, Delhi, India

² 

Max Superspeciality Hospital, Delhi, India

Abstract: Introduction and Objectives: Robotic pelvic surgeries have distinct advantage especially with regard to intraoperative manoeuvrability and post operative outcomes for the patient. However, there are many hurdles associated with the procedure one of which is the steep Trendelenburg position and complications that comes with it. With the steep tilt anaesthetic, ophthalmic, pulmonary, cardiovascular as well as cerebrovascular complication might occur. The optimal angle at which these complications can be reduced maximally without compromising the surgical outcomes is still a mystery which brings us to the need of this study. Materials and Methods: A total of 60 patients were included in the study. All patients divided in case and control group and were operated in Trendelenburg position and angle was kept at minimum where surgical resection was not compromised. Two main surgeries were studied: Robotic Radical Prostatectomy and Robotic Hysterectomy. Intraocular pressure (IOP) and intracerebral pressure (ICP) were also measured during the tilted position. Various demographic parameters were also studied. Statistical analysis was done using SPSS Software version 24. Results: We found there was significant variation of IOP and ICP when patients were kept at 25–30 degree tilt with no variation at below 25 degree till. Hemodynamic variation was also less below 25 degree. Surgical difficulty was minimal below 20 degree tilt. Among the demographic parameters high BMI, high waist hip ratio were found to have more adverse parameters with tilt above 25 degree. Conclusions: There has been an exponential increase pelvic surgeries being performed robotically. With this the adverse effects of a steep Trendelenburg is encountered more frequently. The question of optimal angle at which the surgery can be performed with ease and minimal alteration of the hemodynamic parameters which is of paramount importance is answered through our present study.

1.12.8. MP-12.08: Role of Contrast Enhanced Ultrasound and Shear Wave Elastography in the Evaluation of Patients with Anterior Urethral Stricture

• Kumar M, Agarwal K, Das C and Seth A
• AIIMS, Delhi, India

Abstract: Introduction and Objectives: Contrast-enhanced ultrasound (CEUS) with shear wave elastography (SWE) allows excellent delineation of length of urethral strictures and estimating surrounding spongiofibrosis without exposure to ionising radiation. Our study aimed to evaluate CEUS and SWE’s role in evaluating anterior urethral strictures. Materials and Methods: 34 patients diagnosed to have anterior urethral stricture on RGU were prospectively evaluated with CEUS and SWE. Based on intraoperative findings and clinical follow-up, the diagnostic performance of CEUS and RGU was evaluated; and correlation was obtained between elastographic patterns (qualitative) and strain ratio (quantitative) obtained on SWE and the response to treatment. Results: Out of 34 patients, stricture location was proximal bulbar in 16, mid bulbar in 9, distal bulbar in 7 and proximal penile in 2 patients. 26 patients underwent OIU with cold knife, 2 underwent endo dilatation, 2 underwent end-to-end urethroplasty and 4 underwent BMG urethroplasty. The mean stricture length on RGU, CEUS and intraoperatively was 1.7 ± 1.1, 2.2 ± 0.9 and 2.3 ± 0.8 cm respectively. On SWE, the elastographic strain pattern was red (high strain) in 28 patients and green (equal strain) in 6 patients and the median (range) strain ratio was 12.8 (4.6–17.4). There were no intraoperative/postoperative complications. At 6 months, among 26 patients who underwent OIU, the mean maximum flow rate in patients with green and red patterns on SWE was 13.3 ± 2.8 and 11.5 ± 1.7 mL/s respectively, although none of them required any further intervention. Conclusions: CEUS helps in more accurate delineation of stricture length and further characterised the degree of spongiofibrosis as compared to RGU in patients with anterior urethral stricture without exposure to ionizing radiation. Additionally, strain patterns on SWE helps in surgical decision-making and also correlate with maximum flow rate at 6 months post OIU. The combination of CEUS with SWE, thus, in future, could play a key role in operative decision-making.

1.12.9. MP-12.09: Incorporating the NSQIP Surgical Risk Calculator into the Urology Multidisciplinary Meeting

• Guduguntla A ¹, Wu H ² and Satasivasm P ³

¹ 

Northern Health/Austin Health, Melbourne, Australia

² 

University of Melbourne/Northern Health, Melbourne, Australia

³ 

Northern Health, Melbourne, Australia

Abstract: Introduction and Objectives: To assess the utility of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator for decision-making in the Urology Multidisciplinary Meeting (MDM) setting, with particular consideration to decisions about surgical candidacy, following the recent commencement of its use at Northern Health Urology MDM’s. Materials and Methods: Between August 2022 and July 2023 an NSQIP score was formulated by the unit medical officer not involved in MDM decision making for patients undergoing discussion for management where major uro-oncological surgery was being considered. This score was then provided to the blinded MDM team members after a consensus decision was made. A change of decision, if any, was recorded including rationale. Any discordance between NSQIP and decision made was also noted. Continuous variables were assessed using the student’s t-test for 2 variables and analysis of variance (ANOVA) for > 2 variables. Categorical variables were assessed using the Fisher’s exact test for expected count < 5 and Chi-square test for expected count > 5. For all the presented statistical analysis, a two-sided p value < 0.05 was considered statistically significant. Results: Over the study period, 42 (12%) out of 340 cases being discussed at MDM warranted calculation of NSQIP scores to help guide management. Prostate, bladder, kidney and testicular cancer represented 47.6%, 28.5%, 9.5%, 2.4% of the discussions, respectively. 90.5% (n = 38) of patients did not have a change in the MDM management plan after reveal of NSQIP score. This included two cases where the NSQIP risk assessment was discordant with the MDM consensus. NSQIP score led to a change in the MDM management decision in four cases (p = 0.54): two renal cancer cases where biopsy was deemed necessary, one prostate cancer case deemed more suitable for radiotherapy, and one prostate cancer case for whom active surveillance was deemed preferable. Conclusions: The NSQIP risk calculator is a useful tool in the Urology MDM setting. It reinforced decisions that were already made and led to a change in management in several cases where clinical doubt remained.

1.12.10. MP-12.10: Cost or Deception? Dissecting the Article Processing Charge Landscape of Urology Publishing

• Vo L ¹, Armany D ² and Woo H ²

¹ 

Blacktown Hospital, Sydney, Australia

² 

Blacktown District Hospital, Sydney, Australia

Abstract: Introduction and Objectives: In the evolving landscape of academic publishing, article processing charges (APCs) have emerged as a significant factor influencing publication decisions. This study aims to dissect the APC landscape by comparing charges levied by recognised urology journals against those claimed by potentially predatory counterparts. We explore the premise that predatory journals may exploit the open-access model to mask substandard services with disproportionate fees. Materials and Methods: A cohort of 226 potentially predatory journals was identified through unsolicited manuscript invitations to an academic urologist from December 2023 to January 2024. These were contrasted with the 69 legitimate urology journals listed in the Royal Australasian College of Surgeons library. APCs for gold open access publishing were examined, noting transparency of APC disclosure prior to submission and publication. Results: In the cohort of journals deemed potentially predatory, 4% did not require APCs, 22% lacked transparency regarding their fees, and 74% openly disclosed APCs. These disclosed APCs had an average cost of $2277 USD, with a median of $2000 USD, and a wide range spanning from $150 to $3690 USD. In contrast, among the established legitimate journals, 13.04% waived APCs entirely, 8.70% were not transparent about their fees, and 78.26% provided clear APC listings. The fees for these legitimate journals were notably steeper, with a mean APC of $2792 USD and a median of $3340 USD, ranging from $635 to an upper limit of $6950 USD. Conclusions: The analysis reveals an unexpected juxtaposition, in that while predatory journals are often criticised for their opaque and questionable fee structures, it is the legitimate journals that impose significantly higher APCs—sometimes prohibitively so. This raises concerns about the accessibility of esteemed publishing platforms, particularly for those with constrained budgets or institutions with limited funding. The disparity in cost suggests that the financial gatekeeping by legitimate journals may, inadvertently, be as counterproductive to the advancement of science as the predatory practices they overshadow. Future research should delve into the implications of such high fees on the dissemination of scientific work and explore models for more equitable access in publishing in reputable journals.

1.12.11. MP-12.11: Establishment of a Urethroplasty Cadaver Training Lab

• Damm T, Koeppen R, Hudson C and Monn M
• Southern Illinois University School of Medicine, Springfield, United States

Abstract: Introduction and Objectives: Resident education for complex perineal surgeries can be challenging. Cadaver labs provide a rare opportunity for autonomous operating to learn the anatomy and surgical steps, along with troubleshooting challenging steps. The objective of this study was to create a urethroplasty cadaver lab and assess resident self-assessed learning. Materials and Methods: Hands on surgical training labs are performed 12–14 times annually for urologic residents. Four cadavers were obtained for the lab and were shared with other surgical specialties at a later date. Two weeks before the lab, a two-hour lecture was given to the residents providing an overview and discussion of urethral strictures and standard repairs. During the lab a pre-test was given followed by 3.5 h of uninterrupted cadaver lab to perform an excision with primary anastomosis (EPA) (non-transecting or transecting) and a dorsal onlay buccal mucosal graft (BMG) urethroplasty. Junior and senior residents were paired at each cadaver. A post-test immediately followed. A Likert scale of very unfamiliar-0, unfamiliar-1, somewhat familiar-2, familiar-3, very familiar-4 was used, and participation was optional. Institutional Review Board exempt status was granted. Results: Eight residents participated, four of whom were juniors (PGY1–3) and four were seniors (PGY4–5). The majority of residents reported unchanged (n = 5/8) or one point (n = 3/8) improved familiarity with perineal anatomy from pre to post lab. One resident reported improved familiarity with urethral anatomy. Junior and senior level residents reported an average 1 point increase in familiarity with the steps of transecting and non-transecting EPAs. Similarly, junior and senior level residents reported a 0.75 point increase in familiarity with the steps of a dorsal onlay BMG urethroplasty. In regard to familiarity with bulbar and posterior urethral dissections, juniors reported an average 0.75 and 1 point increase, respectively, and seniors reported a 0.25 and 0.75 point increase, respectively. All residents reported that the lab was educational. Conclusions: Use of a urethroplasty cadaver lab improved resident familiarity with the specific steps of surgery and dissection for the surgery. Cadaver labs are beneficial for perineal surgical training.

1.12.12. MP-12.12: Knowledge, Self-Confidence, and Handling Difficulties of Residents and Consultants to Perform Transurethral Catheterization (TUC): A Multicentre Survey

• Calik G ¹, De La Rosette J ², Bahadir Z ¹, Madendere B ¹, Arikan O ³, Guzelburc V ⁴, Evci E ⁵, Cakir S ⁶, Altay B ⁷, Laguna P ⁸, Kocak M ¹ and Albayrak S ⁴

¹ 

Istanbul Medipol University, Faculty of Medicine, İstanbul, Türkiye

² 

Istanbul Medipol University, International Faculty of Medicine, Istanbul, Türkiye

³ 

Istanbul Medipol Univ., Fac. of Medicine, Camlica Health Application and Research Center, İstanbul, Türkiye

⁴ 

Istanbul Medipol University, Faculty of Medicine, Department of Urology, İstanbul, Türkiye

⁵ 

Istanbul Medipol University, Faculty of Medicine, Pendik Health Application and Research Center, Istanbul, Türkiye

⁶ 

Istanbul Medipol University, Faculty of Medicine, Sefakoy Health Application and Research Center, Istanbul, Türkiye

⁷ 

Istanbul Medipol University, Faculty of Medicine, Kosuyolu Medipol Hospital, Istanbul, Türkiye

⁸ 

Istanbul Medipol University, International Faculty of Medicine, Department of Urology, Istanbul, Türkiye

Abstract: Introduction and Objectives: To compare the self-reported confidence, knowledge, and experience of medical residents and consultants performing TUC. Materials and Methods: A cross-sectional questionnaire-based study was performed among healthcare workers from 5 university hospitals. Data was transferred to an online Data Management System and analyzed using descriptive and graphical statistics. The association of medical roles with TUC confidence and knowledge was investigated using the Chi-Square test. Results: All active healthcare workers employed at the 5 university hospitals were eligible to participate in the study. Out of 846 healthcare workers, 747 participants filled out the survey (88% response rate) including 184 consultants and 78 residents. Questions addressing the self-confidence, knowledge, and experience of medical doctors and residents. The vast majority feel confident about the necessary preparatory steps in TUC. In terms of patient gender, consultants, and residents felt (very) confident in performing male and female TUC. The question related to performing TUC is equally divided into the categories ‘always’, ‘sometimes’, or ‘never’ for consultants and residents. A significant difference was found when asked about a difficult catheterization experience and seeking help. When facing difficulties performing TUC, consultants mostly opted for the help of “urologists/urology residents” or any colleague while the residents asked for help more from other colleagues. Asking for help from a medical doctor or a nurse was a different issue as 2% of the consultants and 9% of residents would seek assistance from them in case of a difficult catheterization (p = 0.0008). Conclusions: Most medical doctors who perform TUC feel confident in their knowledge and preparation skills. However, residents more often than consultants reported meeting difficulties in TUC. When facing a difficult catheterization consultants seek more often help from urologists whereas a significantly higher percentage of the residents preferred other colleagues or nurses.

1.12.13. MP-12.13: Unsolicited Invitations Unveiled: An Analysis of Academic Urology Communication

• Vo L, Armany D and Woo H
• Blacktown District Hospital, Sydney, Australia

Abstract: Introduction and Objectives: The inbox of an academic urologist is often bombarded with hundreds of unsolicited invitations for publications in various journals across a variety of medical and surgical disciplines. These invitations provide several claims including unverified PubMed indexing, and fictitious impact factor scores. These unsolicited invitations aim to tempt the unaware academic with a quick open access publication following exorbitant article processing fees with poor transparency regarding peer-review procedures potentially leading to unethical practices. This study aims to shed light on the validity of these invites claims with regards to PubMed indexing, impact factors and relevance to urological research. Materials and Methods: We analysed 422 unsolicited emails from 227 journals from a single academic urologist’s inbox from December 2023–January 2024. A quantitative analysis was conducted to highlight any discrepancies with regards to PubMed indexing claims, impact factors, personalisation of solicitations and their relevance to the academic surgeon’s prior urological research. Results: Of the total of 227 journals, 24 claimed PubMed Indexing (n = 24). Of these 24 journals, 22 were verified to have PubMed indexing whilst 2 (8%) were inaccurately represented. 53 of the 227 journals (23%) cited impact factors with only 1 (2%) proving legitimacy. Personalisation of invites was evident in 52 emails out of the 422 received (13%) in which prior research works was cited. However, 14 of these (27%) cited publications not involving the invited surgeons research and 17(33%) were irrelevant to the corresponding journals scope. Additionally, despite the recipient’s specialty in urology, 49% of journals soliciting emails were associated with disciplines lacking relevance to the recipient’s field of study. Conclusions: Whilst the few journals claiming PubMed indexing are verified (92%), those with legitimately claimed impact factor scores were not (98%). Similarly, personalisation scores were low with a significant proportion of these citing studies not involving the recipient academic surgeon. The misrepresentation of these common journal metrics and solicitation tactics should be considered in the academic urologist’s due diligence tasks prior to submission of their work in these rapacious journals.

1.12.14. MP-12.14: Use of Audio Recordings in the Consultation of Patients Seeking Genital Gender-Affirming Surgery: An Opportunity for Broader Application Throughout Urology, and Development of a Novel Smartphone App

• Stelmar J ¹, Mallavarapu S ², Smith S ², Sandhu S ² and Garcia M ²

¹ 

University of California San Diego School of Medicine, San Diego, United States

² 

Cedars-Sinai Medical Center, Los Angeles, United States

Abstract: Introduction and Objectives: It has been demonstrated that patient recall of medical information is often poor and inaccurate. Audio recordings for patient consultation has been described, but, to our knowledge, no specific consultations pertaining to gender-affirming surgery. Our aim was to determine whether, and specifically how, consultation recordings for patients presenting for genital gender-affirming surgery would be of benefit. Materials and Methods: Patients were offered the opportunity to record their consultation. One copy was provided to the patient and a second copy was retained for medical record-keeping. An anonymous, internet-based survey of these patients was undertaken to query its utility post-visit. In parallel, we developed a smartphone App to simplify the technological aspect of our approach. Results: 71/72 (98.6%) patients consented to audio recording of their consultation. 50/71 (70%) participants responded to our survey (Figure 1a), of which, a large proportion reported benefit and viewed the option of recording their consultation positively (Figure 1b). We developed a smartphone App (Visit Replay, iOS and Android) (U.S. and International Patents Pending) (Figure 1c) that: 1. Records up to 90-min consultations; 2. Can attach additional patient-education files (manuscripts, documents, audiovisual materials); 3. Attach hyperlinks, such as studies or websites to the associated email; and 4. Emails the audio and attachments to the patient, followed by immediate deletion of patients’ files. Conclusions: Routine audio recording of patient consultations is highly beneficial, with little provider cost, and should be considered as a valuable addition to new patient consultations. This approach may have applications in broader clinical contexts with complex, nuanced discussions pertaining to patient care. Since patients face similar challenges during medical consultations globally, larger studies are warranted.

1.13. Moderated Oral ePoster Session 13: BPO/LUTS, Penis/Testis Benign Disease

• Saturday, October 26
• 0800–0900

1.13.1. MP-13.01: Comparing GreenLight PVP and HoLEP Beyond 5 Years: A Systematic Review of Long-Term Functional Outcomes and Reoperation Rates

• Alberto M ¹, Yim A ¹, Yan X ², Bolton D ¹, Wong L ¹ and Sethi K ¹

¹ 

Austin Health, Heidelberg, Australia

² 

The University of Melbourne, Melbourne, Australia

Abstract: Introduction and Objectives: There is a large body of evidence for the short-term safety and efficacy of holmium laser enucleation of prostate (HoLEP) and GreenLight photoselective vaporisation of prostate (GLPVP) for the treatment of BPH. In contrast, the durability of long-term functional outcomes has been less studied. The purpose of this review is to compare long-term (≥ 5 years) functional outcomes and reoperation rates following HoLEP vs. GLPVP. Materials and Methods: MEDLINE, Embase and Cochrane databases were searched from inception to December 2023. Included were randomised controlled trials (RCTs), cohort studies and case series studying HoLEP and/or GLPVP, where functional outcomes and reoperation rates were reported. Studies with <5 years follow up were excluded. Evidence from studies was synthesised as a comparison between two operative techniques across all parameters. Quality of evidence was assessed with the Newcastle-Ottawa Scale. Results: Of 3047 records identified, 25 were eligible, including 2 RCTs, 2 cohort study, 1 cross-sectional study and 20 case series. 23 studies focused on HoLEP or GLPVP, whilst 2 case series were comparative studies. HoLEP demonstrated long-term durability of outcomes and low reoperation rates (mean 4.1%, range 2.0–6.3%) at a mean follow-up of 7.3 years. GLPVP also had durable outcomes at 5-year follow-up, but inconclusive evidence for improvements at 10-year follow-up. Reoperation rates were also higher (mean 12.6%, range 3.8–33.3%). This is in keeping with findings of comparison studies, where the HoLEP arm demonstrated greater improvements in all functional parameters except PVR, and lower reoperation rates compared with GLPVP. These findings are limited by significant patient attrition, lack of comparison studies, and lack of long-term data beyond 10 years. 3 studies examined the 180 W GLPVP model at 5-years showed superior durability to earlier 80 W/120 W models. Conclusions: Current evidence suggests that HoLEP provides significantly greater functional improvements and a lower reoperation rate when compared to the GLPVP 80 W/120 W model at 5-year follow-up. The 180 W model is comparable to HoLEP based on limited data at 5 years, but there is a lack of data beyond 10 years for longer-term functional outcomes.

1.13.2. MP-13.02: Comparison of Prostate Volume and Prostate Specific Antigen Change After Rezūm Procedure

• Madendere S ¹, Kiliç M ¹, Esen B ², Aykanat I ² and Balbay M ²

¹ 

VKV American Hospital, Istanbul, Türkiye

² 

Koç University School of Medicine, Istanbul, Türkiye

Abstract: Introduction and Objectives: We aimed to present our experiences with the Rezūm procedure, regarding changes in prostate volume and prostate specific antigen (PSA). Materials and Methods: Out of a total of 81 patients who underwent Rezūm procedure between June 2021 and December 2023, 35 with postoperative follow-up evaluation within 3 months, were included in this retrospective study. On these patients, 2 to 8 injections per procedure were done into the prostate lobes. We analyzed the postoperative third months follow-up data and compared changes in prostate volume and PSA. Results: The median age was 65. Mean number of injections was 3 (2–8). Prostate volume change of 32 patients and PSA change of 29 patients were compared postoperatively. PSA level decreased in 20 (68.9%) patients, while the mean decrease was 0.4 ng/dL. Prostate volume decreased in 24 (75%) patients, while the mean decrease was 8.3 mL. Conclusions: The Rezūm procedure results in a clinically insignificant change both in prostate volume and PSA level in the first 3 months after the operation.

1.13.3. MP-13.03: Comparison of Serenoa Repens, Lycopene and Selenium versus Dutasteride. An Italian Multicenter Case-Control Prospective Study (Comp Study)

• Lo Giudice A ¹, Cimino S ², Larganà G ³, Madonia M ⁴, Reale G ³, Persico F ⁵, Terrone C ⁶, Malinaric R ⁶, Carini M ⁷, Cruciano N ⁸, Vespasiani G ⁹, Santaniello F ¹⁰, Zaganelli S ¹¹, Arnone S ¹¹, Carrino M ⁵, Tedde A ⁴, Russo G ² and Morgia G ²

¹ 

Mediterranean Institute of Oncology (IOM), Urology Section, Catania, Italy

² 

University of Catania, Catania, Italy

³ 

S. Maria delle Croci Hospital—Ravenna, Ravenna, Italy

⁴ 

University of Sassari, Sassari, Italy

⁵ 

A Cardarelli Hospital, Urology Section, Napoli, Italy

⁶ 

IRCCS Policlinico San Martino Hospital, Genova, Italy

⁷ 

University of Florence, Florence, Italy

⁸ 

Maria Vittoria Hospital, Torino, Italy

⁹ 

University of Roma Tor Vergata, Roma, Italy

¹⁰ 

Civile Fabriano Hospital, Ancona, Italy

¹¹ 

Lugo of Romagna Hospital, Lugo, Italy

Abstract: Introduction and Objectives: Medical therapy of BPH is based on alpha-blockers in monotherapy/combination with 5 alpha reductase inhibitors (5-ARIs). Different side effects of these drugs, such erectile dysfunction, ejaculatory disorders, loss of libido, could affect the adherence to treatment. Previous randomized controlled trial validated the use of alpha-blockers in combination with Lipidic Extract (LE) of Serenoa Repens (SeR) and, in particular, compounds containing also Selenium (Se) and Lycopene (Ly) against BPH symptoms; the aim of this study is to compare the therapy with SeR-Se-Ly alone versus Dutasteride alone against BPH, in order to research a good therapeutic alternative with limited side effects. Materials and Methods: We conducted this Italian multicenter case-control prospective non-randomized study from April 2021 to April 2022. Inclusion criteria: age between 55 and 80 years old, digital rectal examination negative for prostate nodules, PSA < 4 ng/mL, IPSS > 12, prostate volume > 40 cc, Qmax < 15 mL/s. Exclusion criteria: patients with prostate cancer, previous bladder cancer, diabetes mellitus, neurogenic disorders, severe liver disease, history of orthostatic hypotension or syncope, symptomatic urinary tract infection, anti-androgens, antidepressants therapy, recent treatment with an a-blocker or phytotherapy including saw palmetto extract, previous medical therapy with 5-ARI or surgical treatment for LUTS/BPH, presence of catheter or an episode of acute retention of urine in the last 4 weeks, patients affected by any disorders of erection of ejaculation. Results: We observed increasing of Qmax of 2 points in group A and 2.5 points group B; IPSS has been reduced of 4 points in group A and 4.5 points in group B; IIEF-5 didn’t change in group A and it has been reduced in group B by −1; regarding the MSHQ, only the item MSHQ-Satisfaction has changed in group A: −1, in group B MSHQ was reduced by −2 points in ED, by −5 points in EJ, by −2.5 points in Satisfaction, by −0.5 points in Intercourse, by −3.2 points in Desire. (Figure 1 and 2). Conclusions: Profluss could be a valid alternative to dutasteride, providing comparable benefits and avoiding sexual dysfunctions. Profluss should not be substituted for dutasteride in those patients for whom prostate volume reduction is desired. Source of funding: none.

1.13.4. MP-13.04: Consensus on Alpha Blocker Use in BPH Management: Insights from Indian Urological Experts

• Maheshwari P ¹, Mokashi A ², Swami G ³, Bhosle A ⁴, Borade K ³, Gupte D ⁵, Kanbur A ⁶, Birla V ⁶, Nanjappa K ⁷, Bhave P ², Bapat A ⁸, Shetty P ⁹, Khandkar A ⁴, Sinha L ¹⁰, Khan A ¹¹, Kale N ⁹, Mehendale A ¹², Chaurasia A ¹³, Shah T ¹⁴, Sonwane D ¹⁵, Vaishampayan R ¹⁶, Kulkarni A ¹⁷, Godbole R ¹⁸ and Naik M ¹⁹

¹ 

Fortis Hospital Mulund, Mumbai, India

² 

Kaushlya Hospital, Mumbai, India

³ 

Chhatrapati Shivaji Hospital Kalva, Mumbai, India

⁴ 

Hira-Mongi Navneet Hospital, Mumbai, India

⁵ 

Bombay Hospital, Mumbai, India

⁶ 

Jupiter Hospital, Thane, Mumbai, India

⁷ 

Cauvery Uroderm Centre Kalyan, Mumbai, India

⁸ 

Nanavati Max Hospital, Mumbai, India

⁹ 

Hiranandani Hospital Powai, Mumbai, India

¹⁰ 

Global Hospital, Mumbai, India

¹¹ 

Prime Hospital, Mumbai, India

¹² 

Jaslok Hospital, Mumbai, India

¹³ 

NuLife Hospital, Ghatkopar, Mumbai, India

¹⁴ 

Saifee Hospital, Mumbai, India

¹⁵ 

Currae Hospital, Thane, Mumbai, India

¹⁶ 

Pinnacle Hospital, Thane, Mumbai, India

¹⁷ 

Kulkarni Hospital, Mumbai, India

¹⁸ 

Mamata Hospital Dombivali, Mumbai, India

¹⁹ 

Goa Medical College, Goa, India

Abstract: Introduction and Objectives: To establish a comprehensive consensus statement on BPH management with alpha blockers, incorporating contemporary evidence and drawing from the valuable real-world experiences of Indian urologists. Materials and Methods: The AURA Consensus Group, a collective 750 years of clinical expertise, convened in person for a pivotal discussion and consensus-building session. This assembly of thirty seasoned urologists, each averaging a quarter-century of experience, critically evaluated eleven key questions using a 5-point Likert scale. A consensus was determined by a score exceeding 100. The session was prefaced by a rigorous review of the latest evidence-based research, spanning the past three years, concerning the management of BPH with alpha blockers. Results: Top agreement scores included: tamsulosin is an established treatment for medical expulsive therapy used for distal ureteric stones (122.9), adding mirabegron 50 mg to alpha-blocker treatment (121.7), silodosin’s efficacy at 8 mg without cardiovascular side effects (109.1), ureteric jet frequency for diagnosis of obstructive uropathy (ureteric jet frequency of less than 2 per minute may indicate partial obstruction) (106), silodosin can be an effective first-line treatment for pain associated with Zinner syndrome before considering surgical interventions (105.9), silodosin 8 mg/day for 6 weeks significantly improves the maximum flow rate, flow duration, and flow frequency of ureteric jets in patients with LUTS (103.7), 8 mg silodosin is more effective than 4 mg in improving symptoms of LUTS in patients with severe LUTS due to BPH (100.9) (Figure). The highest mean response scores (±SD, 95% CI) for consensus were for agree (53 ± 25.1, 95% CI 36.1 to 69.8) followed by neither agree nor disagree (22 ± 19.3, 95% CI 9 to 35), strongly agree (19.4 ± 16.2, 95% CI 8.5 to 30.3). Conclusions: The AURA Consensus Group, harnessing a collective 750 years of clinical insight, established a robust consensus on BPH management using alpha blockers. Endorsement was high for tamsulosin in expulsive therapy for ureteric stones and for the co-administration of mirabegron with alpha blockers. Silodosin was recognized for its efficacy and safety, recommended as a first-line therapy for Zinner syndrome, and for improving LUTS in BPH without cardiovascular detriment.

1.13.5. MP-13.05: Dissemination of Misinformative and Biased Information About Benign Prostate Hyperplasia (BPH) on YouTube in South Korea

• Park J ¹, Song M ², Koo H ², Yoo J ², Chang H ², Tae B ¹ and Bae J ¹

¹ 

Korea University, Ansan-Si, South Korea

² 

Korea University Ansan Hospital, Ansan-Si, South Korea

Abstract: Introduction and Objectives: YouTube is a social media platform with more than 1 billion users and nowadays many people search the health information on YouTube when they want to get it. The purpose of this study was to analyze the accuracy of health information provided in videos about BPH on YouTube. Materials and Methods: We performed the quality analysis of benign prostate hyperplasia (BPH) information on YouTube in South Korea, with the most-view 100 videos. We used the validated DISCERN quality criteria for consumer health information. DISCERN quality criteria is a tool consisting of 16 questionnaires and each has a scoring system. (1 = poor, 2 = generally poor, 3 = moderate, 4 = good, 5 = excellent). Results: The mean DISCERN score of the overall quality questionnaire (No.16 of DISCERN variable) for the analyzed videos was 2.75, which means that the overall quality of information was moderate to poor. A total of 62 videos (62%) contained potentially misinformative and/or biased content within the video. Conclusions: Many popular videos about BPH on YouTube in South Korea don’t guarantee the quality of health information, so urologists should try their efforts to disseminate high-quality health information on YouTube.

1.13.6. MP-13.06: Exime^® Urethral Stent Implantation (EUSI) as Initial Treatment for Patients Presenting with Acute Urinary Retention (AUR) for the First Time as a Result of BPH

• Amara N ¹, Massa A ¹, Hlodec I ¹, Séjourné C ¹, El Khoury E ¹, Ait Kaki A ¹, Al Youssef T ¹, Deswarte C ², Gutierrez P ³ and Patel B ⁴

¹ 

Department Urology/Oncology Dunkirk Center Hospital, Dunkirk, France

² 

Anesthesia Department Dunkirk Hospital Center, Dunkirk, France

³ 

Radiology Dunkirk Hospital Center, Dunkirk, France

⁴ 

Scott and White Hospital, Temple, Texas, United States

Abstract: Introduction and Objectives: Acute urinary retention (AUR) is a distressing condition associated with considerable morbidity, necessitating hospitalization, catheterization, and often surgical intervention. AUR frequently arises from benign prostatic hyperplasia (BPH), with its incidence escalating with advancing age. The conventional medical approach often involves urinary catheter insertion. This prospective study aimed to evaluate the efficacy of Exime urethral stent implantation (EUSI) in patients experiencing their initial episode of AUR attributed to BPH. This study sought to investigate the surgical technique and clinical outcomes associated with EUSI in patients presenting with acute urinary retention (AUR). Materials and Methods: Between January 2019 and June 2022, 78 BPH patients with AUR underwent EUSI. A uniform technique involving local anesthesia was employed for catheter insertion in each patient. The patient cohort, aged 58 to 91 years, exhibited prostate volumes ranging from 30 to 120 mL, with an International Prostate Symptom Score (IPSS) of 24 ± 5.9. Results: Immediate spontaneous urination was achieved in 72 patients, while 3 patients developed prostatitis, and 3 others experienced bladder clot embolism. Conclusions: EUSI, characterized by its simplicity, high safety profile, and evident efficacy, emerges as a novel and effective therapeutic option for AUR secondary to BPH. In the evolving landscape of minimally invasive, office-based technologies, the availability of diverse treatment options allows physicians and patients to tailor interventions according to individual expectations. Further research is essential to delineate the optimal role of EUSI in this clinical context.

1.13.7. MP-13.07: Feasibility of Constructing Model to Predict Acute Urinary Retention in Men with Lower Urinary Tract Symptoms with Machine Learning Algorithm

• Chan E ¹, Leung C ², Chu S ¹, Kwok S ² and Ng C ²

¹ 

Tuen Mun Hospital, Hong Kong, China

² 

Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China

Abstract: Introduction and Objectives: To develop and compare different machine learning algorithms in predicting acute urinary retention (AUR) incidence in men with lower urinary tract symptoms (LUTS) 5 years upon presentation. Materials and Methods: The algorithm was trained with multi-centre retrospective data. Men who attended the urology nurse clinic in two tertiary hospitals were reviewed. Their baseline voiding functions, metabolic status and comorbidities were retrieved and became the dependent variables of the training dataset. The occurrence of AUR in 5 years after their first consultation was labelled as the outcome. Under-sampling of patients not developing AUR was performed to minimize the effect from class imbalance biased towards them. This labelled dataset was used to train the algorithm to predict the incidence of 5-year AUR. Different types of supervised machine learning, including neural networks, decision trees and K-nearest neighbours (KNN), were applied. The performance of each trained model was reviewed with accuracy and area under the receiving operating characteristics curve (AUC). Results: A total of 2149 patients attending the urology nurse clinic in Prince of Wales Hospital and Tuen Mun Hospital in Hong Kong from 2009 to 2018 were retrieved for training the algorithm. AUR developed in 510 patients (24%). The training dataset included 24 dependent variables, including age, body mass index, metabolic comorbidities, uroflowmetry result, International Prostate Symptom Score, lipid profile, serum prostate-specific antigen, and 1 binary outcome, with 20% data subject used for internal validation of the trained algorithm. A model trained with a decision tree showed the best performance with an accuracy of 0.72 and an AUC of 0.65. The model trained neural network had an accuracy of 0.758 and an AUC of 0.5, while that of KNN had an accuracy of 0.72 and an AUC of 0.55. Conclusions: Building up a prediction model to predict 5-year AUR in men with LUTS is feasible with acceptable performance, which is expected to improve with a larger training dataset and less class imbalance.

1.13.8. MP-13.08: Holmium and Thulium Fiber Laser Enucleation of the Prostate. Prospective Randomized Multicenter Study

• Brime Menendez R, García Rojo E, Lista Mateos F, Justo Quintas J, Hevia Palacios V, Carracedo Calvo D and Romero Otero J
• Hospital HM Sanchinarro, Madrid, Spain

Abstract: Introduction and Objectives: Benign prostatic hyperplasia (BPH) is a common condition causing lower urinary tract symptoms (LUTS) in men. Holmium (HoLEP) and thulium (ThuLEP) laser enucleation are established minimally invasive techniques to treat benign prostatic hyperplasia (BPH). Recently, thulium fiber laser (TFL) has been proposed for prostate enucleation (ThuFLEP) with promising outcomes. Our objective is to compare the efficacy and safety of HoLEP and ThuFLEP in treating BPH. Materials and Methods: We designed a prospective randomized multicenter study. Patients with BPH-related lower urinary tract symptoms and failure of BPH medical therapy were enrolled. Preoperative, surgical, perioperative and postoperative data were recorded. Follow-up visits were scheduled at 3 and 6 months. Efficacy in terms of improvement of functional outcomes was chosen as the primary outcome, whereas safety in terms of intraoperative and postoperative complications was selected as the secondary outcome. Results: A total of 200 patients were included (HoLEP 100, ThuFLEP 100). No significant difference in baseline characteristics was found between the two groups. At 3 and 6 months we found statistically significant improvements from baseline for both HoLEP and ThuFLEP in IPSS, IPSS-QoL, Qmax, and PVR (p < 0.05). At 6 months, mean ± SD IPSS, IPSS-QoL, Qmax, and PVR for HoLEP vs. ThuFLEP were 5.8 ± 4.9 vs. 4.8 ± 5.0 points (p = 0.57), 1.6 ± 1.4 vs. 0.7 ± 1.1 points (p = 0.09), 29.9 ± 12.5 vs. 29.6 ± 8.0 mL/s (p = 0.8), and 16.3 ± 17.7 vs. 15.5 ± 13.4 mL (p = 0.92), respectively. No intraoperative complication was recorded. No Clavien-Dindo ≥ III complication occurred during hospitalization. After 6 months 8 (8%) and 6 (6%) patients reported mild stress urinary incontinence in HoLEP and ThuFLEP group, respectively (p = 0.24). Urethral stenosis was observed in 3 men (3%) in the HoLEP group and 1 subject (1%) in the ThuFLEP group (p = 0.72). Conclusions: Both HoLEP and ThuFLEP are effective and safe for benign prostatic hyperplasia treatment, with comparable functional outcomes and complications at 6 months. Further studies are needed to confirm our preliminary findings.

1.13.9. MP-13.09: Impact of Transurethral Resection of Prostate in Hypocontractile Detrusor: A Retrospective Observational Study

• Deshpande A, Gunavanthe V, Pattnaik P and Shukla V
• Bombay Hospital Institute of Medical Sciences, Mumbai, India

Abstract: Introduction and Objectives: Transurethral resection of the prostate (TURP) has long been regarded as the gold standard for treating bladder outflow obstruction due to benign prostatic enlargement. Despite advancements in medical management, TURP remains an ideal therapeutic option for a substantial cohort of patients. Urodynamic studies (UDS) play a pivotal role in the assessment of bladder function, particularly in cases where clinical decision-making is equivocal. This study aims to evaluate the outcome of TURP in patients with hypocontractile detrusor identified through UDS. Materials and Methods: A retrospective observational analysis was conducted on 154 UDS reports from our institution, encompassing patients with hypocontractile detrusors (defined by a bladder contractility index of < 100) who underwent TURP between 2015 and 2022. Exclusion criteria included patients with acontractile detrusors, neurogenic bladder, spinal or pelvic trauma, uncontrolled diabetes mellitus, congenital neurological conditions, urethral pathology, prostate cancer, or untraceable data. Preoperative and postoperative parameters were compared using paired t-tests, with significance set at p < 0.05. Additionally, postoperative catheterization rates and post-void residual volumes were assessed. Results: The study cohort had a mean age of 72 years and a mean prostate size of 63 g. Preoperative catheterization duration averaged 30.5 days, while preoperative post-void residual volume was 130 cc. The mean preoperative International Prostate Symptom Score (IPSS) was 24.3, which significantly improved to 14.2 postoperatively. Post-TURP post-void residual volume decreased to 54.8 mL. Postoperative catheterization rates exceeding one month or necessitating self-catheterization were observed in 13% of patients. Comparison with meta-analysis data revealed significantly higher recatherisation rates post-TURP. Conclusions: In carefully selected patients with hypocontractile detrusors and refractory symptoms, TURP emerges as a highly effective therapeutic modality following failed medical management. Proper patient selection and comprehensive preoperative assessment, including UDS, are crucial for optimizing outcomes. These findings underscore the continued relevance of TURP in the contemporary management of bladder outflow obstruction.

1.13.10. MP-13.10: Medication Use Rates Through 5 Years Are Similar After PUL, TURP and GreenLight: A US Healthcare Claims Study

• Elterman D ¹, Roehrborn C ², Kaufman R ³ and Kaplan S ⁴

¹ 

University of Toronto, Toronto, Canada

² 

UT Southwestern, Dallas, United States

³ 

Albany Medical College, Albany, United States

⁴ 

Icahn School of Medicine at Mount Sinai, New York, United States

Abstract: Introduction and Objectives: Though patients electing BPH surgery may wish to cease BPH medical therapy, some may continue or begin medication post-surgery to treat residual symptoms. This large-scale healthcare claims analysis produces rates of continued and de novo BPH medical therapy following TURP, GreenLight PVP and UroLift PUL procedures through 5 years. Materials and Methods: Patients with ≥ 1 year of follow-up who underwent outpatient TURP (n = 20,319), GreenLight (n = 10,517), or PUL (n = 5793) were identified within a representative sample of 2015–2021 Medicare and commercial insurance claims. Pharmaceutical claims were linked to outpatient surgical claims and rates of continuous and de novo use assessed (alpha-blocker, 5ARI, or combination therapy); only patients with ≥2 instances of medical therapy prescriptions post-surgery were included. Perioperative medication usage was defined as ≥ 2 med prescriptions within 3 mo and not beyond; prolonged use was assessed through 1 and 5 yrs post-surgery. Results: Rates of perioperative medical therapy were similar between all treatments. 1 yr medication: The rate of continued medication use following PUL, TURP and PVP was 2.5%, 4.0% and 4.2%, respectively. De novo use was low after all therapies—(PUL 0.5%; TURP 0.9%; PVP 1.0%). The total 1 yr medical therapy rate was lowest for PUL (3.9%; TURP 6.1%; PVP 6.5%). 5 yr medication: Rates of continued and de novo use were: PUL—8.4% cont.; 1.0% de novo, TURP—7.0% cont.; 2.0% de novo, and PVP—7.2% cont.; 1.7% de novo. The total 5 yr medical therapy rate was similar between all three therapies: PUL—10.3%, TURP—10.2% and PVP—10.2%. Alpha-blockers were the leading BPH drug class utilized through 1 and 5 yrs for all treatments. Conclusions: Post-surgery medication use is a relatively unexplored element of the BPH patient journey. Rates of medication use through 1 yr were higher following TURP and PVP compared to PUL, and were equivalent at 5 yrs. This may indicate that, in a real-world setting, TURP and PVP patients have more advanced disease that doesn’t fully respond to the benefits of the selected intervention. The 5 yr real-world rate of medication usage for PUL in this analysis is similar to the rate demonstrated in the LIFT pivotal trial (10.3% vs. 10.7% LIFT).

1.13.11. MP-13.11: Men’s Health Related Quality of Life in Patients Surgically Treated for BPH: Results of a Turkish Multicentre Assessment in 1807 Cases

• Güzelburç V ¹, Madendere B ², Erkurt B ¹, Albayrak S ¹, Koçak M ³, Laguna P ¹, De La Rosette J ¹ and Çalık G ¹

¹ 

Istanbul Medipol University Hospital, Istanbul, Türkiye

² 

Istanbul Medipol University School of Medicine, Istanbul, Türkiye

³ 

Istanbul Medipol University, Istanbul, Türkiye

Abstract: Introduction and Objectives: To assess men’s health quality of life before surgically treated for lower urinary tract symptoms (LUTS) because of benign prostatic hyperplasia (BPH). Materials and Methods: 28 university and community hospitals from Turkiye participated in the study and performed various BPH surgeries based on their own preference or equipment availability (transurethral resection of the prostate (monopolar/bipolar TURP), photoselective vaporization of the prostate (PVP), holmium laser enucleation of the prostate (HOLEP), open prostatectomy (OP), robotic/laparoscopic adenomectomy and plasmakinetic resection of the prostate (PKRP)). International Index of Erectile Function (IIEF-5) and Male Sexual Health Questionnaire-short form (MSHQ-EjD-SF) were used to assess the sexual functions and Short Form Quality of Life Survey was used to measure the general quality of life including mental and physical health (SF-12). Voiding evaluation included IPSS, uroflowmetry, post voiding residual (PVR), PSA, prostate volume, catheterization status and use of medication. Demographic data were captured including age, and body mass index (BMI). Data from all participating medical centers were captured through electronic case report forms (eCRFs) through an online data management system (DMS). Categorical variables were presented as frequencies and percentages and continuous variables were presented as mean and standard deviation. To compare the distribution of continuous variables between the levels of a factor of interest, Wilcoxon-Mann-Whitney test was used. All analyses were carried out using SAS^® Version 9.4 (Cary, North Carolina, USA). Results: Between April 2020 and January 2023, we enrolled 1807 patients. 504 patients were in urinary retention and were removed from this analysis. For the remaining 1303 participants, we presented the baseline characteristics and clinical data according to MSHQ and IIEF-5 categorization of being within normal or Impaired range in the table. Conclusions: Patients with sexual health dysfunction were older and presented with lower mental and physical health. The voiding parameters are only slightly impaired.

1.13.12. MP-13.12: Abstract Title Observational Study on Efficacy of Palmitoylethanolamide, Epilobium and Calendula Suppositories for the Treatment of Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome Type III

• Lo Giudice A ¹, Tedde A ², Terrone C ³, Persico F ⁴, Santaniello F ⁵, Larganà G ⁶, Reale G ⁶, Vespasiani G ⁷, Carini M ⁸, Madonia M ², Carrino M ⁴, Cruciano N ⁹, Malinaric R ³, Arnone S ¹⁰, Cimino S ¹¹, Zaganelli S ¹⁰, Russo G ¹¹ and Morgia G ¹¹

¹ 

Mediterranean Institute of Oncology (IOM), Urology Section, Catania, Italy

² 

University of Sassari, Sassari, Italy

³ 

IRCCS Policlinico San Martino Hospital, Genova, Italy

⁴ 

A Cardarelli Hospital, Urology Section, Napoli, Italy

⁵ 

Civile Fabriano Hospital, Ancona, Italy

⁶ 

S. Maria delle Croci Hospital—Ravenna, Ravenna, Italy

⁷ 

University of Roma Tor Vergata, Roma, Italy

⁸ 

University of Florence, Florence, Italy

⁹ 

Maria Vittoria Hospital, Torino, Italy

¹⁰ 

Lugo of Romagna Hospital, Lugo, Italy

¹¹ 

University of Catania, Catania, Italy

Abstract: Introduction and Objectives: The management of chronic prostatitis/chronic pelvic pain syndrome type III (CP/CPPS) has been always considered complex due to several biopsychological factors underling the disease. In this clinical study, we aimed to evaluate the efficacy of the treatment with Palmitoylethanolamide, Epilobium and Calendula extract in patients with CP/CPPS III. Materials and Methods: From June 2023 to July 2023 we enrolled 45 consecutive patients affected by CP/CPPS III in three different institutions. Patients between 18 and 75 years of age with symptoms of pelvic pain for 6 months or more before study, a total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score ≥ 12 point and diagnosed with NIH category III. Patients were then allocated to receive rectal suppositories of Palmitoylethanolamide, Epilobium and Calendula (1 suppository/die for 1 month). All patients have been tested with standard urine exam in order to assess urinary leukocytes (U-WBC). The primary endpoint of the study was the reduction of NIH-CPSI. The secondary outcomes were the change of peak flow, post-void residual (PVR), IIEF-5, VAS score, PSA and reduction of U-WBC. Results: A total of 45 patients concluded the study protocol. At baseline, the median age of the all cohort was 49 years, the median PSA was 2.8 ng/mL, the median NIH-CPSI was 18.5, the median IIEF-5 was 18, the median U-WBC was 485, the median VAS score was 6.5, the median PVR was 26 cc and the median peak flow was 20.2. After 1 months of therapy we observed a significant improvement of NIH-CPSI (9; p < 0.01), IIEF-5 (20; p < 0.01), IIEF5 (20; p < 0.01), peak flow (22; p < 0.01), PVR (19; p < 0.01) and VAS (3; p < 0.01). Conclusions: In this observational study, we showed the clinical efficacy of the treatment with Palmitoylethanolamide, Epilobium and Calendula in patients with CP/CPPS III. The benefits of this treatment could be related to the reduction of inflammatory cytokines and of inflammatory cells. These results should be confirmed in further studies with greater sample size.

1.13.13. MP-13.13: Outcomes of Rezūm Water Vapour Thermal Therapy for Patients on Oral Antiplatelet or Anticoagulants

• Lee H, Lim B, Sundaram P, Chan T, Neo S, Cheng C, Lee L, Low A and Lim Y
• Sengkang General Hospital, Singapore

Abstract: Introduction and Objectives: Rezūm water vapour thermal therapy has been gaining traction as a minimally-invasive treatment of men with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH). Due to the low degree of trauma delivered to the prostate, it has been postulated that continuation of antiplatelet (AP) or anticoagulation (AC) therapy in the peri-procedural period might be possible. We therefore aimed to evaluate the safety profile and efficacy of such patients on AP or AC undergoing Rezūm. Materials and Methods: A review of a prospectively-collected registry of patients undergoing the Rezūm procedure between January 2021 and June 2023 was performed. Baseline characteristics, operative details and outcomes of patients who continued AP or AC treatment perioperatively were compared with patients who did not. Results: A total of 58 patients were included for analysis, of which 18 (31.0%) were on either AP or AC therapy that was continued across the Rezūm procedure. Of the patients on AP or AC, one was kept on Warfarin, one was bridged with Clexane, one continued apixaban, one was on dual antiplatelet therapy, and the remaining 14 patients were on single antiplatelet therapy. There were no significant differences in both groups in terms of baseline peak urinary flow (Qmax), prostate volume, prostate-specific antigen (PSA) and use of pharmacological therapy, and both groups were similar in terms of the number of intra-operative treatment doses (p = 0.50) and treatment duration (p = 0.79). Post-operatively, the AP/AC group had a slightly higher 30-day complication rate (27.8% vs. 10.0%) but was not statistically significant (p = 0.27), and no Clavien ≥ 3 complications were noted. Patients on AP/AC were noted to have a lower rate of successful trial of void (55.6% vs. 92.5%, p = 0.01), and trended toward a longer duration on IDC (11 days vs. 6 days, p = 0.08), but had a similar International Prostate Symptom Score (IPSS, 9 vs. 6, p = 0.18) and Qmax at 3 months (11.8 mL/s vs. 12.9 mL/s, p = 0.27). Conclusions: The continuation of AP or AC through Rezūm appears to be safe; despite a trend towards slightly higher overall complications rates for the AP/AC group, there is no increase in major complications.

1.13.14. MP-13.14: SLIMFLEP {Slim (22f) Thulium Fibre Laser Enucleation of Prostate}

• Poleboyina V
• Care Hospital, Hyderabad, India

Abstract: Introduction and Objectives: Endoscopic enucleation of the prostate (EEP) techniques for the treatment of benign prostatic enlargement (BPE) have become increasingly popular among urologists over the past 25 years. In trans urethral resection of prostate (TURP) the size of the endoscope is directly associated with efficiency, with larger loops allowing more tissue removal. Moreover, the greater inflow of irrigant can help maintain good vision. In a proportion of patients the girth of the urethral lumen does not allow atraumatic passage of the “standard” 26Ch resectoscope. Our goal is to adapt the instruments to the size of most urethras. The hypothesis is that, for prostate enucleation instrument miniaturization would not affect efficacy, while reducing trauma and complications. Primary objective is to study the enucleation efficiency with SLIM-19.5/22Fr resectoscope. Secondary objective is to estimate post-operative complications, if any, in follow up period. Materials and Methods: In this study, we collected data of patients who underwent SLIMFLEP for lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). Both pre and perioperative data as well as follow up data after 6 months were included: prostate volume, postvoid residue (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life (QoL) and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization, and data on hospital stays were also collected. A subgroup analysis was performed to assess whether older patients (> 65 years) or those with larger glands (> 80 cc) are prone to increased complication risks. Results: Of the 80 patients who underwent SLIMFLEP, the mean age was 66 ± 7.5 years, mean prostatic volume was 96 ± 51 CC, mean operative time was 64.6 min, average enucleated tissue weight was 52.3 gm, catheterization time was 1.9 days, haemoglobin fall was 0.45 gm/dL, mean duration of hospital was 2.2 days. All the functional parameters (IPSS, PVR, Qmax, QoL) significantly improved after surgery and showed durable improvement after 6 months follow up. 3 patients developed transient urinary incontinence which resolved after 1–2 months, 1 patient developed urethral stricture after 3 months. Conclusions: SLIMFLEP represents an effective and durable technique of endoscopic prostate enucleation characterized by low incidence of complications after 6 months follow up.

1.13.15. MP-13.15: The Impact of Serotonin Reuptake Inhibitors and Complications of Benign Prostatic Hyperplasia Surgery in France: The Scratch Study

• Uleri A ¹, Baboudjian M ¹, Pradere B ², Elterman D ³, Zorn K ⁴, Gauhar V ⁵, Charbonneau H ⁶, Tikkinen K ⁷, Scailteux L ⁸ and Misrai V ⁶

¹ 

Department of Urology, APHM, North Academic Hospital, Marseille, France

² 

Department of Urology UROSUD, La Croix Du Sud Hospital, Quint-Fonsegrives, Tolouse, France

³ 

University Health Network, Toronto, Canada

⁴ 

University of Montreal Hospital Center, Montreal, Canada

⁵ 

Ng Teng Fong Hospital, Singapore

⁶ 

Clinique Pasteur, Toulouse, France

⁷ 

University of Helsinki and Helsinki University Hospital, Helsinki, Finland

⁸ 

Rennes University Hospital, Rennes, France

Abstract: Introduction and Objectives: Bleeding is the most common complication of transurethral resection of the prostate (TURP) often prolonging hospital stays. Antiplatelet therapy (APT) and potentially also selective serotonin reuptake inhibitors (SSRIs) may increase bleeding. We aimed to assess the impact of SSRIs and/or acetylsalicylic acid (ASA) on length of hospital stay (LOS) in patients undergoing TURP. Materials and Methods: We included patients who underwent TURP between 01.2017 and 12.2020, excluding those with active cancer, impaired coagulation, or taking anticoagulants or other APTs. A directed acyclic graph (DAG) identified potential confounders to be adjusted in regression models. DAG-guided multivariable Poisson and logistic regression (adjusted for the presence of diabetes and cardiovascular comorbidity) were set. Sensitivity analysis was conducted for patients with and without indwelling catheters (IDC). Results: From an initial cohort of 167,768 patients, 89,492 were included, of these 13,937 (15.6%) were exposed to ASA, 3443 (3.8%) to SSRIs, 1061 (1.8%) to both. Median age was 70 (IQR 64–75) years, 5.1% had cardiovascular comorbidities, 15.7% diabetes, and 8.9% had an IDC. Median LOS was 3 (2–4), the rates of transfusion, rehospitalization, and death are presented in Table 1. At Poisson regression patients exposed to SSRIs + ASA had longer LOS than patients exposed to ASA (IRR = 1.15; p = 0.006) while the non-exposed group had lower LOS (IRR = 0.94; p = 0.001). Patients exposed only to SSRIs had comparable LOS to ASA group, but when considering only patients without an IDC, LOS was lower (IRR = 0.98; p = 0.03). Non-exposed group had less risk of transfusion (OR = 0.76; 95%CI:0.69–0.85; p < 0.001), 30-day re-hospitalization (OR = 0.72; 95%CI:0.68–0.76; p < 0.001), and death (OR = 0.51; 95%CI:0.30–0.89; p = 0.015) compared to ASA group. Notably, no significant difference was found between the groups exposed to SSRIs, SSRIs + ASA, and ASA (all p > 0.05). Conclusions: The combination of SSRIs and ASA was associated with longer LOS. Difference was minimal in patients with IDC. No significant difference was found in terms of risk of transfusion, re-hospitalization, and death.

1.13.16. MP-13.16: Mental Health Changes in Boys Undergoing Emergency Unilateral Orchiectomy for Torsion Testis

• Agrawal P ¹, Sharma G ², Mulawkar P ³, Kanbur A ⁴, Gupte D ¹ and Maheshwari P ¹

¹ 

Fortis Hospital, Mulund, Mumbai, India

² 

Chitale Clinic, Solapur, India

³ 

Tirthankar Hospital, Akola, India

⁴ 

Jupiter Hospital, Mumbai, India

Abstract: Introduction and Objectives: Torsion testis is a common emergency often afflicting young children. Most often the diagnosis gets delayed and quite a few boys land with orchiectomy for management of gangrenous testis. Although there are ample studies looking at the sexual and fertility issues in these children, the mental health changes has not been given due importance. Materials and Methods: This is a multi-centric pilot study, where 68 patients who underwent unilateral orchiectomy for torsion testis, were evaluated. Based in the Diagnostic and Statistical Manual of Mental Health-5, a questionnaire was created and either the kids or their parents were asked to submit the answers. The questionnaire looked at various domains like depression, mania, anxiety, self-harm, psychosis, obsessive-compulsive symptoms, sleep, learning difficulty and substance abuse. Total 44 responses were received and were analysed. Results: The age range of the patients when they submitted the answers was between 14 to 35 years (average 24 years). The average time after orchiectomy was 8 years (2–12 years). Twelve patients had features of depression while nine had mania. Fifteen patients had significant anxiety and more than half of them had thoughts of self-harm. About 20 patients complained of sleep disturbances while seven thought that they had learning difficulties. More than half had issues with body image and were hooked to substance abuse. Conclusions: Anxiety, issues with body image and self-confidence, depression and memory issues are commonly seen in the kids who had unilateral orchiectomy for torsion. These issues persist long after the orchiectomy episode and impacts their quality of life. Awareness of this psychological impact and involvement of a psychotherapist and psychologist in the management would be very important for the well-being of these children.

1.13.17. MP-13.17: Preliminary Results with the Use of Adipose Tissue Grafting Regenerative Surgery for Peyronie Disease

• Berdondini E ¹, Silvani M ¹, Ferretti S ², Eissa A ² and Gacci M ³

¹ 

Center for Urethral and Genital Surgery, Torino, Italy

² 

University of Modena & Reggio Emilia, Modena, Italy

³ 

Univerisity of Florence, Florence, Italy

Abstract: Introduction and Objectives: To report the first use of purified adipose tissue grafting for the treatment of Peyronie disease (PD). Adipose tissue guarantees regeneration of tissue and scar remodeling. This is a monocentric study to assess the use of adipose tissue in PD. Materials and Methods: After obtaining Clinical Trials.gov NCT05316714, we enrolled 23 pts men with PD between 2022 and 2023. Inclusion criteria were non-active PD. Exclusion criteria were pts with calcified plaques and erectile dysfunction. The diagnostic workup was based on medical history, physical examination, picture during erection, penile ultrasonography, IIEF. Surgical procedure: after liposuction we pass the adipose tissue between filters to obtain nanofat and microfat. The microfat was used to infilter the plaques, while the nanofat was used to treat all the tunica albuginea bilaterally. All pts followed rehabilitative protocol starting the day after surgery with daily massage of the tunica albuginea and vacuum for 6 mo. Follow-up included the same diagnostic workup of the preoperative. All patients were followed up every 3 mo for the first year and every 6 mo for the second year. Results: Median age 55 yrs (35–67). Median n of plaques 2 (1–5). Median curvature 40° (30°–90°). Median nanofat quantity 20 mL (range 10–40). Median microfat quantity 5 mL (range 3–8). Median surgical time 40 min (30–60). No periop or postop complications occurred. Median follow-up was 18 mo (range 12–23). The regenerative effect occurs within 3 mo after surgery and at 6 mo follow-up pts reported: 19 pts (83%) improvements as reduction of half curvature 8 (42%) evaluated with auto picture, half reduction of the plaque 15 (78%) evaluated with ultrasonography, improvement in softness of the tunica albuginea 19 (100%), enlargement of the penis 19 (100%), improvement of sexual activity due to the greater elasticity and softness of the tunica albuginea 16 (84%), improvement in IIEF 17 (89%). 4 pts, including pts 2 times treated (17%) reported complete restoration of the penis. Conclusions: Adipose tissue with its regenerative properties represents a new instrument in the treatment of PD. Larger prospective series with longer follow-up are expected to confirm efficacy.

1.14. Moderated Oral ePoster Session 14: Infertility, Trauma, Sexual Dysfunction

• Saturday, October 26
• 0800–0900

1.14.1. MP-14.01: A Stitch in Time Saves Nine: A Case of Anorgasmic Anejaculation Falsely Diagnosed as Ejaculatory Duct Obstruction

• Kothari P
• B.Y.L Nair Ch Hospital, Mumbai, India

Abstract: Introduction and Objectives: Delayed orgasm/anorgasmia is defined as the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress. Differentiation between the orgasmic and anorgasmic subtypes is subtle and needs to be elicited on history more so in a male who has no previous experience of orgasm. EDO (ejaculatory duct obstruction) can present as orgasmic anejaculation though (EDO) itself is an uncommon cause of OA, occurring in 1–5% of cases. Here we present a case of anorgasmic anejcaultion falsely diagnosed as EDO on basis of a transrectal ultrasound and how we avoided catastrophic results by a simple vibrator trial. Materials and Methods: 31-year-old male presented with a history of anejaculation and was already investigated and diagnosed as ejaculatory duct obstruction on basis of transrectal ultrasound suggesting midline prostatic cyst with bilateral prominent seminal vesicles 2 cm on the right and 1.9 cm on the left in greatest dimensions. Patient was planned provisionally for TURED on basis of diagnosis of EDO. Results: On detailed evaluation the patient agreed to never felt a pumping action and satisfaction at the end of intercourse, though he could not clearly mention whether he achieved orgasms. Occasional nocturnal emission was present and examination was normal. Vibrator stimulation for 15 min was followed by ejaculation of semen, 7 mL which was reddish tinged, 2nd time after stimulation 3 mL of reddish tinged semen was obtained following 3 days abstinence. Analysis revealed 32 million sperms/mL with sluggish motility and 8–10 Rbc’s/hpf. Conclusions: The differential diagnosis for anorgasmic and orgasmic anejaculation is tricky due to varied presentations. Pooled up secretions in the seminal vesicles can lead to illusion of backpressure changes due to EDO. Simple history and vibrator trial can sometimes help avoid unnecessary intervention.

1.14.2. MP-14.02: Effect of Weight Loss on Hormonal and Semen Parameters in Patients with Primary Infertility

• Shukla V, Gupte D and Sapkal Y
• Bombay Hospital Institute of Medical Sciences, Mumbai, India

Abstract: Introduction and Objectives: Adipose tissue, where various metabolic hormones are secreted, plays a role in metabolizing different substances including androgen. Within fat tissue, enzymes such as aromatase and aldo-keto reductase 1C are responsible for metabolizing testosterone into estrogen and 5-dihydrotestosterone into inactive metabolites. The adrenoreceptors for catecholamines, which have been proven to play an essential role in controlling lipolysis, function by being up-regulated by androgens. The aim of this study was to evaluate the relationship between body mass index (BMI) and sperm parameters and reproductive hormone levels in patients with primary+ infertility. Materials and Methods: This study included sixty patient with known primary infertility, deranged semen analysis and low T/E2 level (< 1.7 ± 0.12) who met the inclusion criteria and were divided into three groups according to their BMI values as Group A normal weight n = 10 (BMI: 18.5–24.9 kg/m²) (excluded), Group B overweight n = 20 (BMI 25–29.9 kg/m²), and Group C obese n = 30 (BMI ≥ 30 kg/m²). Weight loss, semen parameters, and testosterone/estradiol ratio were compared retrospectively between the groups. Results: Upon 1 year follow up of group B and C a significant improvement was found in the T/E2 ratio and semen parameters within the group members with > 10 percent weight loss during the period. Also higher number of patients in group C showed improvement compared to group B. However absolute weight was not found an indicator for infertility. Conclusions: Weight loss was significantly correlated with change in the semen parameters and it was inversely related with T levels and T/E2 ratio.

1.14.3. MP-14.03: Evaluation of Sperm Chromatin Structure and Its Association with Semen Parameters for Male Fertility Assessment

• Umarane P ¹, Chamanmalik S ¹ and Nerli R ²

¹ 

KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India

² 

KLE’s Dr. Prabhakar Kore Hospital & MRC, Belagavi, India

Abstract: Introduction and Objectives: Routine semen analysis has limited parameters in predicting male infertility. Recent clinical studies indicate that DNA fragmentation levels above 30% are considered to be abnormal with lesser clinical outcomes. The aim of the study was to investigate the association between sperm quality and sperm DNA fragmentation index by the use of the sperm chromatin dispersion (SCD) test and its association with clinical pregnancy rates. Materials and Methods: Semen samples were obtained from males attending an infertility clinic. Semen parameters were analyzed and were classified as having normal or abnormal parameters according to World Health Organization (2021) criteria. Samples with abnormal semen parameters were defined as those having a sperm concentration ≤ to 16 million/mL, sperm motility ≤ to 42% in which progressive motility count was ≤ to 32%, and sperm morphology ≤ 4%. Samples with leukocytes were excluded from the study. Aliquots of 0.2–0.5 mL of raw semen were analyzed directly under a computer-assisted semen analyzer (CASA) following several steps of staining and incubation. Sperm DNA fragmentation was carried out by the SCD method. More than 30% of fragmented cells were labeled as positive for sperm DNA fragmentation. Results: A total of 235 males who attended the infertility clinic underwent SCD tests. 126 of these patients had normal semen analysis and the remaining 109 had abnormal parameters. SCD showed fragmentation in 42% in normal, whereas it was 54% in patients with abnormal semen parameters. The study showed a significant correlation between sperm quality and DFI values for assessment of fertility. Conclusions: DFI test can be offered to the patient with abnormal semen parameters or idiopathic infertility as semen parameters alone cannot predict pregnancy outcome. Moreover, DFI can be considered for infertile couples undergoing assisted reproduction techniques.

1.14.4. MP-14.04: Incidence of Gynecomastia in Klinefelter Syndrome and Its Response to Testosterone Therapy

• Nayar S ¹, Cook B ¹, Yap T ² and Filson S ²

¹ 

King’s College London, London, United Kingdom

² 

Guy’s and St Thomas’ NHS Trust, London, United Kingdom

Abstract: Introduction and Objectives: This systematic review provides the most up to date information regarding the incidence of gynecomastia in Klinefelter’s syndrome (KS) compared to the standard male population. It also looks at the effect testosterone therapy has on gynecomastia. Materials and Methods: A PRISMA protocol was used to select papers for review. For incidence, cohort studies were favoured with a minimum number of 10 participants due to the small population sizes used. When reviewing testosterone therapy, no minimum population size was given due to relative lack of data. 6 number of papers were eventually identified after 129 were screened. Results: 3 papers reviewed a total of 170 patients with Klinefelter syndrome. Overall incidence of gynecomastia was not significantly different from that of patients without KS (18.8% vs. 13.6% of patients [p > 0.1]). Standardised incidence ratios were calculated across the 3 studies (Below). Age of onset in KS was found to be 1.3 years younger than control (13.6) in one population (12.3) but was found to be almost identical in another (13.7). Testosterone therapy in two studies proved to be highly effective in treating gynecomastia in adolescent males with KS. 12/14 boys (86%) who began testosterone (10 mg 2% transdermal or 40 mg test. undecanoate) during early puberty found complete resolution of gynecomastia. An earlier study showed complete resolution of 3/5 (60%) KS patients treated with testosterone. Recurrence after cessation of treatment across both studies was shown to respond well to restarting therapy. Conclusions: Incidence of gynecomastia in Klinefelter’s syndrome appears to be like that of the average male population, contrary to previous belief. Larger and more robust cohort studies are needed to identify its true incidence and establish if any difference in age of onset exists. Testosterone therapy over 2 small trials was shown to have drastic improvements in gynecomastia, and subsequent use seemed to provide a treatment should relapse occur. Again, larger RCTs are needed to establish the true efficacy of testosterone therapy on gynecomastia.

1.14.5. MP-14.05: Mapping of Brain Activity Following Transcutaneous Poster Tibial Nerve Stimulation for Lower Urinary Tract Symptoms in Pediatric Patients: A PET Study

• Ansari M and Yadav P
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: Peripheral nerve stimulation via lumbosacral route has shown to modulate cortical and subcortical brain areas which seem to control the complex process of micturition, i.e., sensation of bladder filling and the timing of micturition. The present study was conducted to investigate the changes in brain activity during modulation of various brain areas after transcutaneous posterior tibial nerve stimulation (TcPTNS) for lower urinary tract symptoms (LUTS) in pediatric patients. Materials and Methods: We used 18 FDG PET to investigate the effects of PTNS on brain activity in pediatric patients with urodynamically proven detrusor overactivity (DO) or underactive detrusor (UD). All the patients underwent weekly sessions for 30 min for 12 weeks followed by 3 weekly maintenance therapy. PET CT brain was done before the start of TcPTNS and at the end of induction therapy i.e., 3 months. Results: The study included 21 pediatric patients with a mean age of 5.6 yrs (range 4–16 yrs). Of the 21 patients, 12 had overactive bladder with urodynamically proven DO and 9 had underactive detrusor. In cases overactive bladder TcPTNS decreased the activity in the cerebellum, midbrain and adjacent midline thalamus and limbic cortical areas, i.e., the cingulate gyrus, ventromedial orbitofrontal gyrus and prefrontal cortex. These are the areas involved in the sense of bladder filling. While FDG uptake was more avid in these areas before the start of TcPTNS. On contrary the avid uptake was noted in hypothalamus and prefrontal area in cases of underactive detrusor. These are the areas involved sensorimotor learning and the initiation of voiding. Conclusions: Our findings suggest that after therapy by TcPTNS the focus of brain activation changes from areas involved in sensorimotor learning to areas involved in the sense of bladder filling (as to overcome urge in DO) and the initiation of voiding (in cases of underactive detrusor).

1.14.6. MP-14.06: Clinical Follow up of Patients with Multiple Sclerosis 10 Years After PDE5Is Treatment for Erectile Dysfunction: A Real Life Cohort Study

• Thomas C ¹, Kratiras Z ², Samarinas M ³, Kartsaklis P ⁴ and Konstantinidis C ⁵

¹ 

General Hospital of Corinth, CORINTH, Greece

² 

National & Kapodistrian University, Urology Dept, Attiko Hospital, Athens, Greece

³ 

General Hospital of Larissa, Larissa, Greece

⁴ 

General Hospital Of Patras “O Aghios Andreas”, Patras, Greece

⁵ 

National Rehabilitation Center, Athens, Greece

Abstract: Introduction and Objectives: Erectile dysfunction is very common in patients suffering from multiple sclerosis, the prevalence varies from 30 to almost 90. Our aim was to study the adherence of MS patients to PDE 5 Is, in 10 years period. Materials and Methods: 119 MS patients suffering from ED that were treated with PDE 5 Is were evaluated in 2015 concomitant cardiovascular diseases, hormonal and psychiatric disorders were excluded efficacy was evaluated with IIEF 5 and SEP 2 3 questions. We re-evaluate our data now in order to assess the adherence to PDE 5 Is, almost 10 years after. Results: 10 years after we collected data from 94 patients out of the original 101 responders. From the sildenafil group, 20 out of 36 are still on, 5 on daily tadalafil, 1 on intra cavernosal injections, 1 died, 3 were lost from follow up, 1 underwent a 3 piece inflatable penile prosthesis insertion, 2 stopped due to lack of sexual partner and 3 stopped due to MS progression. From the vardenafil group, 5 15 are still on, 2 on sildenafil, 2 on daily tadalafil, 1 on ICC, 3 without partner and 2 stopped due to progression. From the avanafil group, 48 responders are still on, 1 on sildenafil, 1 on daily tadalafil, 1 on ICC and 1 stopped to progression. From the on demand tadalafil group, 7 18 are still on, 5 on daily tadalafil, 1 on sildenafil, 2 were lost from follow up, 1 on ICC, 1 without partner and 1 stopped due to progression. From daily tadalafil group, 10 24 are still on, 1 is dead, 1 on ICC, 6 on sildenafil on, 1 underwent penile prosthesis, 2 without partner, 3 stopped due to progression. Conclusions: After almost 10 years of follow up, the majority of our MS patients remained on PDE 5 inhibitors, either the one prescribed initially or a different one. The medication dropout rate, in our cohort, is approximately 24 while disease progression and lack of sexual partner were the major reasons for withdrawal.

1.14.7. MP-14.07: Couple Satisfaction After Treatment of Premature Ejaculation with Erectile Dysfunction is Better than Premature Ejaculation Alone: A Retrospective Analysis

• Deshpande A, Gupte D, Shukla V and Pattnaik P
• Bombay Hospital Institute of Medical Sciences, Mumbai, India

Abstract: Introduction and Objectives: This retrospective study aimed to compare the efficacy of medical treatment in two groups: patients with premature ejaculation (PE) and patients with both erectile dysfunction (ED) and premature ejaculation in terms of subjective patient satisfaction with premature ejaculation index (PEI) and intravaginal ejaculation latency time (IELT). Materials and Methods: Medical records of male patients diagnosed with premature ejaculation, according to the International Society of Sexual Medicine, who received treatment with Dapoxetine/Paroxetine or Tadalafil with Dapoxetine for PE or ED + PE, respectively, were analyzed. Data on patient satisfaction, treatment details, and safety profiles were collected from the records and through telephonic conversations. The pre- and 4-week post-treatment assessment parameters were compared, including IELT and PEI. Exclusion criteria included refractory erectile dysfunction, patients with contraindications to study medications, and patients lost to follow-up. Results: The dataset comprised 40 patients with a median age of 52 years (range: 32–70 years) who were treated for PE. Patients were divided into two groups: Group 1 (PE; n1 = 18) and Group 2 (ED with PE; n2 = 22) who received appropriate treatment. In both groups, there was a significant increase in mean IELT after treatment (p < 0.05). The premature ejaculation index score improved from 22 to 35 in Group 1 and from 18 to 42 in Group 2 post-treatment. Patient-perceived improvement, assessed through paired t-tests, was significantly better in Group 2 (ED + PE) compared to Group 1 (PE) (p < 0.05). However, there was no statistically significant difference in IELT improvement between the two groups. Conclusions: Patients with ED + PE showed greater subjective improvement in overall sexual satisfaction compared to those with PE alone. The study did not find any statistically significant difference in the improvement of IELT between the two groups. These findings highlight the importance of considering subjective patient satisfaction when assessing the efficacy of medical treatments for sexual disorders.

1.14.8. MP-14.08: Efficacy and Safety of Treatment with the Use of Intraurethral Alprostadil (Vitaros^©) on Demand in Men with Spinal Cord Injury and Multiple Sclerosis

• Thomas C ¹, Kartsaklis P ² and Konstantinidis C ³

¹ 

General Hospital of Corinth, CORINTH, Greece

² 

General Hospital Of Patras “O Aghios Andreas”, Patras, Greece

³ 

National Rehabilitation Center, Athens, Greece

Abstract: Introduction and Objectives: Erectile dysfunction is a great concern of patients suffering from SCI and MS, 80% and 70% respectively, deteriorating their QoL. Although PDE5Is consist the first line of ED treatment, intraurethral use of alprostadil seems a challenging alternative treatment. The aim of the study is the evaluation of the efficacy and safety of treatment with the use of intraurethral alprostadil on demand in men with neurogenic ED due to spinal cord injury or multiple sclerosis. Materials and Methods: We prospectively collected data of 54 men suffering from SCI and 50 from MS who used Vitaros for ED. The protocol required a minimum administration of intraurethral alprostadil for at least twice a week, even without a subsequent sexual intercourse for a period of 6 weeks. Inclusion criteria absence of ED prior the accident or the onset of the disease (IIEF5 score > 21, Erection Hardness Score EHS ≥ 3, affirmatively answers to Sexual Encounter Profile questions 2 and 3 (SEP2 & SEP3), absence of moderate/severe cardiovascular disease, diabetes mellitus and metabolic syndrome. All men with SCI were performing intermittent catheterizations (ICs) and 75% of MS group (35 patients). Mean age was 43.5 and 38.5 respectively, mean IIEF5 score prior the therapy 15 and 16 and EHS score 1.7 and 1.9. Results: After 6 weeks, 6 patients dropped out from the group of SCI due to hypotension or urethral pain and 3 from MS group due to urethral pain. Vitaros implied an improvement of 4.4 points for the IIEF5 score and 1.1 for the EHS score in the SCI group, while the improvement for the MS group was 4.1 points and 1.3 points respectively. The subgroup of MS patients who did not perform ICs benefited the most in comparison with the other patients and none of them discontinued the treatment. At the end, 23 SCI patients and 27 MS patients selected Vitaros as an alternative. Conclusions: Vitaros is an alternative treatment for neurogenic patients suffering from SCI and MS, less effective though in ICs users, due to alteration of the epithelium of the urethra tosquamous due to repetitive injuries as catheters pass through, making the agent less absorbable through it.

1.14.9. MP-14.09: Intracavernosal Application of Placenta-Derived Stem Cells for the Treatment of Erectile Dysfunction, Double-Blind Clinical Trial

• Vega Tepos I
• Urologia/Andrologia, Córdoba, Veracruz, Mexico

Abstract: Introduction and Objectives: The characteristics of stem cells have triggered significant interest due to their regenerative capacity and the potential to replace damaged cells particularly, there has been a notable interest in its application for erectile dysfunction. We assess the safety and efficacy of stem cell treatment in patients with erectile dysfunction, through a randomized clinical trial with control groups. Materials and Methods: The analysis included 18 patients between August 2022 and October 2023, divided into 3 groups; stem cells/stem cells with scaffold (specially prepared with albumin) and placebo and they were monitored for 14 months. For statistical analysis, patient data were collected, including medical records, the IIEF-5 scale to assess erectile dysfunction, and measurements of penile dimensions (thickness and length), as well as peak systolic velocity and end diastolic velocity from penile Doppler ultrasound, both before and after the application of stem cells. Statistical analyses such as t-tests and ANOVA were conducted to compare IIEF-5 scores and penile measurements before and after intervention across different. Results: In terms of IIEF scores, the cohort treated with stem cells + scaffold (albumin) demonstrated significant improvements in IIEF-5 scores compared to both the placebo cohort and those who received only stem cells. The placebo group did not show notable differences in IIEF-5 scores or penile dimensions. Regarding the evaluation of penile Doppler parameters, a substantial and notably superior improvement was observed in the group of patients treated with stem cells + scaffold (albumin). Conclusions: Our clinical trial holds significant importance as it employs a double-blind methodology with a placebo. It is one of the few clinical trials worldwide and marks the first known research in Latin America, with encouraging results. A larger-scale studies are necessary to confirm these findings. The intracavernosal application of stem cells is deemed safe, well-tolerated, and generates minimal side effects.

1.14.10. MP-14.10: Our Experience with the Effective Shah Penile Prosthesis at a Municipal Tertiary Care Center: Report of Outcomes and Patient& Partner Satisfaction Rates Using QoLPSS Scoring

• Kothari P, Parab S and Ghosai K
• B.Y.L Nair Ch Hospital, Mumbai, India

Abstract: Introduction and Objectives: Penile prosthesis implantation is the final stop treatment for men with severe ED (erectile dysfunction) not responding to other treatments. Shah prosthesis is a hinged silicon prosthesis which is a cost effective option compared to the imported malleable and inflatable prosthesis especially in the Indian scenario. We aim to present our experience with 25 cases of Shah prosthesis with documentation of patient & partner satisfaction scores using the QOLPSS score translated into local languages. This is a novel attempt as this score has not been used previously for Indian Shah penile prosthesis. Materials and Methods: 25 patients with arteriogenic (9), venogenic (6), psychogenic (3), combined (3) and post priapism ED underwent prosthesis placement with mean operative time of 146 min. Stretched penile length (SPL) was measured preoperatively and intraoperatively corporal measurements were taken and need for removal of sleeves and use of rear tip extenders noted. Patient satisfaction scores were calculated 6 months to 2 years post operatively using Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire translated into local languages and adding a question for residual tumesence. The scores were analysed to ascertain factors for patient or partner dissatisfaction. Results: 20/25 (80%) patients reported good satisfaction scores in all domains (functional, social, relational and personal) at 3 and 6 months. One patient had poor relational score and the post priapism patient requiring revision. Superficial wound infection was seen in one patient. The average cost of surgery was INR 30,000. Partner satisfaction rates were also calculated, and it was found partner satisfaction and counselling of partner were very important aspects for satisfaction. The scores for post priapism patients and the patient with infection were significantly lower compared to other patients. One Female partner remained dissatisfied despite successful surgical outcome. Conclusions: Shah penile prosthesis is very effective and economic solution for ED patients in the lower socioeconomic strata with excellent satisfaction rates when done after appropriate counselling including the partner. Preoperative assessment and specific intraoperative nuances to select the model and tailor it achieves best results. QoLPSS scoring system can be used successfully for post op outcomes in malleable and hinged prosthesis after further validation.

1.14.11. MP-14.11: Patients’ Understanding and Perception of Erectile Dysfunction: Hong Kong Versus Europe

• Pang K ¹, Tsang S ², Na Y ¹, Chun S ¹, Ho B ² and Ng A ²

¹ 

The University of Hong Kong, Hong Kong, China

² 

Queen Mary Hospital, Hong Kong, China

Abstract: Introduction and Objectives: The worldwide incidence of erectile dysfunction (ED) is ~42–52%. Recent data from Europe have shown that patients have little understanding about ED. The aim of this study was to compare the findings from a Hong Kong (HK) cohort with data from Europe. Materials and Methods: In December 2023, batch emails were sent out via the Hong Kong University portal and surveys were distributed in outpatient clinics. Our survey questions were based on The Urology Foundation (TUF, n = 2000, June 2023) and European Association of Urology (EAU, n = 3032, July 2020) questionnaires to ensure consistency. Results: Overall, 420 responses were received. The incidence of ED in our cohort was 51%. Around 47% of HK men (EAU, 51%) were incorrect about what ED is; 77% (EAU, 27%) do not talk with anyone about ED, because around 53% (EAU, 21%) do not feel comfortable talking about ED; 33% (TUF, ~50%) would not visit a doctor if they had ED; 27% (TUF, 22%) are not aware that ED could be a sign of heart disease; 89% (TUF, 77%) would be more likely to seek help if they knew ED was a sign of heart disease; 85% (EAU, 54%) have heard of phosphodiesterase-5 inhibitors (PDE5i); but 34% (EAU, 17%), 21% (EAU, 14%), 28% (EAU, 11%), 12% (EAU, 7%), 14% (EAU, 7%) have heard of vacuum device, penile injections, penile implants, shockwave, topical therapies respectively. Conclusions: Around half of men do not know what ED is. Majority of men do not talk to anyone about ED because half of them feel uncomfortable talking about it. Around a third would not visit a doctor if they had ED, but majority wound if they knew ED could be a sign of heart disease. Up to a third are not aware of alternative treatments to oral PDE5i. Increased patient awareness is required to exclude significant underlying causes of ED, to encourage patients to seek help and to improved knowledge on various treatment options.

1.14.12. MP-14.12: Peyronie’s Disease: Surgical Treatment of Challenging Situation with Modern Strategies- Penile Prosthesis

• Uddin M
• Cumilla Medical College, Cumilla, Bangladesh

Abstract: Introduction and Objectives: Peyronie’s disease is a common debilitating condition results in penile deformity and compromises sexual functioning. Presence of erectile dysfunction significantly impacts treatment considerations. Patients of Peyronie’s disease with significant erectile dysfunction who desires the most reliable treatment, penile prosthesis placement should be strongly considered. Patients with relatively mild curvature, prosthesis placement alone may result in adequate straightening. However, many patients will require additional straightening maneuvers such as manual modeling and plaque incision with or without grafting for severe curvature. Objectives: To share outcome and satisfaction of our patients series and to show the feasibility of use of semi rigid penile prosthesis for treatment of Peyronie’s disease with erectile dysfunction. Materials and Methods: In this retrospective study total 26 patients underwent semi rigid penile prosthesis implantation for Peyronie’s disease who have significant penile curvature and erectile dysfunction from January 2018 to February 2024 with age range 45 to 67, mean 56 years at Cumilla Medical College and private clinics. Follow up period was 3 months to 5 years. Results: Among 26 patients, 22 (84.61%) patients underwent prosthesis implantation along. 2 (7.69%) patients with residual curvature improved with manual modeling and another 2 (7.69%) patients required plaque incision and tunical grafting. 25 patients (96.15%) showed functionally straight penis. 1 patient (3.85%) had shortening. 3 patients (11.53%) had infection, 1 patient (3.85%) had sensory change and 1 patient (3.85%) complain of pain. Overall 24 patients (92.30%) were satisfied with penile prosthesis implantation for correction of deformity and penetrating intercourse. Conclusions: Penile prosthesis is the only treatment modalities to provide acute and satisfactory outcomes to the morphologic deformities associated with Peyronie’s diseases and erectile dysfunction.

1.14.13. MP-14.13: Prediction of Left Ventricular Diastolic Dysfunction by Investigation of Erectile Dysfunction

• Bajramovic S ¹, Sabanovic Bajramovic N ¹, Alic J ¹, Iglica A ¹ and Begic E ²

¹ 

Clinical Centre University Sarajevo, Sarajevo, Bosnia and Herzegovina

² 

General Hospital Abdulah Nakas, Sarajevo, Bosnia and Herzegovina

Abstract: Introduction and Objectives: Erectile dysfunction is associated with an increased risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the association between left ventricular diastolic dysfunction (LVDD) and erectile dysfunction (ED) without overt cardiovascular disease. Materials and Methods: Cardiac structure and function were evaluated in 60 male patients (mean age 54.6 ± 5.6) with ED and compared to controls without ED (60 male patients of matching age and comorbidities). The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade ED. Left ventricular diastolic function was assessed by peak early and late diastolic mitral inflow velocities, early diastolic mitral annular velocity, ratio of early transmitral filling velocity to early diastolic mitral annular velocity, maximum LA volume index and peak tricuspid regurgitation velocity. Left ventricular systolic function and left ventricular mass index were also analyzed as additional echocardiographic parameters. Sociodemographic data as well as medical comorbidities like age, smoking, diabetes, hypertension, and dyslipidemia were screened for. The relationship between the severity of ED and LVDD as determined by Doppler measurements and tissue Doppler imaging were examined. Results: The mean age, Body Mass Index, total testosterone, low- and high-density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the LVDD and control group (p > 0.05). There was a negative correlation between the stage of LVDD and IIEF-5 score (r = −0.548, p < 0.05). Additionally, the left atrial volume index, peak TR velocity and E/e’ ratio were independent risk factors for lower IIEF-5 score (95% CI: 0.704–0.154, p < 0.001); (95% CI: 0.862–1.342, p < 0.001); (95% CI: 0.956–1.473, p < 0.001) respectively. Conclusions: This study indicates that LVDD is significantly associated with ED. There were significant associations between the increased severity of ED and the presence of LVDD in middle-aged men. Early detection of diastolic dysfunction in men with ED may be beneficial for initiating preventive treatments or lifestyle changes before heart disease develops.

1.14.14. MP-14.14: Responses of AI Chatbots to Testosterone Replacement Therapy: Patient’s Beware!

• Pabla H ¹, Lange A ², Nadiminty N ² and Sindhwani P ²

¹ 

Government Medical College and Hospital, Chandigarh, India

² 

University of Toledo College of Medicine and Life Sciences, Toledo, United States

Abstract: Introduction and Objectives: Using chatbots to seek healthcare information is becoming more popular. Misinformation and gaps in knowledge exist regarding risk and benefits of testosterone replacement therapy (TRT). Here we aimed to assess and compare the quality and readability of responses generated by four AI chatbots. Materials and Methods: ChatGPT, Google Bard, Bing Chat and Perplexity AI were asked the same eleven questions regarding TRT. The responses were evaluated by four reviewers using DISCERN and Patient Education Materials Assessment Tool (PEMAT) questionnaires. Readability was assessed using the Readability Scoring system v2.0 to calculate the Flesch-Kincaid Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). Kruskal-Wallis statistics were completed using GraphPad Prism V10.1.0. Results: The DISCERN scores varied across the AI chatbots with Google Bard achieving the highest at 56.5 and Bing AI lowest at 40. For PEMAT understandability, Google Bard excelled with a score of 96%, whereas Bing AI received the lowest score of 57%. Similarly, for PEMAT actionability, Google Bard scored highest at 74% and both Bing AI and Perplexity lagged with a score of 40%. The readability parameter FRES was highest for Perplexity at 41.9 and Chat GPT was lowest at 25.1. Perplexity had the best FKGL score of 10.8 and Chat GPT had the worst score of 14.9. Significant differences were found in DISCERN and PEMAT understandability scores between Bing and Google Bard, FRES and FKGL scoring between ChatGPT and Perplexity. Conclusions: ChatGPT and Google Bard were top performers based on their quality, understandability and actionability. Despite Perplexity scoring higher in readability, the generated text still maintained an eleventh-grade complexity. Perplexity stood out for its extensive use of citations, however, it offered repetitive answers despite the diversity of questions posed to it. Google Bard demonstrated a high level of detail in its answers, offering additional value through visual aids.

1.14.15. MP-14.15: Devastated Bulbous Urethra: Preputial Flap Tubularization with Bilateral Gracilis Flap Interposition and Scrotal Advancement as Salvage Urethroplasty in a Case of Resilient Stricture Urethra

• Bhusal I, Jain S and Aggarwal N
• AIIMS, New Delhi, Nepal

Abstract: Introduction and Objectives: In patients with devastated bulbous urethra, traditional repair options are often limited due to the lack of reliable local tissue for reconstruction. We present a case report detailing a novel approach utilizing preputial flap tubularization combined with bilateral gracilis flap and scrotal advancement for salvage of a devastated bulbous urethra in an 18-year-old male with pelvic fracture urethral injury and rectourethral fistula secondary to a road traffic accident. Materials and Methods: In December 2023 post 6 months of RTA and PFUI our patient underwent transpubic urethroplasty along with primary repair of rectal fistula. However he developed urine leak from the perineal wound in post operative period and was found to have bulbar necrosis. Review of literature done to explore different surgical techniques. Salvage surgery was performed three weeks (early) later utilizing a combination of preputial flap tubularization and interposition of bilateral gracilis muscle flap and scrotal advancement. Patient was followed up after surgery till recovery. Results: At two month post-surgery, the patient demonstrated successful reconstruction with no evidence of urethral dehiscence and voiding well. Conclusions: Bulbar urethral ischemic necrosis (BUIN) is a catastrophic iatrogenic event that occurs after repeated urethral transection. These patients represent a challenging cohort requiring a versatile approach and a broad knowledge of different reconstructive technique. BUIN must be managed in high-volume centers by experts to achieve satisfactory long-term outcomes. This case illustrates the efficacy of this innovative technique in managing complex urethral injuries when traditional repair options are not feasible. The combination of prepucial flap tubularization with bilateral gracilis flap and scrotal advancement offers a promising salvage option for devastated bulbous urethra, providing reliable tissue for reconstruction and achieving favourable outcomes. Single-stage pedicle flapvs. from prepuce or distal penile skin should be preferred over multi-stage surgery.

1.14.16. MP-14.16: Kenya’s Experience with Penile Fracture in a Tertiary Hospital-Kenyatta National Hospital

• Otele W ¹ and Oluoch C ²

¹ 

Univerity of Nairobi, Nairobi, Kenya

² 

Nyamira County Government, Nyamira, Kenya

Abstract: Introduction and Objectives: Penile fracture is the rupture of tunica albuginea of the corpus cavernosum occurring during erection. Contemporary literature reports vaginal intercourse as the most common cause of penile fracture. Other reported causes are self-inflicted injuries, masturbating against a hard surface, or placing an erect penis into tight pants. Optimal management is not yet well established because of paucity of cases. The experience with penile fractures at the Kenyatta National Hospital (KNH) was reviewed to help add to world knowledge. Study objective was to determine the mechanisms of fracture, clinical presentation, concurrent urethral injuries, utilized diagnostic and therapeutic methods and patient reported outcomes. Materials and Methods: This was a descriptive retrospective study for all patients with penile fractures managed between January 2011–December 2021. Statistical Packages for Social Sciences (SPSS) version 23.0 was employed for data analysis. Results: A total of 28 patients presented with penile fractures. Mean age was 32 years (range 19–48 years). Majority of the patients (27) presented early in the acute phase while one patient presented with late symptoms (chordee, plaque and painful erections) after 3 months. The average length of hospital stay was 3 days (range 2–6 days). The three common symptoms presenting in all patients were penile pain, pop sound and penile deformity. No patient presented with inability to void or blood at the urethral meatus. Sexual intercourse (46%) was the commonest aetiology followed by masturbation (29%). Penile ultrasound was performed in half of the patients while only 19% had urinalysis done prior to treatment. Corrective surgery was performed in all patients who presented early but non-operative treatment prevailed in the late presenter. Majority of patients (86%) were satisfied with both erection and cosmetic appearance and only 14% developed chordee. Conclusions: Penile fracture predominantly occurred secondary to sexual intercourse and was bimodal in clinical presentation. Corrective surgical management was the hall mark of early presentation. Complications emanating from this rare condition are few and amenable to conservative treatment leaving patient with good cosmetic appearance and a high satisfaction rate.

1.15. Moderated Oral ePoster Session 15: Stones—Evaluation & Medical Management, Stones—Surgical Treatment

• Saturday, October 26
• 0800–0900

1.15.1. MP-15.01: A Prospective Observational Study to Correlate the Ureteral Wall Thickness (UWT) with the Severity of Symptoms and Spontaneous Passage of Solitary Ureteral Stones of 10 mm or Less and Find Predictive Factors for Spontaneous Passage

• Pathak N, Singh A, Ganpule A, Sabnis R and Desai M
• MPUH, Nadiad, India

Abstract: Introduction and Objectives: Primary objective was to study predictive factors for spontaneous passage of ureteral stones of 10 mm or less. Secondary objectives were to assess symptom severity, spontaneous passage rates, ureteral wall thickness, degree of impaction, type of treatment required, stone free rates, complications, auxillary procedure requirement. Materials and Methods: Prospective observational study done in a single center in 54 consecutive patients presenting with a single ureteral stone of 10 mm size or less. Initial evaluation consisted of NCCT at the time of presentation and patients were divided into two groups based on whether spontaneous passage of stone had happened with medical expulsion therapy. 27 patients had spontaneous stone passage and 27 required surgical intervention for stone removal (Group 1 and Group 2). Results: Group 1 had smaller maximal stone diameter (Median, IQR in mm = 5.5 (5–7) vs. 7.8 (6–8.5), p < 0.001). Group 1 had lesser ureteral wall thickness on NCCT scan (Median, IQR in mm = 0.9 (1–1.23) vs. 1.5 (1–2.1), p −0.001). Stone location, symptom severity, stone density, degree of hydronephrosis, renal parenchymal thickness were not statistically significant variables between both the groups. Standard binary multivariate logistic regression analysis was done to know the predictive factors for intervention for stone removal which showed that history of recurrent stone formation correlated negatively with risk of requiring intervention and maximal stone diameter and ureteral wall thickness correlated positively with risk of requiring intervention. Conclusions: Maximal stone diameter and ureteral wall thickness were predictive factors for spontaneous expulsion for ureteral stones of size 10 mm or less.

1.15.2. MP-15.02: Decision Regret Analysis of Patients Opting for Early URSL Versus Trial of Medical Expulsive Therapy After Shared Decision Making for Uncomplicated Small Ureteric Calculi ≤ 1 cm: Results from the Draumet Study

• Chawla A ¹, Singh A ², Vishwanath K ¹, Hegde P ², Pillai S ² and De La Rosette J ³

¹ 

KMC Manipal. Manipal Academy of Higher Education, Manipal, India

² 

KMC Manipal. MAHE, Manipal, India

³ 

Istanbul Medipol University, Istanbul, Türkiye

Abstract: Introduction and Objectives: Adults aged more than 18 years with one stone up to 10 mm in either ureter were included. After SDM, the patients were allocated into their opted group viz. URSL or MET. Patients in each group were reassessed at “treatment completion”. Cambridge Ureteric Stone PROM (CUSP) questionnaire, Decision Regret Scale and the OPTION scale were filled at treatment completion. Materials and Methods: Adults aged more than 18 years with one stone up to 10 mm in either ureter were included. After SDM, the patients were allocated into their opted group viz. URSL or MET. Patients in each group were reassessed at “treatment completion”. Cambridge Ureteric Stone PROM (CUSP) questionnaire, Decision Regret Scale and the OPTION scale were filled at treatment completion. Results: 111 patients opted for MET, while 396 patients opted for early URSL. Mean stone size was larger in URSL group (7.16 ± 1.63 mm vs. 5.50 ± 1.89; p < 0.001). Decisional conflict was higher in patients opting for URSL (77.3% vs. 57.7%; p < 0.001). Stone-free rate at four weeks was higher in URSL group (87.1% vs. 68.5%, p < 0.001). Decisional regret was higher in patients opting for MET (33.24 ± 30.89 vs. 17.26 ± 12.92; p = 0.002). Anxiety, was higher in patients opting for MET (6.94 ± 1.89 vs. 5.85 ± 1.54; p < 0.001). Urinary symptoms and interference in patients’ travel plans and work-related activities were more in URSL group (6.21 ± 1.57 vs. 5.59 ± 1.46; p < 0.001 and 6.56 ± 1.59 vs. 6.05 ± 1.72; p < 0.001 respectively). Conclusions: After SDM, decisional regret is higher in patients opting for MET mainly due to need for additional procedure for attaining stone clearance and the protracted treatment duration with increased pain and anxiety during the treatment course. Despite higher decisional conflict, more patients opt for early URSL for attaining early stone clearance.

1.15.3. MP-15.03: Evaluating the Effect of Visipaque Contrast Agent Used in Intravenous Urography on Expulsion or Displacement of Ureteral Stones in Shahid Beheshti Hospital in Hamedan

• Mehrabi S ¹, Mohammadsouri B ², Amirzargar M ³ and Derisi M ⁴

¹ 

Assistant Professor of Urology, Urology & Nephrology Research Center, Hamadan University of Medical Science, Hamedan, Iran

² 

Assistant Professor, Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamedan, Iran

³ 

Kidney Transplant Fellowship, Professor, Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamedan, Iran

⁴ 

Urology & Nephrology Research Center, Hamadan University of Medical Science, Hamedan, Iran

Abstract: Introduction and Objectives: Urinary tract stone disease is among the oldest known diseases that induce a large number of negative effects, including recurrent stone formation and kidney failure. One method of diagnosing urinary tract stones is intravenous urography (IVU), which uses iodine-containing contrast agents. Since no study was found that has evaluated the role of the contrast agent injected for IVU in the displacement or expulsion of ureteral stones, the present study was designed to evaluate the effect of the Visipaque contrast agent used in IVU on displacement or treatment of ureteral stones. Urinary tract stone disease is among the oldest known diseases that induce a large number of negative effects, including recurrent stone formation and kidney failure. One method of diagnosing urinary tract stones is intravenous urography (IVU), which uses iodine-containing contrast agents. Since no study was found that has evaluated the role of the contrast agent injected for IVU in the displacement or expulsion of ureteral stones, the present study was designed to evaluate the effect of the Visipaque contrast agent used in IVU on displacement or treatment of ureteral stones. Materials and Methods: In this clinical trial, patients with flank pain and renal colic symptoms referring to the Urology Clinic of Shahid Beheshti Hospital, Hamedan, Iran, during 2020–2021, were entered into the study after examination, request for ultrasound, kidney ureter bladder (KUB), and confirmation of opaque ureteral stone and were randomly (by lottery method) divided into two groups: Case (IVU using Visipaque) and control. Then, the results of the stone site and expulsion were compared in both groups. This study was registered in the Iranian Registry of Clinical Trial Database (IRCTID) (code: IRCT20200616047796N1). Results: One hundred and seventeen (n = 117) patients with ureteral stones participated in this research. The mean age of patients was 38.13 ± 10.47 years. The percentage of stone expulsion was 22% in the intervention group versus 5.2% in the control group (p = 0.008), and the percentage of stone displacement was 34.80% in the intervention group versus 5.20% in the control group (p = 0.047), demonstrating the significant effect of this method on stone expulsion and displacement. Conclusions: Our results showed that IVU significantly affected stone expulsion and displacement.

1.15.4. MP-15.04: Improving Visual Recognition of Urinary Stones with Artificial Intelligence by Learning Frequent Associated Morphologies

• Turcotte B, Estrade V, Denis De Senneville B, Chicaud M, Alezra É, Capon G, Robert G, Bernhard J and Bladou F
• CHU de Bordeaux, Bordeaux, France

Abstract: Introduction and Objectives: Urinary stone morphology analysis, as described by Daudon and al., leads to increased knowledge of lithogenic factors associated with stone formation compared to spectrophotometric infrared recognition alone. Endoscopic visual recognition of stone morphologies may increase the rapidity and accuracy of knowledge as we can evaluate macroscopic surface, section, and core morphology while fragment analysis only evaluates a part of the entire stone. Recently, we showed concordance between endoscopic visual recognition by an expert urologist and microscopy. We also showed very high accuracy of visual recognition of digital pictures with artificial intelligence (AI). This study aimed to see if we could increase AI accuracy by learning frequent associations between morphologies. Materials and Methods: We used a database of 398 endoscopic pictures of urinary stones with their respective microscopic and spectrophotometric infrared analysis. We looked for frequent associations between mixed morphologies. We tested our hypothesis with the most frequent pure and mixed stones: Ia, IIb, IIIb, Ia + IIb, and Ia + IIIb. Results: With our original process, we aimed a mean accuracy of identifying the right morphology of 81% (± 10%) with 90% for Ia, 81% for IIb, 81% for IIIb, 72% for Ia + IIb and 79% for Ia + IIIb. After learning frequent associations to AI, we increased the mean accuracy to 90% (± 7%) with 94% for Ia, 88% for IIb, 94% for IIIb, 85% for Ia + IIb, and 91% for Ia + IIIb. The p value was statistically significant for all morphologies (Mann-Whitney). Conclusions: Teaching AI frequent associations of urinary stone morphologies increases its ability to accurately identify the right morphology on digital pictures of in situ stones of pure and mixed morphologies.

1.15.5. MP-15.05: Quantitative Analysis of Pyelovenous Backflow in a Porcine Model

• Hong A, Bolton D and Jack G
• Austin Health, Melbourne, Australia

Abstract: Introduction and Objectives: Irrigation fluid is required for visualization during ureteroscopy and pyeloscopy. Pressurized irrigation can result in pyelovenous backflow of irrigation into the vascular system providing a mechanism for urosepsis. We aim to quantify the amount of irrigation substrate that is absorbed via pyelovenous backflow into the venous system at various pressures. Materials and Methods: 6 deceased donor porcine kidneys were flushed with 1 L heparinized saline and preserved on ice using a renal transplant protocol. The renal artery was cannulated with a 10Fr catheter and perfused continuously with 0.9% normal saline solution (pH 6.77) at mean arterial pressure of 90 mmHg to simulate arterial blood flow. A steady state of venous effluent from the renal vein was achieved and collected continuously from the renal vein for the duration of the study. The ureter was cannulated with a 10Fr dual lumen ureteric catheter and the tip placed at the ureteropelvic junction and fixed in place with silk ties around the ureter. A pressure monitor (Comet II Pressure Guidewire^®, Boston Scientific Corporation, Massachusetts, United States) was inserted through one lumen and positioned in the renal pelvis for continuous renal pelvis irrigation pressure monitoring. Distilled white vinegar (8% acetic acid, pH 3.32) was infused under pressure through the ureteral access catheter at various renal pelvic pressures (RPP) to replicate pyeloscopy irrigation. RPP was increased in increments of 15 mmHg every 3 min and the venous effluent was collected at each increment. A control arm was conducted using RPP fixed at 30 mmHg for the duration of the 1 h study with the venous effluent collected in the same 3 min intervals. Statistical comparisons were performed using Wilcoxon rank test to compare the 15 mmHg increments. Results: Figure 1 shows venous pH following simulated ureteroscopy with 8% acetic acid at increasing RPP. Wilcoxon rank test demonstrated that from 90 mmHg onwards, the changes in pH were statistically significant. Conclusions: Ureteral irrigation fluids are initially detected in the renal venous effluent in trace amounts when renal pelvis irrigation pressures exceed 60 mmHg, and are statistically significant when RPP exceeds 90 mmHg.

1.15.6. MP-15.06: A Retrospective Study on the Feasibility of 550 μm Holmium Laser Fiber Combined with Disposable Flexible Ureterorenoscope for the Treatment of Renal Cast Stones

• He Q and Zhuo H
• The Third People’s Hospital of Chengdu, Southwest Jiaotong University, Chengdu, China

Abstract: Introduction and Objectives: To explore the feasibility and safety of 550 um holmium laser fiber combined with the disposable flexible ureterorenoscope in the treatment of renal cast stones. Materials and Methods: A retrospective analysis was performed on 60 cases of kidney cast stones (diameter greater than 2 cm) in our hospital from October 2022 to July 2023. Among them, 30 cases of kidney cast stones were treated by 200 μm holmium laser fiber (200 μm group), and the rest were broken by 550 μm holmium laser fiber (550 μm group). The disposable flexible ureterorenoscope (Innovex^®, China) and intelligent pressure control and stone cleaning system (Inventor Technology^®, China) were used in both groups during the operation. The operation time, postoperative infection, and stone-free rate (SFR) of the two groups were analyzed. Results: The mean stone diameter of the two groups was comparable (200 μm group: 3.15 ± 0.55 cm, 550 μm group: 3.34 ± 0.61 cm). However, the CT density of stone was significantly higher in the 550 μm group (1021.1 ± 313.5 HU vs. 928.3 ± 213.5 HU, p < 0.05). The difference in operative time between the two groups was statistically significant (200 μm group: 135.2 ± 21.3 min, 550 μm group: 102 ± 31.3 min). However, the postoperative values of procalcitonin were similar between the two groups (200 μm group: 0.23 ± 0.18 mmol/L, 550 μm group: 0.28 ± 0.14 mmol/L). Intriguingly, the abdominal plain film examination 1 month after the operation indicated that the SFR of the 550 μm group (92.3 ± 5.2%) was significantly higher than 200 μm group (84.2 ± 6.4%). Conclusions: The treatment of renal cast stones with 550 μm holmium laser fiber can significantly improve the effectiveness of lithotripsy. The SFR can be significantly improved when combined with the stone removal basket and negative pressure stone removal system during the operation.

1.15.7. MP-15.07: Comparing the Outcomes of High Power and High Frequency 100 w Holmium Laser with Low Power and Low Frequency 50 w Holmium Laser in the Treatment of Renal Stones Using Flexible Ureterorenoscopes, is the New Technology Winning? A Single Surgeon Single Centre Review

• Gaur A
• University Hospitals of North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees, United Kingdom

Abstract: Introduction and Objectives: High power lasers are now being commonly used for stone surgery and gradually replacing the low power lasers. This study was done to see if cases done by me using high power 100 w holmium laser have better outcomes when compared to the cases done by me using low power 50 w laser machine. Materials and Methods: 2 groups were created. Group A for high power laser and group B for low power laser. In group A cases done by me between December 2020 till December 2023 were reviewed prospectively. While in group B prospectively kept data from September 2017 till December 2020 was reviewed retrospectively. Laser settings in group A were 1 j and 30–53 hz and 0.3 j and 53 hz and in group B 1 j and 12 hz and 0.4 and 12 hz. Results: 102 patients underwent 113 procedures in group A. In group B 102 patients underwent 115 procedures. Mean age in group A was 57.17 ± 16.4 and 61.7 ± 15.7 yrs in group B. Mean stone size in group A was 14.8 mm ± 9.08, range 5–65 mm (including multiple stones) and 13.8 ± 8.13, range 5–40 mm in B. Average time taken in group A was 79.38 ± 38.98 min and 73 ± 31.9 min in group B. Overall all 90.16% were stone free in group A compared to group B in which 81.3% were stone free, this increased to 92% in group A and 84.4% in group B when patients with < 5 mm asymptomatic residual stone fragments were included. Mean duration of stay was 0.4 day in group A and 0.9 days in group B. Mean duration for which stent was left in was 17.06 ± 7.9 days in group A and 15.2 ± 7 in group B. 4/113 3.53% episodes of sepsis or temperature seen in group A with no need for ITU admission. While in group B 6/115 (5.2%) had sepsis or temperature of which 2 needed ITU admission. 1 patient in each group developed ureteric stricture. Conclusions: Group A had better stone clearance than group B. No statistically significant difference was seen in the time taken to clear the stones and complications.

1.15.8. MP-15.08: Cranio-Caudal Bull’s Eye Technique for Superior Calyceal Access During Percutaneous Nephrolithotomy: Determination of Angle, Efficacy, and Outcomes

• Agarwal K, Das C and Kumar R
• All India Institute of Medical Sciences, New Delhi, India

Abstract: Introduction and Objectives: The bull’s-eye technique aims at creating a track through the calyceal fornix, in-line with the medio-laterally oriented infundibulum of middle calyx to minimize intra-renal torque. However, the superior calyx infundibulum has a cranio-caudal (CC) orientation and a medio-lateral access is not in-line with its infundibulum. We evaluated a modified bull’s-eye technique in a cranio-caudal orientation (CCBE) for superior calyceal access during PCNL. Materials and Methods: In an IRB approved, two-phase study, we evaluated the ideal angle for CC puncture in 24 patients who underwent CT scans for unrelated indications. A line was drawn joining the midpoints of the pelvis and superior calyx and extended to body surface. The angle it made with the perpendicular to body surface was recorded as the ideal angle (Figure 1). Subsequently, patients planned for superior pole access PCNL were prospectively enrolled for the study and outcomes were recorded. Results: CT scans of 24 patients were reviewed and the ideal angle for CC rotation for left and right kidney were 68.6° and 68.1° respectively. All these would have resulted in access above the 10th rib. CCBE technique was then used in 24 other subjects and was successful in 23, requiring single attempt in 21 of them. The median angle of CC rotation, puncture time and fluoroscopy screening time were 15°, 205 s, and 36 s respectively (Table 1). Conclusions: Superior calyceal access, in line with its infundibulum, can be achieved using a 15° CCBE technique. This is safe and successful in most patients with a single attempt and short fluoroscopy time.

1.15.9. MP-15.09: Does Quality of Life Matter in Patients with Ureteral After Ureteroscopy?

• Azli M, Sadki R and Benrabah R
• Kouba Hospital, Algiers, Algeria

Abstract: Introduction and Objectives: To evaluate the prevalence of the side effects associated with ureteral stents and their impact on sexual function and quality of life of patients. Materials and Methods: From March 2013 to April 2014, 100 patients (66 men and 44 women; mean age: 41.3 years [range: 18–74]) with unilateral ureteral stents were included in this study. Stents were placed for various etiologies, urolithiasis (66 cases), infection diseases (14 cases), ureteroplasty (08 cases), renal transplantation (06 cases) and cancer diseases (06 cases). 28 cm 7F polyurethane stents double J. The safety of stents and their impact on sexual function and quality of life of patients were evaluated on the day of removal by a questionnaire USSQ. Results: The mean duration of stenting was 5.6 weeks [range: 3–12]. Of the 100 individuals in the final study, 100% reported one or more urinary symptoms after stent removal. Dysuria, urinary frequency, hematuria and urgency were reported by 21%, 50%, 52% and 90% of the patients respectively. Flank pain 68%, the mean score on the VAS was 3.6 [0–10] for global impression, for bladder pain 75% and for low back pain during micturition 50%. More than 22% of patients experienced stent related pain affecting daily activities, 32% reported sexual dysfunction, and 16% reported reduced work capacity and negative economic impact. At the end of the study, all patients did not want to renew the experience. Conclusions: Double J stents are associated with high morbidity and significant impact on patient quality of life. Our study confirms that the duration of stenting must be as short as possible in order to improve patient comfort.

1.15.10. MP-15.10: Factors Predicting Postoperative Acute Kidney Injury in Patients Undergoing Percutaneous Nephrolithotomy

• Chawla A ¹, Vishwanath K ¹, Hegde P ¹, Pillai S ¹ and De La Rosette J ²

¹ 

KMC Manipal. Manipal Academy of Higher Education, Manipal, India

² 

Istanbul Medipol University, Istanbul, Türkiye

Abstract: Introduction and Objectives: Nephrolithiasis is the third most prevalent condition treated by urologists. The most common stone is a renal stone, and the lifetime prevalence of this condition is 15%. PNL remains the standard procedure for large renal calculi. The main drawback of PNL is its affect on renal functions. The objective of this prospective observational study is to identify the incidence, risk factors, and outcomes of post-PNL-AKI and to create nomogram to predict post-PNL–AKI. Materials and Methods: Demographic and laboratory, stone factors, intraoperative factors were considered. AKI was defined by KIDIGO guidelines. Post-operative AKI patients were followed up with creatinine values till 3 months. Results: Among 322 patients analysed, 40 (12%) patients developed post-PNL-AKI. Male, HTN, hyperuricemia, staghorn calculi, higher Hounsfield units, stone volume, B/L PNL, tract size, and operative time were significantly associated with post-PNL-AKI. To nullify the confounding effect of other risk factors univariate and multivariate analysis was done which showed stag horn, volume of the stone, operative time, B/L PNL, serum uric acid, gender were found to be significant. Based on these factors a nomogram was created. Each factor is assigned points according to the nomogram, the points scale ranges from 140 to 320, and each individual factor is assigned score, and the total score is used to predict the AKI percentage. Internal validation of the nomogram was done and the area under the ROC curve for total score predicting AKI was 0.984 (95% C), with statistically significant (p = < 0.001). At a cut-off of total score ≥ 226, it predicts AKI with a sensitivity of 100%, and a specificity of 97%. The area under the ROC curve for probability predicting AKI was 0.984 (95% CI), was statistically significant (p = <0.001). At a cut-off of probability ≥ 0.15, it predicts AKI with a sensitivity of 100%, and a specificity of 97%. Thus both demonstrating excellent diagnostic performance. Conclusions: Our nomogram can predict percentage of pre-operative AKI in each individual patient, which will help in early identification, proper preoperative counselling and structured planning for the post-operative course to avoid further insult to the kidneys.

1.15.11. MP-15.11: Gopalakrishna Technique: A Novel Approach for Renal Displacement for Superior Calyx Access During PCNL

• Ghosh N
• Baharampur Urology Clinic, Berhampore, India

Abstract: Introduction and Objectives: Access to upper calyx during PCNL is always considered difficult and risky due to increased risk of chest complications. We describe a new technique, named after Dr. R. K. Gopalakrishna, for renal descent for access to upper calyx, even in very high kidneys. Materials and Methods: 18 G Chiba needle was used for renal displacement. After RGP, the needle was passed through the skin and muscle into peri renal fat (but not within renal parenchyma). It was used as a lever to pull the kidney down and then access was made to the upper calyx with another needle. Results: A total of 42 patients, between 2021 and 2023, were undergone PCNL by Gopalakrishna technique of needle displacement of kidney for safe access to upper calyx. Kidney units with congenital anomalies, previous renal or retroperitoneal surgeries, fixed kidneys were excluded from the study. The overall stone clearance rate was 98%. Four patients had significant blood loss necessitating blood transfusion. Two patients developed plural effusion but improved on conservative treatment. Conclusions: Renal displacement by Gopalakrishna technique is a simple, reproducible method for superior calyx access with relatively low complication rates.

1.15.12. MP-15.12: Postoperative Renal Function in Patients with Urolithiasis: A Prospective Observational Study

• Chawla A ¹, Vishwanath K ¹, Hegde P ¹, Pillai S ¹ and De La Rosette J ²

¹ 

KMC Manipal. Manipal Academy of Higher Education, Manipal, India

² 

Istanbul Medipol University, Istanbul, Türkiye

Abstract: Introduction and Objectives: This study aims to investigate the impact of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL) procedures on postoperative renal function in patients with urolithiasis. This study explores how PCNL and URSL procedures impact the preservation of renal function and the progression of chronic kidney disease (CKD) stages. Materials and Methods: A prospective observational study was conducted at a single centre involving 543 patients undergoing PCNL or URSL for urolithiasis. Patient demographics, pre-existing conditions, surgical outcomes, and complications were assessed. Renal function was evaluated using the estimated glomerular filtration rate (eGFR) calculated by the Modification of Diet in Renal Disease (MDRD) formula. Patient distribution across CKD stages was examined, and factors influencing renal function preservation were analysed using multivariate logistic regression. Results: Male predominance was observed in both groups, consistent with urolithiasis trends. Diabetes and hypertension affect around 20% of patients. Complications were mainly of mild severity (Grade 1) as per the Modified Clavien Dindo Classification. URSL demonstrated superior preservation of renal function in advanced CKD stages compared to PCNL. Age, gender, diabetes, hypertension, and prior urolithiasis surgeries influenced patient distribution across CKD stages and postoperative renal function outcomes. Multivariate analysis identified preoperative eGFR, eGFR levels on postoperative days 1 and 30, and hypertension as significant predictors for patients progressing towards renal function deterioration. Conclusions: This study underscores the importance of preserving renal function while managing urolithiasis. URSL exhibited favourable outcomes in advanced CKD stages, highlighting its potential benefit for patients with compromised renal function. The findings emphasise the need for individualised treatment approaches, considering patient demographics and comorbidities. Larger samples, standardised methodologies, and longer-term follow-up are recommended to validate these findings further and enhance understanding of nephrolithiasis treatment implications.

1.15.13. MP-15.13: Systematic Review and Meta-Analysis of Percutaneous Nephrolithotomy in Flank Versus Prone Position

• He Q ¹ and Zhuo H ²

¹ 

Department of Urology, Sichuan, China

² 

The Third People’s Hospital of Chengdu, Southwest Jiaotong University, Chengdu, China

Abstract: Introduction and Objectives: This systematic review and meta-analysis aim to evaluate the efficiency and safety of percutaneous nephrolithotomy (PCNL) between flank position and prone position for the treatment of renal stones. Materials and Methods: PubMed, Embase, and Cochrane Library were comprehensively searched from their inception to Apr 2022. Randomized and nonrandomized trials evaluating renal calculi patients who underwent PCNL via flank position or prone position were included. Data extraction and quality assessment were conducted by two independent reviewers. The outcomes and complications of both groups were compared in this meta-analysis. Results: This review involved five articles (554 patients). Specifically, three articles were randomized controlled trials, and the remaining publications were prospective cohort studies. No significant difference was found in stone-free rate between the flank group and prone group after the PCNL procedure. Similarly, the percutaneous access time, operative time, and hospital stay of flank position had no significant difference compared with the prone group. There was no significant difference in the comparison of complication rates between the flank group and the prone group. Although further analysis indicated that patients in the prone position suffered more hemoglobin drop than the flank group, no significant difference was found in the hemorrhage and blood transfusion rates. Conclusions: Both surgical positions were appropriate for most PCNL procedures and had shown similar efficacy and safety. In practice, the optimal choice should be made according to the patients’ conditions and urologists’ acquaintance.

1.15.14. MP-15.14: The Relationship Between Raised Intrarenal Pressures at Ureteroscopy and Bacteraemia

• Hong A, Leroi M, Bolton D and Jack G
• Austin Health, Melbourne, Australia

Abstract: Introduction and Objectives: Irrigation fluid is used during ureteroscopy and pyeloscopy to aid visualization during the procedure. However, this can result in raised intrarenal pressures (IRPs) which has been associated with peri-operative complications such as sepsis and increased pain. The exact mechanism of these complications is unknown. To explore this, we aim to demonstrate bacteraemia during raised IRPs. Materials and Methods: Four deceased donor porcine kidneys were flushed with 1 L heparinized saline and preserved on ice using a renal transplant protocol. The renal artery was cannulated with a 10Fr ureteric catheter and perfused continuously with 0.9% normal saline solution at mean arterial pressure of 90 mmHg to simulate arterial blood flow. A steady state of venous effluent from the renal vein was achieved and collected continuously from the renal vein for the duration of the study. The ureter was cannulated with a 10Fr dual lumen ureteric catheter and the tip placed at the ureteropelvic junction and fixed in place with silk ties. A pressure monitor (Comet II Pressure Guidewire^®, Boston Scientific, Massachusetts, USA) was inserted through one lumen and positioned in the renal pelvis for continuous renal pelvis irrigation pressure monitoring. An Escherichia coli broth diluted to a concentration of 1×106 colony forming units (CFU) was used as the irrigation fluid. This was infused under pressure through the ureteral access catheter at various IRPs to replicate pyeloscopy conditions. IRP was increased in increments of 15 mmHg every 3-min and the venous effluent was collected at each increment. Results: Figure 1 shows the number of CFUs cultured following simulated ureteroscopy at increasing IRP. Wilcoxon rank test demonstrated that from 90 mmHg onwards, the changes in CFU were statistically significant. Conclusions: E. coli was detected in the renal venous effluent renal pelvis irrigation pressures exceeded 60 mmHg. This became statistically significant when IRP exceeded 90 mmHg.

1.15.15. MP-15.15: Tubeless Percutaneous Nephrolithotomy in Management of Renal Stone, Study of 97 Cases

• Abusamra R ¹, Aburgiga O ² and Benomran A ¹

¹ 

National Cancer Institute Misurata Libya, Misurata, Libya

² 

Ibn Sena Hospital Sirte, Sirte, Libya

Abstract: Introduction and Objectives: In last two decades PCNL became the standard approach in treatment of big sized renal stones and stag horn stones. Placement of a nephrostomy tube at the end of PCNL procedure was believed for many years to prevent urinary extravasation or significant haemorrhage. Here we present our experience with 97 cases of tubeless PCNL (no nephrostomy tube only ureteric catheter left) with respect to the exclusion criteria for tubeless PCNL (significant haemorrhage, perforation, residual stones, & multiple punctures). Materials and Methods: A total of 245 percutaneous nephrolithotomy (PCNL) procedures were done in our department since May 2004 up to February 2011 in Ibn Sena Hospital Sirte & since Jan 2012 up to December 2023 in National Cancer Institute Misrata & private clinic were done. In 97 cases we did not put nephrostomy tube at the end of procedure (tubeless PNCL) only we keep ureteric stent for 24–48 h. Results: In the 97 cases of tubeless PNCL, the procedures were completed in 1–4 h (mean 2.3 h), stone free rate 90/97 (92.8%), the 6 pt. left with 5 mm stone or less in small middle calyx & upper calyx, 3 cases need blood transfusion, 2 cases with perinephrec hematoma (resolved with conservative treatment, one case with recurrent significant haematuria treated by angioembolization, less analgesia required post operatively, hospital stay 2–4 (m = 2.8) days in all cases from the day of operation. Conclusions: Our results indicate that tubeless PCNL is a highly safe, efficient and cost-effective method in the treatment of renal stones. Tubeless approach did not determine increase in complication rate. Tubeless PCNL reduced analgesics’ requirement, patients’ discomfort, & hospitalization stay.

1.15.16. MP-15.16: Upfront Retrograde Intrarenal Surgery without Prestenting: A Feasibility Study

• Gupta A, Vincent P and R R
• Meenakshi Mission Hospital And Research Centre, Madurai, India

Abstract: Introduction and Objectives: Flexible ureterorenoscopy is considered as the standard of care for renal stone disease up to 2 cm. In many centres around the world, prestenting is done before retrograde intrarenal surgeries (RIRS) to passively dilate the ureter which facilitates the passage of flexible ureteroscope with or without access sheath. We present a prospective study to assess the feasibility of RIRS without prestenting and assessment of outcomes. Materials and Methods: From September 2022 to December 2023 all patients with renal stone undergoing RIRS were included in the study. Patients presenting with fever, sepsis, acute kidney injury, musculoskeletal deformity and anomalous kidney were excluded. The lower ureter was dilated with balloon under C-Arm fluoroscopy guidance up to 12 French (Fr). An access sheath (9.5/11.5 Fr) was passed over the guidewire. Stone fragmented using thulium fiber laser. Results: 142 patients were enrolled, of which 32 were excluded for the above stated reasons. 110 patients with 118 renal units underwent RIRS. Patients were between 16–85 years of age. The stone size ranged from 5 mm to 25 mm. In 104 out of 118 renal units (88%) a flexible ureteroscope could be passed successfully into the kidney through an access sheath. In 14 patients ureter was tight for 6 Fr semirigid ureteroscopy (URS) for whom JJ stent was placed and RIRS was done after 1 month. X-Ray kidney ureter and bladder (KUB)/ultrasonography KUB was done after 1 month of RIRS. A total of 113 renal units (95.7%) were stone free at 1 month follow up visit. 3 patients had Clavien-Dindo 3A complications managed by JJ stent removal and ureteric catheter placement, 2 patients had Clavien-Dindo 2 grade complication and managed conservatively. Conclusions: In vast majority of cases (88%) upfront RIRS was feasible in a single setting with good stone free rate. The distinct advantages of upfront RIRS are fewer procedures, decreased cost and lesser duration of indwelling stent.

1.16. Moderated Oral ePoster Session 16: Prostate Cancer—Clinical Localized, Prostate Cancer—Basic Science

• Saturday, October 26
• 0800–0900

1.16.1. MP-16.01: Diagnostic Potential of Urinary Extracellular Vesicle mRNA in Prostate Cancer: A Non-Invasive Gene Panel Approach

• Patnam S ¹, Manda S ¹ and Addla S ²

¹ 

Apollo Hospital Educational and Research Foundation, Hyderabad, India

² 

Apollo Cancer Institutes, Hyderabad, India

Abstract: Introduction and Objectives: Prostate cancer (PC) diagnosis is challenged by the limitations of the prostate-specific antigen (PSA) test, which lacks specificity and can lead to unnecessary biopsies. This study investigates urinary extracellular vesicles (UEVs) as a source for non-invasive biomarker discovery, aiming to develop a gene panel for PC stratification that could offer a more specific alternative to the PSA test. Materials and Methods: Urinary extracellular vesicles (UEVs) were isolated from urine samples of 40 participants, categorized into healthy controls, prostate cancer (PC) patients, and benign prostatic hyperplasia (BPH) individuals. The study quantified mRNA expressions of a gene panel—accessory gene regulator (AGR), phosphatase and tensin homolog (PTEN), SAM pointed domain-containing ETS transcription factor (SPDEF), prostate cancer antigen 3 (PCA3), and cadherin 3 (CDH3)—using RT-qPCR, with beta-2 microglobulin (B2M) as the housekeeping gene. Diagnostic performance was evaluated via ROC curve analysis. UEVs were characterized following MISEV 2023 guidelines, including nanoparticle tracking, Western blotting for CD9, CD63, TSG101, and electron microscopy. Results: UEVs were successfully characterised, displaying the expected size range of 30–200 nm and expressing the vesicle-specific markers CD9, CD63, and TSG101, confirming their identity as extracellular vesicles. Significant gene expression differences were noted between PC patients and controls. AGR, SPDEF, and PCA3 were upregulated, while PTEN and CDH3 were downregulated in PC patients’ UEVs. The ROC analysis indicated an AUC of 0.75 for the upregulated markers and 0.80 for the downregulated markers. The combined gene panel provided a sensitivity of 91.2% and a specificity of 89%, showing superior specificity in distinguishing PC from BPH compared to the PSA test. Additionally, the gene panel’s performance correlated inversely with PSA levels, suggesting that the panel could serve as a more specific diagnostic tool, particularly in cases with borderline or inconclusive PSA results. Conclusions: The gene panel derived from UEVs demonstrates high diagnostic potential for PC, with robust sensitivity and specificity that surpass the PSA test. This non-invasive approach could significantly improve PC patient stratification.

1.16.2. MP-16.02: Erectile Dysfunction in Focal Low-Dose-Rate Brachytherapy—Early Results from Australia’s LIBERATE Registry

• Adhami M ¹, Anderson E ², Smyth L ², O’Sullivan R ³, Ryan A ⁴, Lawrentschuk N ⁵, See A ² and Grummet J ²

¹ 

Monash University, Melbourne, Australia

² 

Icon Cancer Centre, Melbourne, Australia

³ 

Lumus Imaging, Melbourne, Australia

⁴ 

TissuPath Specialist Pathology Services, Melbourne, Australia

⁵ 

The Royal Melbourne Hospital, Melbourne, Australia

Abstract: Introduction and Objectives: Definitive treatment for localised prostate cancer is associated with significant morbidity. Focal therapy for patients with low-intermediate risk features is an emerging modality aimed at reducing treatment-related toxicity. This study describes the initial patient-reported outcome measures and clinician-reported adverse events relating to erectile dysfunction following focal low-dose-rate (LDR) brachytherapy for low-intermediate risk prostate cancer. Materials and Methods: Patients enrolled in an ongoing, prospective, multi-centre clinical registry of focal LDR brachytherapy for low-intermediate risk prostate cancer from September 2019 (LIBERATE Clinical Registry, ACTRN:12619001669189), with a minimum of 6 months of follow-up, were included in this study. Clinician and patient-reported assessments for erectile dysfunction were conducted at 6 weeks following implant, and 3 monthly thereafter utilising the validated International Index of Erectile Function [IIEF-5] questionnaire and Common Terminology Criteria for Adverse Events [CTCAE, version 5.0] guidelines. IIEF-5 classified erectile dysfunction into severe (5–7), moderate (8–11), mild-to-moderate (12–16), mild (17–21), and no ED (22–25). The minimal clinically important difference (MID) for the IIEF-5 score was considered to be ± 4 points. Results: Of 77 patients, 54 (70.1%) responded to the IIEF-5 questionnaire with a median follow-up of 18 months. A median IIEF-5 score of 19 (IQR 12.5–23) was observed at baseline, 8 (IQR 2–20.5) at 6 weeks, 14 (IQR 4.3–21) at 6 months, and 15.5 (IQR 5–21) at last follow-up post implant. In the 32 (59.3%) men who reported no or mild erectile dysfunction at baseline, 10 (31.3%) had a worse MID IIEF-5 score at last follow-up. CTCAE data was collected for all patients; of the 52 men classified as having a normal erectile function at baseline, grade 3 toxicity (medical treatment unhelpful) was experienced by 7 (13.5%) men at any time after implant and 1 (2%) patient at last follow-up. Conclusions: Focal LDR brachytherapy in low-intermediate risk prostate cancer was found to be associated with an early detrimental effect on erectile function that improves over time and by 6 months only has a mild negative impact in the majority of men, although some men will experience persistent impairment. This supports the hypothesis that focal LDR brachytherapy minimises impact on erectile function.

1.16.3. MP-16.03: Evaluating the Thermal Properties of Hyaluronic Acid for Rectal Spacing Pre-Prostatectomy or Radiation

• Alberto M ¹, Bolton D ¹, Hong A ¹, Tempo J ¹, Ischia J ¹, Orio P ² and Chao M ³

¹ 

Austin Health, Heidelberg, Australia

² 

Dana-Farber Brigham Cancer Center, New York City, United States

³ 

The University of Melbourne, Melbourne, Australia

Abstract: Introduction and Objectives: Hyaluronic acid has been increasingly used as a rectal spacer for prostate cancer radiotherapy to mitigate the risk of proctitis. Although its use immediately prior to robot-assisted prostatectomy has not been investigated and given its ability to safely separate tissues, we posit whether rectal injury in high-risk cases can be reduced. However, the safety of hyaluronic acid when subjected to high temperatures such as those during diathermy remains questionable. Therefore, we aim to assess the heat conductivity of hyaluronic acid using electrocautery to ascertain if this poses an increased risk to tissue damage. Materials and Methods: Temperatures of both hyaluronic acid and water were compared after the application of energy. Using bipolar diathermy forceps powered by Valleylab FT10 machine (Covidien), electrocautery was continuously applied (setting 15) to 3 mL of hyaluronic acid and 10 mL sample of water in a cylindrical plastic container. Bipolar forceps were placed in each substance with the tips against the container bottom. Temperature was continuously monitored by a probe (Digitech Digital Thermometer, K-type Thermocouple QM-1602), and the change in temperature assessed. Results: Temperature was unchanged in water after the application of bipolar diathermy energy for 60 s. Figure 1 demonstrates results for energy applied to hyaluronic acid. There was a gradual rise from ambient temperature to a plateau of 100 °C over 35 s. Macroscopic appearance of hyaluronic acid and water were unchanged. Prior studies note fulguration (cell death) occurring at 60 °C, coagulation (dehydration) at 60–99 °C and cutting (tissue vaporisation) at 100 °C. Furthermore, when starting at 37 °C, application of diathermy to hyaluronic acid took 27 s to reach 100 °C. Conclusions: The heat conductivity safety profile of hyaluronic acid with electrocautery requires further testing. There is a potential for its use as a protective physical barrier in the setting of radical prostatectomy, especially cases with difficult posterior dissection such as in salvage prostatectomy.

1.16.4. MP-16.04: Low Urinary and Bowel Toxicity of Focal Low-Dose-Rate Brachytherapy—Early Results from Australia’s LIBERATE Registry

• Adhami M ¹, Anderson E ², Smyth L ², O’Sullivan R ³, Ryan A ⁴, Lawrentschuk N ⁵, See A ² and Grummet J ²

¹ 

Monash University, Melbourne, Australia

² 

Icon Cancer Centre, Melbourne, Australia

³ 

Lumus Imaging, Melbourne, Australia

⁴ 

TissuPath Specialist Pathology Services, Melbourne, Australia

⁵ 

The Royal Melbourne Hospital, Melbourne, Australia

Abstract: Introduction and Objectives: Focal treatment for prostate cancer aims to minimise adverse events without compromising oncological outcomes in highly selected patients. This study measures the genitourinary and rectal toxicity and patient impact following focal low-dose-rate (LDR) brachytherapy for low-intermediate risk prostate cancer. Materials and Methods: LIBERATE registry is an ongoing, prospective, multi-centre clinical registry of patients who underwent focal LDR brachytherapy for low-intermediate risk, unifocal, MRI- or PSMA PET-visible prostate cancer from September 2019 (ACTRN:12619001669189). This clinical registry was utilised to evaluate clinician and patient-reported outcomes at six weeks following implant, and three monthly thereafter. The impact of treatment was assessed using validated questionnaires (International Prostate Symptom Score [IPSS], Expanded Prostate Cancer Index Composite [EPIC] Bowel Assessment) and adverse events were clinically graded as per Common Terminology Criteria for Adverse Events [CTCAE, version 5.0] guidelines. The minimal important difference (MID) was considered to be ± 3.1 points for the IPSS and ± 5.1 points for the EPIC bowel assessment. Results: Of 77 patients, 65 (84.4%) and 64 (83.1%) patients responded to IPSS and EPIC questionnaires respectively, with a median follow-up duration of 18 months. The cohort had a mean IPSS score of 6.6 (SD ± 5.1) at baseline, 10.0 (SD ± 8.0) at 6 weeks, 7.8 (SD ± 5.5) at 6 months, improving to 7.0 (SD ± 5.4) at the time of last follow-up. Fourteen (21.5%) men had a worse MID IPSS score at the time of their last assessment compared to their baseline. The mean EPIC Bowel Assessment score was 91.6 (SD ± 7.1) at baseline, 87.8 (SD ± 15.9) at 6 weeks, 90.7 (SD ± 13.6) at 6 months, and 89.8 (SD ± 14.1) at last follow up. Sixteen (25%) men had a negative MID at last follow-up. The overall urinary incontinence rate was 2.6%, and at last follow-up, grade 2 urinary frequency and urgency occurred in 4 (5.2%) and 3 (3.9%), respectively. No grade ≥ 2 bowel symptoms were described. Conclusions: Focal LDR brachytherapy was associated with superior functional outcomes with only mild initial urinary and bowel function impairment that most men make a durable recovery from by six months post implant. This supports the rationale for focal LDR brachytherapy to maximise quality of life in selected patients undergoing curative intent treatment.

1.16.5. MP-16.05: Negative MRI Cannot Be Used to Omit an Initial Prostate Biopsy—An Ambispective Study

• Arulraj K, Sharma S, Das C, Seth A and Kumar R
• All India Institute of Medical Sciences, New Delhi, India

Abstract: Introduction and Objectives: Men suspected of localized prostate cancer (PCa) currently undergo an mpMRI before biopsy. 20% to 40% of these patients have a negative prebiopsy MRI (nMRI) and up to 15% may have clinically significant PCa (csPCa) on biopsy. The ability to predict which men are likely to have csPCa despite a nMRI can avoid unnecessary biopsies. We aimed to find the NPV of mpMRI, the influence of MRI reporting patterns in clinical practice, and the factors that predict csPCa among men with nMRI. Materials and Methods: In an ambispective study, we included men who underwent primary prostate biopsy from 2016 to 2023 for suspected PCa and had a prebiopsy MRI. The primary outcome was the presence of csPCa in men with nMRI. The reporting patterns of community and institutional MRI were evaluated. Age, DRE findings, PSA, PSA density (PSAD), and MRI reporting were evaluated for their ability to predict csPCa in men with nMRI. Results: 1660 patients who underwent prostate biopsy were assessed for eligibility and 685 were enrolled in the study. The median age, PSA, and PSAD were 60 years, 11.63 ng/mL and 0.23 ng/mL/cm3 respectively. 62 (9%) men had a nMRI among which csPCa, non-csPCa, and negative biopsy were found in 34%, 5%, and 61% of men respectively. 61% had an institutional MRI while 39% had a community MRI. The sensitivity and NPV of any MRI for csPCa were 93% and 66% respectively which improved to 96% and 81% for institutional MRI. Abnormal DRE and PSAD ≥ 0.25 ng/mL/cc were predictive for csPCa in men with nMRI. Conclusions: 34% of men with negative MRI were found to harbor csPCa on biopsy. The NPV of institutional MRI was higher than for community MRI. Men with an abnormal DRE or PSAD ≥ 0.25 ng/mL/cc had a higher incidence of csPCa despite a nMRI.

1.16.6. MP-16.06: Stromal Tumor of Uncertain Malignancy Potential of Prostate: A Scoping Review

• Al-Jubouri A ¹, A. Khalil I ², Murshed K ², Younes N ² and Alrumaihi K ²

¹ 

Qatar University, Doha, Qatar

² 

Hamad Medical Corporation, Doha, Qatar

Abstract: Introduction and Objectives: The prostatic stromal tumor of uncertain malignancy potential (STUMP) is a rare and perplexing form of prostate cancer characterized by its development within the prostate stroma, which may evolve into malignancy, manifesting as either prostatic stromal sarcoma (PSS) or STUMP. The ambiguity surrounding its diagnosis and treatment presents a significant challenge for medical professionals, necessitating a detailed review of existing literature to consolidate knowledge on its demographics, clinical manifestations, and diagnostic markers. This review aims to meticulously analyze published data to offer a comprehensive overview of STUMP’s demographic and clinical characteristics, alongside its diagnostic immunohistochemical markers, thereby aiding in the establishment of a consensus for diagnosis and treatment. Materials and Methods: A search was conducted in the PUBMED database using the term “STUMP.” The selection criteria included papers focusing exclusively on STUMP and published in English. Studies not solely dedicated to STUMP were excluded unless they contained relevant STUMP cases, which were then selectively analyzed. The quality of the included papers was assessed using MURAD’s tool for methodological quality assessment. Results: The review encompassed 88 patients from 17 studies featuring STUMP cases. The average age at presentation was 58.9 years, with symptoms like lower urinary tract symptoms (LUTS), urinary retention, and abnormal digital rectal examination (DRE) being prevalent in 40.9%, 29.5%, and 17.0% of cases, respectively. Immunohistochemical markers such as CD34, progesterone, and vimentin were commonly observed. The predominant treatment was prostatectomy, administered to 35.2% of patients, followed by transurethral resection of the prostate (TURP) in 21.6% of cases. The outcome analysis, excluding 32 patients due to lack of prognostic data, highlighted that some TURP patients eventually required radical prostatectomy or repeat TURP due to symptom aggravation or recurrent urinary retention. Conclusions: The diagnosis and management of STUMP pose considerable challenges, with LUTS being the most frequent initial presentation and prostatectomy the most common treatment, followed by TURP. This review underscores the need for a unified diagnostic and treatment approach to better manage this rare condition.

1.16.7. MP-16.07: When Does Focal Low-Dose-Rate Brachytherapy Fail? Early Lessons from Australia’s LIBERATE Registry

• Adhami M ¹, Anderson E ², Smyth L ², O’Sullivan R ³, Ryan A ⁴, Lawrentschuk N ⁵, See A ² and Grummet J ²

¹ 

Monash University, Melbourne, Australia

² 

Icon Cancer Centre, Melbourne, Australia

³ 

Lumus Imaging, Melbourne, Australia

⁴ 

TissuPath Specialist Pathology Services, Melbourne, Australia

⁵ 

The Royal Melbourne Hospital, Melbourne, Australia

Abstract: Introduction and Objectives: Organ-confined clinically significant prostate cancer (PCa) is typically managed with radical prostatectomy or whole gland radiation therapy which are associated with substantial morbidity. Focal therapy has emerged as a hybrid approach that involves ablative treatment of the cancer and continued active surveillance of the unaffected gland. This study reports oncological control and pathological progression following focal low-dose-rate (LDR) brachytherapy for low-intermediate risk PCa. Materials and Methods: Patients were recruited from an ongoing, prospective, multi-centre clinical registry of focal LDR brachytherapy cases for the treatment of low-intermediate risk prostate cancer from September 2019 (LIBERATE Clinical Registry, ACTRN:12619001669189). PCa was diagnosed utilising mpMRI or PSMA PET and targeted plus template transperineal (TP) prostate biopsy. Men received monotherapy treatment using iodine-125 seeds to deliver a prescribed dose of 145 Gy to the index lesion. Rigorous follow-up was conducted with surveillance MRI and repeat TP biopsy completed at 18–36 months post implant to assess for pathological control or progression. Control was achieved if there were no visible neoplastic characteristics and/or ≤ Gleason 3 + 3 in < 10 mm of core. Progression occurred if there were no pathological changes from baseline or tumour upgrading occurred compared to baseline. Results: Currently, 77 men are enrolled within the LIBERATE registry with a median follow-up of 18.2 months. Thirty-seven (40%) patients have completed their follow-up imaging and biopsy assessment with a median time between pre- and post-treatment biopsies of 19.1 months. Pathological control was reported in 28 (75%) men, and 8 (21%) patients demonstrated an out-of-field pathological progression that was managed in all cases with continued active surveillance. Pathological progression within the treatment field occurred in 1 (2%) patient, who had 5 mm Gleason 4 +3 disease identified in one target core. After focal treatment, 2 (3.1%) patients proceeded to radical prostatectomy without any acute postoperative complications. Conclusions: These early results suggest that focal LDR brachytherapy for low-intermediate risk, single lesion, imaging-visible prostate cancer demonstrates satisfactory oncological control at 18–36 months given the trade-off of minimised side effects and allows for early recognition of treatment failure and decision-making on further intervention. However, longer-term follow-up is needed to assess clinical oncological outcomes.

1.16.8. MP-16.08: A Comparative Analysis Between the Conventional Posterior Reconstruction Technique and a Novel Technique Pioneered by Our Institution During Robot-Assisted Radical Prostatectomy

• Pavlov V, Denejko A, Urmantsev M, Gilmanova R and Akinyemi S
• Bashkir State Medical University, Ufa, Russia

Abstract: Introduction and Objectives: Robot-assisted radical prostatectomy (RARP) was introduced with the aim of enhancing functional outcomes when compared to retropubic or laparoscopic procedures. This comprehensive review examines the anatomical and functional changes post-prostatectomy, emphasizing reconstructive techniques. The incorporation of posterior musculofascial plate reconstruction during radical prostatectomy aims to expedite urinary continence recovery and minimize the risks of bleeding and anastomosis leakage. Materials and Methods: The study included 100 patients (mean age 67 years) with localized prostate cancer, divided into two groups. Group 1 (n = 50) utilized the standard VUA technique, while Group 2 (n = 50) underwent two-layer posterior reconstruction. The impact of urinary incontinence on the quality of life was assessed using the ICIQ-SF questionnaire at 1, 3, and 6 months post-operation. Cystography on postoperative days 5–7 evaluated VUA tightness. Results: One month after RARP in the group 1 the mean score of ICIQ-SF questionnaire was 6.72, compared to 1.7 in group 2 (p = 0.01). After 3 and 6 months the respective values were 4.1 vs. 1.3 (p = 0.03) and 2.1 vs. 1.0 (p = 0.05), respectively. Cystography revealed no extravasation of the contrast. Conclusions: This retrospective comparative study suggests that the two-layer posterior reconstruction of the VUA during RARP, although a straightforward method, yields a superior continence rate one month postoperatively compared to the standard technique. Larger randomized clinical trials are warranted to further validate these findings.

1.16.9. MP-16.09: Cystic Prostate Carcinoma, an Unusual Type: Case Series and Review of Literature

• Pratihar S, Aggarwal M, Rawal S, Khanna A, Singh A, Saurabh N, Kumar B, Ali M and Malla I
• Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Abstract: Introduction and Objectives: Large cystic formations in prostate are very uncommon. Most of the prostatic cysts are benign. Malignant prostatic cysts include papillary cystadenocarcinoma, combined transitional cell/adenocarcinoma, and cystic prostatic carcinoma. A high index of suspicion required for its detection. Natural history of these lesions has not been fully elucidated. Here, we present three cases with cystic prostate adenocarcinoma that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach with short review of literature. Materials and Methods: We encountered this entity first in our institute on 2022. Then onwards we found 2 more similar patients in 1 year. Multiparametric MRI was done based on clinical suspicion and raised PSA. TRUS guided prostate biopsy was done. During biopsy we particularly targeted solid areas within and at the wall of cyst. Patients underwent PSMA PET CT scan for staging after confirmation of positive biopsy report. Patients were managed as per their clinical stage and they were followed up. Results: Median age and PSA was 70 years and 99 ng/mL. Prostate cyst size varied from 5.4 to 7 cm among patients. One patient had localized disease with PSA of 99 ng/mL and Gleason score (GS) 3 + 3 = 6. He underwent radical prostatectomy. He was started on androgen deprivation therapy (ADT) for PSA persistence. Other patient had locally advanced disease with bilateral seminal vesicle invasion, PSA-109 ng/mL, GS 4 + 4= 8. He underwent neoadjuvant ADT for 3 months followed by radical prostatectomy. Post operatively ADT was continued. Another patient had metastatic disease to pelvic bones and humerus. He was put on ADT and abiraterone. All patients are alive on follow up and none had gone into castrate resistant stage. Conclusions: Malignant prostatic cysts are rare but an important differential diagnosis in prostatic cystic lesion. Prostatic cystic lesion with solid components is highly suspicious of cystic prostatic carcinoma. Image-guided biopsy targeting the solid component is suggested to obtain a histological diagnosis. Mangement is similar to classical adenocarcinoma of prostate. Further research on its clinical cases would allow a study of pathogenesis and determine recommendations for optimal scope of diagnosis and treatment.

1.16.10. MP-16.10: Histopathological Biomarkers of Metastatic Prostate Cancer in Lymph Nodes

• Pavlov V, Sharafutdinova L, Kabirov I, Neryakhin A, Nadezhdina E, Tukhbatullin A and Khannanova G
• Institute of Urology and Clinical Oncology, Ufa, Russia

Abstract: Introduction and Objectives: In 60% of patients with prostate cancer who have undergone dissection of regional lymph nodes, there is a recurrence of the disease, which requires the identification of new markers necessary to improve the accuracy of diagnosis. To identify new specific immunological markers of lymphovascular invasion of prostate cancer. Materials and Methods: The prospective study was conducted in Institute of Urology and Clinical Oncology (Ufa) during the period 2021–2023. The study included 115 patients who underwent robot-assisted radical prostatectomy with pelvic lymphadenectomy. The number of excised lymph nodes (LN) in one patient averaged 9.1, a total of 461 lymph nodes were isolated. According to the obtained data, of a routine histopathological examination, 26 patients with pelvic lesion were identified. These lymph nodes were underwent to additional immunohistochemical staining for biochemical markers of tumor-associated cells (CD3+, CD4+, CD8+, CD10+, CD20+, CD30+, CD35+, CD56+, Myeloperoxidase+ (MPO+), CD68+, S100+). Results: According to the data obtained, 2 dominant candidate markers were identified—CD68 and MPO (p < 0.01), for which all samples were tested. In the total group of subjects, 12 patients with infiltration by stromal macrophages and neutrophils (2.42 versus 15.26 cells/mm² and 17.18 versus 27.7 cells/mm², respectively) (p < 0.01) were found to potentially remodeling LN into metastatic niches and related to subclinical metastases. In control examination after 36 months an increase of PSA more than 0.2 ng/mL³ was detected, and LN was detected according to PET-CT with 11C-choline. In 6 cases with metastatic foci, radiation therapy was initiated, the rest of the group are considered potentially at high risk of systemic dissemination and requiring active monitoring. Conclusions: Were detected histopathological markers may hypothetically have prognostic value in determining prognosis and recurrence of the disease. A risk factor for lymphogenic invasion is the detection of increased infiltration by tumor-associated M1/2 macrophages and neutrophils.

1.16.11. MP-16.11: Identification of Potential Gene Markers Expressed in Monocytes of Prostate Cancer Patients Through Single-Cell Transcriptome Sequencing

• Pavlov V, Rafikova G, Enikeeva K, Sharifyanova J and Kalimullina L
• Bashkir State Medical University, Ufa, Russia

Abstract: Introduction and Objectives: Prostate cancer (PCA) is a prevalent malignancy in men, necessitating the exploration of molecular signatures for improved diagnosis and treatment. This study aimed to identify potential gene markers expressed in monocytes of PCA patients using single-cell transcriptome sequencing. Materials and Methods: Peripheral mononuclear cells were isolated from five PCA patients and five age-matched controls with normal prostate-specific antigen (PSA) levels. Patients were at T2N0M0 stage, with PSA levels ranging from 4.98 to 23.6 ng/mL and Gleason scores of 7–8. Single-cell transcriptome sequencing was conducted following the Chromium Next GEM Single Cell 3 v3.1 protocol. Sequencing was performed on the Illumina NextSeq 2000 Sequencing system, with data processing carried out using R and Seurat packages. Results: Analysis of transcriptome data revealed distinct gene expression profiles in non-classical monocytes of PCA patients compared to controls. Among the top 20 highly expressed genes in PCA patient monocytes, LINC02085, CASP5, FAM20A, KCNMA1, and MS4A4A exhibited significant upregulation, absent in the control group. Additionally, genes such as AC020651.2, ABCC3, and FCGR3A showed elevated expression in PCA patients but did not rank among the top 20 expressed genes in controls. Clustering analysis demonstrated clear separation between PCA patient and control monocyte populations (see Figure 1). Conclusions: The identified genes, particularly LINC02085, CASP5, FAM20A, KCNMA1, and MS4A4A, hold promise as potential biomarkers or therapeutic targets in PCA. Further validation studies are necessary to elucidate their functional significance and clinical utility.

1.16.12. MP-16.12: Is the Surgeon Experience the Most Important Prognostic Factor? A Review of the Outcome of 648 Open Radical Prostatectomies by the Same Surgical Team in Private Practice

• Neyra Lee-Eng G, Neyra Argote J, Alvarez Nuño H, Gutierrez B R, Ramos-Solano F and Herrera-Gomez D
• Centro Urologia Integral, Guadalajara, Mexico

Abstract: Introduction and Objectives: Radical prostatectomy (RP) remains as the gold standard treatment for localized prostate cancer, whether it’s open (ORP) or robotic surgery (RS). There are several studies comparing these two modalities, and most of them conclude that the surgical and oncological outcomes are equal; leading us to a debate: which surgical modality is the best for the patient? The objective of this study is to demonstrate how the surgeon’s experience can become the best prognostic factor regardless of the surgical approach. Materials and Methods: We analyzed 648 cases of open radical prostatectomy (ORP) with bilateral lymph node dissection done by the same surgeon and surgical team in a private practice basis, performed from 1991 to 2022. There were no limitations on age: our youngest patient was 40 years old and the oldest 87. All patients underwent a pre-operative assessment by an anesthesiologist. All surgeries were performed under spinal blockage. For the analysis of the cases, the patients were divided in four groups of 162 surgeries each one. The surgical outcome was evaluated by measuring the following factors: surgical time (ST), bleeding amount (BA), mortality (MT), use of intensive care unit (ICU), incontinence (ICT), erectile dysfunction (ED) and hospitalization time (HT). Results: The overall surgical outcome results are: MT 0%, ICU 0%, BA 508 mL, HT 2.9 days, ED 18.45%, ICT 0.4%. The improvement on the surgical outcome from group 1 to group 4 were the following: ST 36.5%, HT 21.9%, BA 21.3%, ED 10%, ICT 1.2%. ICU and MT show no improvement because they remained at 0%. The results of the analysis are shown in Table 1. Conclusions: Our data show that there’s an evident improvement on the surgery outcome directly related to the number of surgeries performed by the surgeon; thus confirming to us that the surgeon experience should be considered one of the most important prognostic factors in RP, regardless if it’s ORP or RS.

1.16.13. MP-16.13: Single Center Experience of Robot Assisted Radical Prostatectomy with CMR Versius^® Robotic Surgical System

• Prakash P
• Yashoda Superspeciality Hospital and Cancer Institute, Ghaziabad, India

Abstract: Introduction and Objectives: Robot assisted radical prostatectomy (RARP) is the standard of care for localized prostate cancer worldwide. The most important barrier to widespread availability of robotic systems is the associated high cost. Recent availability of newer robotic systems has brought down the cost but limited data is available about their efficacy and safety. We present our experience of RARP with CMR Versius^® surgical system. Materials and Methods: Consecutive patients undergoing RARP in our department between January 2023 to January 2024 were included. Operative time, docking time of system, anastomosis time, blood loss and other parameters were assessed. Postoperative recovery and follow up data including days to socially acceptable continence was recorded. Results: Eleven patients underwent RARP during the study period. The median age was 67 years (range 59–72) and the median BMI was 30.2 (range 26.8–39.1). The median prostate size was 45 g (range 28–60) and median PSA was 7.8 ng/dL (4.7–18.2). The median operating time was 290 min (range 250–330) and median vesicourethral anastomosis time was 45 min (range 26–55). The median docking time was 15 min (range 13–25). The median blood loss was 350 mL (250–750 mL) and 2 patients (18.1%) required blood transfusion. The robotic malfunction was limited to errors in instruments bedside units which were 5 times in first case which were absent by fourth case. There was no major intraoperative or postoperative complications and median hospital stay was 4 days (range 4–6). The median time for return to socially acceptable continence was 8 days (range 3–20). The median cost of RARP at our center was 4557 USD (range 4197–5156) as compared to average 7500 USD for RARP in India with Da Vinci^® Surgical system. Conclusions: CMR Versius^® is a cost effective surgical system and it is feasible and safe to perform RARP with this system with comparable perioperative and functional recovery outcomes. The errors encountered during the surgery leads to longer operating times initially but they improve gradually with technical modifications as we get accustomed to the system.

1.16.14. MP-16.14: TP4303 a Urinary Biomarker in the Diagnosis of Prostate Cancer in Comparison with Multiparametric MRI in Patients

• Nerli R
• KLE’s Dr. Prabhakar Kore Hospital & MRC, Belagavi, India

Abstract: Introduction and Objectives: Presently prostate cancer (PCa) is suspected whenever the serum prostate-specific antigen (PSA) is elevated or the digital rectal examination (DRE) reveals an abnormality in prostate. Ca prostate is diagnosed by performing a needle biopsy of prostate. However, serum PSA is not specific for prostate cancer, nor is DRE. Moreover, biopsy is associated with severe complications. Multiparametric-magnetic resonance imaging (mp-MRI) has shown promising results in diagnosis, localization, risk stratification, and staging of clinically significant PCa. Similarly, targeting VPAC receptors using TP4303 in identifying cancer cells by using a fluorescent microscope in voided urine samples has a high positivity rate. The aim and objective of our study were to compare the mp-MRI results with TP4303 in diagnosis of PCa in patients (> 50 years age) presenting with lower urinary tract symptoms (LUTS) and having a serum PSA ≥ 4 but ≤ 15 ng/mL. Materials and Methods: Patients (> 50 age) presenting to the Urology OPD with LUTS and serum PSA of ≥ 4 but ≤ 15 ng/mL formed the study group. A 50 mL of voided urinary sample (initial) was collected and sent for fluorescent staining using TP4303 and observed under the microscope. mp-MRI was performed in all and the findings were classified as per the Prostate Imaging Reporting and Data System (PIRADS). A transrectal ultrasound-guided biopsy of the prostate was performed (12 cores) in all patients and sent for histo-pathological examination (HPR). Results: During the period Nov 2022 till Oct 2023, a total of 40 patients were included in the study. The mean age was 71 years and the mean PSA was 10.4 ng/mL. There were 20 patients with PIRADS scores of I and II, and 20 patients with scores of III, IV & V. The VPAC receptors were positive in 11 of the 40 patients. HPR of the biopsy samples showed cancer in 12 and benign in the remaining 28. The positive predictive value of the biomarker study was significantly more accurate than the mp-MRI study. Conclusions: This preliminary study of ours shows that a urinary biomarker study using TP4303 and targeting VPAC receptors is a simple, non-invasive technique to diagnose PCa. The urinary biomarker positivity for VPAC receptors was more accurate than the mp-MRI study.

2. Moderated Oral ePoster

2.1. Moderated Video ePoster Session 01: Minimally Invasive Surgery/Robotics, Reconstruction, Stones—Surgical Management

• Thursday, October 24, 2024
• 0800–0900

2.1.1. MVP-01.01: Emergency Robotic Exploration for Obstructed Parastomal Hernia Following Robotic Radical Cystectomy with Ileal Conduit—Our Initial Experience, Tips and Tricks

• Saurabh N, Singh A, Pratihar S, Khanna A, Kumar B and Rawal S
• Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Abstract: Introduction and Objectives: With the rise of minimal invasive techniques for pelvic urooncologic malignancies, parastomal hernia with adhesive acute small bowel obstruction (PHAASBO) forces patients to the emergency department, leading to admission and emergency surgical interventions. Around 20% of all acute surgical admissions belong to adhesive bowel obstruction and this is commonly seen after radical cystectomy. Management depends on a variety of factors like partial vs. complete obstruction, signs of ischemia or perforation, duration and symptoms etc. This study aims to describe the feasibility of robotic exploration for selected post radical cystectomy (RC) patients with PHAASBO. Materials and Methods: A retrospective analysis of a prospectively maintained database of all patients undergoing robotic exploration for PHAASBO between August 2018 and December 2023 was done. Data was collected for all patients (n = 4) and analysed. All patients had undergone complete blood investigations and a pre- operative imaging of CECT (contrast enhanced CT scan) whole abdomen. After pre anaesthesia assessment, they were taken for robotic exploration with mesh repair. Results: Median age was 61 years, equally divided among sexes, all had BMI >31 and it occurred between 2–15 years after RC. All patients underwent robotic exploration with adhesiolysis and mesh repair of the hernia. Surgery was successful with a median console time of 84 min. Median time to flatus and discharge was 4 days and 6 days respectively. Postoperatively, one patient had ileus which was treated conservatively with gastrograffin and prokinetic agents. Robotic exploration was accomplished without open exploration and there was no increased incidence of infection or mesh-related complications. All patients are on follow-up with no incidence of recurrence. Conclusions: Robotic exploration of selected post RC patients with PHAASBO is an option in hands of robotic surgeons with expertise.

2.1.2. MVP-01.02: Robot-Assisted Simple Prostatectomy: Video-Based Illustration of Modified Technique for Large Prostatic Adenoma and Its Outcomes

• Kushwaha S, Kumar A, Chaturvedi S, Maheshwari R, Desai P, Kaushal R, Vasudeo V, Aggarwal A and Agrawal O
• Max Super Speciality Hospital, Saket, New Delhi, India

Abstract: Introduction and Objectives: Open simple prostatectomy is recommended for patients with large prostate (>80–100 g) but is less commonly performed given the widespread adoption of endoscopic techniques. Nonetheless, there is still a role for enucleating large adenomas, and minimally invasive techniques may provide benefits such as reduced blood loss, lower morbidity, and faster recovery. In this video, we demonstrate our technique and share our experience of robot-assisted simple prostatectomy (RASP) in patients with large prostatic adenoma. Materials and Methods: We present a retrospective analysis of fifty-four consecutively performed RASPs in our institution from 2020 to 2023. Baseline functional parameters along with perioperative outcomes, including operative time, estimated blood loss, complications, catheterization time and length of hospital stay, were analysed. The technique involves developing the space of Retzius and a transverse cystostomy on the anterior bladder wall. Adenoma is approached by incising between the posterior bladder wall and the median lobe. After enucleation of the adenoma, ‘trigonization’ is performed by reapproximating the mucosal-free edge of the posterior bladder neck to the posterior urethral plate. Results: The median age was 69 years, with a median prostatic volume of 164 cc. The median operative time was 136 min, and the median estimated blood loss was 220 mL. The median catheterization time and length of hospital stay were 5 and 2 days, respectively. There was notable improvement in functional outcomes, evidenced by a median increase in Qmax of +16.5 mL/s, along with reductions in IPSS and PVR of −18 and −90 mL, respectively. Pathological analysis confirmed benign prostatic hyperplasia in all cases except for four patients who were incidentally diagnosed with pT1a disease. All are on active surveillance. Urgency and urge incontinence were noted in 6 patients in the immediate postoperative period, which improved at 1–3 months. At the end of 6 months, only one patient has stress incontinence. Conclusions: RASP is technically feasible and safe for large adenoma, providing excellent visibility of the adenoma’s lateral lobes and apex during enucleation. It serves as an alternative to open or endourologic methods, offering a short operative time and hospital stay, along with minimal perioperative complications, with similar functional outcomes, particularly for very large glands.

2.1.3. MVP-01.03: Salvage Vaginoplasty with Single-Port Robot Assisted Tubularized Urachus Peritoneal Hinge Flap: Technique Highlights, Outcomes, and an Evidence-Based Proposal for How and When to Use (and Not Use) Peritoneum with Vaginoplasty

• Sandhu S ¹, Smith S ¹, Mallavarapu S ¹, Stelmar J ², Yuan N ¹, Gupta A ¹, Kim H ¹ and Garcia M ¹

¹ 

Cedars-Sinai Medical Center, Los Angeles, United States

² 

University of California San Diego School of Medicine, San Diego, United States

Abstract: Introduction and Objectives: Vaginoplasty is a commonly performed genital gender affirming surgery. Currently, two techniques describe using peritoneal tissue: the modified Davydov technique (Zhao, 2019), and the Tubularized Urachus-Peritoneal Hinge Flap (Garcia, 2022). Many providers use the Davydov technique at primary vaginoplasty, while others argue that peritoneum should be reserved for salvage surgery. We report our technical innovations related to the urachus hinge flap, and our clinical outcomes. We also review the literature related to maximizing neovaginal depth at the time of primary vaginoplasty. Materials and Methods: We review our robot-assisted urachus hinge flap technique to augment neovaginal depth post-vaginoplasty complicated by loss of neovaginal depth. We review technical innovations to maximize neovaginal depth with primary vaginoplasty using only penile and scrotal skin. We present our literature review, and posit a theory that explains why mean neovaginal depth is 11–13 cm regardless of technique. Results: Our mean neovaginal depth post-salvage urachus hinge flap technique is 12.5 cm (range 11–14.2) at 409 days post-op. This is comparable to the Davydov technique. With primary vaginoplasty using only penile and scrotal skin, our mean depth is 12.5 cm, which exceeds other series using only penile/scrotal skin, and is comparable to series using peritoneum primarily. We use video to show how, with the Davydov technique, rectum and bowel are pulled into the pelvis post-op, increasing risk of bowel injury at time of salvage intestinal vaginoplasty. Conclusions: By the techniques described herein, in our hands, with primary vaginoplasty using only penile and scrotal skin we achieve vaginal depth comparable to techniques that augment with peritoneum. We suggest that peritoneum is rarely to never necessary primarily, and should be reserved as a salvage procedure if and when needed. We also suggest that the urachus flap is a safer alternative to the Davydov technique if and when PV fails and salvage intestinal vaginoplasty must be undertaken.

2.1.4. MVP-01.04: Transvaginal Bowel Stapling in Robotic Intraccorporeal Neobladder

• Bakshi H, Tilva V, Rajyaguru D and Mohan S
• HCG Cancer Centre, Ahmedabad, India

Abstract: Introduction and Objectives: Intracorporeal neobladder is increasingly used after robotic radical cystectomy in high volume centres globally. Traditionally, bowel isolation and reconstitution of small bowel anastomoses have been done intracorporeally using stapler through another specific 12 to 15 mm assistant port in left iliac fossa. The angle of these staplers is often 45 to 60 degrees and is challenging many times to obtain a precise angle for optimum firing. We describe our technique and outcomes of using transvaginal approach to fire the staplers in bowel anastomoses. Our technique is more ergonomic, economic and saves the use and cost an extra port. Materials and Methods: A 70-year-old lady with muscle invasive bladder cancer underwent robotic radical cystectomy with enbloc pan hysterectomy. A 50 cms small bowel segment 20 cms proximal to the ileocaecal junction was isolated using ICG dye and firefly technology. Staplers were not used to isolate the segment-the bowel was simply divided with scissors. The cut bowel ends were brought down in pelvis and each limb was engaged by the jaws of a covidien 60 cms stapler introduced transvaginally. The angle was a straight line and the stapler was fired. Another 60 cm cartridge was fired at right angles to the previous suture line to complete the anastomosis. Neobladder reconstruction was then done after vaginal closure using Karolinska modification of Studer technique. We used this technique in 7 women aged 45 to 78 years over a period of 4 years. Results: The patient was discharged on 6th postop day without complications. All 7 women had no bowel obstruction or leak and the average length of stay was 7 days. The average number of stapler cartridges fired was 3, instead of the usual 5. Average time to flatus was 3 days. Conclusions: Transvaginal bowel stapling in ileo-ileal anastomoses for intracorporeal neobladder after robotic radical cystectomy has distinct advantages over conventional use of staplers which are used for isolating neobladder and for ileo-ileal anastomoses. First, a separate port to introduce stapler in left iliac fossa is not needed. Second, the straight angle of presentation of bowel ends to the stapler makes the stapler firing more ergonomic and precise. Third, an average of 3 cartridges are needed instead of 5, which saves the cost of two cartridges.

2.1.5. MVP-01.05: Non-Transecting Non-Augmented Urethroplasty Techniques for Short Segment Bulbar Urethral Strictures

• Chawla A, Viswanath K, Pillai S and Hegde P
• Kasturba Medical College, Manipal, India

Abstract: Introduction and Objectives: Complete transection of the urethra is associated with complications such as ejaculatory disturbance, cold glans, decreased sensitivity, and erectile dysfunction. Harvesting a graft in augmented urethroplasty is associated with donor site morbidity. We present our experience with non-transecting non-augmented urethroplasty in the management of short segment bulbar urethral strictures. Materials and Methods: A prospective comparative study on primary short segment bulbar stricture patients who underwent non-transecting non-augmented anastomosis, which included a total of 99 patients over duration of 5 years. Assessments included uroflowmetry, RGU/MCU, modified USS PROM (pre-procedure, 1st, 3rd, 6th and 12 month follow-up), and validated questionnaires (IPSS, IIEF) for subjective outcome measures. Results: Mean stricture length was 1.2 cm. History of VIU was present in all patients. 6 patients had SPC at presentation. Failed procedures were noted in 7 patients at follow-up with poor flow rates, giving an overall success rate of 93%. Factors associated with failures were near obliterative strictures, previous multiple VIU’s. Post micturition dribble was noted in 14.2% which subsided on 6-month follow up with conservative management. Conclusions: While post-operative flow rate is a critical consideration, functional outcomes carry equal significance in urethroplasty. When the procedure is performed without augmentation and the urethra is not completely transected, patients have preserved erectile and ejaculatory functions with good flow rates.

2.1.6. MVP-01.06: Robotic Augmentation Cystoplasty and Ancillary Procedure for Minimizing Morbidity and Enhancing Outcomes in Adults with Small Bladder Capacity and Incontinence After Bladder Exstrophy Reconstruction

• Thakor P, Kalra S, Dorairajan L, K.S. S, Sah S and Gour S
• Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Abstract: Introduction and Objectives: The spectrum of genitourinary anomalies encompassed by classical bladder exstrophy (CBE) and cloacal exstrophy brings profound physical, functional, and psychological challenges. Despite primary bladder exstrophy repair in adults, urinary incontinence persists due to bladder neck issues and reduced capacity, leading to varying degrees of incontinence or limited retention. The presence of previous abdominal scars amplifies risks associated with traditional open surgeries, including wound complications. Enter robotic surgical augmentation cystoplasty, a transformative alternative boasting minimally invasive techniques and promising outcomes. By potentially mitigating postoperative complications such as injury to the primary repair site, abdominal wound dehiscence, and surgical site infections, it offers renewed hope. With enhanced surgical vision and the capability to facilitate adjunct procedures, robotic platforms significantly broaden therapeutic horizons for individuals grappling with challenges post-bladder exstrophy repair. Materials and Methods: In this video, we present three cases in urological reconstruction. The first involves a patient with primary bladder exstrophy and epispadias repair, facing urinary incontinence and limited bladder capacity. The second case deals with post-bladder exstrophy repair with bladder neck reconstruction in childhood presented with urinary incontinence and reduced bladder capacity. Both underwent robotic augmentation cystoplasty. Additionally, we discuss a patient with continuous urinary incontinence post-primary exstrophy repair in childhood, finding relief through robotic Kropp’s repair with augmentation cystoplasty. Results: All patients showed normal renal function. No abdominal or bowel complications. Two patients who underwent robotic augmentation cystoplasty had no post operative complications and on follow up have urine holding capacity of 2 h. Other patients with adjunct kropps procedure and augmentation cystoplasty had less urine holding capacity with more frequent micturition. Conclusions: Robotic augmentation cystoplasty emerges as a transformative solution for addressing small bladder capacity post-bladder exstrophy repair in adults. Through minimally invasive techniques, it offers promising outcomes while mitigating the risks associated with traditional open surgeries. Our study demonstrates successful outcomes, including improved urine holding capacity and minimal postoperative complications, highlighting the potential of robotic-assisted techniques in reshaping urological reconstruction and enhancing the quality of life for patients facing urinary dysfunction post-bladder exstrophy repair.

2.1.7. MVP-01.07: Renocolic Fistula—A Rare Complication of Obstructive Uropathy

• Mesquita S, Fraga A, Silva-Ramos M, Silva E and Sampaio M
• ULS Santo António, Porto, Portugal

Abstract: Introduction and Objectives: In the past, renocolic fistulas were mainly caused by untreated infections or blockages from stones. Nowadays, with quick diagnosis, targeted antibiotics, and improved techniques for managing kidney stones, renocolic fistulas have become rare. Most cases reported now are iatrogenic. Surgical treatment is usually necessary. Materials and Methods: A 71-year-old woman presented to the Emergency Department (ED) with a sudden onset of left flank pain and fever that started 5 days ago. The patient also reported nausea and vomiting. She was previously followed in urology clinic for urolithiasis with functional exclusion of the left kidney. In the ED, she was febrile and her blood pressure was 96/60 mmHg. Laboratory findings revealed hemoglobin of 9.9 g/dL, white blood cell count of 28,000 cells/mm³, creatinine of 3.15 mg/dL and C-reactive protein of 186 mg/L. Arterial blood gas revealed lactate of 3.15 mmol/L. A CT scan showed the left kidney with a significant decrease in thickness, dilation of the pyelocaliceal and noticeable thickening of the urothelium suggesting emphysematous pyelitis. The scan also detected a fistulous tract between the upper front calyx and the back wall of the splenic flexure of the colon. The patient progressed to shock, requiring admission to the Intensive Care Unit for adrenergic support. Initial conservative treatment was decided, completing a course of antibiotic therapy with piperacillin and tazobactam. She improved and was transferred to the Urology Department on the fourth day. On the 14th day of hospitalization she underwent laparoscopic left nephrectomy with sectioning of the fistulous tract. Results: An incision in the left paracolic gutter and medial mobilization of the descending colon were performed. A fistulous tract, about 1 cm in diameter, between the splenic flexure and the kidney was identified. The tract was cut with endo GIA, and the staple line was folded using V-Loc. Dissecting the renal hilum included locating and tying the renal artery and vein with Hemo-Locks, as well as tying the ureter. The postoperative period proceeded without complications. Conclusions: Chronic obstructive uropathy can lead to kidney function loss and inflammation in nearby structures, possibly leading to the formation of renocolic fistulas. In patients with a nonfunctional kidney, nephrectomy should be performed.

2.2. Moderated Video ePoster Session 02: Kidney and Ureteral Cancer—Clinical, Renal Transplantation, Penis/Testis/Urethra: Cancer—Clinical, Reconstruction

• Friday, October 25, 2024
• 0800–0900

2.2.1. MVP-02.01: Going “Retro”: A Step-by-Step Guide on Retroperitoneal Robotic Partial Nephrectomy in Complex Hilar Renal Mass

• Agrawal S, Menon A and Kumar G
• Amrita Institute of Medical Sciences, Kochi, India

Abstract: Introduction and Objectives: The initial adoption of robotic partial nephrectomy favored the transperitoneal approach, benefiting from enhanced workspace, recognizable landmarks, and accessibility. Nevertheless, studies have demonstrated that the retroperitoneal approach for robotic partial nephrectomy reduces operative time, blood loss, and hospitalization duration, without an increase in perioperative complications. In this video, we describe our step-by-step technique for performing a robotic retroperitoneal partial nephrectomy for complex hilar mass. Materials and Methods: The patient is fully sedated and positioned in a complete flank (90-degree) posture. To enhance access, the operating table is flexed at the level of the umbilicus, widening the space between the iliac crest and the 12th rib. Initial entry into the retroperitoneum is made through a mid-axillary incision, followed by the insertion of an 11 mm visiport equipped with a zero-degree telescope. The initial surgical plane is established by dissecting the fat away from the psoas muscle, and additional space is created using a balloon dilator. Following the development of sufficient space, four robotic ports, along with one assistant port, are placed under direct visualization. Subsequently, the robotic system is docked, and a robotic partial nephrectomy is performed using techniques similar to those employed in the transperitoneal approach. Results: Robotic retroperitoneal partial nephrectomy was performed using a 4 robotic port configuration and one 12 mm assistant port. Salient steps of the technique that are highlighted include (1) access and balloon dilation of the retroperitoneal space, (2) peritoneal mobilization to allow space for 4 robotic ports, (3) port placement under direct vision, (4) management of paranephric fat, (5) incision of Gerota’s fascia above the psoas muscle and exposure of renal artery. Conclusions: The retroperitoneal approach for robotic partial nephrectomy is safe and reproducible.

2.2.2. MVP-02.02: Laparoscopic/Robotic Video-Endoscopic Inguinal Lymph Node Dissection (VEIL) with Lateral Approach; Technique & Initial Experience

• Patel R ¹, Patel R ² and Patel M ²

¹ 

Zydus Cancer Hospital, Ahmedabad, India

² 

Zydus Hospitals, Ahmedabad, India

Abstract: Introduction and Objectives: Management of inguinal lymph node dissection is an integral part of penile cancer treatment. While open surgery has high incidence of complications and morbidity, minimally invasive way by laparoscopic or robotic video-endoscopic inguinal node dissection (L- VEIL or RA- VEIL) reduced morbidity significantly. Recently lateral approach VEIL has been described to overcome technical difficulties associated conventional VEIL. We present our initial experience with this technique. Materials and Methods: Seven patients (12 groins) underwent L-VEIL/RA-VEIL with lateral approach between January 2023–February 2024 for clinically negative groin with penile malignancies by a single surgeon. Indication was invasive nodal staging due to high risk of occult nodal metastases. Port placement (1 camera, 2 working ports) was identical in laparoscopic/robotic with one additional assistant port in RA-VEIL. Peri-operative parameters, pathological parameters & complication rate was noted till last follow up. RA-VEILs were done on DaVinci Xi system. All cases were done under general anaesthesia. Results: See Table 1. Conclusions: L-VEIL/RA-VEIL with lateral approach has several technical advantages than conventional VEIL including early identification of anatomical landmarks, better ergonomics, less instrument clashes & easy re-producibility of technique without compromising lymph node yield and complication rates. Sephanous Vein preservation is easier than conventional VEIL in single surgeon’s experience.

2.2.3. MVP-02.03: Supine Approach for RA-RPLND for Post Chemotherapy Residual Mass in Testicular Cancer: Video Based Illustration and Long Term Experience

• Ali M, Rawal S, Singh A, Khanna A and Pratihaar S
• Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India

Abstract: Introduction and Objectives: Retroperitoneal Lymph Node Dissection of residual masses after chemotherapy for nonseminomatous germ cell tumours (NSGCT) is mandated when serum tumour markers are normal. Minimally invasive Robot assisted approach is preferred to lessen the morbidity associated with open RPLND as it offers comparable lymph node yield and shortens the length of stay. Our aim is to demonstrate the procedure of Robotic RPLND and present intermediatetolongterm oncological and functional outcomes. Materials and Methods: Supine approach was used in which the patient was placed in a modified lithotomy position. 8 mm camera port was placed in between the umbilicus and symphysis pubis. Other robotic ports were placed, two in the right lower quadrant and one in the left lower quadrant. Standard surgical steps were followed. Results: Fifty-two patients who underwent RA PC-PLND between February 2012 and December 2023, were included. The median age of the cohort was 27 years. The procedure was performed in lateral position and supine position in 29% and 71% patients, respectively. The median console time and estimated blood loss were 180 and 150 mL, respectively. The median size of the excised residual mass was 4.25 cm. The most common histology in the excised nodes being necrosis, teratoma and viable malignancy in 29, 19 and 4 patients. Conclusions: Supine approach for Robot assisted Post Chemotherapy RPLND is a feasible and oncologically effective option. Ease of access mitigates the need for repositioning or redocking and reduces operative time.

2.2.4. MVP-02.04: Straighten and Close (STAC) Repair for a Peno-Scrotal Hypospadias with Severe Chordee

• Kore R
• Warana Institute of Uro-Surgery, Kolhapur, India

Abstract: Introduction and Objectives: Extreme forms of hypospadias require a planned multistage repair. correction of chordee is essential for a successful outcome. A severe chordee of >300 is corrected by ventral lengthening by doing multiple corporotomies. These corporotomies need to heal with or without interposing tissue. Any graft over these would heal thick and eventually get scarred. Hence, covering these corporotomies with surrounding tissue like dartos flap and closing the skin over yields better healing. This stage can thereafter be followed by grafting at 6 months and tubularization at 12 months. Materials and Methods: From February 2021 to March 2022, seven consecutive cases of severe forms of hypospadias with ventral curvature >300. were repaired. After a ventral sub-coronal incision skirting the hypospadias meatus, ventral degloving was done. Persistence of chordee required urethral plate transection. The chordee persisted despite this transection due to corporal disproportion. Three corporotomies were done at the point of maximum bend. This achieved complete correction of chordee as well as penile lengthening. The corporotomies were covered with dartos facia. Penile skin was closed ventrally after preputioplasty and proximal urethrostomy at a suitable spot. Bladder was drained with a silicon catheter. Results: Ventral corporotomies healed completely without any complications in all seven patients. The ventral curvature was corrected, and significant penile lengthening was achieved. Five of these had second stage of preputial skin grafting. Three of them completed their third and final stage of tubularization. None has shown recurrent curvature or any voiding difficulty so far. Conclusions: A systematic, planned staged approach is a good option in most cases of proximal hypospadias with severe chordee, although it stretches over a longer duration. Fewer complications and a successful outcome make it a strong alternative to traditional single stage repair, which has a higher rate of complications, which in turn may potentially make it a multistage procedure.

2.2.5. MVP-02.05: Ventral Onlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: Medium-Term Results in Our Experience

• Berdondini E ¹, Silvani M ¹, Eissa A ², Ferretti S ² and Gacci M ³

¹ 

Center for Urethral and Genital Surgery, Torino, Italy

² 

University of Modena & Reggio Emilia, Modena, Italy

³ 

Univerisity of Florence, Florence, Italy

Abstract: Introduction and Objectives: Urethral strictures in women are relatively uncommon but can have a serious impact on the quality of life. A number of different surgical approaches have been described but there is no consensus on either the best means of diagnosis or of treatment. The aim of this article is to describe our own approach using buccal mucosal grafting and to assess the outcome of this approach. Materials and Methods: A total of 42 patients underwent ventral onlay BMG by a single person between 2017 and 2022. A longitudinal incision along the length of the urethra was made through the anterior vaginal wall and the peri-urethral fascia was incised to create two flaps. This ventral urethrotomy ran from the meatus into the proximal health urethra above the level of the stricture. A buccal mucosal graft was harvested and sutured to the margins of the urethral mucosa itself and the flaps of peri-urethral fascia. The vaginal wall was then closed. Results: The mean age of the patients was 53.6 ± 12.8 years. There were no perioperative or postoperative complications. At a mean follow-up of 38.1 months, 41 patients (97.7%) were voiding normally. Peak flow rate improved from a mean of 7.74 ± 3.21 mL/s preoperatively to 25.9 ± 5.9 mL/s postoperatively. No patient developed incontinence. One patient developed a recurrent urethral stricture which was treated by redo urethroplasty. Conclusions: The surgical technique applied has proved very successful. The ventral BMG preserves the urethral sphincter and so avoids postoperative incontinence. The use of peri-urethral fascia as vascular and mechanical support for the graft avoids diverticulum formation and fistulation.

2.2.6. MVP-02.06: Robotic Right Donor Nephrectomy: Nouveau Arrival

• Sharma G and Agarwal V
• Aakash Healthcare Superspeciality Hospital, Delhi, India

Abstract: Introduction and Objectives: Living donor nephrectomy is being increasingly done robotically. Right side donor nephrectomy poses the challenge of shorter renal vein for good surgical outcome. Robotic nephrectomy provide with precision suturing and ergonomics to minimise this disadvantage of laparoscopic nephrectomy. Materials and Methods: We present a video of robotic right donor nephrectomy with excellent result. Results: The surgical outcome was excellent with long length of renal vein with IVC cuff being harvested for anastomosis. Post operative period was uneventful with patient being discharged on POD 5. Patient is on follow up and doing very well with normal creatinine. Conclusions: Good length of renal vein with IVC cuff is of paramount importance in right side donor nephrectomy. Precise incision with the help of robotic arm helps achieve a good IVC cuff when compared to laparoscopic approach.

2.3. Moderated Video ePoster Session 03: Female Urology, Kidney and Ureter, Benign Diseases, Reconstruction, Sexual Dysfunction

• Saturday, October 26, 2024
• 0800–0900

2.3.1. MVP-03.01: Autologous Fascia Lata Sling Placement: A Minimally Invasive Technique

• Jain A, Verma B and Pal A
• Medanta—The Medicity Gurugram, India

Abstract: Introduction and Objectives: Synthetic mid-urethral sling for the treatment of stress urinary incontinence (SUI) has been criticized for its mesh-related complications. Autologous sling, once fell out of favor as a management option for SUI has found its renaissance in recent times. The objective of this video was to demonstrate the placement of autologous fascia lata sling (AFLS) at mid-urethra for the management of SUI. We tried to evolve the technique in a minimally invasive way and included a few learning points in this video. Materials and Methods: A 48-year-old female presented with SUI for the last 12 months after failed conservative management. Examination confirmed positive stress leak test. USG abdomen revealed a heterogenous solid-cystic lesion of 3.5×3.4×3.3 cm in the left adnexal region with normal bladder wall thickness. MRI confirmed left ovarian cyst. Uroflowmetry demonstrated Qmax 18.4 mL/s; Qave 8.2 mL/s; VV 220.5 mL; PVR 8 mL. Urodynamic study showed a complaint stable bladder with normal capacity and sensations (Pdet@Qmax 20 cm of H₂O; No PVR). An informed decision was taken for laparoscopic ovarian cystectomy with simultaneous AFLS placement. The preparation for fascia lata graft harvesting was done after laparoscopic ovarian cystectomy. The bony landmarks like iliac spine and lateral femoral condyle were marked, and a 2 cm small longitudinal incision was given 10 cm above the lateral femoral condyle. Hydrodissection was done with saline, and fascia lata was dissected out. A stab incision was given at the superior end to harvest a graft of 12 cm in length. Both the incisions of the donor site closed. A mid-urethral 2.5 cm incision was given, and periurethral dissection was performed bilaterally. A small 5 cm horizontal suprapubic incision was given and deepened till rectus fascia. The rectus fascia was not breached. The AFLS was placed through retropubic route and fixed in a tension-free manner. Suprapubic and periurethral incisions were closed. Results: The patient had a smooth postoperative recovery. She reported complete continence with good urinary flow on the first postoperative day. She maintained the same at 3-month follow-up. Conclusions: The minimally invasive technique of AFLS harvesting and placement reduces invasiveness and subsequent morbidity and provides good functional outcomes.

2.3.2. MVP-03.02: Challenges and Options for Management of Stones in Pelvic Ectopic Kidney: An Algorithm Based Management

• Shetty R, Singh A and Sabnis R
• Muljibhai Patel Urological Hospital, Nadiad, India

Abstract: Introduction and Objectives: A kidney that fails to ascend from the pelvis to the renal fossa is considered an ectopic pelvic kidney. Affected patients have structural and architectural anomalies due to which conditions such as reflux, hydronephrosis, nephrolithiasis, and renal failure are common. Nephrolithiasis is a common cause of obstruction in patients with an ectopic pelvic kidney. This abnormal situation creates altered spatial relations with the adjacent organs, abnormal calyceal orientation, and anomalous vascular patterns making the approach to the pelvic kidney a big challenge. Thus in this video we highlight 4 treatment modalities for management of ectopic pelvic kidney stones: robotic pyelolithotomy, laparoscopic guided PCNL, PCNL and RIRS. Materials and Methods: Patients who presented to our renal unit with urolithiasis in a pelvic ectopic kidney. They were appropriated classified and managed according to algorithm from the publication by Singh et al.: “Changing trends in endourological management of urolithiasis in anomalous kidney”. Results: We have demonstrated 4 cases undergoing different modalities of endourological management including flexible ureteroscopy, laparoscopic-assisted percutaneous nephrolithotomy (PNL), PCNL and laparoscopic/ robotic pyelolithotomy and have got complete clearance in all cases. We also have included our own data with various modalities of treatment in ectopic pelvic kidney. Conclusions: The management of renal calculi depends on different factors such as stone size, density and location in accordance with upper urinary tract alterations, kidney anatomy and operator experience. The choice of approach should be carefully selected evaluating upper urinary tract anatomy and stone features. An algorithm-based approach could help surgeons decide the appropriate treatment in this population.

2.3.3. MVP-03.03: Robot-Assisted Boari Flap Ureteral Reimplantation (RA-BFUR) for Upper Ureteral Stricture Reconstruction: Replicating the Open Technique

• Wadhwa P, Singh A, Talwar H and Ahlawat R
• Medanta Medicity Gurugram, Gurgaon, India

Abstract: Introduction and Objectives: Robotic-assisted laparoscopy has been efficaciously utilized in a variety of ureteral reconstructive procedures. Over the last decade we have performed 81 ureteral reconstructive procedures using the robotic platform- which includes modified Lich-Gregoir ureteroneocystostomy/Psoas Hitch- 64; uretero-ureterostomy −14; Buccal ureteroplasty- 2, Boari flap ureteral reimplant- 1. In this video, we demonstrate robotic assisted Boari flap ureteral reimplant (RA-BFUR) for an upper ureteral stricture. Materials and Methods: A 32-year-old male was treated elsewhere for bilateral upper ureteral calculi, with left ureteroscopy and right antegrade percutaneous antegrade ureteroscopic stone removal/bilateral DJ stenting. Post stent removal he developed left flank pain with perinephric urinoma needing percutaneous nephrostomy drainage. Evaluation confirmed a uniform left ureteral stricture segment from L4- S2 level; dilated upper ureter till L4 level. He underwent a RA-BFUR using the DaVinci Si, replicating the open technique. After identifying healthy ureter, length of bladder flap needed was measured and marked out on a distended bladder, after dropping it. A long U-shaped anterior bladder flap reaching to right anterior bladder neck was developed; after confirming its tension-free bridging of the gap, the flap is fixed to the psoas sheath to ease of any tension on the anastomosis. The anastomosis was completed with 3/0 PDSÒ, while the bladder tube was sutured with 3/0 V-LocÒ, in 2 layers after placing a DJ stent. A 16 Fr urethral catheter and an abdominal tube drain was placed after checking for anastomotic leak. The console time was 128 min. Results: The patient had an uneventful post op; was discharged on 3rd day. Left nephrostogram at 2 weeks demonstrated good drainage and a healed anastomotic line. Nephrostomy and Foleys were sequentially removed. Stent was removed at 6 weeks. Patient remains asymptomatic with improving bladder capacity at 8 weeks, on bladder relaxants. Conclusions: RA-BFUR is feasible for managing ureteral strictures, though upper ureteral reconstruction is especially challenging, and alternative ileal replacement should be kept as back up. The robotic platform easily allows minimally invasive, safe, dextrous reconstruction of mid and distal ureteral strictures utilising Psoas Hitch ureteroneocystostomy.

2.3.4. MVP-03.04: Partial Staged Repair for Pan-Urethral Stricture—A Modification for Variable Urethral Lumen Size

• Kore R
• Warana Institute of Uro-Surgery, Kolhapur, India

Abstract: Introduction and Objectives: Pan-urethral stricture is not an uncommon condition in males. It is managed by substitution pan-urethroplasty. Many times, there is difference in lumen size, with distal segment being significantly more occluded than the proximal. Principle of treatment for this more significantly narrow segment is to do two-stage procedure. However, it may not be necessary to do staged procedure for the proximal segment if the lumen is not that narrow. It also avoids the bi-valving of scrotum and possible hair growth after the second stage of tubularization in that segment. We are suggesting modification to the routinely done dorsal onlay substitution in pan-urethroplasty. We have demonstrated in this video, how the modification of distal Johansson I and proximal dorsal onlay is done. This procedure is then subsequently followed by Asopa II procedure with tubularization for the distal segment in the second stage. This technique has potential advantages of reduced requirement of oral mucosa during each individual stage, avoiding penile skin in presence of Lichen Sclerosus, dealing with variable lumen size appropriately, and possible reduction in complication rate. Materials and Methods: From February 2019 to March 2021, eleven patients with pan-urethral strictures were treated with the modified repair. Significantly narrow distal segment was repaired by doing Johansson first stage procedure with ventral cutback and mucocutaneous suturing. The proximal wider segment was repaired by standard dorsal onlay using buccal mucosa in the same first stage. The second stage for distal half was done after six months using Asopa II technique of dorsal inlay substitution followed by simultaneous tubularization. Results: The age range was 36 to 64 years (average: 47). Follow-up was done for 23 to 48 months (average: 33). One patient developed pyrexia, and another developed wound infection. Nine out of eleven patients completed second stage. The Q max improved from 4 mL/s to 20 mL/s. One patient was lost to follow-up after first stage. Conclusions: The modification of repair of pan-urethral stricture in a partial staged manner improves outcome, reduces complications, and facilitates controlled use of oral mucosa as a substitution material in select group of patients with variable lumen size.

2.3.5. MVP-03.05: Vaginal Flap and Dorsal Onlay Techniques of Urethroplasty for Female Urethral Strictures

• Chawla A, Viswanath K, Pillai S and Hegde P
• Kasturba Medical College, Manipal, India

Abstract: Introduction and Objectives: Urethroplasty has been considered the definitive management of urethral stricture in males and has been proven in multiple studies to be safe and effective. Traditionally, urethral stricture in females has been treated with urethral dilatation and other nonsurgical methods but recently there is a growing interest in the use of surgical methods for management of urethral stricture in females. Data regarding outcome assessment and complications of female urethroplasty is scarce and therefore, this study aims to evaluate the safety and efficacy of female urethroplasty in our institute. Materials and Methods: We performed a retrospective analysis of all the female patients who underwent urethroplasty at our center in the past 5 years with the aim of evaluating the efficacy and outcomes of the procedure. Assessments included pre and postoperative uroflowmetry, VCUG, sexual satisfaction, urinary symptoms and postoperative overall QoL at 3, 6, 12 and 24 months. Results: A total of 84 female urethroplasties were performed, of which 21 were vaginal flap and 63 were dorsal onlay graft urethroplasty. History of prior dilatations was present in 71 patients and 1 patient had a failed prior urethroplasty. Preoperatively, 5 patients had a suprapubic catheter. Mean follow up was 17 months in vaginal flap group and 41 months in dorsal onlay group. Overall, success rate was 95% in terms of improved flow rates, urinary symptoms and QoL. Clavien Dindo Class I and II complications were seen in 1 patient in vaginal flap group and 5 patients in dorsal onlay group. Sexual dysfunction was more in the vaginal flap group compared to the dorsal onlay group but was statistically insignificant. Conclusions: Both vaginal flap and dorsal onlay urethroplasty techniques have good comparable postoperative outcomes in the management of female urethral strictures. A surgeon well versed with both techniques can opt for the appropriate procedure tailored to the patient.

2.3.6. MVP-03.06: Fused Double-Cylinder Penile Prosthesis Placement After Phalloplasty Without Urethral Lengthening: A Novel Technique Using a 2-Piece IPP

• Sandhu S ¹, Mallavarapu S ¹, Stelmar J ², Smith S ¹ and Garcia M ¹

¹ 

Cedars-Sinai Medical Center, Los Angeles, United States

² 

University of California San Diego School of Medicine, San Diego, United States

Abstract: Introduction and Objectives: Transmen (TM) require a penile prosthesis to achieve erection. All prostheses in the US are designed for cisgender anatomy. There is no recognized gold-standard technique for prosthesis-insertion post-phalloplasty. We believe the ideal IPP to use is the 2-piece IPP. We describe 1) Our technique for insertion of a 2-piece IPP in TM; 2) Our outcomes over a 6-year period. Materials and Methods: 1) Retrospective chart review of TM undergoing IPP insertion post-phalloplasty at our center over 6-years. 2) We show a video of our technique for placement of 2-piece AMS Ambicor™ IPP (2-cylinders) for TM post-phalloplasty without urethral lengthening (p-UL). Results: 28 patients underwent 34 implants between April 2017-Oct 2023 (Mean Age = 40.8 years ± 13.8(SD). 17/28 (60.7%) patients underwent phalloplasty with urethral lengthening, and 11/28 (39.3%) had P-UL. All implants were with either the AMS 700™ 3-piece IPP (5/34 = 14.7%; all 1 cylinder), or AMS Ambicor™ 2-piece IPP (29/34 = 85.3% [22/29 (76%) = 1 cylinder, 7/29 (24%) = 2 cylinders). 2/34 IPP’s required explant (5.9%): infection: 1/38 (2.9%); wound dehiscence secondary to traumatic injury post-op: 1/38 (2.9%). Our technique for insertion of an Ambicor 2-piece IPP for TM post-P-UL (Figure 1). Because the phallus does not contain a full-length neourethra (2 cm cosmetic neourethra at the tip), there is sufficient room to insert 2-cylinders. Conclusions: Our “2-cylinders in a single sock” technique has key advantages: 1) Two-cylinders yield a more symmetric-appearing, fuller erection; 2) Use of Dacron graft to fuse and anchor both cylinders increases stability; 3) Our practice of pre-placing a testicle at the planned pump-site ensures a capsule-lined pocket to protect the pump; 4) Our single 4-cm incision at the scrotum-edge provides adequate exposure with favourable cosmetic results. In our experience with different devices and techniques, the technique described here has the best results. A multi-center outcomes-study to compare devices and techniques, is warranted.

3. Residents’ Forum

3.1. Residents’ Forum 01

• Thursday, October 24, 2024
• 0800–0900

3.1.1. RF-01.01: Bilateral Simultaneous Robot-Assisted Redo-Pyeloplasty in Horse-Shoe Kidney Using Same-Midline Ports: Technical Appraisal

• Kushwaha S, Kumar A, Chaturvedi S, Maheshwari R, Desai P, Kaushal R, Vasudeo V, Aggarwal A and Agrawal O
• Max Super Speciality Hospital, Saket, New Delhi, India

Abstract: Introduction and Objectives: Pyeloplasty for ureteropelvic junction obstruction (UPJO) in horseshoe kidneys (HSK) is technically challenging due to the inherent aberrant anatomy. Surgery for bilateral UPJO after failed pyeloplasty in HSK is even more complex and challenging. Conventionally, the management of bilateral UPJO in adults involves a staged approach. However, robot-assisted surgery has made this approach feasible with the same-midline ports. In this video, we demonstrated the technical challenges and troubleshooting for bilateral simultaneous robot-assisted redo-pyeloplasty in HSK. Materials and Methods: A 58-year-old male with HSK presented with bilateral lower quadrant pain with a history of bilateral laparoscopic sequential pyeloplasty 3 years ago. CT scan revealed HSK with bilateral gross hydronephrosis with parenchymal thinning. The serum creatinine concentration was 5.1 mg/dL which stabilized at 2.6 mg/dL after ureteral stenting. Key components of the approach to redo-pyeloplasty on both moieties of HSK include modified patient positioning, caudal and midline port placement and attention to the variant and distorted anatomy. Results: The procedure was completed with operative time of 375 min, which includes a change-over time of 35 min and 155 and 185 min for right and left side, respectively. The estimated blood loss was < 100 mL. There were no intra-operative complications and surgery was completed without conversion. Post-operative course was uneventful with a hospital stay of 6 days. DJ stents were removed at 8 weeks. The patient had complete symptomatic relief and the follow-up scan showed preserved function and slow unobstructed drainage with stable creatinine of 2.5 mg/dL. Conclusions: Performing bilateral simultaneous robot-assisted pyeloplasty for HSK is technically feasible and safe, with an acceptable change-over time and minimal operative morbidity. This approach eliminates the need for two separate surgeries, which reduces costs related to consumables, additional anaesthesia, and hospital stay.

3.1.2. RF-01.02: What It Is Out There: Management of a Retrovesical Mass by Robotic Approach with Technical Nuances

• Imran Q, Ranjan A, Patel K, Hussain A, Sureka S and Singh U
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: Inflammatory myofibroblastic tumor (IMT) is a rare lesion of unclear pathogenesis that shows a wide, highly variable spectrum of clinical behavior. They have been described in prostate and bladder but origin from seminal vesical is never reported to best of our knowledge. Materials and Methods: We report a case of a 68 year-old male who presented with a complaint of obstructive lower urinary tract symptoms and lower abdominal pain for 2 years. On evaluation with computed tomography imaging showed a homogeneously enhancing soft tissue mass of 50 × 82 × 71 mm (AP × TR × CC) was seen in retro vesical space. MRI pelvis showed well defined lobulated, heterogeneously enhancing lesion in recto-vesical pouch and loss of fat planes with rectum. PET scan showed faintly FDG avid (SUV max—2.0) well defined soft tissue mass lesion (measuring ~ 5.9 × 8.3 × 5.6 cm) in rectovesical space. Results: Patient underwent robotic assisted laparoscopic retro vesical mass excision. Intraoperatively planes with rectum and bladder were maintained and separated from seminal vesicle except in the midline. On histopathological examination revealed elongated spindle cells disposed in intersecting fascicles with lymphocyte infiltrate reported as to be a mesenchymal tumour (low grade myofibroblastic tumor). Patient developed a lymphocele of size 2 × 2 cm adjacent to surgical area which was conservatively managed. On further follow up there was no evidence of any recurrence. Conclusions: IMT (inflammatory myofibroblastic tumor) originating from seminal vesical is rare. Complete surgical resection is the best therapeutic management. Although benign, long term follow up is needed to detect recurrence.

3.1.3. RF-01.03: Comparative Analysis Between Paclitaxel-Coated Balloon Dilatation and Direct Vision Internal Urethrotomy for Recurrent Anterior Urethral Strictures

• Fernandes J ¹, Fernandes P ¹, Azevedo V ¹, Grenha V ¹, Versos R ¹, Passos P ¹, Ramires R ¹ and Marques-Monteiro M ²

¹ 

Hospital de Guimarães (ULSAA), Guimarães, Portugal

² 

Centro Hospitalar Universitário do Porto, Porto, Portugal

Abstract: Introduction and Objectives: Recurrent urethral strictures pose a significant challenge in urology, commonly managed through chronic dilatation, repeated endoscopic interventions, or more intricate reconstructive surgeries. The emergence of the paclitaxel-coated balloon represents an innovative approach aimed at reducing recurrence rates compared to traditional endoscopic treatments such as direct vision internal urethrotomy (DVIU). This study aims to assess and compare the efficacy and safety of paclitaxel-coated balloon dilatation (PCBD) and DVIU in managing recurrent anterior urethral strictures. Materials and Methods: A retrospective analysis was conducted between January 2021 and September 2023. Participants included patients with recurrent anterior urethral strictures previously treated with 1–3 DVIU who underwent paclitaxel-coated balloon dilation or DVIU. Data on demographics, baseline characteristics, and intervention outcomes were collected and analyzed. Efficacy assessment included recurrence rates, symptom resolution, and uroflowmetry parameters, while safety evaluation considered intraoperative and postoperative complications. Descriptive and comparative statistical analysis was performed using SPSS Statistics 28^®. A two-sided p value < 0.05 was considered statistically significant. Results: A total of 42 patients were included, with balanced demographic data and characteristics between groups. The recurrence rate at 3 months post-intervention was significantly lower in the PCBD group compared to the DVIU group (0.0% vs. 17.9%, p < 0.01), and persisted at the 6-month follow-up (4.8% vs. 40.2%, <0.01). Both interventions showed improvements in urinary flow and post-void residual volume. Patients in the DVIU group had a significantly longer mean catheterization duration compared to the PCBD group (15.1 ± 3.1 days vs. 5.8 ± 3.4 days, p < 0.01). Safety profiles were favorable, with no intraoperative complications observed in either group. Conclusions: Paclitaxel-coated balloon dilatation demonstrated superior efficacy in reducing recurrence rates compared to DVIU at both 3 and 6-month follow-up intervals. Both interventions led to improvements in urinary flow and resolution of symptoms, with paclitaxel-coated balloon dilatation offering early catheter removal.

3.1.4. RF-01.04: Effect of Low Intensity Shock Wave Therapy in Peyronie’s Disease

• Manek P and Pattnaik P
• Bombay Hospital & Medical Research Center Mumbai, Mumbai, India

Abstract: Introduction and Objectives: Aim of our study was to determine the role of low intensity shock wave therapy (LiSWT) in the management of Peyronie’s disease. Materials and Methods: A total of 65 patients were included in our study. Plaque size was noted, along with pain at erection & deviation and associated erectile dysfunction (ED). A detailed medical history and physical examination was carried out, followed by Doppler USG. All patients were counselled and consent was obtained. They received LiSWT. Duolith SD ultra (electromagnetic) was used, perpendicular to penile shaft. Tip of plaque received 500 shock waves, middle portion-1000, right and left of plaque 500 each, root of penis-1000, frenulum 500 shock waves using 0.25 J/mm². Each Patient got 6 treatments (1 treatment/week). Penile curvature was measured after intracavernal injection. Penile length was measured during erection. Plaque size was measured by USG. IIEF, VAS and NRS (numerical rating scale) Score were obtained. Results: Data was obtained at baseline and at 3 months. PDE5i was given to all patients. Mean age was 42.1 years (35–52). Hypertension was present in 12 patients and diabetes in 10 patients. Mean duration of disease was 8.2 months and mean plaque size of 1.65 cm² with a penile curvature of 30 degrees. NRS Score 4–6 and mean IIEF Score of 16 with severity of ED as follows- severe 9, moderate 23, mild 25, no ED 8. Post treatment plaque size reduced to 1.42 cm². Penile length increased to 14.5 cm from 12.8 cm and penile curvature decreased to 24 degrees. NRS score reduced to 2. IIEF Score significantly improved to 22 with a maximum improvement in overall satisfaction component. Patients associated with HTN and DM also showed improvement. Conclusions: LiSWT acts by mechanical stimulation of cells by the waves inducing a cavition effect, hence causing plaque damage. Generation of nitric oxide (NO) and VEGF (vascular endothelial growth factor) which leads to neovascularisation. LiSWT also has a neuroprotective effect. Inflammatory reaction causes plaque lysis, resorption of calcification and their removal by macrophages causing smoothening/softening of plaques. It also improves erectile function. Reduce pain by inhibiting peripheral nerves by release of kinins. LiSWT reduces severity of disease and improves sexual function.

3.1.5. RF-01.05: Complex Reconstruction in a Peculiar Case of Double Urethra with Ectopic Ureter Having Five Openings in Anal Canal

• Pirzada F
• AIIMS, New Delhi, India

Abstract: Introduction and Objectives: Genito urinary reconstruction can be very challenging in the pediatric age group. These patients should be evaluated by endoscopy under general anesthesia along with imaging to understand the nature of anomalies so that proper reconstruction can be performed. Here we present a case of a male child who had five openings (left ureter, blind-ending posterior double urethra, posterior urethra connected to the bladder, anterior urethra, anal canal) in a single common channel. Materials and Methods: 15-y male presented with abnormal passage of urine from the anal opening since birth. The child was full-term borne by normal vaginal delivery. Developmental milestones were normal. The patient achieved urinary continence at 5 years, with occasional incontinence episodes during giggling. Sometimes there was soakage of undergarments. There were recurrent episodes of epididymo orchitis. There was no history of fecal incontinence or lower limb weakness. The evaluation revealed a double urethra with pan-anterior urethral stricture with a left ectopic ureter, and a left non-functioning kidney with rectourethral fistula. Laparoscopic left nephroureterectomy followed by urethro-anal separation with quarty flap reconstruction urethroplasty was done till penoscrotum. Results: The patient is doing well with separate urethral and anal openings. The patient is continent and is planned for second-stage urethroplasty surgery so that the meatus comes to a normal position. Conclusions: Definitive repair should never occur until the urinary tract has been evaluated and other anomalies identified. If endoscopy has not been performed previously, it should be done as a separate procedure before the definitive repair. Defining the anatomy can be tedious but should be done in all cases for successful reconstruction.

3.1.6. RF-01.06: Penile Circular Fasciocutaneous Flap for Pananterior Urethral Stricture in Balanitis Xerotica Obliterans

• Roy R, Mandal T and Chatterjee U
• Nil Ratan Sircar Medical College, Kolkata, India

Abstract: Introduction and Objectives: Distal penile circular fasciocutaneous flap (FCF) urethroplasty is a popular technique for complex anterior urethral stricture although it is relatively contraindicated in balanitis xerotica obliterans (BXO). We present our experience of using penile FCF in pananterior urethral stricture due to BXO. Materials and Methods: This is a case report of two male patients of BXO with pananterior urethral stricture who underwent penile circular FCF (McAninch) urethroplasty from January 2022 to July 2022. Local application of Tacrolimus 0.03% ointment was started 3 months prior to the surgery. Circular penile skin flap was marked and a 2 cm wide circumferential dartos based fasciocutaneous flap was harvested. The flap was 15 cm in length after splitting ventrally. Ventral meatomy as well as ventral urethrotomy was made over the distal tip of the catheter and extended proximally at least 1 cm into normal urethra. The most proximal and distal portions of the flap were secured to the normal proximal urethra and to the meatus respectively using interrupted 4–0 vicryl over 16 Fr 100% silicone catheter. Results: Mean patient age was 41 years, mean stricture length was 13 cm and mean follow-up was 13 months. The outcome was considered successful if postoperative peak flow rate was 12 mL/s or more and patient required no further urethral dilatation or internal urethrotomy. Mean post op Qmax was 28 mL/s. The procedure was successful in both the cases. None of them developed any sexual dysfunction. Conclusions: Penile circular FCF urethroplasty can be a reasonably good option for complex pananterior urethral stricture even in the presence of BXO.

3.1.7. RF-01.07: Relationship Between Testosterone Levels and the Different Causes of Urethral Stricture

• Vila Braña P, Jimenez Dominguez A, Puerto Jimenez C, Puche Sanz I and Rodriguez Cantón D
• Hospital Virgen de las Nieves, Granada, Spain

Abstract: Introduction and Objectives: Recent studies have determined the relationship between low levels of androgen expression and their association with decreased periurethral vascularization, and that hypoandrogenism (HA) is a common condition in these patients. Our aim was to analyze hormone levels in males with urethral stricture and determine if there is an association regarding the triggering cause, whether idiopathic, iatrogenic, or due to lichen sclerosus. Materials and Methods: A retrospective review was conducted, based on a prospective database, of patients with urethral stricture enrolled in our service from July 2018 to May 2023. Blood tests were performed on all of them, under the same collection conditions and sample analysis methodology. The exposure variables were Total Testosterone (Ttotal), Free Testosterone (Tfree), and Bioavailable Testosterone (Tbio), SHBG, Estrogens (E), Prolactin (PRL), FSH, and TSH. Uni and multivariate analysis were performed using an ANOVA logistic regression model to obtain odds ratio (OR) values for dichotomous variables and coefficient values for quantitative ones, determining if any of the causes presented statistically significant hormonal differences compared to the others. HA was marked as Ttotal < 300 ng/dL and Tfree < 6 ng/dL. Results: A total of 167 patients were analyzed and classified into three groups based on their history: 54 idiopathic, 88 iatrogenic, and 25 with lichen sclerosus. In the group of patients with iatrogenic urethral stricture, mean levels of Ttotal, Tfree, and Tbio were significantly lower (383.31 ng/dL; 6.89 ng/dL and 161.19 ng/dL respectively) compared to idiopathic (447.79 ng/dL; 8.77 ng/dL and 208.22 ng/dL respectively). There were no significant differences between the groups with the variables SHBG, prolactin, and TSH. Uni and multivariate analysis yielded an OR = 4.2 (p value 0.028) for total HA, meaning there was a 4 times higher probability of having a Ttotal lower than 300 ng/dL in patients with iatrogenic stricture compared to idiopathic. Conclusions: Patients with iatrogenic urethral stricture present lower mean testosterone levels compared to those with idiopathic and lichenoid causes. Low testosterone levels could be related to a higher risk of developing urethral stricture in patients undergoing endourological treatments or traumatic catheterizations. Prospective studies with a larger number of patients are needed to determine this possible association.

3.1.8. RF-01.08: Single Stage Repair of Classic Bladder Exstrophy—Our Experience in a Tertiary Care Centre

• Roy R, Mandal T and Chatterjee U
• Nil Ratan Sircar Medical College, Kolkata, India

Abstract: Introduction and Objectives: Repair of bladder exstrophy commonly demands multiple surgical procedures and associated with significant perioperative morbidity. In our institution we started single stage repair by compulsion because in the initial two cases the bladder plate was very small. We continued to use this novel technique in subsequent three cases and reviewed our results. Materials and Methods: This is a case series of 5 patients (4 male and 1 female) of classic bladder exstrophy who operated in our institution from 2018 to 2022. Mean age at repair was 12.8 years (range 2–20 years). All of them underwent tennis bat augmentation (TBA) entero cystoplasty with 40 cm ileum in “W” pouch manner with cystostomy vent to release intra vesical pressure and for clean intermittent catheterisation in future if needed. 18 Fr Foley catheter was placed into bladder via cystostomy tract for irrigation and removal of mucous flakes. Keratinised bladder mucosa was excised to prevent future bladder stone. Pubic osteotomy minimal (POM) was done for facilitating abdominal wall closure. Bladder neck reconfiguration with omental wrapping was done over 8 Fr infant feeding tube. In the male patient, epispadias repair was done by modified Cantwell-Ransley technique. Anterior abdominal wall was closed primarily. Results: Mean follow-up period was 3 years. Three of them had leakage from penopubic area that closed spontaneously. One of them developed dehiscence at bladder neck for which redo surgery was needed. Average bladder capacity after repair was 190 cm³ (range 120–230 cm³). Two of them were incontinent and rest were continent doing clean intermittent catheterisation per urethrally. None of them developed vesico-ureteral reflux during follow-up and their renal function was also preserved. Conclusions: Single stage repair of classic bladder exstrophy by our technique can be done in selected cases with satisfactory cosmetic and functional outcomes. This can minimise number of surgical procedures and can prevent deterioration of renal function.

3.1.9. RF-01.09: Transvesical Subtrigonal Buccal Mucosal Graft Inlay for an Almost Completely Obliterated Bladder Neck Contracture: A First in the Philippines

• Faustino K ¹ and Abalajon M ²

¹ 

Dr. Paulino J. Garcia Memorial Research and Medical Center, Cabanatuan City, Philippines

² 

East Avenue Medical Center, Quezon City, Philippines

Abstract: Introduction and Objectives: The true incidence of urethral strictures is unknown, but some authors put it at around 4–20%. In the Philippines, there is no national database that keeps track of the number of strictures in the country, but a paper presented by Galut M., Abalajon M. et al. described 547 strictures from 2020–2023. Of these, only 11 were strictures in females. The causes of urethral strictures in women have been a topic of discussion for a considerable period. Pelvic fractures resulting from blunt trauma to the lower abdomen can lead to posterior urethral disruption in males, which has been observed in male patients who were car passengers or fell from a height. While such injuries in males have been reported previously, they are considered to be rare in females. The authors of this report aim to present a case involving a 12-year-old female patient who underwent a transvesical subtrigonal buccal mucosal graft inlay to repair an almost completely obliterated bladder neck. As to the authors’ knowledge, this is the first reported case in the Philippines to utilize this technique. Materials and Methods: A 12-year-old female with a history of complete obliterated bladder neck, which was initially managed with suprapubic cystostomy insertion. This patient underwent a transvesical subtrigonal buccal mucosal graft inlay. A 2 × 1 cm mucosal graft was harvested from the buccal cavity. The buccal mucosa graft was then spread-fixed and quilted to the denuded subtrigonal area, with placement at the 4 to 8 o’clock positions. Results: This patient underwent a transvesical subtrigonal buccal mucosal graft inlay. The patient was discharged on the 3rd postoperative day with no complications. The urethral catheter was removed after 4 weeks, and the suprapubic tube was removed two weeks thereafter. Conclusions: There are various treatment options available for the management of female urethral stricture, including conservative management with dilatation, endoscopic treatment, or open repair. In cases where the location of the stricture is at the bladder neck, a subtrigonal buccal mucosal graft inlay might prove to be a very viable option for bladder neck reconstruction. This is especially useful if the patient is not amenable to urinary diversion using bowel segments.

3.1.10. RF-01.10: A Novel Classification of Aneurysmal Complication of A-V Fistula based on Site and Management Strategy: A Retrospective Study with Prospective Validation

• Imran Q, Baid A, Mandal S, Pathak A, Patel K, Sureka S and Singh U
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: Our aim is to propose a clinically relevant classification of aneurysmal complications of arteriovenous fistulae (AVF) created for dialysis access with prospective internal validation. Materials and Methods: We retrospectively evaluated aneurysmal complications of AVF at our centre from January 2001 to July 2019. Demographics, site of fistula, type of aneurysm (true vs. pseudoaneurysm), location of aneurysm (anastomotic site vs. outflow vein vs. inflow artery) and the management strategy were recorded. Aneurysmal complications were classified as type I to type IV, based on the anatomical location. Further subdivided into Subtype a, b and c based on need for observation (a) or elective (b) or emergency (c) surgical management, respectively. From September 2019 to September 2021, internal validation of this classification system was done over 47 patients with fistula related complications. Every patient was classified by 2 observers (one resident and one consultant). Results: A total of 384 patients were managed at our centre with aneurysmal (true aneurysm n = 205, 53.3%; pseudo-aneurysm n = 179, 46.7%) complications of AVF. True aneurysms (Type 1) were the most common (53.3%). Location of pseudo aneurysm was at anastomotic site (Type 2) in 35.4% of patients (n = 136), outflow vein (Type 3) in 9.3% (n = 36) and inflow artery (Type 4) in 1.8% (n = 7). 39.5% of patients were managed conservatively (n = 152), 30.2% were managed by elective surgery (n = 116) and 30.2% needed emergency surgery (n = 116). The indication of emergency surgery was intractable bleeding or impending rupture. Patients with no significant symptoms and no or minimal risk of bleed were closely observed. The classification system was applied to over 47 patients. Kappa value for Type 1, 2, 3 and 4 was 0.86, 0.81, 0.82 and 0.74 respectively (average—0.80 suggestive of excellent inter-observer agreement and reproducibility). The Kappa value for type a, b and c was 0.86, 0.61 and 0.69 respectively (average—0.72 suggestive of good inter-observer agreement and reproducibility). Overall average Kappa value is 77 suggesting excellent inter-observer agreement and reproducibility. Conclusions: This classification system having excellent reproducible (average Kappa value is 77) and will help surgeons in reporting and comparing their experiences. This will also assist in taking timely decision for surgery as it is a pre-requisite for classification.

3.1.11. RF-01.11: Impact of Renal Transplant on Erectile Dysfunction in End Stage Renal Disease Patients

• Manek P
• Bombay Hospital & Medical Research Center, Mumbai, India

Abstract: Introduction and Objectives: Erectile dysfunction (ED) is defined as “inability to attain and/or maintain an erection sufficient for satisfactory sexual intercourse”. Incidence is > 50% in men > 40 years and up to 80% of patients with chronic kidney disease (CKD). The etiology of ED in ESRD population is multi-factorial. Many of the effects of uremia can potentially contribute to the development of ED. Depression is an independent factor predicting sexual dysfunction in long term hemodialysis patients. Multiple studies have demonstrated that ED improves after renal transplant surgery. The objective of our study was to assess ED in ESRD patients before and after renal transplant by means of a validated, self-administered questionnaire in Indian population. Materials and Methods: Ours was an observational, retrospective, single center research study. All adult male patients with ESRD who underwent renal transplant between January 2021 till April 2023 at our center were included. IIEF-5 Questionnaire was used for assessment of ED, which classified into 5 categories based on the IIEF scores ranging from 5–25: severe, moderate, mild-to-moderate, mild, and no ED. Other factors studied- age, duration of dialysis before transplant, co-morbidities, cardiovascular risk, smoking, sexual history and laboratory results. Results: Total patients were 45 with mean age of 37.1 years (23–61). Dialysis duration before transplant was 18.6 months (4–96). Hypertension and diabetes was present in 80% and 36% patients respectively. Mean follow-up time of 3–6 months. Mean IIEF Score pre-transplant was 15.1 which significantly improved to 21.6 post-transplant (p 0.01). Patients with age < 40 years showed significant improvement in IIEF score. Pre-transplant, majority were mild-moderate and mild severity of ED, which improved post-transplant to mild & no ED. Statistical significant improvement was seen in patients especially who underwent pre-emptive transplant & had a short duration of hemodialysis. More the duration of dialysis, lesser was the improvement seen. Improvement was seen in 62% patients. Conclusions: The genesis of ED in ESRD is multifactorial. Early transplant delays the development of penile vasculopathy. It reverses the uremic state, endocrine alteration in long-term dialysis patients. Renal transplant is considered optimal renal replacement therapy in ESRD. Our findings confirm that RT significantly improves IIEF-5 Score and erectile function.

3.1.12. RF-01.12: Association of Heavy Metals and Trace Elements in Urolithiasis: A Case-Controlled Study

• Aggarwal V, Seth A, Quadri J, Shariff A, Singh C and Kumar S
• All India Institute of Medical Sciences (AIIMS), New Delhi, India

Abstract: Introduction and Objectives: Trace elements & heavy metals play a significant role in many biological systems and may act as promoters in stone formation. Materials and Methods: We compared the level of trace elements & heavy metals in urine, serum and stone samples in patients with renal stones who underwent percutaneous nephrolithotomy (n (cases) = 102) and patients with ureteropelvic junction obstruction (n (controls) = 78) who underwent pyeloplasty. Samples were compared for aluminium (Al), barium (Ba), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), lead (Pb), manganese (Mn), mercury (Hg), magnesium (Mg), selenium (Se), strontium (Sr), zinc (Zn), silver (Ag) and iron (Fe). Levels were measured by inductively coupled plasma mass spectroscopy. Patients with metabolic abnormalities were excluded. Results: A significantly higher concentration of urine Zn and a lower concentration of urine Pb were observed in patients with renal stones compared to controls (346 vs. 250.2, p = 0.02; 0 vs. 7.05, p = 0.017 respectively). Serum Co (1.3 vs. 4.2, p = 0.008) and Mn levels (28.4 vs. 40.7, p = 0.001) were significantly lower in patients with renal stones. Serum and urine Cr were significantly higher than the permitted level in both cases and controls and significantly negatively correlated with stone Cr levels (r = −0.29, p = 0.002; r = −0.25, p = 0.01 respectively). Conclusions: Significantly altered levels of some heavy metals and trace elements were found in patients with renal stones which might promote lithogenesis. Higher serum and urine Cr levels than the permitted limit might be an indicator marker of environmental pollution.

3.1.13. RF-01.13: The Elementome of Calcium-Based and Non-Calcium-Based Urinary Stones: A Cross-Sectional Analysis

• Aggarwal V, Quadri J, Shariff A, Kumar S, Seth A and Singh C
• All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

Abstract: Introduction and Objectives: Understanding the elemental composition of the urinary stones may help identify key aspects of stone formation and new targets for treatment. Materials and Methods: We performed a cross-sectional analysis of data on stones’ chemical composition and elementome obtained from patients who underwent percutaneous nephrolithotomy (n = 162). Stones’ chemical composition and structural analysis were done using Fourier transform infrared spectroscopy. The levels of trace elements & heavy metals (Aluminium (Al), Barium (Ba), Cadmium (Cd), Chromium (Cr), Cobalt (Co), Copper (Cu), Lead (Pb), Manganese (Mn), Mercury (Hg), Magnesium (Mg), Selenium (Se), Strontium (Sr), Zinc (Zn), Silver (Ag), and Iron (Fe)) in stone and urine samples were measured by inductively coupled plasma mass spectroscopy. Patients with metabolic abnormalities were excluded. Results: The most abundant trace elements in urinary stones were Mg (mean 1,363,689.5 ± 8,961,151 ppb), followed by Fe (160,489.33 ± 1,746,388). A significantly higher concentration of Co (median 196 vs. 45, p = 0.008), Mg (29,656 vs. 555.05, p = 0.03), Zn (9567.2 vs. 219.5, p = 0.05) and Fe (1803.79 vs. 153.2, p = 0.05) were observed in patients with calcium-based stones (n = 150; calcium oxalate, calcium and magnesium phosphates) compared to non-calcium-based stones (n = 12; uric acid). Urine Co and Mn levels were significantly negatively correlated with stone Co and Mn levels respectively (n = 124; r = −0.22, p = 0.01; r = −0.26, p = 0.002 respectively). Conclusions: Trace elements’ concentration in urinary stones may reach several orders of magnitude. Significantly higher levels of Co, Mg, Zn and Fe were found in the calcium-based stones compared to non-calcium-based stones. The amount of Co and Mn in stones negatively correlates with the urinary levels suggesting that accumulation and other processes affect the stone elementome.

3.1.14. RF-01.14: Endourological Management of Urolithiasis in Transplanted Kidneys

• Manek P, Pattnaik P and Oza U
• Bombay Hospital & Medical Research Center, Mumbai, India

Abstract: Introduction and Objectives: Incidence of urolithiasis in transplanted kidney—0.2 to 6.3%. Urolithiasis in transplanted kidney do not present with classic colic, rather present with hematuria, AKI, oligouria or repeated UTI. Hence they are clinically difficult to diagnose with risk of significant morbidity. We examined the efficacy and safety of endourological procedures used to manage cases of urolithiasis in renal transplant recipients. Materials and Methods: This was a retrospective analysis of patients with post transplant urolithiasis who were referred to our center, from January 1998 to December 2018. We included 21 patients (15 males and 6 females). Mean age was 39.5 years. Mean interval from transplant to diagnosis of urolithiasis was 2.5 years. The most common clinical presentation was painless hematuria in 7 patients. Rising creatinine was found on routine follow up of 6 patients. 3 patients had vague lower abdominal pain, 2 patients had repeated UTI and 1 patient had sudden oligouria. NCCT was done in 18 patients preoperatively for surgical planning. Mean stone size was 1.9 cm, ranging from 0.8 cm to 4.2 cm. Results: Most common location of calculi was renal pelvis in 10 patients followed by calyces in 5, ureter in 3, and 1 in bladder. Lap-guided PCNL was performed in 8 cases, with complete clearance in all cases. Percutaneous approaches like PCNL, lap-guided PCNL and ECIRS have a better clearance for a larger stone burden. However, there were certain challenges associated with transplanted allografts like -dense post inflammatory capsule made puncture and dilatation of tract difficult, not all allografts were placed in the same position. RIRS was done in 5 cases, 3 upper calyx and 2 upper ureteric calculi. Complete clearance was achieved in all cases using holmium laser. Key here is to 1st identify neo ureteric orifice and negotiate wire into tortuous ureter. 2 procedures had to be staged (ECIRS and PCNL). Conclusions: Transplant urolithiasis requires nephrologists and urologists to maintain vigilance and a high index of suspicion. Using endourological procedures, alone or in combination is beneficial to improve efficiency. We recommend that such patients be managed in specialist centers with well equipped endourological armamentarium.

3.1.15. RF-01.15: Extracorporeal Shock Wave Lithotripsy (ESWL) for Pancreatic and Common Bile Duct (CBD) Calculi

• Manek P and Pattnaik P
• Bombay Hospital & Medical Research Center, Mumbai, India

Abstract: Introduction and Objectives: Pancreatic stones are sequelae of chronic pancreatitis, resulting in poor quality of life, frequent hospitalizations. Extraction of large pancreatic and common bile duct (CBD) calculi has always challenged the therapeutic endoscopist. Extracorporeal shockwave lithotripsy (ESWL) is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy. Pancreatic calculi in the head and body and difficult CBD stones (>15 mm) are targeted by ESWL, with an aim to fragment them to <3–5 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangiopancreatography (ERCP). Materials and Methods: ESWL is indicated in all patients of CCP with large PD calculi (>5 mm) that are not amenable to routine endotherapy—where pain is the predominant symptom, patients with large CBD calculi that are not extractable by routine techniques of sphincterotomy followed by basket/balloon. It is especially useful for patients with post-cholecystectomy retained stones, isolated or primary CBD stones. A third-generation electromagnetic lithotripter is used to deliver a maximum of 5000 shocks are delivered per session. Repeat sessions are carried out on successive days until the stone fragments are <3–5 mm in diameter. An intensity of 5–6 (15 000–16 000 kV) on a scale of 1–6 with a frequency of 90 shocks per minute is used for fragmentation. Results: A total of 451 patients of pancreatic calculi and 51 patients of CBD calculi were included with mean age of 42.1 years (8–72 years). 62% were males and rest were females. In our experience, complete and partial clearance of the PD and CBD was achieved in 75.5%, 15.5% and 80.3%, 11.7% of patients. Short-term pain relief with reduction in the number of analgesics ingested was seen in 85% of these patients. More than 90% of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being delivered at each session. Conclusions: In view of its high efficiency, non-invasive nature and low complication rates, ESWL can be offered as the first-line therapy for selected patients with large pancreatic/CBD calculi. The potential for ESWL to affect clinical outcomes is substantial.

3.1.16. RF-01.16: Horrors of Forgotten DJ Stent

• Mohapatra S and Ratkal J
• Karnataka Institute of Medical Sciences, Hubli-Dharwad, India

Abstract: Introduction and Objectives: Double-J (DJ) stents are an indispensable part of a urologist’s armamentarium saving many a lives and also salvaging many difficult situations for the caregivers. The term “forgotten stent” denotes the presence of stent beyond the intended therapeutic duration of dwell time, without patient’s awareness. Patients with a forgotten stent present with a host of symptoms like dysuria, hematuria but in some, results in severe encrustations or even non-functioning kidney status. We retrospectively studied such patients to analyse the morbidity and highlight management challenges of forgotten stents. Materials and Methods: The hospital records of 22 patients with 26 renal units with forgotten DJ-stent presenting at a tertiary care center between September 2022 to March 2024 were collected. The data reviewed included demographic details, presenting complaints, nature of previous surgery, dwell time of stent, radiological findings including degree of stent encrustation, intervention required and duration of hospital stay. Results: The gender & age distribution was equivocal. The most common symptom was pain (45.5%) followed by dysuria (31.8%) and one patient presented with septic shock. Majority of patients had stent for 13 to 24 months, while one patient carried the stent for an astonishing 12 years! 12 years. The type of intervention depended on the degree & position of encrustation and included cystolithotripsy/cystolitholapaxy, ureteroscopic lithotripsy and percutaneous nephrolithotripsy. Two patients who had encrustations at both ends were managed with combined cystolitholapaxy and supine PCNL as combined approach. For those with encrustation at the upper end, supine approach (32%) was the preferred position. Two patients in renal failure had to be initiated hemodialysis and one of them underwent nephrectomy. The average hospital stay was 8.6 days (min—3 days to max—45 days). Conclusions: The consequences of a forgotten stent are varied ending up even with a loss of kidney. Though the usage of ureteral stents cannot be avoided but needs to be judicious, to avert the horrors of a “forgotten DJ-stent.” We feel the same can be reduced to an absolute minimum by a vigorous adoption of CURSE strategy—Counselling, Undertaking the follow up, Radiographic images of DJ-stent in situ, Stent card to be issued, Enrolling in stent registry.

3.1.17. RF-01.17: Supine Percutaneous Nephrolithotomy (PCNL) in Pediatric Patients

• Manek P, Pattnaik P and Punjani H
• Bombay Hospital & Medical Research Center, Mumbai, India

Abstract: Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) in the supine position is increasingly and successfully used in pediatric age group with a lower patient morbidity. This encouraged us to perform supine PCNL in pediatric population. The aim of this study is to evaluate the safety and efficacy of supine pediatric PCNL. Materials and Methods: This retrospective study included 20 children presenting with renal calculi (2–3 cm) in the period between January 2021 and December 2023. Diagnosis was set by plain x-ray and computed tomography in all patients. The stones were single pelvic stone in 14 cases, pelvic stone with lower calyceal stones in 3 cases and pelvic stone with upper calyceal stones in 3 cases. PCNL was performed with the patients placed in supine position with elevation of the ipsilateral shoulder and hip by means of two bags, one underneath the shoulder and the other underneath the hip to widen the operative field. The operative time and hospital stay were estimated. The outcome (SFR) and any perioperative complications were recorded. Results: The study included 20 children (14 boys and 6 girls) with a solitary renal pelvis stone. Stone length, operative time, and hospital stay had mean standard deviation of 2.5_0.21 cm, 55.1_15.5 min, and 4.5_0.9 days. Stone-free rate was 90% after 1 session of PCNL. One patient (5%) needed a second-look PCNL. ESWL was performed for another patient. Postoperative fever occurred in 4 patients (20%) that responded to medical treatment. One patient received postoperative blood transfusion. Conclusions: The main advantages of supine pediatric PCNL are that it is comfortable for the surgeon, the anesthetist and the child. It carries the advantages of easily upper calyx access through the lower calyceal tract, low incidence of fluid absorption or hypothermia and easy anesthesia monitoring. However a larger number of cases are needed to be evaluated. PCNL in pediatric age group via supine PCNL was proved to be safe and effective in management of renal pelvis stones of size 2–3 cm. It provides stone clearance rate comparable with that reported of conventional PCNL in the prone position.

3.2. Residents’ Forum 02

• Friday, October 25, 2024
• 0800-0900

3.2.1. RF-02.01: Innovative Role of FDG PET-CT in Assessing Systemic Therapy Response for Metastatic Renal Cell Carcinoma: Cost-Effective Evaluation in Critical Cases

• Usmani A, Mittal A and Sureka S
• Sanjay Gandhi Postgraduate Institute, Lucknow, India

Abstract: Introduction and Objectives: The application of FDG PET/CT is limited in primary renal cell carcinoma (RCC) due to physiological excretion, which decreases the contrast between renal lesions and normal tissue. While contrast-enhanced CT (CECT) scans evaluate lesions based on their anatomical context, including size and appearance of new lesions, FDG PET/CT scans offer an additional metabolic component. In many cases, the size of the lesion may take time to respond to treatment, while metabolic activity changes may occur first. This study aims to assess the utility of FDG-PET/CT as a monitoring tool for early response to systemic therapy in metastatic renal cell carcinoma (RCC). Materials and Methods: A study was conducted from January 2020 to December 2023 analyzed 48 metastatic RCC patients with ECOG<2, who underwent baseline and 3-month follow-up 18-FDG/PET-CT scans. Exclusions comprised pregnant/nursing mothers, hypothyroid, diabetics, and individuals with brain metastasis or other malignancies. Response evaluation utilized RECIST version 1.1 (for CECT) and PERCIST criteria, alongside total lesion glycolysis (TLG) and metabolic tumor volume (MTV) assessments. Interrater agreement was determined using Cohen’s Kappa. Results: Out of 48 patients, 44 had clear cell histology. Treatment regimens included Sunitinib, Pazopanib, Everolimus, and Axitinib administered to 12, 22, 6, and 8 patients, respectively. Among RECIST partial responders (PR), 8 were reclassified as stable disease (SD) or progressive disease (PD) according to PERCIST, influencing subsequent management changes. Patients with PERCIST-defined PR exhibited superior long-term survival compared to those reclassified. Significant decreases in median SUVmax, MTV, and TLG were observed after 3 months in these patients. Conclusions: 18-FDG PET/CT scans effectively monitor systemic therapy response in metastatic RCC, identifying partial responders with prolonged survival based on 18-FDG avidity. Additionally, changes in metabolic parameters facilitate early therapy response detection and guide subsequent treatment adjustments.

3.2.2. RF-02.02: Unveiling the Power of Diffusion-Weighted MRI: A Novel Diagnostic Approach for Distinguishing Renal Pseudotumors and RCC in CKD Patients: Advanced, Cost-Effective Innovation

• Usmani A, Sureka S, Raj H and Mittal A
• Sanjay Gandhi Post Graduate Institute, Lucknow, India

Abstract: Introduction and Objectives: Pseudotumors are benign lesions that can resemble malignant tumors on conventional imaging. They often develop in kidneys affected by chronic pyelonephritis, glomerulonephritis, trauma, or infarction. Distinguishing between renal cell carcinomas (RCCs) and pseudotumors presents a diagnostic challenge. Our study indicates that bp-MRI (T2-weighted, diffusion-weighted MRI) can effectively differentiate pseudotumors from RCCs, offering a non-contrast, non-invasive alternative for patients with chronic kidney disease (CKD). Materials and Methods: We prospectively evaluated 80 CKD patients (CKD IV/V) with suspicious renal masses (< 4 cm) detected on ultrasound. Patients underwent bp-MRI, and two groups were defined based on the restriction pattern observed on diffusion-weighted imaging (DWI). ADC values were calculated. Group I (suspected RCC or malignant tumor) underwent surgical management per institutional protocol, while Group II (suspected pseudotumor) underwent biopsy. ROC curves were generated to determine the area under the curve for differentiating between groups, and cut-off ADC values were determined to achieve the highest average sensitivity and specificity. A p value of < 0.05 was considered statistically significant. Results: Among the patients, 60 (Group I) exhibited a restricted pattern on DWI imaging, while 20 showed no restriction (Group II), ruling out malignancy. This approach demonstrated a sensitivity of 81.82% and specificity of 96.55% in correct diagnosis. The mean ADC value for CKD pseudotumors (Group II) was significantly higher than that for RCCs and surrounding diseased parenchyma [2.20 vs. 1.52 (×10⁻³ mm²/s) (p < 0.0001) and 1.99 (×10⁻³ mm²/s) (p = 0.0001), respectively]. ROC analysis for differentiating CKD pseudotumors and RCC yielded high sensitivity (85%) and specificity (99%) for a cut-off ADC value of 1.71 (×10⁻³ mm²/s). Conclusions: bp-MRI emerges as a highly reliable imaging modality for evaluating renal lesions. Its capacity to accurately distinguish pseudotumors from RCCs, even without contrast administration, enhances the diagnostic armamentarium available for clinicians.

3.2.3. RF-02.03: A Rare Case of Mucinous Adenocarcinoma of Renal Pelvis Masquerading as a Non Functioning Pyonephrotic Kidney

• Kadam A and Vaddi S
• Yashoda Super Speciality Hospital, Somajiguda, Hyderabad, India

Abstract: Introduction and Objectives: Mucinous adenocarcinoma of the renal pelvis is a rare and intriguing variant of renal malignancies. Diagnosing preoperatively is challenging due to its rarity and limited cases. In this we aim to unravel clinical presentation, histological characteristics and potential etiological factors associated with this tumor variant. Materials and Methods: 48-year-old diabetic and hypertensive male complain of cloudy urine and generalized weakness since 1 year. H/o left renal calculi with bladder calculi underwent CLT with left PCNL in 2020. On evaluation urine examination -pus cells: 2–5; CS-klebsiella pneumoniae sensitive to fosfomycin, amikacin. Urine for chyle-negative. CT KUB- normal. LK—95 × 49 mm, severe dilated calyces in upper and mid pole noted with focal areas of cortical thinning. EC Renogram: non functioning left kidney. Results: Patient underwent left laparoscopic nephrectomy by transperitoneal port placement method. Intraoperative pus filled kidney noted and cut section showed gelatinous material filling the whole of kidney. PUC and ADK removed on POD 1 & 2 respectively. HPE -High grade mixed adenocarcinoma with abundant extracellular mucin infiltrating into renal cortex till perinephric fat. pT4 pN0 On follow up 9 months later PET scan was done which showed metabolically active sclerotic lesions involving axial multiple axial and appendicular skeleton likely metastatic. Patient underwent radiotherapy for the same. Conclusions: Primary mucinous adenocarcinoma is an especially rare disease with fewer than 100 cases reported till date without characteristics, radiological features and standard treatment. The prognosis of primary adenocarcinoma of renal pelvis is generally poor with survival of less than 02 years with no adjuvant chemotherapy drug treatment.

3.2.4. RF-02.04: Algorithm for Management of Urolithiasis in Patients Undergoing Partial Nephrectomy for Coexistent Renal Masses-Single Center Experience

• Patel D, Gowda N, Vijay V, Singh A, Ganpule A, Sabnis R, Desai M and Shete N
• Muljibhai Patel Urological Hospital, Nadiad, India

Abstract: Introduction and Objectives: The incidence of renal calculi with coexistent renal masses is unknown. Although guidelines exist for individual management of renal calculi and tumor, same cannot be applied for their combined management. With this study we tried to calculate the incidence and have come up with the algorithm for the management of urolithiasis in patients undergoing partial nephrectomy for coexistent renal masses. Materials and Methods: We conducted a retrospective observational study in a tertiary care urological hospital. Patients have been managed conservatively for calculi, calculi first followed by tumor, tumor first followed by calculi and both tumor & calculi managed simultaneously. Demography, clinical presentation and management details of these patients were reviewed over the last 13 years. Algorithm for management was built after reviewing the follow up, creatinine levels, oncological outcomes and complications. Results: Incidence of coexisting renal calculi with coexistent tumor for which partial nephrectomy contemplated was 13.2%. Stones have been managed with various procedures ranging from ESWL, URSL, RIRS, PCNL to open pyelolithotomy. Tumor management was by partial nephrectomy either by open or minimally invasive laparoscopic or robotic approach. 13 year follow up showed complication rate to be significant (p = 0.013) in patient undergoing simultaneous management of tumor and calculi group and in the group also who were managed conservatively for calculi. Conclusions: Incidence of urolithiasis with coexistent renal masses for which partial nephrectomy contemplated is significant. Although we recommend against conservative and simultaneous management of tumor and calculi based on the results of our study, treatment options have to be individualised based on the clinical presentation, tumor and stone characteristics. Long term follow up did not show much recurrence of stones, renal function impairment and also no difference in oncological outcomes (recurrence & metastases). Follow up must be close and in the lines of both tumor and stones. Although by this study we have formulated algorithm for same but large sample size multi-institutional trials and prospective randomised controlled trials are required to validate it.

3.2.5. RF-02.05: Breaking New Ground: Exploring the Diagnostic Accuracy of 99mTc MIBI Scan in Distinguishing Oncocytoma from RCC: Fulfilling Critical Needs with Innovative Precision

• Usmani A, Shukla A, Pratap U, Mittal A and Qazi I
• Sanjay Gandhi Postgraduate Institute, Lucknow, India

Abstract: Introduction and Objectives: Despite advancements in multiphasic CT and MRI scans, fully characterizing solid kidney lesions remains challenging. About 10% of solid renal tumors are oncocytomas. While literature suggests that 99mTc-sestamibi SPECT/CT can preoperatively differentiate oncocytoma from renal cell carcinoma (RCC), our study did not yield promising results in accurately distinguishing between the two using Sesta-MIBI SPECT/CT scans. Our pilot study aims to evaluate whether 99mTc Sesta-MIBI SPECT/CT can aid in characterizing solid renal neoplasms and differentiating oncocytomas from RCC. Materials and Methods: The study comprised 35 patients with solid renal lesions scheduled for surgical intervention. Prior to invasive procedures, patients underwent SPECT/CT with 99mTc-SestaMIBI. Any focal 99mTc Sesta-MIBI uptake detected on SPECT within the tumor’s localization was considered positive. Results: Among the 31 clear cell RCC cases, none showed uptake of 99mTc-sestamibi. Two oncocytomas and one hybrid tumor (mixed-type oncocytoma and chromophobe renal cancer) exhibited positive uptake on SPECT/CT. One papillary renal cell carcinoma showed weak uptake of 99mTc-sesta-MIBI. Conclusions: The sensitivity and specificity of Sesta-MIBI scans in preoperatively differentiating between oncocytoma and clear cell RCC are nearly 100%. While clear cell RCCs do not exhibit uptake on Tc99 Sesta-MIBI, papillary RCCs may display weak uptake on MIBI scans, likely due to the presence of mitochondria in the cytoplasm of these tumor cells.

3.2.6. RF-02.06: Salvage Robot-Assisted Partial Nephrectomy After Radiofrequency Ablation: Technique and Challenges Encounter

• Kushwaha S, Kumar A, Maheshwari R, Chaturvedi S, Desai P, Kaushal R, Vasudeo V, Aggarwal A and Agrawal O
• Max Super Speciality Hospital, Saket, New Delhi, India

Abstract: Introduction and Objectives: The emergence of new renal tumors or recurrence following thermal ablation poses a challenging therapeutic dilemma. Salvage robot-assisted partial nephrectomy (sRAPN) after radiofrequency ablation (RFA) is challenging and associated with more complications due to significant desmoplastic reaction and fibrosis. We describe a unique case of sRAPN, one year after RFA, highlighting the technique and challenges encountered. Materials and Methods: The patient is a 49-year-old male, case of chronic liver disease post TIPS, underwent radiofrequency ablation of right mid-pole renal mass of size 30 × 25 × 28 mm. He remained on surveillance with periodic imaging. Follow-up MRI after 1 year demonstrated a mass in the mid-pole of the right kidney- the previous site of RFA. We utilized transperitoneal approach using 6-ports with da Vinci Xi. Ultrasound guidance was used to demarcate the tumor. Intraoperative ICG was used to assess the vascularity of parenchyma before and after the excision of tumor. A V-loc suture was used for the renorraphy using the running sliding hem-o-lok clip technique. Results: The case was completed without complications within 390 min. Estimated blood loss was 400 mL with an ischemia time of 40 min. The perioperative period was uneventful and the patient was discharged 5 days after surgery. The histopathology showed clear cell-type renal cell carcinoma and an area of ablated tissue adjacent to the lesion. Renal function was normal at 3 and 6-month follow-up and the most recent creatinine was 0.9 mg/dL. Follow-up imaging did not reveal any evidence of recurrence. Conclusions: In an era of new modalities for addressing small renal mass, RAPN may be utilized for salvage procedures for recurrences after ablative technologies. sRAPN after RFA is technically challenging, even in experienced hands but feasible with acceptable warm ischemia time and has a safe complication profile.

3.2.7. RF-02.07: Treatment Outcomes of Primary Genitourinary Sarcomas in a Resource Challenged Setting: Experience from a High Volume Tertiary Care Center in India

• Aggarwal V, Kumar M and Rastogi S
• All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

Abstract: Introduction and Objectives: Primary adult genitourinary sarcoma is uncommon. The evidence for the optimal management and survival outcomes of such patients in resource-challenged settings is limited. Materials and Methods: This is a retrospective review of the prospectively maintained database of adult patients diagnosed with primary genitourinary sarcoma treated at our institution between January 2016 and March 2024. We studied the clinicopathological characteristics, treatment and survival outcomes of such patients. Results: A total of 27 cases were identified with a median age of 32 years (range 15–65 years) and a median follow-up of 24 months. There were 20 males and 7 females. The most common presenting symptom was hematuria (41.6%). The most common primary site was the kidney (59.2%) followed by the bladder (22.2%). The most common histological subtype was Ewing’s sarcoma (n = 14, 51.8%). At the time of diagnosis, 6 (28.5%) patients had metastatic disease. The majority of patients (60%) were treated by surgical resection and chemotherapy/targeted therapy with or without radiotherapy. The overall survival at 5 years was 39.7%. The median survival was 25 months. On Cox proportional hazard multivariate regression analysis, metastasis at the time of presentation was predictive of poor survival (HR 5.57, p value = 0.03). Conclusions: Primary genitourinary sarcomas are difficult to treat and prognosis remains poor even in the era of targeted therapy. The presence of metastasis at diagnosis is an important predictor of overall survival.

3.2.8. RF-02.08: Bilateral Testicular Tumor as a Manifestation of Relapse in Acute Lymphoblastic Leukemia (ALL): A Case Report

• Delgado A, Martinez A, Arguelles G, Toledo M, Santiago R, Vieyra O, Garza G, Trujillo L, Perez R and Osornio V
• Hospital Regional de Alta Especialidad de Ixtapaluca, Chihuahua, Mexico

Abstract: Introduction and Objectives: Acute lymphoblastic leukemia (ALL) is the most common neoplasm in pediatric age. Leukemic testicular relapse is rarely observed, a frequency range between 0.9 to 8.8% is reported. This recurrence occurs mainly during a sustained remission of the disease in the bone marrow. Extramedullary involvement, mainly testicular and central nervous system, is an important factor in monitoring and determining risk, prognosis and survival. To present the clinical case of a patient with a history of remitted ALL, who presents systemic recurrence, debuting with a testicular tumor, managed with radical orchiectomy and chemotherapy. However, despite systemic management, recurrence occurred in the contralateral testicle. Materials and Methods: 21-year-old male patient with a history of ALL since 2016, managed with chemotherapy (Etoposide, Metrotexate, 6-Mercaptopurine, Vincristine, L-Asparaginase) for 120 weeks with disease remitted until April 2022. Debuts with increased volume, hyperemia, hyperthermia and pain in the right testicle, fever and contralateral testicle without alterations. Blood count: Leu 6.6 × 10³ uL, Hb 13.4 g/dL, Hct 40.5%, Platelets 171 × 10³ uL. Testicular USG: 66cc right testicle, heterogeneous and with increased vascularity. It is managed with right radical orchiectomy. Results: Histopathological report: Testicular involvement due to ALL, infiltration at the margin of the spermatic cord, epididymis and tunica albuginea. One month later he had involvement in the contralateral testicle. A bone marrow biopsy was performed, reporting lymphocytes in 92% of the sample. Management is given with chemotherapy for 30 days with partial response. (Cyclophosphamide, Vincristine, Doxorubicin, Dexamethasone). Conclusions: ALL with testicular involvement is a rare manifestation, even more so in remitted disease, this patient presents these characteristics, debuting with a testicular tumor, which is generally observed in advanced stages of the disease. The clinical manifestations of ALL in the testis are indistinguishable from a testicular germinal neoplasia, making differential diagnosis difficult. It highlights the fact that after the surgical event there is an exacerbation of the symptoms; in addition to hematological and bone marrow alterations, so the surgical event could be considered a stress factor that exacerbates the previously established disease.

3.2.9. RF-02.09: Clear Cell Sarcoma of the Penis: An Uncommon Entity with Review of the Literature

• Damm T, Hudson C and Monn M
• Southern Illinois University School of Medicine, Springfield, United States

Abstract: Introduction and Objectives: The majority of penile cancer is squamous cell carcinoma, often HPV related. Sarcomas to the penis, and more specifically clear cell sarcoma to the penis, is a rarely identified entity. We present the case of a patient with clear cell sarcoma of the penis with a review of the literature to discuss management. Materials and Methods: Patients with clear cell sarcoma of the penis were identified using retrospective review. Clinical and pathologic details were included. A systematic review of the literature was performed using key terms in PubMed of “clear cell sarcoma” and “penis”/“penile” and relevant articles identified for inclusion. Results: Patient is a 54-year-old male with a history of Peyronie’s disease who presented with enlargement of the distal third of the penile shaft without distinct mass or plaque. MRI demonstrated a 1.7 cm tissue density with disruption of the tunica albuginea in the distal penis. Initial biopsy was performed followed by partial penectomy with creation of penile urethrostomy. Tumor on partial penectomy measured 5.6 cm and stained positive for Melan-A, SOX10, HMB-45, vimentin, and focally positive for tyrosinase. Differential was clear cell sarcoma vs. melanoma. FISH showed an EWSR1 rearrangement consistent with clear cell sarcoma. PET CT demonstrated a solitary metastatic site to the lung and the patient was scheduled for wedge resection; however, he developed a soft tissue arm lesion that was biopsied and consistent for metastatic clear cell sarcoma prior to pulmonary wedge resection. Patient subsequently underwent 6 cycles with Atezolizumab and disease has remained stable, without new lesions diagnosed, at four months of treatment. Three prior case reports were identified, of which X articles were available for evaluation. Age ranged from ten to 32, and pathology stained positive for S-100 with evidence of melanocytes. FISH analysis confirmed the EWSR1 rearrangement in one of these patients. Metastatic disease was common. Conclusions: Clear cell sarcoma of the penis is a rare but aggressive tumor. It can be challenging to distinguish from melanoma and requires FISH analysis for definitive diagnosis. Newer therapies including PDL1 inhibitors may offer improved survivability. Surgical treatment remains a clinical mainstay.

3.2.10. RF-02.10: “Fascia Lata First” Approach to Robot-Assisted Inguinal Lymphadenectomy-Initial Experience and Outcomes

• Pirzada F
• AIIMS, New Delhi, India

Abstract: Introduction and Objectives: To present a modified and simplified technique, the ‘fascia lata first’ approach, for bilateral robot-assisted inguinal lymphadenectomy. Materials and Methods: This study was conducted on six consecutive patients who underwent the modified ‘fascia lata first’ approach for robot-assisted inguinal lymphadenectomy. All patients had squamous cell carcinoma of the penis, with two presenting with T2 disease and the remaining four with T3 disease. Results: The mean age of the patients was 48 years, and the average operating time was 185 min (excluding 35 min for combined docking time on both sides). The procedure resulted in a minimal blood loss of 75 mL, and an average of 12 lymph nodes were evaluated through histopathology. Postoperatively, patients were discharged on a mean of 6 days, and drain removal occurred after 10 days. Notably, none of the cases reported skin flap necrosis, and only one patient exhibited a superficial wound site infection, which was managed conservatively. Conclusions: The ‘fascia lata first’ approach for robot-assisted inguinal lymphadenectomy is associated with a simpler technique and a smoother learning curve while demonstrating equivalent oncological outcomes compared to standard methods. This approach may be advantageous for surgeons seeking to optimize the surgical management of penile cancers. Further research with larger cohorts is warranted to validate these promising preliminary findings.

3.2.11. RF-02.11: Growing Teratoma Syndrome: A Case Report & Review of Literature

• Kumar L, M C, Nayak B, Ghorai R and Seth A
• AIIMS, New Delhi, India

Abstract: Introduction and Objectives: Growing teratoma syndrome (GTS) is a rare clinical phenomenon with incidence up to 8%. It is a paradox of growing metastatic germ cell masses while tumor markers are normalizing during chemotherapy or follow up. Diagnosis is made after resection, which show mature teratoma elements without viable germ cells. Treatment of choice is complete surgical resection. It requires a complex multidisciplinary management with 23–100% need for adjunctive procedures and morbidity of 18–44%. Materials and Methods: 38-year male from Nepal with chief complaints of backache & dyspepsia. He was evaluated in Nepal with USG and CT, found to have enlarged retroperitoneal lymph nodes. Underwent FNAC from the mass at outside hospital which was suggestive of poorly differentiated germ cell tumor (GCT) and referred to AIIMS. He underwent right high inguinal orchidectomy biopsy was suggestive of mature cystic teratoma: pT1b. Post orchidectomy he was given 4 sessions of BEP chemotherapy. Post chemotherapy tumor markers normalized. On post chemo CECT, there was a large retroperitoneal mass encasing and lifting up abdominal aorta with encasement off celiac axis, SMA and bilateral renal arteries. Results: He underwent post chemo RPLND. Intra op multiple large retroperitoneal Lymph nodal mass, precaval, paracaval, interaortocaval, retropancreatic, multiple mesenteric LN mass, largest 8 × 8 cm mass in inter aortocaval region. Multiple left paraaortic LN mass along left Renal artery and IMA, largest 4 × 3 cm. Complete resection done without any adjunctive procedures HPE s/o- mature cystic teratoma. Patient is doing well till date. Conclusions: GTS is a rare entity warranting early recognition. The most important predictor for survival complete surgical resection. Completion of individual stage-stratified numbers of chemotherapy courses under thorough monitoring of size and clinical response. Multidisciplinary approach and complete surgical resection with intent to cure is the treatment of choice.

3.2.12. RF-02.12: Effect of Androgen Deprivation Therapy on Cardiovascular Function in Patients with Advanced Prostate Carcinoma: A Prospective Cohort Study

• Kumar L, Arulraj K, Nayak B, Singh P, Seth A and Yadav S
• AIIMS, New Delhi, India

Abstract: Introduction and Objectives: Objectives were to estimate cardiovascular effects of ADT using Framingham risk score, history of any adverse event, ECG & 2D-Echocardiography changes. Secondary objectives were to know metabolic effects of ADT using BMI & waist hip ratio, effect on peripheral vascular function using history of any adverse event and ABI, difference between medical & surgical castration adverse events. Materials and Methods: Cases of carcinoma prostate who underwent treatment in the Department of Urology, AIIMS, New Delhi from January 2022 to January 2023 were included in the study. Cases of locally advanced & metastatic carcinoma prostate being managed by androgen deprivation therapy were enrolled in the ADT arm. Cases of localized carcinoma prostate being managed either by active surveillance or by local therapy without ADT were enrolled in the control arm. Both groups were followed up by clinical assessment, ABI, ECG, 2D ECHO, Biochemical investigations, cardiovascular risk assessment using Framingham risk score. Results: Baseline characteristics were comparable between both groups. There were three major cardiac mortality in the ADT group within one year. At one year, ADT arm had a significant increase in their mean Framingham risk score compared to the control group having a mean increase in absolute score by 2.54 ± 4.45%. There was no significant change in the blood pressure between the two groups at one year. ECG changes in cases & controls were not significantly different. Mean increase in body weight at 12 months was 2.8 ± 2.9 kg (4.2%) among the ADT group and 0.94 ± 1.8 kg (1.4%) in the control group. The ADT arm had a significant increase in weight compared to controls. Cases had a significant increase in mean waist hip ratio. Total cholesterol increased significantly within the cases over 1 year with a mean increase of 13.25 mg/dL (7.9%). There was no significant difference in the parameters studied at 12 months between medical & surgical castration except for increased weight in medical group. Conclusions: There are significant metabolic derangements by ADT which can increase the risk of cardiovascular events. Despite the presence of cardiovascular risk, ADT should be offered to patients who require it. A thorough evaluation should be done prior & during ADT.

3.2.13. RF-02.13: Anterior First vs. Posterior First Approach for Robot Assisted Radical Prostatectomy: A Comparative Study

• Pirzada F
• AIIMS, New Delhi, India

Abstract: Introduction and Objectives: Robot-assisted radical prostatectomy is the surgical treatment of choice for localized prostate cancer. Due to the wide adoption of robots in radical prostatectomy, multiple techniques have evolved. Most commonly it is the anterior-first approach or the posterior-first approach, depending upon the manner of dissection of seminal vesicles. Despite the abundant data on RARP, there are not many studies to compare the outcome between an anterior vs. a posterior approach. Materials and Methods: This study was conducted in the department of urology AIIMS, New Delhi. After an institutional ethical committee board review, data of all RARPs performed in the last 10 years was retrieved from the maintained database. Demographic, clinical, intraoperative, and postoperative parameters were collected. Continence was assessed by number of pad usage and potency by using IIEF-5 questionnaire. Patients were divided into two groups; those that had a posterior-first (PF) surgery and those that had an anterior-first (AF) surgery. Baseline, operative, pathology and outcomes data were compared between these two groups. Results: Intraoperative and perioperative outcomes including console time, transfusion rate, positive margins, and complication rates were compared. There was no difference observed in the outcomes between the two approaches. The console time and blood loss were higher in the posterior-first approach compared to the anterior-first approach. Conclusions: There is not much difference between the two techniques of RARP. The choice of approach is the discretion of the surgeon with which he is comfortable.

3.2.14. RF-02.14: Effects of Using Radiologic T Stage Based on Multiparametric MRI for Preoperative Risk Stratification of Localized Prostate Cancer

• Marques-Monteiro M, Rocha M, Madanelo M, Mesquita S, Vital J, Carneiro D, Cabral J, Teves F and Fraga A
• Centro Hospitalar Universitário do Porto, Porto, Portugal

Abstract: Introduction and Objectives: Clinical staging (cT) has relied solely on only in digital rectal exams for risk group classification of localized prostate cancer according to D’Amico classification. The primary purpose of this study was to assess the impact of utilizing radiologic T based on multiparametric MRI as the primary method of T assessment for risk group classification. Materials and Methods: Patients with localized prostate cancer who underwent radical prostatectomy between 2021–2023 were analyzed. cT staging was determined according to TMN classification for prostate cancer. rT staging was classified as follows: rT1c if the PIRADS score was ≤2 and rT2 if the PIRADS score was ≥ 3. For rT2 lesions, they were further categorized as rT2a if the lesion involved less than 50% of one lobe, rT2b if it involved more than 50% of one lobe, and rT2c if bilateral lesions were observed. Risk group classification was determined similar to D’Amico risk group classification, differing only in T staging modalities (rT vs. cT). PSA persistence at 6 weeks and biochemical recurrence at 12 months were assessed. Results: We analyzed 190 patients. The median age was 67 years and 56.3% patients had PSA inferior to 10 ng/mL. The digital rectal exam was negative in 71.2% and only 4.3% patients had negative mpMRI. There was a substantial level of concordance between risk stratification incorporating rT or cT (77.13%, κ = 0.648, p < 0.01). Risk stratification incorporating rT upgraded low-risk disease based on cT in 36.4% (41.6% to the intermediate-risk and 58.3% to the high-risk) and upgraded 28.57% of the intermediate-risk group to high-risk, resulting in an overall upgrade of 31.3%. rT presents greater concordance to pT compared to cT, however, both cT and rT present a fair agreement with pT (κ < 0.1, p < 0.05). No statistical difference was observed in PSA persistence or biochemical recurrence between the risk groups classification using cT or rT. Conclusions: rT upgrades the risk stratification in one-third of patients. However, this stage shift doesn’t seem to influence PSA persistence and biochemical recurrence. Despite the low accuracy of digital rectal exam to predict pT, there was no apparent advantage to support the use of rT in risk group classification.

3.2.15. RF-02.15: Prostate Cancer: Neoadjuvant Chemotherapy Prior to Robotic Prostatectomy—Emerging Evidence

• Sharma G, WoodWard J, Wagh Y and Singh S
• Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Redhill, United Kingdom

Abstract: Introduction and Objectives: The role of neo-adjuvant androgen therapy (NAT) prior to radical prostatectomy (RP) is an evolving area of interest in uro-oncology. Studies including a 2006 Cochrane review have not shown conclusive evidence that NAT prior to RP is beneficial. Therefore, in our uro-oncology centre we compared the pre and post-operative histologies of intermediate and high risk localised prostate cancer (PCa) patients who received NAT and who did not, also analysing the timespan between diagnosis and RP. Materials and Methods: Single centre retrospective review of patients who underwent RP between October 2022 and February 2024. We classified cases as per Cambridge Prognostic Group Classification and analysed prostate biopsy and post RP histology results in patients who received NAT prior to RP vs. those who did not. We also analysed the effect of duration between diagnosis and surgery on post-operative histology and outcome for patients. Results: 120 patients with PCa, of which 52% (n = 63/120) were intermediate or high grade PCa, were audited. 30% (n = 36/120) patients received NAT, of which 50% (n = 18/36) were intermediate or high risk PCa. We observed improved surgical negative margins rates in this group of patients (downstaging was most prevalent in intermediate risk PCa). 38% (n = 32/84) cases which did not receive NAT had positive surgical margins, in comparison to only 25% (n = 9/36) cases which received ADT. Analysis showed mean of 99 days between diagnosis and RP. 21% (n = 25/120) had RP in <60 days & 17% (n = 20/120) > 120 days. We found evidence of histological upstaging in 55% (n = 52/95) cases who had RP after 60 days of initial treatment plan. Conclusions: We conclude that NAT before RP increases rate of negative surgical margins and ease of intraoperative dissection in intermediate risk and some high risk (low volume) PCa. Therefore, careful selection of patients is recommended. This in turn delays need for adjuvant therapy in these patients -long term data awaited. We conclude that longer delays (>60 days) in RP from initial diagnosis were associated with histological upstaging of PCa. We propose comparison of different hormonal therapies and duration of NAT prior to RP in a multicentre trial and long term follow up to assess long term outcome.

3.2.16. RF-02.16: Serum PSA Post Holmium Enucleation of the Prostate Helps Predict Future Risk of Prostate Cancer

• MacDiarmid S, Mann J and Chemasle C
• Palmerston North Hospital, Palmerston North, New Zealand

Abstract: Introduction and Objectives: Men who undergo holmium laser enucleation of the prostate (HoLEP) for benign prostatic obstruction (BPO) still have the potential to develop prostate cancer post-surgery. Changes in prostate specific antigen (PSA) post HoLEP can make subsequent prostate cancer screening and diagnosis challenging as it remains unclear what values should be considered normal and what values should trigger follow up and or investigation. The aim of this study was to identify a post HoLEP PSA cut off which may help predict the future risk of prostate cancer in those patients with benign histology. Materials and Methods: Data from 686 patients who underwent HOLEP at a regional New Zealand center between January 2009 and December 2023 was analysed. Exclusion criteria included a pre-existing diagnosis of prostate cancer, a diagnosis of prostate cancer on post-operative histology or absence of post-operative PSA. Patients were divided into two groups based on whether or not they were diagnosed with prostate cancer subsequent to their HoLEP procedure. Prostate size, number of grams resected, pre-op PSA, post-op PSA, change in PSA and PSA change per gram of tissue resected was analysed and compared between groups. Multi-variate ROC analysis was used to identify a PSA value that would predict future development of prostate cancer. Results: 15 (3%) patients were diagnosed with prostate cancer post HoLEP. The average post-operative PSA in this group was 8.14 (95%CI 3.98–12.3) compared to 1.26 for patients who remained prostate cancer free (95%CI 1.14–1.38). Post-operative PSA was an independent predictor of prostate cancer diagnosis post HoLEP with a cut off value of 1.5 ng/mL (sensitivity 100%, specificity 73%, AUC 0.86). Conclusions: Among patients who undergo HOLEP for benign prostatic obstruction, post-operative PSA helps in predicting the risk of future prostate cancer diagnosis. When post-operative PSA is > 1.5 ng/mL within the first year, close follow up and consideration of diagnostic investigation is warranted.

3.3. Residents’ Forum 03

• Saturday, October 26, 2024
• 0800–0900

3.3.1. RF-03.01: Amyloidosis of Bladder

• Manek P
• Bombay Hospital & Medical Research Center, Mumbai, India

Abstract: Introduction and Objectives: 71 year old male with no comorbidities came with complaints of poor flow of urine, increased frequency and urgency since 3–4 months. No complaints of fever, pain in abdomen, vomiting, lithuria, loss of appetite/loss of weight. No h/o addictions. No h/o malignancy in family. No surgical procedure in past. General and systemic examination was normal. On DRE-Grade 1 prostate, firm. Materials and Methods: Blood tests were essentially normal. Uroflowmetry showed a Qmax of 8.5 mL/s with a poor flow. Retrograde urethrogram (RGU) showed narrowing at junction of anterior and posterior urethra. On ultrasound, a focal non-mobile calcific focus seen in bladder, with few other small calcific foci adjacent to it. Results: He underwent cystoscopy-anterior urethra was normal. Bilateral prostatic lobes meeting in midline. Yellow-white calcific spots seen in posterior wall of bladder (above trigone) & right postero-lateral wall. Rest of bladder was normal. Biopsy taken from calcific spots. Histopathology revealed amyloidosis of bladder with positive Congo red staining and apple green birefringence under polarised light and negative for malignancy. Conclusions: Amyloidosis is a heterogenous group of disorder affecting a single-or multiple-organ system and presents as generalized or localized disease. It is benign, non-neoplastic characterized by extracellular deposition of fibrillar protein in tissue. Amyloidosis of the genitourinary tract is a rare entity. The urinary bladder is rarely the primary site of amyloid deposition but can be involved secondarily in systemic amyloidosis. Less than 100 cases of primary amyloidosis of the bladder have been reported in the literature. The differentiation from secondary amyloidosis is by exclusion of predisposing causes and the absence of amyloid deposition elsewhere in the body. Primary amyloidosis of bladder is a rare disease with an excellent prognosis in most cases. It is of interest to the urologist as it closely resembles bladder cancer on clinical presentation with painless gross hematuria. Urinary dysfunction is found in 50% of cases in patients due to amyloidotic neuropathy. Amyloidosis of bladder primarily affects posterior and posterior lateral walls. Cystoscopic appearance is similar to transitional cell carcinoma. Management of localized primary amyloidosis is mainly TURBT with symptomatic therapy. However, follow up periodic cystoscopy is mandatory.

3.3.2. RF-03.02: Minor and Major Complications Following Radical Cystectomy in Older Patients: A Systematic Review and Meta-Analysis

• Tempo J ¹, Qin K ², Ischia J ², Perera M ², Bolton D ², O’Callaghan M ¹ and Felemban S ²

¹ 

Flinders University, Adelaide, Australia

² 

Austin Health, Melbourne, Australia

Abstract: Introduction and Objectives: Radical cystectomy (RC) is the gold standard treatment for the management of invasive bladder cancer. However, it is a complex surgical procedure with high morbidity and mortality. This systematic review and meta-analysis aim to assess the minor (Clavien-Dindo (CD) I and II) and major (CD III and IV) complications within 90-day of RC in older patients (aged over 75 years old) and identify modifiable risk factors associated with this. Materials and Methods: A systematic literature review and critical appraisal was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on all studies published after 2003. MEDLINE, Embase and Scopus were searched for relevant papers published between 2003 and 2023. Studies reporting post-operative mortality and complications following radical cystectomy in older patients aged over 75 and 80 years old were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Heterogeneity was assessed using I2 values. Results: Our search retrieved 4456 articles, of which 109 studies (from 19 countries, five continents) were eligible for inclusion. Comparison of the minor complications (CD I and II) following RC comparing older (≥75 years old) and younger age groups demonstrated an increased risk of developing minor complications after RC (OR 1.17, 95% confidence interval [CI]: 1.01–1.37). Comparison of the major complications (CD III and IV) following RC between older and younger patients demonstrated a similar risk after RC (OR 0.96, 95% CI: 0.55–1.69). Conclusions: Minor and major complications after radical cystectomy are similar across all age groups (older and younger than 75 years old) however mortality is higher in the older population. Radical cystectomy in older people is feasible however precise patient selection remains essential.

3.3.3. RF-03.03: Ninety-Day Mortality Following Radical Cystectomy in Patients Aged 75 Years and over: A Systematic Review and Meta-Analysis

• Tempo J ¹, Qin K ², Ischia J ², Perera M ², Bolton D ², O’Callaghan M ¹ and Felemban S ²

¹ 

Flinders University, Adelaide, Australia

² 

Austin Health, Melbourne, Australia

Abstract: Introduction and Objectives: Radical cystectomy (RC) is the gold standard treatment for the management of invasive bladder cancer. However, it is a complex surgical procedure with high morbidity and mortality. There is evidence in the literature of under-treatment of older patients with muscle-invasive bladder cancer. The objective of this study was to conduct a systematic review and meta-analysis to assess the 90-day mortality post RC in older people, over the age of 75. Materials and Methods: We performed a systematic review and critical appraisal of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase and Scopus were searched for relevant papers published between 2003 and 2023. Studies reporting post-operative mortality and complications following RC on older patients over 75 and 80 years old were included. These studies were reviewed according to strict criteria and using the Risk of Bias in Newcastle-Ottawa tool. Results: Our search retrieved 4456 articles, of which 109 studies (from 19 countries, five continents) were eligible for inclusion. Comparison of the 90-day mortality after RC between old and young age groups demonstrates that patients over 75 years old are at higher risk of dying within 90 days of RC (OR 2.48, 95% confidence interval (CI): 1.99–3.08). The weighted 90-day mortality after RC in patients older than 75 was 7% (95% CI: 0.3–13.6%) compared to 3% (95% CI: 0.0–6.3%) in patients younger than 75. This risk increases in patients over the age of 80 compared to younger patients (OR 3.42, 95% CI: 1.62–7.22). The weighted 90-day mortality for patients aged over 80 was 11% (95% CI: 4.6–17.5%) compared to 2% (95% CI: 0.0–5.2%) for patients aged less than 80. Conclusions: Short-term (90-day) mortality after radical cystectomy is higher in patients older than 75. More randomised controlled trials in RC in older patients are needed to investigate modifications that reduce mortality following RC.

3.3.4. RF-03.04: Prospective Assessment of VI-RADS Score in Multiparametric MRI for Prediction of Muscle Invasion in Bladder Cancer

• Imran Q, Shukla A, Mandal S, Hussain A, Raj H, Patel K, Singh S, Sureka S and Singh U
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: Multiparametric magnetic resonance imaging (mp-MRI) of urinary bladder (UB) is a novel imaging to predict detrusor muscle invasion in bladder cancer (BC). The Vesical Imaging Reporting and Data System (VI-RADS) was introduced in 2018 to standardize the reporting of BC with mp-MRI and to diagnose muscle invasion. This study was performed to evaluate the role of mp-MRI using VI-RADS to predict muscle invasive BC. Materials and Methods: Our prospective study was carried from June 2021 to April 2023 in a tertiary care institute. 62 patients with bladder mass underwent mp-MRI followed by transurethral resection of the tumour (TURBT). Mp-MRI findings were evaluated by two radiologists and VI-RADS scoring was used to determine the probability of muscle invasion. The scores were compared with pathological results to evaluate the accuracy of the VI-RADS scoring system. Results: VI-RADS scores of 4 and 5 assigned to 10 (16%) and 19 (30.6%) cases, respectively, while 3 (4.8%) cases had VI-RADS score 3 on mp-MRI. VI-RADS 1 and 2 lesions were observed in 5 (8.0%) and 25 (40.3%) cases, respectively. On histopathology, 28 cases (45.16%) had muscle-invasive cancer and 34 cases (54.83%) had non–muscle-invasive cancer. The sensitivity, specificity and diagnostic accuracy of mp-MRI in predicting muscle invasive BC was 96.43%, 94.12% and 95.16% respectively. Conclusions: Mp-MRI has high sensitivity, specificity and diagnostic accuracy in predicting muscle invasive bladder cancer. So, this score can be used to predict muscle invasion preoperatively and guide the better clinical management of patients by decreasing morbidity and cost of treatment.

3.3.5. RF-03.05: A Single-Center Retrospective Observational Study in Comparison of Prostate Volume Measurement from Transabdominal Ultrasound, Transrectal Ultrasound and MRI Prostate

• Abd Karim M ¹, Fadzli A ² and Kuppusamy S ²

¹ 

Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia

² 

Universiti Malaya, Kuala Lumpur, Malaysia

Abstract: Introduction and Objectives: Prostate volume (PV) measurement plays an important role in managing prostate conditions such as benign prostatic hyperplasia (BPH) and prostate cancer. The aim of this study was to compare the PV measurement from three different imaging modalities, which is transabdominal ultrasound (TAUS), transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) of the prostate. Materials and Methods: Single centre retrospective analysis of PV measurements of the same patient obtained through TAUS, TRUS and MRI prostate prior to biopsy. Mean PV from each imaging measurement was analysed using analysis of variance (ANOVA) and the null hypothesis states that there is no significant difference in prostate volume measurement from each of the imaging modalities (p > 0.05). Results: Out of 718 patients who underwent TRUS biopsy from January 2018 until December 2022, only 311 patients were eligible for this study according to the inclusion criteria. The median age was 71 years and PSA was 33.3 ng/mL. ANOVA was used to analyze the difference among means of each imaging modalities and we found no significant difference in the means of PV measurement among imaging modalities (F = 0.713, p—0.49). A Tukey post-hoc test revealed that there is no significant difference among each modality with a p value of 0.45 (TAUS-TRUS), p = 0.79 (MRI-TRUS) and p = 0.85 (TAUS-MRI). Conclusions: This study has demonstrated that the prostate volume measurement from three different imaging modalities which is TAUS, TRUS and MRI of the prostate are not statistically significantly different. Potential clinical implications from this result is to suggest TAUS as the initial imaging modalities for prostate volume estimations especially in primary or peripheral centres where more sophisticated imaging are limited.

3.3.6. RF-03.06: Novel Technique of Thulium Fibre Laser Enucleation of Prostate for Benign Prostatic Obstruction: Our Institutional Experience

• Kadam A and V S
• Yashoda Hospital, Hyderabad, India

Abstract: Introduction and Objectives: Laser lithotripsy was first adopted by urologists in the 1980s. with holmium:yttrium-aluminium-garnet (Ho:YAG) becoming the laser of choice in the mid 1990s. In recent years, there has been a surge of interest in thulium fiber laser (TFL) which has a 4× higher absorption coefficient in water-containing tissue, smaller operating fibers (50–150 μm core diameter), lower energy pulses (0.025 J), and higher pulse rate capability (up to 2 KHz). The theoretical benefits of TFL have seen its application outside of stone surgery, in soft tissue surgery such as BPE and bladder tumour en-bloc resection. Materials and Methods: We analyzed 60 patients who underwent ThuFLEP due to lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). Both the pre- and perioperative data as well as the follow-up data for 3 months were evaluated: prostate volume, postvoid residual (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), prostate-specific antigen level, and the complication rate. Results: A total of 60 patients were included in the analysis. The mean age was 68 years. Mean prostate volume was 54cc. The frequency of late complications was as follows: stress urinary incontinence–1.6%; passable urethral stricture–3.3%; and increased frequency–6.6% which settled down after a period of 1 month. Postoperative complications after foleys removal were minimal limiting to recatherisation in one patient. Conclusions: Irrespective of the patient’s age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 months of follow up. In the hands of an experienced surgeon, ThuFLEP can rightly be a promising alternative to holmium laser enucleation of the prostate for treatment of LUTS associated with BPO. 1.

3.3.7. RF-03.07: Morbimortality in Patients with Xanthogranulomatous Pyelonephritis. Is Time to Change the Concept of Simple Nephrectomy?

• Martinez Correa A, Delgado Corral A, Vieyra Valdez O, Santiago Gonzales R, Perez Becerra R, Osornio Sanchez V, Garza Sainz G, Trujillo Ortiz L, Toledo Diaz M, Arguelles Morales G and Garcia Lopez
• Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico

Abstract: Introduction and Objectives: Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory chronic condition of the kidney, and it’s treatment most often involves a combination of antibiotics and simple nephrectomy. The aim of this study was to analyze the clinical and imaging features, the medical and surgical management as well as its complications associated. Materials and Methods: We retrospectively reviewed all nephrectomy specimens between February 2017 and June 2023. We found 30 cases of xanthogranulomatous pyelonephritis corroborated by histopathological diagnosis. Postoperative complications were stratified in minor and major according to Clavien-Dindo classification. Results: 30 patients were included. 53.3% were women. Mean age was 42.8 years. 30% were overweight. The clinical presentation was urinary tract infection in 50% and urosepsis in 23.3%. Tomographic features: 63.3% had staghorn calculi (SC) and 40% had stage I Malek & Elder classification. 33.3% had positive urine culture and 23.3% were associated with extended-spectrum beta-lactamase-producing enterobacterales (ESBL-E). Complications Clavien-Dindo grade II was the most frequent (26.6%). 53.3% developed major complications; grade III: 6.6%, grade IV: 26.6% and grade V: 16.6%. Conclusions: These “simple” nephrectomy is associated with greater morbidity and mortality than radical nephrectomy. XGP lead to fibrosis, adhesions and scarring making the dissection of the kidney, especially the hilum, a challenge. Here is why the word “simple” doesn’t reflect the difficulty of this surgery and a different terminology should be used in this challenging procedure. We propose the term “chaotic nephrectomy” or “complex nephrectomy” to describe more precisely the possible outcome in this surgery.

3.3.8. RF-03.08: Current Application of Blockchain Technology in Healthcare and Its Potential Roles in Urology

• Felemban S ¹, Harvey M ¹, Lim H ¹, Zhu J ², Ischia J ¹ and Bolton D ¹

¹ 

Austin Health, Melbourne, Australia

² 

University of Melbourne, Melbourne, Australia

Abstract: Introduction and Objectives: Blockchain, a novel technology, has changed the way data is stored on the Internet. It is unique in its inherent feature of maintaining secure and decentralised records, making it immutable to changes or deletion. Once data is entered and stored, it becomes permanently irreversible. The application of blockchain is well exemplified in cryptocurrencies. Other sectors such as governance, security, education and healthcare have also embraced using the technology. The objective of this study is to assess the current uses of blockchain in healthcare, especially surgery and urology, and to explore further potential applications in urology. Materials and Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on all studies published after 2003. PubMed, clinicaltrials.gov and OVID databases were searched for relevant papers published in English, between 2003 and 2023. Results: When pairing blockchain and surgery, the search yielded 59 results, of which 35 were eligible. In urology, there were six results using similar search criteria. Current application of blockchain is at its early stage in the surgical field, and sparse in urology. The main current use being the secured decentralised dataset across multiple international cancer research centres. Our proposed potential utilisations for blockchain in urology include: decentralised indelible timestamp with two-level secured operative consent, supply chain of BCG and other common urological therapeutics, ureteric stent tracing, optimising surgery and complication reporting, and universal management of low-risk prostate cancer. Conclusions: Blockchain is a highly secure technology that has been well deployed in cryptocurrency. Its use in surgery and urology is at its infancy. Despite its limitations, there is a wide range of potential applications in urology, especially in the era of AI and robotic surgeries. The characteristic advantages of blockchain include data immutability, system transparency, built-in security and increased autonomy of its users are drawcards to healthcare industry and policy makers. Widespread awareness and gradual integration of the technology is required within the healthcare system and to the public.

3.3.9. RF-03.09: Retrospective Analysis of Idiopathic Retroperitoneal Fibrosis Cases: Urological Perspective from a Tertiary Care Centre in Northern India

• Aggarwal V, Kumar M, Seth A and Soneja M
• All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

Abstract: Introduction and Objectives: Idiopathic retroperitoneal fibrosis (IRPF) is a rare fibro-inflammatory disease that develops around the abdominal aorta, iliac arteries and ureters. The evidence for the optimal management of such patients is limited. Efforts must be made to increase awareness among urologists about the treatment of this disease to institute appropriate treatment early. Materials and Methods: Adult patients’ data who were admitted to the urology ward in a tertiary care centre located in northern India with a diagnosis of IRPF and who underwent double DJ stenting between January 2017 and January 2023 were retrospectively reviewed. The clinical, and radiological characteristics and treatment outcomes of such patients were studied. Results: A total of 9 cases were identified with a median age of 42.8 years (range 17–55 years). There were 7 males and 2 females. All patients presented with pain or abdominal discomfort related to local mass effect or hydronephrosis. 7 patients had moderate-severe unilateral hydronephrosis and 2 had bilateral hydronephrosis. The median duration of symptoms at diagnosis was 24 months (range 12–36 months). Cross-sectional imaging showed soft tissue masses in all cases. All patients showed enhancement on computed tomography and/or MRI. Biopsies were performed on all patients. All patients were treated with a median dose of 1 mg/kg/day (range 0.5–1 mg/kg/day) prednisolone. Treatment response was assessed using FDG PET in all patients at 3 months. 1 patient received rituximab and 1 received methotrexate as a second-line treatment. Steroids were successfully tapered in all cases. 1 patient was lost to follow-up. Conclusions: Idiopathic RPF is a rare disease, in which the diagnosis is often delayed and commonly presents with obstructive uropathy. IRPF shows an excellent response to treatment with steroids with rituximab or methotrexate as second-line treatments. We propose an algorithm for the diagnosis, treatment, and follow-up of these patients to help guide urologists in the treatment of this disease.

3.3.10. RF-03.10: Genitourinary Primitive Neuroectodermal Tumors-Single Center Experience

• Patel D, Agrawal S, Pathak N, Batra R, Patil A, Singh A, Ganpule A, Sabnis R and Desai M
• Muljibhai Patel Urological Hospital, Nadiad, India

Abstract: Introduction and Objectives: Primitive neuroectodermal tumors (PNETs) of genitourinary origin are extremely rare. They belong to Ewing sarcoma family of tumors. They affect young adults and present at advanced stage. They are having aggressive tumor biology. Diagnosis is reached on CT/MRI with histopathology of the specimen confirmed with immunohistochemistry and cytogenetics. Management needs to be also aggressive with multimodal therapy. In this case series of 10 cases, we aim to present our institutional experience of managing rare PNETs of kidney (eight cases), prostate (one case) and seminal vesicle (one case). Probably this will be the largest case series in literature and unique with regards to 3 different genitourinary PNET locations. Materials and Methods: We retrospectively reviewed hospital’s tumor board database & found eight kidney, one prostate and one seminal vesicle PNET cases. We reviewed clinical presentation, imaging features, diagnostic features, treatment and follow-up details of all cases. Results: Kidney PNETs (eight cases)- Male to female ratio was 7:1, the mean age was 26.5 years. All were locally advanced tumors on presentation-one patient had inferior vena cava thrombus, one patient had metastases, two patients had tumor extending to paranephric space. Diagnosis was made by histopathology supported by immunohistochemistry showing CD99 positivity. All patients were treated by radical nephrectomy, followed by chemotherapy in all and radiotherapy in three patients. Two patients expired at 3.5 and 6 years after surgery, remaining six patients are alive at median follow-up period of 34.5 years. Prostate PNET (single case)—32-year-old male diagnosed to be having prostate PNET on TRUS biopsy & MRI, after neoadjuvant chemotherapy (VAC/IE) referred to our center for further management. He underwent robot assisted radical prostatectomy and received adjuvant chemotherapy and radiotherapy, now after 6 month follow up having no recurrence/metastases. Seminal vesicle PNET (single case)—39-year-old male presented with urinary retention and on imaging having tumor in rectovesical pouch-seminal vesicle/prostate origin. Robotic excision was done and histopathology/immunohistochemistry showing PNET of seminal vesicle. He received adjuvant radiotherapy with chemotherapy and now after 6 month follow up having no recurrence/metastases. Conclusions: Genitourinary PNETs are extremely rare tumors with aggressive tumor biology. They are having dismal prognosis. Combination of surgery, chemotherapy and radiotherapy help clinician to get better local/systemic control of disease and better survival.

3.3.11. RF-03.11: Challenges in Wilms Tumor: Impact of Subject, Source and Support System: 15 Years Experience from a Tertiary Care Centre in Northern India

• Imran Q, Hussain A, Singh S, Pathak A, Yadav P and Ansari M
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: To study the clinical, pathological and demographical characteristics, outcome of multimodality treatment and challenges faced in treatment of Wilms tumor in Indian patients. Materials and Methods: Retrospectively data of patients which presented from 2003–2018 to our center with Wilms tumor was studied. Patients underwent routine workup, biopsy ± 4–6 cycles of neoadjuvant chemotherapy. Surgery was followed by chemotherapy with or without radiotherapy. Results: Total 60 patients presented with Wilms tumor from 2003 till 2018. 64% (34/53) of the patients with age <10 yrs were underweight. Late presentation was common with 50% of patients presenting after 5 years of age. Average size of tumor was around 10 cm in each stage (range 5 cm to 20 cm). 52% of patients presented with stage I, 23%, 10%, 8% and 7% with stage II, III, IV and V respectively. Mean follow up period was 50 months (range 1–111 months). Mean survival time was 94, 77, 36, 49 and 31 months for stage I, II, III, IV and V respectively. Overall, 5 year survival was 72% and event free survival was 67%. Total of 9 events occurred in total including metastasis and recurrences. Conclusions: Although multimodality treatment has significantly increased survival in Wilms tumor but in low-income population there are many other challenges which restricts full utilization of these new approach.

3.3.12. RF-03.12: Delayed Surgical Repair of Pediatric Pelvic Fracture Urethral Injury: Critical Analysis of Outcomes Using Algorithmic Approach

• Imran Q, Ranjan A, Singh S, Pathak A, Yadav P and Ansari M
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: Pelvic fracture urethral injury (PFUI) in the pediatric age group is a complicated case and their treatment is a highly challenging task. In our study, we have retrospectively reviewed our experience of the surgical management of pediatric PFUIs and have formulated an algorithm for the need for pubectomy. Materials and Methods: Relevant history, investigations, and treatment of 85 boys with PFUI were documented and managed at our institute between January 1992 and December 2022 and were reviewed. All boys aged less than 18 years with urethral injury associated with pelvic fracture who underwent some definitive surgical procedure for PFUI were included & complex strictures were excluded. Results: At our center, all patients except one were managed with end-to-end urethroplasty via perineal route. Inferior pubectomy was required in 44.7% of cases while 8.2% needed total pubectomy. Length of the stricture/distraction defect was a predictor for need for pubectomy. In boys younger than 5 years, pubectomy was needed in all cases with a defect of >3 cm. Likewise, the critical length was 4 cm between 5–10 years, and 5 cm in >10 years of age. Conclusions: Our study depicts that most of the PFUI in paediatric age can be effectively managed via the perineal route with a high success rate with pubectomy being reserved for more complex cases. Our algorithm can help decide if a pubectomy is necessary to perform tension free anastomosis.

3.3.13. RF-03.13: Management of Neurogenic Bladder & Bowel Dysfunction in Spinal Dysraphism: Our Experience

• Debnath S, Mandal T and Chatterjee U
• Nil Ratan Sircar Medical College, Kolkata, India

Abstract: Introduction and Objectives: Neurogenic bladder & bowel dysfunction is a sequelae of surgical closure of neural tube defect. Renal impairment secondary to back-pressure changes is preventable given proper evaluation, follow-up and active management. The aim of our study is to present a case scenario in our hospital and also present a novel augmentation technique of augmentation cystoplasty in one such case. Materials and Methods: This is a case series of 5 patients (3 female and 2 male) with neurogenic bladder and bowel dysfunction following meningomyelocele repair, who were under treatment in our institute from 2022 to 2023. Out of this five, three (2 female and 1 male) had destrusor sphincter dyssynergia with reduced compliance but near normal capacity. One male patient was treated with superficial BNI and rhabdosphicter fulgration. One female patient is being treated with external sphincter dialation. Another female patient was treated with superficial BNI. Of the rest 2 patients (one male and one female) the male patient had DSD with reduced compliance and small capacity. He was on anticholinergics for last 2 years. A rhabdosphincter fulgration was done. In the female patient who had small capacity, reduced compliance and no detrusor activity in voiding phase, a novel technique of augmentation enterocystoplasty was done with a single ileal segment which was uses for augmentation as well as conduit for CISC. Also a simple appendicostomy was done for antegrade enema. The rest four patients are being conservatively managed for constipation. Results: 4 out of 5 patients above patients are continent (with fluid restriction) except one male child with small capacity reduced compliance bladder where presently bladder augmentation is contemplated. The female patient who underwent augmentation and CISC conduit, is presently socially dry and doing CISC and antegrade colonic enema (ACE) herself and attending local government school which she could not previously. All the patients have stable creatinine level and no hydronephrosis on USG follow-up. Conclusions: The varied presentation of neurogenic bladder dysfunction in spinal dysraphism warrants an individualised treatment approach for prevention of renal impairment. Despite conservative treatment a subset of patient may need augmentation cystoplasty.

3.3.14. RF-03.14: Impact of Double J (DJ) Stent on Erectile Dysfunction in Men Undergoing Endourological Procedures

• Manek P, Pattnaik P and Gupte D
• Bombay Hospital & Medical Research Center, Mumbai, India

Abstract: Introduction and Objectives: Endourological procedures like ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) are often followed with DJ stenting. However, it has been shown to have a negative impact on sexual function. It is thought that the stent can irritate the trigone. The irritation can cause pain, burning, and difficulty urinating, which can all interfere with sexual activity. Trigonal irritation may result in sexual dysfunction. This study protocol proposes to assess the effects of DJ stenting on sexual function in a prospective cohort study of patients who undergo the procedure. Materials and Methods: Ours is a prospective, observational study. All patients aged 25–65 years undergoing endourological procedures—URS, RIRS, or PCNL with DJ stenting and sexually active patients were included. They were assessed for ED using IIEF-5 Score before stenting (baseline), 4 weeks after stenting and 4 weeks after stent removal. Post stenting-—How many days-stent in-situ –Coital activity while stent in-situ—If avoiding, then why?—Performing-frequency/week -Satisfaction (IIEF-5 Score)—Issues faced-arousal, erection, ejaculation, orgasm –Medications (alpha blocker/anticholinergics) were assessed. Results: Total of 65 patients included in our study, carried out from April 2023 to October 2023. Mean age of patients was 39.1 years (25–65 years) 46% underwent URS, 30.5% had RIRS and 23.5% had PCNL with DJ stenting. DJ stent was placed for average 4.1 weeks (2–6 weeks). Most patients who had earlier stent removal had LUTS/hematuria/lower abdominal pain. The mean IIEF Score pre-operatively was 23.3 which reduced to 19.1 during stents and patients experienced mild pain/discomfort with stents and hence avoided sexual intercourse with stents. However after stent removal, IIEF score went up to 23.1, which was similar to pre-operative status. Conclusions: This study highlights that DJ stents may temporarily hamper the sexual function and patients may avoid sexual activity due to pain/discomfort/LUTS. However, post stent removal IIEF Score returns similar to pre-operative status hence proving that DJ stents do NOT lead to any permanent sexual dysfunction.

3.3.15. RF-03.15: International Collaboration in Laparoscopy Surgery Training in Urology: First Experiences at a University Hospital in West Africa

• Gassama C ¹, Ndoye M ², Sene M ¹, Mbodj M ¹, Niang L ², Jalloh M ² and Diallo A ¹

¹ 

Hôpital Général Idrissa Pouye, Dakar, Senegal

² 

UCAD, Dakar, Senegal

Abstract: Introduction and Objectives: In Senegal, laparoscopy training and practice are lagging behind compared to other minimally invasive surgeries in Urology. Over 13 years from 2010 to 2023, several international collaborations ended up with a routine practice of the main techniques. This study presents the results of a long, but game-changing process to describe the indications, procedures performed, postoperative outcomes, and associated complications of this surgical modality. Materials and Methods: A retrospective analysis of patient records who underwent laparoscopic procedures in the urology department was conducted. Data were collected from hospital records and electronic medical records. Variables studied included number of workshops, patient demographics, surgical indications, specific procedures performed, preoperative examination results, length of hospital stay, and postoperative complications. Results: The training methods were based on the organization of regular workshops with different teams coming from the USA, France, and the UK combining real cases surgery and simulation training. Overall, 31 patients underwent laparoscopic procedures, with a peak observed in 2017 (25.8%). The mean age of pa tients was 44.74 years, with the majority being male (77.4%). Over half of the patients (53.57%) had medical histories, mainly related to hypertension (26.7%). The most common procedures were nephrectomy (45.16%), varicocelectomy (25.81%), and radical prostatectomy (9.68%). The mean hospital stay was 4.57 days, with complications occurring in 3 patients (10.7%), requiring conversion to open surgery in 2 cases. Conclusions: This analysis provides a comprehensive overview of laparoscopy implementation in the urology department at Idrissa Pouye General Hospital. Despite some complications, overall results were satisfactory, demonstrating the effectiveness and safety of this surgical approach. These findings will help guide future surgical practices and improve patient management in urology in Senegal.

4. Moderated ePosters—Nurses’ Symposium

4.1. Nurses’ Symposium 01

• Saturday, October 26, 2024
• 1450-1515

4.1.1. MPN-01.01: Local Anaesthetic Transperineal Prostate Biopsies (LATP): Initial Outcomes and Lessons Learnt from a Single Specialist Nurse Led Approach

• Drudge-Coates L, Khati V, Ballesteros R, Cianfrani L, Sturch P and Ethappiri B
• King’s College Hospital NHS Trust, London, United Kingdom

Abstract: Introduction and Objectives: Local anaesthetic transperineal (LATP) prostate biopsy is recommended as an option to diagnose prostate cancer. While there is no current evidence to suggest that the detection rates of cancer differ significantly, LATP biopsy, has been suggested to be associated with a reduced risk of sepsis leading to a reduction in hospital admissions and therefore better patient outcomes. In addition it can be performed in an outpatient clinic, reducing pressure on operating theatres, therefore reducing the financial burden on the healthcare system. We present the initial outcomes and lessons learnt from a single Specialist Nurse undertaking LATP biopsies over an initial 12 months. Materials and Methods: 290 men were included in the analysis. Data was prospectively collected from September 2022–2023, which included age, PSA level at diagnosis, MRI results (PI-RADS), histopathology & complication rates. The first 50 patients were asked to complete a questionnaire following their biopsies, giving a pain score on a visual analog scale (VAS). Pain levels were measured from 0–10 (VAS 0 = No pain, VAS 1–3 = Mild pain, VAS 4–6 = Moderate pain & VAS 7–10 = Severe pain). Pain was assessed firstly in relation to the local anaesthetic given to the perineal skin and peri-prostatic block (stage 1) and then during the prostate biopsy (stage 2). Results: 290 men underwent prostate biopsies, the median age was 69 (43–84), PSA level 8.9 (4.2–29.7), PI-RADS 2 n = 6 (2.1%), MRI: PI-RADS 3, n = 69 (23.8%), PI-RADS 4 n = 135 (46.5%), PI-RADS 5 n = 80 (27.5%). Prostate cancer was diagnosed in 210/290 patients (72.4%). Using the Clavien-Dindo classification, 5 complications occurred—urinary retention (2), sepsis (1), haematuria (1) and pain (1) requiring emergency dept intervention. In relation to pain 47/50 (94%) patients returned their questionnaire. At stage (1): 2 reported no pain, 23 mild, 20 moderate & 2 severe. In relation to stage (2): 12 no pain, 27 mild, 6 moderate and 2 severe. Conclusions: Prostate cancer detection rates and patient tolerability of freehand LATP are similar to those reported by non nurse health care professionals in the current literature, showing this procedure to be safely and effectively undertaken by a nurse specialist with specific training. Training must include and should assess a comprehensive understanding of anatomy and anomalies by MRI to improve diagnostic rates.

4.1.2. MPN-01.02: Patient Education of Elderly Bladder Cancer Patients Undergoing Radical Cystectomy and Creation of a Urinary Diversion

• Livingston V
• Memorial Sloan Kettering Cancer Center, New York, United States

Abstract: Introduction and Objectives: Radical cystectomy (RC) is the standard treatment for patients diagnosed with muscle invasive bladder cancer. Enhanced recovery after surgery (ERAS) is designed to improve morbidity, enhance recovery, and reduce hospital stays after RC. With reduced length of stay and less time for patient education inpatient there is the challenge of teaching elderly clients utilizing nontraditional interventions. Prior to ERAS patients would receive printed handouts operatively and sit with a nurse at a clinic visit for about an hour. Inpatient education would be over several days (7–10 days) and discharge included home health services and outpatient clinics. The objectives now are to maximize patient education using other methods. LOS is less (3–5 days), transitional care post-COVID-19 is fragmented, and long-term care of aging patients poses new challenges. Materials and Methods: An interdisciplinary task force developed the ERAS protocol for cystectomy patients and the patient education now includes the use of videos, use of Apps, QR codes, smart phones, and patient portals. Written handouts could also be obtained on the portal, with large fonts, sixth grade educational level, more visuals and graphics, and translation into several languages. Results: In the early post operative period family could be taught basic management of any diversion prior to discharge. However, for the elderly patient without computer access or inability to travel we utilize more use of smartphones. Elderly patients with an Indiana pouch and reduced manual dexterity using a catheter, or diminished cognition to recall catheterization schedule could have increased infections and readmissions. Elderly patients with a neobladder may develop diminished control of the pelvic muscle floor leading to increased urinary incontinence, or hyper continence and inability to self-cath. For elderly patients with ileal conduits, the family members can be taught to do the pouch changes. Telehealth education is provided to caretakers. Conclusions: Elderly patients with urinary diversions will pose patient education challenges and health care providers will need to be innovative and involve family and caretakers as needed.

5. Unmoderated ePOSTERS

• Daily Viewing:
• Thursday, October 24, 0930–1630
• Friday, October 25, 0930–1630
• Saturday, October 26, 0930–1500

5.1. Basic Science—Benign Diseases

UP-01.01: Histoscan-Guided Prostate Biopsy: Multicenter Study—Survey of Practicing Urologists

• Kim Y, Govorov A, Arutyunyan P, Pushkar D and Vasilyev A
• FSBEI HE “ROSUNIMED” of MOH of Russia, Botkin Hospital, Moscow, Russia

Abstract: Introduction and Objectives: We conducted a comparative observational clinical study with an anonymous internet survey implemented based on the SurveyMonkey program. Materials and Methods: The survey was conducted between September and December 2023 and consisted of 16 questions. Results: The division by hospitals showed that transrectal prostate biopsy is performed under the conditions in one day hospital in 91% of cases. Biopsy takes no more than 17 min on average. Half of the respondents—47.2% had experience about 5 years, and only 15.9% about 15 years. Answers to the question: “In what position is transrectal prostate biopsy most often performed?” in most cases, transrectal prostate biopsy is performed in the position on the left side, in 22%—in the gynecological chair. Answers to the question: “What method of anesthesia is used more often?” the results of the survey were distributed evenly into 3 groups: 1- the use of only a gel with anesthetic, 2- the use of paraprostatic injection of novocaine or lidocaine (5–20 mL), 3- the use of a gel with anesthetic and paraprostatic injection novocaine or lidocaine. About 82% of specialists recommend performing MRI with contrast. However, only 29% of patients perform results. About 17% note the impossibility of performing MRI due to contraindications or other difficulties of the healthcare system. The most common complications are hemospermia and hematuria. In 100% of cases, respondents noted the need to prescribe antibiotic therapy. In 77% of cases, doctors note the need for a histoscan-guided prostate biopsy, and 87% are sure that in the future it is necessary to standardize the method of performing histoscan-guided prostate biopsy. Conclusions: Our survey showed that at the moment there is an interest in performing targeted biopsy under the control of histoscanning. We also note the lack of standardization of histoscan-guided prostate biopsy. We suggest that the results of histoscan-guided prostate biopsy can be improved by developing a standardized follow-up as well as an algorithm aimed at optimizing for each patient.

5.2. Bladder Cancer—Basic Science

5.2.1. UP-02.01: Characterization of the Immune Infiltration in High Grade NMIBC: Immunvessie Project

• Boyer T ¹, Robert G ², Larmonier N ¹, Domblides C ¹ and Klein C ¹

¹ 

Bordeaux University, Bordeaux, France

² 

Bordeaux Universisty Hospital, Bordeaux, France

Abstract: Introduction and Objectives: Despite resection followed by BCG instillations, the prognosis of high-risk NMIBC remains poor owing to frequent recurrences. In our study, we aimed to evaluate the expression of PD-L1 (immunotherapies targeting PD-1/PD-L1 have shown promising results in the metastatic setting) and to characterize the immune context of high-grade pTa and Cis to better understand the role of BCG in relapsing NMIBC. Materials and Methods: We selected 100 FFPE tumors from patients treated for NMIBC at our institution with corresponding clinical data. The CPS PD-L1 score (combined positive score) was assessed by an expert pathologist and transcriptomic analysis was performed using NanoString technology before and after BCG exposure. Results: Only 51 tumors were assessable because of the low-quality tissue after the pathological review. The median age was 73 years, and 48% of the patients were male. Among our cohort, 22 and 10 patients relapsed as NMIBC and MIBC or metastatic disease, respectively. Regarding the relapse-free survival rate, we did not find any significant difference with respect to CPS status (p = 0.7). In contrast, the OS rate was significantly higher in the CPS-neg group (p = 0.003) (Figure 1). Furthermore, we found gene signatures evoking higher tumor cell intrinsic resistance and an impaired effector phase through decreased T-cell activation and/or higher potent myeloid immunosuppressive infiltrate (Figure 2) in relapsing NMIBC. Conclusions: Our current study suggests that targeting the PD-1/PD-L1 axis and/or the myeloid immunosuppressive environment may represent an interesting alternative to BCG-therapy in improving patient prognosis.

5.2.2. UP-02.02: Dynamic Transition from NMIBC to MIBC in the Bladder Cancer Rely on Stiffness Microenvironment Determined Methionine Metabolism

• Yang C ¹, Chen W ², Zhou Q ² and Jiang H ²

¹ 

Huashan Hospital, Shanghai, China

² 

Department of Urology, Huashan Hospital, Shanghai, China

Abstract: Introduction and Objectives: Atomic force microscope (AFM) and integrated multi-omics analysis was applied to elucidate the regulation mechanism in bladder cancer (BCa) of dynamic transition from NMIBC to MIBC. Materials and Methods: Atomic force microscope was used to discover the dynamic stiffness alternation in 30 paired NMIBC and MIBC (from the same patient in different time). Metabonomics, proteomics and RNA-seq were performed on 10 pairs of NMIBC and MIBC. MAT2A expression was evaluated through immunohistochemistry in NMIBC and MIBC. Cell phenotype assay such as colony formation, EdU assay, CCK-8 assay were performed in T24 and primary bladder cancer cells cultured on 10 Pa and 10 KPa extracellular medium with or without methionine supplement. T24 cells and PDX models in non-SCID mice were enrolled in immuno-deficiency model. Results: As for the transition from NMIBC to MIBC, extracellular stiffness increased gradually during the progression of the bladder cancer (NMIBC 235 ± 12 Pa, MIBC 1689 ± 143 Pa). Integrated multi-omics analysis of metabonomics, proteomics and RNA-seq revealed that MAT2A orchestrated methionine metabolism in dynamic transition from NMIBC to MIBC. We further validated downstream target of MAT2A and methionine metabolism is crucial to malignant transition from NMIBC to MIBC. Synergistic usage of in-vivo grade of si-MAT2A and methionine could overcome the transition from NMIBC to MIBC in vivo. Conclusions: Bladder cancer cells rely on methionine metabolism to sustain survival in stiffness microenvironment from NMIBC to MIBC transition.

5.2.3. UP-02.03: Nested Variant of Urothelial Carcinoma

• Omar K ¹, Ahmed S ¹, Firas Z ¹, Mohamed Abdelkader F ², Ali E ², Mohamed Amine M ¹, Nouri R ¹, Mourad H ¹ and Hazem H ²

¹ 

University Hospital Habib Bourguiba, Sfax, Tunisia

² 

Urology Department, Habib Bourguiba Hospital, Sfax, Tunisia

Abstract: Introduction and Objectives: The large nest variant of urothelial carcinoma is a rare variant of recent individualization. It was first described by Cox and Epstein in 2011 and has since been included in the latest classification of bladder tumors 2016 in the nested/large nested category. This is a little-studied variant which seems to be different from the nested variant. the purpose of our work is to contribute to improving knowledge concerning the anatomo-clinical particularities of this variant. Materials and Methods: We carried out a retrospective descriptive study on 11 cases of invasive UC variant with large nests collected in the department of urology and pathological anatomy and cytology of the Habib Bourguibe hospital in Sfax over a period of 9 years (2013–2021). We selected cases of bladder sampling presenting simultaneously these three characteristics: an architecture in large nests, a quiescent cytology and invasion of the muscularis, tumors associating foci of more than 5% of high-grade cytology or a mode of classic infiltration (clumps/retraction/paradoxical maturation artifacts) were excluded from the study. Results: The average age of the patients was 55.9 years and a clear male predominance was observed (10M/1F). Smoking intoxication was noted in 9/10 patients. On microscopic examination, the tumors presented endophytic development in all cases in our series, as well as an associated low-grade surface papillary contingent. We noted the frequent presence (8/11) of an essentially lymphoid inflammatory stroma-reaction, often organized into nodules. The lymph nodes removed with the cystoprostatectomy specimens were all reactive. Among our patients, 8 were followed for a duration varying from 3 to 60 months with an average of 27 months. The three patients who underwent cystoprostatectomy did not recur after a follow-up of 2 and 5 years. Conclusions: Homogenization of diagnostic criteria should facilitate the comparability of data from different studies and would make it possible to verify the positive prognostic impact which seems to emerge through the Cox and Epstein series and ours.

5.2.4. UP-02.04: Transcriptional Regulation of NUPR1 by MYH11 Activates PI3K/AKT and Promotes Bladder Cancer Progression Through Ferroptosis and M2 Polarization of Macrophages

• Zhang L
• Changzhou Second People’s Hospital, Changzhou, China

Abstract: Introduction and Objectives: NUPR1 is a small molecule protein that plays an important role in tumor progression and drug resistance. Our previous study found that NUPR1 promotes the progression of bladder cancer, but the specific mechanism is still unclear. MYH11 encodes the smooth muscle myosin heavy chain and belongs to the conventional myosin family. MYH11 has been found to be associated with a variety of malignant tumors. Materials and Methods: We identified MYH11 as an upstream regulator of NUPR1 using a bioinformatics approach and tested this hypothesis by knocking down MYH11 and ChIP-qPCR. Subsequently, we verified the association of MYH11 and NUPR1 with the PI3K/AKT pathway by WB. In addition, gene enrichment results showed that the effect of NUPR1 on bladder cancer was related to ferroptosis and M2 macrophage polarization. We examined ferroptosis metabolites in bladder cancer cells overexpressing NUPR1 and expression of the M2 macrophage marker CD206 in NUPR1 overexpression or MYH11 knockdown bladder cancer cells. Results: Bioinformatics results showed that MYH11 was positively correlated with NUPR1, and there might be an X-reciprocal binding site in the promoter region of NUPR1. Knockdown of MYH11 decreased NUPR1 expression, and ChIP-qPCR showed that MYH11 bound to the promoter of NUPR1. Subsequently, WB results showed that MYH11 knockdown inhibited the PI3K/AKT pathway, whereas NUPR1 overexpression activated this pathway. After adding ferroptosis activator, the viability of bladder cancer cells decreased, and the content of ferrous ion and MDA increased. However, ferroptosis was significantly inhibited after overexpression of NUPR1. Knockdown of MYH11 inhibited M2 macrophage polarization, while overexpression of NUPR1 promoted this process. Conclusions: This study suggests that MYH11 activates the PI3K/AKT pathway by up-regulating the expression of NUPR1, and promotes bladder cancer progression by inhibiting ferroptosis and promoting M2 polarization of macrophages.

5.3. Bladder Cancer—Clinical

5.3.1. UP-03.01: Adherence to Surveillance Guidelines for Non-Muscle Invasive Bladder Cancer in a Tertiary Center: A Retrospective Study

• Abul M ¹, Almtotah A ¹, Salem S ², Aldousari S ², Almarzouq A ² and Geevarghese A ³

¹ 

Kuwait Institute for Medical Specializations, Kuwait City, Kuwait

² 

Department of Urology, Sabah Al-Ahmad Urology Centre, Kuwait City, Kuwait

³ 

Faculty of Dentistry, United States

Abstract: Introduction and Objectives: Post TURBT surveillance plays a central role in the continued management of non-muscle invasive bladder cancer (NMIBC). We report our experience in evaluating trends and local practice in the follow up of NMIBC in patients with cystoscopy, urine cytology and upper tract imaging to assess adherence to guidelines based practice. Materials and Methods: Data obtained from Sabah Al-Ahmad Urology Center (SAUC) in Kuwait between November 2013 and May 2023. A retrospective case review of patients diagnosed with bladder masses. Patients with muscle invasive disease and benign pathologies were excluded from the analysis. Follow up data and intervals were collected. The Statistical Package for Social Sciences (SPSS) was used for data analysis. Results: A total 193 patients were collected. We excluded 64 who had disease other than NMIBC. Analysis included a total of 129 patients. Of these, 76.7% had high-grade NMIBC, while 23.3% had low-grade NMIBC. Upper tract imaging surveillance was found performed in 39.5%, 29.5% and 12.4% of the patients over 1, 2 and 5 years respectively. Cystoscopy surveillance was performed in 86% of the patients. Surveillance rate was at 69.8%, 55%, 38.8% and 18.6% of the patients at 3 months, 1 year, 2 years and 5 years respectively. Regarding urine cytology, it was performed in 55.8%, 44.2%, 35.9% and 10.1% over 3 months, 1 year, 2 years and 5 years respectively. Conclusions: Adherence to post TURBT surveillance for NMIBC has significant room for improvement. Upper and lower tract surveillance decreases significantly after the first year. Further research is needed to elucidate whether this is lack of education in the urological community or a patient compliance issue.

5.3.2. UP-03.02: Assessing Health-Related Quality of Life One Year After Radical Cystectomy with Orthotopic Neobladder Reconstruction

• Blaiech W, Ben Othmen M, Loghmari A, Bouassida K, Hmida W, Jaidane M and Ben Hamida M
• Sahloul Hospital, Sousse, Tunisia

Abstract: Introduction and Objectives: Radical cystectomy (RC) is considered the gold standard treatment for invasive bladder cancer. The choice of the appropriate urinary diversion (UD) technique is contingent upon several factors including patient age, associated co-morbidities, continence status, renal function and surgeon experience. UD frequently leads to substantial postoperative changes in quality of life (QoL), involving intricate psychological, physical, social, and sexual consequences. This study aims to describe the postoperative QoL experienced by Tunisian men who have undergone RC with an orthotopic neobladder. Materials and Methods: This is a retrospective descriptive study conducted at a 700-bed teaching hospital of Tunisia, including 42 patients with invasive bladder cancer who underwent RC with Studer orthotopic enterocystoplasty between May 2011 and May 2023. The patients were evaluated one year after the operation and completed the Qualiveen-30 questionnaire, translated into Arabic and validated, and the Mesure du Handicap Urinaire (MHU; Measurement of Urinary Handicap) questionnaire. Results: The mean score on the Qualiveen-30 questionnaire 12 months postoperatively was 0.996, with values ranging from 0 to 2.06. The average score for limitations was 1.13. Eighty-eight percent of the patients were not at all or slightly bothered by the urinary consequences of enterocystoplasty. The average score for constraints score was 1.06. Patients’ primary concern revolved around adapting their daily routines to accommodate their urinary disorders, such as limiting fluid intake before bedtime or experiencing multiple nocturnal awakenings. The average fear score was 0.83. The average score for feelings was 0.97. Ninety percent of the patients reported a positive experience regarding the consequences of enterocystoplasty. The MHU score averaged 6.6 out of 28, which is notably low. The subscore for dysuria was the highest, with an average of 2.2. This is explained by the necessity, in patients with a neobladder, to void by abdominal straining. In the majority of cases, patients were not polyuric, and daytime urinary voiding intervals exceeded two hours in 62% of patients. Conclusions: Pre and postoperative counseling is crucial to facilitate the transition after the surgery and ensure a better quality of life for men who have undergone RC with an orthotopic neobladder.

5.3.3. UP-03.03: Clinical Study of Non-Radical-Treated Elderly Patients with Non-Metastatic Muscle Invasive Bladder Cancer

• Mizusawa H, Shizukuda Y, Shimizu T and Mimura Y
• NHO Shinshu Ueda Medical Center, Ueda Nagano, Japan

Abstract: Introduction and Objectives: The standard treatment for non-metastatic muscle invasive bladder cancer is total cystectomy. However, this procedure is relatively invasive, and is not medically indicated for certain elderly patients such as those with reduced general health or those with cardiopulmonary dysfunction related to concurrent diseases. In this study, we clinically analyzed elderly patients with non-metastatic muscle invasive bladder cancer who did not undergo radical treatment. We aimed to elucidate the outcomes of this approach and reassess the management of such cases. Materials and Methods: Inclusion criteria were non-metastatic bladder cancer patients who were over 75 years, had pathologically confirmed muscle invasion between January 2011 and December 2023, and did not undergo total cystectomy or radical radiation therapy. We retrospectively examined age, sex, comorbidity, histological type, stage, treatment, and outcome. Results: We enrolled 47 patients (37 males, 10 females). Ages ranged from 75 to 94 years, with a median of 83 years. Thirty patients had stage II cancer, and 17 had stage III cancer. Histological diagnosis on transurethral resection of the bladder tumor suggested urothelial carcinoma in 43 patients and non-urothelial carcinoma in four. Nine patients had other malignant diseases, and seven had dementia. After a diagnosis of muscle invasive bladder cancer was made, nephrostomy/ureteral stent placement was performed in 10 patients, transurethral resection for tumor reduction or coagulation in eight, cancer chemotherapy in six, and palliative irradiation in four. The follow-up period ranged from 2 to 104 months, with a median of 16 months. The 2- and 5-year overall survival rates were 37.5 and 5.6%, respectively. The median survival in the 35 patients who died was 15 months. The median overall survival in the stage II and III patients was 21 and 8 months, respectively. Radical cystectomy was performed in 21 patients over 75 years during the same period (corresponding to approximately 30% of locally advanced bladder cancer). Conclusions: The median overall survival was 16 months. Stage II patients had a significantly longer overall survival than stage III patients. Based on adequate information provision, therapeutic strategies must be determined based on factors including the patients’ wishes, physical/mental assessment, and living/medical environment.

5.3.4. UP-03.04: Comparative Study Between the Use of Double J Ureteric Stents vs. Bander Ureteric Stents During Robotic Assisted Radical Cystectomy with Intra Corporeal Ileal Conduit Urinary Diversion

• Ibrahim M ¹, Nayak A ¹, Patel A ¹, Brodie A ¹, Decaestecker K ², Teoh J ³ and Vasdev N ¹

¹ 

Lister Hospital ENH NHS Trust, Stevenage, United Kingdom

² 

AZ Maria Middelares Hospital, Gent, Belgium

³ 

The Chinese University of Hong Kong, Hong Kong, China

Abstract: Introduction and Objectives: Robotic assisted radical cystectomy (RARC) is fast becoming the standard of care with comparable oncological outcomes to open surgery for patients with muscle invasive bladder cancer. Use of stents is common practice to reduce uretero-enteric anastomosis related complications. In the current study, practice was changed from the use of Double J (DJ) stents to banders stent intraoperatively. The potential advantages of using bander stent are avoiding second surgery for stent removal and easier change under local anesthetic in the interventional radiology department. The objective of this study is to compare the incidence of blocked, slipped stents and rate of ureteroileal anastomotic stricture after RARC with intracorporeal ileal conduit between practices of using DJ stents and banders stents. Materials and Methods: Retrospective analysis of all the patients undergoing RARC-IC between June 2014 to August 2023 was done. Initially all intracorporeal anastomosis were covered with DJ stents. The practice was changed to cover the anastomosis with banders stent in November 2020. Number of patients needing re-surgery for blocked, slipped stents and ureteroileal anastomotic stricture were analyzed and compared using Chi-square analysis and Fisher’s exact test. Results: A total of 168 patients underwent RARC with intracorporeal ileal conduit between June 2014 to August 2023 of which 128 patients were diverted with DJ stents and 40 with bander stent. The mean age and the patient demographics between the two groups were comparable. Of the 128 patients who were diverted with DJ stents, 6 (4.7%) had blocked stents, 3 (2.3%) had slipped stents and 3 (2.3%) developed ureteroileal stricture needing readmission and urgent invasive intervention to exchange the stent or nephrostomy tube, whereas only 1 (2.5%) of the 40 patients with bander stent had blocked stent which was changed under local anesthetic in the interventional radiology suite with no slipped stents reported and 2 (5%) had uerteroileal stricture who needed nephrostomies. Conclusions: Intraoperative ureteric stenting using bander stent has the potential to reduce the incidence of stent related complications (blockage, slippage and ureteroileal anastomotic stricture), following RARC with intracorporeal ileal conduit urinary diversion. Additionally, managing bander stent related complications is less invasive with lower rate of readmission postoperatively compared to managing DJ stent related ones.

5.3.5. UP-03.05: Comparison of 3 Months Recurrence Free Survival by 3–10 mm Recurrent Non-Muscle Invasive Bladder Cancer Treated by Flex PDD Guided Laser Photo Coagulation in Local Anesthesia at Outpatient Clinic Versus Trans Urethral Resection of Bladder Tumor in General Anesthesia

• Ozeke R ¹, Dadfar A ¹, Larssen K ¹ and Baco E ²

¹ 

Oslo University Hospital, Kolbotn, Norway

² 

Oslo University Hospital University of Oslo, Oslo, Norway

Abstract: Introduction and Objectives: Aim of this study is to compare 3 months recurrence-free survival in patients with recurrent, non-muscle invasive bladder cancer (NMIBC) treated by photo dynamic diagnosis (PDD) guided diode laser photo coagulation (DLPC) in local anesthesia versus transurethral bladder cancer resection (TURB) in general anesthesia. Materials and Methods: A total of 103 patients with suspicion on NMIBC recurrence 3–10 mm were prospectively included in this study in a period of 18 months from 1 January 2021 to 30 June 2022. 55 patients were treated with biopsy and DLPC under local anesthesia at outpatient clinic. Intravesical application of Hexvix and 20 mL of Xylocain 1% was done 1 h before the procedure patients treated by DLBC. 48 patients in TURB group were selected retrospectively by our TUR-B register, the tumor resection was done in general anesthesia in the operating room in the same period. Control flexible cystoscopy was done at 3 months after both treatments in all patients. Cystoscopy findings were classified as positive or negative, based on visible tumor recurrence. Results: Mean (45–89) age was 72.8 years in DLPC and (36–96) 74.1 in TURB patients. In DLPC group, biopsy revealed Bca in 67% (37/55) patients In TURB group, Bca was found in 60% (29/48) patients. Control post-treatment cystoscopy at 3 months diagnosed BCa in 27% (10/37) in DLPC and 31% (9/29) in TURB group. Recurrence free survival for Bca was 73% in DLPC 69% in TURB patients. Conclusions: Recurrence free survival of recurrent NMIBC 3–10 mm was 4% higher in patients treated with PDD guided diode laser photo coagulation in local anesthesia than in patients treated by PDD guided TURB in general anesthesia.

5.3.6. UP-03.06: Contemporary Survival in Metastatic Bladder Cancer Patients: A Population-Based Study

• Di Bello F ¹, Collà Ruvolo C ², Siech C ³, Jannello L ⁴, De Angelis M ⁵, Rodriguez Peñaranda N ⁶, Goyal J ⁷, Baudo A ⁸, Califano G ¹, Creta M ¹, Saad F ⁷, Shariat S ⁹, Acquati P ⁸, De Cobelli O ⁴, Briganti A ⁵, Morra S ¹, Chun F ³, Micali S ⁶, Longo N ¹ and Karakiewicz P ⁷

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

Università Di Napoli Federico II, Napoli, Italy

³ 

Goethe Frankfurt University, Frankfurt, Germany

⁴ 

IEO Istituto Europeo di Oncologia, Milano, Italy

⁵ 

Università Salute Vita San Raffaele, Milano, Italy

⁶ 

University of Modena and Reggio Emilia, Modena, Italy

⁷ 

University of Montréal Health Center, Montréal, Canada

⁸ 

Ospedale Gruppo San Donato, Milano, Italy

⁹ 

Comprehensive Cancer Center, Wien, Austria

Abstract: Introduction and Objectives: To test whether the advent of several novel systemic therapies, designed for treatment of metastatic urothelial carcinoma of the urinary bladder (mUCUB), resulted in improved overall survival (OS) in either contemporary UCUB patients and/or non-UCUB patients. Materials and Methods: Within the Surveillance, Epidemiology, and End Results database, contemporary (2017–2020) and historical (2000–2016) systemic therapy-exposed metastatic UCUB and, subsequently, non-UCUB patients were identified. Separate Kaplan-Meier and multivariable Cox regression (CRM) analyses first addressed OS in mUCUB and, subsequently, in mn-UCUB. Results: Of 3443 systemic therapy-exposed patients, 2725 (79%) harbored mUCUB vs. 709 (21%) harbored mn-UCUB. Of 2725 mUCUB patients, 582 (21%) were contemporary (2017–2020) vs. 2143 (79%) were historical (2000–2016). In mUCUB, median OS was 11 months in contemporary vs. 8 months in historical patients (D = 3 months; p < 0.0001). In multivariable CRM, contemporary membership status (2017–2020) independently predicted lower overall mortality (OM, hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.60–0.76; p < 0.001). Of 709 mn-UCUB patients, 167 (24%) were contemporary (2017–2020) and 542 (76%) were historical (2000–2016). In mn-UCUB, median OS was 8 months in contemporary vs. 7 months in historical patients (D = 1 months; p = 0.034). In multivariable CRM, contemporary membership status (2017–2020) was associated with HR of 0.81 (95% CI = 0.66–1.01; p = 0.06). Conclusions: Contemporary systemic therapy-exposed metastatic patients exhibited better OS in UCUB. However, the magnitude of survival benefit was three-fold higher in mUCUB and approximated the survival benefits recorded in prospective randomized trials of novel systemic therapies.

5.3.7. UP-03.07: CXC Chemokine Receptor 6 Associates with Postoperative Patient Outcomes and Immune Infiltrations in Muscle-Invasive Bladder Cancer

• Chang Y, Liu Z and Ye D
• Fudan University Shanghai Cancer Center, Shanghai, China

Abstract: Introduction and Objectives: Growing evidence suggests that CXC Chemokine receptor 6 (CXCR6) has an influence on tumor progression and participate in regulation of tumor immunology. However, the role of CXCR6 in muscle-invasive bladder cancer (MIBC) are not evaluated. Materials and Methods: Our study comprised 391 MIBC patients from TCGA, 212 MIBC patients from GEO dataset and 131 MIBC patients from FUSCC cohort. The Kaplan-Meier method, Cox regression models and prognostic nomogram were used to evaluate the prognostic significance of CXCR6 in MIBC. The CIBERSORT method was used to explore the association between CXCR6 and cancer immune cell infiltrations. Gene set enrichment analysis (GSEA) was applied to evaluate the detailed mechanisms of CXCR6 in MIBC. Results: We showed that CXCR6 expression was significantly correlated with tumor grade (p = 0.024). A low expression of CXCR6 was associated with diminished recurrence-free survival (RFS) (p = 0.034) and overall survival (OS) (p = 0.019) in TCGA dataset (Figure 1A,B). The same prognostic value was also validated in meta-GEO dataset and FUSCC cohort (Figure 1C,D). Multivariate analyses confirmed that low expression of CXCR6 was an independent worse prognosticator for OS (p = 0.019) and RFS (p = 0.018). When integrating CXCR6 expression and identified independent prognosticators, a nomogram was built to accurately predict OS at 3 and 5 years. Furthermore, CXCR6 expression was positively correlated with a series of anti-tumoral immune cell infiltrations. GSEA indicated that immune responses activation related pathways were differentially enriched in CXCR6 high phenotype. Moreover, we found that CXCR6 could predict patients’ response to immune-checkpoint blockade therapy in IMvigor210 dataset (Figure 2). Conclusions: To conclude, our study suggested that CXCR6 expression might be a promising independent predictor of outcomes in patients with MIBC and have a crucial impact on regulation of tumor immunology in MIBC.

5.3.8. UP-03.08: Direct Oral Anti-Coagulants vs. Low-Molecular-Weight-Heparin Injections After Urological Surgery: A Meta-Analysis

• Ramadhan M ¹, Al-Mehandi A ², Al-Naseem A ³, Hayat J ¹ and Almarzouq A ⁴

¹ 

Jaber Al Ahmad Al Sabah Hospital, South Surra, Kuwait

² 

The University of Manchester, Manchester, United Kingdom

³ 

University College London, London, United Kingdom

⁴ 

Sabah Al Ahmad Urology Centre, Shuwaikh Medical Area, Kuwait

Abstract: Introduction and Objectives: Venous thromboembolism (VTE) is a common source of post-operative morbidity and mortality in major urological surgery. Low molecular weight heparin (LMWH) has been the standard thromboprophylaxis regimen post-operatively. However, direct oral anti coagulants (DOAC) are a novel and safe option that potentially improves compliance, whilst being cost-effective. We aimed to compare the outcomes of using prophylactic direct oral anti-coagulants (DOAC) and low-molecular-weight heparin after major urologic surgery. Materials and Methods: Systematic literature searches of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL were performed up to November 9, 2023, and protocols were registered on PROSPERO (CRD42024494424). The primary outcomes were post operative incidence of VTE and bleeding. The secondary outcomes included re-admissions and transfusions needed, post-operative complications and to explore the radical cystectomy sub-group. Outcomes were reported in 30 and 90 days where feasible with sub-group analysis. Results: Searches yielded 4 trials that included 856 patients and the outcomes were reported within 30 and 90 days, with sub-analysis performed for each time-interval. We found no statistically significant differences between DOAC and LWMH within neither primary nor secondary outcomes; VTE events (RR 0.37; p = 0.07); bleeding events (RR 0.73; p = 0.64); re-admissions (RR 1.14; p = 0.38); transfusions (RR 0.19; p = 0.08) within 0–90 days and post-operative complications within 30 days (RR 0.76; p = 0.17). Similar results were found when exploring radical cystectomy sub-group: VTE risk (RR 0.43, p = 0.15) bleeding risk (RR 1.10; p = 0.90). re-admissions to hospital (RR 1.18, p = 0.35). Limitations include small sample size, and difficult generalization to all urological surgery as most of the analysed cohort underwent radical cystectomy. Conclusions: DOACs may be a safe and possibly cost-effective alternative to LMWH as post-operative thromboprophylaxis. However, these findings should be interpreted with caution due to limitations, therefore, more randomized studies are needed to ascertain our findings.

5.3.9. UP-03.09: Factors Involved in a Complete Histologic Response After Neoadjuvant Chemotherapy in Patients with an Muscle-Invasive Bladder Cancer

• Morales Pinto S, Cobo Díaz C, Lanza Pérez M, Cantero Mellado J and Herrera Imbroda B
• University Hospital Virgen de la Victoria Málaga-España, MALAGA, Spain

Abstract: Introduction and Objectives: Neoadjuvant chemotherapy (NAC) using cisplatin-based regimens has demonstrated improved survival outcomes in managing muscle-invasive bladder tumors (MIBC), often associated with histological tumor regression. However, less than 50% of patients exhibit a complete histopathological response (ypT0). Our objective is to identify clinical-pathological factors predictive of ypT0 in response to neoadjuvant chemotherapy. Materials and Methods: A retrospective cohort of 163 patients diagnosed with MIBC, treated with NAC and undergoing radical cystectomy between 2010 and 2023 at our center. Pre- and post-surgical clinical-pathological variables were collected. Descriptive analysis, bivariate, and multivariate inferential analysis using logistic regression were conducted. Results: The mean age was 64.7 years, with 86% being male. ECOG performance status was 0–1 in 97.5%, and 54% had an ASA score of ≤2. Unilateral or bilateral hydronephrosis was present in 25.2%, and 86% had a stage ≤ cT2. Transurethral resection (TUR) was macroscopically complete in 73%. Cisplatin-based chemotherapy regimens were administered to 93.8% of patients, with a median of 3 cycles, resulting in a ypT0 rate of 40.5% in cystectomy specimens. Partial response was observed in 26.4% of patients, with progression in 33.1%. Univariate analysis revealed a statistically significant relationship (p < 0.05) between ypT0 and several variables, including complete TUR (44.5% ypT0 vs. 55.5% > ypT0), presence of a pure or predominant urothelial histological variant compared to other variants (ypT0 48.1% vs. 3.6%, respectively), and absence of lymphovascular invasion (LVI) (3% ypT0 vs. 97% > ypT0). No differences were found regarding advanced clinical stage or hydronephrosis. In multivariate analysis, independent predictors of ypT0 were the pure or predominant urothelial histology compared to other variants (p = 0.023) with an odds ratio (OR) of 11.3, and absence of LVI (p = 0.004) with an OR of 20.8. Conclusions: In our series, the presence of a pure or predominant urothelial variant and absence of LVI serve as predictors of ypT0, providing valuable insights for patient selection in optimizing neoadjuvant chemotherapy strategies.

5.3.10. UP-03.10: Functional and Oncological Outcomes of Robotic Intracorporeal Bordeaux Neobladder in Radical Cystectomy: Median Follow-Up of 53 Months

• Swinn M, Faeed A, Peacock J, Abou Chedid W, Kusuma V, Woodhams S, Roodhouse A, Moschonas D, Patil K, Perry M and Carbin Joseph D
• Royal Surrey County Hospital, Guildford, United Kingdom

Abstract: Introduction and Objectives: The advent of robotic platforms allows surgeons to re-construct intracorporeal neo-bladders after radical cystectomies (RARC). The modified Y or Bordeaux neobladder has been in practice in several centres. We aimed to analyse the long-term functional outcomes of this neobladder in our centre. Materials and Methods: Intracorporeal neobladders done in our centre (2014–2022) were selected from a prospectively maintained robotic radical cystectomy database. We included 25 intracorporeal Bordeaux neobladders performed robotically in radical cystectomies. The intraoperative and perioperative data, overall continence rates, self-catheterisation rates, cancer recurrence rates and overall survival were analysed in the study. Results: The mean age was 62 years and 96% were males. 28% had RARC for MIBC and the rest for NMIBC/CIS. The mean BMI was 27.85, and 20% had preoperative neoadjuvant chemotherapy. The mean eGFR was 65.1. The mean console time was 487 min and all of them underwent Bricker anastomosis. The average blood loss was 373 mLs and none of them required blood transfusion. 8% required post-operative NG tube. Mean LOS was 26 days (4–76 days). 1 neobladder perforation, 3 ileus, 1 bowel obstruction, 2 leaks requiring nephrostomy occurred within 90 days. Median follow-up was 53 months (4–113 months). Mean eGFR on one-year follow-up was 59.2 and three developed disease recurrences in that period. Mean ISC duration was 13 months (1–108 months). Conclusions: This study provides a snapshot of the functional and oncological outcomes of robotic intracorporeal Bordeaux neobladder. Multi-institutional studies with larger numbers can throw more light on the outcomes of these complex reconstructive operations.

5.3.11. UP-03.11: Impact of Complete Tumor Resection on Survival in Muscle-Invasive Bladder Cancer Patients Treated with Neoadjuvant Chemotherapy and Radical Cystectomy

• Fernandes C ¹, Vale L ¹, Baptista I ², Silva C ¹ and Lopes T ¹

¹ 

CHUSJ, Valongo, Portugal

² 

FMUP, Porto, Portugal

Abstract: Introduction and Objectives: Neoadjuvant chemotherapy (NAC) has an impact on overall survival for patients with muscle-invasive bladder cancer (MIBC) before radical cystectomy (RC). The role of a complete transurethral resection bladder tumor (cTURBT) in non-muscle invasive bladder cancer is well established. There is a lack of consensus regarding its significance before NAC and RC. We aimed to assess the effect of cTURBT on pathologic response and survival outcomes in patients with MIBC undergoing NAC and RC. Materials and Methods: A retrospective analysis was conducted on a cohort of patients with MIBC (pT2–4aN0M0) treated at a single tertiary center between 2010 and 2022. These patients received cisplatin/gemcitabine or carboplatin/gemcitabine NAC followed by RC. cTURBT was defined as the complete endoscopic resection of all visible tumors before NAC. Patients were divided into groups based on the completeness of TURBT. Pathologic response was assessed after NAC and RC, defined as positive if downstaging occurred (ypT0/1/is/aN0) and negative if ypT ≥ 2. The primary endpoint was overall survival (OS), and secondary endpoints included cancer-specific survival (CSS), recurrence-free survival (RFS), and the impact of cTURBT on pathologic response. Results: A total of 37 patients were included in the study. Among them, 15 (40.5%) patients underwent cTURBT. No significant differences were observed in clinicodemographic characteristics. But, the cTURBT group exhibited higher rates of lymphovascular invasion (71.4% vs. 18.3%, p = 0.004) and lower rates of carcinoma in situ (CIS) (46.7% vs. 9.5%, p = 0.019). The cTURBT group showed a significantly positive pathologic response (50% vs. 13.3%, p = 0.022). Survival outcomes, including OS, CSS, and RFS, were also significantly better in the cTURBT group. The OS Kaplan-Meier curves showed that at the 5-year mark, 84% of patients were disease-free, compared to 40% (log-rank = 0.002). Similarly, CSS has a 5-year survival rate of 90% compared to 50% (log-rank = 0.002), and RFS had 85% of cTURBT patients free from disease at 5 years compared to 32% (log-rank = 0.003). The OS differences remained significant despite adjusting for CIS in a multivariate Cox regression analysis. (Hazard ratio 0.157, 95% confidence interval [0.031–0.794], p = 0.025). Conclusions: Complete TURBT before NAC improves response and outcomes in muscle-invasive bladder cancer.

5.3.12. UP-03.12: Impact of Time Elapsed Until ReRTUv in Terms of Recurrence and Progression: Experience in Our Center

• Montuenga Fernández I, García Loarte E, Sánchez Pellejero A, Vázquez Valdés S, Peral Parra D and Tamayo Ruiz J
• Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

Abstract: Introduction and Objectives: Transurethral resection of bladder tumor is a fundamental procedure for the management of non-muscle-invasive urothelial carcinoma. A second TURBT should be performed in case of incomplete tumor resection, T1 tumors, and absence of muscle in the sample. The recommended time until ReRTUv by European guidelines should range between 2–6 weeks. Some studies have even demonstrated that performing it between 14 and 42 days after the initial intervention significantly reduces risks of subsequent recurrence and progression. The aim of this study was to analyze, in our center, the average time elapsed until the second TURBT and evaluate the impact of this on recurrence and progression rates. Materials and Methods: A retrospective analysis of ReRTUv performed between 2017 and 2022 in our center was conducted. Demographic and clinicopathological data derived from surgeries were collected, as well as recurrence rates, progression, and disease-free rates. Results: The average time until the second TURBT was 68 days. 32.4% of patients presented tumor multifocality, and 38.5% had a tumor size larger than 3 cm in the initial TURBT. 94.4% had stage T1, with 58.7% being T1G3. After the second TURBT, 67.6% of patients were tumor-free. After the procedure, 54.2% received induction and maintenance with BCG for at least 1 year. The average follow-up time was 40 months. During this time, the overall recurrence rate was 29.9%, the progression rate was 6.6%, and the disease-free rate was 64.8%. When dividing patients into subgroups based on the number of days elapsed until ReRTUv (group 1 < 42 days; group 2 > 42 days; group 3 < 68 days; group 4 > 68 days), no statistically significant differences were found in terms of recurrence, progression, and disease-free rates. There were also no differences in the mean time elapsed until recurrence and/or progression. Conclusions: In disagreement with general recommendations, we can affirm that, in our series, the time until ReRTUv did not condition differences in recurrence and progression rates.

5.3.13. UP-03.13: Long-Term Survival of Patients with Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy as a Function of Response to Neoadjuvant Chemotherapy

• Morales Pinto S, Lanza Pérez M, García Góngora B, Cantero Mellado J and Herrera Imbroda B
• University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

Abstract: Introduction and Objectives: The use of neoadjuvant chemotherapy (NAC) with cisplatin-based regimens in patients with muscle-invasive bladder tumor has shown benefit, with an improvement in survival of around 5–8% at 5 years. The aim is to determine overall survival and cancer-specific survival in relation to the use of neoadjuvant chemotherapy, as well as based on response to it. Materials and Methods: Retrospective cohort of 330 patients treated at Virgen de la Victoria Hospital with radical cystectomy between 2010–2023. Descriptive and inferential analysis of pre-surgical variables. Analysis with Kaplan-Meier test of overall survival (OS) and cancer-specific survival (CSS), stratifying results according to the use or not of neoadjuvant chemotherapy and according to response to it. Comparison of survival curves using log rank test. Results: The mean age was 67.2 years, with 14.5% women and 85.5% men. Regarding staging, 89.1% were cT2 and 10.9% cT3. Of the 330 patients, 49.1% received neoadjuvant chemotherapy, of which 90.7% received Cisplatin-Gemcitabine. The rate of complete histopathological response (pT0) was 40.7%. Survival analysis according to the use or not of neoadjuvant chemotherapy shows the following results: overall survival was 103.3 months (95% CI 93.3–113.3) in the NAC group versus 82.9 months (95% CI 71.0–94.8) in the non-NAC group with a p: 0.002. As for cancer-specific survival, the results were 100.9 months (95% CI 90.8–111.0) in the NAC group and 77.3 months (95% CI 65.7–89.0) in the non-NAC group with a p 0.001. In the survival analysis according to response to neoadjuvant chemotherapy, we observed statistically significant differences in the two groups, with the results: overall survival was 101.8 months (95% CI 86.9–116.9) in the complete response group and 70.1 months (95% CI 57.8–85.5) in the incomplete response group, with a p: 0.001. Cancer-specific survival was 122.3 months (95% CI 108.9–135.8) in the complete response group versus 84.9 months (95% CI 71.8–98.1) in the incomplete response group with a p 0.0001. Conclusions: The neoadjuvant chemotherapy implies a significant increase in overall and cancer-specific survival, observing a greater benefit in cancer-specific survival in patients with complete response to it.

5.3.14. UP-03.14: Malignant Priapism Following Radical Cystoprostatectomy as the First Sign of Recurrence: A Case Report

• Araújo A, Cardoso A, Tinoco C, Capinha M, Rodrigues R and Marques V
• Hospital de Braga, Braga, Portugal

Abstract: Introduction and Objectives: Metastatic involvement of the penis presenting as malignant priapism is an extremely rare entity. It is most caused by a primary malignant genitourinary tumor, and, of these, urothelial carcinoma of the bladder is the most common. It usually reflects disseminated malignancy and confers a catastrophic prognosis. We describe here a case of painful priapism caused by replacement of almost the entire corpora cavernosa by high-grade urothelial malignancy. Materials and Methods: We present here a case of a 67-year-old male who underwent radical cystoprostatectomy for a locally advanced urothelial bladder malignancy (pT4aN0M0). Seven months later he presented to the emergency department with some penile discomfort. It was done a doppler ultrasound that excluded venous thrombosis with nothing else of relevance at this time. One month after, the patient returned to the emergency department with a clinical priapism with 3 days duration. Corporal fine needle aspiration for blood-gas analysis wasn’t confirmatory. So, it was tried cavernosal blood aspiration and irrigation with saline solution and intracavernosal therapy with phenylephrine, all without success. We proceed with a percutaneous distal (corpora-glanular) shunt (Ebbehoj’s technique) and a dorsal slit. At this time, it could be identifying a solid tissue very suggestive of a metastatic infiltration of both corpora cavernosa, so an excisional biopsy was done. Results: Pelvic magnetic resonance revealed a suspected penile mass and two other metastasis in the ischiopubic bones. Full radiological evaluation with computed tomography failed to reveal any other evidence of disease in thorax and abdomen. Histopathology analysis confirmed metastatic urothelial carcinoma. As a palliative treatment, the patient did a combination of carboplatin and gemcitabine chemotherapy and penile radiotherapy which slightly improve his symptoms of pain. Conclusions: Malignant priapism is a rare pathology which makes its diagnosis and management very challenging. The pathogenesis of metastatic involvement of the penis is unclear. Priapism occurs due to tumor infiltration of the corpora cavernosa as we see in this case report and/or impairment of the venous drainage. Regardless of the treatment choice, it is usually palliative with low success rate as penile metastasis indicates an advanced disease with a poor prognosis with life expectancy estimated less than 1 year.

5.3.15. UP-03.15: Predictor Factors for Perioperative Complications After Radical Cystectomy

• Morales Pinto S ¹, Lanza Pérez M ¹, Amores Vergara C ², Cantero Mellado J ¹ and Herrera Imbroda B ¹

¹ 

University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

² 

Virgen de la Victoria University Hospital, Malaga, Spain

Abstract: Introduction and Objectives: Radical cystectomy (RC) is a technically demanding procedure with high morbidity and mortality. Factors related to the development of perioperative complications have been identified, some of which are potentially addressable and could help reduce their incidence. The objective is to identify clinical factors related to the risk of developing perioperative complications in patients undergoing RC. Materials and Methods: Retrospective cohort of 351 patients undergoing RC between 2010–2023 at Virgen de la Victoria Hospital, including those diagnosed with muscle-infiltrating bladder tumor, non-muscle-infiltrating very high-risk tumors, and non-responders to BCG. Descriptive analysis, bivariate inferential analysis of pre and perioperative variables using Chi-square and Student’s t-test, and multivariate analysis using Cox regression were conducted. The Clavien-Dindo scale was used to classify complications. Results: The mean age was 67.2 years, and 85.5% were male. ASA score was ≤ 2 in 57.6%, and ECOG was 0–1 in 93.3%. 31.2% had a BMI >30, and 34.5% had hypoalbuminemia (<3.5 g/dL) in preoperative controls. The approach was minimally invasive in 13.5% of cases, with cutaneous ureteroileostomy being the most commonly used urinary diversion (88.2%). 46.4% experienced some perioperative complication, with 36.6% being Clavien ≥ III. The most frequent complications were infectious (26.1%), followed by prolonged paralytic ileus (20.3%). In the bivariate analysis, age ≥ 75 years (p = 0.03), presence of previous renal insufficiency (p = 0.008), hypoalbuminemia (p = 0.03), open approach (p = 0.04), and history of previous abdominal surgery (p = 0.04) were associated with a higher frequency of perioperative complications. In the multivariate analysis, age ≥75 years (OR 1.7, 95% CI 1.1–2.7; p = 0.018), preoperative hypoalbuminemia (OR 1.8, 95% CI 1.2–2.6; p = 0.004), open approach (OR 2.7, 95% CI 1.4–5; p = 0.002), and previous abdominal surgeries (OR 1.6, 95% CI 1.1–2.3; p = 0.03) were independent prognostic factors for perioperative complications after RC. Conclusions: Adequate patient selection, optimization of preoperative nutritional status, and minimally invasive approaches are factors to consider in minimizing perioperative morbidity in patients undergoing radical cystectomy.

5.3.16. UP-03.16: Present Position of the Radical Treatment in Elderly Patients with Muscle-Invasive Bladder Cancer

• Startsev V ¹, Sarychev S ² and Tyapkin N ³

¹ 

SPbSPMU, St. Petersburg, Russia

² 

Spital Thurgau AG, Frauenfeld, Switzerland

³ 

State Leningrad Regional Clinic, St. Petersburg, Russia

Abstract: Introduction and Objectives: Bladder cancer (BC) stands as a significant malignancy within the urinary tract, ranking fifth and seventh in frequency among men and women worldwide, respectively. It’s estimated that by 2030, BC incidence will reach its peak, coinciding with a global surge in the population aged over 65. This demographic shift presents a substantial challenge, as most BC patients are over 75 years old. Muscle-invasive bladder cancer (MIBC) in particular exhibits a high disability and mortality rate, underscoring the urgency for improved diagnosis, treatment, and rehabilitation strategies. With the primary treatment being surgical intervention, this study aims to explore the viability of modern surgical methods in treating elderly patients (over 75 years) with aggressive MIBC, in the context of a rapidly aging global population and evolving medical practices. Materials and Methods: We analyzed global scientific literature from 1997–2021 on the outcomes of radical surgical treatments in elderly patients over 75 years, focusing on complications of robot-assisted radical cystectomy (RARC), advantages, and risks, using keyword searches in PubMed, CrossRef, and Scopus databases. Results: Recent studies suggest RARC is feasible and may have lower complication rates for selected patients over 80 years old with MIBC. Elderly patients undergoing RARC often return to baseline functions within 3 months post-surgery and maintain functionality at 12 months. The choice of urinary diversion method in RARC significantly affects complication rates and mortality in elderly patients, with age and ASA physical status being key predictors of 90-day mortality. Despite the advantages of RARC in terms of low need for blood transfusion and shorter hospital stay, its financial costs and complication rates compared to open radical cystectomy remain a matter of debate. Conclusions: Selected elderly patients can effectively undergo radical surgery for aggressive bladder tumors. The life expectancy of patients with muscle-invasive bladder cancer living in rural areas depends on the availability of medical care during the rehabilitation stage, and on the completeness of their family composition. When considering surgery, it’s essential to factor in various scores, patient preferences, and mental readiness for rehabilitation. Robotic surgery offers benefits like reduced complications and shorter hospital stay, but its cost-effectiveness, especially for elderly patients, requires further evaluation.

5.3.17. UP-03.17: Re-RTU, Can We Avoid It in Any Case?

• Montuenga Fernández I, García Loarte E, Sánchez Pellejero A, Vázquez Valdés S, Peral Parra D and Tamayo Ruiz J
• Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

Abstract: Introduction and Objectives: Following the recommendations of European guidelines, Re-RTU of the bladder (ReRTUv) is indicated as part of the treatment for those patients diagnosed with non-muscle-invasive bladder tumors in case of incomplete tumor resection, T1 tumors, and absence of muscularis propria in the sample. In a context where surgical waiting lists are extensive and resources limited, it becomes imperative to optimize such resources. The study aims to explore in which tumor profile ReRTUv could be avoided without compromising the course of the disease. Materials and Methods: A retrospective analysis of ReRTUv performed between 2017 and 2022 at our center was conducted. Demographic and clinicopathological data (RTUv and ReRTUv) were collected, considering aspects such as tumor size, focality, quality of resection, presence of muscular layer, tumor staging, presence of residual tumor, and tumor restaging. Results: Of the 179 patients included in the study, 58.7% were T1G3 and 37.4% were T1G1 or G2. There were 38.5% of tumors larger than 3 cm and 32.4% of tumors with multiple foci. After the second RTUv, 32.4% of patients presented residual tumor and 6.7% were restaged to T2. Tumor persistence and staging to T2 were associated with T1G3 tumors (0.024). Tumors T1G1 or T1G2, on the other hand, showed less association with tumor persistence and staging to T2 (p = 0.027). Within T1G1 and T1G2 tumors, it was observed that 11.6% were larger than 3 cm and 8.3% were multifocal. There was no clear association between these two factors and tumor persistence or staging in the case of T1G1/G2 tumors. There was an association in the case of T1G3 tumors (p = 0.029; p = 0.034). Conclusions: Although studies with larger sample sizes and higher quality are needed, the results suggest that in those T1G1 or G2 tumors, regardless of size and focality, Re-RTU could be avoided, suggesting that to improve preserving good outcomes, sending the tumor base separately and ensuring it is tumor-free, as well as early cystoscopy in follow-up, should be considered.

5.3.18. UP-03.18: Restaging and Tumor Persistence After ReTURBT: What Factors May Influence?

• Montuenga Fernández I, García Loarte E, Sánchez Pellejero A, Vázquez Valdés S, Peral Parra D and Tamayo Ruiz J
• Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

Abstract: Introduction and Objectives: Transurethral resection of the bladder (TURBT) is an essential diagnostic and therapeutic procedure for the treatment of non-muscle invasive bladder urothelial carcinoma. Despite its efficacy, various studies have shown the possibility of understaging and residual tumor persistence after this intervention. Consequently, European guidelines currently recommend performing a second TURBT (ReTURBT) in situations of incomplete resection, absence of detrusor muscle in the sample, and tumors at stage T1. The aim of this study was to analyze the results of ReTURBT performed at our center, focusing particularly on identifying factors that could be related to tumor persistence and restaging, in addition to those established by the guidelines. Materials and Methods: A retrospective analysis of ReTURBT performed between 2017 and 2022 at our center was conducted. Demographic and clinicopathological data (from both initial TURBT and ReTURBT) were collected, considering aspects such as tumor size, focality, quality of resection, presence of muscular layer, tumor staging, presence of residual tumor, and tumor restaging. Results: A total of 179 patients undergoing ReTURBT were examined, with a mean time of 68 days until intervention. 32.4% presented multifocal tumors, and 38.5% had a tumor size of 3 cm or more in the initial TURBT. There were 6.1% incomplete resections. Regarding histopathological characteristics, 37.4% showed no proper muscular layer, and 94.4% had stage T1, with 58.7% being T1G3. After the second TURBT, 32.4% had residual tumor, and 6.7% were restaged to T2. Tumor persistence was associated with tumor multifocality (0.034), size >3 cm (0.029), T1G3 tumors (0.024), and CIS (0.019). Restaging to T2 was related to T1G3 tumors (0.016). The absence of muscular layer after TURBT was not associated with either tumor persistence or restaging. Conclusions: ReTURBT is a fundamental tool to ensure correct staging and tumor removal. Factors such as tumor size, multifocality, or the presence of T1G3 are associated with a higher risk of tumor persistence and restaging.

5.3.19. UP-03.19: Robot-Assisted Radical Cystectomy (RARC) with Intracorporeal Urinary Diversion (ICUD): 8-Years Single Institution Experience

• Hayashi T, Kawanishi Y, Hori K, Kita S, Miyake T, Tujioka T, Fujiwara A, Izumi K and Yamanaka M
• Takamatsu Red Cross Hospital, Takamatsu, Japan

Abstract: Introduction and Objectives: To evaluate the oncological and perioperative adverse events of a single-center, robot-assisted radical cystectomy cohort performed with intracorporeal urinary diversion. Materials and Methods: Patients who underwent RARC because of bladder cancer or recurrent carcinoma in situ from April 2016 until August 2022 at Takamatsu Red Cross Hospital were retrospectively and consecutively included. The RARC with extended pelvic lymphadenectomy was performed by 2 different surgeons over the period using the da Vinci Si and Xi Surgical system using a six-port transperitoneal approach. Patients were offered orthotopic neobladder or ileal conduit. Contraindications to orthotopic diversion was impaired renal function and disease at het urethral margin, relative contraindications were high age and comorbidity. Kaplan-Meier survival analysis was used to estimate recurrence-free survival (RFS), cancer-specific survival (CSS). A Cox proportional hazards model was used to identify individual predictors of outcome. Multiple regression analysis was used to identify predictors of high-grade complications (Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Grade > III). Results: A total of 72 patients were included. The median follow-up was 4 years with an interval of 2 days to 7 years. In all, no patients were converted to open surgery. The 5-years RFS, CSS rates were 80.6%, and 86.1%, respectively. Pathological non-organ-confined disease (tumor stage > T2 or positive lymph nodes) predict poor RFS, CSS. Reconstruction with a neobladder (84.7% of cases) compared to an ileal conduit was not a predictor of high-grade adverse events. Conclusions: A RARC with ICUD is feasible as a standard surgical procedure for bladder cancer. Reconstruction with neobladder with ICUD was not a significant predictor for high-grade adverse events.

5.3.20. UP-03.20: Survival of Metastatic Urothelial Carcinoma of Urinary Bladder According to Number and Location of Visceral Metastases

• Di Bello F ¹, De Angelis M ², Siech C ³, Jannello L ⁴, Rodriguez Peñaranda N ⁵, Goyal J ⁶, Collà Ruvolo C ⁷, Califano G ¹, La Rocca R ¹, Saad F ⁶, Shariat S ⁸, De Cobelli O ⁴, Briganti A ², Morra S ¹, Chun F ³, Puliatti S ⁹, Longo N ¹ and Karakiewicz P ⁶

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

Università Salute Vita San Raffaele, Milano, Italy

³ 

Goethe Frankfurt University, Frankfurt, Germany

⁴ 

IEO Istituto Europeo di Oncologia, Milano, Italy

⁵ 

University of Modena and Reggio Emilia, Modena, Italy

⁶ 

University of Montréal Health Center, Montréal, Canada

⁷ 

Università Federico II di Napoli, Napoli, Italy

⁸ 

Comprehensive Cancer Center, Wien, Austria

⁹ 

Università di Modena e Reggio Emilia, Modena, Italy

Abstract: Introduction and Objectives: To test the association between number as well as locations of organ-specific metastatic sites and overall survival (OS) in systhemic-therapy exposed metastatic urothelial carcinoma of urinary bladder (mUCUB) patients. Materials and Methods: Within Surveillance, Epidemiology and End Results database (2010–2020), all systhemic therapy-exposed mUCUB patients were identified. Kaplan-Meier and multivariable Cox regression (CRM) models first addressed OS in patients according to number of metastatic organ-locations: solitary vs. two vs. three or more. Subsequently, separate analyses stratified according to location type were completed in patients with solitary metastatic organ-location as well as in patients with two metastatic organ-locations. Results: Of 1310 mUCUB, 1069 (82%) harbored solitary metastatic organ-location vs. 193 (15%) harbored two separate metastatic organ-locations vs. 48 (3%) harbored three or more metastatic organ-locations. Median OS decreased with increasing number of metastatic organ-locations (solitary vs. two vs. three or more, p < 0.0001). In multivariable CRM, relative to solitary metastatic organ-location, two (HR: 1.57, 95 Confidence interval [CI]: 1.33–1.85) as well as three or more (HR: 1.69, 95% CI: 1.23–2.31) metastatic organ-locations independently predicted higher overall mortality (OM) (p = 0.001). In patients with solitary metastatic organ-location, brain metastases independently predicted higher OM (HR 1.67; 95% CI: 1.05–2.67; p = 0.03) than other locations. In patients with two metastatic organ-locations, no differences in OM were recorded according to organ type location. Conclusions: In systemic therapy exposed mUCUB, number of metastatic organ-locations (solitary vs. two vs. three or more), independently predicted increasingly worse prognosis. In patients with solitary metastatic organ-location, brain purported worse prognosis than others.

5.3.21. UP-03.21: Toxicity of Chemotherapy in Elderly Patients with Advanced Bladder Cancer

• Nfissi H, Oualla K, Agaraoui M, Amaadour L, Benbrahim Z, Arifi S and Mellas N
• Hassan II University Hospital, Fez, Morocco

Abstract: Introduction and Objectives: The management of bladder cancer, especially at an advanced stage, poses a considerable challenge. Although chemotherapy has proven to be an essential weapon in the therapeutic arsenal, its use in elderly patients raises significant concerns regarding tolerance and associated toxicity. The aim of this study is to highlight the specificities of secondary toxicities related to systemic treatment in elderly patients with advanced bladder cancer. Materials and Methods: This is a retrospective, descriptive study conducted at the Medical Oncology Department of the University Hospital Center of Fez, focusing on 77 patients aged 70 years or older, treated for advanced bladder cancer between January 2018 and December 2023. Results: The median age of our patients was 75.31 years (range: 70 to 90 years), with 81.8% being male. Twenty-three patients (29.9%) underwent evaluation of their G8 score upon admission, with 73.9% having a G8 score < 14 and 26.1% having a G8 score ≥ 14. Eighty-seven percent of our patients had urothelial carcinoma, 82% had distant metastasis, and 18% had locally advanced disease. Regarding treatment modalities, 63.64% of patients received systemic treatment, including 28.6% who received carboplatin-gemcitabine, 24.7% received cisplatin-gemcitabine, 5.2% received gemcitabine monotherapy, and 5.2% received chemoradiation. Among patients who received systemic treatment, 73% experienced toxicity of any grade, with 34.7% of these being grade 3 or higher. The most frequent hematologic toxicities were neutropenia (42.9%), anemia (40.8%), thrombocytopenia (20.4%), and febrile neutropenia (8.2%). Among non-hematologic toxicities, asthenia (44.9%) was predominant, followed by nausea (30.6%), anorexia (24.5%) vomiting (22.4%), renal function impairment (22.4%), and decreased hearing acuity (2%). Treatment discontinuation due to significant toxicities was decided for 14.9% of patients, while dose fractionation was applied in 8.16%. Conclusions: The results of our study highlight the inherent complexity in managing elderly patients treated for advanced bladder cancer. The substantial rates of both hematologic and non-hematologic toxicities underscore the delicate balance between therapeutic efficacy and tolerance in this specific patient population.

5.3.22. UP-03.22: Trial in Progress: BOND-003- Cohort P, a Multi-National, Single-Arm Study of Intravesical Cretostimogene Grenadenorepvec for the Treatment of High Risk, Papillary Only, BCG-Unresponsive Non-Muscle Invasive Bladder Cancer

• Tyson M ¹, Dickstein R ², Zainfeld D ³, Kim J ⁴, Keegan K ⁴, Li R ⁵ and Smelser W ⁶

¹ 

Mayo Clinic, Scottsdale, Arizona, United States

² 

Chesapeake Urology, Hanover, Maryland, United States

³ 

Urology San Antonio, San Antonio, Texas, United States

⁴ 

CG Oncology, Irvine, California, United States

⁵ 

Moffitt Cancer Center, Tampa, Florida, United States

⁶ 

Washington University, St Louis, Missouri, United States

Abstract: Introduction and Objectives: Current guideline recommendations for patients with High Risk, BCG-Unresponsive Non-Muscle Invasive Bladder Cancer (HR BCG-UR NMIBC) is radical cystectomy. However, many patients are unwilling or unable to undergo such a morbid operative intervention. Cretostimogene grenadenorepvec, is an oncolytic adenovirus engineered to preferentially replicate in cancer cells, resulting in tumor lysis and the release of GM-CSF via an encoded transgene. Cretostimogene recently received both US FDA Fast Track and Breakthrough Therapy Designations in the HR BCG-UR NMIBC CIS with or without Ta/T1 tumor indication. The BOND-003 Cohort P study is a multi-national, single-arm, clinical trial designed to assess the efficacy and safety of intravesical cretostimogene in HR BCG-UR NMIBC patients with Ta/T1 tumors without CIS. Materials and Methods: Eligibility criteria: Histologically confirmed BCG-Unresponsive HG Ta/T1 papillary disease without CIS within eight weeks of study enrollment. Patients are required to have received adequate BCG by the US FDA definition. Recurrence must be within six months of the last dose of adequate BCG. Patients must have no evidence of residual bladder cancer before treatment. Patients (n~70) will receive intravesical cretostimogene adjuvant to TURBT and will undergo instillations in combination with n-dodecyl-B-D-maltoside (DDM, an inactive detergent) for six weekly doses during the induction phase, followed by three weekly maintenance cycles quarterly through month 12, then every six months through month 36. Primary disease assessments include serial cystoscopy, urine cytology, axial imaging, mandatory biopsy at month 12, and centralized review of pathologic samples. The primary outcome measure is event free survival. Secondary and exploratory outcome measures will be assessed. Results: This clinical trial is in progress. Data will be summarized and displayed graphically, where appropriate. It is expected that 70 evaluable patients will result in adequate confidence interval precision for comparisons to historical and published data in the BCG-Unresponsive HG Ta/T1 without CIS disease state. Conclusions: Patients with BCG-Unresponsive HG Ta/T1 represent a considerable unmet medical need. Cretostimogene may provide a highly effective and well-tolerated treatment for this critical clinical gap. 35+ clinical sites have been selected in the United States and Japan. Enrollment has been initiated. NCT044552591

5.3.23. UP-03.23: Urothelial Sarcomatoid Carcinoma of the Bladder: Epidemiological, Diagnostic, Anatomopathological and Prognosis Aspects

• Hazem H ¹, Nouri R ², Firas Z ³, Ali E ¹, Walid S ², Ahmed C ³, Mohamed F ² and Mourad H ²

¹ 

Urology Department, Habib Bourguiba Hospital, Sfax, Tunisia

² 

University Hospital Habib Bourguiba, Sfax, Tunisia

Abstract: Introduction and Objectives: Sarcomatoid urothelial carcinoma of the bladder is a rare malignant tumor with a very poor prognosis. It is very aggressive, often diagnosed at an advanced stage and responsible for high mortality. The aim of our study is to identify the epidemiological characteristics, the clinical profile and the paraclinical specificities of these tumors, to display the anatomopathological characteristics and to determine the prognostic factors of this tumor type. Materials and Methods: We conducted a descriptive, retrospective study of 22 cases of CUSV treated in the urology department and anatomy and pathological cytology laboratory of Habib Bourguiba University Hospital in Sfax, during a period from January 2000 to December 2019. Results: The average age of our patients was 75.1 years. A male predominance was noted with a sex ratio of 6.3/1. The clinical presentation was the same as classic urothelial tumors with predominance of hematuria (77.3%). Radiological explorations showed locoregional extension in 77.8% of cases and metastatic in 27.7% of cases. Cystoscopy was the reference examination for the positive diagnosis, performed in all our patients. The diagnosis was made on the histopathological examination of the endoscopic resection chips in 19 cases and on surgical excision specimens in 3 cases, showing a malignant tumor with double contingent. The average size was 6.6 cm. Histologically, the tumor cells of the 2 contingents were of high grade showing heterologous elements in 36.6% cases. In the immunohistochemical study, the sarcomatoid tumor cells were positive for vimentin in 85.7% of cases and for epithelial markers such as keratin in 52.3%. Therapeutically, there is no well-codified protocol. Our patients were treated by RTUV alone in 23% of cases, by total cystectomy in 41% of cases and by concomitant radio-chemotherapy in 5% of cases. Treatment with radiotherapy was necessary in 14% of cases and chemotherapy in 9% of cases. Overall survival was poor with a rate of 39% at one year and 5.6% at 5 years. Conclusions: CUSV is a rare, aggressive and rapidly growing tumor, often diagnosed at a late stage. The standard treatment is total cystectomy which often remains insufficient given the potential aggressiveness of this tumor.

5.3.24. UP-03.24: Radical Cystectomy in Octogenariand

• Brausi M ¹, Oltolina P ², Rabito S ², Toso S ², Morselli S ² and Ferrari G ²

¹ 

AUSL Modena, Dept. of Urology, Modena, Italy

² 

Hesperia Hospital, Dept. of Urology, Modena, Italy

Abstract: Introduction and Objectives: Primary objective is to compare radical cystectomies (RC) mortality, survival and complication rate in elderly treated with or without ERAS protocol. Secondary end-point is to evaluate their quality of life (QoL). Materials and Methods: A retrospective analysis of 2 tertiary centres for elder pts who received RC by the same surgeon (MB) between March 2000 and December 2012 was conducted. Pts were divided in Group 1: RC plus modified ERAS protocol, Group 2, traditional care. Clinical, radiological, pathological and surgical data were obtained from medical records and analysed comparing mortality and complication rate of RC. In ERAS GROUP pts were evaluated pre-operatively, received mini-invasive surgery and were closely followed. QoL was assessed through EORTC-Q30 questionnaire. Results: A total of 84 pts were included in this study. Median age: 83 years (IQR 80–91), male-female ratio 75% and median follow-up 44.5 months. Comorbidities were present in 83.6%. Group 1 had 47 pts (56%) whom followed all ERAS items. They all received an extraperitoneal RC with uretero-cutaneostomy as diversion. Group 2 had 37 pts (44%) who underwent trans-peritoneal RC. In detail, 31 (83.8%) had Bricker, while 6 (16.2%) had an orthotopic ileal neobladder. Tumour stage, grade and ASA score were comparable. Perioperative deaths were 4 (4.8%), 1 in Group 1 and 3 in Group 2. Globally, Clavien-Dindo 3 or more complication rate was 36%, statistically higher in Group 2, 29.7% vs. 12.7% (p = 0.001). In fact, 7/37 patients in Group 2 needed a second surgery 18.9% vs. 0 in Group 1 (p = 0.001). Clavien Dindo 2 medical complications rate was 40.4% in Group 1 vs. 27% in Group 2 (p = 0.045). Regarding oncological outcomes, 28 pts (33.3%) progressed: 10 in Group 1 (21.2%) and 18 in Group 2 (48.6%), p = 0.001. Overall survival at 3 years was 40%, while CSS was 50%. Regarding QoL, only 43 pts answered (49%): 21 in Group 1 and 22 in Group 2. Overall, 37/43 patients (86%) reported QoL improvements after RC. Conclusions: RC can still be performed in elderly patients with positive results. Indeed, ERAS protocol implementation might decrease surgical complications and has a positive impact on OS and on QoL of patients observed.

5.4. BPO/LUTS

5.4.1. UP-04.01: A Training Centre Analysis of Procedural Efficiency and Enucleation Ratio of Holmium Laser Enucleation of Prostate Considering Surgeon and Patient Factors

• Rahman E, Penev B, Javed U and Cynk M
• Maidstone and Tunbridge NHS Trust, Maidstone, United Kingdom

Abstract: Introduction and Objectives: In this study, we have assessed the influence of operator and patient factors on the efficiency and enucleation ratio of HoLEP in our centre over a period of 3 years by looking at surgeon’s techniques as well as prostate size variables. Materials and Methods: Prospective data was collected on 502 HoLEP patients who were operated on by 5 surgeons between 2020–2023, who used two, three lobe or en-cloc techniques. Collected data include estimated prostate size in cubic centimetres (cc), the specimen weight in grams (g) and duration of operation in minutes (min). To compare performances across techniques and operators, we studied the effect of those parameters on the efficiency (the ratio of the resected tissue weight with the total operation time) and the enucleation ratio (resected tissue weight divided by estimated prostate size). PRISM 9 was used for statistical analysis. Results: It was observed that 3 lobe techniques had a mean efficiency and enucleation ratio of 0.33 gm/min & 0.40 gm/cc in comparison to the mean of 0.67 gm/min & 0.56 gm/cc for the en-bloc and 2 lobe technique (p = <0.0001 for both). No significant difference in efficiency was found in 2 lobe and en- bloc techniques (p = 0.089). HoLEP for larger than 100 cc prostates had superior efficiency than those under 100 cc size group with means of 0.69 and 0.48 gm/min, respectively (p < 0.0001). In the latest 271 cases, 26 cases involved trainees, which resulted in significant (p < 0.001) reduction of efficiency, mean from 0.61 to 0.39 gm/min, respectively, resulting in around 37% less efficiency. Conclusions: This study clearly demonstrates that the 3 lobe enucleation technique has the least efficiency and enucleation ratio. These results can be used in optimising theatre planned time along with implementing measures to improve HoLEP training.

5.4.3. UP-04.03: Comparative Therapeutic Outcomes of Holmium Laser Enucleation of the Prostate in Benign Prostatic Hyperplasia and Prostate Cancer

• Alzahrani A, Aleid M, Alshamsi H, Alahmari A, Hamouche F, Carrier S and Aubé-Peterkin M
• McGill University, Montreal, Canada

Abstract: Introduction and Objectives: Holmium laser enucleation of the prostate (HoLEP) is a standard treatment for benign prostatic hyperplasia (BPH), but its use in prostate cancer management is still under research. Our objective was to conduct a comparative analysis of the therapeutic outcomes of HoLEP in patients who have been pre-operatively diagnosed with either PCa or BPH. Materials and Methods: A retrospective review was conducted on known PCa and BPH patients who received HoLEP treatment at our institution from January 2006 through December 2022. The study included demographic data at baseline, preoperative and postoperative levels of prostate-specific antigen (PSA), the International Prostate Symptom Score (IPSS), duration of enucleation and morcellation, prostate size, and complications that occurred intraoperatively and postoperatively. Patients who received any prior surgical prostate intervention or radiotherapy for the PCa were excluded. Results: A total of 1121 patients, with 40 diagnosed with PCa and 1081 with BPH. The median age for PCa patients was 69 years, while for BPH patients, it was 70 years. Post-operative complications were significantly higher in PCa patients (15%) than in BPH patients (9%), with a p value < 0.05. The most common complications in the BPH group were urethral stricture requiring visual internal urethrotomy at 2.1%, persistent lower urinary tract symptoms (LUTS) requiring cystoscopy at 1.3%, and persistent urge incontinence at 1.0%. In the PCa group, the complications were more evenly distributed, with hematuria, bladder neck contracture, LUTS requiring medications, chronic urinary retention requiring clean intermittent catheterization, and persistent urge incontinence each occurring in 2.5% of patients. The postoperative IPSS and QOL at 3 months showed no significant difference between PCa and BPH patients. Conclusions: The outcome of HoLEP in PCa patients is comparable to that of BPH patients. However, there is a higher likelihood of post-operative complications in PCa patients compared to those with BPH.

5.4.4. UP-04.04: Comparison of Peri-Operative Outcomes of Endoscopic BPH Surgeries (TURP, LEP, LVP) Across Kidney Function Status

• Nasrallah O ¹, Herrera M ¹, Mahdi J ² and Nasr R ¹

¹ 

American University of Beirut Medical Center, Beirut, Lebanon

² 

Faculty of Medical Sciences- Lebanese University, Beirut, Lebanon

Abstract: Introduction and Objectives: The objective is to assess the effect of one surgical technique (laser enucleation of the prostate (LEP) or laser vaporization of the prostate (LVP)) over transurethral resection of prostate (TURP), on post-operative outcomes in patients undergoing endoscopic BPH surgery when stratified based on kidney function. Materials and Methods: The ACS-NSQIP database (2008–2021) was reviewed for 83,020 patients that underwent TURP, LEP, and LVP. Pre-operative variables were compared across kidney function groups: G1, normal/high function; G2-G3, mild/moderate kidney disease; and G4-G5, severe kidney disease. Multivariate logistic regression was performed on 30-day peri-operative complications adjusting for pre-operative variables. Propensity score matching compared LEP and LVP to TURP. Results: In the G1 category, LEP showed a significant protective effect against UTI (OR = 0.59), shorter hospital stay (OR= 0.72), and longer operative time (OR = 5.29). LVP had a significant protective effect against bleeding and blood transfusion requirement (OR = 0.19), a shorter hospital stay (OR = 0.18), and a lower rate of return to OR (OR = 0.59). In the G2-G3 category, LEP showed a significant protective effect against UTI and sepsis with OR of 0.65 and 0.48 respectively, and shorter hospital stay (OR = 0.64) and longer operative time (OR = 5.47). LVP had a significant protective effect against bleeding and blood transfusion requirement with OR = 0.35, shorter hospital stay (OR = 0.24), lower rate of return to OR and thromboembolic events with OR = 0.71 and 0.64 respectively, and shorter operative time (OR = 0.95). In the G4-G5 category, LEP lost the protective effect provided against UTI and sepsis and had longer operative time with OR = 5.29. LVP had a significant protective effect against cardiac complications, bleeding and blood transfusion requirement, with OR = 0.27 and 0.49 respectively, and shorter hospital stay (OR = 0.30). Conclusions: LEP and LVP are superior to TURP in terms of post-operative complications. The type of endoscopic surgery technique should be tailored according to patient’s pre-operative kidney status and risk.

5.4.5. UP-04.05: Day-Case Holmium Laser Enucleation of the Prostate (HoLEP): Success Rate and Predictive Factors of D0 Discharge After 10 Years of Clinical Experience

• Klein C, Lacroix X, Capon G, Alezra E, Estrade V, Blanc P, Bladou F, Bernhard J and Robert G
• Bordeaux University Hospital, Bordeaux, France

Abstract: Introduction and Objectives: Most international guidelines recommend HoLEP for the surgical management of BPH, regardless of prostatic volume. The main advantages reported by randomized clinical studies are reduced perioperative bleeding, catheterization time, and length of hospitalization. HoLEP is mostly performed as a one-night stay; however, several studies have reported that HoLEP can be performed as a day-case procedure. We aimed at evaluating the feasibility and safety of day-case HoLEP in a large cohort of patients. Materials and Methods: Clinical data for HoLEP procedures were prospectively collected on a dedicated database. We retrospectively analysed perioperative data of consecutive day-case procedures performed at our institution between January 2013 and April 2022 by only one experimented surgeon (n = 396). Day-case success was defined as successful discharge within 12 h of admission without any readmission within 48 h. The protocol for day-case treatment included systematic bladder catheter insertion with continuous irrigation for approximately 2 h and catheter removal on postoperative day 1. Uni- and multivariate analyses were performed to identify predictive factors of failure. Results: In total, 89% of patients (n = 354) were successfully discharged within 12 h and 83% (n = 328) were not readmitted within 48 h. The main reason for discharge failure was hematuria requiring continuous bladder irrigation. In univariate analysis, age (p = 0.04), PSA (p = 0.03), prostate volume (p = 0.003), operating time (p = 0.001), resected tissue weight (p = 0.001), and indwelling catheter (p = 0.007) were associated with discharge failure. In multivariate analysis, prostate volume over 90 mL (p = 0.05) was the only risk factor associated with discharge failure. Conclusions: Day-case HoLEP is a reliable and safe procedure, with a high success rate. In our experience, the most important factor leading to failure to discharge patients within 12 h of surgery was prostate volume. The success rate was 82% in patients with prostate volume > 90 mL.

5.4.6. UP-04.06: Efficiency and Morbidity of HoLEP Treatment in Patients over 85 Years of Age with Failed Indwelling Catheter Weaning: Results of a Bi-Centric Retrospective Study

• Klein C ¹, Anract J ², Lacroix X ¹, Mansour R ², Barry Delongchamps N ² and Robert G ¹

¹ 

Bordeaux University Hospital, Bordeaux, France

² 

Cochin Hospital, Bordeaux, France

Abstract: Introduction and Objectives: Wearing an indwelling urinary catheter (IDC) leads to a loss of autonomy in elderly individuals. Surgical treatment with holmium laser enucleation of the prostate (HoLEP) may be proposed in cases of failed removal from a urinary catheter in patients with benign prostatic hyperplasia (BPH). We evaluated the interest in HoLEP in patients aged > 85 years using an IDC. Materials and Methods: HoLEP procedures performed on patients aged ≥ 85 years between June 2012 and April 2020 in two university hospitals were retrospectively analyzed. Among the 111 patients who underwent surgery, 71 (63.9%) had an IDC preoperatively and were included in this study. The outcome measures were mortality and failure rates of catheter removal at 1 year postoperatively. Results: In total, 71 patients were included with an average age and prostatic volume of 89.4 ± 3.2 years and 107.1 ± 62.2 g, respectively. The median Charlson score was 6 [5–7]. Among the patients, 29 (40.8%) and 25 (35.2%) were receiving antiplatelet and anticoagulant treatments, respectively. Postoperatively, the rates of major complications (Clavien-Dindo grade > 2) and transfusion were 1.4% and 11.3%, respectively, with an average hospitalization duration of 3.7 ± 8.9 days. At one year, 10 patients (14.1%) died following the intervention due to causes unrelated to the procedure. At one year, two patients (2.8%) had catheter removal failure. Conclusions: According to our results, HoLEP appears to be a safe and effective procedure, with a 1-year mortality rate comparable to that of the general male population aged 90 years (14.8%; French National Institute for Statistics and Economic Studies data, 2018). These results confirm that HoLEP is a viable therapeutic option for elderly patients with indwelling urinary catheters.

5.4.7. UP-04.07: Evaluation of Treatment with Rezūm^® Water Vapor Therapy: Functional Results and Impact on Quality of Life After Three Years of Follow-Up

• Tagalos Muñoz A, García Barreras S, Mínguez Ojeda C, López Curtis D, Mata Alcaraz M, Fernandez Mardomingo A, Fernández Conejo G, Sanz Mayayo E, Rodríguez-Patrón Rodríguez R and Burgos Revilla F
• Ramón y Cajal University Hospital, Madrid, Spain

Abstract: Introduction and Objectives: Prostate tissue ablation with water vapor or the Rezūm^® system represents an additional therapeutic tool in the treatment of benign prostatic hyperplasia. It is a minimally invasive technique with few complications. The objective is to present our experience with Rezūm^® and report sexual and functional outcomes at 3 years of follow-up. Materials and Methods: Observational, retrospective study including all patients treated with Rezūm^® from March 2019 to December 2023. Follow-up at 1, 3, 6, 12, 24, and 36 months postoperatively. Baseline characteristics, validated questionnaires (IPSS, IIEF, and MSHQ), and Qmax were collected. The number of intraprostatic injections was recorded and related to prostate volume to calculate treatment density. Comparison between high and low injection density groups using U-Mann-Whitney. Results: Total: 52 patients. Table 1: Clinical Data. Regarding functional results, there is improvement in IPSS, IPSS-QoL and Qmax from the third month onwards (Table 2). Results were compared based on the concentration of injections administered, with no significant differences (p = 0.6) in IPSS and Qmax. Regarding sexual function, the IIEF remained similar, showing improvement in ejaculatory function and satisfaction. Conclusions: Rezūm^® is a safe and effective therapeutic tool to treat obstructive symptoms of BPH. It improves voiding symptoms while preserving erectile and ejaculatory function after three years of follow-up.

5.4.8. UP-04.08: Impact of Bipolar Plasma Enucleation of Prostate (BPEP) and Thulium Laser Enucleation of Prostate (ThuLEP) on Erectile Function

• Morsy S, Enayet M, Abdel Mohsen M and Hossam A
• Cairo University, Cairo, Egypt

Abstract: Introduction and Objectives: Novel techniques for prostate enucleation either by bipolar or thulium laser started to take over. However, the impact on sexual function remains uncertain and contradictory, with a number of patients who actually refers new episodes of ED following prostatectomy. We evaluated the effect of both bipolar enucleation and thulium enucleation of prostate on erectile function (EF). Materials and Methods: This is a prospective randomized comparative study, held in urology department, Cairo University hospitals during the period from November 2022 till December 2023, including 48 patients with symptomatic BPH patients’ candidate for bipolar or laser prostatectomy, divided into 2 groups, group A for ThuLEP & B for BPEP. All patients were assessed by IPSS, serum PSA, uroflowmetry, PVR, TRUS, IIEF score and HADS preoperative and postoperative at 1, 3 and 6 months. Results: The mean age was 67.9 ± 4.5 years in group A and mean prostate size was 104 ± 24.6 gm, meanwhile the mean age was 66.5 ± 3.5 years in group B, with mean prostate size 102 ± 24.6 gm. There was statistical significant difference between both enucleation techniques as 29.2% improved, 50% worsened and 20.8% preserved their initial level of EF with bipolar enucleation, while 25% improved, 20.8% worsened and 54.2% preserved their initial level of EF in thulium enucleation of prostate. p = 0.038. No statistical significant difference between both types of enucleation regarding improvement of HADS score for anxiety and depression. Conclusions: Both bipolar & thulium laser enucleation may affect erectile function after prostatectomy. However, BPEP appear to be have more deleterious effect on erectile function than ThuLEP.

5.4.9. UP-04.09: Impact of Kidney Disease on Peri-Operative Outcomes of Endoscopic BPH Surgery Using the ACS-NSQIP Database

• Nasrallah O ¹, Herrera M ¹, Mahdi J ² and Nasr R ¹

¹ 

American University of Beirut Medical Center, Beirut, Lebanon

² 

Faculty of Medical Sciences- Lebanese University, Beirut, Lebanon

Abstract: Introduction and Objectives: The objective of this study was to assess the impact of kidney function in patients with BPH undergoing surgery prior to transurethral resection of prostate (TURP), laser enucleation of the prostate (LEP), and laser vaporization of the prostate (LVP) on operative and post-operative outcomes using the ACS-NSQIP database. Materials and Methods: The ACS-NSQIP database was reviewed for patients that underwent TURP, LEP and LVP for treatment of patients with BPH between the years of 2008 and 2021. Demographics, comorbidities, bleeding disorders, operative time, and surgical procedure performed were collected for comparison between kidney function groups: G1, normal/high function; G2-G3, mild/moderate kidney disease; and G4-G5, severe kidney disease. The 30-day peri-operative complications were measured and a multivariate logistic regression analysis was performed while adjusting for all confounding variables. Propensity score matching was performed between the G1 and G4–G5 cohorts. Results: A total of 83,020 patients were included. On multivariable regression, mild/moderate CKD (G2–G3) was found to be an independent risk factor only for renal complications postoperatively with an odds ratio of 2.43 [1.56–3.79], p < 0.001. After propensity score matching, the G4-G5 cohort showed increased odds of pneumonia (OR = 4.02 [1.34–12.06], p = 0.013), renal complications (OR = 7.62 [2.28–25.41], p < 0.001), cardiac complications (OR = 4.53 [1.53–13.41], p = 0.006) and sepsis/septic shock (OR = 1.76 [1.09–2.83], p = 0.021). They also had a higher need for blood transfusion (OR = 3.58 [2.24–5.71], p < 0.001), and had longer length of hospital stay (OR = 1.49 [1.30–1.72], p < 0.001). Conclusions: Actual data effectively demonstrates that pre-operative kidney disease poses an increased risk of complications for patients undergoing endoscopic BPH surgery. The literature lacks information on the effect of pre-operative kidney disease on endoscopic BPH surgeries. Further studies are required to compare post-operative outcomes of LEP and LVP as compared to TURP across kidney function status.

5.4.10. UP-04.10: Implantation of the Adjustable Transobturator Male System (ATOMS^®) as a Treatment for Stress Urinary Incontinence After Prostate Surgery: Our Experience in 11 Years

• Arce Cuartango P, Herrera Aranda N, San Martín Vilariño P, Duque Martínez I, García De Garayo Pires N, Pinto Martín R, Ayerra Pérez H, Campà Bortoló J, Merino Narro I, Díez Razquín M, Polvorinos García L, Extramiana Cameno J and Martín-Marquina Aspiunza A
• Bioaraba, Cáncer Urológico, Vitoria-Gasteiz, España; Osakidetza, Hospital Universitario Araba, Urología, Vitoria-Gasteiz, Spain

Abstract: Introduction and Objectives: Stress urinary incontinence (SUI) after prostate surgery is a health problem that significantly affects the quality of life of those who suffer from it. The adjustable transobturator male system (ATOMS^®) acts by compressing the bulbospongiosus muscle and indirectly the urethra, replacing the sphincter function, making it a treatment option for these patients. Materials and Methods: Retrospective analysis of the efficacy and safety of the ATOMS^® device in 45 patients with persistent SUI secondary to prostate surgery, between 2012 and 2023. We considered an effective treatment, remaining dry or requiring a level 1 safety pad within 24 h. We assessed device efficacy after appropriate adjustments compared to baseline, using PAD-test/24 h, pad count, ICIQ-SF and PGI-I questionnaire. We analysed postoperative complications based on the Clavien-Dindo classification. Results: Mean age: 71.87 ± 6.2 years. Mean follow-up time: 12 months. 100% of patients had a history of previous prostate surgery: 28.89% open radical prostatectomy (RP), 17.78% laparoscopic RP, 37.78% robotic RP and 15.55% transurethral prostate resection. 9 patients (20%) received previous RT and 4 patients (8.9%) had undergone other surgery for their incontinence previously. Surgery was effective in 77.78% of patients, with 44.45% remaining dry and 33.33% requiring a safety pad/24 h. 10 patients (22.22%) did not achieve improvement of their incontinence, 5 of these (50%) had a history of RT. The baseline pad-test was 223.40 ± 98.98 g and the number of pads/24 h was 2.58 ± 0.87. After surgery and appropriate adjustments the pad-test was 1.66 ± 1.75 gr and the number of pads/24 h 0 ± 1. We observed a decrease in ICIQ-SF (13.3 ± 4.14 vs. 2.8 ± 1.3). The overall impression of improvement after surgery was very positive (PGI-I 1.4 ± 0.87). 7 patients (15.56%) presented complications, all of them grade ≤ 3 in the Clavien-Dindo classification. Two of them required device removal, one due to infection and one due to device extrusion. Conclusions: In our experience, the ATOMS^® device appears to be an effective alternative with a good safety profile for the treatment of mild-to-moderate SUI after prostate surgery.

5.4.11. UP-04.11: Long Term Outcome of the Optilume™ Stricture Drug-Coated Balloon in a Challenging Cohort of Anterior Urethral Stricture Disease—A Prospective Cohort Study

• Alhamdani Z ¹, Ong S ², Zhong W ² and Chin P ²

¹ 

Austin Health, Melbourne, Australia

² 

Wollongong Health, Sydney, Australia

Abstract: Introduction and Objectives: Urethral stricture disease remains a challenging presentation in urology, leading to multiple complications including kidney failure and destrusor dysfunction. The Urotronic Optilume drug coated balloon (DCB) (Urotronic, Inc., Plymouth, MN, USA) is the first drug coated balloon for the treatment of urethral strictures in men. The DCB treats strictures via mechanical dilation via a balloon, and the local application of paclitaxel, an antimitotic agent. Our study examines the safety and efficacy of the DCB in an Australian population with strictures greater than 2 cm who have undergone at least 2 prior procedures for urethral strictures. Materials and Methods: After institutional approval, we identified all patients with urethral stricture disease who have required at least 2 prior treatments from Nov 2019 to Sep 2021. Baseline characteristics, International Prostate Symptom Score (IPSS) and IPPS quality of life, voiding flow study rates were collected. This were then repeated at 1 month, 6 months, 12 months, 24 months and 30 months. Information regarding re-treatment rate and complications including re-hospitalisation post procedure was collected. All procedures were performed under general anesthesia via cystoscope. Cold knife urethrotomy was performed to stricture sites (in at least 5 areas) before dilatation with DCB. Results: We had 17 patients with a follow-up of 24 months or greater, with a median follow-up time of 30 months. Re-treatment survival rate at 30 months median follow-up was 76%. All patients had an improvement in IPSS, IPSS QOL, max and median flow at 12 and 24 months follow-up. A detailed summary is described in tables 1 and 2. Conclusions: The DCB in our cohort of 17 patients with notoriously difficult to manage stricture disease had improvements in all areas of investigation, including IPSS, IPSS QOL, voiding flow tests at each time point investigated. This demonstrates a promising future for a new treatment for stricture disease. Larger comparative studies are required to validate our results.

5.4.12. UP-04.12: Nocturia and Sleep Quality After Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

• Zouari F, Masmoudi S, Samet A, Fourati M, Kammoun O, Mejdoub B, Chaabouni A, Smaoui W, Mseddi M, Rebai N and Hadj Slimen M
• Habib Bourguiba Academic Hospital, Sfax, Tunisia

Abstract: Introduction and Objectives: Lower urinary tract symptoms (LUTS) in men are often secondary to benign prostatic hyperplasia (BPH). Nocturia is an irritative symptom among LUTS. Its influence on the quality of life of patients has been evaluated at different levels, particularly on the sleep quality (SQ). The objective of our study is to evaluate the impact of TURP on nocturia and sleep disorders in patients with LUTS related to BPH. Materials and Methods: We retrospectively examined the records of 104 patients, who presented to the urology department of the Sfax University Hospital from January to December 2022, for LUTS related to BPH, including nocturia (2 times or more) and who underwent a TURP. Histological examination confirmed the benign nature of the prostatic hypertrophy. All patients were assessed using the International Prostate Symptom Score (IPSS) and the Pittsburgh Sleep Quality Index (PSQI) at baseline and 3 months after TURP. Results: A total of 86 patients were included in the study. The average age was 70.21 years (51–86). Fifty patients (58%) had a sleep disorder defined as an overall PSQI score ≥ 5.5, with a mean PSQI score of 11.1. The nocturia score (question 7 of the IPSS) was significantly correlated with habitual sleep efficiency (component 4 of the PSQI) (r = 0.73, p < 0.01). Nocturia significantly decreased after TURP from 2.93 to 1.02 (p < 0.01), unlike the PSQI score (p = 0.016). In the 50 patients with a sleep disorder before TURP, subjective SQ (component 6 of the PSQI) and habitual sleep efficiency significantly decreased after TURP (p < 0.01), but this was not the case for the overall PSQI score (p = 0.21). Patients with persistent sleep disorder after TURP, IPSS score was higher than those of patients without sleep disorder, although nocturia score improved equivalently in both groups. Conclusions: TURP has been recognized as a gold standard and effective surgical procedure for improving LUTS in patients with BPH, although the spread of other surgical procedures using a variety of lasers continues gradually. TURP reduces the frequency of nocturia and partly improves SQ in patients with nocturia and LUTS related to BPH.

5.4.13. UP-04.13: Outcomes and Complications of Trans Urethral Resection of Prostate (TURP) in Patients with and without Acute Urinary Retention: A Comparative Study

• Gaur R and M N
• Govt TD Medical College Alappuzha Kerala, Alappuzha, India

Abstract: Introduction and Objectives: With a reported prevalence rate of up to 53% in men with BPH, acute urinary retention (AUR) poses a significant concern. Previous research has indicated elevated mortality and morbidity rates subsequent to transurethral resection of the prostate (TURP). In our investigation, we aimed to scrutinize the occurrence of post-TURP complications among patients with and without AUR at presentation. Materials and Methods: This prospective study enrolled patients presenting with lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH), with and without acute urinary retention (AUR), at Govt. TD Medical College. The study period spanned from January 2023 to December 2023, involving a total of 149 participants, comprising 90 with AUR and 59 without AUR. Inclusion criteria encompassed a comprehensive evaluation including history taking, physical examination, digital rectal examination (DRE), ultrasound of the kidneys, ureters, and bladder (USG KUB), uroflowmetry, and post-void residual (PVR) measurement. Exclusion criteria comprised patients aged over 70 years, those with neurological diseases, prostate cancer, urethral stricture, or prior prostate or urethral surgery. All patients underwent transurethral resection of the prostate (TURP) using monopolar current with glycine irrigation. Postoperative variables including TUR syndrome, persistent hematuria, the requirement for blood transfusion, postoperative urinary tract infection (UTI), sepsis, re-catheterization rate, re-surgery, postoperative stricture, LUTS, maximum flow rate (Q max), PVR, and length of hospital stay were compared between the groups. Results: Our findings indicate a higher incidence of complications among patients presenting with acute urinary retention (AUR). Specifically, postoperative urinary tract infection (UTI), recatheterization rate, and length of hospital stay were notably elevated in the AUR group compared to patients without AUR. Conclusions: In conclusion, our study underscores the importance of early intervention in patients with benign prostatic hyperplasia (BPH), prior to the onset of acute urinary retention (AUR). Taking proactive measures at an earlier stage is crucial for minimizing complications and enhancing treatment outcomes.

5.4.14. UP-04.14: Perioperative Risk Factors and Predictors of Urinary Disorders After Surgical Treatment of Prostate Hyperplasia

• Bogdanov D and Kotov S
• RNRMU named after N.I.Pirogov, Moscow, Russia

Abstract: Introduction and Objectives: The aim of the study was to assess the frequency of urinary disorders in patients to identify predisposing risk factors leading to unsatisfactory treatment results. Materials and Methods: 398 patients with BPH aged 47–88 years who underwent surgery for BPH. Laser enucleation was performed in 207 (52%) cases, transurethral resection of the prostate was performed in 92 (23.1%) cases. Simple prostatectomy was performed in 53 (13.3%) patients, laparoscopic adenomectomy was performed in 46 (11.6%) patients. 192 (48.2%) patients underwent a urodynamic study to assess the index of BOO and detrusor hyperactivity. Patients underwent a follow-up examination at 1–6–12 months. The assessment of urinary disorders was carried out using a validated IPSS-QoL questionnaire. Statistical data processing was carried out using the SPSS software. The differences were considered significant at p < 005. Results: Before surgery, the average IPSS value was 21.2 ± 6.7 points; Qmax was 7.5 ± 3.4 mL/s; Detrusor hyperactivity was detected in 159 (82.8%) patients. After 12 months, the Qmax value was 22 ± 7.8 mL/s, the IPSS value was 4.6 ± 4.8 points. 61 (15.3%) patients had infectious complications. This factor was not significant for the rate of urination during observation (p = 0.375), but with a statistically significant difference, it affects the dynamics of LUTS (p = 0.031). The risk of infectious was higher in patients with diabetes mellitus, the growth of microflora in urine (p = 0.017). Other factors do not increase the risk of infectious complications. Scarring complications were detected in 15 patients (3.8%). In patients with cystostomy drainage, the frequency of cicatricial complications is lower (p = 0.032), risk factors are a positive culture in urine culture and an increase in surgery time (p = 0.000). The factor of irritative symptoms, including nocturia, is hyperactivity of the bladder, although statistically the difference is not significant (p = 0.084). Detrusor hyperactivity persisted in 25.5% of patients, urgent urinary incontinence was noted in 10 patients, which required the appointment of conservative therapy. Patients with urinary incontinence were older than patients with complete continence (p < 0.05). Conclusions: It is necessary to diagnose and treat BPH in a timely manner, in compliance with clinical recommendations, and careful preoperative preparation.

5.4.15. UP-04.15: Predicting Poor Voiding Pattern After Holmium Laser Enucleation of the Prostate Using Maximum Flow Rate as an Objective Outcome

• Alzahrani A, Aleid M, Arezki A, Alshamsi H, Alahmari A, Addar A, Hamouche F, Carrier S and Aubé-Peterkin M
• McGill University, Montreal, Canada

Abstract: Introduction and Objectives: Holmium laser enucleation of the prostate (HoLEP) is considered a size-independent gold standard for surgical management of benign prostatic hyperplasia (BPH). The aim of this study is to identify preoperative patient characteristics that predict poor voiding patterns after HoLEP using the postoperative maximum flow rate (Qmax) as an objective measurement. Materials and Methods: A retrospective chart review of all patients who underwent HoLEP at our institution between January 2006 and December 2022 was performed. Patient demographics, preoperative and postoperative PSA, IPSS score, Qmax, post-void residual (PVR) and catheter time were collected. Postoperative catheter time, trial of void results, IPSS score, PVR and Qmax were obtained. Predictive factors of post-operative poor flow rate, defined as Qmax < 15 mL/s, were identified using logistic regression models. Results: A total of 1081 HoLEP procedures were analysed. The median age was 70 years old (SD ± 8) and the median prostate volume was 90 g (SD ± 49 g). The procedures were performed as a day surgery in 977 patients (90.4%). Post-operative poor flow rate was found in 219 patients (29.2%) at 1-month follow-up. Diabetes mellitus (DM) and pre-operative combination medication for BPH were identified as independent risk factors for low Qmax with OR of 1.29 and 1.16, respectively (p value < 0.005). Conclusions: Diabetes mellitus and pre-operative combination BPH therapy are risk factors for low Qmax post-HoLEP. Understanding these factors can help improve patient counselling and follow-up.

5.4.16. UP-04.16: Predicting Successful Photoselective Vaporization of the Prostate Using Maximum Flow Rate as an Objective Outcome

• Alzahrani A, Aleid M, Arezki A, Addar A, Hamouda A, Alahmari A, Alshamsi H, Carrier S, Hamouche F and Aubé-Peterkin M
• McGill University, Montreal, Canada

Abstract: Introduction and Objectives: Photoselective vaporization of the prostate (PVP) is a minimally invasive surgical option for patients with benign prostatic hyperplasia (BPH). This study aims to identify preoperative patient characteristics that predict a lower postoperative maximum urinary flow rate (Qmax), which is relevant for patient counseling and surgical decision-making. Materials and Methods: We conducted a retrospective analysis of 369 men who underwent PVP at our institution from January 2006 to December 2022. Baseline demographics, preoperative and postoperative PSA levels, prostate volume, presence of diabetes, and medication use were collected. Postoperative Qmax, hospital stay, and early complications were also recorded. Multivariate logistic regression was utilized to determine predictors for a postoperative Qmax lower than 15 mL/s. Results: The median age of the cohort was 71 years old with a median preoperative PSA of 1.7 ng/dL, and median prostate volume of 41 g. At 1-month follow-up, 40.6% of patients had a Qmax of less than 15 mL/s (Table 1). Multivariate analysis identified higher preoperative PSA (OR 1.106, p < 0.001), presence of diabetes (OR 1.434, p = 0.021), and smaller prostate size (OR 0.995, p = 0.026) as significant independent predictors of a lower postoperative Qmax. Age was not found to be a significant predictor of suboptimal outcome. Conclusions: Elevated preoperative PSA and the presence of diabetes are significant predictors of a lower Qmax following PVP. These findings can guide preoperative discussions, enabling tailored surgical approaches and a more accurate prognosis of surgical outcomes.

5.4.17. UP-04.17: The Characteristics of Autonomic Activity in Men with LUTS and Sleep Apnea

• Choi J ¹, Choo S ¹, Kim J ², Kim H ² and Kim H ³

¹ 

Ajou University, College of Medicine, Suwon, South Korea

² 

Catholic University College of Medicine, Bucheon, South Korea

³ 

Keon Kook University College of Medicine, Seoul, South Korea

Abstract: Introduction and Objectives: Heart rate variability (HRV) is a tool to measure autonomic nervous function (ANS), however there is no evidence that it is able to define sympathetic hyperactivity in men with LUTS. Also sleep is affected by autonomic nervous system activity according to several studies. We suppose that men with LUTS and sleep apnea have different ANS activity from sleep apnea patients without LUTS. Therefore we measured their HRV, divided subjects into two groups, sleep apnea with LUTS group and sleep apnea without LUTS group according to their IPSS. Materials and Methods: A total of 60 patients who diagnosed sleep apnea by specialist were enrolled. All subjects had no disease that can affect autonomic nervous system, such as diabetes, hypertension and so on. Electrocardiographic signals were obtained from each subject in sleep laboratory and calculated the HRV indices with spectral analyses. We divided subjects into two groups by IPSS over 8 and the parameters of HRV were compared by independent sample t-test using SPSS version 12. Results: There was no difference in age between groups. The comparative results of parameters of HRV between groups (mean ± SE) are in the Table 1. Conclusions: Patients with sleep apnea and LUTS have high LF ratio which reflect increased activity of parasympathetic activity. We suggest that the imbalance of the autonomic nervous system activity may be a factor that evokes varieties of symptoms in men with LUTS.

5.4.18. UP-04.18: The Use of Solifenacin and Mirabegron While Maintaining Irritative Symptoms After Surgical Treatment of BPH

• Bogdanov D and Kotov S
• RNRMU named after N.I.Pirogov, Moscow, Russia

Abstract: Introduction and Objectives: To determine the benefits of prescribing M-cholinolytics and/or β3-adrenomimetics in patients with persistent irritative complaints after surgical treatment of BPH. Materials and Methods: 398 patients with BPH aged 47–88 years underwent surgery. 192 (48.2%) patients underwent urodynamic study to assess the BOO index and detrusor hyperactivity. Patients underwent a control examination at 1–6–12 months. 94 (23.6%) patients underwent a control urodynamic study. While maintaining irritative symptoms and detrusor overactivity, patients were prescribed therapy with M-cholinolytics and/or β3-adrenomimetics. Results: Before surgical treatment, the IPSS value was 21.2 ± 6.7 points; The Qmax was 7.5 ± 3.4 mL/s; Detrusor overactivity was detected in 159 (82.8%) patients. After 12 months, the Qmax was 22 ± 7.8 mL/s, the IPSS was 4.6 ± 4.8 points. In a control urodynamic study conducted in 94 patients, the BOO index decreased from 73.6 ± 29.9 to 4 ± 10.3. Out of 94 patients, detrusor overactivity before surgery was detected in 78 (83%), and during the control examination in 24 (25.5%) patients, i.e., one in four men retains irritative symptoms due to HD, which is demonstrated when filling out the IPSS-QoL. Value of irritative symptoms before surgery in this group of patients was 9.9 ± 3.4; in turn, in patients without DO, 6.6 ± 3.6. Also, performing uroflowmetry in this category of patients, the volume of urination is statistically significantly less than in patients without DO (p = 0.018). Therapy was prescribed to 91 patients with persistent irritative symptoms and/or detrusor hyperactivity: 45 patients took solifenacin 5 mg, 46—mirabegron 50 mg. The therapy demonstrated effectiveness in reducing irritative symptoms, increasing the volume of urination. Irritative symptoms in patients without therapy and HD after 6 months 2.7 ± 2; in patients with additional prescription of drugs after 6 months, the score is 3 ± 2.1, thus practically equating to the group of patients without hyperactivity and severe symptoms before surgery. There were no significant side effects from mirabegron therapy, dry mouth and constipation were rarely detected during solifenacin therapy, which led to the rejection of therapy in 5 (11.1%) patients. Conclusions: Therapy with M-cholinolytics and/or β3-adrenomimetics is effective and can be used in patients with persistent irritative symptoms after surgical treatment of BPH, significantly improving the quality of life.

5.5. Female Urology

5.5.1. UP-05.01: Surgical Management of Urinary Tract Endometriosis

• Yadav A, P A and Parashar R
• Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Andhra Pradesh, India

Abstract: Introduction and Objectives: Endometriosis refers to all diseases where extrauterine growth of uterine mucosa results in painful, chronic inflammation. In less than 0.5% of all cases, endometriosis involves the urogenital tract, in particular the ureter; yet, the bladder and the kidneys can be affected as well. When this results in ureteral compression or stenosis, it inevitably leads to hydronephrosis with risk of organ failure. In this video presentation we present our experience of surgical management in 3 cases of urogenital endometriosis including complications during management. Materials and Methods: Case 1 A 28-year female with right flank pain and dysmenorrhea. After proper evaluation and investigations she underwent laparoscopic right ureteric reimplantation and excision of the endometriotic mass. Biopsy report showed endometriosis. Case 2 36-year-old patient who suffered from chronic lower abdominal pain and irregular menstruation since last 3 years. In view of persistent bilateral hydroureteronephrosis possibility of extrinsic ureteric compression, bilateral percutaneous nephrotomy was done along with RGP bilateral. Later on, nephrostogram on left side showed significant contrast holdup in the distal ureter. She underwent laparoscopic left ureteric reimplantation with psoas hitch with excision of pelvic endometriotic mass. Now in 6 months of follow up her renal functions are normal with resolved hydroureteronephrosis. Case 3 A 35-year female with lower abdominal pain for 6 months on investigation found to have extravesical enhancing mass on the right anterolateral wall of urinary bladder. She underwent scopy with bilateral retrograde pyelography with laparoscopic excision of mass with partial cystectomy. Her biopsy report showed endometriosis of urinary bladder. She voided well. Results: In this video presentation we have illustrated the varying presentation of patients with urogenital endometriosis and difficulties involved in the management of such a complex condition. Conclusions: The surgical management may vary from simple ureteric reimplantation to psoas hitch, Boaris flap, partial cystectomy. One has to be very careful while dissecting due to presence of dense adhesions and the risk of bowel injury. Through this video we hope to demonstrate the various surgical procedures involved in management of urogenital endometriosis and also associated difficulties that can be encountered during their management.

5.5.2. UP-05.02: Aggressive Angiomyxoma Presenting as an Infected Urethral Diverticulum in Pregnancy

• Araújo A, Cardoso A, Tinoco C, Capinha M, Rodrigues R and Oliveira C
• Hospital de Braga, Braga, Portugal

Abstract: Introduction and Objectives: Aggressive angiomyxoma is a rare interstitial tumor of vulvo-perineal region that is often misdiagnosed. Although aggressive angiomyxoma is common in females of reproductive age, only a few cases during pregnancy have been documented. We, hereby, report a rare case of aggressive angiomyxoma of the vagina in pregnant women, which was first misdiagnosed as an infected urethral diverticulum. Materials and Methods: We report a case of a 31-year-old pregnant female presenting with a painful vaginal mass. This mass was clinically thought to be an infected urethral diverticulum. Conservative treatment with antibiotics and vaginal drainage was attempted but it was ineffective. So, the patient was submitted a local excision of this lesion in operating room, which was diagnosed as an aggressive angiomyxoma on histopathology. As the patient was at the 37 weeks’ gestation, she was submitted to a caesarean section to prevent a vaginal birth. Results: Postpartum magnetic resonance imaging (MRI) and positron emission tomography (PET) scan showed no residual disease. No other adjuvant treatment with gonadotropin-releasing hormone agonist was done. No recurrence was observed in 4 months of follow-up. Conclusions: According to literature review, aggressive angiomyxoma is associated with good maternal and child outcomes. Treatment for angiomyxoma is mainly postpartum with local complete resection and hormone therapy. As this tumor carries a high risk of local recurrence, patients should undergo long-term follow-up. The high recurrence rate can partially be due to inadequate excision, which may be due to an incorrect preoperative diagnosis as we can see in this case. So, it should always be considered the diagnosis of an aggressive angiomyxoma when a young female especially during her pregnancy presents with a vulvo-perineal mass.

5.5.3. UP-05.03: Evaluation of Urinary Incontinence After Treatment of Urogenital Prolapse

• Hazem H ¹, Mohamed F ², Mohamed Abdelkader F ¹, Mohamed T ², Mohamed Amine M ², Nouri R ², Ahmed C ² and Mourad H ²

¹ 

Urology Department, Habib Bourguiba Hospital, Sfax, Tunisia

² 

University Hospital Habib Bourguiba, Sfax, Tunisia

Abstract: Introduction and Objectives: Surgery for urogenital prolapse carries risks, in particular that of developing postoperative urinary incontinence, likely to cause a greater functional impact than that observed before the surgical procedure. This study aims to determine the epidemiological and clinical characteristics of patients who underwent surgery for urogenital prolapse, as well as to study the risk factors associated with the occurrence of postoperative urinary incontinence. Materials and Methods: This is a retrospective study covering the files of 102 patients operated on for urogenital prolapse without intervention on the urinary system, between January 2016 and September 2020, in the urology and gynecology departments of Habib Bourguiba and Hedi University Hospitals. Shaker of Sfax. All patients were contacted at least 12 months after surgery to assess the presence of urinary symptoms. Results: The average age of the patients was 59.67 years, with a prevalence of menopause in 91.2% of women and hysterectomy in 5.8% of them. The average number of vaginal deliveries was 3.84. Preoperative urinary symptoms were present in 41.2% of patients, in the form of stress urinary incontinence in 14.7% of cases, overactive bladder in 11.8% of cases and mixed urinary incontinence in 11.8% of cases. Physical examination revealed a predominance of grades 2 and 3 of the Baden and Walker classification for cystoceles in 88.2% of cases, and for hysteroceles in 73.5% of cases, as well as grades I and II. for rectoceles in 54% of cases. The patients were operated on by promontofixation by laparotomy in 40.3% of cases, by laparoscopic route in 16.3% of cases and by non-prosthetic vaginal route in 42.7% of cases. Hysterectomy was performed in 91% of cases and levator myorrhaphy in 12.7% of cases. Postoperative urinary incontinence was present in 14.7% of patients. Surgery led to the disappearance of urinary symptoms in 73.8% of patients, with a disappearance of stress urinary incontinence in 80% of cases and overactive bladder in 71% of cases. De novo urinary incontinence was reported in 3.9% of patients. Conclusions: The indication for surgery for urogenital prolapse must be made appropriately in order to improve the quality of life of patients.

5.5.4. UP-05.04: FLUX Trial: 3-Month Outcome of Female Urethral Bulking with DEFLUX Bulking Agent

• Li T, Masiha E, Foley S and Yang B
• Royal Berkshire Hospital, Reading, United Kingdom

Abstract: Introduction and Objectives: Urethra bulking is a well-established endoscopic intervention for female stress incontinence. Current bulking agents include Bulkamid^® and Macroplastiue^®. Deflux^® is a non-animal stabilised hyaluronic acid (NASHA) and dextranomer (Dx) agent used commonly in paediatric vesicoureteral reflux, with good safety profile and clinical effectiveness. However, though licenced in the UK, clinical data on its role in adult urethral bulking is lacking. In this study, we investigated the efficacy and safety of Deflux as urethral bulking agent in adult female stress incontinence. Materials and Methods: 51 female patients, with urodynamics proven stress incontinence received urethral bulking with Deflux from 2021 to 2023 with follow up planned for 12 months. In lithotomy position under general anaesthetic with IV gentamicin prophylaxis, 2 mL of Deflux was injected endoscopically at the bladder neck using 22-gauge flexible needle via rigid cystoscope. Treatment success (dry) was defined as using 1 or fewer pads for reassurance only per day. Clinical effectiveness was determined by comparing pre- and post-procedure ICIQ-UI (Short Form) score, number of pads used and weight of 24-h urine. Results: At 3 months, 28 in 51 (55%) of patients were dry. Mean number of pads used reduced from 3.2 to 1.4 (p ≤ 0.001, paired t-test). Average 24-h urine weight was reduced by 76%, from 225 g to 54 g (p = 0.05). Mean ICIQ also decreased from 15.7 to 7.8 3-month after the injection (p ≤ 0.001). Logistic regression of baseline characteristics shows the number of pads pre-treatment and baseline ICIQ are both statistically significant predictors of treatment success. A complication rate of 6% was observed, namely urinary tract infections (n = 2, treated with antibiotics) and urinary retention (n = 1, treated by temporary catheter). Conclusions: Deflux is a clinically effective and safe bulking agent in female stress incontinence treatment. By utilising a flexible needle with rigid cystoscopy which is already readily available in most urology departments, Deflux is thus a cost-effective choice of bulking agent. Longer term follow up for 12 months is ongoing to confirm longevity of efficacy as well as safety profile.

5.5.5. UP-05.05: The Vaginal Flap Technique in Fistula Repair

• Fouda J ¹, Mekeme Mekeme J ¹, Epoupa Ngalle F ², Nwaha Makon A ², Mbouche L ², Fouda P ¹ and Angwafo III Fru F ²

¹ 

University of Yaounde I/Yaounde Central Hospital, Yaounde, Cameroon

² 

University of Yaounde I, Yaounde, Cameroon

Abstract: Introduction and Objectives: Obstetric cervical-urethral fistula is a real public health problem with a high rate of repeat surgery due to sphincter damage and therefore the problem of incontinence and residual fistula. The objective of this study was to contribute to the solution of the problems caused by obstetric fistula in Africa. Materials and Methods: We conducted a retrospective study of patients who underwent surgery for obstetric fistula using the vaginal flap technique, the Martius flap or the Falandry technique between January 1, 2008 and December 31, 2015 at the Yaounde Central Hospital and the Ngaoundere Protestant Hospital. The functional results were evaluated at 12 months respectively. The vaginal flap technique is a technique that involves taking a vaginal pedicle flap to close the vaginal defect making the vaginal mucosa, the bladder neo-mucosa. It is a mucous membrane that supports urine well. Results: Among the 212 patients, 84 (40%) were operated on using the vaginal flap technique, 72 (34%) using the Martius flap technique and 56 (26%) using the Falandry labial flap technique with a success rate of 94%, 87.5%, and 78.6% respectively at 12 months. After comparison of the three techniques, it appears that the vaginal flap technique is indicated for all patients who have never been operated on with a flexible vagina, a fistula less than 10 years old and the last cm of the urethra respected. The size of the fistula was a relative contraindication and urethral fistulas an absolute contraindication. The limitations of the technique are the quality of the vaginal tissue and urethral involvement. The duration of the procedure was less than 2 h. Conclusions: The vaginal flap technique seems to obtain better results in the treatment of cervical and cervico-urethral fistulas. In addition to other techniques, it can provide a solution in the cure of cervical and cervico-urethral fistulas. Its limitations are the quality of the vaginal tissue, urethral involvement and the experience of the surgeon.

5.6. History of Medicine

5.6.1. UP-06.01: Bridging Cardiology and Urology: How Werner Forssmann’s Early Work Influenced Urological Practices

• Sitharthan D ¹ and Mitterdorfer A ²

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

Bankstown-Lidcombe Hospital, Sydney, Australia

Abstract: Introduction and Objectives: While Werner Forssmann is widely celebrated for pioneering cardiac catheterization through self-experimentation, his significant contributions to urology are less known but equally impactful. This study aims to shed light on Forssmann’s urological innovations and publications, underscoring his influence on modern urological practices and surgical techniques. Materials and Methods: A systematic literature review was performed using MedLine and secondary historical sources to identify the urological contributions and surgical advancements of Werner Forssmann. By analyzing his work within the context of historical medical developments and its reception by the medical community, we aim to articulate the scope and depth of his contributions to urology. Results: After transitioning to urology from his groundbreaking self-experimentation in cardiology, Forssmann made significant contributions to the field, demonstrating his versatility and innovative spirit. His tenure at the Rudolf Virchow Hospital in Berlin was marked by pioneering work, leading to influential publications in “Zeitschrift für Urologie.” These publications spanned a variety of urological concerns, including advanced anesthesia techniques, meticulous methods for transurethral prostate resection, and bladder surgery improvements, showcasing his commitment to enhancing surgical outcomes and patient safety. Forssmann’s seminal contributions also extended to the management of ureteral obstructions, where he employed surgical interventions that were both innovative and conservative, aiming to minimize patient discomfort and postoperative complications. His cautious approach towards cystectomies in the treatment of papillomatosis reflected his patient-centred philosophy, advocating for less invasive options when possible. This holistic approach to urology not only emphasized the importance of surgical precision but also a deep understanding of the pathophysiological aspects underlying urological conditions, thereby paving the way for the development of safer and more effective urological treatments. Conclusions: Werner Forssmann’s early explorations in cardiac catheterization had a profound indirect impact on his urological practice. The techniques and insights garnered from his Nobel Prize-winning work in cardiology informed his approach to urological surgeries, exemplifying an interdisciplinary strategy that leveraged knowledge across medical fields to improve patient care. This blend of innovation, grounded in both his cardiological and urological endeavours, underscores Forssmann’s enduring legacy in shaping modern medical practices.

5.6.2. UP-06.02: Eugen Steinach’s Legacy in Urology: Bridging Endocrinology and Sexual Function

• Sitharthan D ¹ and Mitterdorfer A ²

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

Bankstown-Lidcombe Hospital, Sydney, Australia

Abstract: Introduction and Objectives: Eugen Steinach, a trailblazer in the field of urology and endocrinology, made significant contributions to our understanding of the uro-endocrine system’s role in sexual development and function. Despite never receiving the Nobel Prize, his work laid the groundwork for modern sexual medicine. This article aims to highlight Steinach’s pivotal research within urology while acknowledging his broader impact on the medical understanding of sexuality and rejuvenation. Materials and Methods: Through a systematic literature review of Steinach’s experimental research, particularly his studies on vasectomy, gonad transplantation, and hormone therapy, this study examines the implications of his work for the field of urology. Steinach’s innovative approaches to understanding the hormonal basis of sexual development and his attempts at rejuvenation therapy through endocrine manipulations are critically evaluated against the backdrop of early 20th-century scientific and societal contexts. Results: Steinach’s pioneering experiments, especially in the realm of gonadal functions and their influence on secondary sexual characteristics, have profoundly influenced urology. His work on the rejuvenation effects of vasoligation and subsequent hormone replacement therapies opened new avenues for treating age-related degenerative diseases and sexual dysfunctions. Despite controversies and scepticism, Steinach’s hypotheses about the endocrine system’s role in sexual health spurred further research, leading to the development of hormone replacement therapies and contraceptive technologies. While his broader contributions to understanding sexuality were significant, it was his work in the physiological and therapeutic aspects of urology that marked a turning point in sexual medicine. Conclusions: Eugen Steinach’s legacy in the field of urology is characterized by his innovative research into the hormonal regulation of sexual function and the therapeutic potential of endocrine manipulation. Although he was never awarded the Nobel Prize, his work has had a lasting impact on medical approaches to sexual health, aging, and reproductive biology. Steinach’s pioneering efforts underscore the importance of interdisciplinary research in urology, highlighting the interconnectedness of endocrine function, sexual health, and overall well-being.

5.6.3. UP-06.03: From Ancient India to Modern Urology: Unveiling Sushruta’s Timeless Wisdom

• Alam A
• John Hunter Hospital, Mayfield, Australia

Abstract: Introduction and Objectives: Sushruta (800–700 BC) is hailed as the father of Indian surgery and urology, earning the title “greatest surgeon of the premedieval period.” This study explores Sushruta’s contributions to urology, focusing on his seminal work, the Sushruta Samhita, a comprehensive treatise on surgery dating back to the 6th century BCE. Materials and Methods: A comprehensive review of available literature detailing Sushruta’s works in the Sushruta Samhita, an ancient Sanskrit text, was conducted to understand his contributions to urology. The review focused on his observations, surgical techniques, and treatment methods documented in the 6th century BCE text. Results: Sushruta’s ancient text, the Sushruta-Samhita, provides the earliest documentation of urethral catheters. These catheters were made from materials like gold, silver, iron, and wood, lubricated with clarified butter. He placed significant importance on the study of anatomy, and although his observations may appear outdated today, he conducted his research by closely examining decomposing bodies in the absence of dissecting tools. Sushruta’s meticulous approach to managing urethral strictures, involving dilation with progressively thicker tubes and incision when needed, remains relevant in modern medicine. Sushruta linked stone formation to factors like phlegm, bile, air, or semen, detailing associated painful symptoms. Treatment advice involved a vegetarian diet, medicated milk, clarified butter, and alkalis, reserving surgery as a last option. Conclusions: Sushruta’s contributions to urology remain remarkably significant even in the context of contemporary medicine. His groundbreaking work in surgical techniques and catheterization have had a lasting impact on the practice of urology.

5.6.4. UP-06.04: From Australia to the Annals of Urology: The Revolutionary Work of Harry Harris

• Sitharthan D ¹ and Mitterdorfer A ²

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

Bankstown-Lidcombe Hospital, Sydney, Australia

Abstract: Introduction and Objectives: Dr. Samuel Henry “Harry” Harris stands as a colossus in the history of urology for his innovative contributions to prostate surgery and holistic patient care. This study aims to illuminate Harris’s transformative impact on the field, delineating his surgical advancements and the integration of compassionate patient support, which have significantly shaped modern urological practices. Materials and Methods: A systematic literature review was performed using MedLine and secondary historical sources to identify the urological contributions of Dr. Harry Harris. Results: Dr. Harry Harris is celebrated for pioneering the “Harris prostatectomy,” a technique that substantially improved the safety and efficacy of prostate surgery. Prior to his innovation, the prostatectomy was fraught with high mortality rates. Dr. Harris’s method, characterized by meticulous haemostasis and precision, dramatically reduced mortality to 2.8% over 469 operations by 1935. His inventions, including a lighted bladder retractor, underscored the importance of surgical visibility and precision. Furthermore, Dr. Harris’s approach to patient care was revolutionary. Eschewing the mechanical treatment models of his time, he championed treating the patient as a whole, emphasizing the necessity of integrating emotional and psychological support into medical care. His advocacy for comprehensive post-operative care not only improved surgical outcomes but also set a new standard for patient well-being in the medical community. Additionally, Dr. Harris played a pivotal role in founding the Urological Society of Australasia in 1936, one of the first organizations of its kind globally. This initiative not only underscored his leadership and foresight but also established a professional community dedicated to advancing urological practices, reflecting his lasting impact on the field. Conclusions: Dr. Samuel Henry “Harry” Harris’s legacy in urology is indelible and multifaceted, marked by surgical innovation and an empathetic approach to patient care. His work significantly reduced the risks associated with prostate surgery and redefined the standards of patient support in urology. Harris’s methodologies and philosophies continue to influence contemporary urological practices, embodying the ideal of holistic patient care. His story is a beacon of innovation and compassion, offering invaluable lessons for current and future generations in the medical profession.

5.6.5. UP-06.05: From Eugenics to Contraception: Unraveling the Complex History of Vasectomy

• Alam A
• John Hunter Hospital, Mayfield, Australia

Abstract: Introduction and Objectives: The history of vasectomy dates to the early 20th century, with the first successful procedure performed in the 1890s. Dr. Harry Sharp, in 1902, is often credited with its development. However, it only gained popularity as a contraceptive method in the mid-20th century. Prior to this it hid a darker history associated with eugenics and vitality. Materials and Methods: To understand this better, we conducted a comprehensive review of the available literature that has detailed the history of vasectomy. Results: The eugenics movement, aiming to enhance the human race by eliminating undesirable genetic traits, gained momentum in the US through advocates like Albert Oschner and Harry Sharp, who promoted forced sterilization, notably through vasectomy. Indiana enacted the first mandatory sterilization law in 1907, targeting “confirmed criminals, idiots, imbeciles, and rapists.” This led to a proliferation of similar laws in the US and Europe, resulting in over 6000 involuntary sterilizations in the US between 1909 and 1924. Vasectomy gained popularity in 1923 with Eugen Steinach’s “Steinach vasoligature,” a one-sided vasectomy endorsed by Sigmund Freud and William Butler Yeats. Freud sought it at 67 for improved sexuality, while Yeats, at 69, credited it with reviving creativity. However, as understanding of testosterone increased, Steinach’s procedure fell out of favor, impacting his reputation. Despite six Nobel Prize nominations, he died in exile in 1944. Conclusions: Vasectomy’s evolution from eugenics to a common contraceptive highlights the intertwining factors of science, ethics, and societal changes, emphasizing the need for ethical awareness and scientific rigor in healthcare.

5.6.6. UP-06.06: The Anaesthetic Dalliance of Hugh Hampton Young: A Pathway to Urological Mastery

• Thayanantharajah K ¹, Boulas J ² and Sitharthan D ³

¹ 

Royal Prince Alfred Hospital, Sydney, Australia

² 

Bankstown-Lidcombe Hospital, Sydney, Australia

³ 

Chris O’Brien Lifehouse, Sydney, Australia

Abstract: Introduction and Objectives: Hugh Hampton Young’s early medical career at Johns Hopkins was marked by his dedication to improving surgical outcomes through innovations in anaesthesia. While primarily celebrated for his foundational contributions to urology, Young’s initial foray into the realm of anaesthesia had a lasting impact on surgical practices. This study aims to explores Young’s experimental approaches to anaesthesia, his role in recognising Crawford W. Long’s pioneering use of ether, and the implications of these endeavours for the field of urology. Materials and Methods: Utilising a comprehensive literature review, this study examines historical documents, Young’s publications, and records from Johns Hopkins to trace his journey from an intern responsible for administering anaesthesia to a leading figure in urology. Results: Young’s dissatisfaction with traditional ether administration led to the creation of an apparatus designed to mitigate the spasms and coughing associated with early anaesthesia stages. This device, appreciated by his mentor William Halsted, was a precursor to modern anaesthetic tools. Furthermore, Young’s investigative efforts unearthed substantial evidence confirming Crawford W. Long as the first to employ ether for surgical anaesthesia, predating the widely celebrated public demonstration by Morton. This revelation, highlighted through Young’s presentations and publications, contributed to a broader historical understanding of anaesthesia’s origins and underscored the importance of meticulous documentation in medical advancements. Young’s unique contribution to anaesthesia, although a brief chapter in his career, laid foundational principles that influenced the development of safer, more effective anaesthetic techniques, thereby enhancing the surgical care of urological patients. Conclusions: Hugh Hampton Young’s exploration of anaesthesia, alongside his renowned contributions to urology, showcases his multifaceted commitment to medical advancement. His innovative work in anaesthesia, enriched by meticulous historical inquiry, not only pioneered new techniques but also highlighted the critical role of cross-disciplinary efforts in medicine. Young’s indelible mark on urology, coupled with his achievements in anaesthesia, reflects a legacy defined by an insatiable curiosity and dedication to improving both patient care and the annals of medical history. His endeavours illustrate the significant impact of embracing interdisciplinary research and valuing historical veracity on the development of medical fields and healthcare at large.

5.6.7. UP-06.07: The Legacy of Al-Zahrawi: Urological Innovations Unveiled

• Alam A
• John Hunter Hospital, Mayfield, Australia

Abstract: Introduction and Objectives: Al-Zahrawi, was a prominent physician and polymath of the Islamic Golden Age. He made significant contributions to various fields of medicine, one of which was urology. Materials and Methods: To understand Al-Zahrawi’s contributions to urology, we conducted a comprehensive review of the current available literature that has detailed his works in ‘Kitab al Tasrif’. Results: Abu Qasim Khalaf Ibn Abbas Al Zahrawi, also known as Albucasis, was born in 936 AD in Al-Zahra, near Cordoba, the capital of Muslim Spain. He served as the court physician to Caliph Al-Hakam-II during the “Golden Age” of Arab Spain. His medical treatise, “Kitab al-Tasrif,” completed in 1000, covered various medical topics and emphasized a positive doctor-patient relationship. Al Zahrawi dedicated fourteen chapters to urology, introducing innovative surgical instruments and techniques. Notably, he advocated the use of smooth silver catheters with lubrication from oil for managing urinary retention. He pioneered lithotripsy and introduced forceps for stone fragmentation. Notably, he addressed stones in women, challenging the norms of his time. His contributions include procedures for congenital meatal stricture, circumcision, and treating fractures of the pubic arch. Conclusions: Al-Zahrawi’s contributions to urology were remarkable and transformative. His pioneering work in surgical instruments and procedures, particularly in stone removal, set a strong foundation for the development of modern urology. His emphasis on meticulous documentation and detailed illustrations provided invaluable insights for future generations of physicians and surgeons.

5.6.8. UP-06.08: The Urological Tribulations of Michel De Montaigne: How the Essayist’s Stones Influenced His Writings

• Sitharthan D ¹ and Mitterdorfer A ²

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

Bankstown-Lidcombe Hospital, Sydney, Australia

Abstract: Introduction and Objectives: Michel de Montaigne, a prominent literary figure of the Renaissance, suffered from chronic urolithiasis, which profoundly influenced his literary and philosophical output. This article aims to explore how Montaigne’s urological condition impacted his views on health, suffering, and the human condition, offering insights into the early development of patient narratives in medicine. Materials and Methods: A comprehensive analysis of Montaigne’s writings, particularly his essays, was conducted to extract detailed accounts of his experiences with kidney stones. These narratives were contextualized within the medical practices and beliefs of the Renaissance period, focusing on the treatment modalities for urolithiasis and the prevailing theories of humoral balance. Results: Montaigne’s enduring battle with kidney stones is meticulously documented in his essays, where he articulates the physical pain and psychological turmoil wrought by the condition. His reflections provide a rare, introspective look into the patient experience of the time, highlighting the limitations of Renaissance medicine and the deeply personal journey of living with a chronic illness. Montaigne’s pursuit of thermal baths across Europe and consultations with renowned physicians of his time underscore the lengths to which he went in search of relief, paralleling the modern patient’s journey through chronic disease management. Furthermore, his scepticism towards contemporary medical practices and emphasis on the patient’s perspective in understanding and treating illness resonate with current principles of patient-centred care in urology and beyond. Conclusions: Michel de Montaigne’s writings on his experiences with urolithiasis not only provide a historical perspective on the condition but also underscore the timeless importance of integrating the patient’s voice into medical care. His work foreshadows contemporary approaches in urology that prioritize empathetic listening and holistic care. Montaigne’s reflections on illness, mortality, and the human spirit continue to inspire a more compassionate and patient-focused approach in modern medicine, reinforcing the idea that understanding the patient’s experience is as crucial as the clinical treatment itself.

5.7. Infections and Inflammatory Diseases

5.7.1. UP-07.01: Advancing Care for Haemorrhagic Cystitis: Evaluating Treatment Pathways

• Sitharthan D ¹, Rosario M ² and Boulas J ³

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

Westmead Hospital, Sydney, Australia

³ 

Bankstown-Lidcombe Hospital, Sydney, Australia

Abstract: Introduction and Objectives: Haemorrhagic cystitis (HC), characterized by severe bladder inflammation and bleeding, poses significant diagnostic and therapeutic challenges. This condition ranges from mild, self-resolving haematuria to severe, life-threatening haemorrhage requiring complex interventions. Despite its prevalence, literature on HC’s comprehensive management remains sparse. This review aims to consolidate current knowledge on HC’s etiology, diagnosis, and treatment, providing a systematic approach to managing intractable cases effectively. Materials and Methods: A comprehensive literature review and analysis was conducted on MedLine, focusing on the investigation, diagnosis and management of HC. Two key classification systems for HC severity, DeVries and Vela-Ojeda, were examined to stratify patient management further. Results: The aetiology of HC is multifaceted, involving infections, chemical exposure, malignancy, nephropathy, and radiation therapy. Initial management focuses on conservative measures such as manual irrigation and bladder irrigation. When haematuria persists despite conservative surgery, intravesical treatments (such as alum, silver nitrate, Amicar, prostaglandins, and formalin) and extravesical options (including hyperbaric oxygen therapy, bladder embolization, and cystectomy with urinary diversion) should be considered. Alum instillation demonstrates success rates ranging from 60% to 100% in patients with normal renal function. Hyperbaric oxygen therapy shows promise as a treatment, promoting tissue healing with response rates exceeding 90%. Conversely, formalin, although highly effective, is reserved for severe cases due to its caustic nature and associated risks. Vesical artery embolization emerges as a safe and effective procedure performed under local anesthesia for patients unresponsive to previous treatments. Managing HC requires a tailored approach, taking into account the patient’s renal function and potential treatment side effects. The efficacy of various treatments underscores the importance of a stepwise management strategy, progressing from conservative to more aggressive therapies as necessary. Conclusions: Intractable HC represents a complex clinical challenge requiring a multidisciplinary approach for effective management. Our review suggests a systematic treatment algorithm, starting with conservative measures and escalating to advanced therapies based on severity and patient response. It underscores the significance of innovative treatments like hyperbaric oxygen therapy and embolization in managing refractory cases, advocating for ongoing research and adaptation of new strategies to improve patient outcomes in HC management.

5.7.2. UP-07.02: Clinical and Microbiological Profile of Patients with Urinary Tract Infections After Radical Cistectomy

• López-Curtis D ¹, Artiles-Medina A ¹, Subiela-Henríquez J ¹, Muriel-Garcia A ², Sánchez-González A ¹, Brasero-Burgos J ¹, Mata-Alcaraz M ¹, Minguez-Ojeda C ¹, Fernández-Mardomingo A ¹, Gómez-Dos Santos V ¹, Jiménez-Cidre M ¹ and Burgos-Revilla F ¹

¹ 

Hospital Ramón y Cajal, Madrid, Spain

² 

University of Alcalá, Madrid, Spain

Abstract: Introduction and Objectives: Febrile urinary tract infection (UTI) after radical cystectomy (RC) is a frequent complication which can increase morbidity and readmission rates after surgery. The aim of this study is to determine the incidence and associated risk factors of this complication and to asses microbiological aspects, including antibiotic resistance patterns. Materials and Methods: A retrospective study was conducted, including 310 patients who underwent RC between 2009 and 2019 at our institution. We collected data on clinical, demographic, laboratory and microbiological features. To identify factors associated with readmission due to UTI in the first 90 days following RC (primary outcome) univariable and multivariable logistic regression was employed. The model’s performance was assessed for calibration and discrimination. Results: 82 (26.5%) readmissions due to 90-day febrile UTI after RC were identified. The mean age of readmitted patients was 68.9 (SD 13.2) years and the majority were classified as ASA class II (56.9%). Significant specific predictive factors for readmission in this context were previous hydronephrosis (OR = 0.38 [0.18–0.80], p = 0.011), laparoscopic approach (OR = 2.98 [1.71–5.18], p = 0.000), and neutrophil–lymphocyte ratio (NLR) (OR = 1.07 [1.01–1.14], p = 0.016) in multivariate analysis. Urine culture was positive in 52/68 (76.5%), whilst blood cultures confirmed bacteriemia in 12/35 patients (34%). The predominant isolated pathogens were Escherichia coli (23.5%) and Klebsiella pneumoniae (14.7%). 14 (20.6%) mixed infections were detected. We identified 18/47 (38.3%) multidrug-resistant pathogens. When considering antibiotic sensitivity and resistance pattern, we found that pathogens exhibited resistance to quinolones in 11 out of 39 tested samples (33.3%), cephalosporins in 9/38 (23.7%) and carbapenems in 4/31 (12.9%). Conclusions: A high rate of readmissions due to 90-day febrile UTI after RC is noted. Bacteriological complexity is observed with high rates of mixed infections and infections produced by MDR strains. Risk factors for readmission due to febril UTI within 90 days following cystectomy are laparoscopic surgery, higher NRL and absence of priori hydronephrosis. These factors could be used to identify patients at higher risk of UTI after RC.

5.7.3. UP-07.03: Expressed Prostatic Secretions Cultures in Men Undergoing Transrectal Prostate Biopsies and Correlation with Histopathological Results

• Gatsos S ¹, Kalogeras N ², Papaefstathiou E ³, Samarinas M ⁴, Papakonstantinou A ⁵, Petinaki E ¹, Tzortzis V ¹ and Gravas S ⁶

¹ 

University of Thessaly, Larisa, Greece

² 

Agios Dimitrios General Hospital, Thessaloniki, Greece

³ 

University College London Hospitals, London, United Kingdom

⁴ 

Koutlibanio General Hospital, Larisa, Greece

⁵ 

Children’s Hospital Agia Sofia, Athens, Greece

⁶ 

University of Cyprus, Nicosia, Cyprus

Abstract: Introduction and Objectives: To evaluate the prevalence of positive expressed prostatic secretions (EPS) cultures in asymptomatic men, undergoing a prostate biopsy (PBx) and report the antibiotic susceptibility of the isolated bacteria. We also aim to evaluate the correlation between positive cultures, baseline characteristics and biopsy results. Materials and Methods: A total of 71 men who were scheduled for a PBx were enrolled in this prospective observational study. EPS was retrieved, with urethral swabs, and sent for culture at the time of the first appointment. They underwent a transrectal PBx, in a single tertiary hospital in Northern Greece. Biopsy results of 64 men were analysed, and 7 men were excluded by the analysis as their specimen was reported by a different pathology laboratory. The results were categorised into four categories based on the Irani’s score, for the extent of prostatic inflammation (from 0–no presence of inflammation, to 3–extended inflammatory findings). Statistical analysis was conducted with IBM SPSS version 25 and comparisons between the group with positive versus negative urethral cultures were made for the prevalence of histopathological inflammation and with the baseline characteristics. Results: 28 out of the 71 men (39.4%) had negative EPS cultures and 43 positive (60.6%). The most common isolate was Staphylococcus coagulase negative in 17 men (23.9%), followed by E. Coli (n = 15, 21.1%). Fluoroquinolone resistance rates for gram positive bacteria was 27.3% and for gram negative 19.1%. The prevalence of ESBL positive gram negative bacteria was 47.6%. Cumulative carbapenem resistance was 4.6%. In the subgroup of men whose biopsy results were included in the analysis, 60.9% (n = 39) had positive urethral cultures and 39.1% (n = 25) had negative. Statistically significant correlation was observed between positive urethral cultures and presence of inflammation in the biopsy results (p = 0.02), with 74% and 100% of the patients with moderate and extensive inflammation, respectively, having positive urethral cultures. Conclusions: We observed a high prevalence of positive EPS cultures, with high rates of antibiotic resistance. Positive urethral cultures were associated with histopathological inflammatory changes. This observation can have clinical implications in the management of antibiotic prophylaxis for the cohort of men undergoing a prostate biopsy.

5.7.4. UP-07.04: Fournier’s Gangrene: Clinical Profile, Management, and Outcomes

• Ben Othmen M, Bouassida K, Blaiech W, Loghmari A, Hmida W, Jaidane M and Ben Hamida M
• Sahloul Hospital, Sousse, Tunisia

Abstract: Introduction and Objectives: Fournier’s gangrene (FG) is a rare form of multifactorial necrotizing fasciitis affecting the perineal genital region. When not promptly treated, FG progresses rapidly with significant morbidity and mortality. This study aims to share our experience in managing patients with FG. Materials and Methods: This is a retrospective descriptive study conducted at the urology department of Sahloul Hospital in Sousse. The study collected 31 cases over a period of 4 years from January 2020 to January 2024. We studied clinical and laboratory elements, including risk factors and predictive factors of mortality, such as the Fournier’s Gangrene Severity Index (FGSI). Results: The mean age of patients was 60.7 ± 11.9 years. Smoking was found in 45% of patients and alcoholism in 6.4%. The majority of patients (83.9%) had medical histories. Diabetes and hypertension were the main comorbidities (71% and 32.3%, respectively). The median consultation delay was 3 days. The scrotal skin was the starting point in the majority of patients (87.1%). A SOFA score of 2 or higher was calculated in 51.6% of patients. An FGSI score greater than 9 was found in two patients (6.5%). All patients received triple empiric antibiotic therapy. They underwent extensive debridement of necrotic tissues in the operating room with bacterial sampling. The most implicated pathogens were mainly Escherichia coli and Pseudomonas aeruginosa. The median postoperative length of stay was 10 days. Orchidectomy was performed in two patients and colostomy in one patient. Testicular burying was performed in 25.8% of patients, and skin approximation in the rest of the patients. The mortality rate was 12.9%. Conclusions: FG is a serious condition with considerable morbidity and mortality. Advanced age, comorbidities, FGSI, and delayed management are the main prognostic factors.

5.7.5. UP-07.05: How Do We Manage Uncomplicated Recurrent Urinary Tract Infections at Eastern Health?

• Rival P, Botros A, Snider R, Dowling C and Sengupta S
• Eastern Health, Melbourne, Australia

Abstract: Introduction and Objectives: In Australia, managing recurrent urinary tract infections (rUTIs) is challenging and costly. The traditional management approach, low-dose antibiotic prophylaxis, is now complemented by alternatives like behavioral modifications, immunoactive agents, cranberry products, D-mannose, and Methenamine Hippurate, due to concerns over antibiotic resistance. However, Australia lacks comprehensive rUTI management guidelines that integrate both antibiotics and preventative measures. Our study evaluated current rUTI management practices at Eastern Health, a major tertiary referral center. Materials and Methods: We audited the management practices for rUTIs among adult females from March to May 2023. This audit included patients with no significant co-morbidities, abnormalities or pathologies on radiological exams of the urinary tract, and no history of genitourinary or pelvic surgery or radiation, focusing on their referral patterns, symptoms, initial treatments, and any subsequent interventions post-Urology clinic review. Results: Of 675 referrals over the 3-month period, 65 adult females had rUTIs; of which 25 met uncomplicated rUTI criteria. Uncomplicated rUTI patients were younger (median 37 yrs ± 18. vs. 60 yrs ± 19; p = 0.00012) and more often referred by GPs (80% vs. 20%; p = 0.0006) than complicated cases. Wait times did not differ significantly. Among uncomplicated cases, 36% had been seen in Urology clinic, while the rest remained on waiting lists. Referrals often included relevant investigations, however only 60% confirmed rUTI with culture reports for each episode. Treatment at referral varied: 32% had no specified treatment recorded and it is presumed that they received courses of antibiotics for each episode, 36% had confirmed reports of only receiving courses of antibiotics with each episode, and 24% had antibiotics with non-antibiotic alternatives. Few (8%) received prophylactic antibiotics. No patient received topical estrogen. Of those reviewed in the Urology clinic, 56% received non-antibiotic alternatives, and 44% were discharged. Conclusions: The triaging system does not consider rUTI complexity or referral source, resulting in prolonged waits. Antibiotics dominated initial treatment. The limited use of non-antibiotic alternatives upon referral highlights the need for exploring alternative community-based management. We employed the Delphi technique to create an evidence-based clinical pathway for uncomplicated rUTIs in general practice, now being tested in a pilot study with patients recruited from the Urology clinic waitlist.

5.7.6. UP-07.06: How Melioidosis Affects the Female Genitourinary System—A 25 Year Case Series

• Bain M ¹, Baker K ¹, Stewart J ¹, Smith S ¹, Withey G ¹, Pridgeon S ¹ and Hanson J ²

¹ 

Queensland Health, Cairns, Australia

² 

University of New South Wales, Sydney, Australia

Abstract: Introduction and Objectives: Melioidosis is an opportunistic infection caused by environmental, gram-negative bacterium Burkholderia Pseudomallei. It is endemic in tropical South East Asia and Northern Australia, and is typically transmitted percutaneously through soil, contaminated water or inhalation following heavy rain. Melioidosis is well known for its affinity to causing prostate abscesses, but melioidosis involving the genitourinary tract in females is less commonly encountered. This case series explores the presentation, workup and outcomes for female patients with melioidosis affecting the genitourinary system. Materials and Methods: Cases of melioidosis were identified between January 1998 and April 2023 in Far North Queensland, Australia and female cases reviewed. Prospective data collection was conducted from October 2016, prior to this was retrospective. Presentation, comorbidities, culture results and management were collected. Genitourinary infection was confirmed with either Burkholderia Pseudomallei cultured in urine, or with radiological evidence of genitourinary involvement and growth confirmed from another site (blood, sputum or other body fluid). Data was deidentified and analysed using statistical software (Stata version 14.2). Groups were compared using Fisher’s exact and the ×2 test and logistic regression. Results: 140 of the 453 cases occurred in women (31%). 9% of female patients had genitourinary involvement, compared to 24% of men (odds ratio [95% confidence interval]: 0.32 [0.17–0.60], p 5 0.0004). The majority (11/13) had infection involving other organ systems, most commonly with coexisting pneumonia. The 2 patients with isolated genitourinary infection had other pathology related to their genitourinary tract. Only 4/12 with urinary system involvement had lower urinary tract symptoms, and 54% (7/12) of those with urinary infection had pyelonephritis or a renal abscess. Conclusions: Genitourinary melioidosis is an uncommon pathology and may present without symptoms of a urinary tract infection. Routine imaging should be encouraged as some with genitourinary involvement may be culture negative or asymptomatic. This facilitates earlier diagnosis of unexpected foci of disease to expedite source control and guides duration of intensive therapy. In isolated genitourinary infection, there may be a predisposing anatomical anomaly underlying.

5.7.7. UP-07.07: Incidence of Postoperative Bacteriuria in Patients Undergoing Endourological Procedures with Prior Negative Urine Culture

• Yella K, Jain D and Vartak K
• Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India

Abstract: Introduction and Objectives: Endoscopic procedures and surgeries involve the use of instruments into the urinary system through retrograde and antegrade approaches. There is no fixed opinion on the use of antibiotics for these procedures. There is evidence to show that with every endourological procedure there is an increase in the risk of urinary tract infection (UTI) and bacteraemia. The purpose of this study was to study to study the incidence of urinary tract infections post endourological procedures in patients with prior negative urine culture. Materials and Methods: The study was a prospective study conducted between April 2023 to September 2023 in patients who were hospitalized for various endourological procedures either for diagnostic and therapeutic purposes. All patients planned for endourological procedures had undergone urine culture within one week of the procedure. Patients in whom urine culture showed no growth were included in this study (total of 335 patients were included in this study). Urine culture was sent again within 5 days of endourological procedure either through midstream first morning urine or through the per-urethral catheter using aseptic precautions. Results: 16 of the 133 patients (12.03%) operated for percutaneous nephrolithotomy (PCNL), 9 of the 58 (15.51%) patients operated for transurethral resection of prostate (TURP), 3 out of 77 patients (3.89%) operated for ureteroscopic lithotripsy (URSL) and 2 of the 16 patients (12.5%) operated for retrograde intrarenal surgery (RIRS) had postoperative bacteriuria. None of the patients operated for CLT, OIU and THULEP had postoperative bacteriuria. 13 of the 29 diabetics (44.8%) operated for PCNL, 2 of the 11 diabetics (18.18%) operated for URSL, 2 of the 4 (25%) cases operated for RIRS, 5 of the 12 patients (41.67%) operated for TURP had postoperative bacteriuria. 7 of the 9 patients who had bacteriuria operated for TURP had chronic prostatitis (77.78%) on histopathological evaluation of the prostatic chips. Conclusions: Endourological procedures are safe procedures in terms of urinary tract infections. Despite the low rate of urinary tract infections postoperatively, in everyday urological practice it is important to identify and control risk factors of UTI (especially diabetes) with main objective to minimize occurrence of postoperative bacteriuria.

5.7.8. UP-07.08: Prevalence of Urinary Infections in Patients with COVID-19: Large Data Analysis Using I2b2

• Varela J ¹, Patel P ¹, Liang C ¹, Flambert G ¹ and Bird V ²

¹ 

University of Florida, Gainesville, United States

² 

Urologic Integrated Care, Gainesville, United States

Abstract: Introduction and Objectives: The aim of this study is to compare and evaluate the effects of COVID-19 on the prevalence of urinary infections within a large cohort of patients in North Florida. Materials and Methods: From a total cohort of patients we selected between December 2019 and October 2023, we retrospectively collected patient data from the University of Florida Informatics for Integrating Biology and the Bedside (i2b2), a patient registry platform organized via demographic, procedural, and diagnosis codes used for institutional billing. Statistical analyses were performed using the SASv. 9.4 software and Microsoft Excel V16.90. Results: Out of 2.3 million patients, we selected 774,347; males accounted for 46.2% and females 53.8% during the COVID 19 pandemic. UTI prevalences for general population were: 2.35%, 1.81%, 5.72%, 6.15%, 6.46%, 7.14%, 7.98%, 10.89%, 17.65% for the age groups 0–9, 10–17, 18–34, 35–44, 45–54, 55–64, 65–74, 75–84, and > 85, respectively. Males with COVID-19 experienced UTIs at a significantly higher rate than males without recorded COVID-19 at all age groups, except between the 10–17 age range: 1.10% vs. 0.55% (p > 0.01). Females with COVID-19 experienced UTIs at a higher rate than females without recorded COVID-19 at all age groups: 8.31% vs. 3.68%, 6.06% vs. 2.93%, 15.05% vs. 8.20%, 17.30% vs. 7.86%, 19.07% vs. 8.02%, 22.08% vs. 8.57%, 24.89% vs. 9.24%, 30.57% vs. 13.03%, 36.47% vs. 20.72%, for the age groups 0–9, 10–17, 18–34, 35–44, 45–54, 55–64, 65–74, 75–84, and >85, respectively (p < 0.001). Conclusions: The prevalence of UTIs in patients with COVID-19 diagnoses was significantly higher than those without COVID-19, except for men within the 10–17 age group. This study is the largest cohort study to our knowledge examining this relationship, but further analyses are needed to elucidate the relationship between COVID-19 to UTIs.

5.7.9. UP-07.09: Redefining Uropathogenicity: Insights into Emerging Microbes in Urinary Infections

• Sitharthan D ¹, Rosario M ² and Boulas J ³

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

Westmead Hospital, Sydney, Australia

³ 

Bankstown-Lidcombe Hospital, Sydney, Australia

Abstract: Introduction and Objectives: Traditional urine culture methods often report urine as sterile in the absence of recognized urinary tract infection (UTI) pathogens. However, advanced enhanced culture (metaculturomic) and culture-independent DNA-based (metagenomic) methods have uncovered a plethora of lesser-known or emerging uropathogens in the urinary microbiome. This review aims to highlight the significance of these emerging uropathogens, their potential impact on urinary health, and the necessity for enhanced diagnostic and treatment approaches. Materials and Methods: This review systematically analyzed recent studies employing high-throughput DNA sequencing and enhanced culture methods to identify and characterize bacteria in urine samples deemed “no significant growth” by standard urine culture techniques. We focused on the taxonomy, pathophysiology, and clinical implications of poorly understood, emerging, and suspected uropathogens, particularly those belonging to the families Aerococcaceae, Actinomycetaceae, and Bifidobacteriaceae, as well as specific genera such as Streptococcus anginosus and Enterococcus faecalis. Results: Our review identified an extensive array of emerging uropathogens beyond the traditional entities associated with UTIs. Notably, it unveiled a significant prevalence of newer, lesser-known taxa such as Actinotignum schaalii and Alloscardovia omnicolens in symptomatic individuals, highlighting their potential role in urological infections. These findings underscore the diversity and complexity of the urinary microbiota, including facultative and strict anaerobes, many of which are fastidious and not readily detectable using standard methodologies. Specifically, E. faecalis, though well-studied, has shown an increasingly significant role in urinary tract disorders, emphasizing the need for comprehensive understanding and targeted antibiotic surveillance. The results call for further research to elucidate the pathophysiology of these microbes and develop effective treatment strategies. Conclusions: The discovery of emerging uropathogens in the urinary microbiome challenges the traditional view of urine sterility and the microbial etiology of UTIs. This review underscores the urgent need for the medical community to adopt more sensitive and comprehensive diagnostic techniques to accurately identify and understand the role of these lesser-known microbes in urinary health and disease. Further research is essential to unravel the complexities of the urinary microbiome and its impact on urological conditions, facilitating the development of more effective diagnostic, preventive, and therapeutic strategies.

5.7.10. UP-07.10: Retroperitoneal Echinococcosis: Diagnostic Challenges and Therapeutic Implications

• Ben Hamida M, Blaiech W, Bouassida K, Kenani M, Ben Othmen M, Hmida W and Jaidane M
• Sahloul Hospital, Sousse, Tunisia

Abstract: Introduction and Objectives: Echinococcosis is a zoonotic infection caused by the larval stage of Echinococcus granulosus. While it commonly affects the liver and lungs, retroperitoneal (RP) localization, including renal, adrenal gland, and retroperitoneal cavity involvement, is less common. This study aims to address the specificity of retroperitoneal localization of hydatidosis, including diagnostic challenges, imaging features, and therapeutic implications. Materials and Methods: Between January 2021 and September 2023, 18 cases of retroperitoneal echinococcosis were observed at Sahloul Teaching Hospital in Sousse. Each patient underwent evaluation in the urology department, including serological tests for hydatid disease, screening for hyper-eosinophilia, and an abdominal CT scan with iodinated contrast agent. Results: Most of the patients (77.8%) were asymptomatic with incidental uncovering on an abdominal imaging examination for other chief complaints. Four patients (22.2%) presented with vague abdominal pain with no significant findings upon physical examination. Out of the cases studied, twelve (66.6%) were identified as renal parenchymal cysts based on imaging findings. These cystic lesions exhibited both unilocular and multilocular characteristics (type 1 and 3), with four cases showing peripheral calcifications (type 5) and three cases presenting with daughter cysts and floating intra-cystic membranes (type 2). No solid-tumor-like lesions were observed. Six remaining patients were distributed equally between adrenal gland hydatid cyst and retroperitoneal cavity hydatid cyst with and without renal participation with overlapping imaging findings. Eight patients underwent surgical treatment through a lumbotomy approach, with one patient undergoing nephrectomy, while the remaining seven received conservative treatment, which involved internal endocyst excision. Except for a single case of relapse in a patient with a renal parenchymal cavity cyst, no mid-term complications have been detected thus far. Nine patients declined surgical treatment and were consequently transferred to other establishments, while the remaining patient initiated a pharmacotherapy regimen. Conclusions: Retroperitoneal hydatid disease is an uncommon condition that presents diagnostic challenges due to its atypical symptoms and a wide range of potential alternative diagnoses. Essential for an accurate diagnosis, abdominal imaging methods, particularly contrast-enhanced CT scans, play a crucial role. The preferred treatment for this condition is a surgical approach, which typically leads to a positive outlook for the patient in the medium term following the operation.

5.7.11. UP-07.11: Standardising Treatment for Women Referred with Uncomplicated Recurrent Urinary Tract Infections at Eastern Health—Preliminary Results of a Pilot Study

• Rival P, Botros A, Snider R, Dowling C and Sengupta S
• Eastern Health, Melbourne, Australia

Abstract: Introduction and Objectives: This pilot study aims to improve the management of recurrent urinary tract infections (rUTIs) in adult females by introducing a standardised treatment pathway, developed using the Delphi technique. Current management practices are inefficient, highlighted by long waiting times for Urology clinic reviews, with a median waiting period of 640 days identified in a 2023 audit at Eastern Health. Additionally, there’s a lack of non-antibiotic treatment utilisation at referral. This pathway prioritises reducing antibiotic overuse, thus mitigating resistance, by promoting early access to low-risk, non-antibiotic treatments under general practitioner (GP) supervision, enhancing patient outcomes and quality of life (QOL). Materials and Methods: We enrolled adult females referred for uncomplicated rUTIs, collecting data through questionnaires on personal details, urinary symptoms, medical history, and QOL. Both patients and GPs were given the treatment pathway for implementation, with follow-up surveys planned at 1, 3, and 6 months. Results: Preliminary results from 14 enrolled patients show a median age of 41 years (range: 19–77) and a BMI of 26 (range: 20–32). Eight participants regularly consumed caffeinated drinks (>7 times/week), while others did so less frequently (4–6 times/week). Notably, none smoked, and one vaped. Ten were sexually active, with four using contraception. Nine were pre-menopausal, four post-menopausal, and one peri-menopausal. A majority (13/14) had a history of anxiety/depression. Two had a history of renal stones in the past, and one had undergone laparoscopy for endometriosis. Using the UTI-SIQ-8, urgency and lower abdominal pain were prominent symptoms, with median severity and impact scores of 2.4 and 1.7–2.1 out of 5, respectively. Less severe were frequency and dysuria. Management included lifestyle changes (9 patients), non-antibiotic treatments (8), and prophylactic antibiotics (5), with all receiving antibiotics for UTI episodes. Early intervention showed seven seeking GP consultations within 3 months, leading to increased lifestyle changes, targeted investigations, and non-antibiotic treatments. Two patients discontinued prophylactic antibiotics, with patient satisfaction increasing slightly from 4.5 to 5/10 over three months. Conclusions: These early results underscore the potential of a standardised treatment pathway to significantly enhance the management of uncomplicated rUTIs, reducing reliance on antibiotics, and improving patient outcomes and QOL.

5.7.12. UP-07.12: The Renal Localization of Hydatidosis: Clinical and Therapeutic Features

• Hazem H ¹, Firas Z ², Mohamed Abdelkader F ³, Ali E ³, Mohamed Amine M ², Nouri R ⁴, Mohamed F ² and Mourad H ⁴

¹ 

Urology’s Department Ibn El Jazzar Teaching Hospital of Kairouan, Sfax, Tunisia

² 

University Hospital Habib Bourguiba, Sfax, Tunisia

³ 

Urology Department, Habib Bourguiba Hospital, Sfax, Tunisia

⁴ 

University Hospital Habib Bourguiba, Sfax, Tunisia

Abstract: Introduction and Objectives: The hydatid cyst of the kidney constitutes a rare attack of visceral hydatidosis, estimated between 2 and 4% of all locations of the disease. It constitutes a real public health problem in certain Mediterranean countries. Our work aims to recall the epidemiological and parasitological bases of the development of renal hydatid cyst, study its clinical and paraclinical particularities and determine the different therapeutic options. Materials and Methods: We conducted a retrospective descriptive study of 55 cases of KHR treated in the urology department of Habib Bourguiba University Hospital in Sfax, Tunisia during a period from 1982 to 2018. Results: The average age was 46 years with a female predominance (sex ratio = 0.44) and rural geographic origin (63%). Painful symptomatology was the most frequent presenting sign (87%), hydaturia which is the only pathognomonic sign was reported in 16% of cases. Hydatid serology was carried out in 49% of cases, 89% of which came back positive, but its diagnostic value remains limited. Ultrasound was the first-line complementary examination (performed in 95% of cases), and the Gharbi classification provided the following results: Type I: 27%; Type II: 9%; Type III: 22%; Type IV: 24% Type V: 3%. CT, performed in 45% of cases, was of considerable benefit in complicated or unspecified forms by ultrasound (Gharbi Types IV and V). The right kidney was the most affected (58%). and the lesions were mainly polar (47% lower and 39% upper). The treatment was exclusively open surgical with a lumbar approach in 87% of cases. Partial pericystectomy or resection of the protruding dome was the method of choice (78%). The postoperative course was simple in 71% of cases, and the average length of hospitalization was 20 days. We deplore a single post-operative death, and two hydatid recurrences of hepatic location. Conclusions: The diagnosis of KHR has benefited from the great contribution of imaging (CT, MRI). The treatment most often offered in Tunisia is open surgery.

5.7.13. UP-07.13: To Determine the Effectiveness of Uromune Reducing Urinary Tract Infections in Patients with a Spinal Cord Injury Who Suffer from Them Recurrently

• Razi B, Canagasingham A, Kovacic J and Chung A
• Royal North Shore Hospital, Sydney, Australia

Abstract: Introduction and Objectives: Uromune (IMMUNOTEK) is an autoimmune agent that is delivered as a sublingual spray, which has become recently licenced in Australia. It contains a mixture of components of ‘inactivated’ bacteria including E.coli, K.pneumoniae, E.faecalis and Proteus vulgaris. The innate and adaptive immune systems are stimulated, generating CD4+T cells against the recognised bacteria within the Uromune, generating immune memory. A recent study by Lorenzo-Gomez et al. demonstrated a 90.28% absolute risk reduction when using Uromune in women with recurrent UTIs. Materials and Methods: We performed a retrospective cohort study on spinal cord injury patients who had Uromune therapy. Patients underwent a 3 month course of twice daily Uromune sublingual sprays. Patients were then followed up with patient surveys and Urine MSUs at 1, 3, 6 and 12 month. A clinically significant result was deemed as a rate of urinary tract infections reducing by 50%. Results: Our study included a current cohort of 11 patients, of which 2 were female, each with a history of recurrent UTI who received a complete course of the Uromune vaccine and at least 12 months follow up. The mean age was 48.5 years (range 31–64). Within the 12 months follow up post Uromune treatment, 3 (27%) of patients had 0 UTIs, 3 (27%) had 1 infection, 1 (9%) had 2 infections, 1 (9%) had 7 infections, 1 (9%) had 9 and 1 (9%) had 12. The patient who had 9 UTIs had pseudomonas which doesn’t respond to Uromune therapy. Conclusions: There is a trough between 1 months and 6 months where UTI frequency appears to taper off, and by 12 months the frequency appears to increase again. However over the 12 month period, 8 (72%) patients had less than 3 UTIs in 12 months, of which 7 (63%) patients achieved the criteria of a 50% reduction in UTI’s over the course of the 12 month follow up.

5.8. Infertility

5.8.1. UP-08.01: Surgical Outcomes of Microsurgical Testicular Sperm Extraction in Patients with Non-Obstructive Azoospermia: A Retrospective Chart Review

• Nasrallah O, Al Jardali B, Fawaz M, Alameddine B, El Achkar A and Bachir B
• American University of Beirut Medical Center, Beirut, Lebanon

Abstract: Introduction and Objectives: Azoospermia is seen in approximately 1% of all males and 10–15% of infertile men. Male factors causes may be due to genetic, congenital, or acquired causes (surgical, medication induced, or trauma). The management of non-obstructive azoospermia (NOA) disease relies on microdissection testicular sperm extraction (micro-TESE). Our aim is to conduct a single institution study evaluating the outcomes of micro-TESE in patients with NOA at our institution. Materials and Methods: Data was collected from patients with NOA (2017–2023) including demographics, testicular size, presence of underlying diseases, history of inguino-scrotal surgery, pre-hormone hormonal profile (FSH, LH, Testosterone, Estradiol, Prolactin, TSH), hormone supplementation type (oral/injectables), duration, post-hormone hormonal profile (FSH, LH, testosterone, estradiol), operative data (presence of sperm under bench side microscope, and operative time) and post-operative outcomes (presence of sperm in IVF lab, fertilization of ovum, pregnancy, and live birth). Results: A total of 77 patients with NOA were included in the analysis in which the successful sperm retrieval (SSR) was 46.7% (36/77) and the rate of embryo transfer, pregnancy rate and live birth rate were 63.9% (23/36), 41.6% (15/36), and 30.6% (11/36) respectively. There was no significant difference in demographics between positive micro-TESE and negative micro-TESE groups. A significant difference was seen in post hormone testosterone levels between the two groups with an average level of 771 ng/dL versus 464 ng/dL respectively, and testosterone response (difference between pre-hormone and post-hormone testosterone), and a significance in operative time. The type of hormone treatment between oral and injectables showed clinical significance (56.8% vs. 33.3% respectively) but not statistical significance. Conclusions: The SSR in patients with NOA undergoing micro-TESE was higher in males with higher testosterone response and post-hormone testosterone. The use of hormone treatment may as well play an important role in SRR. Shorter operative time was also significant due to finding sperm early during the operation.

5.8.2. UP-08.02: The Impact of Male Factor Infertility Multidisciplinary Team Meeting—A Regional Perspective from United Kingdom

• Wong S ¹, Stasinou T ¹, Modgil V ¹, Pearce I ¹ and Mathur R ²

¹ 

Manchester Royal Infirmary, Manchester, United Kingdom

² 

Old St. Mary’s Hospital, Manchester, United Kingdom

Abstract: Introduction and Objectives: Management of male factor infertility (MFI) is complex and a multidisciplinary team (MDT) approach can serve to optimise outcomes for the affected men and their partners. Since its conceptualisation, MDT meeting has made positive impacts including: agreement on the best management option/strategy through quality, joint decision-making; reduction of unorthodox/suboptimal practices; formal documentation of recommendations and fostering mutual learning experiences. Our National Commissioning Policy for Surgical Sperm Retrieval recommends MFI-MDT meeting as integral to the MFI management pathway, with a core panel including Urologist and Reproductive Medicine Physician with interest in MFI, and Embryologist. MFI-MDT meetings are held regularly throughout UK’s specialist fertility centres, but to-date there is no study into their utility. We aim to demonstrate their utility with our regional experience, with our panel including all core members stated in the policy, and our service administrator and Endocrinologist. Materials and Methods: Retrospective review of records of MFI-MDT meetings from July 2022 to December 2023, at a high volume MFI service centre in the Northwest Region of England, UK. Results: A total of 135 meeting discussions took place for 116 male patients. The average patient age was 36.3 years. 41.5% (56/135) of discussions were to validate the appropriateness of the initially proposed management. Over half (79/135 = 58.5%) of the discussions involved complex decision-making where more than one management options was proposed. The commonest reasons for complex decision-making input included anatomical/functional abnormality, relevant oncological history, previous fertility intervention failure, and endocrine or genetic abnormality. Nearly half (66/135 = 48.9%) of the discussions led to a change in the initially proposed management plan as outlined in Table 1. Conclusions: We demonstrated the utility of MFI-MDT meeting. It provided a holistic environment where quality care decisions were made and allowed for comprehensive follow-up planning for the affected men and their partners, beyond their immediate fertility concerns.

5.8.3. UP-08.03: Zinner’s Syndrome—Case Report

• Maciel R, Bastos S, Lourenco M, Sabenca A, Ferreira A, Peralta J, Amorim R, Oliveira V and Xambre L
• Unidade Local de Saúde Gaia/Espinho, Vila Nova De Gaia, Portugal

Abstract: Introduction and Objectives: Zinner’s syndrome results from a mesonephric duct development abnormality, consisting on the triad of unilateral renal agenesis with ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. This syndrome is usually diagnosed around 3rd and 4th life decades, often presenting as obstructive azoospermia and infertility. We present a case of Zinner’s syndrome as manifestation of adult primary infertility. Materials and Methods: Retrospective revision of patient’s medical process and diagnostic exams. Results: 23 year-old Caucasian male patient was referred to reproductive medicine consultation after primary infertility after 3 years without conception. Genital revealed fully developed secondary sexual characters, both testes were within range for normal size and both at the level of the scrotum, but failure to identify the left sided deferens duct. Remaining physical examination was otherwise unremarkable. Studies for the male infertility factor demonstrated a normal cariotype for a male sex individual, hormonal study revealed FSH and testosterone with normal range. Semen analysis revealed severe azoospermia. Abdominal and transrectal ultrasound demonstrated absence of left kidney in normal topography and apparent left seminal vesical atrophy. Abdominal and pelvic MR revealed absence of left seminal vesicle, left duct deferens and of the left kidney, with vicariant right kidney. Testicular sperm aspiration was performed, demonstrating numerous motile sperm cells, confirming obstructive azoospermia secondary to Zinner’s Syndrome. Sperm cell cryopreservation was performed for posterior ICSI. Conclusions: Zinner’s Syndrome consists triad of unilateral renal agenesis with ipsilateral seminal vesicle cyst and ejaculatory duct obstruction resulting from mesonephric duct development abnormality between 4th and 13th weeks of gestation. Some patients may present with lower urinary tract symptoms such as dysuria, urinary frequency or perineal pain, while others remain asymptomatic, often presenting and infertility. Although ultrasound and CT scan can often reveal typical alterations frequently associated with Zinner’s syndrome, MRI represents the gold-standard to evaluate pelvic organs characterization. Treatment of infertility usually consists of sperm retrieval through testicular or epidydimal sperm aspiration are frequently successful in achieving good quality sperm for posterior cryopreservation and assisted reproduction techniques.

5.9. Kidney and Ureter—Benign Diseases

5.9.1. UP-09.01: Laparoscopic Transmesocolic Pyelolithotomy in an Ectopic Pelvic Kidney

• Araújo A, Cardoso A, Tinoco C, Capinha M, Rodrigues R, Marques V, Torres J and Mota P
• Hospital de Braga, Braga, Portugal

Abstract: Introduction and Objectives: Ectopic pelvic kidney is a rare congenital anomaly with higher incidence of stone formation and obstruction. So, the treatment of renal stones in these patients is challenging. Here, we aim to demonstrate the feasibility and safety of minimally invasive laparoscopic pyelolithotomy. We present here a case of a 34-year-old male patient with no relevant past medical history, that was referred to urology with persistent lower/right abdominal pain. On investigation, the CT scan without contrast material revealed an ectopic kidney in right iliac fossa with notable hydronephrosis conditioned by a 17 mm stone in the proximal ureter. The left kidney was in normal position. So, we proposed the patient for minimally invasive laparoscopic pyelolithotomy. Materials and Methods: First, patient was placed in lithotomy position and the procedure started by cistoscopic placement of a double J 6Fr 24 cm ureteral catheter under fluoroscopic control. Then, the patient was repositioned in Trendelenburg position and 2 10 mm-trocars, and 2 5 mm-trocars were introduced in abdominal cavity. Immediately we could identify the ectopic kidney through the mesocolon. So, we proceed to the mesocolon overlying opening. After that, we open the Gerota’s Fascia and dissect the perirenal fat. We continue the dissection to identify the proximal ureter. After that, we follow the ureter and found the renal pelvis. So, we did the pyelolithotomy and identify the double J catheter. After that we identify the stone, and we remove it intact with an endobag from the peritoneal cavity. The renal pelvis was closed with a vicryl 4/0 running suture. Then the mesocolon was also closed with a v-loc 2/0 running suture. An intraperitoneal drain was placed through a 5 mm trocar. Results: The total operative time for this surgery was 1.5 h. Post-operative period was uneventful, and the drain was removed, and patient was discharged after 48 h. The ureteral catheter was removed in 6 weeks. The patient remained with no symptoms with a stone free rate of 100%. Conclusions: Laparoscopic pyelolithotomy is a feasible, safe, and simple minimally invasive technique option for ectopic pelvic kidneys with minimal perioperative morbidity and should be standard of care in these patients.

5.9.2. UP-09.02: Laparoscopic Transperitoneal Partial Ureterectomy with Ureteroureterostomy for the Management of Benign Mid-Ureter Stricture

• Araújo A, Rodrigues R, Tinoco C, Cardoso A, Capinha M, Pinto L, Marques V, Torres J and Mota P
• Hospital de Braga, Braga, Portugal

Abstract: Introduction and Objectives: Proper evaluation and treatment of a ureteral stricture are essential to improve symptoms and preserve renal function. Since endoscopic treatments are only successful for shorter strictures, we aim to demonstrate a laparoscopic transperitoneal partial ureterectomy with ureteroureterostomy. We present a case of a 40-year-old woman who was referred with left lumbar pain and ipsilateral ureterohydronephrosis. A diagnostic ureterorenoscopy with a retrograde pyelogram showed a mid-ureter unsuspicious stenosis with 2 cm, transposable to the 8Fr ureterorenoscope. The ureteral cytology was negative for urothelial carcinoma. The CT-urogram and the MAG3-renogram with the double-J catheter revealed no relevant changes and a symmetrical differential renal function. After a double-J catheter removal, the new CT-urogram showed, again, a moderate left ureterohydronephrosis. So, we proposed the patient for laparoscopic transperitoneal partial ureterectomy with ureteroureterostomy. Materials and Methods: First, the procedure started with a ureterorenoscopy that confirmed the stenosis and a straight ureteral catheter was left at this level. Second, the patient was positioned in a right lateral decubitus. Then, two 10 mm trocars and one 5 mm trocar were introduced. After, it was done a cephalic mobilization of the left colon and the dilated ureter under the peritoneum was identified and then the peritoneum was opened. The straight catheter was identified and therefore the stenosis level. Next, a partial ureterectomy with spatulation of the nondilated ureteral segment was done. The ureteroureterostomy was done under a double-J catheter with the help of a stab incision, in a running fashion. The stenotic ureter was removed, and a drain was placed. Results: Total operative time was 145 min. Postoperative period was uneventful. Drain was removed, and patient was discharged on the 2nd day postoperative. Pathology results reveal chronic ureteritis. The double-J catheter was removed 6 weeks after surgery. At the 3-month-postoperative evaluation, the patient remains with no urinary symptoms and no ureterohydronephrosis on ultrasound. Conclusions: Laparoscopic partial ureterectomy with ureteroureterostomy is a safe and simple minimally invasive technique for the management of a 2 cm/longer, benign mid-ureter stricture with minimal morbidity and optimal functional results. Therefore, this technique should be the standard of care for these patients and should be preferred over endoscopic treatments.

5.9.3. UP-09.03: Robot Assisted 3D Model & Indocyanine Guided Ureteral Reimplantation in Renal Transplant Patients: 4 Emblematic Cases from Our Series

• Lavagno F, Allasia M, Oderda M, Marquis A, D’Agate D, Mangione C, Greco A, Pasquale G, Bosio A and Gontero P
• Città della Salute e della Scienza di Torino, Torino, Italy

Abstract: Introduction and Objectives: The outcomes of kidney transplants have improved significantly in recent years. Even though, urological complications occur in the 2–10%. The ureteral stenosis of the graft ureter is the most common, with a probability of 0.5%–6.3%. Usually presenting within the first few weeks, or the first year, the most common site of stenosis is the ureterovesical junction. Several imaging are useful to assess hydronephrosis, including ultrasonography, CT, MR and scintigraphy. Once ureteric obstruction is confirmed, urinary diversion must be undertaken with a percutaneous nephrostomy insertion or a retrograde stent positioning. Definitive treatment include percutaneous balloon dilatation if technically feasible, followed by temporary ureteric stent placement. If the stenosis recurs after stent removal, surgical revision or long-term ureteric stenting is advocated. Materials and Methods: We used a robot assisted technique (Da Vinci Xi), with pre-op 3D models planning (Medics^©–Hyper Accuracy 3D^®) and intra-op ICG. Even if the scheduled intervention was the reimplantation of the ureteral graft to the bladder, this was not always possible. First step is to identify and isolate the graft ureter and then anastomotic stricture is transected and removed. Later a tension-free uretero-vesical anastomosis complete the anastomosis. In other cases, due to sclerotic tissue, we harvested a Boari-Casati flap or we had to think to different solutions such as shown in the video. Results: To date, 14 patients (8 F and 6 M) with distal graft ureteral stenosis, planned for ureteral reimplantation, were treated with a robot assisted technique (Da Vinci Xi). The mean time to onset of ureteral stricture was 3.4 months. Mean operative time was 220 min. Mean preop s-CR was 2.3 mg/dL, while post operative s-CR 1.34 mg/dL. After 1 month observation mean s-CR was 1.44 mg/dL. Conclusions: Reconstructive surgery for renal transplant complications is often challenging. The transperitoneal robotic approach with the use of 3D reconstructions and indocyanine could help in the identification and isolation of the ureter. 3D guidance can also make it easier to identify the renal vessels and the pelvis. On the other hand, the high costs of robotic surgery, further burdened by the use of 3D models, need to be considered.

5.9.4. UP-09.04: Ureteric Stent Tracking Through the Implementation of a Semi-Automatic Stent Register at a District General Hospital

• Bleakley C, Al-Karasneh A and Wozniak S
• Torbay Hospital, Torquay, United Kingdom

Abstract: Introduction and Objectives: Ureteric stent insertions represent a large proportion of the general urology workload. Stents require timely follow up, and forgotten stents create a significant burden on both patient and clinician. Various stent register initiatives have been trialled throughout the UK to enable effective monitoring and recording of patients with stents in situ, however challenges are often faced with integration into existing IT software or laborious manual input of data. By recognising the need for a more streamlined and accessible system, a novel system was introduced at a District General Hospital. Materials and Methods: Led by a consultant, the project focused on establishing a semi-automatic ureteric stent register software which integrated with the hospital’s existing software infrastructure. The software utilises a barcode scanner available at theatre computer workstations, to rapidly record stent insertions within a patient’s electronic record via the barcode available on the stent packaging. Planned duration of stent is also recorded, and existing stents can be “removed” on the system as required. Results: This semi-automatic stent register was successfully implemented after a 4 month integration period, after collaboration with our IT colleagues. Stent insertions are now able to be recorded at time of insertion, requiring 3 clicks of a computer mouse. As of February 2024, there are 321 patients logged on the system. There has been no recorded “missed stent” events since its implementation. Conclusions: The implementation of this stent register improves the ease with which accurate patient records can be maintained around stent insertions. Further work is ongoing to allow easy removal of patients from the register once all stents are removed, a process which currently requires liaison with the managerial staff. This initiative outlines the importance of collaboration between clinical staff and software specialists to improve practicality and accuracy of patient records.

5.10. Kidney and Ureteral Cancer—Basic Science

UP-10.01: HIF-2α/MCJ Induces ROS Accumulation Which Oxidatively Modifies Legumain to Promote Its Extracellular Secretion Leading to Tumor Metastasis in ccRCC

• Shen T and Tan X
• Nankai University, Tianjin, China

Abstract: Introduction and Objectives: Hypoxia-inducible factor 2α (HIF2α) and legumain are highly expressed in a variety of solid tumor tissues, but the role of these two in clear cell renal cell carcinoma (ccRCC) is not fully understood. In a variable tumor environment, legumain can exist in multiple forms and perform different functions. The aim of this project is to explore the mechanism of Legumain’s role in ccRCC tumor metastasis. Materials and Methods: Western blot, ELISA, and IHC were used to detect the levels of legumain and HIF2α in tissues and urines of ccRCC patients, separately. Methylation-controlled J (MCJ) was screened using bioinformatics, and the effects of MCJ on mitochondrial morphology were observed using transmission electron microscopy. The effects of the HIF2α/MCJ axis on ROS accumulation, ATP production, oxidative stress, and proleguamin secretion were examined by DHE and MitoSOX probes, colorimetric kits, and western blot, respectively. Mass spectrometry was performed to analyze and validate the oxidation sites and oxidation types of prolegumain. The Transwell invasion and tube formation assay detects the effects of silencing MCJ or scavenging ROS on tumor cell invasion and angiogenesis. Construction of an orthotopic xenograft model in mice, and observation of tumor growth and metastasis using in vivo imaging. Tumor tissue levels of HIF2α, MCJ, and MMP2, ROS accumulation, and levels of prolegumain in mouse urine were detected. Results: Urinary prolegumain levels positively correlated with the malignant characteristics of ccRCC. In 786-O and OSRC-2 cells, HIF2α/MCJ axis downregulation or ROS removal reduced prolegumain secretion, and MCJ overexpression restored prolegumain secretion inhibited by HIF2α downregulation. HIF2α can transcriptionally regulate MCJ and the ectopic MCJ overexpression reversed the improved mitochondrial damage resulting from HIF2α downregulation. The His343 on the legumain sequence as contributing to the prolegumain secretion. Silencing of MCJ or HIF2α or use of ROS scavengers attenuated MMP2 activation as well as cell invasion and angiogenesis, and reduced lung metastasis of tumors in vivo. Conclusions: Reducing ROS levels in ccRCC patients can suppress the secretion of prolegumain and subsequently reducing tumor metastasis. the level of prolegumain in urine may serve as an independent predictor of tumor metastasis in ccRCC patients.

5.11. Kidney and Ureteral Cancer—Clinical

5.11.1. UP-11.01: A Quality Improvement Project to Increase the Use of the IDENTIFY Calculator in Assessing Patients Referred to Secondary Care with Haematuria

• Rival P, Ooi L, Lim H, Varughese A, Pandey M, Dowling C and Sengupta S
• Eastern Health, Melbourne, Australia

Abstract: Introduction and Objectives: The IDENTIFY calculator is a recently introduced tool able to predict a newly referred patient with haematuria’s risk of urothelial cancer. An audit found that documentation from a patient’s first encounter with the Eastern Health Haematuria Clinic (HC) provided on average only 28.6% of the information required to accurately use the IDENTIFY calculator. We aimed to improve the quality of our documentation to increase the use of the IDENTIFY calculator in our HC. Materials and Methods: We conducted an audit reviewing clinic notes for 20 patients recently referred to the HC at Eastern Health. We audited the ability to use the IDENTIFY calculator from the documentation of these encounters. Our audit suggested that certain areas of the history such as presence of previous benign haematuria investigations (80%), smoking status (55%) and workplace exposure (45%) were well documented. However, other areas were not well documented such as family history of urothelial cancer (0%), presence of previous radiotherapy to the pelvis (0%) and presence of a urinary catheter (0%). We designed a documentation template addressing all the sections required to accurately use the IDENTIFY tool and provided a teaching session to the doctors who undertook the HC. Results: We performed a re-audit reviewing clinic notes of 15 patients referred to the HC at Eastern Health after the introduction of the template and the provision of the teaching session. We found that these clinic notes provided 100% of the information required to accurately use the IDENTIFY calculator. Conclusions: The predictive capacity of the IDENTIFY calculator is only as good as the data introduced to make the prediction. Therefore, it is essential to accurately document all the required information for this tool to perform as a supporting guide for doctors to make clinical decisions when reviewing haematuric patients and to promote patient care.

5.11.2. UP-11.02: Active Surveillance of Smal Renal Masses in the General Population

• Morales Pinto S, García Góngora B, Lanza Pérez M, Saez Barraquero F and Herrera Imbroda B
• University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

Abstract: Introduction and Objectives: Active surveillance of small renal masses (SRMs) is becoming increasingly widespread, especially in comorbid or elderly patients. There are no established active surveillance protocols specifically for the general population. Most likely, the majority of SRMs have an indolent course with little metastatic potential as long as they maintain their radiological characteristics. Our objective is to verify that surveillance of small renal tumors is feasible. Materials and Methods: Retrospective study of 54 patients diagnosed with SRMs (small renal masses, less than 4 cm) suspected of renal cell carcinoma on contrast-enhanced imaging between January 2016 and January 2023. Patients underwent clinical and radiological monitoring every 6 months. Clinical and radiological variables were analyzed. A descriptive observational study was conducted using the SPSS21 statistical package. Results: 54 patients were included in the active surveillance protocol for SRMs. The median age was 68 years (IQR 25–75; 54–76 years). The mean tumor size was 21 mm (SD; 8 mm). Sixty-four point eight percent (35 patients) were male, 33.3% (18 patients) had diabetes mellitus, 42.6% (23 patients) were obese, 22.2% (12 patients) had chronic kidney disease, and 64.8% (35 patients) were smokers. Eighty-five point two percent (46 patients) were incidentally diagnosed. Ninety-eight point one percent (53 patients) had an ECOG score of 0, and 1.9% (1 patient) had an ECOG score of 1. Sixty-one point one percent (33 patients) were diagnosed by contrast-enhanced CT, 33.3% (18 patients) by ultrasound, and 5.6% (3 patients) by MRI. Patients initially diagnosed with ultrasound underwent subsequent CT scans. Most masses were right-sided (55.6%, 30 cases), mesorenal (38.9%, 21 cases), located in the upper pole (35.2%, 19 cases), and anterior (55.6%, 30 cases). The mean growth rate was 1.75 mm/year. No patients experienced metastatic progression. The 18.5% (10 patients) exited active surveillance, 8 due to tumor growth and 2 by personal request. The mean tumor size of patients who exited surveillance was 25.9 mm, with a growth rate of 2.15 mm/year for these patients. Conclusions: Active surveillance of small renal masses is feasible and safe in the general population; accelerated growth could be a variable to consider in changing therapeutic approach.

5.11.3. UP-11.03: Adjuvant Pembrolizumab in Kidney Cancer: First Steps Since Its Approval in Spain

• Gonzalez R, Hernando A, Martinez I, Coloma L, Amaruch N, Gomez B, Perez X, Tufet J, Osorio F, Ruiz De Castroviejo J, Matta J, Yanes B, Jimenez J, Cabello R and Gonzalez Enguita C
• Jiménez Díaz Foundation University Hospital, Madrid, Spain

Abstract: Introduction and Objectives: Renal cell carcinoma (RCC) occupies a high frequency in urinary oncological pathology. The development of targeted immunotherapy has displaced previous therapies such as receptor tyrosine kinase inhibitors. Since the Keynote-564 trial, the use of pembrolizumab for adjuvant treatment in renal cell carcinoma after surgery has increased, improving disease-free survival in patients at high risk of recurrence after nephrectomy, our objective is to show real results of this therapy. Materials and Methods: We present a descriptive, retrospective study in patients with RCC who underwent radical surgery and who started pembrolizumab in our center. Sex, age, type of surgery, histology, ISUP, risk of recurrence (dived in M0 middle risk [pT2N0M0 ISUP 4 and T3N0M0], High risk M0 to pT4N0M0 and N+, and M1 NED (metastasis at diagnosis with nephrectomy and metasectomy or metachronic metastasis resection < 1 year of nephrectomy) and completed pembrolizumab cycles were recorded. The recurrence rates in our population and the side effects presented are shown, and the treatment interruption rates are compared with the study. Results: A total of 11 patients under adjuvant treatment with pembrolizumab since February 2023, after surgery with radical intent were analyzed. 45.5% (5) were M1 NED and 54% 6 middle risks. Of these 11 patients, 1 has completed the pause of 17 cycles of 200 mg every 21 days, 8 are complying and 2 have been permanently suspended. 54% of the patients (6) presented side effect at least grade 3, 33% (2) required permanent suspension and in 3 of them it was temporary. 18% (2) of patients had recurrence before finishing treatment. Conclusions: The rate in the Keynote study of serious adverse effects was 32.4%, in our center is 54%. Although it has been shown that increase in disease-free survival in therapy with pembrolizumab is effective, in our experience it involves a greater number of side effects than expected.

5.11.4. UP-11.04: Adjuvant Systemic Therapy Improved Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

• Di Bello F ¹, Rodriguez Peñaranda N ², Jannello L ³, Siech C ⁴, De Angelis M ⁵, Goyal J ⁶, Collà Ruvolo C ⁷, Califano G ¹, Creta M ¹, Morra S ¹, Saad F ⁶, Shariat S ⁸, De Cobelli O ³, Briganti A ⁵, Chun F ⁴, Puliatti S ⁹, Longo N ¹ and Karakiewicz P ⁶

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

University of Modena and Reggio Emilia, Modena, Italy

³ 

IEO Istituto Europeo di Oncologia, Milano, Italy

⁴ 

Goethe Frankfurt University, Frankfurt, Germany

⁵ 

Università Salute Vita San Raffaele, Milano, Italy

⁶ 

University of Montréal Health Center, Montréal, Canada

⁷ 

Università Federico II di Napoli, Napoli, Italy

⁸ 

Comprehensive Cancer Center, Wien, Austria

⁹ 

Università di Modena e Reggio Emilia, Modena, Italy

Abstract: Introduction and Objectives: To test for survival differences according to adjuvant chemotherapy (AC) status in radical nephroureterectomy (RNU) patients with pT2-T4 and/or N1–2 upper tract urothelial carcinoma (UTUC). Materials and Methods: Within the Surveillance, Epidemiology, and End Results database (2007–2020), UTUC patients treated with AC vs. RNU alone were identified. Kaplan-Meier plots and multivariable Cox regression models (CRM) addressed cancer-specific mortality (CSM). Results: Of 1995 UTUC patients, 804 (40%) underwent AC vs. 1191 (60%) RNU alone. AC rates increased from 36.1 to 57.0% over time in the overall cohort (EAPC = +4.5%, p < 0.001). The increase was from 28.8 to 50.0% in TanyN0 patients (EAPC = +7.8%, p < 0.001) vs. 50.0 to 70.9% in TanyN1–2 patients (EAPC = +2.3%, p = 0.002). Within 698 patients harboring TanyN1–2 stage, median CSM was 31 months after AC vs. 16 months in RNU alone (Δ = 15 months, p < 0.0001) and AC independently predicted lower CSM (hazard ratio [HR] 0.64; p < 0.001). Similarly, within subgroup analyses according to stage, relative to RNU alone, AC independently predicted lower CSM in T2N1–2 (HR 0.49; p = 0.04), in T3N1–2 (HR 0.72; p = 0.015), and in T4N1–2 (HR 0.49, p < 0.001) patients. Conversely, in all TanyN0 as well as in all stage-specific subgroup analyses addressing N0 patients, AC did not affect CSM rates (all p > 0.05). Conclusions: In RNU patients, AC use is associated with significantly lower CSM in lymph node positive (N1–2) patients but not in lymph node negative patients (N0). The distinction between N1–2 and N0 regarding the effect of AC on CSM applied across all T stages from T2 to T4, inclusively.

5.11.5. UP-11.05: Ambulatory Robot Assisted Partial Nephrectomy: Perioperative Optimization and Surgical Technique

• Margue G, Ricard S, Degryse C, Estrade V, Alezra E, Capon G, Bladou F, Robert G and Bernhard J
• Bordeaux University Hospital, Bordeaux, France

Abstract: Introduction and Objectives: Minimally invasive approach has led to a reduction in the hospital stay for robot-assisted partial nephrectomy (RAPN), to the point where patients can now be managed as outpatients, thus reducing the cost of the procedure. The aim of this video was to present the optimization of the RAPN technique for ambulatory procedures. Materials and Methods: Surgery was performed using the Da-Vinci Xi surgical robot (Intuitive surgical). We used 3 operating arms, a 30° optic and 2 trocars (5 and 12 mm) for the assistant. Tumor limits were assessed using intraoperative ultrasound (Hitachi). All patients managed in the ambulatory pathway for RAPN were prospectively included in the French kidney cancer database UroCCR. Their clinical, biological, radiological and pathological data were collected, and a satisfaction questionnaire (EVAN-G) was distributed. Results: To illustrate the nurse-coordinated ambulatory care pathway, we chose the case of a 57-year-old patient with no previous medical history and a 3 cm left kidney lesion discovered incidentally. To optimize the surgical procedure, the kidney was approached directly over the lesion. Minimal dissection was performed, and the renal pedicle was not dissected. Enucleation was performed without clamping, following the pseudo capsule plane in order to minimize bleeding, and reconstruction was done without renorrhaphy to simplify the procedure and reduce the operative time. The patient was discharged the same evening and continued to be monitored by the coordinating nurse until day 30. 159 patients underwent ambulatory RAPN at our center. These were mainly young patients with small tumors of low complexity. 12% of patients were finally kept overnight for observation. The satisfaction questionnaires distributed on Day 1 showed a high level of overall satisfaction. Conclusions: Ambulatory RAPN is feasible and safe in selected patients. The surgical technique needs to be modified to allow simpler and shorter surgery. Nurse coordination allows these outpatient procedures to be carried out with a high level of patient satisfaction.

5.11.6. UP-11.06: Bladder Cuff Excision After Radical Nephroureterectomy Is Associated with Better Survival than No Excision in Upper Tract Urothelial Carcinoma

• Di Bello F ¹, Siech C ², De Angelis M ³, Rodriguez Peñaranda N ⁴, Jannello L ⁵, Goyal J ⁶, Collà Ruvolo C ⁷, Califano G ¹, Mangiapia F ¹, Saad F ⁶, Shariat S ⁸, De Cobelli O ⁵, Briganti A ³, Morra S ¹, Chun F ², Micali S ⁴, Longo N ¹ and Karakiewicz P ⁶

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

Goethe Frankfurt University, Frankfurt, Germany

³ 

Università Salute Vita San Raffaele, Milano, Italy

⁴ 

University of Modena and Reggio Emilia, Modena, Italy

⁵ 

IEO Istituto Europeo di Oncologia, Milano, Italy

⁶ 

University of Montréal Health Center, Montréal, Canada

⁷ 

Università Federico II di Napoli, Napoli, Italy

⁸ 

Comprehensive Cancer Center, Wien, Austria

Abstract: Introduction and Objectives: To test for survival differences after radical nephroureterectomy (RNU) in pT1-T3N0 upper tract urothelial carcinoma (UTUC) patients according to bladder cuff excision (BCE) status. Materials and Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2020), we identified RNU patients and documented BCE status. Prior and after propensity score matching (ratio 1:1), cumulative incidence plots and competing risk regression (CRR) models addressed cancer specific mortality (CSM) and other-cause mortality (OCM). Results: Of 4426 RNU-treated patients, 3186 (72%) patients underwent BCE and 1240 (28%) did not. BCE rates significantly increased over time from 65.2 to 77.0% (EAPC: +1.0%, 95% CI +0.4 to +1.6%, p = 0.004) between 2004 and 2020. After 1:1 propensity score matching for T stage, 1240 of 1240 (100%) RNU patients without BCE and 1240 of 3186 (39%) RNU patients with BCE were included in subsequent analyses. Five-year CSM rates were 30% in RNU with BCE patients vs. 36% in RNU without BCE patients (Δ = 6%). In multivariable CRR, RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70–0.93; p < 0.001). Conversely, BCE status did not affect OCM (p = 0.4). Conclusions: The rate of guideline recommended BCE at RNU increased over time. Additionally, RNU with BCE is associated with significantly lower CSM than RNU without BCE in pT1-T3N0 UTUC patients. In consequence, BCE should represent an integral part of RNU as recommended in guidelines.

5.11.7. UP-11.07: Comparison of Success Rate and Safety of Laparoscopic and Cone-Beam CT-Guided Cryoablation for the Management of Localized Renal Cell Carcinoma: A Single-Center Long-Term Follow-Up Study

• Duijn M, Ruiter A, Montauban Van Swijndregt A, Van Der Hulst V and Lagerveld B
• OLVG, Amsterdam, Netherlands

Abstract: Introduction and Objectives: Cryoablation (CA) has already demonstrated its efficacy as an alternative modality for the primary treatment of cT1 renal cell carcinoma (RCC). Presently, different techniques are available for CA of localized renal tumors. This study represents the inaugural comprehensive evaluation of our clinical experience involving laparoscopic and cone beam CT-guided (CBCT) CA for the treatment of localized RCC. The objective is to compare and analyze the long-term effectiveness and safety of laparoscopic and CBCT-guided CA for the treatment of cT1 RCC, based on long-term follow-up data obtained from a single-center. Materials and Methods: In this single-center long-term follow-up study patients who underwent laparoscopic or CBCT-guided CA for biopsy-proven cT1 RCC were retrospectively included. Laparoscopic procedures were included between December 2006 and March 2021. CBCT-guided procedures were included between January 2014 and February 2023. Primary end points were compared between both groups. Success rate was classified as post-procedure recurrence rate (RR) and safety of procedure was translated into overall post-procedure complication rate (OCR). Results: A total of 224 procedures were included for analysis. Of them, 133 (59.4%) were performed laparoscopically and 91 (40.6%) were CBCT-guided. The independent-samples T-test was used to determine statistical significance between both groups. During follow up 8 (6.1%) recurrences were observed after laparoscopic CA and 10 (11%) after CBCT-guided CA. This difference in RR was statistically significant (p = 0.008). The OCR was significantly higher in the laparoscopic group than in the CBCT-guided group (p < 0.001), 26 (20%) and 8 (9%) respectively. The highest Clavien-Dindo score reported was 2. None of the patients died as a direct result of the procedure. Conclusions: Our extensive long-term data suggest a higher success rate in the laparoscopic group based on a significantly lower RR. On the other hand, the OCR is significantly lower in the CBCT-guided group. No serious post-procedure complications were reported in both groups. In light of these findings, laparoscopic CA seems to have an oncological advantage over CBCT-guided CA with respect to the prevention of local recurrence. In contrast, CBCT-guided CA reduces the risk of post-procedure complications.

5.11.8. UP-11.08: Comparison of Survival in the Treatment of Small Renal Cancer; Active Surveillance Versus Minimally Invasive Surgery

• Morales Pinto S, García Góngora B, Lanza Pérez M and Herrera Imbroda B
• University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

Abstract: Introduction and Objectives: Partial nephrectomy is the treatment of choice for cT1 renal masses; however, active surveillance of small renal masses is becoming increasingly common, especially in comorbid or elderly patients. It has been observed that the majority of small renal masses demonstrate an indolent evolution with minimal metastatic potential as long as they maintain their radiological characteristics. The aim of this study is to compare the survival of patients undergoing active surveillance versus surgery. Materials and Methods: Retrospective study of 267 patients diagnosed radiologically with a clinical stage T1 renal tumor between January 2006 and January 2023. 213 patients underwent surgery, and 54 underwent active surveillance with clinical and radiological follow-up every 6 months. Clinical and radiological variables were analyzed. A descriptive observational study and survival analysis were conducted. The statistical package SPSS21 was used. Results: Active surveillance protocol: 54 patients participated. The mean age was 68 years (SD: 9.5), with a mean tumor size of 21 mm (SD: 8 mm). Of these, 64.8% (35 patients) were male. ECOG scores were predominantly 0, with 98.1% (53 patients). Diagnostic methods varied, with 61.1% (33 patients) diagnosed via contrast-enhanced CT, 33.3% (18 patients) via ultrasound, and 5.6% (3 patients) via MRI. The majority of masses were located on the right side (55.6%, 30 cases). No patient experienced metastatic progression. Of the participants, 18.5% (10 patients) discontinued active surveillance, with 8 ceasing due to tumor growth and 2 by personal request. The mean tumor size of patients who discontinued surveillance was 25.9 mm, with a growth rate of 2.15 mm/year. The median follow-up period was 22.5 months (IQR: 25th–75th percentile; 4–36.2 m). Patients undergoing surgery: The study included 213 patients, with a median age of 60.2 years (SD: 11.8). The mean tumor size was 3.1 mm (SD: 1.2 mm). Of these patients, 61.5% were male (131 patients). Among the surgeries, 75% (158 patients) were classified as T1a and 25% (55 patients) as T1b. Survival rate was 99.5% (1 death). The median follow-up duration was 49.5 months (IQR: 25th–75th percentile; 20.8–94.6 m). Conclusions: Active surveillance of small renal masses is viable and safe in the general population when comparing survivals with patients undergoing standard treatment.

5.11.9. UP-11.09: Conservative Treatment for Upper Urinary Tract Urothelial Carcinoma: Presentation of the Therapeutic Management Algorithm at Our Center and Results from 2018 to Present

• Monllor Méndez A, Fumero Arteaga S, Orribo Morales N, Falcón Barroso J, Carrión Valencia A, Torres León L, Clemente Graffigna R, Sotillo A, Díaz Mesa C, Rodríguez Talavera J and Monllor Gisbert J
• Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain

Abstract: Introduction and Objectives: Radical nephroureterectomy (NU) has been the gold standard treatment for upper urinary tract urothelial carcinoma (UTUC). Conservative management has been reserved for imperative situations requiring renal preservation (bilateral tumors, single kidney, renal function impairment). Currently, European and American guidelines recommend endoscopic treatment (ET) for low-risk UTUC and high-risk cases with imperative indications. However, there is no consensus among scientific societies regarding the therapeutic management or follow-up of these patients. The objectives of this study are to introduce the therapeutic management algorithm for UTUC at our center and review the indications and outcomes of patients undergoing endoscopic treatment (ET) for UTUC. Materials and Methods: All patients undergoing endoscopic treatment (ET) for UTUC at our center since 2018 were included. We present the therapeutic management algorithm for UTUC at our center and an analysis of the results. Results: During the presentation, we will introduce the therapeutic management algorithm for UTUC at our center. Over the past 5 years, 7 patients (71% males, 29% females) underwent endoscopic treatment (ET) for UTUC. The median age was 77 years [54–91]. The indication for ET was mostly imperative (86%), primarily due to a solitary kidney condition (except for one case of stage IV chronic kidney disease). One elective treatment was initiated based on the patient’s decision. Thulium fiber laser was used in 57% of cases, and Holmium laser in 43%. Postoperative instillation of mitomycin C (MMC) was performed in 71% of cases. Most patients presented with a solitary lesion (57%), located in the kidney (71%), ureter (14%), or multifocal (14%). The average size was 21.86 mm [8–35]. Concurrent bladder lesions were observed in 57% of cases. With a median follow-up of 20 months [9–60], 71% of patients experienced neoplastic recurrence. Radical nephroureterectomy (NU) was indicated in 14% of cases, with a median time from primary treatment to NU of 301 days. Conclusions: In the management of UTUC, the physician should inform the patient about the risks and the need for endoscopic follow-up. There is no absolute consensus among scientific societies regarding the modalities of follow-up. However, in cases where it is indicated, it is the first choice.

5.11.10. UP-11.10: Delayed Partial Nephrectomy Following Complete Response to Immunotherapy: Feasibility and Results (UroCCR N°157)

• Margue G ¹, Parier B ², Albiges L ³, Klein C ¹, Pignot G ⁴, Gravis G ⁴, Bigot P ⁵, Baize N ⁵, Ingels A ⁶, Joly C ⁶, Audenet F ⁷, Vano Y ⁷, Waeckel T ⁸, Levard R ⁸, Gross-Goupil M ¹ and Bernhard J ¹

¹ 

Bordeaux University Hospital, Bordeaux, France

² 

Kremlin-Bicetre Hospital—APHP, Paris, France

³ 

Gustave Roussy Institute, Paris, France

⁴ 

Paoli Calmettes Institute, Marseille, France

⁵ 

Angers University Hospital, Angers, France

⁶ 

Henri Mondor Hospital—APHP, Paris, France

⁷ 

HEGP—APHP, Paris, France

⁸ 

Caen University Hospital, Caen, France

Abstract: Introduction and Objectives: Complete responses to immunotherapy (IO) in metastatic kidney cancer have led to a renewed interest in primary site surgery. The prolonged survival of these patients has prompted consideration for nephron-sparing surgery when it is technically feasible. However, in view of the surgical difficulties reported in the literature, it is essential to assess the feasibility as well as the functional and oncological results of partial nephrectomy (PN) following IO. Materials and Methods: Using the UroCCR database (CNIL DR 2013–206; NCT03293563), we conducted a multicentric retrospective study including all metastatic patients who underwent PN after a complete response to IO on metastatic sites. We assessed intraoperative difficulties, morbidity, renal function, positive margin rate, and oncological outcomes. Results: Between January 2019 and September 2023, 13 patients underwent PN following IO. Population characteristics and surgical outcomes are described in Table 1. After surgery, IO was not reintroduced in ten patients (77%), one patient continued treatment for 2 months and two patient was still on treatment at last follow-up (no recurrence). Median GFR at 3 months was 84.7 [66.6–95.2] mL/min/1.73 m² with no significant difference from preoperative GFR. Median follow-up was 8.4 [3.0–21.1] months and overall survival at last follow-up was 90%. Median treatment-free survival was 12.9 [8.0–30.9] months and recurrence-free survival at 12 months was 84.6%. Conclusions: This first series of delayed PN following IO confirms the feasibility of the procedure with good functional and oncological results leading to prolonged remissions.

5.11.11. UP-11.11: Malignancy Risk of Bosniak IV Renal Cystic Lesions According to the New Bosniak Subclassification, 2019 Version

• Martinez Pérez S, Toribio Vazquez C, De Garcillán De La Joya I, Fernández Pascual E, Morón Hodge S, Solano Heranz P, Alonso Bartolomé M, Martínez Piñeiro L, Aguilera Bazán A and Ayllón Blanco H
• Hospital Universitario La Paz, Madrid, Spain

Abstract: Introduction and Objectives: Bosniak grade IV renal cysts have a malignancy risk exceeding 80%. In 2019, their classification was updated to make it more objective by adding a subclassification based on the angles drawn by their nodules, acute (IV-AP), and obtuse (IV-OP). The aim of this study is to assess the prevalence of malignancy, histopathological characteristics, and oncological behavior of Bosniak IV cysts according to the new 2019 classification (v2019) to determine the actual risk of malignancy in our population. Materials and Methods: A retrospective review of Bosniak IV cysts identified by CT or MRI in operated patients between February 2015 and August 2022 was conducted. Two radiologists reclassified the images according to v2019. The association of this subclassification with malignancy, histological characteristics, and survival was analyzed. Results: A total of 12 patients underwent surgery, 9 with partial nephrectomy (75%) and 3 with radical nephrectomy (25%). The laparoscopic approach was the preferred method in the majority with 11 patients (91.7%) compared to 1 open procedure (8.3%). Reclassification according to v2019 concluded that there were 7 IV-OP (58.3%) and 5 IV-AP (41.7%). Only one case was benign (8.3%) classified as IV-OP. Of the 11 malignancies (91.7%), 5 were clear cell carcinomas (41.7%), 1 papillary type I (8.3%), 2 papillary type II (16.7%), and 3 clear cell tubulopapillary (25%). There is a statistical trend that all clear cell carcinomas are IV-OP compared to all papillary tumors, which are IV-AP (p = 0.055). There is also a statistical trend regarding Fuhrman grade: 7 patients had grade 1 (58.3%), 3 patients had grade 3 (25%), all of which were IV-OA, and 1 patient had grade IV, which was IV-OP (p = 0.073). No statistically significant differences were observed in progression free survival. Conclusions: The malignancy rate of Bosniak IV in our series is 91.6%. The analyzed data show a trend that Bosniak IV-AP has a worse prognosis regarding histopathological data and Fuhrman grade, without affecting progression-free survival.

5.11.12. UP-11.12: Mendelian Randomization Analysis Revealed the Casual Association Between Fatty Acid and Renal Cancer Risk

• Zhang L, Shi X, Yue C, Gao S and Zuo L
• The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, China

Abstract: Introduction and Objectives: Fatty acids play a critical role in carcinogenesis and cancer progression. While the casual association between fatty acids and renal cancer risk remains unclear. In this study, we aimed to investigate the casual association between fatty acids and renal cancer risk using bidirectional two sample mendelian randomization analysis. Materials and Methods: Genome-wide association studies (GWAS) summary data for fatty acids, including total fatty acid (Total FA), saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), omega-3 fatty acid (Omega-3), Docosahexaenoic acid (DHA), omega-6 fatty acid (Omega-6), Linoleic acid (LA), were separately obtained from the UK Biobank and Kettunen J et al.’s study. GWAS summary data for renal cancer were acquired from FinnGen database. The primary assessment of causality relied on inverse-variance weighted (IVW) results, while MR-Egger and weighted median analyses served as supplementary methods. Sensitivity analysis was conducted utilizing two approaches: Cochran’s Q test and MR-Egger intercept test. Reverse MR Analysis was used to eliminate reverse causality. Using multivariable MR (MVMR) straightening renal cancer known risk factors. Results: This MR Study showed that total FA, SFA, MUFA, Omega-3, DHA, Omega-6, and LA increased the risk of renal cancer (Total FA: OR = 1.26, 95%CI: [1.06–1.50], p = 0.009; SFA: OR = 1.34, 95%CI: [1.10–1.64], p = 0.003; MUFA: OR = 1.37, 95%CI: [1.14–1.66], p < 0.001; Omega-3: OR = 1.24, 95%CI: [1.05–1.46], p = 0.012; DHA: OR = 1.32, 95%CI: [1.07–1.63], p = 0.009; Omega-6: OR = 1.39, 95%CI: [1.17–1.65], p < 0.001; LA: OR = 1.21, 95%CI: [1.00–1.46], p = 0.045), while renal cancer had no effect on fatty acids. MVMR analysis showed that fatty acids could affect renal cancer independently of BMI and other risk factors. Conclusions: Collectively, this study revealed that genetically predicted metabolic levels of Total FA, SFA, MUFA, Omega-3, DHA, Omega-6, and LA are casually associated with an increased risk of renal cancer.

5.11.13. UP-11.13: Multiple Renal Tumorectomies: A Matched Comparative Analysis of Robotic and Open Approaches (UroCCR Study N°60)

• Margue G ¹, Debard C ¹, Klein C ¹, Doumerc N ², Dariane C ³, Bruyere F ⁴, Rizk J ⁵, Lebacle C ⁶, Bigot P ⁷, De La Taille A ⁸, Lang H ⁹, Mejean A ¹⁰, Bensalah K ¹¹ and Bernhard J ¹

¹ 

Bordeaux University Hospital, Bordeaux, France

² 

Toulouse University Hospital, Toulouse, France

³ 

HEGP—APHP, Paris, France

⁴ 

Tours University Hospital, Tours, France

⁵ 

HP La Louvière, Lille, France

⁶ 

Kremlin-Bicêtre APHP, Paris, France,

⁷ 

Angers University Hospital, Angers, France

⁸ 

Henri Mondor—APHP, Paris, France

⁹ 

Strasbourg University Hospital, Strasbourg, France

¹⁰ 

HEGP APHP, Paris, France

¹¹ 

Rennes University Hospital, Rennes, France

Abstract: Introduction and Objectives: In patients with multiple renal tumors, the risk of recurrence is high. It is therefore essential to achieve nephron-sparing surgery (NSS) to preserve the renal parenchyma as much as possible. Because of their complexity, these procedures are usually performed using an open approach. Our aim was therefore to compare the robot-assisted approach (RAPN) with the open approach (OPN) for multiple tumorectomies. Materials and Methods: We conducted a multicentric retrospective study including all patients undergoing surgery for multiple renal tumors between June 2007 and March 2023. Clinical data were collected prospectively, after written consent, in the French kidney cancer research network database UroCCR (CNIL DR 2013–206; NCT03293563). A comparison of RAPN and OPN was performed after matching (1:1) for age, sex, and RENAL score. Results: A total of 212 patients had multiple renal tumorectomies (46 NPO and 166 RAPN) and 92 patients were included in the matched analysis. The two cohorts were comparable for all preoperative characteristics except for single kidney and indication for NSS. There was a significant difference in the rate of main renal artery clamping, length of stay and, operating time. There was no significant difference for the other criteria, in particular blood loss and rates of complications, positive margins, and trifecta satisfaction (Table 1). Recurrence-free survival at 1 year was 89.7% for OPN and 81.4% in RAPN and recurrence-free survival at last follow-up was respectively 76.2% and 73.3% with a median follow-up of 29.9 months. Conclusions: Robotic approach for NSS in patients with multiple ipsilateral renal tumors is feasible and safe. RAPN and OPN allows good functional and oncological outcomes with the advantage of shorter lengths of stay for the minimally invasive approach.

5.11.14. UP-11.14: Outcomes in Partial Nephrectomy of Renal Lesions Clinical Stage T1a and T1b. Is Active Surveillance of Small Renal Masses Feasible?

• Morales Pinto S, García Góngora B, Lanza Pérez M, Saez Barraquero F and Herrera Imbroda B
• University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

Abstract: Introduction and Objectives: Partial nephrectomy is the treatment of choice for clinical stage T1 renal tumors whenever possible. However, a higher frequency of benign histologies and a better prognosis have been observed in lesions < 4 cm, which could imply overtreatment. Our goal is to compare the results of our partial nephrectomies in cT1a renal lesions versus cT1b. Materials and Methods: A retrospective and inferential analysis was conducted on 169 cT1a renal lesions and 64 cT1b lesions treated with minimally invasive partial nephrectomy between 2006 and 2022. Perioperative, histological, and survival outcomes of both groups were compared using Chi-square or Mann-Whitney U tests for statistical analysis. Results: The demographic characteristics of both groups were similar. The average lesion size was 2.87 cm in cT1a and 5.08 cm in cT1b. There were no differences in mean surgical time or conversion rates. The mean ischemia time was higher for cT1b lesions (20.98 min vs. 24.18 min, p = 0.01), with a higher frequency of urinary tract opening observed (23.7% vs. 50%, p = 0.001). However, there were no differences in postoperative complications (Clavien > III in < 15% of cases). A higher incidence of non-tumoral histology was observed among cT1a lesions (3.6% vs. 1.6%), but these differences were not significant. Additionally, there was a slightly higher frequency of benign histologies among lesions <3 cm, such as oncocytomas (8.7% vs. 8.6%) and angiomyolipomas (9.7% vs. 5.5%). There were more positive margins among cT1b lesions (25.8% vs. 11.2%, p = 0.006). Recurrence and overall cancer-specific survival were comparable between both groups. Conclusions: A higher frequency of lesions with non-tumoral or benign histology was observed among cT1a, which would support the surveillance proposal for tumors smaller than 4 cm.

5.11.15. UP-11.15: Preliminary Efficacy and Safety Results of Tislelizumab (T) and Axitinib (A) Combined with Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Oligometastatic Renal Cell Carcinoma (omRCC)

• Gan X, Dong K and Wang L
• The First Affiliated Hospital, Naval University, Shanghai, China

Abstract: Introduction and Objectives: SBRT has become standard of care for pts with oligometastatic renal cell carcinoma. Increasing evidence shows that SBRT can not only eliminate tumors at primary or metastatic sites, but also enhance the antitumor immune response. The aim of this study is to investigate the efficacy and safety of T plus A combined with SBRT in the treatment of omRCC. Materials and Methods: Patients who had histologically confirmed renal cell carcinoma with oligometastases (≤5 lesions) and had not received any prior systemic therapy were enrolled. One course of SBRT (30–40 Gy/6–8 fractions) was given to all metastatic lesions. T (200 mg IV q3w) and A (5 mg bid PO qd) were given 7 days after SBRT until disease progression, intolerable toxicity or consent withdrawal. The primary endpoint was objective response rate (ORR) according to RECIST v1.1. The secondary endpoint were progression free survival, overall survival and safety. Results: From September 2022 to December 2023, 10 patients were enrolled, including 8 with bone metastasis, 1 with adrenal metastasis, 2 with retroperitoneal lymph node metastasis, and 1 with pancreatic metastasis. Median number of metastatic sites was 2. Overall, ORR was 80% and DCR was 90% (CR = 1, PR = 7, SD = 1, PD = 1). No new safety signals were observed and no treatment-related death occurred. Conclusions: The preliminary results of T plus A combined with SBRT shows promising efficacy and safety in the treatment of omRCC. Further recruitment is ongoing.

5.11.16. UP-11.16: Re-Do Robot-Assisted Vena Cava Thrombectomy: Feasibility and Results

• Margue G ¹, Khaddad A ¹, Allenet C ¹, Luyckx F ², Yacoub M ¹, Estrade V ¹, Alezra E ¹, Capon G ¹, Bladou F ¹, Robert G ¹, Gross-Goupil M ¹ and Bernhard J ¹

¹ 

Bordeaux University Hospital, Bordeaux, France

² 

Centre Clinical de Soyaux, Soyaux, France

Abstract: Introduction and Objectives: The aim was to present the surgical management of vena cava carcinomatous thrombus recurrence using a robot-assisted laparoscopic approach. Materials and Methods: The surgery was performed using the Da-Vinci Xi surgical robot (Intuitive surgical). We used 3 operative arms, a 30° optic and 2 trocars (5 and 12 mm) for the assistant. Thrombus extension was assessed using an intraoperative ultrasound (Hitachi). Results: Our patient was a 59-year-old man in good general condition, who underwent a right radical nephrectomy with vena cava thrombectomy using a subcostal incision in November 2021 for a clear cell renal cell carcinoma, Fuhrman 4, pT3b, N0 R0. A local recurrence of an isolated suspended vena cava thrombus was detected on a follow-up scan in August 2022. The PET scan showed hypermetabolism of the thrombus and surgical management of this recurrence was validated. A robot-assisted vena cava thrombectomy was performed. Surgery lasted 4 h and 20 min, with 16 min of vena cava clamping and an estimated blood loss of 300 cc. The postoperative course was uncomplicated. Pathological analysis confirmed a clear cell renal cell carcinoma, Fürhman 3, invading the venous wall, with negative margins. Conclusions: In the case of vena cava carcinomatous thrombus recurrence, minimally invasive salvage surgery is feasible with low morbidity in selected patients. It should be considered as an alternative to systemic treatment, thereby allowing therapeutic savings.

5.11.17. UP-11.17: Reliability of the IDENTIFY Calculator in Stratifying Risk of Urothelial Carcinoma in Patients with Haematuria: An Initial Evaluation at an Australian Centre

• Rival P, Ooi L, Lim H, Varughese A, Pandey M, Dowling C and Sengupta S
• Eastern Health, Melbourne, Australia

Abstract: Introduction and Objectives: Haematuria necessitates efficient risk stratification to identify patients at risk for urothelial carcinoma (UC). This study evaluates the efficacy of the IDENTIFY calculator in stratifying UC risk among patients presenting with haematuria, with a focus on optimising diagnostic pathways and resource allocation. Materials and Methods: We retrospectively assessed 89 patients referred for haematuria over one year at a single Australian centre. Utilising the IDENTIFY calculator, we retrospectively classified patients into risk groups (very low, low, intermediate, high) based on their UC risk. The outcomes of diagnostic investigations were then analysed relative to these risk stratifications. Ethics approval was obtained from Eastern Health. Results: The cohort was primarily referred from primary care (70%), with the remainder from emergency departments (24%). Visible haematuria was reported in 67% of cases, with a male majority (62%) and most patients over 50 years of age (75%). Diagnostic assessments included urine cytology (69%), CT IVP (57%), and cystoscopy (78%, with biopsies in 9%). The IDENTIFY calculator accurately categorised all UC-diagnosed patients into high (4/5) or intermediate (1/5) risk groups, guiding the appropriate diagnostic urgency and potentially mitigating unnecessary investigations for those at lower risk. Median times to cystoscopy varied across risk groups, from 2.3 weeks in intermediate-risk to 6 weeks in low-risk patients, illustrating the tool’s matching capacity to prioritise care based on UC risk. Conclusions: The IDENTIFY calculator presents a novel approach in the risk stratification of UC among haematuria patients, surpassing traditional visible vs. non-visible haematuria categorisations. By prioritising high- and intermediate-risk patients for urgent diagnostics and advising more conservative approaches for those at lower risk, the tool promises to enhance clinical decision-making, reduce invasive investigations, and focus resources on those most in need. Larger-scale studies are needed to confirm these findings and further explore the calculator’s integration into clinical practice.

5.11.18. UP-11.18: Survival Benefit of Nephroureterectomy in Systemic Therapy Exposed Metastatic Upper Tract Urinary Urothelial Carcinoma Patients

• Morra S ¹, Scheipner L ¹, Baudo A ¹, Tian Z ¹, Creta M ², Califano G ², Colla’ Ruvolo C ², Saad F ¹, Shariat S ³, Chun F ⁴, De Cobelli O ⁵, Musi G ⁵, Briganti A ⁶, Tilki D ⁷, Ahyai S ⁸, Carmignani L ⁹, Longo N ², Karakiewicz P ¹, Incesu R ¹, Jannello L ¹, Siech C ¹, De Angelis M ¹ and Di Bello F ²

¹ 

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada

² 

Federico II University of Naples, Italy

³ 

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

⁴ 

University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany

⁵ 

IEO European Institute of Oncology, Milan, Italy

⁶ 

IRCCS San Raffaele Institute, Milan, Italy

⁷ 

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

⁸ 

Department of Urology, Medical University of Graz, Graz, Austria

⁹ 

Department of Urology, IRCCS Policlinico San Donato, Milan, Italy

Abstract: Introduction and Objectives: It is unknown whether the stage of the primary may influence the survival (OS) of metastatic upper tract urothelial carcinoma (mUTUC) patients treated with nephroureterectomy (NU) and systemic therapy (ST). We tested this hypothesis within a large-scale North American cohort. Materials and Methods: Within the Surveillance Epidemiology and End Results database 2000–2020, all mUTUC patients treated with ST + NU or with ST alone were identified. Kaplan-Maier plots depicted OS. Multivariable Cox regression (MCR) models tested for differences between ST + NU and ST alone predicting overall mortality (OM). All analyses were performed in localized (T1–T2) and then repeated in locally advanced (T3–T4) patients. Results: Of all 728 mUTUC patients, 187 (26%) harbored T1-T2 vs. 541 (74%) harbored T3-T4. In T1-T2 patients, the median OS was 20 months in ST + NU vs. 10 months in ST alone. Moreover, in MCR analyses that also relied on three months’ landmark analyses, the combination of ST + NU independently predicted lower OM (HR 0.37, p < 0.001). Conversely, in T3-T4 patients, the median OS was 12 in ST + NU vs. 10 months in ST alone. Moreover, in MCR analyses that also relied on three months’ landmark analyses, the combination of ST + NU was not independently associated with lower OM (HR:0.85, p = 0.1). Conclusions: In mUTUC patients, treated with ST, NU drastically improved survival in T1-T2 patients, even after strict methodological adjustments (multivariable and landmark analyses). However, this survival benefit did not apply to patients with locally more advanced disease (T3–T4).

5.11.19. UP-11.19: The Efficacy and Safety of Presurgical Therapy with Tislelizumab and Axitinib for Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus

• Wang X
• The First Affiliated Hospital of Xiamen University, Xiamen, China

Abstract: Introduction and Objectives: There is no currently consensus on presurgical therapy for renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus. Tyrosine kinase inhibitor (TKI) combined with immune checkpoint inhibitor (ICI) had shown a survival benefit in metastatic RCC patients in clinical trials. However, the efficacy of presurgical therapy with combined ICI and TKI for nonmetastatic RCC with IVC tumor thrombus has not been adequately investigated. Materials and Methods: We retrospectively evaluated 7 patients of nonmetastatic RCC with IVC tumor thrombus treated with tislelizumab and axitinib as presurgical therapy and radical nephrectomy and tumor thrombectomy at the First Affiliated Hospital of Xiamen University from May 2020 to December 2022. The IVC tumor thrombus improvement by Mayo level and diameter were evaluated on magnetic resonance imaging (MRI), and clinical response of primary renal mass and adverse events (AEs) were retrospectively collected. Results: 7 RCC with IVC tumor thrombus patients received neoadjuvant tislelizumab combined axitinib for 3 cycles, with a median age of 62 (50–72) years. 57.1% (4/7) were Mayo level 2 tumor thrombus and 42.9% (3/7) were Mayo level 3. At follow-up after systematic therapy, 57.1% (4/7) patients had a reduction in Mayo level of tumor thrombus. The median decrease in thrombus diameter and length was 5.3 (1.8–17.2) mm and 18.5 (4.4–41.5) mm, respectively. The overall response rate (ORR) in primary renal mass was 57.1% (4/7) with 4 partial responses (PR). Radical nephrectomy and thrombectomy were performed for all 7 patients at 1.5 months after finish of presurgical therapy. 3 patients were planned to have hepatic vein clamping and liver mobilization but following treatment, neither of these manoeuvers was needed. The most common AE were all grade 1–2, only 1 patient occurred grade 4 liver function injury which did not affect normal operation after symptomatic treatment. During a median follow-up of 24.9 (14.0–45.0) months, only 1 patient had local IVC tumor thrombus metastasis, disease recovered stabilized after stereotactic radiotherapy. Conclusions: Presurgical therapy with tislelizumab and axitinib for RCC patient could be effective in reducing IVC tumor thrombus and were able to undergo easier radical surgery without serious AE.

5.11.20. UP-11.20: The Impact of Sarcopenia on Partial Nephrectomy’s Outcomes

• Duarte S, Pinheiro A, Felício E, Bernardo G, Gaboleiro F, Pita A, Furtado A, Silva A and Ferrito F
• Hospital Prof. Dr Fernando Fonseca, Amadora, Portugal

Abstract: Introduction and Objectives: Renal cell carcinoma represents about 3% of all cancers. Malnutrition and sarcopenia are common between patients with malignancies. The progressive loss of muscle mass and strength increase the risk of complications. Psoas muscle area (PMA) at the L4 vertebral level, is a proper sarcopenia measurement. Partial nephrectomy (PN) is the preferred approach for small renal masses. Despite its irrevocable benefits, it’s associated with high complication rates (30%). Patients’ characteristics and frailty are predictors of surgical complications. The aim of this study is to compare the complication rate, likelihood of chronic kidney disease (CKD) progression and prognosis between sarcopenic patients (SP) and non-sarcopenic (NSP), submitted to PN. Materials and Methods: A retrospective observational study was made using data from 96 patients submitted to PN, from 2013 to 2023. We excluded 7 patients. We used cross-sectional images from computed tomography scans at L4 level and OsiriX to calculate PMA and assess the presence of sarcopenia, supported by Sarcopenia T-score calculator from Morphomics^®. Statistical analyses were performed using IBM SPSS Statistics. The chi-square test was used to evaluate associations. Recurrence-free survival (RFS) and overall survival (OS) curves were generated using Kaplan-Meier method and compared using the log-rank test. For all statistical analyses, p < 0.05 was considered statistically significant. Results: From the 89 patients, 65 (73%) were NSP and 24 (27%) were SP. Comorbidities such as hypertension, diabetes and CKD were similar (p = 0.425, p = 0.995 and p = 0.518). Warm ischemia time (WIT) (17 min vs. 21 min, p = 0.075), mean surgical time (p = 0.938) and overall perioperative complications (p = 0.095) were similar. The main differences were: trifecta achievement (58.7% vs. 33.3%, p = 0.034), higher ISUP grades in SP (p = 0.029) and positive margins (11.3% vs. 42.9%, p = 0.002). No differences were identified in CKD progression (p = 0.183). Worth mentioning that WIT wasn’t associated with CKD progression (p = 0.285). Recurrence rates (local and distant) were higher in SP (p = 0.027 and p = 0.023) but no differences were seen in RFS and OS (p = 0.815 and p = 0.338). Conclusions: Being sarcopenic isn’t associated with more surgical complications, higher likelihood of CKD progression or worse OS. Nonetheless, SP may have poorer prognosis, since it is more difficult to achieve the trifecta and the recurrence rates are higher.

5.11.21. UP-11.21: Therapeutic Ureterorenoscopy for High-Risk Upper Tract Urothelial Cancer: A Single-Center Experience

• Gaspar F ¹, Morais A ², Lopes F ¹, Freitas R ² and Braga I ²

¹ 

Hospital Egas Moniz, ULSLO, Lisbon, Portugal

² 

IpoPorto, Porto, Portugal

Abstract: Introduction and Objectives: The standard of care for high-risk localized upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU). However, this population is very heterogenous regarding prognosis. A subgroup of “favourable high-risk” patients has been recently recognized in which a kidney-sparing approach may ensure adequate oncological control. The aim of our work is to present a population of high-risk UTUC patients managed with therapeutic ureterorenoscopy (URS). Materials and Methods: We performed a retrospective study by reviewing the clinical records of patients submitted to therapeutic URS for high-risk localized UTUC (EAU classification), both elective or imperative indications, from January of 2018 to June of 2023 in our institution. Demographics, clinical and tumour variables at presentation, pathological details and oncological outcomes were collected. Disease-free survival (DFS) status was defined as the absence of any clinical event, namely local recurrence, bladder recurrence, transition to RNU, distant recurrence or death. Results: Eleven patients were included. 7 (64%) were male and the mean age at diagnosis was 71 ± 4 years old. Four patients (36%) had previous history of bladder urothelial carcinoma (UC). Biopsy high grade UC was present in 3 cases (27%). The most common high-risk feature was lesion size > 2 cm (n = 9; 82%). Three cases (27%) had imperative indication (single kidney) for kidney-sparing approach. Follow-up data was available for 10 patients with a mean follow-up was 27.5 ± 3 months and an average of 3 surgeries per patient. Local recurrence was observed in 30% (n = 3) and bladder recurrence was observed in 33.3% (n = 3). One case transitioned to RNU at 25 months of follow-up. There were no cases of metastization or death. DFS status was observed in 40% (n = 4) of the patients with any event taking place after an interval of mean 11 ± 3 months from the first surgery. Conclusions: Our results suggest that favourable high-risk UTUC patients may be good candidates to therapeutic URS given the absence of metastization or death. However, our results also underline the need for close follow-up due to an important recurrence rate, which occurred in more than half of the patients.

5.12. Minimally Invasive Surgery/Robotics

5.12.1. UP-12.01: Comparative Analysis of Perioperative, Oncological, and Functional Outcomes in Robotic and Laparoscopic Surgery: A Study of 1121 Radical Prostatectomies

• Morales Pinto S, Amores Vergara C, Martín Jimenez S, Cantero Mellado J, Martín Jimenez S and Herrera Imbroda B
• University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

Abstract: Introduction and Objectives: The management of prostate cancer through radical prostatectomy (RP) remains the most established treatment option. With the introduction of various minimally invasive techniques, results have been achieved that offer benefits to patient comorbidity without compromising oncological safety. Our goal is to compare the surgical, oncological, and functional outcomes of laparoscopic radical prostatectomy with those of robotic surgery. Materials and Methods: We conducted a retrospective descriptive study, including 1121 patients who underwent laparoscopic radical prostatectomy between 2004 and 2023, and robotic radical prostatectomy between 2020 and 2023. Univariate and multivariate analysis was performed using Cox regression. Results: Robotic prostatectomy demonstrates superiority in terms of biochemical recurrence rates (p = 0.009) and metastatic progression (p = 0.283). However, laparoscopic surgery has shown a lower presence of positive surgical margins in the surgical specimen (p = 0.001). Robotic surgery presents lower rates of conversion to open surgery (p = 0.044), shorter surgical time (p = 0.98), less intraoperative bleeding (p = 0.007) although with similar transfusion needs in both groups; shorter hospital stay (p = 0.001), and lower drainage output (p < 0.001). Intra and postoperative complications, although rare in both, have been reduced in robotic surgery, with a decrease in rectal and bladder injuries, and transfusion requirement (p < 0.005). Additionally, a lower risk of paralytic ileus, urethrovesical stenosis, and urinary leakage (p < 0.05). Regarding functional outcomes, severe urinary incontinence has been lower in patients undergoing robotic surgery (p = 0.04). No statistically significant differences have been found in sexual potency. Conclusions: The presented data demonstrate the advantages of robotic surgery in terms of the perioperative outcomes previously mentioned, achieving a reduction in hospital stay and bleeding. It also presents advantages in terms of biochemical recurrence rates and conversion to open surgery. Regarding functional outcomes, it shows a lower percentage of patients with severe urinary incontinence. These results should be taken into account when choosing the best surgical technique for our patients.

5.12.2. UP-12.02: Comparing Perioperative Outcomes of Robotic and Laparoscopic Partial Nephrectomy

• Morales Pinto S, Lanza Pérez M, Cantero Mellado J, Herrera Imbroda B and Martín Jimenez S
• University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

Abstract: Introduction and Objectives: Partial nephrectomy is the preferred treatment for cT1 renal masses, with minimally invasive approaches such as laparoscopic and, more recently, robotic surgeries gaining widespread acceptance. While robotic surgery techniques offer potential advantages that could positively impact perioperative outcomes, controversy remains. We aim to compare the outcomes of robotic partial nephrectomy versus laparoscopic procedures in our center. Materials and Methods: A retrospective review was conducted on 186 patients who underwent laparoscopic partial nephrectomy (LPN) and 46 patients who underwent robotic partial nephrectomy (RPN) between 2006 and 2022. Demographic characteristics of the patients and lesions, as well as intra- and postoperative variables, including the R.E.N.A.L. Score and the Trifecta index, were collected. A comparative analysis was performed using the Chi-square test or Mann-Whitney U test, with a significance level of p < 0.05. Results: Both groups were comparable in terms of demographic characteristics and characteristics of the intervened lesions. The R.E.N.A.L. Score was calculated, showing no significant differences in the mean score or grades of difficulty. There were no differences in the mean surgical time: 158.7 min for LPN compared to 165 min for RPN (p = 0.18), or in the mean ischemia time: 22.4 min compared to 19.3 min respectively (p = 0.19). Statistically significant differences were found regarding intraoperative bleeding, favoring RPN (90 cc vs. 284 cc, p = 0.001), with no differences in the need for transfusions. Robotic procedures had a higher conversion rate (11%, 6 cases) compared to laparoscopic procedures (2.2%, 4 cases) (p = 0.001). Both groups had a similar percentage of positive margins below 20%. There were no differences in postoperative complications (Clavien > III in < 11% in both groups). The mean hospital stay was significantly shorter in the RPN group (2.8 days vs. 3.6 days, p = 0.006). In both groups, the Trifecta index was higher than 55%. Conclusions: In our series, robotic partial nephrectomy exhibited more favorable outcomes regarding intraoperative bleeding and hospital stay, albeit with a higher percentage of conversions compared to the laparoscopic approach.

5.12.3. UP-12.03: Descriptive Analysis of the First Thousand Prostatectomies Performed with Minimally Invasive Surgery (Laparoscopic or Robotic) After the Diagnosis of Prostate Cancer

• Herrera Imbroda B ¹, Martín Jimenez S ¹, Amores Vergara C ², Cantero Mellado J ¹ and Morales Pinto S ¹

¹ 

University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

² 

Virgen de la Victoria University Hospital, Malaga, Spain

Abstract: Introduction and Objectives: Prostate cancer (PCa) is the most common malignancy. Laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) is one of the widely accepted alternatives in PCa treatment at experienced centers. We present the surgical, oncological, and functional outcomes of our series of radical prostatectomies in our latest 1000 consecutive cases. Materials and Methods: A retrospective review was conducted in our database from January 2004 to December 2022. Clinical data, preoperative oncological data, operative data, and oncological and functional data post-treatment were obtained, followed by a descriptive statistical analysis of the variables studied. Results: Preoperative analysis: The mean age was 62.62 years (SD: 6.1 years). The mean PSA at diagnosis was 9.18 ng/dL (SD 7.6 ng/dL). Gleason score 6 (ISUP1) in 37.9%, 7 (ISUP2) = 29.6%, 7 (ISUP3) = 17.9%, and ≥ 8 (ISUP4–5) = 14.6%. Operative data: 834 LRP (83.4%) and 166 RARP (16.6%) were performed. The median surgical time was 174 min (IQR: 25–75%: 145–200 min), with a blood loss during surgery of 300 mL (SD 222 mL). The neurovascular bundle approach was extrafascial in 15%, interfascial in 52.1%, intrafascial in 14.4%, and a combination of approaches based on laterality and tumor involvement in 18.4%. The median hospital stay was 3.32 days (IQR:25–75%: 2–3 days), with a conversion rate of 1.6% and a transfusion rate of 2.9%. Oncological data: pathological stage pT0 in 0.3% (3 cases), pT2a in 13.1% (131 cases), pT2b in 3.3% (33 cases), pT2c in 59.3% (593 cases), pT3 in 23.7% (237 cases), and T4 in 0.3% (3 cases). Postoperative Gleason score 6 (ISUP1) = 27.1%, 7 (ISUP2) = 35%, 7 (ISUP3) = 23.9%, and ≥ 8 (ISUP4–5) = 13.8%, with no tumor in 0.2% (2 cases) and a positive surgical margin rate of 36% of the total series. The biochemical recurrence rate was 17.8%, with a median follow-up of 63 months and a cancer-specific survival rate of 98.9%. Functional data: urinary continence preservation was 75.2%, and the rate of erectile dysfunction unresponsive to medical treatment was 53.5%. Conclusions: Laparoscopic and robotic radical prostatectomy are safe techniques, with satisfactory oncological outcomes and acceptable functional results. At this time, they should be considered as the technique of choice.

5.12.4. UP-12.04: Extraperitoneal Laparoscopic Adenomectomy: Description of the Surgical Technique

• Tagalos Muñoz A, García Barreras S, Mínguez Ojeda C, Mata Alcaraz M, López Curtis D, Fernandez Mardomingo A, Del Olmo Durán P, Fernández Conejo G, Sanz Mayayo E, Rodríguez-Patrón Rodríguez R and Burgos Revilla F
• Ramón y Cajal University Hospital, Madrid, Spain

Abstract: Introduction and Objectives: Lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) are highly prevalent. Once medical treatment has failed, surgical treatment is considered. Bipolar transurethral resection, as well as holmium laser enucleation of the prostate (HoLEP), are reflected as gold standards in clinical guidelines. However, in glands > 80 g, open adenomectomy is still practiced. Extraperitoneal laparoscopic adenomectomy (AL) is a minimally invasive option for these cases. Our aim is to describe the step-by-step AL technique performed at our center. Materials and Methods: Indication criteria at our hospital are: prostatic volume > 80 g, absence of urinary catheter, and absence of intravesical stones. The laparoscopic approach over open surgery provides significant advantages for the patient: lower risk of bleeding, less pain, fewer postoperative complications, as well as shorter hospital stay, achieving very satisfactory and long-lasting functional results (IPSS, Q max, ICIQ-SF). Results: We present a descriptive video of the surgical technique of AL. Conclusions: AL plays a relevant role in large prostates as it is a safe and effective technique with short hospital stays and a low rate of postoperative complications, yielding excellent functional outcomes.

5.12.5. UP-12.05: Local Excision and Not Radical Cystectomy for Bladder Paraganglioma: Findings and Learning from Three Cases in 1 Year

• Whyte E, Arora A and Nambiar A
• Freeman Hospital, Newcastle-upon-Tyne, United Kingdom

Abstract: Introduction and Objectives: Bladder paraganglioma is a rare tumour originating from chromaffin cells in the sympathetic nervous system. It accounts for 0.06% of bladder tumours and 10% of extra-adrenal paragangliomas, and has a strong genetic component present in 40% of cases. Patients may present with haematuria, paroxysmal hypertension during micturition, or generalised symptoms including headaches, blurred vision, flushing and palpitations associated with increased catecholamine levels. Materials and Methods: Three cases from a single surgeon, single site over 1-year. Results: Patients (1 male, 2 female) were aged between 27–77 years. Two were asymptomatic at presentation. Bladder paraganglioma was confirmed in one asymptomatic patient (patient 1) via endocrinological investigations, and in patient 2 via ultrasound detection of an incidental bladder mass. The youngest (patient 3) presented symptomatically with significant haematuria requiring urgent endoscopic management. Patients 2&3 had resection biopsies confirming paraganglioma. All underwent staging imaging (including neck) and measurement of plasma metanephrine levels. All patients had functional paragangliomas with raised normatenephrine levels and required pre-operative androgen blockade. Patient 3 also had an enlarged external iliac lymph node (PET active). All patients were successfully managed with robotic excision of the paraganglioma and partial cystectomy (lymph node excision in 1 case), with no short- to medium-term complications/recurrence. Hospital stay duration ranged from 1–5 days. Conclusions: Bladder paragangliomas are a rare but important differential especially in younger patients presenting with haematuria. All patients presenting with a paraganglioma should have an assessment of their plasma metanephrine levels and full body imaging including the neck to help with management planning. If a patient has a confirmed functional paraganglioma they will require androgen blockade pre-operatively. These tumours can be treated successfully with local excision and, when the bladder is involved, the treatment of choice should be a partial, rather than radical, cystectomy. Nodal metastases can be treated by excision of the involved lymph node.

5.12.6. UP-12.06: Non-Closure Partial Nephrectomy Technique in Complex Hilar Tumors: Analysis of Perioperative, Oncologic and Functional Outcomes

• Yebes A ¹, Pérez-Marchán M ², Lopez H ² and Cadillo-Chávez R ²

¹ 

Department of Urology, La Paz University Hospital, Madrid, Spain

² 

Center for Advanced Urology & Robotic Surgery, Bayamón Medical Center, Bayamón, Puerto Rico

Abstract: Introduction and Objectives: Complex renal tumors in hilar location represent a surgical challenge due to the higher risk of bleeding and their difficult reconstruction because of their proximity to vascular structures. The non-closure technique for robotic assisted partial nephrectomy (RAPN), in which the parenchymal external suture is omitted, seeks to minimize warm ischemia time and renal function damage while maintaining effective bleeding control. The aim of this study was to assess perioperative and follow-up outcomes in our patients. Materials and Methods: Data for patients undergoing transperitoneal RAPN with non-closure technique by a single surgeon (RCC) between years 2017 and 2024 was collected. These patients were treated by enucleoresection of the tumor. A single-layer at the corticomedullary junction of the defect (base) was used for hemostasia. Defect was not closed due to its proximity to the renal hilum and/or lack of renal parenchyma to reconstruct it (outer layer). Perioperative performance and safety as well as follow-up outcomes were assessed. Results: Thirty-five patients were identified with a mean age of 58.3 years old and 71.4% were male. The mean preoperative hemoglobin and eGFR values were 14.0 g/dL and 67.8 mL/min/1.73 m². An 80% of the tumors had hilar location. They were classified as high (85.7%) and medium complexity (14.2%) tumors according to the R.E.N.A.L. score. The mean operative time was 178 min and warm ischemia time was 19.6 min (all cases were performed with arterial or en-bloc clamping). Collecting system entry occurred in 26 (74%) patients. Intraoperative complications occurred in 2 cases, related to segmental branch bleeding. The mean EBL was 130 mL and mean length of stay was 1 day. Only one patient required postoperative blood transfusion (Clavien-Dindo 2). No additional complications were observed. Renal function parameters normalized during follow-up. There were no positive margins and only one patient had distant recurrence during follow-up. Conclusions: In our experience, the non-closure technique seems to be a feasible procedure allowing to maintain good functional and oncologic results. RAPN avoiding cortex closure may be a safe technique to consider in complex hilar renal tumors.

5.12.7. UP-12.07: Residual Stones in PCNL Trajectory—Retroperitoneoscopic Exploration with Nephroscopy and Partial Nephrectomy

• Cardoso A, Capinha M, Laranjo Tinoco C, Araújo A, Pinto L, Coutinho A, Torres J and Carvalho-Dias E
• Unidade Local de Saúde de Braga, Braga, Portugal

Abstract: Introduction and Objectives: Management of residual stones and complications after percutaneous nephrolithotomy (PCNL) can be challenging. Narrow, long and angled infundibulum calyces, especially in lower pole, difficult endoscopic access. Parenchymal calcifications in PCNL trajectory, particularly when contacting the collecting system may grow, infect or cause pain. In some cases, the ideal approach is not obvious and multiple strategies can be used. Thus, we report an unusual retroperitoneoscopic exploration with nephroscopy followed by partial nephrectomy (PN). Materials and Methods: An obese 60-year-old man had been submitted to PCNL 5 years before. CT-scan revealed a high density calculi conglomerate on the lower calyceal group of the left kidney, with parenchyma atrophy and suspected extrusion to posterior perirenal fat, perhaps in previous PCNL trajectory. Thus, retroperitoneoscopic exploration for stone extraction and possibly PN was proposed. Using Hasson technique, the 1st 10 mm trocar is placed near the 12th rib tip. Retroperitoneal space is created with balloon. Then, 2 trocars are placed under finger guidance, after feeling for the iliacus and psoas muscles and renal fascia. The renal artery is immediately encountered and referenced. Perirenal fat is dissected, but calcifications are inapparent. Atrophic parenchyma is opened and calyceal exploration begins. Residual lithiasis is cleared using suction and saline instillation, and forceps extraction. Semirigid ureteroscope is inserted through a trocar and nephroscopy is performed. Hydrophilic guidewire is used to search for narrow infundibulum hidden calyces, but they are not encountered. Thus, PN is performed. Results: Operative time was 100 min, and warm ischemia 20 min. Drain was removed on the 3rd day (< 100 cc/day). Chronic pyelonephritis was confirmed. After uneventful 9 months, the patient is asymptomatic, has stable creatinine, and CT-scan reveals calcifications’ resolution. Conclusions: Retroperitoneoscopy seemed ideal for this case: it allows direct access to renal artery and posterior kidney lesions, and avoids entrance in peritoneal cavity, relevant in cases of lithiasis and risk of urinary and bacterial leak. Limited working space, few anatomic landmarks and abundant fat difficult these surgeries, making precise positioning and ports’ placement crucial. As shown, obesity and prior percutaneous procedures do not always contraindicate retroperitoneoscopy. Thus, this technique seems a feasible, safe and effective option for similar cases.

5.12.8. UP-12.08: Retained DJ Stent—Experience at Tertiary Hospital

• Zain Us Zaman T ¹, G C ¹, V E ² and G S ¹

¹ 

Institute of Urology, Madras Medical College & RGGGH, Chennai, India

² 

Institute of Urology, RGGGH and MMC, Chennai, India

Abstract: Introduction and Objectives: Urology practice has evolved over the years, but one thing which has been vital throughout its development is the use of Double J (DJ) stent. It plays a vital part in most of the endo urological procedures and is frequently used in daily practice. However, one thing to be cautious about is that it should be removed timely without fail following the procedure. Our goal is to share our experience regarding patient presentation and our management. Materials and Methods: This study was done at our tertiary care centre and we have analyzed the post operative case records of patients that been diagnosed or presented with a forgotten stent during the period between February 2023 to the end of January 2024. Demographic information such as age, gender, indication for insertion of stent, duration since the stent has been inserted, symptoms with which the patient presented to our setup and the treatment modality the patient underwent to remove the stent and post operative complications were analyzed. Results: 20 cases were taken for the study. Of them, 14 patients (70%) underwent stenting at other hospital and 6 patients (30%) underwent previous treatment at our hospital. The patients included 13 male (65%) and 7 female (35%) patients. The mean age was 58.7 yrs. Mean duration of stent indwelling time was 15.6 months and ranged from 8 to 34 months. The most common indication for stenting was following URS 40% (n = 8). Presenting complaint ranged from dysuria (n = 6; 30%), recurrent infections of the urinary tract (n = 5; 25%), storage LUTS (n = 4; 20%) flank pain (n = 4; 20%), renal failure (n = 3; 15%), and some were diagnosed incidentally (Asymptomatic)(n = 4; 20%). Post-op complications following stent removal included fever (n = 8; 40%), sepsis (n = 2; 10%), hematuria requiring blood transfusion (n = 1; 5%) and fragmented stent on attempting removal (n = 1; 5%). However, 40% (n = 8) patients didn’t experience any complication. Conclusions: Forgotten DJ stents can cause significant morbidity and it is important to explain the patients regarding its complications. Also, it is necessary for the urologist to track the patient for stent removal by various methods.

5.12.9. UP-12.09: Robot-Assisted Radical Prostatectomy is Beneficial Regarding Urinary Incontinence and Erectile Dysfunction Compared to Open Radical Prostatectomy

• Brito-Lança M ¹, Andrade V ¹, Medeiros M ¹, Guerra J ¹, Gil M ¹, Veloso N ¹, Cunha J ¹, Silva P ¹, Pereira P ¹, Meireles A ¹, Gomes A ², Caceiro R ³, Carneiro C ¹, Severo L ¹, Pina J ¹ and Campos-Pinheiro L ¹

¹ 

Saint Joseph’s Local Health Unit, Lisbon, Portugal

² 

Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal

³ 

São Bernardo Hospital, Lisbon, Portugal

Abstract: Introduction and Objectives: The preservation of urinary continence and sexual function constitutes a main concern in radical prostatectomy (RP) since both are of crucial importance for future quality of life. Although the results regarding functional and oncological outcomes of robot-assisted radical prostatectomy (RARP) compared to open radical prostatectomy (ORP) remain inconsistent, RARP has become increasingly used worldwide. This study aims to compare patient-reported urinary incontinence (UI) and erectile dysfunction (ED) 1 year after RARP and ORP. Materials and Methods: This was a prospective and controlled study of patients undergoing radical prostatectomy (RARP or ORP) for localized prostate cancer, in a tertiary center. Patients who undergone RARP and ORP between 2016–2021 were selected. Clinical records and patient questionnaires—Daily Pad Questionnaire and IIEF-5—were collected at 12 months after surgery. Exclusion criteria were applied. Odds ratios (ORs) were calculated with logistic regression and adjusted for possible confounders. Results: 167 men who undergone RARP, and 147 men who undergone ORP were included. Regarding UI, 137 (82.0%) men after RARP and 112 (76.2%) men after ORP were continent at 12 months, respectively (adjusted OR: 1.132, 95% confidence interval [CI] 0.597–2.150). When considering < 67-year-old patients, 85% of men were continent at 12 months. Regarding ED, severe ED was present in 93 (55.7%) men who undergone RARP and in 105 (71.4%) men who undergone ORP at 12 months (adjusted OR: 0.429, 95% CI 0.233–0.790). The presence of severe ED at 12 months was considerably lower in patients under 65 and 60 years. For < 65-year-old patients, severe ED was present in 38.5% of men who undergone RARP and in 60.4% of men who undergone ORP (adjusted OR: 0.294, 95% CI 0.103–0.837). For < 60-year-old patients, it was present in 34.5% of RARP patients and in 61.1% of men who undergone ORP (adjusted OR: 0.104, 95% CI 0.011–0.958). Conclusions: In our cohort, RARP was beneficial in preserving erectile function compared to ORP in patients with localized prostate cancer, with better results for younger patients. On the other hand, RARP was associated with a higher probability of urinary continence, although without statistically significant difference.

5.12.10. UP-12.10: Robotic Management of Complex Ureteric Strictures

• Dsouza N
• Yenepoya Medical College Hospital, Mangalore, India

Abstract: Introduction and Objectives: Complex post surgical strictures are difficult to manage. The objective of this study is to demonstrate the technique and outcomes of robotic assisted management of complex ureteric strictures. Materials and Methods: We are presenting two cases of ureteric strictures, which were managed with robotic surgery. 1. 35/Male. Post renal transplantation. Developed peri ureteric collection. 2. 65/Male. Post radical cystectomy and ileal conduit. Developed mid ureteric stricture. Results: In 1st case, pelvi-ureterostomy was done with the native ureter. 5Fr/16 cm DJ stent placed. Stent removed after 6 weeks. Creatinine and urine output improved. In 2nd case, a buccal mucosal graft was taken to augment the stricture segment of ureter. 5Fr/26 cm DJ stent placed. Stent removed after 6 weeks. Creatinine and urine output improved. Conclusions: Robotic surgery is safe and effective management for complex ureteric strictures.

5.12.11. UP-12.11: Surgeons Perspective on Robotic Assisted Surgery in Oncosurgery: A Collective View from the Institute that Pioneered Laparoscopy in Oncosurgery

• Giridhar A ¹ and Sharma R ²

¹ 

Basavatarakam IndoAmerican Cancer Hospitals and Research Institute, Hyderabad, India

² 

IndoAmerican Cancer Hospital and Research Institute, Hyderabad, India

Abstract: Introduction and Objectives: To compare the views on robotic surgery vs. laparoscopy surgery from experienced laparoscopy surgeons practising oncosurgery including urooncosurgery; and to precisely opine on the factors that make surgeons adapt to operate the new robotic system, how easy it is, how it would impact the performance, what is its impact on social influence and what are the clinical benefits. Materials and Methods: The study used the Unified Theory of Acceptance and Use of Technology model (UTAUT) questionnaire, where data was collected by semi-interview using the questionnaire, eliciting the response for. 4 main domains, containing performance expectancy, effort expectancy, social influence and facilitating conditions, which determines the user acceptance, usage behaviour and its affect on surgeons practise. Results: The study comprised 10 onco-surgeons from a single institute. The responses to the specific domains were compared; the comments, related to the enhancement of the performance, showed 60% proadaptive, 27% neutral and 13% contraadaptive; perceived ease of use and complexity while operating robotic showed 46.67% proadaptive, 40% neutral and 13.33% contraadaptive; social influence and image 56% proadaptive, 36% contraadaptive and 8% neutral comments; facilitators like encouragement of organisation as well as technical support showed 90% proadaptive and remaining 10% were neutral. Conclusions: The institute had successfully adapted towards robotic surgical system although the ratio of operated on robotic system to laparoscopy was low, especially in gastrointestinal and gynecology oncosurgery. The reasons listed were limited indications, unfavourable anatomy, limited utility, limited evidence; further it was opined that laparoscopy is in par with robotic system when it comes to the final impact of surgery on patients except in few procedures; However in urooncology this system was much favoured because it had definite impact on patient outcome especially in prostatectomy and nephton sparing surgery. Apart from clinical impact the acceptance and adaptability was more in lesser laparoscopy experienced surgeons and the surgeons practising the uro-onco, further the younger generation surgeons who are just beginning their career, the robotic system made greater social influences and it’s regarded as a marketing tool building the surgeons and hospitals.

5.13. Miscellaneous

5.13.1. UP-13.01: Exploring the Frontier: A Systematic Review of AI in Urology

• Alsharrah S and Osman B
• West Midlands, University Hospitals Birmingham, Birmingham, United Kingdom

Abstract: Introduction and Objectives: Artificial intelligence (AI) stands at the forefront of innovation within the realm of urology, offering promising avenues to enhance diagnosis, treatment modalities, and the overall quality of patient care. The purpose of this review is to evaluate the influence of AI on patient outcomes and physician efficacy in urological practice, delving deep into the transformative potential of this groundbreaking technology. Materials and Methods: In February 2024, an extensive literature review was conducted utilizing prominent databases including MEDLINE, EMBASE, and Google Scholar. This rigorous approach ensured a comprehensive review of current research and developments in AI applications within the field of urology. Results: Our review encompassed over 20 articles, spanning a spectrum of urological specialties, including but not limited to oncology, functional urology, renal transplant, urolithiasis, robotics, pediatric urology, and patient care. Through meticulous analysis, we elucidated the multifaceted ways in which AI is poised to revolutionize urological practice. Conclusions: The transformative potential of AI in urological care is profound, promising to revolutionize diagnostics, treatment strategies, and patient management. Through our systematic analysis, we provide a comprehensive overview of both current applications and future trends in AI within urology, shedding light on the advantages and potential drawbacks encountered in navigating the landscape of data-driven analysis. As the field continues to evolve, embracing AI technologies holds the key to unlocking new frontiers in urological care, ultimately leading to improved outcomes and enhanced quality of life for patients worldwide.

5.13.2. UP-13.02: Effect of Preoperative Parameters (Like Serum Calcium and Lipid Profile) and Histopathology of Artery & Vein on Upper Limb Arteriovenous Fistula Outcomes: An Observational Study

• Gupta S
• Father Muller Medical College, Mangalore, India

Abstract: Introduction and Objectives: Rising prevalence of end-stage renal disease (ESRD) has resulted in a sharp increase in proportion of patients requiring hemodialysis (HD). The most commonly preferred form of vascular access is radiocephalic AVF, however, a maturation failure rate of 20% to 50% has been reported in AVF cases. This study will be undertaken to evaluate the effect of preoperative parameters like serum calcium and lipid profile, and histopathology of artery and vein used for AVF creation in terms of outcomes. Materials and Methods: This prospective observational study was conducted for a period of 1 year in the Department of Urology. Study included 66 patients with diagnosis of chronic kidney disease (CKD) undergoing upper limb AVF formation for HD. Demographic data, history, examination, blood investigations (mainly serum calcium and lipid profile) and ultrasonography (USG) Doppler were performed before surgery, and findings were recorded. Edge biopsy of artery and vein was taken before anastomosis and was sent for histopathological evaluation. Postoperative outcomes like AV fistula patency, functionality, time to maturation and complications like surgical site infection, pseudoaneurysm, bleed/hematoma and fistula failure were evaluated. Data thus collected was subjected to statistical analysis and results were drawn. Results: In our study, deranged lipid profile was associated with decreased AVF patency and maturation failure. Also, smaller diameter and presence of pathological changes (intimal fibrosis, hyperplasia, microcalcification) in the arteries and veins used for AVF creation were associated with adverse AVF outcomes in our study. Hypercalcemia or hypocalcemia did not have effect on AVF outcomes until patient developed calciphylaxis. Conclusions: Pre-operative assessment of lipid profile, USG Doppler, and histological evaluation of artery and vein to be used for AVF is helpful in predicting the post-operative AVF outcomes in patients with CKD and also in better prognostication.

5.13.3. UP-13.03: Advancements in Digital Health Interventions in Urology: A Comprehensive Review of the Indian Landscape

• Vishavadia K ¹, Chauhan A ², Singh N ² and Mishra A ³

¹ 

Gujarat Technological University, Ahmedabad, India

² 

GTU, Ahmedabad, India

³ 

IIHMR, Jaipur, India

Abstract: Introduction and Objectives: Innovations in digital health, encompassing mobile apps and wearable sensors, are revolutionizing modern healthcare, heralding the era of digital medicine. Digital therapeutics (DTx) offers evidence-based software interventions for preventing and managing medical conditions, including urological disorders like benign prostatic hyperplasia (BPH) and urinary incontinence (UI). These conditions, often addressed with lifestyle changes and behavioral therapies, present a fertile ground for the integration of DTx. This study aims to investigate the potential of DTx in addressing urological disorders, notably BPH and UI, within the Indian healthcare context. Materials and Methods: A systematic review was conducted to assess the landscape of digital health interventions in urology within India. Relevant literature was identified through searches of electronic databases including PubMed & Google Scholar and key urology and digital health journals. Search terms included “digital health,” “urology,” “telemedicine,” “mobile health apps,” “artificial intelligence,” and “remote monitoring systems”. The inclusion criteria comprised studies published in English, focusing on digital health interventions targeting urological disorders in the Indian population. Data extraction involved cataloging intervention modalities, outcomes, challenges, and future prospects. Additionally, regulatory frameworks and ethical considerations surrounding digital health adoption in India were examined. Results: The review reveals a significant potential for integrating digital technologies into urological care in India, driven by the nation’s burgeoning population and escalating burden of urological diseases. Despite being in the nascent stages of adoption, digital health interventions exhibit promising outcomes in optimizing urological care delivery and enhancing patient outcomes. Conclusions: In conclusion, this study emphasizes the imperative of leveraging digital health interventions to mitigate the escalating burden of urological disorders in India. By addressing regulatory and ethical considerations, alongside ensuring equitable access, policymakers, healthcare providers, and researchers can harness the full potential of digital technologies to advance urological care delivery and outcomes in India.

5.13.4. UP-13.04: Enhancing Patient Communication: Evaluating Large Language Models for English-to-Arabic Translation of a Urological Patient Information Leaflet

• Alsharrah S and Dukic I
• West Midlands, University Hospitals Birmingham, Birmingham, United Kingdom

Abstract: Introduction and Objectives: Ensuring accurate translation of patient information leaflets allows clear communication and empowers patients to make informed decisions about their care, leading to better health outcomes across diverse communities. Materials and Methods: This study investigates the accuracy of English-to-Arabic translations for the British Association of Urological Surgeons (BAUS) flexible cystoscopy patient information leaflet. We compare translations produced by human translators with those generated by Large Language Models (LLMs). An online text comparison tool assesses the fidelity of LLM translations to the native version. Results: Significant differences in LLM accuracy were observed: Gemini 1.0: Highest accuracy (166 corrections, 85% similarity). ChatGPT 3.5: Closely followed (144 corrections, 81% similarity). CoPilot (GPT-4): Required the most corrections (200) with similar accuracy (81%). Additionally, translation length varied between LLMs, with Gemini 1.0 generating the longest outputs. Conclusions: While all three LLMs show promise in aiding translations, their accuracy and performance differ. Currently, Gemini 1.0 demonstrates the highest efficiency. Leveraging the accuracy of LLMs alongside human translators could lead to substantial time and cost savings, enhancing patient access to accurate healthcare information. Further research is essential to refine accuracy and ensure culturally sensitive communication across multiple languages.

5.13.5. UP-13.05: Acute Urinary Retention (AUR) in Females: Perception Differences Among Different Medical Specialties

• Nadeem R, Faruqui N, Chugtai N and Kashif U
• Aga Khan University Hospital, Karachi, Pakistan

Abstract: Introduction and Objectives: According to a study done by Klarskov et al., female AUR occurs 1 in 100,000 every year, and female:male incidence rate is 1:13. As female urinary retention is a contrasting situation as compared to men, the underlying conditions are minimally understood. This study identify differences in perception regarding factors, diagnosis and management among urology and gynecology trainees and consultants with different work settings in nationwide hospitals in Pakistan. The aim is to assess knowledge, attitudes, and practices related to female AUR. Materials and Methods: This is a multi center cross sectional study. Questionnaire is designed by an expert panel of one urologist and two urogynaecologists and was distributed to nationwide doctors of OBGYN, urology specialties working in hospital. Results: 59.1% of participants were from urology and remaining were from OBGYN. In terms of the working facility, a significant proportion 84.7% of respondents worked in training institutes while non-training institutes accounted 15.3% of respondents. Exposure to cases of AUR was variable with majority of respondents 54.4% encountering 1–2 cases per month. If all factors are taken into account, it was observed that in both specialties 78% OBGYN and 74.2% urologists displayed knowledge in AUR management in females. Decision-making and treatment approaches were different among both specialties. Differences were observed among training and non-training institutes. Maximum noted knowledge for investigations in AUR was 77.3% vs. 52.2% in training and non-training groups respectively. There are variations in the evaluation and management of female patients with AUR between respondents in both sub-specialties and training institutes and non-training institutes. These differences reflect variations in baseline knowledge, training and expertise. Conclusions: Based on the findings, it is evident that both specialists exhibit distinct perspectives on the management of acute urinary retention (AUR) in female patients, largely influenced by its infrequent presentation.

5.13.6. UP-13.06: Implantation Technique of the Adjustable Trans-Obturator Male System Sling with a Silicone-Covered Scrotal Port: Challenges and Tips

• Alzahrani A, Aleid M and Carrier S
• McGill University, Montreal, Canada

Abstract: Introduction and Objectives: Based on our experience, we are presenting a procedure for the Adjustable Trans-Obturator Male System (ATOMS) sling that includes certain challenges and comments. ATOMS SSP^® was done on a male patient, aged 58 years old, who had a body mass index of 25 kg/m². He was diagnosed with prostate cancer in 2020; radiotherapy and robotic-assisted laparoscopic prostatectomy were his treatments. His PSA is undetectable. An incision and a steroid injection for vesicourethral stenosis were performed after his prostatectomy. He presented with stress urinary incontinence and an approximately 400 mL 24-h pad test. Following a thorough evaluation of all viable options, the patient selected the ATOMS. Materials and Methods: We are providing a procedure for the Adjustable Trans-Obturator Male System (ATOMS) sling that incorporates specific challenges and remarks based on our experience. Results: Two months after his operation. The patient is happy, has no post-void residual, and his daily incontinence pad usage has decreased to two pads. As necessary, the cushion will be refilled during the follow-up period to ensure a satisfactory outcome. Conclusions: The Adjustable Trans-Obturator Male System Sling with a silicone-covered scrotal port results in ventral compression of the bulbospongiosus muscle and, subsequently, of the urethra, which will increase the urethral resistance. The implant can be adjusted post-operatively by means of a simple percutaneous puncture of the scrotal port, even years after the implantation, with favorable results in the treatment of male stress urinary incontinence.

5.13.7. UP-13.07: Malignant Peripheral Nerve Sheath Tumor in Urethral Caruncle

• Riaza Montes M, Ambuila Facundo E, López Martínez L, Gambra Arregui L, Gil Azkarate M, Esturo Sacristán S and Gallego Sánchez J
• Galdakao-Usansolo University Hospital, Galdakao, Spain

Abstract: Introduction and Objectives: Urethral caruncle is a benign tumor of the urethral meatus, prevalent in postmenopausal women. It is usually detected incidentally during physical examination. It may present with bleeding, dysuria or a lumpy feeling, requiring long periods of topical estrogenic treatment or surgical removal. Malignant peripheral nerve sheath tumor (MPNST) is a soft tissue cancer arising from the external lining of the peripheral nerves. Its incidence is 0.001%, being infrequent in genital mucosa. Approximately 11 cases have been reported with lower urinary tract involvement. 50% occur in young patients with neurofibromatosis type 1 (NF1). Sporadic cases are associated with previous exposure to radiation (RT). Pain and tumor growth may be present. Diagnosis is histopathological and immunohistochemical (IHC), reflecting Schwann cell differentiation. Surgery is the treatment and may be associated with RT or chemotherapy. The prognosis is unfavorable, with a recurrence rate of 30–60%. The most frequent metastases are lung and bone. The prognostic factors are: size, location, stage and histologic grade. Our aim is to show a typical case and to perform a systematic review. Materials and Methods: We present a 70-year-old woman evaluated for incoercible bleeding from the urethral caruncle. She reports a history of intermittent bleeding with progressive increase of genital lump feeling since 8 months ago. No history of NF1 or RT. On examination, urethral caruncle of approx. 4 cm. Given the impossibility of cessation of bleeding with conservative measures, it was decided to perform excision with prior injection of local anesthesia. Results: The histologic study shows infiltration by malignant tumor of neuroectodermal origin, compatible with MPNST. The IHC study is positive for SOX10, S100 and synaptophysin and proliferation index (ki67) of 25–30%. Local study with MRI and urethroscopy and CT-TAP extension ruled out tumor dissemination. After five months of follow-up she presented a recurrence in urethra infiltrating vagina to bladder floor without signs of distant dissemination. A radical cystectomy, urethrectomy and excision of the anterior vagina and uterus were performed. After 2 months of follow-up, she remains asymptomatic with no signs of recurrence. Conclusions: MPNST are an anecdotal entity in the urinary tract. They are aggressive, being their diagnosis histological and IHC. They require resection with safety margins and close follow-up due to their high recurrence rate.

5.13.8. UP-13.08: Impact of Preoperative Video-Based Education on Anxiety Levels in Patients with Ureteral Stones Scheduled for Ureteroscopy: A Comparative Study Using APAIS and STAI

• Ben Hamida M, Blaiech W, Ben Othmen M, Bouassida K, Tlili G, Hmida W and Jaidane M
• Sahloul Hospital, Sousse, Tunisia

Abstract: Introduction and Objectives: Patients undergoing surgery often experience anxiety due to fears related to anesthesia and the surgical procedures involved. Studies estimate that preoperative anxiety affects a significant portion of patients worldwide, with incidence rates ranging from 60% to 92%. Elevated levels of anxiety experienced before surgery have been linked to adverse surgical outcomes. This study aimed to investigate how preoperative anxiety among patients with ureteral stones scheduled for ureteroscopy is influenced by the type of information they receive: video-based versus verbal. Materials and Methods: We included 42 patients with ureteral stones who were scheduled for ureteroscopy. These patients were randomly divided into two groups: Group 1 (21 patients) received preoperative video-based information and Group 2 (21 patients) received only verbal information. Anxiety levels were assessed using the Amsterdam Pre-Operative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory (STAI). On the first postoperative day, each patient indicated their pain using a visual analogue scale and filled out a questionnaire about their willingness to undergo the procedure again. Results: Group 1 exhibited significantly lower anxiety levels across various aspects measured by APAIS scores for anesthesia, surgery, overall anxiety, and information needs (p < 0.005). However, there was no notable difference in STAI-trait anxiety scores between the groups. Conversely, Group 2 showed significantly higher anxiety levels related to the surgical procedure, as indicated by STAI-state scores (p < 0.005). The average pain score was 4.1 ± 2.1 for Group 1 and 5.22 ± 2.6 for Group 2, Moreover, patients in Group 1 expressed a greater willingness to undergo the surgery again. Conclusions: Effective doctor-patient communication coupled with real-time video technology has the potential to markedly decrease preoperative anxiety and depression among patients, thereby aiding in both their physical and mental health recuperation.

5.13.9. UP-13.09: Impact of Preoperative Video-Based Education on Anxiety Levels in Patients Scheduled for Prostate Biopsy: A Comparative Study Using APAIS and STAI

• Ben Hamida M, Blaiech W, Ben Othmen M, Bouassida K, Tlili G, Hmida W and Jaidane M
• Sahloul Hospital, Sousse, Tunisia

Abstract: Introduction and Objectives: Prostate biopsy (PB) is a crucial tool in the diagnosis and the active surveillance of prostate cancer (PCa). Traditionally, PB has been conducted transrectally (TRUS), mostly under local anesthesia. However, this approach may cause anxiety for patients, given the fear of peri-procedural pain and complications. This study aimed to investigate how preoperative anxiety is influenced by the type of information they receive video-based versus verbal. Materials and Methods: We included 30 patients scheduled for prostate biopsy. These patients were divided randomly into two groups: Group 1 (15 patients) received before the procedure video-based information and Group 2 (15 patients) received only verbal information. Anxiety levels were assessed using the Amsterdam Pre-Operative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory (STAI). After the procedure, each patient indicated their pain using a visual analogue scale and filled out a questionnaire about their willingness to undergo the procedure again. Results: Group 1 demonstrated notably lower anxiety levels across multiple dimensions, as measured by APAIS scores for anesthesia, surgery, overall anxiety, and information needs. Similar findings were observed in STAI-trait anxiety scores (p < 0.001). Conversely, Group 2 exhibited significantly higher anxiety levels on both scales (p < 0.001). The average pain score was 4.6 ± 2.3 for Group 1 and 5.4 ± 2.7 for Group 2. Additionally, patients in Group 1 expressed a greater willingness to undergo the procedure again. Conclusions: Efficient communication between doctors and patients, along with the use of real-time video technology, holds promise in significantly reducing preoperative anxiety and depression among patients. This, in turn, can contribute to their overall physical and mental well-being during the recovery process.

5.13.10. UP-13.10: Okoko-Item Telehealth Program Reducing Disparities, Improving Access in Health Care in Rural Communities-Another Pathway of Medical Volunteerism to Consider

• Abara E ¹, Abara E ², Okereke O ³, Onyekwere N ⁴, Okereke A ⁵ and Okoronkwo O ⁶

¹ 

Northern Ontario School of Medicine NOSM University; Richmond Hill Urology Practice and Prostate Institute, Richmond Hill, Canada

² 

Abara Telemedicine, Richmond Hill, Canada

³ 

University of Abuja, Abuja, Nigeria

⁴ 

Nekede College of Technology, Nekede Owerri, Nigeria

⁵ 

Okereke Pharmacy, Umuahia, Nigeria

⁶ 

Okoko-Item Worldwide Forum (OIWWF), Okoko-Item, Nigeria

Abstract: Introduction and Objectives: Okoko-Item, one of 9 autonomous communities in Item clan, Bende Local Government Area (LGA), Abia State, Nigeria has a population of about 15,000. There are 2 public, 2 private elementary schools, 1 high school, 1 health centre, and 1 general hospital serving the Bende LGA. Over the past 40 years, a volunteer team has provided medical and social services for 2 to 4 weeks every one to two years from Canada. Six years ago, a group of young professionals started a program to provide free medical service to the community during the annual heritage celebrations. With COVID-19 pandemic declared by WHO on 18 March 2020, travel to Okoko-Item and health care around the world were disrupted. On 27 December 2022, a telemedicine program was launched with the goal of increasing access, reducing disparity and building equity in rural health. Materials and Methods: We built a multidisciplinary team—local and ‘diaspora’ and created an 8-h day program: 1 h of health education through Zoom and 6-h consultation and counseling through Whats App. Appropriate informed consent and licenses were obtained. Communication and technological equipment such as smart phones were individualized. Dispensing of prescriptions, tests and results were handled by the local team. Records and documentation were electronic. Program feedback was obtained orally. This program has run on 27 December 2022 and 2023. Results: Total attendance was 60 (24-health education by Zoom and 36-WhatsApp consult/counseling) There were some technical issues with ‘erratic’ network and reception in the rural. The feedback from the attendees was positive for this ‘novelty’ experience. There were limitations: short duration, program co-ordination; logistics challenges primary and specialty care need better platforms. It was a good collaboration between local and diaspora professionals for the community good! Conclusions: Telemedicine is transformational, reducing disparities, building capacity, and improving access. The collaborative partnership between home-bred young professionals and those in diaspora using technology appear promising-another pathway of medical volunteerism. All stakeholders including Governments, business communities, health care professionals through improved infrastructure, good policies, funding and technology-driven volunteerism can improve rural health.

5.13.12. UP-13.12: Delirium in Elderly Patients Undergoing Urologic Surgery. Incidence and Predictive Role of Multidimensional Geriatric Evaluation to Define a High-Risk Population: Results of a Prospective Study

• Brausi M ¹, Oltolina P ², Bergamini L ³, Toso S ², Rabito S ², Morselli S ², Ferrari G ² and Zavatti L ⁴

¹ 

AUSL Modena, Dept. of Urology, Modena, Italy

² 

Hesperia Hospital, Dept. of Urology, Modena, Italy

³ 

University of Modena and Reggio Emilia, Dept. of Geriatrics, Modena, Italy

⁴ 

Hesperia Hospital, Dept. of Anesthesiology, Modena, Italy

Abstract: Introduction and Objectives: Objective of this prospective study was to identify the domains of a comprehensive geriatric evaluation (CGA) linked to the incidence and characteristics of delirium in > 70 years-old pts hospitalized for elective urologic surgery. Materials and Methods: A complete urological, anesthesiology and geriatric evaluation with CGA was applied in the pre-operative evaluation before hospital admission. During hospitalization the Mini Mental State Examination (MMSE) questionnaire was daily applied by nurses to define cognitive performance, together with the Confusion Assessment Method (CAM), to define incidence and clinical characteristics of delirium. Follow-up was planned at 1, 3 months and 1 year after discharge to evaluate global health and specifically functional and cognitive status. Results: Globally, 83 pts have been recruited: 55 men (66%) and 28 women (34%). Mean age was 76 yrs. Reason for admission was bladder outlet obstructions (BOO) in 35/83 pts (42.1%), while prostate, bladder and kidney cancer was present in 25, 18 and 5/83 pts, respectively. ASA score was 1–2 in 58 pts (70%), 3–4 in 25 (30%). In detail, 43/83 (51.8%) of pts had major open/laparoscopic or robotic surgery under general anesthesia, while 40/83 (48.2%) received an endoscopic procedure under spinal anesthesia. IC unit was necessary for 6/83 for 1 day. No major surgical complications (Clavien III-IV) were observed. The re-operation rate was 0. Overall cognitive performance was mildly impaired at MMSE: mean 24.6 ± 4.3. With CAM, 18/83 pts (21.7%) assessedly developed post-surgical delirium. Of them, 9/18 pts (50%) were ASA 2 while 9/18 (50%) ASA 3–4. Among them, 15/18 pts received general anesthesia while 3 spinal. In these pts, the basal mean MMSE score was significantly lower (p < 0.001), whereas no significant differences were found with respect to basal scores of depression and disability domains. Moreover, 17 of these 18 patients (94.4%) had sleeping disorders, depression or anxiety and thus were on continuous therapy. Conclusions: In elderly patients > 70 year-old the incidence of delirium in the post-operative period was present in 21.7% and their overall cognitive performance was impaired. Ongoing therapies for depression and anxiety played a key role, therefore, a careful geriatric evaluation before surgery could help to prevent or at least mitigate this effect.

5.14. Pediatric Urology

5.14.1. UP-14.01: Children with Congenital Bilateral Megaureter: What Will Happen in Adulthood

• Sabirzyanova Z and Pavlov A
• Russian Scientific Center of Roentgenradiology, Moscow, Russia

Abstract: Introduction and Objectives: Bilateral megaureter plays a causative role in 15–30% of cases of chronic kidney disease requiring renal replacement therapy in children. But does any patient with BM develop ESKD or other problems? Materials and Methods: 150 patients (122 males and 28 females) with bilateral megaureter were followed for 15 to 20 years prior to adulthood. There were variety treatment options at them: from observation and conservative treatment in 37 patients to different types of surgical correction of megaureter (in 80), bladder outlet obstruction correction (in 78). Renal and lower urinary tract function was assessed in adulthood. Results: All patients were definitively screened at the age of 16 years and older. 37 (24.6%) of them were completely healthy without any renal disorders and low urinary tract symptoms. 12 patients had severe renal scares in one kidney and even nephrectomy, but they did not have significant chronic kidney diseases or arterial hypertension. 11 patients (7.3%) got to the end-stage of kidney disease, and 5 of them underwent kidney transplantation. Lower urinary tract disorders of varying severity were detected in 83 patients. Of these, 3 boys had undergone bladder augmentation and use intermitted catheterization and 14 need intermitted bladder catheterization of their own bladder. Therefore, dry vesicostomies (appendicovesicostomies or ureterovesicostomies) were performed in 15 boys for this purpose, but 2 girls use transuretral bladder catheterization. In 22 patients, there was an overactive bladder with symptoms of urgency and daytime urinary incontinence. 16 have only nocturnal enuresis due to nocturia. Another 28 patients have clinical signs of a lazy bladder with a pronounced urodynamic low detrusor reflex, for which they need timely urination. There was no residual urine and any incontinence in them. Conclusions: Congenital bilateral megaureter is the severe abnormality of the urinary system. This is complicated not only by the loss of kidney function, but also by the lower urinary tract disfunction. Most patients also urological follow up in adulthood, and more and more of them need lifelong rehabilitation.

5.14.2. UP-14.02: Comparison of Outcome of Valve Ablation with Simultaneous Bladder Neck Incision vs. Alpha-Blocker Treatment in Children with Posterior Urethral Valves: A Retrospective Observational Study

• Sharma G and Shekar A
• Sri Satya Sai Institute of Higher Medical Sciences, Puttaparth I (A.P), Sri Satya Sai District, India

Abstract: Introduction and Objectives: Posterior urethral valves (PUV) constitute the most prevalent cause of lower urinary tract obstruction in male children. While endoscopic ablation (PVA) stands as the primary therapeutic approach, persistent bladder dysfunction affects a substantial majority (75–80%) even post-treatment. This is often attributed to a high-riding bladder neck, resulting in potential secondary obstruction and detrusor complications. Various interventions, including alpha blockers and bladder neck incision (BNI), aim to address this issue. However, comparative studies evaluating their efficacy in conjunction with PVA are scarce. This study aims to retrospectively assess outcomes of combined PUA with BNI versus post-ablation alpha-blocker therapy in PUV patients, focusing on renal function and upper tract alterations. Materials and Methods: Medical records of 68 patients diagnosed with and treated for posterior urethral valves were retrospectively reviewed. Group 1 consisted of 38 patients who underwent PVA initially and started on alpha-blocker. Group 2 consisted of 13 patients who underwent simultaneous PVA and BNI. Trends in renal function tests and changes in the upper urinary tracts were evaluated throughout follow up. Results: Between Jan 2002 to Dec 2022 a total of 68 patients underwent PVA and out of that 51 patients met the study inclusion criteria. For group 1, at presentation, median age 3 (1, 4) year, median serum creatinine 0.7 (0.6, 0.9) mg/dL, median GFR-53 (38.7, 69) mL/min/1.73 m². Additional intervention was needed in 13 (31%) patients which included Re-TUVF in 4 patients and bladder neck incision in 8 patients. For group 2, at presentation, median age 4 (2, 5) year, median serum creatinine 1.2 (0.9, 1.59) mg/dL, median GFR-34 (30, 42) mL/min/1.73 m². Additional intervention was needed in 5 (61%) patients. Median follow for group 1 and group 2 were 82 (36, 120) months & 40 (24, 60) months respectively. Renal function deteri ration in group 1 and group 2 were 11 (28.94%) & 7 (53.84%) respectively and which was not statistically significant (p = 0.21). Conclusions: Our study suggests that alpha-blockers alone effectively manage most children with PUV and secondary bladder neck obstruction. While simultaneous BNI with PUA may hold promise for those with good renal function, further investigation via prospective trials is warranted to validate these findings.

5.14.3. UP-14.03: Innate Prognostic Factors for Congenital Megaureter Resolution in Young Children

• Sabirzyanova Z and Pavlov A
• Russian Scientific Center of Roentgenradiology, Moscow, Russia

Abstract: Introduction and Objectives: In some patients with a congenital megaureter (MU), surgical correction is not required, as it resolves as the child grows. However, conservative resolution does not depend on the degree of dilatation of the upper urinary tract, and MAG3 scintigraphy is not fully informative in infants. Materials and Methods: 70 patients with congenital MU were examined in the first 6 months of life, 38 with bilateral and 32 with unilateral (58 boys and 12 girls). Urine tests, serum creatinine, ultrasound, DMSA-scintigraphy, VCUG ang MAG3-scintigraphy were done in all patients. Results: Incomplete bladder emptying with residual urine of more than 20%, impaired renal function, and UTI were indications for early surgical correction. A group of 26 patients (13 bilateral and 13 unilateral) with preserved renal function according to DMSA, without UTI, excluded VUR and absence of residual urine according to ultrasound data was determined for follow up observation. At the same time, the degree of dilatation and disorders of the urodynamics of the upper urinary tract did not matter. Of the 26 patients in the follow-up group during the first year of life, urine tests and ultrasound were monitored every 3–6 months. An increase in dilatated UUT was detected in 15 patients, and in 4 pts with non-febrile UTI. In the second year of life, in 17 patients showed a decrease in established MU and MAG3 disorders in 12 patients and an improvement in 14 patients. By 3 years of age, complete resolution of MU occurred in 19 patients, but functional obstruction with residual dilatation of UUT persisted in 7 patients requiring follow-up. Conclusions: Preservation renal function in the absence of VUR, regardless of the degree of dilatation in infants, can be considered sufficient prognostic criteria for conservative resolution of MU.

5.14.4. UP-14.04: Long Term Results of Treatment of Obstructive Megaureter in 240 Children

• Sabirzyanova Z and Pavlov A
• Russian Scientific Center of Roentgenradiology, Moscow, Russia

Abstract: Introduction and Objectives: Evaluation of the results of surgical treatment in 240 children with primary obstructive megaureter in long term follow up (more than 10 years). Materials and Methods: A prospective and retrospective analysis of different surgical methods of treatment—endoscopic dilatation of the ureter and ureterocystoanastomosis in 240 patients. 167 of them had got bilateral MY, 13—MY of single kidney, 40—one-side MY. Access the efficiency and complications in follow up of all patients until puberty. Results: Up to 90% of patients with primary obstructive megaureter undergo endoscopic dilatation and ureteral stenting. For most patients (76%), primary endoscopic treatment was performed in infancy. Initially through 1–2 years after endoscopy positive results were noted in 87% patients: preserving or restoring of kidney function (95%), improving UUT urodynamics (60%). Among 32 patients who underwent repeated endoscopic treatment after ineffectiveness of the primary endoscopic correction it was found that repeated dilatation carried out at the age of over 3 years, led to improvement in only 2 patients. The deterioration of the urodynamics occurred in 42% of patients through 3–5 years after endoscopy and required reconstructive plastic surgery in the future. Among 180 patients with bilateral MY there were 42 in whom endoscopic correction was completely effective in one side, but another side required reconstructive surgery. The effectiveness of ureterocystoanastomy depended on the type and the age of the operation. In infants (60 patients) the incidence of complications (obstruction, VUR) reached 40%, among them more often in those who used intravesical techniques (80%). Conclusions: Surgical treatment of obstructive megaureter is quite effective, but has a significant number of complications in children when performing reconstructive plastic surgery at an early age. Endoscopic dilatation technologies do not always allow to radically restore urodynamics of upper urinary tract, but they allow to save the kidney function before reconstructive surgery.

5.14.5. UP-14.05: Optimising the Management of Testicular Torsion in Accordance with the Getting It Right First Time (GIRFT) National Report 2024: A One Year Study in a University Teaching Hospital

• Dhanoya G and Quraishi M
• East Sussex NHS Trust, Brighton, United Kingdom

Abstract: Introduction and Objectives: Testicular torsion occurs when a testicle twists and blood supply to the testicle is compromised; causing sudden scrotal pain. It is a time-critical surgical emergency and occurs most commonly in boys aged between 10 and 20 years. Testicles can die within 6 h of twisting without emergency surgical intervention. The Getting it Right First Time (GIRFT) national report outlines key recommendations to ensure boys with suspected testicular torsion are seen promptly and treated closer to home. These include: minimising the number patient transfers, expediting surgical assessment, utilising the TWIST scoring system, and arranging appropriate follow up post orchidopexy and orchidectomy. Our audit assessed adherence to these guidelines in our hospital trust, analyzing data from 77 patients aged 2–24 who underwent surgical exploration for suspected torsion. Materials and Methods: We collected data for 77 patients between the ages of 2 and 24 years from January 2023 to February 2024 who underwent surgical exploration for suspected testicular torsion in our trust. Results: Results showed only 18 out of 77 patients had true torsion on surgical exploration. The average time between presentation to emergency department (ED) and operation start time was 263 min (4.38 h), with no patients operated on within 60 min of presentation to ED. The TWIST scoring system was only used once. 16 patients were transferred from a non-urological trust, with no patients transferred more than once. 54 orchidopexies were performed; 7 of which were followed up. Conclusions: Our data showed that patients need to be assessed by a surgical decision maker in ED more promptly. Increased use of the TWIST scoring system may stress the urgency of a possible torsion and allow patients to be operated sooner. GP practices/patients need to be aware of their local urological centre. This will reduce patient transfers. Increased ultrasound use allows more accurate torsion diagnosis and prevents unnecessary surgical exploration. Ultrasound training for surgical decision makers is warranted. Follow up is needed in all patients undergoing orchidopexies and orchidectomies, to reduce the incidence of delayed testicular atrophy and to ensure patients are aware of the option of a prosthesis in later life.

5.14.6. UP-14.06: Presentation, Management and Outcomes of Transitional Urology Patients Managed in a Tertiary Transitional Care Centre

• Yadav A, Moirangthem T, P A and Parashar R
• Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Andhra Pradesh, India

Abstract: Introduction and Objectives: Transition is a “purposeful, planned process that addresses the medical, psychosocial, and educational need of adolescents with chronic physical and medical conditions as they move from child-centered to adult-oriented health care systems.” In 2017, we established a formal Transitional Urology (TU) clinic co-run by pediatric and adult urology aimed at providing comprehensive urologic care for people progressing into adulthood with complex urologic conditions. The objective was to analyse the presentation, management and outcomes of children and adolescents with congenital genitourinary anomalies as they moved to our transitional care clinic at the centre of reconstructive and transitional urology, a multidisciplinary centre led by an adult urologic team dedicated to the long-term care of these patients. Materials and Methods: We retrospectively reviewed charts of patients with congenial genitourinary abnormalities referred between Dec 2017 and Jan 2024. Analysis included patient characteristics, age at first presentation to health facility, type of surgical intervention, complications following surgery and their management, recurrent urinary tract infection, stones, renal function, upper tract studies, urodynamics if indicated, need for further complex reconstructive surgeries and change in the management. Results: Our cohort included a total of 195 patients with an average age of 18 years attended and managed in our urology transition clinic. 136 patients with hypospadias, 24 patients with posterior urethral valves, 2 cases with anterior urethral valve, 14 patients with epispadias exstrophy complex, 9 patients with isolated epispadias and 5 patients with neurogenic bladder and 5 cases under heading of miscellaneous (including patients with DSD, vaginal atresia and patient with anterior urethral valves) were included. Surgical management was instituted in 55% of patients during their follow up in adulthood to transition clinic and included hypospadias repair, urethral valve fulguration, exstrophy and epispadias repair, bladder augmentation. Conservative management with follow up visits included detailed focused history and local examination in patients with hypospadias, uroflowmetry and along with uroflowmetry renal function test and ultrasound KUB and urodynamic studies (if indicated) in patients with posterior urethral valves. Conclusions: Our study is an attempt to highlight the common problems faced in this small but growing population of children with congenital anomalies entering into adulthood.

5.14.7. UP-14.07: Single Stage Repair of Penoscrotal Hypospadias Using Combined Buccal Graft and Preputial Flap

• S.Elsayed A, Elghoniemy M, Tawfeeq M, Badawy H and Kassem A
• Cairo University Hospitals, Cairo, Egypt

Abstract: Introduction and Objectives: We thought to assess the efficacy of single stage repair of posterior hypospadias using combined buccal graft and preputial flap for neourethra formation. Materials and Methods: This was a prospective cohort study conducted in the urology department at Cairo University. Operative steps were lifting a flap containing the preputial and penile skin by undermining the dissection directly above the tunica albuginea of the penis until complete degloving of the penis. The buccal mucosa is grafted on the tunica albuginea of the penis (Figure 1). The goal of the dissection of the preputial flap was to allow the flap to reach the ventral surface without twisting of the penis and to allow completion of the urethroplasty without tension (Figure 2). The edges of the flap and the buccal mucosa were sutured together using 6/0 absorbable continuous suture. We used the tunica vaginalis as a second layer from the testis or a scrotal septal fascial flap as the waterproof layer. Success was defined as a wide urethral caliber, no residual chordee with functionally and cosmetically good phallus. Results: Our study included 20 patients with a mean follow up of 6 months. Five patients were excluded after degloving of the penis due to salvageable urethral plate. Mean operative time was 178 min. All patients were discharged on the same day. The mean duration of urethral catheter was 9 days, and the mean duration of suprapubic catheter was 15 days. Five patients (33.3%) had complete success. And no ancillary procedures were needed. Three patients developed coronal urethrocutaneous fistula, and six patients developed recession of preputial flap; (two patients of them had regression of the flap to the distal penile level and the remaining four patients had regression to the mid penile level). There was only one patient with complete breakdown of the repair and total loss of preputial flap (6.7%). The ten complicated cases underwent second stage repair and the overall success rate after two stages of repair was 87%. Conclusions: We hereby prove the feasibility of a single stage repair using combined buccal graft and preputial flap for penoscrotal hypospadias.

5.14.8. UP-14.08: The Behavioural and Alarm Therapy for Primary Monosymptomatic Nocturnal Enuresis Before the Age of 5 Years, Why Not? A Prospective Randomized Control Trial

• Eladawy M ¹, Yehia A ², Abdalla S ², Ibrahim H ² and Rammah A ²

¹ 

Fayoum University, Fayoum, Egypt

² 

Cairo University, Faculty of Medicine, Kasr Alainy Hospital, Cairo, Egypt

Abstract: Introduction and Objectives: Primary monosymptomatic nocturnal enuresis (PMNE) is a common health problem with 15% incidence at age of 5 years. To date, the optimal management remains doubtful and the available options are recommended for children older than 5 years. Enuretic children have a deep sleep and are more difficult to arouse than their dry peers. The aim of our study was to assess the efficacy of early behavioral and alarm therapy in these children before the age 5 years. Materials and Methods: 120 children, aged between 48–54 months old, with PMNE were included in our study. They were divided into 2 groups, Group A (followed behavioral and alarm therapy regularly till age of 5) and Group B (control group) was only observed till the age of 5 years. Only 107 (54 in group A, 53 in group B) were interviewed again when they reached 5 years old to determine how many of them achieved > 80%, 50–80% and < 50% stoppage of bedwetting within last month based on the number and weigh of diapers. Results: Group A showed significant improvement than group B as more than 80% stoppage of bedwetting was achieved in 23 (42.6%) children of group A vs. only 8 (15.1%) children of group B (p; 0.002). As regard the sex of the child, no significant difference was recorded between boys and girls. Conclusions: It could be beneficial to start behavioral and alarm therapy for primary monosymptomatic nocturnal enuresis in children younger than 5 years old.

5.15. Penis/Testis: Benign Disease

5.15.1. UP-15.01: Efficacy of Optilume^® Drug-Coated Balloon Post Failed Urethroplasty

• Alharbi A, Behbehani B and Alhajeri F
• Sabah Al-Ahmad Urology Centre, Kuwait City, Kuwait

Abstract: Introduction and Objectives: Urethral stricture, a prevalent condition, can precipitate considerable discomfort and complications. The Optilume^® drug-coated balloon (DCB) has emerged as a therapeutic modality for urethral strictures. Urethroplasty remains the definitive treatment; nonetheless, recurrence remains a possibility. We highlight a case in which the Optilume DCB was used to manage recurrent urethral stricture after an unsuccessful urethroplasty. Materials and Methods: A 60-year-old male underwent urethroplasty with buccal mucosal graft two decades ago for post-traumatic urethral stricture, remaining asymptomatic until three years ago. He subsequently developed lower urinary tract symptoms, presenting as poor stream and sensation of incomplete voiding, progressively worsening over time. A retrograde urethrogram revealed a stricture at the proximal end of the graft site and further narrowing distally. Diagnostic cystoscopy confirmed the presence of a bulbar urethral stricture. Uroflowmetry indicated a maximal flow rate (Qmax) of 4.1 mL/s and a post-void residual (PVR) of 137 mL. With an International Prostate Symptom Score (IPSS) of 21, signifying severe symptoms, the patient reported an IPSS quality of life score of 5. Results: A 30 French, 5 cm-long Optilume DCB was used, inflating it at a pressure of 7 atm for 5 min proximally and 3 min distally. Stricture dilation was visually confirmed via cystoscope. A 14 Fr urethral catheter was inserted for 48 h. The patient underwent follow-up assessments at 7 days, 1 month, and 4 months postoperatively. There were no treatment-related adverse effects. The absolute change in the Qmax score from baseline to 4 months follow-up was 12.4 & PVR was 137, IPSS was 18, IPSS QoL was 5. Erectile function was not affected by treatment. All measures were significantly different when compared with the baseline (Table 1). Conclusions: The Optilume DCB may serve as a potential treatment option for men who have had an unsuccessful urethroplasty. However, further studies and long term follow-up are necessary.

5.15.2. UP-15.02: Microsurgical Subinguinal Varicocelectomy with Intraoperative Doppler Control: Experience of a Single Center

• Ryzhkov A ¹, Sokolova S ² and Shormanov I ¹

¹ 

Yaroslavl State Medical University (YSMU), Yaroskavl, Russia

² 

Mother and Child Clinic, Yaroslavl, Russia

Abstract: Introduction and Objectives: The injury to the testicular artery during microsurgical subinguinal varicocelectomy (MSV) leads to testicular atrophy in 20–40% of cases. The use of techniques that facilitate the visualization of the testicular artery could improve the effectiveness and safety of MSV. The aim of this study was to assess the impact of intraoperative Doppler control (IDC) on the outcomes of microsurgical subinguinal varicocelectomy. Materials and Methods: The study included 101 patients with clinical left-sided varicocele who underwent surgical treatment at the “Mother and Child Yaroslavl” clinic from January 2022 to November 2023. Standard microsurgical subinguinal varicocelectomy was performed on 52 patients (MSV), while MSV with intraoperative Doppler control (MSV + IDC) was performed on 49 patients. The “Minimax-Doppler-K” 20 MHz (SP Minimax, Russia) was used for the intraoperative Doppler control. The number of preserved arterial and ligated venous stems was counted intraoperatively. The presence of postoperative complications and changes in pain syndrome were assessed three months after the surgery. Results: The average operation time was 79.5 ± 11.3 min in the MSV group and 75.4 ± 12.1 min in the MSV + IDC group (p = 0.08). Multiple branches of the testicular artery were observed in 77.6% of patients in the MSV + IDC group and in 36.5% in the MSV group (p < 0.01). The average number of ligated veins was 16.7 ± 2.9 in the MSV + IDC group and 15.0 ± 3.8 in the MSV group (p < 0.05). The number of preserved lymphatic vessels did not differ between the groups. Three months after the surgery, no complications such as varicocele recurrence, hydrocele, or testicular atrophy were observed. Pain relief three months after the surgery was noted in 66.7% and 91.7% of patients with preoperative pain syndrome in the MSV and MSV + IDC group, respectively (p < 0.05). Conclusions: The use of intraoperative Doppler control during microsurgical subinguinal varicocelectomy allows for the preservation of a greater number of branches of the internal testicular artery, ligation of a larger number of veins, and better outcomes in terms of pain relief after the operation

5.16. Penis/Testis/Urethra: Cancer—Basic Science

UP-16.01: Testicular Metastases of Cutaneous Malignant Melanoma: A Case Series and Literature Review

• Capinha M, Pinto L, Tinoco C, Cardoso A, Araújo A, Coutinho A, Matos R, Alves M and Ribeiro J
• Hospital de Braga, Braga, Portugal

Abstract: Introduction and Objectives: Metastatic melanoma to the testis is exceedingly rare, typically identified incidentally during autopsy. It is associated with a poor prognosis. The histologic appearances of metastatic melanoma can be highly variable, which may lead to a misdiagnosis as a primary testicular tumor. The incidence of testicular ranges from 2%–41%, depending on the case series. The differential diagnosis between primary and metastatic tumors of the testicle is of great practical importance in such cases. However, regardless of age, this condition has a high mortality rate, often less than a year from diagnosis to death. The following study aims to analyze the case series and conduct a literature review. Materials and Methods: The information regarding the cases was obtained from the patient files. A literature review was conducted on the PubMed, Cochrane, and Embase databases using the following terms: (Testis) OR (Testicular) AND (Metastatic) AND (melanoma) on July 16th, 2023. A total of 20 articles were selected for analysis. Results: Metastatic melanoma to the testicles occurs with a median age of diagnosis at 58 years (21 to 86 years). The primary tumor location affects regions such as the neck, abdominal wall, and extremities. The Breslow classification, ranges between 1 to 3 mm, and it provides important information about tumor thickness. Additionally, the Clark classification, varies between II/III to IV. Regarding metastatic involvement, the percentage of testicles invaded by melanoma metastases is: Right: 45%; Left: 45% and Bilateral: 10%. Patients with testicular cancer commonly experience symptoms such as the presence of a painful mass, testicular growth, and pain in the affected area. Diagnostic imaging plays a crucial role in the evaluation of testicular cancer. Specifically, ultrasound imaging reveals hypoechoic nodules, while computed tomography (CT) scans display heterogenous, well-limited nodules It is worth noting that testicular cancer lesions exhibit considerable variation in size, ranging from 2 to 9 cm. Consequently, radical orchiectomy, serves as the primary treatment for testicular cancer. Regarding prognosis, the median survival rate is 10 months. Conclusions: In cases where patients with a history of melanoma develop a testicular mass, it serves as a crucial warning sign. Immediate consideration of metastatic disease is imperative.

5.17. Penis/Testis/Urethra: Cancer—Clinical

5.17.1. UP-17.01: Clinical Experience and Outcomes of Post-Chemotherapy Midline Extraperitoneal Retroperitoneal Lymph Node Dissection

• Razi B, Kovacic J, Dhar A, Shepherd A, Chalasani V and Winter M
• Royal North Shore Hospital, Sydney, Australia

Abstract: Introduction and Objectives: To detail the outcomes of an open midline extraperitoneal (EP) approach to post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for metastatic testicular cancer. Materials and Methods: We analysed our prospectively maintained operative database from April 2020 to February 2023 for cases of midline EP approach to PC-RPLND, identifying a total of 11 patients across two hospitals in Sydney, Australia. Demographic and perioperative data was obtained from electronic medical records, including preoperative factors such as cancer staging and preoperative treatment, with ethical approval obtained from local health services. Results: Eleven patients were included in this study. The median age was 37 years (range 26–51 years) with a median ASA grade of 3 (range 3–3). There were a total of six left-sided and five right-sided cases; however, two of the right-sided cases had previously undergone RPLND 15 and 25 years prior, respectively. A modified template was used in eight cases, and a bilateral template was used in three. The median tumor staging was Stage IIB (range IIA–IIIB) with a median retroperitoneal tumour size post chemotherapy 4.2 cm (range 1.5 cm–11.2 cm). Preoperative histology identified 4 cases of seminoma and 7 cases of non-seminomatous germ cell tumors (NSGCT). The median length of the procedure was 300 min (range 223–615), blood loss was 300 mL (range 100–2600), length of stay was 5 days (range 3–10), and post-operative days until bowel opening was 2 days (range 1–3). There were four early complications and no late complications. 91% of the patients had preserved ejaculatory function. Conclusions: The open midline EP approach to PC-RPLND has demonstrated improved perioperative outcomes compared to other open surgical approaches, enabling surgeons to complete complex cases. Therefore, the midline EP approach should be considered when performing PC-RPLND.

5.17.2. UP-17.02: Contemporary Conditional Cancer-Specific Survival Rates in Surgically Treated Non-Metastatic Primary Urethral Carcinoma

• Morra S ¹, Celentano G ², Scheipner L ¹, Baudo A ¹, Jannello L ¹, De Angelis M ¹, Siech C ¹, Goyal J ¹, Touma N ¹, Tian Z ¹, Saad F ¹, Shariat S ³, Creta M ², Califano G ², Colla’ Ruvolo C ², Ahyai S ⁴, Carmignani L ⁵, De Cobelli O ⁶, Musi G ⁶, Briganti A ⁷, Chun F ⁸, Longo N ² and Karakiewicz P ¹

¹ 

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada

² 

Federico II University of Naples, Naples, Italy

³ 

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

⁴ 

Department of Urology, Medical University of Graz, Graz, Austria

⁵ 

Department of Urology, IRCCS Policlinico San Donato, Milan, Italy

⁶ 

IEO European Institute of Oncology, Milan, Italy

⁷ 

RCCS San Raffaele Institute, Milan, Italy

⁸ 

Univerity Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany

Abstract: Introduction and Objectives: We examined the effect of disease-free interval (DFI) duration on cancer-specific mortality (CSM)-free survival, otherwise known as the effect of conditional survival, in radical urethrectomy non-metastatic primary urethral carcinoma (PUC) patients. Materials and Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database 2000–2020, patient (age, sex, race/ethnicity, marital status) and tumor (stage, histology) characteristics, as well as systemic therapy exposure status of non-metastatic PUC patients were tabulated. Conditional survival estimates at 5-year were assessed based on DFI duration and according to stage at presentation (T1–2N0 vs. T3–4N0–2). Results: Of all 512 radical urethrectomy PUC patients, 278 (54%) harbored T1–2N0 stage vs. 234 (46%) harbored T3–4N0–2 stage. In 512 PUC patients, 5-year CSM-free survival at initial diagnosis was 61.8%. Provided a DFI duration of 36 months, 5-year CSM-free survival was 85.6%. In 278 T1–2N0 PUC patients, 5-year CSM-free survival at initial diagnosis was 68.4%. Provided a DFI duration of 36 months, 5-year CSM-free survival was 86.9%In 234 T3–4N0–2 PUC patients, 5-year CSM-free survival at initial diagnosis was 53.8%. Provided a DFI duration of 36 months, 5-year CSM-free survival was 83.6%. Conclusions: Although intuitively, clinicians and patients are well aware of the concept that increasing DFI duration improves survival probability, only a few clinicians can accurately estimate the magnitude of survival improvement, as was done within the current study. Such information is crucial to survivors, especially in those diagnosed with rare malignancies, where the survival estimation according to DFI duration is even more challenging.

5.17.3. UP-17.03: Is There a Role for Dynamic Sentinel Node Biopsy in All Male Genital Cancers?

• Aly K, Lee H, Yan S, Sro M, Anastasiadis E, Raghallaigh H, Ayres B and Watkin N
• St Georges University Hospitals NHS Foundation Trust, London, United Kingdom

Abstract: Introduction and Objectives: The staging of non-palpable inguinal nodes with dynamic sentinel node biopsy (DSNB) in patients with penile cancer (SCCp) is well established. However, there is currently no recommended clinic role or evidence base for performing DSNB in patients with other male genital cancers, namely urethral squamous cell carcinoma (SCCu), scrotal squamous cancer, melanoma and invasive extramammary Paget’s disease (iEMPD). It has been our unit policy to offer DSNB to patients with cN0 disease following MDT discussion for all male genital cancers. The aim of this study is to investigate the role of DSNB in the non-SCCp patient group. Materials and Methods: A prospectively held database of male genital cancer patients was interrogated (2003–2021). Of this cohort, patients were identified with tumours other than SCCp. Outcome measures included non-visualisation rate, number of positive inguinal basins, and false negative rate for each tumour type. Results: 1150 patients had DSNB for intermediate or high-grade disease. Of these, 82 (7%) had non-SCCp tumours (55 SCCu, 9 scrotal SCC, 7 genital melanoma and 11 iEMPD). Non-visualisation rate was 0%. Positive sentinel node findings were 36.5% (30/82) per patient and 23.3% (33/142) per inguinal basin. By tumour type per patient this was SCCu 36.4% (20/55), scrotal SCC 22.2% (2/9), melanoma 71% (5/7) and iEMPD 27.3% (3/11). The overall false negative rate was 7.3% (6/82) and per tumour type, the false negative rates were 7.3% (SCCu), 0% (scrotal SCC), 0% (melanoma) and 0% (iEMPD). Conclusions: DSNB in genital cancers other than SCCp is technically possible. It provides clinically important staging information with significant numbers of positive inguinal nodes identified in all tumour types. There is a very low and acceptable false negative rate. We recommend the adoption of DSNB for these non-penile genital cancers.

5.17.4. UP-17.04: Spermatic Cord Liposarcoma, Review of a Case Series

• Montuenga Fernández I, Domínguez Gutiérrez A, Sánchez Pellejero A, Vázquez Valdés S, Peral Parra D and Tamayo Ruiz J
• Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

Abstract: Introduction and Objectives: Spermatic cord liposarcomas represent a unique entity within soft tissue sarcomas, characterized by their origin in the spermatic cord or paratesticular region. They exhibit a wide histological variability and high capacity for locoregional extension. They pose a challenge due to their low incidence, initial diagnostic difficulty, and aggressiveness of treatment. Existing studies are scarce and involve a small number of patients. The main objective of this study was to analyze survival and aggressiveness in our case series and review the literature on spermatic cord liposarcoma. Materials and Methods: Retrospective analysis of a series of cases of spermatic cord liposarcomas diagnosed in our center between 2000 and 2023. Demographic, clinical (presentation form, laterality), surgical, histopathological (tumor size, histological grade), and survival (recurrence and progression) characteristics were collected. Results: Six cases of spermatic cord liposarcoma were diagnosed between 2000 and 2023. The mean age at diagnosis was 66 (± 8) years. Presentation in all cases was as large inguinal hernia. In 5/6 cases (83.6%), the laterality was left. Regarding surgical aspects, the approach was inguinal in all patients. Ipsilateral orchiectomy was associated in 4 of them (66.7%). Regarding histopathological characteristics, the mean tumor size was 6 cm (± 3). 66.7% had histological grade 2 with 16.6% showing lymphovascular invasion. Surgical margins were positive in 4/6 patients (66.7%), and 100% showed positive immunohistochemical analysis. Regarding staging, 3/6 (50%) were stage II, and 3/6 (50%) were stage III. Only 2/6 (33.3%) received adjuvant radiotherapy. During follow-up, 3/6 (50%) had local recurrence, and 2/6 (33.3%) experienced progression. 2/6 (33.3%) died as a result. Conclusions: Spermatic cord liposarcoma is a challenging entity due to its low incidence, underdiagnosis in early stages, and local aggressiveness, with a high percentage of positive margins after excision. It presents a low survival rate due to the high risk of progression and recurrence. Early and multidisciplinary treatment is needed when suspected.

5.18. Prostate Cancer—Basic Science

5.18.1. UP-18.01: Comparative Analysis of Antioxidant Enzymes’ Activities in the Blood and Tumor Tissues of the Men with Prostate Tumors

• Chigogidze T ¹, Sepiashvili B ², Ramishvili L ², Gabunia N ¹, Gordeziani M ¹, Kotrikadze N ¹, Epitashvili D ¹ and Alibegashvili M ¹

¹ 

Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia

² 

Ivane Javakhishvili Tbilisi State University, Faculty of Exact and Natural Sciences, Tbilisi, Georgia

Abstract: Introduction and Objectives: In response to increased oxidative stress tumor cells tend to increase the expression of antioxidant enzymes for detoxification of free radicals. The goal of the work was to study and to make comparative analysis of alterations of the activities of the antioxidant enzymes: superoxide dismutase and glutathione transferase in the blood and tumor tissues of the men with prostate tumors (benign, malignant). Materials and Methods: Blood and tumor tissue samples of the men with benign hyperplasia of prostate (BHP) and the men with cancer of prostate (CaP) served as material for the studies. Number of patients was 15 in each study group. Mean age of the patients was 60–75 years. The clinical stage of the disease was determined based on the rectal, histomorphological, and ultrasound examinations of the prostate gland in Urology National Center, Tbilisi, Georgia. Spectrophotometric and Enzyme-linked immunosorbent assay (ELISA) methods have been used for the studies. Results: Our investigations have shown that there are obvious changes in the activities of the antioxidant enzymes in case of malignant tumor as well as in benign hyperplasia of prostate. Furthermore, we observed sharp difference between the activities of the enzymes assessed in tumor tissue samples and in the blood plasma and red blood cells of the patients. Conclusions: The above described changes can be conditioned by the response reactions of tumor cells toward the severe oxidative stress as well as remodeling the main functions of the enzymes by tumor cells in order to use these enzymes for survival and proliferation as well as in the process of acquiring resistance toward the anticancer drugs.

5.18.2. UP-18.02: Evaluation of the Effectiveness of More than 3500 Transrectal Prostate Biopsy Under the Control of Histoscanning in a Day Stay Unit

• Kim Y, Vasilyev A, Arutyunyan P and Pushkar D
• FSBEI HE “ROSUNIMED” of MOH of Russia. Botkin Hospital., Moscow, Russia

Abstract: Introduction and Objectives: The effectiveness of a standard 12-point prostate biopsy is largely dependent on the experience of the specialist. One of the most promising, non-invasive methods of additional imaging in prostate biopsy is histoscanning. Using the True Targeting software allows you to perform a targeted biopsy in real time. The purpose of the study is to evaluate the effectiveness of performing prostate biopsy under the control of histoscanning in the day stay unit. Materials and Methods: From May 2020 to December 2023. In the day stay unit on the basis of the S.P. Botkin state clinic 3655 patients with suspected prostate cancer underwent transrectal histoscanning prostate biopsy in real-time. Results: The average prostate-specific antigen value was 13.23 ng/mL (varied from 0.5 to 1900 ng/mL). The average age of the patients was 66 years, the average prostate volume was 54.89 cm³. The average time of a transrectal histoscanning prostate biopsy is 16 min. The average number of biopsies taken was 16 (of which 4 were targeted). Primary biopsy was performed in 2997 patients (82%), repeated—in 658 patients (18%). The presence of prostate cancer in close relatives was noted in 146 patients (4%). Among them, prostate cancer was detected in 126 patients, which is 86%. Suspicious sites were mainly located in the anterior sections of the prostate, which are usually missed when performing a standard transrectal biopsy. The overall incidence of prostate cancer was 64%, and with a standard biopsy this figure was 19%, while with a histoscan-targeted biopsy prostate cancer was diagnosed in 8% of cases. Conclusions: The conducted study showed high efficiency of prostate biopsy under histoscanning control in conditions of day stay unit. The use of this method allows to increase the incidence of clinically significant prostate cancer and influence the choice of further treatment tactics.

5.18.3. UP-18.03: Life-Expectancy in High Grade Incidental Prostate Cancer Patients versus Population-Based Controls According to Treatment Type

• Di Bello F ¹, Jannello L ², Baudo A ³, De Angelis M ⁴, Siech C ⁵, Goyal J ⁶, Creta M ¹, Califano G ¹, Celentano G ¹, Acquati P ³, Saad F ⁶, Carmignani L ⁷, De Cobelli O ², Briganti A ⁴, Chun F ⁵, Collà Ruvolo C ⁸, Morra S ¹, Longo N ¹ and Karakiewicz P ⁶

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

IEO Istituto Europeo di Oncologia, Milano, Italy

³ 

Ospedale Gruppo San Donato, Milano, Italy

⁴ 

Università Salute Vita San Raffaele, Milano, Italy

⁵ 

Goethe Frankfurt University, Frankfurt, Germany

⁶ 

University of Montréal Health Center, Montréal, Canada

⁷ 

Università Statale di Milano, Milano, Italy

⁸ 

Università Federico II di Napoli, Napoli, Italy

Abstract: Introduction and Objectives: To quantify the differences in five-year overall survival (OS) between high-grade (Gleason sum 8–10) incidental prostate cancer (IPCa) patients and age-matched male population-based controls, according to treatment type: no active vs. active treatment. Materials and Methods: We relied on the Surveillance, Epidemiology and End Results (SEER) database (2004–2015) to identify not-actively-treated and actively-treated high-grade IPCa patients. For each case, we simulated an age-matched male control (Monte Carlo simulation), relying on Social Security Administration Life Tables (2004–2020) with five years of follow-up. Additionally, we relied on Kaplan-Meyer plots to display OS for each treatment type. Multivariable Cox regression models were fitted to predict overall mortality (OM). Results: Of 564 high-grade IPCa patients, 345 (61%) were not-actively-treated vs. 219 (39%) were actively-treated, either with radical prostatectomy or radiotherapy. Median OS was three years for not-actively-treated high-grade IPCa patients, with OS difference at five-years follow-up of 27% relative to their age-matched male population-based controls (37 vs. 64%). Median OS was eight years for actively-treated high-grade IPCa patients, with OS difference at five-years follow-up of 6% relative to their age-matched male population-based controls (68 vs. 74%). In multivariable Cox regression model, active treatment independently predicted lower OM (hazard ratio = 0.6; 95% confidence interval = 0.4–0.8; p < 0.001). Conclusions: Relative to Life Tables’ derived age-matched male controls, not-actively-treated high-grade IPCa patients exhibit drastically worse OS than their actively-treated counterparts. These observations may encourage clinicians to consider active treatment in the newly diagnosed high-grade IPCa patients.

5.18.4. UP-18.04: Local Anesthesia for Prostate Biopsies: A Prospective Study Comparing Two Methods

• Hazem H ¹, Ahmad C ¹, Firas Z ¹, Mohamed Abdelkader F ¹, Ahmed S ², Nouri R ², Walid S ² and Mourad H ²

¹ 

Urology Department, Habib Bourguiba Hospital, Sfax, Tunisia

² 

University Hospital Habib Bourguiba Sfax, Sfax, Tunisia

Abstract: Introduction and Objectives: Transrectal ultrasound-guided prostate biopsy is the gold standard for diagnosing prostate cancer. However, it is often perceived as traumatic both physically and psychologically. This study aimed to compare the effectiveness of two local anesthesia techniques in alleviating pain during prostate biopsy. Materials and Methods: A prospective randomized comparative study was conducted from February 2022 to April 2023 at Habib Bourguiba University Hospital in Sfax. Seventy-six patients undergoing transrectal ultrasound-guided prostate biopsy were equally divided into two groups. Group 1 received 20 mL of 2% lidocaine gel intra-rectally, while Group 2 had a bilateral injection of 5 mL of 1% lidocaine at the junction of the seminal vesicles and prostatic base before the biopsy. Twelve prostatic cores were obtained, and pain was assessed using a visual analog scale (VAS) from 0 to 10 at the end of the biopsy. Results: The groups were comparable in terms of age, BMI, PSA, prostatic volume, and number of cores. In Group 1, VAS ranged from 1 to 8 with a mean of 4.45 ± 1.408, while in Group 2, patients reported mild discomfort with scores ranging from 1 to 5 on the VAS and a mean of 2.58 ± 1.106. There was a statistically significant difference between the two groups (p < 0.0001) in favor of the peri-prostatic block. No anesthesia-related complications were reported, and both groups were comparable in terms of overall complications. Conclusions: The peri-prostatic block is a simple, effective, safe, and rapid method for reducing pain during prostate biopsy. However, it is essential to note that lidocaine gel instillation plays a crucial role in inhibiting pain associated with the introduction and manipulation of the endorectal probe.

5.18.5. UP-18.05: YAP1-TEAD1 Mediates the Perineural Invasion of Prostate Cancer Cells Induced by Cancer-Associated Fibroblasts

• Shen T ¹, Tan X ¹ and Niu Y ²

¹ 

Nankai University, Tianjin, China

² 

The Second Hospital of Tianjin Medical University, Tianjin, China

Abstract: Introduction and Objectives: Perineural invasion (PNI) driven by the tumor microenvironment (TME) has emerged as a key mode of metastasis in prostate cancer (PCa), but the underlying mechanisms remain elusive. The aim of this study was to explore the mechanism of YAP1’s role in the process of PNI in PCa cells. Materials and Methods: The stimulatory effects of PCa cells with different levels of YAP1 expression in the co-culture system on the dorsal root ganglion (DRG) were examined by using a live cell workstation. Protein array microarrays were used to detect changes in secreted proteins in PCa cells affected by YAP1 and to screen out NGF. Transcriptional regulation of NGF by YAP1-TEAD1 was confirmed using chromatin immunoprecipitation (ChIP) and Luciferase assay. The effect of NGF-mediated CCL2/CCR2 feedback loop on epithelial-to-mesenchymal transition (EMT) in PCa cells was examined. Nude mice were used to construct a “neural transplantation tumor” model, and the lower limb paralysis was observed in different groups of mice. TRAMP-YAP1+/+ mice were constructed using CRISPR-Cas9, and YAP1 was inducible knocked out using Tamoxifen. After spontaneous tumor formation, the levels of YAP1, S100, NGF, CCL2, and FAP were measured in the prostate tissues of the mice. Results: CAFs and YAP1 expression levels in patients with metastatic PCa. In the cultured PCa cell line LNCaP, co-culture with cancer-associated fibroblasts (CAFs) could upregulate YAP1 protein expression. Either ectopic overexpression of YAP1 or co-culture with CAFs could promote the infiltration of LNCaPs towards dorsal root ganglia (DRG). In vivo, overexpression of YAP1 could increase PNI in a mouse model of sciatic nerve tumor invasion. Mechanistically, TEAD1 binds to the NGF promotor and YAP1/TEAD1 activates its transcription and consequently increases NGF secretion. In turn, PCa cells treated with cm from CAFs or stable YAP1 overexpression can stimulate DRG to secrete CCL2. The EMT of PCa cells is thus activated via CCL2/CCR2. Conclusions: CAFs can activate YAP1/TEAD1 signaling and increase the secretion of NGF, therefore promoting PCa PNI. YAP1 may serve as an early diagnostic marker for mPCa and as an interventional target to prevent PNI in PCa.

5.18.6. UP-18.06: The Prior Use of Statins Can Improve Survival in Patients with Advanced and Metastatic Prostate Cancer (PCa): Our Experience

• Brausi M ¹, Morselli S ², Ferrari G ², Rabito S ², Oltolina P ² and Da Silva F ³

¹ 

AUSL Modena, Dept. of Urology, Modena, Italy

² 

Hesperia Hospital, Dept. of Urology, Modena, Italy

³ 

Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

Abstract: Introduction and Objectives: Statins has been shown to have a protective effect on the risk of PCa mortality. We retrospectively collected data on statin use at baseline in a phase 3 randomized trial of intermittent vs. continuous androgen deprivation using a LHRH analogue (Triptoreline) and Ciproterone acetate. Materials and Methods: Men were evaluated between October 1999 and September 2007 from 8 Europeans Centers. Inclusion criteria were histologically confirmed PCa T3-T4 M0-M1, PSA comprised between 4 ng/mL and 100 ng/mL, age < 80 years, WHO Performance Score 0–2 and normal liver function. Patients who respected inclusion criteria were then randomized. Data on statin use were collected at enrollment and we chose those patients. Follow-up ceased in October 2012. The number of locally advanced and M+ PCa were well balanced in the two groups. Results: A total of 1045 men were evaluated and 918 respected inclusion criteria and 252 were asked about their use of statins at enrollment. These 252 patients were divided in subgroups of intermittent vs. continuous hormone treatment were comparable for M+ and locally advanced PCa. Their median PSA at registration was 15.9 ng/mL. Continuous treatment was administered at 115 patients, while 137 had intermittent treatment. Within the continuous arm 57 (49.6%) used statins while among the intermittent arm 66 (48.2%) used statins. Mortality in patients using statins showed 21 deaths, with 12 of PCa, 5 of cardiovascular disease and 4 of other causes, while patients who did not use statins: had 45 deaths (25 from PCa, 14 from cardiovascular disease and 6 other causes. Metastatic status and statins use were the only variables associated with overall survival with the hazard ratio of death on statins (compared to no statins) is 0.39 (95%Cl 0.23–0.65), p = 0.0004. For prostate cancer death the corresponding hazard ratio is 0.44 (95%Cl 0.22–0.90), p = 0.025 and for cardiovascular disease death is 0.30 (95%Cl 0.11–0.83), p = 0.020. Conclusions: This investigation confirms previous results that the prior use of statins is associated with better survival among men with newly diagnosed prostate cancer. Cardiovascular disease rate was higher in men who did not use statins. Larger randomized, prospective studies are needed to confirm these results.

5.19. Prostate Cancer—Clinical Advanced

5.19.1. UP-19.01: Correlation Between MRI and Pathological Primary Tumour Staging in T3a Prostate Cancers with Broad Capsular Contact: A Study on 383 Patients

• Carbin Joseph D, Ferguson J, Abou Chedid W, Kusuma V, Hicks J, Moschonas D, Patil K and Perry M
• Royal Surrey County Hospital, Guildford, United Kingdom

Abstract: Introduction and Objectives: MpMRI is widely used in the pre-operative staging of prostate cancer. cT3a can be diagnosed in MpMRI based on direct or indirect evidence of extracapsular extension (ECE) such as broad capsular contact (BCC) (> 15 mm). We analysed the pathological outcomes of cT3a prostate cancers with BCC. Materials and Methods: We analysed our prospectively maintained robotic prostatectomy database from 2014 to 2022 and included 383 men with cT3a on MRI based solely on BCC. We included data such as tumour volume, prostate volume, ISUP, PSA, Tumour volume%, pathological staging and stage migration in the final histology report. Logistic regression was used to analyse the risk factors for pathological upstaging after radical prostatectomy. Results: Of the 383 cT3a with BCC, 55% stayed pT3a, 26% became pT2, and 19% upstaged to pT3b. Preoperative PSA level, PI-RADS and ISUP are significantly and positively associated with upstaging. Similarly, tumour volume, % of tumour volume in the prostate, and presence or absence of ISUP upgrade in final histology were significantly associated with pT3 upstaging (p < 0.001). Patient factors such as age, BMI, prostate volume and BCC were not associated with stage migration. Capsule contact length > 15 mm might increase the prediction of positive surgical margins. Conclusions: This study concludes that in MRI cT3a based on BCC, the tumour volume can be used as a criterion to better predict upstaging in the final histology. This data is from a single high-volume centre and needs to be followed by multi-centric studies with large sample size.

5.19.2. UP-19.02: Oncological and Continence Outcomes of Salvage Robot-Assisted Radical Prostatectomy: A Matched Pair Analysis

• Abou Chedid W, Innes M, Casson H, Kusuma V, Hicks J, Moschonas D, Patil K, Perry M and Carbin Joseph D
• Royal Surrey County Hospital, Guildford, United Kingdom

Abstract: Introduction and Objectives: Salvage Robot-Assisted Radical Prostatectomy (sRARP) is considered a complex surgery and is performed in specialised high-volume centres. The outcome of sRARP is generally considered inferior compared to primary RARP. We conducted a matched study to analyse the oncological and functional outcomes of sRARP in our centre. Salvage Robot-Assisted Radical Prostatectomy (sRARP) is considered a complex surgery and is performed in specialised high-volume centres. The outcome of sRARP is generally considered inferior compared to primary RARP. We conducted a matched study to analyse the oncological and functional outcomes of sRARP in our centre. Materials and Methods: Patients who underwent sRARP in our centre from 2015 to 2023 were selected for the study from our prospectively maintained database. The sRARPs were performed by consultant surgeons beyond their learning curve. 30 sRARPs were matched to 90 non-salvage controls (1:3) for Age at RARP, BMI, PSA, Clinical stage, ISUP, D’Amico risk category, Prior TURP, Nerve sparing and Lymph node dissection. One-year BCR and continence (zero pads) rates were compared. Potency rates were not analysed. Results: 43% have had Brachytherapy, 13% EBRT + Brachytherapy, EBRT + ADT 23%, HIFU 0 20%. There was no significant difference in console time, blood loss or extent of nerve spare. Pathological upstaging/upgrading, positive margins did not differ significantly. 93% of the Primary RARP versus 70% of the sRARP were continent in one year (p = 0.002). However, on logistic regression, prior treatment type is not associated with 12-month continence rates or post-RARP biochemical recurrence. Conclusions: sRARP is a safe procedure if performed in high-volume centres with good expertise. It is associated with equivalent BCR rates to primary RARP. However, the continence rates are lower than the primary RARP in our study.

5.19.3. UP-19.03: Prevalence of Depression in Patients with Metastatic Prostate ADK Undergoing Castration Experience of the Medical Oncology Department of the CHU Hassan II in Fez, 100 Cases Reported

• Aabboub B and Oualla K
• Service d’oncologie médicale CHU Hassan II Fès, Fès, Morocco

Abstract: Introduction and Objectives: Prostate cancer is the most common cancer in men, and psychological symptoms such as depression can affect many patients. The aim of this study was to calculate the prevalence of depression in patients with metastatic prostate cancer undergoing medical castration. Materials and Methods: This is a descriptive observational cross-sectional study of 100 patients diagnosed with metastatic prostate cancer undergoing medical castration at the medical oncology department of the HASSAN II University Hospital in Fez. Data were collected through clinical interviews with the study participants. Informed consent was obtained from each participant prior to the interviews. The interviews were conducted by a psychologist who followed a standardised procedure to ensure the consistency and accuracy of data collection. Participants were asked to complete a questionnaire (Beck Depression Inventory) quantitatively assessing the intensity of depressive feelings. This questionnaire is adapted to the Moroccan context and comprises 21 symptom and attitude items describing the manifestations of depression, graded from 0 to 3, by a series of 4 statements, reflecting the degree of severity of the symptom. Depending on the severity of the depression, patients received different interventions, ranging from psychological support through supportive psychotherapy to combined treatments combining psychotherapy and antidepressants. Treatment was orchestrated by specialist psychiatrists and psychotherapists. Results: A total of 100 patients with metastatic prostate ADK undergoing castration were recruited. The most common age group was 45–60 years (43%). With regard to patients’ educational level, 18% had university education, 30% secondary education, 32% primary education, and 20% were illiterate. With regard to marital status, 56% of patients were married, 21% were divorced, 12% were widowed and 11% were single. 54% of patients came from rural areas and 46% from urban areas. 9% of patients were not depressed, 26% had mild mood disturbance, 18% had intermittent depression, 41% had moderate depression, 4% had severe depression, and 2% had extreme depression. Conclusions: Depression is considered the most common psychological problem in cancer patients. Our study has shed light on depression in patients with metastatic prostate ADK undergoing castration, which is common, suggesting the importance of screening for and managing depression in these patients.

5.19.4. UP-19.04: Safety and Efficacy of Retzius Sparing Robot-Assisted Radical Prostatectomy Utilizing Versius System by Cambridge Medical Robotics

• Abdelhakim M, Algammal F, Elfayoumy H, Sheba M, Abou-Elela A and Elsayed A
• Cairo University Hospitals, Cairo, Egypt

Abstract: Introduction and Objectives: Retzius sparing robot-assisted radical prostatectomy (RZ-RARP) was introduced to improve time to continence. All RZ-RARP were performed using laparoscopy and robot assistance using the DaVinci system. We hereby report the functional outcomes of the first RZ-RARP cases utilizing the Versius system by cmR. Materials and Methods: Forty-two cases were done utilizing 4 bedside units of the Versius system. A horizontal incision was performed in the posterior peritoneum. The vas deferens were identified and ligated bilaterally; the seminal vesicles were retracted upwards and dissected from the surrounding tissues. The Denonvilliers’ fascia was incised, and the posterior plane was developed until reaching the prostate-urethral junction. The prostatic pedicles were ligated and divided bilaterally. Dissection was applied to the lateral prostate aspect until the apex and deep vein complex were seen. Then, the bladder neck was dissected sharply. The anterior dissection is continued, sparing the detrusor and anterior pubovesical complex, towards the urethra which is sharply transected. The urethrovesical anastomosis was completed with two 3-0 V-lock sutures. Results: The mean operative time was 3 h, and the estimated blood loss was 300 mL. The average hospital stay was 2 days, and the catheter was removed after one week. Early continence (immediate) was achieved in 92% of cases and 50% potency rate was noticed in the first week postoperatively. Two cases developed urine retention after catheter removal, urinary catheter fixation was done and removed after 3 days. There were no conversion to conventional anterior approach in any of the cases. Conclusions: RZ-RARP is feasible with Versius system with very promising early continence and potency rates.

5.19.5. UP-19.05: The PET/CT-PSMA as a Fundamental Tool in the Diagnosis of Prostate Cancer Recurrence

• Minguez Ojeda C, Garcia Barreras S, Sanz Mayayo E, Fernandez Conejo G, Lopez Plaza J, Fernandez-Mardomingo Diaz A, Rodriguez Patron R, Burgos Revilla F and Del Olmo P
• Hospital Ramon y Cajal, Madrid, Spain

Abstract: Introduction and Objectives: Prostate cancer (PC) recurrence can occur in 30–50% of patients within 10 years of treatment. Currently, imaging techniques are useful in disease evaluation, but computed tomography (CT) or bone scintigraphy (BS) have limited sensitivity. The aim of the study is to assess the utility of PET/CT-PSMA in the therapeutic management of patients with recurrent PC. Materials and Methods: A retrospective study conducted between 2021–2023, including 117 patients who underwent PET/CT-PSMA after recurrence of PC following primary or salvage treatment. Descriptive and analytical analysis of the sample was performed using Chi-square and Student’s t-test to identify variables related to a positive PET/CT-PSMA result. Results: Age 67 years (62–72) PSA at diagnosis 9.4 ng/dL (SD: 5.4) Primary treatment: Radical prostatectomy Radiotherapy Hormone therapy 66 (56%) 44 (37%) 6 (5%) PSA at biochemical recurrence 1.07 ng/dL(SD:1.14) Adjuvant treatment 45 (39%) Positive imaging tests with PET/CT-PSMA CT: 8/75(7%) BS: 4/69(3.4%) CT/PET cholina: 8/23(38%) PSA at which PSMA PET/CT was performed 1.3 ng/dL (SD:1.6) PSMA PET/ CT lesions: (n = 64 (62.5%) positive) 33 (28%) local recurrence 43 (37%) ganglionar disease 22 (19%) bone metastases 3 (2.5%) visceral metastases Upon analyzing the collected variables with a positive PET/CT-PSMA result, it was observed that prior adjuvancy (p = 0.03), higher PSA value in RB (p = 0.02), PET/CT-PSMA request (p = 0.03), as well as a positive CT result prior to PET/CT-PSMA (p = 0.003) and after progression to salvage treatment (p = 0.002), were all statistically significantly associated. Of the 103 patients who underwent PET/CT-PSMA, in 72 of them (64%), the test results aided in making decisions in therapeutic management, whether for choosing conservative treatment (39), radiotherapy (28), or ADT ± second-generation anti-androgens (41). Conclusions: PET/CT-PSMA improves diagnostic accuracy and assists in selecting the appropriate treatment for the patient based on the clinical stage of their disease.

5.19.6. UP-19.06: Treatments and Clinical Outcomes of Latin American Patients with Localized/Locally Advanced Prostate Cancer, a Real-World Evidence Study Using Natural Language Processing and Machine Learning

• Manneh Kopp R ¹, Correa Ochoa J ², Puello Guerrero A ³, Hernández Morán J ⁴, Villareal N ⁵, Dellavedova T ⁶, Felipe Gutiérrez A ⁷, Mota A ⁸, Tejada Mordini J ⁹, Valdivieso J ¹⁰, López M ¹⁰, Sarró E ¹⁰, Marín J ¹⁰, Casadevall D ¹¹, Polo N ¹¹, Salcedo I ¹¹, Menke S ¹¹ and Djordjevic N ¹²

¹ 

Sociedad de Oncología y Hematología del Cesar (SOHEC), Valledupar, Colombia

² 

Hospital Pablo Tobón, Medellín, Colombia

³ 

Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo (UASD); Instituto Nacional del Cáncer (INCART), Santo Domingo, Dominican Republic

⁴ 

Centro de Urología (CDU), Buenos Aires, Argentina

⁵ 

Clínica Foscal, Floridablanca, Colombia

⁶ 

Fundación Urológica (FUCDIM), Córdoba, Argentina

⁷ 

Hospital Universitario San Ignacio, Bogotá DC, Colombia

⁸ 

Clínica AMO, Salvador, Bahia, Brazil

⁹ 

Janssen, Buenos Aires, Argentina

¹⁰ 

Savana Research SL, Madrid, Spain

¹¹ 

Medsavana SL, Madrid, Spain

¹² 

Hospital Italiano La Plata, La Plata, Argentina

Abstract: Introduction and Objectives: Real-world evidence for localized/locally advanced prostate cancer (LPC/LAPC) is scarce. This study aims to extract clinical information to comprehensively describe the treatments and outcomes of real-world LPC/LAPC patients by using natural language processing (NLP) and machine learning (ML) techniques on electronic health records (EHRs) from Latin American patients. Materials and Methods: This was a multicenter, retrospective, and observational study based on the secondary analysis of multilingual free-text and structured clinical information found in EHRs from adult LPC/LAPC patients between 2014 and 2022 in nine Latin American hospitals. Variables related to clinical characteristics, management, and outcomes were extracted using NLP- and ML-powered EHRead^® technology, which employs SNOMED-CT terminology. Descriptive analysis represents medians with interquartile ranges (Q1, Q3). Results: Of 6053 early-stage prostate cancer cases, 93.2% were LPC and 6.8% LAPC. Median inclusion age was 67 (61, 73) years, with adenocarcinoma as the most frequent histological type (48.8%). The most frequent initial treatments were external radiotherapy (RDT, 65.7%), androgen deprivation therapy (ADT, 44.4%), and radical prostatectomy (RP, 33.7%). RP alone was more common in younger patients [median age 63 (58, 68) years], while other treatments had varying median ages: RDT + RP [66 (60, 70) years], active surveillance [67 (61, 74) years], brachytherapy [67 (62, 73) years], RDT [69 (63, 74) years], ADT alone [70 (65, 77) years], and RDT + ADT [72 (66, 76) years]. Median times to metastasis were 4.1 (0.9, 9.2) years for RP, 3.83 (0.5, 7.9) years for RDT, 0.9 (0.2, 4.7) years for RDT + RP, and 0.8 (0.2, 2.8) years for RDT + ADT. Median time until castration resistance were 5.9 (2.2, 10.9) years for RP, 3.7 (1.4, 7.8) years for RDT, 2.8 (0.8, 6.7) years for RDT + RP, and 0.8 (0.3, 2.8) years for RDT + ADT. Conclusions: Most early-stage prostate cancer patients are categorized as LPC, with adenocarcinoma as the predominant histological type. Treatment choices differ across age groups, yielding distinct outcomes. Notably, RP is more common in younger patients, with longer median time to metastasis. By harnessing the EHRead^® technology, this study provides groundbreaking real-world data from Latin America, underscoring the region’s strides in health informatics and its potential to revolutionize patient care.

5.19.7. UP-19.07: Clinical Efficacy of Different Combination Therapies in Treating High-Volume Metastatic Hormone-Sensitive Prostate Cancer

• Bai Y and Dai L
• Yunnan Cancer Hospital, Kunming, China

Abstract: Introduction and Objectives: Exploring the efficacy and safety of different combination therapies in patients with high-volume metastatic hormone-sensitive prostate cancer (mHSPC). Materials and Methods: Retrospective analysis of clinical data from 248 patients with high-volume mHSPC. One hundred patients were treated with androgen-deprivation therapy (ADT) combined with Bicalutamide (Bic). Seventy-eight patients received ADT combined with Docetaxel (DTX), and seventy patients were treated with ADT combined with Abiraterone Acetate (AA). The study compared progression-free survival (PFS), nadir PSA (nPSA), PSA response rates, and adverse reactions among the three groups. Results: The follow-up period ranged from 3.9 to 50.6 months. Compared to the ADT + Bic group, the median PFS was extended by 9.1 months in the ADT + Doc group and by 14.3 months in the ADT + AA group. The ADT + AA group had a median PFS that was 5.2 months longer than that of the ADT + Doc group; the 1-year, 2-year, and 3-year PFS rates of both the ADT + AA and ADT + Doc groups were significantly higher than those of the ADT + Bic group. The median nadir PSA (nPSA) was highest in the ADT + Bic group (0.69 ng/mL), followed by the ADT + Doc group (0.15 ng/mL), and lowest in the ADT + AA group (0.09 ng/mL). The PSA response rates for the ADT + Doc and ADT + AA groups were 56.41% and 62.86%, respectively, both significantly higher than that of the ADT + Bic group (34%). The incidence of grade 3–4 adverse reactions was highest in the ADT + Doc group (21.79%), followed by the ADT + AA group (12.86%), and lowest in the ADT + Bic group (10%). Being in stage M1c, having no PSA response, and having no PSA response within 6 months were independent risk factors for disease progression in patients with high-volume mHSPC. Conclusions: Compared to treatment with androgen deprivation combined with bicalutamide, treatment with androgen deprivation combined with abiraterone or chemotherapy with docetaxel significantly extends the median PFS in patients with high-tumor-burden mHSPC. Treatment with androgen deprivation combined with abiraterone extends the median PFS more than treatment with androgen deprivation combined with docetaxel chemotherapy in patients with high-tumor-burden mHSPC. The side effects of all three treatment methods are controllable.

5.19.8. UP-19.08: Intermittent Androgen Blockade Can Be a Therapeutic Option in Patients with Locally Advanced and Metastatic Prostate Cancer: Long-Term Results from a Pooled Analysis of 2 Prospective Randomized Trials (9401–9901) from SEUG (South European Uro-Onco Group)

• Brausi M ¹, Morselli S ², Oltolina P ², Ferrari P ³, Da Silva F ⁴ and Ferrari G ²

¹ 

AUSL Modena, Dept. of Urology, Modena, Italy

² 

Hesperia Hospital, Dept. of Urology, Modena, Italy

³ 

Hesperia Hospital, Modena, Italy

⁴ 

Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

Abstract: Introduction and Objectives: The use of Intermittent Hormone Therapy (IHT) in pts with advanced (cT3-T4) or M+ PCa is still controversial. The primary objective was to compare the long-term survival of pts with advanced and M+ PCa who received IHT vs. Continuous HT (CHT) and to identify prognostic factors favouring IHT after Induction Therapy (IT). Materials and Methods: SEUG 9401 and 9901 phase 3 randomised trials compared IHT vs. CHT in patients with cT3-T4 or M+ PCa. All the pts. received an initial 3 months with Cyproterone Acetate 200 mg/day for 2 weeks and then CPA 200 mg + a monthly injection of LH-RH analog (Triptorelin) for 3 months. Pts. whose PSA decreased to <4 ng/mL or 80% of the baseline PSA at the end of the IT were randomised. In the IHT arm pts. whose PSA dropped to < 4 ng/mL during the IT restarted the same HT when PSA was > 10 ng/mL for symptomatic pts or to 20 ng/mL for asymptomatic individuals. In the second arm pts. received the same HT continously. In both studies HT was discontinued in case of objective or subjective progression. Results: 1544 patients were randomised: 766 to IHT and 768 to CHT. In SEUG 9401 Median F-Up: 57 mos (48% > 5 years). In SEUG 9901 median F-UP: 67 mos (56% > 5 years). Survival: In SEUG 9401, HR for survival on IHT vs. CHT was 1.15 (95% CI 0.96, 1.38). In SEUG 9901 HR was 0.90 (95% CI 0.75, 1.06). Side effects: hot flushes, gynecomastia, astenia and cardiac problems were more frequent in the CHT arm. Conclusions: The long-term results of a pooled analysis of randomised 9401 and 9901 trials showed NO difference in Overall Survival between IHT and CHT in patients with c T3-T4 and M+ PCa. Favorable prognostic factors for IHT and survival were: PSA < 1 ng/mL after 3 mos of HT, Gleason Score = < 7, age 75 or less. Intermittent therapy with MAB+ Docetaxel or Enzalutamide in M+ patients is appealing and should be evaluated in prospective, randomized studies.

5.20. Prostate Cancer—Clinical Localized

5.20.1. UP-20.01: A Systematic Review on Prostate-Specific Membrane Antigen Positron Emission Tomography Evaluating Localized Low- to Intermediate-Risk Prostate Cancer: A Tool to Improve Risk Stratification for Active Surveillance?

• Liu J ¹, Woon D ², Catterwell R ³, Perera M ⁴, Murphy D ⁵, Lawrentschuk N ⁴ and Santucci J ⁵

¹ 

Epworth Healthcare, Melbourne, Australia

² 

Austin Health, Melbourne, Australia

³ 

The Queen Elizabeth Hospital, Adelaide, Australia

⁴ 

The Royal Melbourne Hospital, Melbourne, Australia

⁵ 

Peter MacCallum Cancer Centre, Melbourne, Australia

Abstract: Introduction and Objectives: Active surveillance remains a treatment option for low- to intermediate-risk prostate cancer (PCa) patients. Prostate-specific membrane antigen positron emission tomography and computed tomography (PSMA PET/CT) has emerged as a useful modality to assess intraprostatic lesions. This systematic review aims to evaluate PSMA PET/CT in localized low- to intermediate-risk PCa to determine its role in active surveillance. Materials and Methods: Following PRISMA guidelines, a search was performed on Medline, Embase, and Scopus. Only studies evaluating PSMA PET/CT in localized low- to intermediate-risk PCa were included. Studies were excluded if patients received previous treatment, or if they included high-risk PCa. Results: The search yielded 335 articles, of which only four publications were suitable for inclusion. One prospective study demonstrated that PSMA PET/CT-targeted biopsy has superior diagnostic accuracy when compared to mpMRI. One prospective and one retrospective study demonstrated MRI occult lesions in 12.3–29% of patients, of which up to 10% may harbor underlying unfavorable pathology. The last retrospective study demonstrated the ability of PSMA PET/CT to predict the volume of Gleason pattern 4 disease. Conclusions: Early evidence demonstrated the utility of PSMA PET/CT as a tool in making AS safer by detecting MRI occult lesions and patients at risk of upgrading of disease.

5.20.2. UP-20.02: Cancer-Specific Mortality After Radical Prostatectomy Versus Radiotherapy in Incidental Prostate Cancer

• Di Bello F ¹, Briganti A ², Chun F ³, Scheipner L ⁴, Baudo A ⁵, De Angelis M ², Jannello L ⁶, Siech C ³, Vitucci K ³, Goyal J ⁷, Collà Ruvolo C ⁸, Califano G ¹, Creta M ¹, Morra S ¹, Acquati P ⁵, Saad F ⁷, Carmignani L ⁹, De Cobelli O ⁶, Ahyai S ⁴, Longo N ¹ and Karakiewicz P ⁷

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

Università Salute Vita San Raffaele, Milano, Italy

³ 

Goethe Frankfurt University, Frankfurt, Germany

⁴ 

Graz Medical University, Graz, Austria

⁵ 

Ospedale Gruppo San Donato, Milano, Italy

⁶ 

IEO Istituto Europeo di Oncologia, Milano, Italy

⁷ 

University of Montréal Health Center, Montréal, Canada

⁸ 

Università Federico II di Napoli, Napoli, Italy

⁹ 

Università Statale di Milano, Milano, Italy

Abstract: Introduction and Objectives: To test for cancer specific mortality (CSM) differences after either radical prostatectomy (RP) or radiotherapy (RT) in incidental prostate cancer (IPCa) patients. Materials and Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004–2015), IPCa patients were identified. Cumulative incidence plots as well as competing risks regression (CRR) models were fitted to address cancer-specific mortality (CSM) after adjustment for other-cause mortality (OCM). Furthermore, a subgroup analysis was performed to test for CSM differences between RP and RT according to Gleason sum (GS 6.7, and 8–10). Results: Of 1466 IPCa patients, 770 (53%) underwent RP vs. 696 (47%) RT. Incidental PCa RT patients were older, and exhibited higher PSA, higher proportion of Gleason sum 8–10, and higher clinical T stage. In cumulative incidence plots, five-year CSM rates adjusted for OCM were 0.9 for RP vs. 6.8% for RT (Δ = 5.9%). After multivariable adjustment for age, PSA, Gleason sum, and clinical T stage as well as adjustment for OCM, RP was associated with a protective hazard ratio (HR) of 0.35 (95% confidence interval [CI] 0.15–0.78, p value = 0.01). Conclusions: Incidental PCa RT-treated patients exhibited less favorable clinical characteristics (age, PSA, Gleason sum, and clinical T stage) than their RP counterparts. Despite full adjustment, RP was associated with a very strong protective effect relative to RT. This effect exclusively applied to the Gleason sum 8–10 subgroup. In consequence, IPCa patients harboring Gleason sum 8–10 should ideally be considered for RP instead of RT.

5.20.3. UP-20.03: High-Intensity Focused Ultrasound (HIFU) for the Primary Treatment of Prostate Cancer: Experience of a Latin-American Cancer Center

• Brazão Jr E ¹, De Oliveira R ², Zanotti R ¹, Gomes D ¹, Mourão T ¹, Santos V ¹, Da Silva C ¹, Santana T ¹, Da Costa W ¹, Guimarães G ² and Zequi S ¹

¹ 

AC Camargo Cancer Center, São Paulo, Brazil

² 

BP—Beneficencia Portuguesa, São Paulo, Brazil

Abstract: Introduction and Objectives: This study aims to report the outcomes of using High-Intensity Focused Ultrasound (HIFU) as the primary treatment for non-metastatic prostate cancer, including both oncological and functional outcomes. Materials and Methods: We retrospectively reviewed data from men with prostate cancer who underwent HIFU as primary treatment at a single center from 2011 to 2019. Patients with PSA > 20 ng/mL, cN+, cm+ at initial staging, or follow-up < 6 months were excluded. Patients underwent partial (PGA) or whole-gland ablation (WGA) of the prostate with Ablatherm^® (2011–2018) and FocalOne^® (2018–2019). The primary outcome was failure-free survival, with failure defined by local recurrence requiring whole-gland or systemic treatment, metastasis, or cancer-specific death. Urinary continence and erectile function were also evaluated. Survival analyses were estimated by the Kaplan-Meier method and compared with the log-rank test. Cox regression was used to identify independent predictors of failure. Results: A total of 253 patients were included in the study. The median age was 71 years, and the median PSA was 6.1 ng/mL. The median follow-up was 47 months. The rate of patients classified as low, intermediate, or high-risk according to D’Amico was 26%, 42%, and 32%, respectively. WGA was performed in 90% of the patients. Overall, the failure-free survival at 1, 3, and 5 years was 97%, 83%, 74%. The failure-free survival at 5 years for low, intermediate, and high-risk was 93%, 74%, and 57%, respectively. There was no difference in failure-free survival between the groups undergoing WGA or PGA. Five-year biochemical recurrence-free, local recurrence-free, metastasis-free, cancer-specific, and overall survivals were 58%, 71%, 94%, 98%, and 93%, respectively. The pad-free continence rate in patients undergoing PGA was 100%, significantly higher than in patients undergoing WGA (83%) (p = 0.0184). About 90% of previously potent patients undergoing PGA maintained erections sufficient for penetration, while 62% of patients undergoing WGA had the same outcome (p = 0.0112). PSA ≥ 6 ng/mL, ISUP ≥ 4, stage T ≥ T2b, and PSA nadir > 1.5 ng/mL were independently associated with failure. Conclusions: HIFU presents good medium-term oncological control in appropriately selected patients. There is functional superiority of PGA compared to WGA.

5.20.4. UP-20.04: Other-Cause Mortality in Incidental Prostate Cancer

• Di Bello F ¹, Baudo A ², De Angelis M ³, Jannello L ⁴, Siech C ⁵, Goyal J ⁶, Collà Ruvolo C ⁷, Califano G ¹, La Rocca R ¹, Morra S ¹, Acquati P ², Saad F ⁶, Carmignani L ⁸, De Cobelli O ⁴, Briganti A ³, Chun F ⁵, Longo N ¹ and Karakiewicz P ⁶

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

Ospedale Gruppo San Donato, Milano, Italy

³ 

Università Salute Vita San Raffaele, Milano, Italy

⁴ 

IEO Istituto Europeo di Oncologia, Milano, Italy

⁵ 

Goethe Frankfurt University, Frankfurt, Germany

⁶ 

University of Montréal Health Center, Montréal, Canada

⁷ 

Università Federico II di Napoli, Napoli, Italy

⁸ 

Università Statale di Milano, Milano, Italy

Abstract: Introduction and Objectives: In incidental prostate cancer (IPCa) elevated other-cause mortality (OCM) may obviate the need for active treatment. We tested OCM rates in IPCa according to treatment type and cancer grade and we hypothesized that OCM is significantly higher in not-actively-treated patients. Materials and Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2015), IPCa patients were identified. Smoothed cumulative incidence plots as well as multivariable competing risks regression models were fitted to address OCM after adjustment for cancer-specific mortality (CSM). Results: Of 5121 IPCa patients, 3655 (71%) were not-actively-treated while 1466 (29%) were actively-treated. Incidental PCa not-actively-treated patients were older and exhibited higher proportion of Gleason sum (GS) 6 and clinical T1a stage. In smoothed cumulative incidence plots, five-year OCM was 20% for not-actively-treated vs. 8% for actively-treated patients. Conversely, five-year CSM was 5% for not-actively-treated vs. 4% for actively-treated patients. No active treatment was associated with 1.4-fold higher OCM, even after adjustment for age, cancer characteristics and CSM. According to GS, OCM reached 16, 27 and 35% in GS6, 7 and 8–10 not-actively-treated IPCa patients, respectively and exceeded CSM recorded for the same three groups (2, 6 and 28%, respectively). Conclusions: Our results quantified OCM rates, confirming that in not-actively-treated IPCa patients OCM is indeed significantly higher than in their actively-treated counterparts (HR:1.4). These observations validate the use of no active treatment in IPCa patients, in whom OCM greatly surpasses CSM (20% vs. 5%).

5.20.5. UP-20.05: Outcome of Robot-Assisted Radical Prostatectomy in Men After Trans-Urethral Resection of the Prostate—A Matched-Pair Analysis

• Carbin Joseph D ¹, Abou Chedid W ¹, Hindley R ² and Eden C ¹

¹ 

Royal Surrey County Hospital, Guildford, United Kingdom

² 

Hampshire Hospitals NHS Foundation Trust, Guildford, United Kingdom

Abstract: Introduction and Objectives: Prior history of transurethral resection of the prostate (TURP) can complicate Robot-assisted radical prostatectomy (RARP). Very few studies analyse the outcomes of RARP in men prior history of TURP. Materials and Methods: We analysed the oncological and functional outcomes of RARP in post-TURP men from our prospectively maintained database. The initial two years of data were excluded to remove the learning curve effect. We included the database from January 2016 to January 2022. Thirty men who had RARP with a prior history of TURP were identified (Group 2). They were matched using R software and propensity score matching to 90 men with no previous TURP (Group 1). The groups were matched for age, body mass index (BMI) and D’Amico risk category in a 1:3 ratio. The two-year oncological and functional outcomes were compared. Results: Overall, the study did not find any significant difference in the preoperative parameters, such as BMI, age, and clinical stage of D’amico risk grouping, between the groups. There was no difference in the operating time or estimated blood loss. The postoperative complications (CD3a 2% versus 6.7%) and hospital stay (median stay of 2 days) were not statistically significant between Non-TURP and TURP groups. None of the men in either group were incontinent in one and two years of follow-up (> 0.9). 73% of non-TURP and 75% of TURP men developed biochemical recurrence in two-year follow-up. Conclusions: In high-volume centres, the oncological and continence outcomes of RARP post-TURP are not inferior to that of men without prior TURP.

5.20.6. UP-20.06: Patient-Reported Outcome Measures (PROMs) and Experience Measures (PREMs) After Active Surveillance vs. Radiation Therapy vs. Radical Prostatectomy for Prostate Cancer: A Systematic Review of Prospective Comparative Studies

• Alberti A ¹, Nicoletti R ¹, Castellani D ², Yuan Y ³, Maggi M ⁴, Dibilio E ¹, Resta G ¹, Makrides P ¹, Sessa F ¹, Sebastianelli A ¹, Serni S ¹, Gacci M ¹, De Nunzio C ⁵, Teoh J ⁶ and Campi R ¹

¹ 

Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy

² 

Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy

³ 

Department of Medicine, McMaster University, Hamilton, Canada

⁴ 

Department of Urology, Sapienza Rome University, Rome, Italy

⁵ 

Department of Urology, Sant’Andrea Hospital, La Sapienza University, Rome, Italy

⁶ 

S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China

Abstract: Introduction and Objectives: Since all treatments for localized Prostate Cancer (PCa) showed comparable oncological outcomes, Patient-Reported Outcomes Measures (PROMs) and Patient-Reported Experience Measures (PREMs) allow to compare their functional, Quality of Life (QoL) and subjective outcomes. This systematic review aimed to compare PROMs and PREMs after all recommended treatments for localized PCa (radical prostatectomy [RP], radiotherapy [RP], active surveillance [AS]), as well as to provide a contemporary state of the art on how these items are used within PCa setting. Materials and Methods: Literature search was performed using the MEDLINE, EMBASE, and Cochrane CENTRAL databases, following the EAU Guidelines Office and the PRISMA statement recommendations. All prospective clinical trials reporting PROMs and/or PREMs comparing both RP, RT and AS were included. The risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions risk-of-bias tool for RCTs and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for prospective studies. Since a meta-analysis was deemed not feasible, a narrative synthesis of the evidence was performed. Results: The literature search identified 2564 papers, of which 21 were included. Our findings reveal that RP mostly affects urinary continence and sexual function, with better results on voiding symptoms compared to other treatments. Bowel function and voiding symptoms are more impaired by RT. None of the treatments showed a significant impact on mental or physical QoL. PROMs assessed in the studies included in the review are summarized in Figure 1. Only three studies reported PREMs, with high rates of decision-regret considering all modalities (up to 23%). Conclusions: All recommended treatments for localized PCa have an impact on PROMs and PREMs, yet on different domains and with different severities. We found significant heterogeneity in PROMs collection, warranting their standardization in real-world practice and clinical trials. Only few studies reported PREMs, highlighting the unmet need to explore these outcomes in future studies.

5.20.7. UP-20.07: Stratification of Potency After Robotic-Assisted Radical Prostatectomy Based on Age and Degree of Nerve-Sparing

• Ibrahim M, Fonseca P, Jinaraj A, Rabinowitz J, Ogbechie C, Haidar O, Kinnear N, Brodie A, Vasdev N, Lane T and Adshead J
• Lister Hospital ENH NHS Trust, Stevenage, United Kingdom

Abstract: Introduction and Objectives: In men undergoing robotic-assisted laparoscopic prostatectomy (RALP), this study aimed to identify the impact of age and degree of neurovascular bundle preservation on one-year post-operative potency. In potent men undergoing RALP, higher one-year potency is strongly associated with younger age and higher degree of nerve-sparing. Patients should be counselled on their individualised risk of erectile dysfunction post RALP. Materials and Methods: Men undergoing RALP 01/01/2009–30/06/2020 were enrolled from a prospectively maintained database. Patients were excluded if they had pre-operative therapy, post-operative adjuvant therapy, clinical trial enrolment, pre-operative sub-optimal potency or unclear potency or nerve-sparing data. Patients were grouped based on age (≤ 54 years; 55–59 years; 60–64 years and ≥ 65 years) and degree of nerve-sparing. Degree of nerve-sparing was graded as NV1 (bilateral intrafascial), NV2 (bilateral other), NV3 (unilateral) and NV4 (non-nerve sparing). Post-operative potency was assessed on a previously reported four-item scale (erections: spontaneous (0), adequate with oral medications (1), adequate with intra-cavernosal injection (2) or absent/minimal (3)). Men with scores 0–1 were considered potent. The primary outcome was difference in one-year potency. Groups were compared using the Pearson’s chisquared test. All tests were two-tailed. Significance was assessed at the 5% alpha level. Ethics approval was obtained. Results: In the enrolment period, 1731 consecutive men underwent RALP, with 992 (57%) excluded due to pre-operative radiotherapy (2), adjuvant treatment (51), clinical trial enrolment (8), pre-operative erectile dysfunction (358) or missing potency or nerve-sparing data (573), resulting in 739 eligible patients. Higher one-year potency rates were significantly associated with both higher degree of nerve-sparing (NV1 (49%), NV2 (46%), NV3 (33%) and NV (17%) (p < 0.00001)) and younger age (48% (≤ 54 years), 39% (55–59 years), 32% (60–64 years) and 27% (≥ 65 years) (p = 0.0003)). When both factors are considered together (Figure 1), one-year potency steadily declines from 55% (NV1 and age ≤ 54 years) to 11% (NV4 and ≥ 65 years). This study is limited by its single-centre retrospective design and large proportion of excluded patients. Conclusions: In potent men undergoing RALP, higher one-year potency is strongly associated with younger age and higher degree of nervesparing. Patients should be counselled on their individualised risk of erectile dysfunction post RALP.

5.20.8. UP-20.08: The Prostate Gland Asymmetry Affects the 3- and 12- Months Continence Recovery After RARP in Patients with Small Prostate Glands: A Single Center Study

• Di Bello F ¹, Napolitano L ², Morra S ¹, Fraia A ¹, Pezone G ¹, Polverino F ¹, Granata G ¹, Collà Ruvolo C ³, Ponsiglione A ¹, Stanzione A ¹, La Rocca R ¹, Creta M ¹, Imbriaco M ¹, Imbimbo C ¹, Longo N ¹ and Califano G ¹

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

Federico II di Napoli, Napoli, Italy

³ 

Università Di Napoli Federico II, Napoli, Italy

Abstract: Introduction and Objectives: To test the impact of the prostate gland asymmetry on continence rates, namely 3- and 12-months continence recovery, in prostate cancer (PCa) patients who underwent robot-assisted radical prostatectomy (RARP). Materials and Methods: Within our institutional database, RARP patients with complete pre-operative MRI features and 12 months follow-up were enrolled (2021–2023). The population has been stratified according to the presence or absence of prostate gland asymmetry (defined as the presence of median lobe or side lobe dominance). Multivariable logistic regression models (LRMs) predicting the continence rate at 3 and 12 months after RARP were fitted in the overall population. Subsequently, the LRMs were repeated in two subgroup analyses based on prostate size (≤40 vs. >40 mL). Results: Overall, 248 consecutive RARP patients were included in the analyses. The rate of continence at 3 and 12 months was 69 and 72%, respectively. After multivariable LRM the bladder neck sparing approach (OR: 3.15, 95% CI: 1.68–6.09, p value < 0.001) and BMI (OR: 0.90, 95% CI: 0.82–0.97, p = 0.006) were independent predictors of recovery continence at 3 months. The prostate gland asymmetry independently predicted lower continence rates at 3 (OR: 0.33, 95% CI: 0.13–0.83, p = 0.02) and 12 months (OR: 0.31, 95% CI: 0.10–0.90, p = 0.03) in patients with prostate size ≤ 40 mL. Conclusions: The presence of prostate lobe asymmetry negatively affected the recovery of 3 and 12 months continence in prostate glands ≤ 40 mL. These observations should be considered in the preoperative planning and counselling of RARP patients.

5.21. Prostate Cancer—Detection

5.21.1. UP-21.01: Assessing the Accuracy of MRI in the Diagnosis of Prostate Cancer

• Bond G, Bowen D, Bondad J, Abdallah M and Ganeshalingam S
• Broomfield Hospital, Essex, Chelmsford, United Kingdom

Abstract: Introduction and Objectives: This study aims to establish the accuracy of our local MRI Prostate in the diagnosis of prostate cancer. Materials and Methods: A single centre retrospective audit was conducted. We identified 550 patients who were referred under the 2 WW pathway for suspected prostate cancer between January 2021 and December 2021. 390 patients (median age of 69 years) underwent MRI prostate. A suspicious MRI was defined as ≥ Pi-RADS 3 or with a PSA density (PSAD) of ≥ 0.15. 214 patients (median age of 71) subsequently underwent local anaesthetic transperineal prostate biopsy. Clinically significant prostate cancer (csPCa) was defined as prostate cancer with a Cambridge prognostic group score of ≥ 3. Results: The positive predictive value (PPV) for suspicious MRI in detecting any prostate cancer and csPca were 77% and 50% respectively. PPVs for csPCA were 26%, 45% and 80% for, respectively, Pi-RADS 3, 4 and 5. The PPV for patients with a PSAD of ≥ 0.15 for any prostate cancer was 41% and 5% for csPCA. Conclusions: Our local data suggests good accuracy of our MRI Prostate in the diagnosis of prostate cancer and csPCa. This information can potentially aid in counselling patients who are in the diagnostic pathway for prostate cancer, providing them with pertinent local data.

5.21.2. UP-21.02: Assessment of PSA Density as a Predictor of Non-Clinically Significant Prostate Cancer in Patients on Active Surveillance with Negative MRI

• Tagalos Muñoz A, García Barreras S, Artiles Medina A, Arribas Terradillos S, Rodríguez-Patrón Rodríguez R, Fernández Conejo G, Mínguez Ojeda C, Mata Alcaraz M, López Curtis D, Sanz Mayayo E and Burgos Revilla F
• Ramón y Cajal University Hospital, Madrid, Spain

Abstract: Introduction and Objectives: Active surveillance (AS) aims to avoid overtreatment of non-significant prostate cancer (PCa). Periodic prostate biopsies are not risk-free, so it is interesting to identify non-clinically significant PC predictors to avoid them. The objective of this study was to determine the role of prostate-specific antigen density (PSAD) as a predictor of non-clinically significant PCa in AS patients with negative MRI (Magnetic Resonance Imaging). Materials and Methods: Retrospective study, including 98 patients with PCa on AS. All of them met criteria for AS: negative MRI, PSA < 10 g/mL, Gleason ≤ 3 + 3 or GG ≤ 1, at least one confirmation biopsy (saturation), maximum 2 cores with tumor and clinical stage T1c–cT2a. PSAD calculation: Total PSA/prostate volume on MRI. There were established two PSAD intervals (< 0.15 ng/mL and ≥ 0.15 ng/mL) to determine its predictive capacity in confirmatory biopsy and its association with clinical and pathological factors. Patient characteristics were compared by independent t-test for continuous variables and Pearson’s Chi-square for categorical variables. Results: There were included 98 patients in AS, 55 (56%) presented positive biopsy and 29 (29.5% of total) progressed to GG ≥ 2 in the subsequent biopsy. The mean PSA was higher in patients with positive biopsy (7.1 vs. 5.8; p = 0.05). The same results occur with dPSA (p = 0.02). After stratifying by PSAD levels, a PSAD ≥ 0.15 was associated with a positive result of the biopsy (p = 0.04). The presence of HGPIN in previous biopsies, a higher BMI as well as older age were associated to positive biopsies (p = 0.014; p = 0.01 y p = 000). Regarding the factors associated to progression, a smaller prostate volume (p = 0.048) was significantly related to progression in the biopsy and also a dPSA > 0.15 is associated with histological progression (p = 0.00). Table 1: Anatomopathological data and treatment in patients with upgrading on saturation biopsy. Conclusions: The use of PSAD < 0.15 ng/mL in patients with a negative MRI was a useful factor to identify men without clinically significant PCa who could omit the indication for confirmatory biopsy in the AS setting.

5.21.3. UP-21.03: Clinically Significant Prostate Cancer: Ability of Multiparametric MRI to Exclude It and Predictors of Positivity in the Biopsy

• Tagalos Muñoz A, García Barreras S, Rodríguez-Patrón Rodríguez R, Artiles Medina A, Fernández Conejo G, Arribas Terradillos S, Mínguez Ojeda C, López Curtis D, Mata Alcaraz M, Sanz Mayayo E and Burgos Revilla F
• Ramón y Cajal University Hospital, Madrid, Spain

Abstract: Introduction and Objectives: Magnetic resonance imaging (MRI) has a high negative predictive value in the detection of clinically significant prostate cancer (CSPCa). The decision to perform a confirmatory saturation biopsy can be difficult in patients with suspected prostate cancer (PCa) and negative MRI. Objective: To determine the proportion of patients with negative MRI who present PCa and CSPCa after saturation biopsy and identify predictive factors for both of them. Materials and Methods: Retrospective study, from April 2017 to December 2023, of 968 men undergoing transperineal biopsy for suspected PCa, of whom 200 had negative MRI (PI-RADS ≤ 2) and underwent saturation biopsy (≥ 20 cores). Analysis of clinical characteristics, biopsy results and possible predictive factors for PCa is performed. Continuous variables were compared using independent test and categorical using Chi-square. Univariate and multivariate logistic regression were used to identify independent risk factors for MRI-invisible PCa. Results: Prostate cancer (PCa) was detected in 90 out of the 200 saturation biopsies performed (45%). Of these, 44 were clinically significant prostate cancers (CSPCa) (48.8%). Regarding the factors associated with positive biopsy, prostate volume, PSA velocity and elevated PSA showed significant association (p = 0.017, p = 0.001 y p = 0.003 respectively). Presenting HGPIN on previous biopsy, having a higher BMI, and older age were also associated with a positive biopsy (p = 0.024, p = 0.015, and p = 0.006, respectively). A negative result in previous biopsies was associated with negative biopsy result (p = 0.00), as well as being in treatment with 5-alpha-reductase inhibitors (p = 0.002). Attending to factors associated with CSPCa, lower prostate volume (p = 0.04), PSA density (PSAD) ≥ 0.15 (p = 0.38), higher PSA and PSA velocity (all p < 0.001) showed statistical association. The multivariate analysis pointed, as risk factors for positive biopsy, the presence of PSA < 10 ng/dl (OR 0.24, 95%CI 0.09–0.61; p = 0.03) and PSAD ≥ 0.15 (OR 2.749, 95%CI 1.07–7.06; p = 0.01). Conclusions: PSAD ≥ 0.15 can be a risk factor for positive biopsy in patients with negative MRI and it’s associated with CPcs. Saturation biopsy could be considered in patients with suspected PCa, despite having a negative MRI.

5.21.4. UP-21.04: Comparative Effectiveness of Magnetic Resonance Imaging (MRI)—Ultrasound Software Fusion versus Cognitive Fusion Targeted Prostate Biopsy Done at a District General Hospital

• Patil M, Abbaraju J, Hossain D, Banerjee S, Ghonaimy A and Gardener A
• Darent valley hospital, Dartford, United Kingdom

Abstract: Introduction and Objectives: Fusion of MRI with ultrasound has enabled urologists to evolve from random systematic prostate biopsies to more precise and targeted ones. There are three methods of achieving this fusion: Cognitive fusion, MRI-Ultrasound software fusion and in-bore fusion. In this study, we compare the results of software fusion and cognitive fusion techniques. Materials and Methods: MRI-ultrasound software fusion for prostate biopsies has been recently adopted at our District General hospital. We retrospectively compared the data of initial 150 patients who underwent biopsies using this technique with that of last the 150 patients who had cognitive fusion biopsies. All biopsies were performed by trans-perineal approach. The same operators performed biopsies in both arms of the study. We used the Trinity Koelis system, which uses elastic MRI fusion. Results: The average number of cores taken during software fusion biopsy were 15 versus 24 during cognitive prostate biopsy. 71.3% (n = 107) patients were diagnosed with prostate cancer by software fusion. Similarly, 68.7% (n = 103) patients were diagnosed by cognitive biopsy. However, the percentage of clinically significant cancer detection was significantly higher in software fusion group (82.2%) as compared to cognitive group (71.8%). Conclusions: MRI fusion biopsies have significantly improved cancer detection rates for clinically significant cancers even in early stages of learning curve. Lesser number of cores are required which signifies more accuracy and is beneficial for the patients. The diagnostic efficacy is expected to further improve as the operators gain more experience.

5.21.5. UP-21.05: Diffuse Bilateral PIRADS 3 Changes Reported as Inflammation and Its Relation to Clinically Significant Prostate Cancer—A Retrospective Observational Study

• Sofi J, Subedi P, Mukerji G and Pradhan A
• London North West University Healthcare NHS Trust, Harrow, United Kingdom

Abstract: Introduction and Objectives: The aim of this study was to investigate if diffuse bilateral PIRADS 3 changes reported on dedicated MRI Prostate harbour clinically significant prostate cancer within them. Materials and Methods: We retrospectively collected data of 108 men from January 2020 to November 2023 who fulfilled the criteria of bilateral diffuse PIRADS 3 changes on the mpMRI of the prostate and who had systematic biopsy of the prostate after their MRIs were discussed in the multidisciplinary meeting. Discrete PIRADS 3 lesions were excluded from the study. Data collection was done for age, ethnicity, prostate volume, PSA, PSA density and histology from the prostate biopsy. Histology was categorised into benign and malignant groups. Benign pathology consisted of normal prostate tissue, inflammation, High grade prostatic intraepithelial neoplasm (HGPIN) and Atypical small acinar proliferation (ASAP). Malignant group was classified as clinically insignificant prostate cancer (cisPCa) and clinically significant prostate cancer (csPCa) (GG ≥ 2) (Gleason score ≥ 3 + 4) (2). csPCa was classified by International Society of Urologic pathologist grade group system. Results: The analysis showed that 30.5% of men with bilateral diffuse PIRADS3 changes had diagnosis of clinically significant prostate cancer. There was correlation (p value < 0.05) of PSA density to diagnosis of clinically significant cancer in these diffuse P3 changes. Conclusions: The likelihood of clinically significant prostate cancer in diffuse PIRADS 3 changes is quite high and hence, it is necessary to exercise caution before embarking on not to biopsy these changes although they look inflammatory on the MRI.

5.21.6. UP-21.06: Factors Influencing Prostate Cancer Diagnosis in Patients Undergoing MRI/Ultrasound Fusion-Guided Biopsy

• Morales Pinto S ¹, Cobo C ¹, García Góngora B ² and Herrera Imbroda B ¹

¹ 

Virgen de la Victoria University Hospital, MALAGA, Spain

² 

University Hospital Virgen de la Victoria Málaga-España, MALAGA, Spain

Abstract: Introduction and Objectives: Prostate cancer is the second most frequent tumor in men in our environment. Multiparametric Multiparametric Magnetic Resonance Imaging (MRImp) prior to prostate biopsy is included in most clinical practice guidelines, both in naïve patients and in patients with previous biopsies. However, fusion biopsy is not widely used. The aim of this work is to determine the pre-surgical factors that determine a positive biopsy result for prostate tumor. Materials and Methods: Retrospective study of 391 patients biopsied by MRImp/Ultrasound fusion-guided biopsy between September 2020 and December 2023 at the University Hospital Virgen de la Victoria-Malaga. Statistical analysis was performed using univariate and multivariate analysis with Cox regression. Results: The median PSA was 7.28 ng/mL. The mean prostate volume was 59.7 cc. The 87.7% of the patients had a previous prostate biopsy. 27.4% (107 patients) were under active surveillance protocol. Univariate analysis showed as risk factors for a positive pathological result: age > 65 years (p = 0.001 Chi²), PSA density > 15 ng/mL/cc (p = 0.001 Chi²), the presence of palpable tumor (p = 0.001 Chi²), peripheral location of the lesion on MRI-mp (p = 0.001 Chi²) and presence of PIRADS lesions ≥ 3 (p = 0.00 Chi²). Multivariate analysis confirmed that: age > 65 years (HR 1.75; CI95%:1.28–2.38, p < 0.001); PSA density > 0.15 ng/mL/cc (HR 10.93; CI95%:3.92–30.52, p < 0.002); the location of lesions in peripheral zone (HR 1. 40; CI95%:1.02–1.93, p = 0.22) and the presence of PIRADS ≥ 3 lesions (HR 1.87; CI95%:1.18–2.95, p < 0.03) are risk factors for identifying positive pathological outcome. In addition, in the multivariate analysis, PSA < 10 ng/mL (HR 0.94; CI95%: 0.90–0.97, p < 0.01), the presence of previous biopsies (HR 0.62; CI95%; 0.41–0.94, p < 0.009) are identified as protective factors. In patients with two foci, both being PIRADS 3, a decreased risk of a positive pathological result in the fusion biopsy was observed (HR 0.82; CI95%; 0.61–0.98 p < 0.04). Conclusions: Age > 65 years, PSA density > 15 ng/mL/cc, peripheral lesion location, and the presence of PIRADS 4–5 lesions are associated with a positive outcome for prostate cancer.

5.21.7. UP-21.07: Incidental Prostate Cancer in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP)

• Arce Cuartango P, Moctezuma Velázquez J, Cachi Fuentes G, Hidalgo Zabala E, Herrera Aranda N, San Martín Vilariño P, Duque Martínez I, García De Garayo Pires N, Ayerra Pérez H, Pinto Martín R, Merino Narro I, Díez Razquín M, Campà Bortoló J and Extramiana Cameno J
• Bioaraba, Cáncer Urológico, Vitoria-Gasteiz, España; Osakidetza, Hospital Universitario Araba, Urología, Vitoria-Gasteiz, Spain

Abstract: Introduction and Objectives: Holmium laser enucleation of the prostate (HoLEP) is a surgical technique used in the treatment of benign prostatic hyperplasia (BPH), especially indicated in prostates > 80 g. Based on current literature, 8% of patients undergoing HoLEP are diagnosed with incidental prostate cancer (PCa), being mostly low-risk and managed with active surveillance (AS). Materials and Methods: We performed a retrospective analysis of 308 patients undergoing HoLEP between January 2019 and May 2023. We divided the sample into two groups: patients with negative anatomical pathology (AP) and patients with AP of PCa. We performed a descriptive analysis in the group of CaP patients, as well as an inferential statistical analysis of baseline data (age, prostate volume and PSA) in both groups, using the t-Student test in SPSS. Results: 32 patients (10.39%) had incidental PCa (87.5% pT1a and 12.5% pT1b), of which 81.25% were ISUP 1, 9.38% ISUP 2, 3.13% ISUP 3, 3.13% ISUP 4 and 3.13% ISUP 5. Of these, 6.25% had a suspicious digital rectal examination and 34.38% had a negative prior prostate biopsy. AS was chosen in 93.75% of patients while 2 (6.25%) received initial RT. Of those managed with AS, 2 (6.67%) had PSA progression and positive MRI and therefore received RT. The mean age of the PCa group was 74.25 years (σ 8.26) vs. 70.42 years (σ 7.91) in PA-negative patients. The mean prostate volume in CaP patients was 107.63 cc (σ 46.19) vs. 99.38 cc (σ 36.24). Mean PSA in CaP patients was 7.26 ng/mL (σ 6.42) vs. 5.21 ng/mL (σ 4.35). We found statistically significant differences in age (p < 0.05) and PSA levels (p < 0.05) of both groups, while we found no differences in prostate volume. Conclusions: Incident PCa is a relatively frequent finding among patients undergoing HoLEP and is generally managed with AS. We can conclude that patients with AP of PCa have higher PSA levels and older age than those with negative AP with statistically negative differences.

5.21.8. UP-21.08: Influence of Histological Factors on Prostate Cancer Detection on Multiparametric MRI

• Zouari F, Fourati M, Toumi N, Charfi S, Chaabouni A, Ben Mahfoudh K, Rebai N and Hadj Slimen M
• Habib Bourguiba Academic Hospital, Sfax, Tunisia

Abstract: Introduction and Objectives: The diagnosis of prostate cancer (PCa) is confirmed by ultrasound-guided prostate biopsy. This is unable to diagnose clinically significant PCa (csPCa) and may expose to the risk of overdiagnosis and overtreatment. Multiparametric MRI (mpMRI) of the prostate, using PI-RADS, has yielded promising results in PCa detection. The objective of this study is to evaluate the histological factors that influence mpMRI performance. Materials and Methods: Thirty-five patients were identified who had undergone mpMRI prior to RP for PCa between June 2013 and June 2023 in the urology department of Habib Bourguiba University Hospital in Sfax. The mpMRI exams were reevaluated using PI-RADS v2.1 by an experienced radiologist who was blinded to the RP results. The mpMRI results and histological findings for the radical prostatectomy (RP) specimens were compared. Results: The average age of patients was 65.29 years. The average PSA was 12.4 ng/mL. Pathological analysis confirmed 57 PCa foci including 34 csPCa (ISUP grade ≥ 2, tumour volume ≥ 2 cc). mpMRI successfully identified 47 lesions. Overall sensitivity of 72.8% was achieved using mpMRI for the detection of PCa (34/57). Of the 40.4% (23/57) tumours that were missed by mpMRI, 73.9% (17/23) were ≤ 1 cc and 47.8% (11/23) were classified as ISUP1. A correlation was observed between higher PI-RADS score and higher ISUP grade (Spearman’s correlation coefficient: 0.366, p < 0.039). In addition, higher PI-RADS scores were associated with increased tumour volume (Pearson’s correlation coefficient: 0.551, p < 0.001). Pathological index tumour volume (p = 0.014) and clinically significant tumour status (p = 0.002) were associated with the detection of PCa by mpMRI, according to univariate analysis. Pathological index tumour volume was the strongest predictor of tumour detection by mpMRI using multivariate analysis (p = 0.032). Conclusions: A significant correlation was observed between higher PI-RADS score and higher ISUP grade and increased tumour volume. Tumour volume was the strongest predictive factor in detecting index tumours. Our results suggest that there is a limit to the diagnostic role of mpMRI for PCa lesions with low ISUP grade and tumour volume. Therefore, the role of mpMRI in early diagnosis and local staging of PCa may be limited.

5.21.9. UP-21.09: Mendelian Randomization Analysis Revealed the Casual Association Between Circulating Glycoprotein Acetyls and Prostate Cancer Risk

• Zuo L, Shi X, Yue C, Zhang L and Gao S
• The Affiliated Changzhou no.2 People’s Hospital of Nanjing Medical University, Changzhou, China

Abstract: Introduction and Objectives: Glycoprotein acetyls (GlycA) is a novel complex biomarker of systemic inflammation. However, the association between circulating GlycA and prostate cancer risk remains unclear. In this study, we aimed to investigate the casual association between circulating GlycA and prostate cancer risk via mendelian randomization analysis. Materials and Methods: GWAS summary data of circulating GlycA concentration were obtained from IEU openGWAS database, and GWAS summary data of prostate cancer were obtained from FinnGen database. Single nucleotide polymorphisms which strongly correlated with circulating GlycA concentration were used as instrumental variables. Two-sample Mendelian randomization analysis was used to analyze the causal relationship between circulating GlycA concentration and prostate cancer risk. Inverse variance weighting method was used as the primary analysis method, MR-egger regression, weighted median, simple model, and weighted model were used as validation methods. Cochran’s Q test and MR-egger intercept method are used for heterogeneity analysis and pleiotropy analysis. Results: Inverse variance weighted (Random-effects model) analysis showed that there was a causal relationship between circulating GlycA and prostate cancer risk, and high circulating concentration of GlycA was a risk factor for prostate cancer. The odds ratio (OR) of circulating GlycA in the training cohort was 1.204, the 95% confidence interval was [1.034, 1.401], and the p value was 0.017. The odds ratio (OR) of GlycA in the validation cohort was 1.204, with a 95% confidence interval of 1.044 to 1.387 and a p value of 0.01. The results of the analysis were of statistic significant. Conclusions: This study suggests that there is a causal link between circulating GlycA and the incidence of prostate cancer, and that elevated circulating GlycA is a risk factor for prostate cancer.

5.21.10. UP-21.10: Combination of C-Reactive Protein/Albumin Ratio and Time to Castration Resistance Can Accurately Predict the Prognosis for Patients with Metastatic Castration-Resistant Prostate Cancer

• Mitsui Y, Uetani M, Hori S, Yamabe F, Kobayashi H, Nagao K and Nakajima K
• Toho University Faculty of Medicine, Tokyo, Japan

Abstract: Introduction and Objectives: Research results presented in recent years have shown that c-reactive protein albumin ratio (CAR) and time to castration resistance (TTCR) are factors associated with metastatic castration-resistant prostate cancer (mCRPC) patient prognosis. Therefore, we speculated that combined use of these two factors, which have different characteristics, could provide accurate information to reflect prognosis and thus performed the present retrospective investigation of mCRPC patients treated at our institution. Materials and Methods: Clinical data from 98 mCRPC patients treated at our institution from 2009 to 2021 were retrospectively evaluated. Optimal cut-off values for CAR and TTCR to predict lethality were generated by use of a receiver operating curve and Youden’s index. The Kaplan-Meier method and Cox proportional hazard regression models for OS were used to analyze the prognostic capabilities of CAR and TTCR. Multiple multivariate Cox models were then constructed based on univariate analysis and their accuracy was validated using that concordance index. Results: The optimal cut-off values for CAR at the time of mCRPC diagnosis and TTCR were 0.48 and 12 months, respectively. Kaplan-Meier curves indicated that patients with CAR > 0.48 or TTCR < 12 months had a significantly worse OS (both p < 0.005, Fig). Univariate analysis also identified age, hemoglobin, CRP, and performance status as candidate prognostic factors. Furthermore, a multivariate analysis model incorporating those factors and excluding CRP showed CAR and TTCR to be independent prognostic factors. This model had better prognostic accuracy as compared with that containing CRP instead of CAR. The results showed effective stratification of mCRPC patients in terms of OS based on CAR and TTCR (p < 0.0001, Fig). Conclusions: CAR and TTCR were found to be independent predictors of prognosis and treatment response in mCRPC patients. In addition, prognosis after mCRPC development and therapeutic efficacy of treatment options may be predicted more accurately by combining CAR and TTCR. It is considered that this method can accurately identify patients who may benefit from treatment and also provide useful information regarding optimal treatment.

5.21.11. UP-21.11: Outcomes of Trans Perineal Cognitive Fusion Biopsy Using the PrecisionPoint Device at a Tertiary Care Centre in the United Kingdom

• Mohan A ¹, Kumar R ², Leonardis F ¹, Santis M ³ and Kastner C ¹

¹ 

Addenbrooke Hospital, Cambridge University Hospital NHS Trust, Cambridge, United Kingdom

² 

University of Cambridge, Cambridge, United Kingdom

³ 

International Medical School of the University of Rome Tor Vergata, Rome, Italy

Abstract: Introduction and Objectives: Precision- Point Transperineal Access System involves a purpose built, probe-mounted needle guide that includes a common access cannula which overcomes the limitations of other free hand techniques of Local Anaesthetic Transperineal prostate biopsy (LATP) and negates the risks and costs of general anaesthesia required for classic Transperineal Prostate Biopsy (TPB). The ability of routine Multi-Parametric Magnetic Resonance Imaging (mpMRI) to localize disease in the prostate allows for targeted or guided biopsy. This abstract will illustrate the latest data about this upcoming method to perform TPB under Local Anaesthesia (LA). Materials and Methods: The PrecisionPoint Transperineal Access System consists of 3 components: a clamp/rail subassembly, a needle carriage with four apertures, and a 15 gauge access needle. The assembled device is clamped to a side-fire transrectal ultrasound transducer such that the access needle is in-line with the linear ultrasound array. The needle carriage is intended to slide freely on the rail system so that the access needle can pierce the perineal skin while maintaining alignment with the ultrasound transducer. The distal portions of the rails are used to stabilize the assembly against the perineal skin. Based on mpMRI findings cognitive targeting in a region of interest is identified prior to biopsy and the biopsy operator estimates where it might be on an ultrasound image. Targeted and systematic biopsies are then taken following the Ginsburg protocol. 137 patients who had their biopsies using PrecisionPoint were retrospectively analysed for detection of prostatic cancer (PCa) and clinically significant prostate cancer(csPCa). Results: Prostate cancer was detected in 53% of Likert 3 lesions and 85% of Likert 4 & 5 biopsies, while csPCa was detected in 23% of Likert 3 lesions and in 63% of Likert 4 and 5 biopsies. This outperforms cancer detection rates as compared to GA template biopsies. Conclusions: PrecisionPoint has the potential to be employed for routine LA TP biopsies in the outpatient clinic setting because of its ease of use, compatibility with different transrectal ultrasound probes, patient comfort and good PCa detection rates.

5.21.12. UP-21.12: Prostate Cancer Diagnosis Using Magnetic Resonance Imaging (MRI)—Ultrasound Software-Guided Fusion Biopsy: Comparison of Biopsy Results with Final Histology from Radical Prostatectomy—A Multi-Centre Analysis

• Patil M, Abbaraju J, Hossain D, Hossain D and Ghonaimy A
• Darent Valley Hospital, Dartford, United Kingdom

Abstract: Introduction and Objectives: The use of MRI with ultrasound guided prostate biopsies enhances the detection rate of prostate cancer. This study analyses the accuracy of grade concordance of prostate cancer diagnosed by software MRI-ultrasound fusion biopsy by comparing it to the final histological grade from prostatectomy specimen. Materials and Methods: A review of 966 patients who underwent software MRI-Ultrasound fusion trans-perineal prostate biopsies using the Koelis Trinity ^® system between 2021 and 2023 across 2 centres was performed. One is a district general hospital the other, a tertiary centre specialising in cancer care. Systemic as well as targeted biopsies were performed to prevent missing clinically significant prostate cancer. The patients, who subsequently proceeded to radical prostatectomy (160 of the 966) after multi-disciplinary team meeting, were included in the study. We compared the overall ISUP (International society of Urological pathologists) grade for the combined standard systemic and targeted biopsy specimens with that of radical prostatectomy specimens. Results: The average prostate size was 42 cc and the average PSA was 6.5 ng/mL. The ISUP grade in biopsy specimen corresponded to that in the radical prostatectomy specimen in 119 of the 160 patients (74.4%). The histology reports for radical prostatectomy specimens showed an upgrade for 12.5% patients (n = 20), while it downgraded in 13.1% patients (n = 21). Conclusions: Combination of standard systemic and targeted prostate biopsies using software MRI-ultrasound fusion predicts the final histology after radical prostatectomy for prostate cancer with high grade of accuracy. Fusion biopsy is a safe technique for prostate cancer patients as there is low risk of under-treatment or over-treatment.

5.21.13. UP-21.13: Re-Staging with MRI/Ultrasound Fusion-Guided Biopsy in Patients with Prostate Cancer Under Active Surveillance with Previous Conventional Biopsy

• Morales Pinto S ¹, Lanza Pérez M ², Diez Farto S ¹ and Herrera Imbroda B ²

¹ 

Virgen de la Victoria University Hospital, Malaga, Spain

² 

University Hospital Virgen de la Victoria Málaga-España, Malaga, Spain

Abstract: Introduction and Objectives: Active surveillance is widely practiced for prostate cancer management in our setting, with established protocols governing patient selection, follow-up, and reclassification criteria. However, widespread adoption of multiparametric magnetic resonance imaging (MRI) of the prostate and fusion biopsy with ultrasound-MRI as confirmatory methods after an initial diagnosis through conventional biopsy could potentially lead to a significant number of patients transitioning from active surveillance to active treatment. The objective of our study is to assess the extent to which patients initially meeting active surveillance criteria are reclassified when fusion biopsy is utilized. Materials and Methods: A retrospective study was conducted on 107 patients with prostate cancer enrolled in an active surveillance protocol. These patients underwent a confirmatory biopsy using the fusion biopsy technique (ultrasound-MRI) six months after the initial conventional prostate biopsy. The study took place between January 1, 2020, and December 31, 2023, at the University Hospital Virgen de la Victoria-Málaga. Results: The median PSA level was 6.3 ng/mL (interquartile range [IQR]: 5.03–8.90 ng/dL), while the mean prostate volume was 49.43 cc (standard deviation [SD]: 29 cc). Among the patients, 11.2% (12 patients) had a positive digital rectal examination, and 46.7% (50 patients) exhibited a PSA density exceeding 15 ng/mL/cc. Furthermore, 63.6% (68 patients) presented with a single suspicious PIRADS lesion > 2 on MRI, with 30.8% (33 patients) having two lesions, and 5.6% (5 patients) having three lesions. Notably, 80.4% (86 patients) displayed a PIRADS lesion rated ≥ 4 on MRI. In the pathology report, prostate adenocarcinoma was confirmed in 82 (76.6%) patients, prompting a shift in therapeutic approach towards active treatment in 43% (46 patients). Conclusions: The introduction of ultrasound-MRI fusion biopsy into the active surveillance protocol for prostate cancer has significantly enhanced diagnostic accuracy, leading to a reclassification of 43% of patients in our cohort for active treatment.

5.21.14. UP-21.14: Trans-Perineal MRI-Ultrasound Fusion Biopsy Has No Significant Learning Curve: Comparative Study of Data from a District General Hospital Where This Technique Has Been Recently Adopted with Data from Experienced Tertiary Hospital Involved in Prostate Cancer Diagnostics

• Patil M, Abbaraju J, Hossain D, Banerjee S, Ghonaimy A, Gardener A and Johal A
• Darent Valley Hospital, Dartford, United Kingdom

Abstract: Introduction and Objectives: The role of Magnetic Resonance Imaging (MRI)- ultrasound fusion targeted biopsy for evaluation of prostate cancer has expanded significantly in recent years. Software-guided fusion technique is the most recent upgrade in prostate cancer diagnostics, which enables the operator the precision of an MRI with superimposed images of real-time trans-rectal ultrasound. In this study, we compare our initial experience with this procedure at a District general hospital with the results achieved by a tertiary hospital involved in cancer care. Materials and Methods: Biopsies were done using Trinity Koelis system which uses elastic fusion. biopsies were performed by the operators who routinely performed cognitive fusion biopsies. This study compares our initial experience of the first 150 biopsies (group 1) with 819 biopsies (group 2) performed at an experienced tertiary hospital. We compared the prostate cancer pick-up rates in different PI-RADS (Prostate Imaging Reporting and Data System) categories and the diagnosis of clinically significant prostate cancer among the two groups of patients. Results: 71.3% (n = 107) patients from group 1 were diagnosed with prostate cancer compared to 70.7% (n = 577) patients from the other group. Out of this, 82.2% (n = 88) of patients from group 1 had clinically significant prostate cancer detected, compared to 83.7% (n = 483) patients from the group 2. The pick-up rates of prostate cancer in PI-RADS 3.4 and 5 lesions on MRI were 38.6% (n = 17), 74.1% (n = 43) and 97.9% (n = 47) in group 1, respectively, compared to 48% (n = 109), 78.3% (n = 303) and 90.5% (n = 153), respectively, in group 2. Conclusions: There was no significant difference in pick-up rate of clinically significant cancer {(p = 0.7) Chi squared test applied}. There is no significant difference between the results achieved in group 1 as compared to group 2, which indicates that there no remarkable learning curve for software MRI-ultrasound fusion prostate biopsy among operators who are trained and experienced in cognitive fusion biopsies.

5.21.15. UP-21.15: Vector Prostate Biopsy: MRI/US Fusion Transperineal Biopsy Technique Using Electro-Magnetic Needle Tracking, Under Local Anaesthesia

• De Santis M ¹, Fletcher P ², Barrett T ², Mohan A ², Kumar R ³, De Leonardis F ⁴ and Kastner C ²

¹ 

International Medical School of the University of Rome Tor Vergata, Rome, Italy

² 

Addebrooke’s Hospital, Cambridge University Hospitals, Cambridge, United Kingdom

³ 

University of Cambridge, Cambridge, United Kingdom

⁴ 

Fondazione Policlinico Tor Vergata, Rome, Italy

Abstract: Introduction and Objectives: Magnetic Resonance (MRI)-guided Transperineal Prostate Biopsy (TBP) is a widely accepted and endorsed technique for its ability to decrease biopsy numbers and enhance clinically significant Prostate Cancer (csPCa) detection. Traditional TPB necessitates general anesthesia, incurring associated expenses and risks. This abstract will illustrate the latest data about a novel method to perform TBP under Local Anaesthesia (LA). Materials and Methods: The BiopSee^® fusion system and EM tracking technology were utilized to biopsy 114 patients via TPB. To ensure fusion stability, the rectal US probe was mounted on a stepper, enabling fusion of US images with MRI. An EM sensor-equipped needle sheath was inserted into the perineum through two locally anesthetized entry points, facilitating EM-aided tracking of the needle trajectory. This method enables precise guidance of the biopsy needle to pre-contoured lesions using previously positioned target cores. Subsequently, targeted and systematic biopsies were performed according to the Ginsburg protocol. Documentation of the procedure can be archived for future image-guided treatment planning. Results: Prostate cancer was detected in 68% of Likert 3 and 95% of Likert 4&5 biopsies, while csPCa was detected in 44% of the former and 96% of the latter. This outperforms gold standard GA template biopsies, with targeted biopsies alone achieving 80% detection of csPCa. More than 80% of patients described their overall pain and discomfort during the procedure as none or minimal. Conclusions: Evidence indicates that performing MRI/US fusion TPB under local anesthesia results in high levels of accuracy and precision, while ensuring patient comfort and minimizing complications.

5.21.16. UP-21.16: X-Marks the Spot

• Razi B, Cole-Clark D, Self D, Gibbs H and Louie-Johnsun M
• Gosford Hospital, Gosford, Australia

Abstract: Introduction and Objectives: With the widespread adoption of multiparametric MRI (mpMRI) for investigation of suspected prostate cancer, targeted biopsy specimens are more common practice than previously held. The PRECISION trial demonstrated a reduced detection of insignificant cancer whilst increasing the detection of significant cancers when patients only with positive MRIs were biopsied. Whilst the PROMIS study demonstrated 11% of normal MRI, had biopsy confirmed prostate cancer. This study aims to investigate the accuracy and sensitivity of targeted trans-rectal ultrasound (TRUS) prostate biopsies when correlated with MRI. Materials and Methods: A prospective database was maintained for the cohort of patients who underwent TRUS procedures with prior mpMRI by a single surgeon. The MRI findings were compared to the subsequent histopathological results from the targeted biopsies. Results: A total of 91 men were included in the study, with a mean age of 67 years and mean PSA of 9.2 ng/mL. 75% had Prostate Imaging and Reporting Data System (PI-RADS) 4–5 lesions 24% had PI-RADS 3 lesions. Clinically significant prostate cancer was identified in 73% target biopsies. 12% had ISUP 5, 10% ISUP 4, 10% ISUP 3 and 41% ISUP 2 disease. 27% of targeted biopsies had a ‘negative’ result, either no malignancy or clinically insignificant (ISUP 1) disease. An ISUP grade of higher significance was identified outside of the target biopsy in 14% patients. The upstaging from a negative targeted biopsy to significant cancer was identified in 8% patients. Targeted TRUS biopsy had a sensitivity of 92% and a negative predictive value of 71%. Conclusions: In the dynamic landscape of prostate cancer diagnosis, the integration of mpMRI and targeted TRUS prostate biopsies accurately identifies significant prostate cancer. This study demonstrates target only biopsy is highly sensitive and has a high negative predictive value. Data collection is ongoing and we will have 4 years of data completed.

5.21.17. UP-21.17: A 20 years Follow-Up Results of the Modena Screening Program for Prostate Cancer (PCa) “Progetto Uomo” (PU)

• Brausi M ¹, Morselli S ², Oltolina P ², Rabito S ², Toso S ², Castagnetti G ³, Ghidini N ⁴, Ferrari R ⁵, Ferrari G ² and Ferrari P ⁴

¹ 

AUSL Modena, Dept. of Urology, Modena, Italy

² 

Hesperia Hospital, Dept. of Urology, Modena, Italy

³ 

Ospedale di Sassuolo, Sassuolo, Italy

⁴ 

Hesperia Hospital, Modena, Italy

⁵ 

University of Modena and Reggio Emilia, Modena, Italy

Abstract: Introduction and Objectives: Objective was to evaluate the incidence and mortality of PCa in time using DRE and PSA as screening tools. Materials and Methods: The program was addressed to all men from Modena province (inhabitants 700,000) between 50–75 years. Questionnaires on PCa familiarity, smoking habit and LUTS were administered. Men were invited to local urological centers with PSA and urine test for a visit including DRE. Trans-rectal Ultrasound (TRUS) and biopsy were performed when PSA > 4 ng/mL and in case of suspicious DRE. The program was shared with GPs and popularized in local media. Data on incidence and mortality from Modena Tumor Registry were collected in 1989 and 2011–12 and the results compared with Reggio-Emilia, which had a similar, comparable population, but no screening program. Results: In 20 years (1989–2008), 71,034 visits were performed in 39 840 men screened for PCa. The mean age was 63.2 years and showed the adherence of 56% of men invited. In the first 5 years, 20,640 individuals were screened. A 2nd, 3rd and 4th visit was required in 8%, 3% and 0.1% of them, respectively. Regarding questionnaires, a PCa familiarity was found in 17.6%, 22.9% were smokers, while LUTS were present in 15%. From these visits, 619 men (3%) had a suspicious of PCa and thus received prostate biopsy. In 43.5% PCa was diagnosed, with 67.5% with an organ confined PCa who received surgical treatment. Regarding PCa incidence, it increased with screening program from 35 cases/100,000 inhabitants in 1988–90 to 78 cases/100,000 inhabitants in 2008, p = 0.001. Meanwhile, PCa mortality dropped from 63 deaths on 142 new cases/year to 155 deaths on 899 new cases/year (17.2%) in 2011–12, p = 0.001. When compared with Reggio Emilia, PCa mortality in 2011–12 was of 129 deaths on 541 new cases (23.8%), p = 0.001. Moreover, the 5-year Relative Survival for PCa in Modena increased from 62% to 86.4% in 1993–99. In addition other urological diseases were diagnosed in 9560 men (24%) and RP in Modena increased due to improved diagnosis. Conclusions: After 20 years the incidence of PCa in our province increased significantly, while mortality decreased by 27.3%. We believe that an adequate early treatment of PCa may be responsible.

5.22. Reconstruction

5.22.1. UP-22.01: Developing a Prediction Model for Anastomosis Method Selection for Male Short-Segment Bulbar Urethral Strictures

• Gu Y and Song L
• Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Abstract: Introduction and Objectives: Excision and primary anastomosis is a standard approach for managing short-segment bulbar urethral strictures. However, the choice between transecting and non-transecting anastomosis is typically determined during the operation based on intraoperative findings. This study aims to develop a predictive model for short-segment stricture patients, forecasting the likelihood of undergoing a non-transecting procedure through preoperative assessments. Materials and Methods: Retrospective data collection was conducted for patients diagnosed with short-segment bulbar urethral strictures at our institution from June 1, 2016, to May 31, 2022. The patients were categorized into the transecting and non-transecting groups. Factors displaying significant differences, as identified through univariate analysis between groups, were integrated into logistic regression. Results: The cohort under study consisted of 81 patients, with 44 individuals allocated to the transecting group and 37 to the non-transecting group. Our final model integrated two factors: the etiology of the stricture and the ventral scar thickness, quantified via ultrasound assessment. The model demonstrated a robust AUC of 0.91, with a 95% confidence interval ranging from 0.85 to 0.98. Validation metrics underscored the discriminative prowess and calibration accuracy of our proposed model. Conclusions: This model enables preoperative prediction of the anastomosis strategy for patients with short-segment bulbar urethral strictures, considering etiology (traumatic or non-traumatic) and urethral ultrasound measurements (ventral scar thickness). Successfully undergoing internal validation, the model demonstrates robust discrimination and calibration, offering crucial support for healthcare professionals in preoperative decision-making.

5.22.2. UP-22.02: Female Dorsal Buccal Mucosa Graft Urethroplasty: Surgical Technique

• Massouh R and Gómez R
• Hospital del Trabajador, Chile

Abstract: Introduction and Objectives: Female urethral stricture (FUS) is an uncommon entity. It is responsible for approximately 1% of all female lower urinary tract symptoms (LUTS). Diagnosis is challenging, as it depends of anatomical and functional parameters, but still lacks of a standardized criteria and a unified definition. Traditionally, urethral dilation (UD) has been the treatment of choice, but in the past decades augmentation urethroplasty (AU) with the use of grafts or flaps have shown better results with 90% of success over 50% with UD. The use of flaps versus grafts, or grafts from local tissues versus distant tissues and whether augmentation is done dorsally or ventrally has not shown differences so far. Materials and Methods: We present the case of a 25 year-old healthy female, with severe urgency and frequency. Her frequency-volume charts shows 13 micturition at day and 2 at night. She has failed conservative therapies. Non-invasive uroflowmetry (UFM) informs a Qmax of 8 mL/s. Pelvic ultrasound shows a bladder capacity of 150 mL. and a post void residue of 1 mL. Flexible urethroscopy describes a 12 French mid-third urethral stricture. Urodynamics shows good compliance, 300 mL. bladder capacity, Qmax of 6 mL/s and PdetQmax of 43 cm H₂O. Urethrocystography shows an adequate bladder neck opening, with a proximal urethra ballooning. Results: We performed an AU with dorsal onlay buccal mucosa graft. Time of surgery was 100 min. Blood loss of a 100 cc. Graft was harvested from the left cheek. No surgically related complications occurred. Patient was discharged the next day with a urethral catheter for 10 days. After catheter removal patient achieved comfortable micturition. Graft donor site healed favorably. At 3 months follow-up UFM showed a Qmax of 22 mL/s. Conclusions: FUS is a rare disease. UD has been the treatment of choice, but better alternatives are now available. Female urethroplasty with dorsal onlay buccal mucosa graft is a feasible, safe and reliable surgical technique with excellent results.

5.22.3. UP-22.03: Hybrid Abdominal and Perineal Robotic Assisted Posterior Urethroplasty with Buccal Graft

• Krebs R, Souza V, De Oliveira A and Brito A
• Hospital Nossa Senhora das Graças, Curitiba, Brazil

Abstract: Introduction and Objectives: There is an increase in the frequency of patients with iatrogenic injuries of the posterior urethra. Most of these injuries are caused by transurethral resection of the prostate, simple prostatectomy, HIFU, whether or not associated with radiotherapy. In general, such patients are managed by endoscopic treatments in an attempt to mitigate the progression of the complication. And in this scenario, damage to other portions of the urethra may occur, with the bulbar region often being affected due to low local flow caused by radiotherapy. Materials and Methods: A 71-year-old male underwent simple prostatectomy. Anatomopathological adenocarcinoma ISUP 3 and radiotherapy was chosen. Three months after radiotherapy he complained of reduced urinary flow. On investigation, collapse of the prostate fossa associated with bulbar urethral stenosis. Indicated a robot-assisted procedure. Trocars in the same way as in radical prostatectomy. Dissection of the space of Retzius with great fibrosis due to previous surgery (simple prostatectomy) and radiotherapy. Bladder opening dorso-lateral bladder neck. Via the perineal site, the perineum was opened in a similar way for urethroplasty, non-transecting the urethra. Passage of a guide wire and dissection of the anterior surface of prostatic fossa to avoid the rectum. Buccal mucosa passage from the perineal route to the abdominal site. Fixation of the oral mucosa from the bladder neck to the membranous urethra. Bladder closure. The robot docked in the perineal region. The procedure continued with a robot in the perineum to fix the oral mucosa in the dorsolateral region up to the bulbar urethra. Results: Surgery time 380 min and blood loss of 250 mL. Hospital stay 2 days. Discharge without with a Foley catheter via the urethra and cystostomy. Removal of the urethral tube in 30 days. The patient progressed with good healing and complained of total incontinence. Removal of the cystostomy after 60 days. He remained under follow-up for 9 months with total patency of the urethra using a 16 Fr catheter. Conclusions: Concomitant involvement of the bladder neck or prostatic fossa and bulbar urethral stenosis, the use of the robot in a hybrid manner in the abdomen and perineum is a feasible procedure, indicated in highly complex cases.

5.22.4. UP-22.04: Laparoscopic Modified Culp-De Weerd Pyeloplasty: an Alternative for the Treatment of Ureteropelvic Junction Obstruction

• Yebes A, Alvarez-Maestro M, Toribio C, Aguilera-Bazan A and Martinez-Piñeiro L
• La Paz University Hospital, Madrid, Spain

Abstract: Introduction and Objectives: Ureteropelvic junction obstruction (UPJO) is a condition that can present with varying clinical findings, including low back pain, hematuria, infections, stones or impaired renal function. UPJO is treated surgically, the most widespread technique being the Anderson-Hynes type dismembered pyeloplasty, which consists of excision of the obstructive or dyskinetic ureteropelvic segment and reanastomosis with or without reconstruction of the renal pelvis. Its failure rate is less than 5–10% and increases with reoperation. An alternative to this procedure is the Culp-De Weerd (CdW) pyeloplasty in which a local renal pelvic flap is created to reconstruct the proximal ureter. This technique interferes less with ureteral vascularization and is ideal in cases of insufficient ureteral length and large renal pelvis. Materials and Methods: We present this educational video of a modified technique from the CdW pyeloplasty in a 68-year-old female patient with a history of UPJO. She had previously undergone an Anderson-Hynes pyeloplasty and subsequent balloon dilatation, both of which failed. Due to persistent symptoms, and worsening urography and diuretic renogram, a laparoscopic CdW pyeloplasty was performed. Patient positioning and trocar placement are similar to conventional renal surgery. A longitudinal renal pelvis flap was mobilized inferiorly. The vascularization of the proximal ureter was assessed by intravenous indocyanine green (ICG) injection. A fragment of stenotic and poorly vascularized proximal ureter was observed and completely resected in order to reduce the risk of restenosis, which is a modification of the original CdW technique. Subsequently, the anastomosis was completed with the aid of the flap, resulting in a wide and unobstructed ureter. Results: No intraoperative or postoperative complications were recorded and the patient was discharged after 3 days. The JJ stent was removed at week 4. After more than 24 months of follow-up there is no recurrence of stenosis in imaging tests (intravenous urogram and diuretic renogram), renal function has recovered and the patient is asymptomatic. Conclusions: Culp-De Weerd pyeloplasty is an alternative surgical technique for the treatment of UPJO in selected cases and after failure of previous pyeloplasty. The use of intravenous ICG may be of additional benefit in discarding devascularized tissue segments, which is a modification of the usual technique.

5.22.5. UP-22.05: Patient Outcomes in Robotic Reconstruction: Early Insights from a Specialized Practice

• Rajan K, Whyte E, Scott-Bazaldua J and Nambiar A
• Freeman Hospital, Newcastle Upon Tyne, United Kingdom

Abstract: Introduction and Objectives: To evaluate initial patient outcomes of a single surgeon’s practice following the completion of a hybrid robotic oncological and functional fellowship. Materials and Methods: A retrospective analysis was conducted on 84 patients who underwent robotic surgery by a single surgeon between February 2022 and December 2023. Evaluation encompassed pre-operative parameters, operative time, blood loss, hospital stay, complication rates and functional outcomes. Results: The mean age of the cohort was 62.12 (27–75) years. Non-reconstructive procedures included radical prostatectomy (n = 53) and abdominal orchidectomy (n = 1). Results of reconstructive procedures are displayed as number of procedures, median console time, median blood loss, hospital stay and CD3+ complications. Partial cystectomy (n = 6, 100 min, 50 mL, 1 day, n = 1), Cystectomy with ileal conduit diversion (n = 11, 375 min, 150 mL, 8.5 days, n = 0), Cystectomy with orthotopic neo-bladder (n = 1, 660 min, 1000 mL, 7 days, n = 0), Ureteric reconstruction (n = 9, 90 min, 50 mL, 2.5 days, n = 1), augmentation ileocystoplasty (n = 1, 210 min, 50 mL, 13 days, n = 0), Colposuspension (n= 1, 30 min, 10 mL, 1 day, n = 0), Mesh removal (n = 1, 110 min, 30 mL, 2 days, n = 0). One patient had an open conversion (radical cystectomy). 2 patients (2.4%) required re-operation for failed pyeloplasty (n = 1) and persistent fistula with pelvic collection post partial cystectomy (n = 1). Conclusions: In conclusion, our preliminary experience indicates that robotic surgery offers favourable functional outcomes with low complication rates in appropriately selected patients. Evaluating an expanded patient cohort with extended follow-up will validate these promising initial outcomes. The reproducibility of dedicated hybrid fellowship warrants further exploration for its impact on training future robotic reconstructive surgeons.

5.22.6. UP-22.06: Pedicled Gracilis Muscle Flap in Salvage Urethroperineal Fistula Repair After Radiotherapy and Miles’ Surgery for the Treatment of Rectal Cancer

• Song L, Zhang R, Hou C, Gu Y and Zhu W
• Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Abstract: Introduction and Objectives: The management of urethroperineal fistula following the surgical and radiotherapeutic interventions for rectal cancer poses a significant clinical challenge, particularly in patients with a history of multiple surgeries. The utilization of the gracilis muscle flap for the reconstruction of urethroperineal fistulae in such patients represents a viable surgical approach. This study aims to assess the efficacy and practicality of this reconstructive technique in managing patients with these complex presentations. Materials and Methods: A case involving a patient with a history of numerous surgical interventions, presenting with a urethroperineal fistula subsequent to radiotherapy and Miles’ procedure for rectal cancer, was addressed utilizing this surgical method. The patient was positioned in the lithotomy stance, followed by a layered incision beneath the scrotum to expose the fistula. Care was taken to preserve the integrity of the bulbar urethra during the dissection. A collaborative effort with an orthopedic specialist facilitated the intermittent incision on the patient’s left inner thigh, enabling the mobilization of the gracilis muscle’s distal end and its transposition to the perineal region. Special attention was devoted to maintaining the vascular supply of the gracilis muscle to prevent necrosis. The muscle flap was then anchored at the site of the fistula and the incision was closed in layers. Results: Post-operative recovery was uneventful, with the surgical wound healing satisfactorily. A two-month follow-up revealed no signs of urinary leakage, and retrograde urethrography confirmed the successful closure of the fistula. However, a six-month follow-up indicated that pre-existing urinary incontinence remained unchanged, as evidenced by an International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) score of 21. Conclusions: This investigation underscores the feasibility of employing the gracilis muscle flap for the reconstruction of complex urethroperineal fistulae in patients with extensive surgical histories. Notably, the preservation of the bulbar urethra lays the groundwork for potential future interventions, such as the implementation of an artificial urinary sphincter, to address urinary incontinence.

5.22.7. UP-22.07: Robotic Assisted Ureteroplasty with Onlay Buccal Graft

• Krebs R, Andurte S and Vidal R
• Hospital Santa Lucia, Brasilia, Brazil

Abstract: Introduction and Objectives: The advent of flexible ureteroscopy, access to the kidney has become increasingly common via the retrograde route. Within this context, the population of renal access through the ureter has led to an increased incidence of ureteral injuries after ureteroscopy. Small injuries go unnoticed and are not investigated, as patients do not develop symptoms. However, in more serious injuries, whether due to extension or degree of stenosis, patients become symptomatic and the injuries are diagnosed. Objective: The aim of the video is to describe the robotic-assisted ureteroplasty technique with oral mucosa graft anchored in the psoas muscle. Materials and Methods: Use of the Da Vinci Xi platform to perform a ureteroplasty procedure with oral mucosa graft. The trocars are placed in the same arrangement as for patients with UPJ stenosis and the patient is positioned in lateral recumbency allowing access for the flexible ureteroscope to identify the region of ureteral stenosis. Results: After insertion of the trocars, dissection of the upper ureter and extensive area of adjacent fibrosis is performed. Local hydrodissection is necessary to allow better tissue definition, in particular to separate the ureter from the inflammatory tissue (generally fat) and also to separate the ureter from the psoas muscle. Next, using a flexible retrograde ureteroscope, the most distal site of the stenosis is located and the ureter is opened towards the renal pelvis. Once the ureterotomy has been carried out to the healthy proximal site, the oral mucosa is fixed to the psoas muscle. Conclusions: robotic ureteroplasty with buccal graft is a feasible technique. With quilting the buccal graft on psoas muscle may help the graft to heal better as it is done in urethroplasty. The advantages of the robotic platform are better view, less use of thermal energy and better dissection over inflammatory tissue.

5.22.8. UP-22.08: Ureterovesical Anastomosis Stenosis—Complex Urethroplasty Associated with Total Pubectomy

• Ruiz De Castroviejo Blanco J, Gomez Jordana Mañas B, Maqueda Arellano J, Perez Aizpurua X, Tufet I Jaumot J, Osorio Ospina F, Garcia Cardoso J, Simón Rodriguez C, López Martin L and Chávez Roa C
• Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain

Abstract: Introduction and Objectives: Ureterovesical anastomotic stenosis is a late complication that can occur after radical prostatectomy, significantly affecting the patient’s quality of life. It presents various risk factors that may influence its occurrence. Management includes endoscopic treatments to surgical reconstruction. Materials and Methods: The case of a 64-year-old male patient with a history of prostate adenocarcinoma treated with open radical prostatectomy is presented, undergoing multiple subsequent endourological surgeries via cervicotomy due to ureterovesical anastomotic stenosis. Subsequently, periodic dilations were performed, followed by several episodes of urinary tract infections and acute urinary retention, requiring bladder catheterization. Serial voiding cystourethrography was performed, revealing persistent ureterovesical anastomotic stenosis. Results: The patient is proposed for open abdominoperineal surgery to reconstruct the anastomosis. In conjunction with the Orthopedic Surgery service, reconstruction of the anastomosis is performed through total pubectomy, reconstruction of the vesical neck, and a new ureterovesical anastomosis. The patient is discharged with a urinary catheter, instructed to partially weight bear with crutches, and is scheduled for a follow-up cystourethrogram to assess the removal of the urinary catheter and continence status. Conclusions: Open surgery for ureterovesical stenosis is a treatment option to consider in cases where less invasive alternatives such as periodic dilations, cervicotomy, mitomycin injection, or endoscopic urethrotomy have failed. Additionally, multidisciplinary support from orthopedic surgery in the approach to ureterovesical anastomosis may be beneficial, particularly in cases like this where the patient’s anatomy and characteristics require it, to avoid tension in the reconstruction and maintain the orthotopic configuration of the urinary tract.

5.22.9. UP-22.09: Youssef Syndrome with Large Defect Managed Laparoscopically with Modified O’ Conor (Transverse Cystotomy) Technique

• Singh S and Gunjan K
• AIIMS Patna, Patna, India

Abstract: Introduction and Objectives: A forty-five-year-old lady presented to urology OPD with complaint of continuous urinary incontinence for 15 years. She had a cesarean section done 15 years back. Materials and Methods: On evaluation she was diagnosed with vesico-uterine fistula (Youssef’s syndrome) with a large supratrigonal defect. Classically vertical cystotomy (O’Connor’s repair) has been described for urinary fistulae repair, but it suffers from multiple problems like difficulty in taking the apical suture and difficulty in developing proper bladder flap for repair. Results: In the index case we attempted to tackle these problems by doing a transverse cystotomy. Patient had uneventful postoperative course. Foleys catheter was removed on postoperative day 21. Patient is doing well since then. Conclusions: Youssef Syndrome with Large Defect Managed Laparoscopically with Modified O’ Conor (transverse cystotomy) Technique.

5.23. Renal Transplantation

5.23.1. UP-23.01: Endometrial Regeneration Cell-Derived Exosomes Carrying siSLAMF6 Inhibit Kidney Allograft Rejection Through Suppression of α-2,6 Sialylation

• Xu Y and Wang H
• Tianjin Medical University General Hospital, Tianjin, China

Abstract: Introduction and Objectives: Kidney transplant rejection is a major component in the poor prognosis of organ transplantation. Due to the multiple complicated mechanisms involved, a novel therapy for it remains under exploration. Although Endometrial regenerative cells (ERCs) have been ubiquitously applied to various refractory immune-related diseases, the role of ERC-derived exosomes (ERC-Exos) in alleviating transplant rejection has not been thoroughly studied. Signaling lymphocyte activation molecule family 6 (SLAMF6) is an immunoglobulin superfamily member that plays an important role in regulating immune responses. In this study, we have demonstrated for the first time that ERC-Exo carried with siSLAMF6 attenuated allograft rejection by inhibiting T-cell proliferation and differentiation. Materials and Methods: C57BL/6 mouse recipients receiving bm12 mouse kidney allografts were randomly divided into four groups. Graft pathological changes were evaluated by H&E staining. Intragraft cellular infiltration and splenic immune cell populations were analyzed using flow cytometry. Serum cytokine profiles of recipients were measured by ELISA assay. The proliferation capacity of CD4+T cell populations of Th1, Th17, and Tregs was also assessed in vitro. α-2,6-sialylation levels in CD4+T cells were measured by SNA blot. Results: In vivo, mice treated with ERC-siSLAMF6 Exos achieved significantly prolonged allograft survival and showed mitigated inflammatory response compared with the ERC-Exos group. Serum cytokine profiles of recipients were significantly changed in ERC-siSLAMF6 Exos-treated recipients. In vitro, we found that ERC-siSLAMF6 Exos considerably down-regulated the α-2,6-sialyltransferase (ST6GAL1) mRNA and protein expression in CD4+T cells, and significantly reduced α-2,6-sialylation levels measured by SNA blot in CD4+T cells. Through desialylation modification, ERC-siSLAMF6 Exo therapy significantly decreased CD4+T cell proliferation and activation and inhibited CD4+T cell differentiation into Th1 and Th17 cells while promoting Treg differentiation. Conclusions: ERC Exo carrying siSLAMF6 reduces the sialic acid connected to α-2,6 at the end of the N-glycan chain on the CD4+T cell surface, increases the number of therapeutic exosomes endocytosed into CD4+T cells and inhibits activation of T-cell receptor signaling pathways, which prolongs allograft survival. This study confirms the feasibility of ERC-derived exosomes as natural carriers combined with gene therapy, which could be used as a potential therapeutic strategy to alleviate allograft rejection.

5.23.2. UP-23.02: Predictors of Recurrent Hospital Admissions with Febrile Urinary Tract Infections Following Renal Transplantation in Patients with Lower Urinary Tract Dysfunction

• Ramez M ¹, Atteya M ², Nashaat A ², Hawash I ², Osman Y ² and El-Dein B ²

¹ 

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

² 

Urology and Nephrology Center, Mansoura, Egypt

Abstract: Introduction and Objectives: Renal transplantation in patients with lower urinary tract dysfunction is associated with more urological complications compared to transplantation in those with a normal urinary tract. This may contribute to higher rates of hospital admissions with febrile urinary tract infection (UTI) and possible worse graft survival. The aim of this study is to define predictors for recurrent hospital admissions for this subgroup of patients. Materials and Methods: We retrospectively analysed our records of living kidney transplant patients with lower urinary tract dysfunction done between January 2018 and December 2022. Patients’ demographics, radiological and operative data in addition to number of admissions due to febrile UTI were reviewed. We categorized number of admissions due to UTI into two groups: frequent and infrequent according to the AUA 2022 guidelines definition of recurrent UTI: Two episodes of urinary tract infections within six months or three episodes within one year. Results: Median follow up duration was 32 months with IQR (12–48). 55 patients with lower urinary tract dysfunction received living kidney transplants were identified. Mean patients’ age was 23 ± 8.2 years. 38 (69.1%) were males and 17 (30.9%) were females. Original disease was posterior urethral valve in 14 (25.5%) patients, neurogenic bladder in 11 (20%) patients and VUR in 30 (54.5%) patients. Of all patients, 15 (27.3%) patients were maintained on CIC post transplantation. At follow up, 23 (41.8%) patients were admitted frequently with febrile UTI. Patients with direct ureteral implantation and those maintained on CIC were significantly associated with frequent hospital admissions with febrile UTI (p 0.04, 0.02 respectively). Conclusions: Febrile UTI is a frequent complication in patients with lower urinary tract dysfunction receiving kidney transplantation. UVR using direct technique and being maintained on CIC were significant risk factors for frequent hospital admissions with febrile UTI.

5.23.3. UP-23.03: Renal Transplantation from Living Donors with Renal Cyst: A Single Center Experience

• Ramez M ¹, Hawash I ², Nashaat A ², Atteya M ², Osman Y ² and El-Dein B ²

¹ 

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

² 

Urology and Nephrology Center, Mansoura, Egypt

Abstract: Introduction and Objectives: Renal cysts are relatively common, particularly in adults more than 50 years. Most of these cystic lesions are morphologically simple and histologically benign. Kidney bearing cysts should not be refused for transplantation, although it might implicate complications later. We present our experience with transplantation of living kidneys containing cysts and their follow up. Materials and Methods: We retrospectively analysed the medical records of transplantation couples receiving living kidney transplants with grafts harbouring cysts between January 2017 and December 2021. Renal function and cyst size were followed up in both donors and recipients. Results: 43 living kidney donors were identified. Their mean follow up period was 40.3 ± 11.2 months. Table 1 shows baseline characteristics for both donors and recipients. After reviewing CT reports of donors, 31 of them had single cysts and 12 had multiple cysts. All of them were Bosniak grade 1 except for two cases which were Bosniak grade 2. Mean cyst size was 7.7 ± 5.6 mL. Cyst excision was done in 8 cases. At follow up, 37 transplanted kidneys had cysts. Mean cyst size in grafts was 6.6 ± 6.5 mL. Cyst recurrence after excision occurred in two cases. No statistically significant difference was found regarding cyst size pre and post transplantation (p 0.069). None of the living donors showed any deterioration of renal function with mean serum creatinine of 1 ± 0.2 mg/dL at last follow up. In addition, mean follow up GFR of grafts was 59.9 ± 14.4 mL/min and graft survival was 100% at last follow up. Conclusions: Kidneys with renal cysts should be considered for transplantation without any hazard to recipients. Cyst excision is not necessary in most cases. Regular follow up with ultrasound is recommended.

5.23.4. UP-23.04: Vascular Prosthesis in Kidney Transplantation

• Hazem H ¹, Ahmed C ², Firas Z ², Ahmed S ², Mohamed Amine M ², Omar K ², Nouri R ² and Mourad H ²

¹ 

Urology department, Habib Bourguiba Hospital, Sfax, Tunisia

² 

University Hospital Habib Bourguiba Sfax, Tunisia

Abstract: Introduction and Objectives: Arteriosclerosis and calcification of iliac arteries are common in patients on dialysis. Severe arteriosclerosis, especially in the iliac arteries, and peripheral arterial occlusive disease can represent contraindications for kidney transplantation in rare cases. This study sought to describe five cases of kidney transplantation in which a vascular graft was interposed between renal vascular and recipient vessel. Materials and Methods: We report five cases of vascular graft, among 300 patients who underwent kidney transplantation between 1994 and 2019: 4 cases of artery grafts and one case of vein graft. Results: The mean age was 40 years (22–54 years). We had 4 men and 1 woman, with 4 transplants from living donors and 1 cadaveric donor. In 2 of these 5 recipients, a vascular graft were used to lengthen short renal artery in one case and a short renal vein in one kidney graft. In the other cases, an artery grafts were performed due to extensive renal arterial stenosis after few days. In one patient receiving a kidney from a cadaveric donor with a prolonged warm ischemic time, the transplanted kidney never functioned and had to be removed after 3 weeks. For the other patients, one patient had graft nephrectomy for hypoperfusion kidney; the three cases were an uneventful post-operative recovery. Three years following the transplant operation, the kidney is functioning well and none of the vascular grafts had to be removed for infectious complications. Conclusions: Vascular reconstruction during kidney transplantation had performed rarely but it had a strong impact on further life and kidney function. Arteriosclerosis is usually not a contraindication for kidney transplantation. However, training in vascular surgery seems to be important to achieve satisfying results. In our series, implantation of vascular prosthetic grafts was safe since there were no infectious complications of the graft itself.

5.24. Sexual Dysfunction

5.24.1. UP-24.01: Efficacy of Tadalafil Citrate as a Treatment for Female Sexual Dysfunction Due to Female Genital Mutilation

• Rammah A, Hussein H, Morsy S, Hassan S, Farouk D and Daw K
• Cairo University, Faculty of medicine, Kasr Alainy hospital, Cairo, Egypt

Abstract: Introduction and Objectives: Female genital mutilation (FGM) has negative impact on sexual, social and psychological life of females. Therefore, we aimed is to assess tadalafil 5 mg on female with FGM and sexual dysfunction and the changes in clitoral color doppler study. Materials and Methods: 50 sexually active female patients, with history of FGM, aged 25–36 years old with regular menstrual cycle, attending the outpatient clinic for sexual dysfunction, were included. women with history of any medical disorder contraindicating the use of tadalafil, as coronary artery disease, were excluded. All patients were randomized into two groups: 25 patients received tadalafil 5 mg once daily for 8 weeks and 25 patients received placebo. Sexual history regarding desire, arousal, orgasm, dyspareunia, satisfaction and frequency of coitus, using female sexual function index (FSFI) was recorded before and at the 8th week of treatment. In addition, colour doppler sonography at day 7 of the menstrual cycle, was performed with the same schedule. Results: 50 female patients with mean age 28 years (range: 21–34) and mean FSFI score 9.4 (range: 8.2–9.6) were included. Both groups showed no significant difference regarding the age (28.68 ± 3.67 vs. 30.52 ± 3.50), BMI (29.20 ± 3.01 vs. 28.24 ± 3.61), FSFI score (9.59 ± 2.22 vs. 9.08 ± 3.1) nor the colour doppler parameters. At 8 weeks follow up, tadalafil group had improvement in all FSFI score domains which were statistically significant different from placebo group except the frequency of coitus (Table 1). Tadalafil group showed also significant increase in peak systolic velocity (PSV) and resistivity index (RI) in colour doppler sonography (Table 1). Three patients in tadalafil group reported backpain which was controlled with paracetamol on demand, while 5 patients had mild GIT upset which was tolerable. Conclusions: Tadalafil 5 mg once daily is an effective and safe treatment for female sexual dysfunction, especially anorgasmia and low arousal, due to FGM with good sexual satisfaction.

5.24.2. UP-24.02: Erectile Dysfunction and Obstructive Sleep Apnea Syndrome: A Post-Hoc Evaluation of Italian Survey Results

• Di Bello F ¹, Cilio S ¹, Collà Ruvolo C ², Morra S ¹, Napolitano L ³, Creta M ¹, Muzii B ¹, Maldonato N ¹, Cantone E ¹, Longo N ¹ and Califano G ¹

¹ 

Università degli Studi di Napoli Federico II, Napoli, Italy

² 

Università Federico II di Napoli, Napoli, Italy

³ 

Federico II di Napoli, Napoli, Italy

Abstract: Introduction and Objectives: The aim of the current study was to identify predictors of erectile dysfunction (ED) and obstructive sleep apnea syndrome (OSAS) in male participants at Italian web-survey. Materials and Methods: A cross-sectional web-based survey was administered via Google Forms between 17th of July and 31st October 2022 among Italian participants. The erectile function and the excessive daytime sleepiness were measured through the International Index of Erectile Function–5 (IIEF5) and Epworth Sleepiness Scale (ESS), respectively. Two separate and independent multivariable logistic regression models (mLRMs) were fitted to predict ED and OSAS, respectively, in men answering to the survey. Results: A total of 238 patients were identified. Of those, 58 (24%) reported to be affected by OSAS disease. Higher proportion of mild (21 vs. 6%), mild-to-moderate (9 vs. 5%), and severe (16 vs. 7%) ED were recorded in OSAS vs. non-OSAS patients (p < 0.001). In mLRMs predicting severe ED (IIEF5 ≤ 7), age (OR: 1.04, 95% confidence interval [CI]: 1.01–1.06; p = 0.002), and IPSS total score (OR: 1.08, 95% CI: 1.02–1.15; p = 0.006) were independent predictors. In mLRMs predicting OSAS, age (OR: 1.08, 95% CI: 1.05–1.12; p < 0.001), BMI (OR: 1.12, 95% CI: 1.05–1.21; p < 0.001), and ESS score (OR: 1.14, 95% CI: 1.05–1.24; p = 0.001) were independent predictors. In the subgroup analyses predicting severe ED, ESS and age or BMI or IPSS resulted as independent predictors (OR from 0.7 to 0.8; all p < 0.05). Conclusions: The ESS score independently predicted severe ED in males. As a result, the OSAS disease should be explored in patients who harbored severe ED to address those patients for a prompt ear, nose and throat evaluation.

5.24.3. UP-24.03: Evaluation of Sexual Function in Patients Treated by Alpha-Blockers

• Bhouri A, Ahmed L, Ben Abdallah W, Najjai Y, Ben Jannet A, Tlili G, Bouassida K, Hmida W and Jaidane M
• Sahloul Hospital, Sousse, Tunisia

Abstract: Introduction and Objectives: Alpha-blockers are widely used for the treatment of symptoms due to benign prostatic hyperplasia (BPH). The effects of alpha-blockers on sexual function may differ according to alpha-1-blocker types. Materials and Methods: A descriptive monocentric cross-sectional study to assess the sexuality of 48 patients followed for BPH under alpha-blocker treatment consulting the months of July and August 2023. A validated self-questionnaire: International Index of Erectile Function 15 questions (IIEF 15) was sent to patients at their follow-up appointment to assess: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. Results: The mean age was 65 years [51–78]. The most common antecedents were diabetes, dyslipidemia (30%) and coronary artery disease (16%). Twenty-six patients were treated with alpha1blockers: 26 patients (T) were treated with Tamsulosin, 22 patients (S) were treated with Silodosin. The mean duration of treatment was 6 months. Mean erectile function, scored out of 30, was 17.3 for T and 17 for S respectively, i.e., moderate erectile dysfunction according to Cappelleri’s classification, with no significant difference between the 2 groups (p = 0.85). The difference was significant for orgasmic function, rated out of 10, which was 7 for T and 5.5 for S (p = 0.038), with a retrograde ejaculation rate of 15.3% for T and 54.5% for S (p = 0.015). Overall satisfaction, rated out of 10, was 7 for T and 5.6 for S (p = 0.029). There was no significant difference in sexual desire, rated out of 10, which was 6.5 for T and 7.45 for S (p = 0.92), or intercourse satisfaction, rated out of 15, which was 7.25 for T and 8.55 for S (p = 0.125). Conclusions: Erectile function was little affected in population treated by alpha-blocker. This could be explained by the comorbidities found in this population. Orgasmic function and overall satisfaction were altered with Silodosin compared to Tamsulosin. Sexual desire and intercourse satisfaction remain unchanged.

5.24.4. UP-24.04: Preliminary Psychometric Validation Report of the Pelvic Fracture Urethral Injury Postoperative Erectile Function Patients Reported Outcome Measures

• Song L, Xiu X, Zhang R and Gu Y
• Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Abstract: Introduction and Objectives: Erectile dysfunction (ED) is common in patients with pelvic fractures associated with urethral injury (PFUI). However, International Index of Erectile Function (IIEF) or IIEF-5 aren’t suitable for erectile function assessment in PFUI asexual patients. This study aims to establish a psychometric validated pelvic fracture urethral injury postoperative erectile function patient reported outcome measure (PFUI pEF PROM). Materials and Methods: A total of 51 PFUI patients who treated by excision and primary anastomotic (EPA) urethroplasty from January 2020 to August 2022, were enrolled to this study and filled out this PROM. Psychometric validation analysis was performed including internal consistency, construct validity, criterion validity. Results: The PFUI pEF PROM comprised six items that specifically investigated the quality of erectile function and its recovery potential in men practicing non-intercourse penile stimulation activities. This PROM demonstrated high reliability and validity. Its Cronbach’s alpha was 0.928 and ranged from 0.902 to 0.929 with any one item deleted. Item-total correlations ranged from 0.682 to 0.889. The factor loading were ranged from 0.675 to 0.943. Criterion validity results showed PFUI pEF PROM had significantly correlation with IIEF-5 (r = 0.550, p < 0.001) and EHS (r = 0.909, p < 0.001). Conclusions: This PROM effectively addresses the current limitation in assessing erectile function in PFUI patients. This study provides a promising tool for stratified assessment, prediction erection recovery and treatment guidance in the PFUI Erectile dysfunction field.

5.24.5. UP-24.05: Prevalence, Risk Factors, and Awareness of Erectile Dysfunction in the Saudi Arabia Population

• Hakami B ¹ and Alhazmi A ²

¹ 

King Faisal Medical City for Southern Region, Abha KFMCity, Saudi Arabia, Department of Urology King Fahad Central Hospital, Jazan, Saudi Arabia

² 

King Fahad Central Hospital, Jazan, Saudi Arabia

Abstract: Introduction and Objectives: Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection powerful enough to permit pleasurable sexual activity. The illness may be influenced by vascular, neurological, psychological, and hormonal factors. Anxiety about performance and relationship issues are common psychological triggers. Materials and Methods: This community-based, cross-sectional study was conducted among adult Saudi males in all five regions of Saudi Arabia (Central, Eastern, Western, Southern, and Northern). A self-administered questionnaire was distributed among participants using an online survey. The questionnaire includes socio-demographic data (i.e., age, region, marital status, education), medical history, and Erectile Function (IIEF-5) as a diagnostic tool for ED. Results: In total, 924 men took part. 55.4% were aged between 18 to 25 years old, and nearly two-thirds (64.4%) were single. The Internet was the most common source of ED information (53.6%). Based on respondents’ knowledge, the most common risk factor of ED was depression (60.8%), while the most common treatment option was lifestyle modification (70.8%). The prevalence of ED among all Saudi men including in the study was 21.4%. and ED in married men in this study was 46%. Independent risk factors for ED include, being an employee, and previous operation of the perineum. Conclusions: Erectile dysfunction was common among the Saudi male population. ED was more prevalent among older men with associated chronic diseases and had elevated body mass index. Having been Hypertension, diabetes, and having a previous perineum operation and all shows significant p value, were identified as the significant independent risk factors for ED. Longitudinal studies are needed to determine the cause and effect of the recognized risk factors for ED among men.

5.24.6. UP-24.06: Relationship of Serum Concentration of Sex Hormone Binding Globulin with Age and Testosterone Level in Men

• Ryzhkov A ¹, Sokolova S ² and Shormanov I ¹

¹ 

Yaroslavl State Medical University (YSMU), Yaroskavl, Russia

² 

Mother and Child Clinic Yaroslavl, Russia

Abstract: Introduction and Objectives: An age-associated increase in serum levels of sex hormone binding globulin (SHBG) is considered to be one of the factors leading to the development of male hypogonadism. The aim of this study was to examine the relationship between the concentration of sex hormone-binding globulin in the blood serum and the age of the man, as well as the levels of total and free testosterone. Materials and Methods: A single-center retrospective cross-sectional study was conducted. The study analyzed the laboratory test results of 162 male patients aged 18 to 56 years (median age: 34 years). The levels of total testosterone and sex hormone binding globulin (SHBG) were determined by chemiluminescent immunoassay, while the level of free testosterone was determined using the calculation method proposed by Vermeullen. The statistical analysis was carried out using SPSS Statistics v23. Results: The correlation analysis did not reveal a significant relationship between age and SHBG levels, as well as between age and total testosterone levels. The serum SHBG concentration showed a significant strong positive correlation with the total testosterone level (p < 0.001, r = 0.61) and a significant but very weak positive correlation with the level of free testosterone (p = 0.042, r = 0.162). When comparing free testosterone levels among groups of patients with SHBG levels below 16 nmol/L, from 16 to 69 nmol/L, and above 69 nmol/L, no significant differences were found (p = 0.163). It was observed that all patients with free testosterone levels below 225 pmol/L also had total testosterone levels below 12 nmol/L. Among men with total testosterone less than 12 nmol/L, only 27% had free testosterone levels below 225 pmol/L. Conclusions: Serum SHBG levels in men aged 18–56 years are not significantly associated with age. An increase in serum SHBG concentration in men is accompanied by an increase in the level of total testosterone, but it does not have a significant effect on the concentration of free testosterone. It is advisable to determine the level of SHBG and calculate free testosterone in patients with total testosterone levels less than 12 nmol/L.

5.24.7. UP-24.07: Sexuality and Prostate Cancer Experience of the Medical Oncology Department at Hassan II Hospital Center in Fes: A Study of 60 Cases

• Amaadour L, Oualla K, Arifi S, Keita D, Benbrahim Z, Mellas N and Nejjari S
• Hassan II University Hospital, Fes, Morocco

Abstract: Introduction and Objectives: Prostate cancer ranks fourth among the most common cancers worldwide, making it the second most prevalent cancer in men. Additionally, it is the fifth leading cause of cancer-related deaths in men. Despite advances in early detection and improved treatment modalities, the morbidity associated with prostate cancer treatment remains significant. Men’s sexual health and erectile function are heavily impacted by these therapies and remain a concern for prostate cancer survivors. Materials and Methods: This was a descriptive cross-sectional study conducted on 60 prostate cancer patients recruited from the medical oncology department of Hassan II Hospital Center in Fes. The prevalence of these disorders was assessed using a questionnaire based on validated questionnaires used in the context of prostate cancer, such as the EORTC QLQ C30 recommended by the AFU and the EPIC 26. Results: Sixty patients were evaluated, with an average age of 65 years (ranging from 53 to 74). 41% underwent prostatectomy without nerve-sparing, either unilateral or bilateral, while all patients underwent medical castration with Zoladex or Decapeptyl. Patients rated their quality of life on a scale of 0 to 10, averaging a score of 6. all patients reported rare and insufficient erections, associated with anejaculation, either immediately after surgery or after starting hormone therapy for non-operated patients. Decreased libido was observed in 80% of cases, while 75% of patients had genital shrinkage and 65% reported hot flashes. None of the patients experienced gynecomastia. Significant distress related to sexual life disruption was reported by 11.6% patients. Loss of erection was found to be the most detrimental side effect for our patients, also responsible for the deterioration of their quality of life, particularly in the context of their relationship. It is noteworthy that none of the patients initiated a discussion or planned changes with their partners or healthcare professionals, and none received follow-up. Conclusions: The sexual quality of life of patients after prostate cancer treatment is profoundly and enduringly affected. Invariably, all treatments lead to sexual complications often debilitating for the patient. Despite the taboo nature of the topic, it is imperative for healthcare professionals to openly address it with patients to provide appropriate therapeutic management.

5.24.8. UP-24.08: The Efficacy of Low-Intensity Shock Wave Therapy Based on the Stratification of Erectile Dysfunction Patients: A Long-Term Follow-Up

• Elsayed A, Abdel-Rassoul M, El-Shorbagy G, Elghoniemy M, Elkousy M and Elgharably M
• Cairo Unversity Hospitals, Cairo, Egypt

Abstract: Introduction and Objectives: Low-intensity extracorporeal shockwave therapy (Li-ESWT) significantly improves erectile function in patients with vasculogenic erectile dysfunction (ED). We aimed to evaluate the effect of Li-ESWT on different subtypes of ED and to assess through a long-term follow-up how long the improvement in erectile function lasts. Materials and Methods: This was a retrospective review of a prospectively maintained database at the department of Urology at Cairo University Hospitals. Patients with vasculogenic ED underwent 6–12 sessions of focal Li-ESWT 5000 impulses 0.01 j/mm² using the electromagnetic Dornier Aries^® 1 machine. All patients received at least 6 sessions of Li-ESWT. Then, patients were assessed clinically by using the erection hardness scores (EHS), and erectile function using the international index of erectile function (IIEF-EF) domain score at three months post Li-ESWT and every six months. Also, penile hemodynamics at three months post Li-ESWT and at the last follow-up visit. Results: 42 patients were identified with mean age 50 ± 12 years, mean ED duration 31 ± 35 months and mean follow-up 10 ± 6 months. Overall IIEF-EF was 16 ± 6 and improved to 22 ± 6 at three months and to 21 ± 6 at last follow-up (p < 0.01). Minimally important clinical difference was achieved in 69% at three months and in 60% of the whole cohort at last follow up. Risk factors associated with higher MICD at three months were age (p = 0.01), uncontrolled diabetes mellitus ratio (p = 0.04), hypertension (p = 0.24), cardiovascular (p = 0.8), smoker (p = 0.63), and ex-smoker (p = 0.3). Conclusions: Li-ESWT have a potential long-term efficacy on different degrees of ED evidenced by the improvement in the penile hemodynamics at the final follow-up particularly in those with controlled diabetes mellitus and advancing age.

5.25. Stones—Surgical Treatment

5.25.1. UP-25.01: Analysis of the Efficacy and Safety of an Intrarenal Retrograde Surgery Program (RIRS) as Treatment for Lithiasis: A Six-Year Retrospective Study

• Montuenga Fernández I ¹, Vázquez Valdés S ¹, García Rico E ², Sánchez Pellejero A ¹, Peral Parra D ¹, Sanchís Bonet A ¹, Ortiz Vico F ¹, Tamayo Ruiz J ¹ and Ortega Polledo L ³

¹ 

Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

² 

Hospital de Torrejón, Torrejón, Madrid, Spain

³ 

Hospital Universitario Príncipe de Asturias; Hospital Clínico San Carlos, Alcalá De Henares, Madrid, Spain

Abstract: Introduction and Objectives: To evaluate the efficacy and safety of RIRS as a treatment for renal lithiasis based on the stone-free rate (SFR), residual stone size (TLR), reintervention rate, and complication rate (Clavien-Dindo). Materials and Methods: We conducted a retrospective analysis of urinary lithiasis treatment at our center, excluding all patients with mid and distal ureteral location and those undergoing percutaneous surgery (PCNL) or combined surgery (Endoscopic Combined Intra-Renal Surgery: ECIRS). Between January 2017 and December 2023, 267 patients underwent RIRS. Baseline characteristics, initial stone size, stone location, and previous ureteral catheterization were recorded, with results re-evaluated at 3 months post-procedure using abdominopelvic CT scans. Stone-free status was defined as fragments < 4 mm in maximum diameter. Results: The median follow-up time was 18 months. The mean initial stone size was 14.97 mm (±7.33). The SFR was 48.7%, and the TLR was 4.21 mm (±5.68). The complication rate was 17.2% (infection 11.2%, ureteral injury 2.2%, bleeding 1.9%), all Clavien-Dindo I and II. Subgroup analysis based on initial stone size divided the cohort into three groups: Group 1: stones <10 mm (31.1%), Group 2: 11–20 mm (49.1%), and Group 3: >20 mm (19%). The overall reintervention rate was 12.4% (33/267). The reintervention rate by subgroups was 2.4% in Group 1, 14.5% in Group 2, and 23.1% in Group 3 (p < 0.01). There were no significant differences in SFR, TLR, need for reintervention, or complications based on the presence of prior double-J stenting (p > 0.05). Conclusions: In our series, RIRS is a safe technique, with the reintervention rate for residual stones depending on the initial stone volume, without influence from prior ureteral catheterization.

5.25.2. UP-25.02: Endourological Management of Ureteral Stump Syndrome

• Alharbi A ¹, Owayed M ¹, Al-Yousef R ¹, Khan R ¹ and Al-Terki A ²

¹ 

Al-Amiri Hospital, Kuwait City, Kuwait

² 

Al-Amiri Unit, Kuwait City, Kuwait

Abstract: Introduction and Objectives: Ureteral Stump Syndrome (USS) is characterized by the inflammation of remnant segment of a ureter, post nephrectomy. It is a rare condition with an incidence of 0.8%–1%, and often asymptomatic. It may be associated with recurrent urinary tract infections (UTI), lower abdominal pain, or haematuria. Conventionally, USS is managed with surgical excision of the stump. However, minimally invasive approaches were reported to treat USS. We report our experience in managing a case of ureteral stump syndrome with a caliculus by a minimally invasive surgery. Our objective is to highlight the advantages and the feasibility of treating ureteral stump syndrome with minimally invasive approaches. Materials and Methods: We report a rare case of USS with a calculus in a 48 year old female patient 22 years post simple right nephrectomy. She presented with a one year history of haematuria and right-sided abdominal pain. On examination, her abdomen was soft and non-tender. During her work-up a Computerized tomographic (CT) scan showed a 6 × 4 mm stone within the right ureteric stump. A Micturating Cystourethrogram (MCUG) showed no evidence of vesicoureteral reflux (VUR) in the retained ureteral stump. Results: After unsuccessful initial conservative management with antibiotics, the patient underwent right semirigid ureteroscopy and laser lithotripsy. The stone was found to be impacted at the proximal part of the stump. The stone was completely fragmented and fragments were removed by basket. Contrast was injected at the end of the procedure and there was no evidence of extravasation. The patient made an uneventful recovery and was discharged on post-operative day 2. During her 6 months follow-up at the outpatient clinic, she was symptom-free. Conclusions: Minimally invasive surgery offers a less morbid treatment and valid alternative to surgical excision in selected cases of Ureteric Stump Syndrome (USS).

5.25.3. UP-25.03: Outcomes of Semirigid Ureteroscopy with Pneumatic Lithotripsy for Upper Ureteric Stones: Five-Year Experience in Yemen (June 2018–June 2023)

• Obad M
• Alyemen Alsaeed Hospital and 48 Typical Hospitals, Sana’a, Yemen, Rep.

Abstract: Introduction and Objectives: Urolithiasis is a common urological condition. Although, the prevalence of urolithiasis ranges from 1–5% in Asia to 7–13% in North America, its prevalence in Yemen remain undetermined. While semirigid ureteroscope with pneumatic lithotripsy (SUPL) is considered an established procedure for treating lower ureteric stones and Extracorporeal Shock Wave Lithotripsy (ESWL) or flexible ureteroscope with laser for upper ureteric stones (UUS), many low-income countries lack access to these advanced lithotripter technology and still treating the UUS by conservative treatment or by traditional open ureterolithotomy. This study aimed to evaluate the outcomes, effectiveness, safety, and feasibility of SUPL for the treatment of UUS in low-income countries, such as Yemen, where advanced lithotripter technologies are unavailable. Materials and Methods: A retrospective analysis was conducted on a cohort comprising 212 patients. Treatment for UUS utilized a semi-rigid ureteroscope with a pneumatic lithotripter, between June 2018 and June 2023 at 48 typical and Alyemen-Alsaeed hospitals in Sana’a. Results: A total of 212 patients underwent SUPL for treating UUS, with 18 to 73 years of age and 62.7% were male, while 37.3% were female. The mean operation time was 46.5 min (range: 24–69 min). The stone sizes ranged from 8 to 22 mm, with 139 patients having stones measuring ≤ 1.5 cm (including 17 patients with stones < 1 cm) and 73 patients having stones > 1.5 cm. The overall procedural stones free rate (SFR) was 89.2% (189 out of 212 patients). Specifically, for patients with stones ≤ 1.5 cm, the SFR was 93.5% (130/139), with a 95% confidence interval ranging from 88.2% to 96.7%. Conversely, patients with stones > 1.5 cm exhibited a slightly lower SFR of 80.8% (59/73), with a 95% confidence interval ranging between 70.1% and 88.0%. Of the total number of patients, fourteen (6.6%) experienced stone retrograde migration to the renal pelvis, including eight with stones ≤ 1.5 cm and six with stones > 1.5 cm. Intraoperative ureteral perforation occurred in four patients (1.9%), leading to procedure termination. This complication exclusively occurred when the stone size exceeded 1.5 cm. Ureteral strictures impeding ureteroscope advancement were noted in five patients (2.3%), one involving stones ≤ 1.5 cm and four involving stones > 1.5 cm. Postoperative urinary tract infections (UTI) were detected in 8.7% of patients. However, no severe complications such as sepsis or avulsion were reported during the study. Conclusions: SUPL appears to be a successful treatment method for UUS in countries with limited resources. However, potential complications such as stone retropulsion, UTI, and perforation should be carefully considered and managed to optimize patient outcomes.

5.25.4. UP-25.04: Quantification of Systemic Absorption of Iodinated Contrast Medium During Retrograde Pyelography

• Bain M, Pridgeon S, Oly A and Wright-Smith M
• Queensland Health, Cairns, Australia

Abstract: Introduction and Objectives: Iodine contrast is routinely used in retrograde pyelography (RPG) as part of urological operations. The amount of systemic absorption of contrast during RPG is unknown. This may be important when managing patients with contrast or iodine allergies. We aimed to quantify contrast absorption following RPG and identify factors influencing its absorption to guide clinicians how to safely manage patients with contraindications to iodinated contrast medium. Materials and Methods: Prospective recruitment of 100 patients was performed at Cairns Hospital, Australia prior to an operation involving RPG. Omnipaque 300 (Iohexol) was the contrast medium for all patients. Blood samples were analysed for serum Iohexol levels at multiple time points including a control sample prior to the procedure, intra operatively, at 1 h and 3 h post contrast administration. A validated Iohexol assay was used with a limit of detection of 0.1 mg/L. The degree of contrast absorption was correlated with the amount of contrast instilled, patient factors including renal function, the degree of extravasation and the type of procedure performed. Logistic regression will be performed to control for variables influencing contrast absorption, analysis is ongoing. Results: Provisional results confirm that iodine contrast is systemically absorbed and detectable on serum samples following RPG. Intraoperative samples were highest, with an average of 35.59 mg/L, followed by 1 h 23.37 mg/L and 3 h 17.27 mg/L. Performing ureteroscopy increased systemic absorption compared to RPG alone (80.49 mg/L intraoperatively vs. 2.08 mg/L). Further data will be available. Conclusions: Iodine contrast when given intraluminally during retrograde pyelography is systemically absorbed. This confirmation will assist clinicians safely manage patients with contraindications to iodinated contrast including allergies. Urologists should consider alternatives (eg Gadolinium) in patients with severe contrast allergies, or perioperative steroids or antihistamines if no alternatives are available. Further analysis is ongoing for which patient and operation factors increase it most.

5.25.5. UP-25.05: Stone Characteristics Associated with Need for Re-Treatment Following URSL: A Single Center Observational Study

• Choube A ¹, Lalgudi N D ¹, K S S ¹, Kalra S ¹, K S ¹, Thakor P ¹, Vishal ¹, Bolar S ¹ and Balaji S ²

¹ 

JIPMER, Pondicherry, India

² 

Government Kilpauk Medical College, Chennai, India

Abstract: Introduction and Objectives: The choice of the right candidate for URSL is detrimental to identify the success rate and curative rate of the procedure. In this study, we aim to determine the association between stone parameters and complication rates between incomplete and complete stone clearance groups post-URSL to identify the patient who will have the best outcome, in an attempt to personalize urolithiasis care. Materials and Methods: 255 cases of ureteric calculi attending the urology OPF planned for URSL were included in this cohort study, and were further analysed for recurrence, stone parameters and complication rates, after obtaining explicit written consent from the patients and having obtained Institutional Ethics Committee approval, in lieu with the principles in the Declaration of Helsinki. Results: All VUJ stones were primary (non-recurrent) in our study. There was no statistically significant difference between the complete clearance and incomplete stone clearance groups concerning number of stones or bilaterality. Mid-ureteric stones had the highest clearance rate (80%) followed by distal ureteric (77.7%), VUJ (68.2%) and the lowest clearance rate observed in proximal ureteric stones (66%) There is an observed statistically significant difference between the stone size (largest stone size in case of multiple/bilateral calculi) amongst the Incomplete clearance (Mean = 12.1404 mm, SD = 4.42, 95% CI [3.73, 5.42]) and complete clearance (Mean = 10.7778 mm, SD= 4.23, 95% CI [3.84, 4.7]) groups (p = 0.0358). Further analysis based on the location of the stones between the incomplete clearance and the incomplete clearance groups, a statistically significant difference in the size (mm) was observed in proximal ureteric stones (p = 0.0032) whereas it was non-significant in distal (p = 0.084), mid-ureteric (p = 0.2785) and VUJ stones (p = 0.4014) No significant difference between post-operative or intra-operative complication rates between the 2 groups. Conclusions: Irrespective of whether it is single or mutiple/unilateral or bilateral, we conclude that mid-ureteric stones have the highest clearance rate when compared to other locations of the calculi, due to anatomical and technical convenience and adequacy of URSL in mid-ureteric calculi. Larger proximal ureteric calculi have better clearance rates, which may be detrimental in deciding the surgical management for best patient outcomes, after validation in larger cohorts.

5.25.6. UP-25.06: The Role of Guy’s Stone Score in Predicting the Outcome of Percutaneous Nephrolithotomy

• Hamedoun L, Mrabti M, Boukhlifi Y, Alami M, Ameur A, Elghazzaly A, Elouardi N and Elbahri A
• Military Hospital of Instruction Mohamed V, Rabat, Morocco

Abstract: Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) remains the gold standard treatment for large renal calculi. The aim of our study was to evaluate the Guy’s Stone Score (GSS) as a system for classifying the complexity of kidney stones prior to percutaneous nephrolithotomy and therefore as a predictive factor for free stone rates. Materials and Methods: This is a retrospective observational and analytical study conducted from January 2022 to December 2023, which included all patients who underwent percutaneous nephrolithotomy for all type of calculi in the urology department of the Mohamed V military training hospital. Patients were divided into four groups based Guy’s Stone Score preoperatively and the stone-free rate is registered. All PCNL surgeries were performed using standard techniques. The GSS is a simple and easily reproducible score for classifying the complexity of kidney stones. In our study, it has also proven to be an excellent tool for predicting the free stone rate, and it can help surgeons and inform patients about their operation. Results: A total of 90 patients (58 men and 32 women) with a median age of 55 years (30–70 years) were included in the study. A majority of the stones were solitary and were found in 58 patients. All patients were classified according to their GSS before the intervention. 36 patients were grouped as 1, 21 patients as 2, 18 patients as 3, and 15 as 4. Overall Stone Free Rate was 87% in the study group. Stone-free rate was found to be 100% for GSS group 1, 90% for group 2.78% for group 3, and 66% for group 4. Which gives a negative correlation: the higher the GSS, the lower the rate of stone free. Conclusions: The GSS is a simple and easily reproducible score for classifying the complexity of kidney stones. In our study, it has also proven to be an excellent tool for predicting the free stone rate, and it can help surgeons and inform patients about their operation.

5.25.7. UP-25.07: Flexible and Navigable Suction Ureteral Access Sheath (FANS) Revolutionizes Modern RIRS: A Prospective Study by the Global FANS Collaborative Group on Behalf of EULIS

• Ali Abdelghaffar M ¹, Gauher V ², Traxer O ³, Castellani D ⁴, Sietz C ⁵, Chew B ⁶, Fong ⁷, Ragoori D ⁸, Somani B ⁹, Ann Chai C ¹⁰ and Elshazly M ¹

¹ 

Menoufia University, Shebin Elkom, Egypt

² 

Department of Urology, Ng Teng Fong General Hospital, Singapore

³ 

Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France

⁴ 

Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy

⁵ 

Department of Urology Medical University of Vienna, Vienna, Austria

⁶ 

Department of Urology, University of British Columbia, Vancouver, Canada

⁷ 

Yong Loo Lin School of Medicine, National University of Singapore, Singapore

⁸ 

Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India

⁹ 

Department of Urology, University Hospitals Southampton, NHS Trust, Southhampton, United Kingdom

¹⁰ 

Department of Surgery, Urology Unit, University of Malaya, Kuala Lampur, Malaysia

Abstract: Introduction and Objectives: To evaluate stone-free rate (SFR) and complications after flexible ureteroscopy (F- URS) for renal stone(s) using a flexible and navigable suction sheath (FANS). Materials and Methods: Data from adults who had F-URS in 25 centers worldwide were prospectively collected (August 2023–January 2024). Exclusion criteria: abnormal renal anatomy, ureteral stones. All patients had a preoperative and within 30 days CT scan. SFR definition: Grade A: zero fragments; Grade B: single fragment ≤ 2 mm; Grade C: single fragment 2.1–4 mm; Grade D: single/multiple fragments > 4 mm. Data are presented as median (25th–75th quartiles). Multivariable logistic regression was performed to evaluate predictors of Grade A SFR. Results: 394 patients were enrolled. Median age was 49 (36–61) years. 59.1% were males. 58.6% of patients were pre-stented. Median stone volume was 1260 (706–1800) mm³. Thulium Fiber Laser was used in 45.9% of cases and Holmium Laser in the rest. Median lasing time was 18 (11–28) minutes. Median operative time was 49 min (37–70). One patient required a blood transfusion. 3.3% of patients had low-grade fever. There was no sepsis case. Low-grade ureteral lesion was seen in 8 (2%) patients. SFR was: Grade A = 57.4%; Grade A + B = 97.2%; Grade C + D = 2.8%. 11 patients had a redo F-URS. At multivariable analysis, stone volume 1501–3000 mm³(OR 0.50) and > 3000 mm³ (OR 0.29) were factors significantly associated with lower odds of Grade A SFR, whilst the use of TFL with higher odds (OR 1.83). Conclusions: F-URS using FANS showed negligible serious adverse events and reintervention with very good SFR.

5.26. Training and Education

5.26.1. UP-26.01: Enhancing Robotic Urological Surgery Outcomes: A Focus on Non-Technical Skills Training and Assessment

• Sitharthan D ¹, Rosario M ² and Gassner P ³

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

Westmead Hospital, Sydney, Australia

³ 

Bankstown-Lidcombe Hospital, Sydney, Australia

Abstract: Introduction and Objectives: The ongoing proliferation of robotic urological surgery (RUS) necessitates a comprehensive understanding of both technical and non-technical skills (NTS) to optimize patient outcomes. This review aims to systematically synthesize current evidence and methodologies for NTS training and assessment in RUS, underscoring their pivotal role in enhancing surgical proficiency and patient safety. Materials and Methods: We conducted an extensive scoping review to explore existing NTS frameworks, training curricula, and assessment tools tailored for RUS. Emphasis was placed on identifying validated methodologies for evaluating cognitive, social, and personal resource factors critical to RUS. Sources included Ovid MEDLINE, Embase, and Pubmed, scrutinizing articles for NTS training efficacy, assessment validity, and their impact on surgical performance. Results: This review pinpointed key NTS domains crucial for RUS, such as decision-making, teamwork, leadership, situational awareness, stress management, and communication. Emphasis on simulation-based training methods like full immersion/distributed simulation, high-fidelity OR simulation, and crisis resource management has been noted as essential in developing these skills. The integration of innovative assessment tools, including the NASA Task Load Index (NASA-TLX) and the Interpersonal and Cognitive Assessment for Robotic Surgery (ICARS), provides comprehensive frameworks for NTS evaluation in RUS settings. These tools have illuminated the cognitive workload challenges unique to robotic surgery, suggesting targeted areas for improvement in training protocols. However, the landscape of NTS assessment in RUS reveals gaps, particularly in procedure-specific assessments and establishing a clear correlation between NTS proficiency and clinical outcomes. Efforts to bridge these gaps have led to the development of new methodologies aiming at enhancing NTS training and ensuring its applicability and relevance to actual surgical practice. The variability in NTS across different stages of surgical expertise underscores the necessity for tailored training programs that adapt to the evolving skill set of surgeons in the robotic domain. Conclusions: This review underscores the critical importance of integrating NTS training and assessment into RUS curricula. It highlights simulation-based training as key to developing essential NTS, with the need for standardized, procedure-specific assessment tools to ensure comprehensive surgical proficiency and patient safety.

5.26.2. UP-26.02: Interest in Andrology and Sexual Medicine by Urology Residents: The Example of a North African Country

• Guebbas S, Azarg A, Chatar A, Amoch A, Dahami Z, Sarf I and Lakmichi M
• Mohammed VI University Hospital, Marrakech, Morocco

Abstract: Introduction and Objectives: Andrology and sexual medicine represent essential pillars of modern urological practice, addressing a range of disorders from male infertility to erectile dysfunction and couple therapy. The aim of this study is to assess the interest of Moroccan urologists in training, in andrology and sexual health, and their opinion of the theoretical and practical training currently offered in their curriculum. Materials and Methods: This is a cross-sectional, descriptive study including all urology resident physicians in Morocco between February and March 2024. A survey questionnaire was prepared and distributed online. It contained 21 questions covering several elements such as age, gender, place of training, area of practice, interest in the specialty, andrology and sexual medicine case management, and an opinion on current training. Data analysis was performed using SPSS 21.0 software. Results: A total of 51 of the 120 urologists in training surveyed (42.5%) completed the questionnaire. The average age of respondents was 30.39 years. All respondents were male. All Moroccan university hospitals were represented, with a predominance of residents from Marrakech University Hospital (38.5%). Respectively, 97.4% were interested in andrology and sexual medicine, and over 90% wished to enroll in a University Diploma. However, only 12.5% of the residents surveyed were enrolled at the time of the survey, most of them volunteers in their last 2 years of training. Of these, 52% had chosen France as their training location. More than half the residents surveyed felt that 10–20% of the cases seen per week in their practice were related to andrology and sexual medicine (57.9%). The majority of residents were convinced that andrology had a future in Morocco, except for vasectomy, where they remained sceptical (50% saw no future). 85% of Moroccan urologists in training were dissatisfied with their theoretical training in andrology and sexual medicine, proposing the integration of dedicated andrology training within the curriculum, as well as scientific and financial accessibility to inter-university diplomas, by opening other inter-university diplomas in Morocco. Conclusions: Andrology and sexual medicine are attractive disciplines for Moroccan urologists in training, who see them as an important part of their future activity. However, they feel that current teaching methods are insufficient.

5.26.3. UP-26.03: Mastery Learning in Urology: Simulation-Based Approaches to Surgical Education

• Sitharthan D ¹, Thayanantharajah K ², Rosario M ³ and Gassner P ⁴

¹ 

Chris O’Brien Lifehouse, Sydney, Australia

² 

Royal Prince Alfred Hospital, Sydney, Australia

³ 

Westmead Hospital, Sydney, Australia

⁴ 

Bankstown-Lidcombe Hospital, Sydney, Australia

Abstract: Introduction and Objectives: Traditional urology training models face challenges in adapting to modern surgical practices, particularly with the shift towards minimally invasive and robotic techniques. With decreased working hours and increased emphasis on patient safety, there’s a pressing need for effective, alternative training methods. Simulation-based education (SBE) offers a comprehensive solution, providing a risk-free environment for trainees to develop both technical and non-technical skills. This review aims to explore the evolution, current practices, and future directions of SBE in urology, highlighting its critical role in addressing the gap in clinical exposure. Materials and Methods: We conducted an extensive literature review, encompassing recent developments in simulation technologies, including part-task trainers, 3D-printed models, laparoscopic and robotic surgery simulations, and scenario-based training. The review focuses on the application of these modalities in urology training programs worldwide, assessing their effectiveness in skill acquisition and competency. Results: SBE has significantly enhanced the learning experience in urology, offering diverse modalities tailored to specific training needs. Part-task trainers and 3D-printed models have revolutionized basic surgical skills training, providing realistic, tactile feedback. Advanced laparoscopic and robotic surgery simulations offer immersive experiences, closely mimicking the operating room environment and enabling mastery of complex procedures. Scenario-based simulations and role-play further enrich training by incorporating non-technical skills, critical for effective team collaboration and emergency management. The integration of SBE in urology curricula has demonstrated marked improvements in technical proficiency, decision-making, and patient safety, with the potential to shorten the learning curve for novice surgeons. Conclusions: The adoption of SBE in urology represents a paradigm shift in surgical training, addressing the limitations of traditional apprenticeship models. By simulating real-life clinical scenarios, SBE provides a scalable, efficient, and safe platform for skill development. Future directions include enhancing the realism of simulation models, standardizing curricula, and further research into the impact of SBE on clinical outcomes. As technology advances, SBE will continue to play a pivotal role in preparing urologists for the challenges of modern surgical practice, ensuring the highest standards of patient care.

5.26.4. UP-26.04: The Psychological Impact of Urological Disorders on Men’s Mental Health: The Argument for Integrated Mental Health Support in Urology

• Sitharthan D
• Chris O’Brien Lifehouse, Sydney, Australia

Abstract: Introduction and Objectives: The intricate relationship between urological disorders and mental health in men presents a multifaceted challenge necessitating an integrated care approach. With a significant portion of the male population grappling with both urological conditions and psychological distress, the objective of this study is to explore the psychological impact of urological disorders on men’s mental health and highlight the critical need for integrated mental health support within urological care. Materials and Methods: This study synthesizes evidence from a range of sources, including global health data, psychological assessments, and outcomes of integrated care models, to assess the psychological burden of urological conditions. It examines societal perceptions of masculinity that contribute to the stigma surrounding urological and mental health issues, thereby affecting men’s willingness to seek help. The effectiveness of current initiatives, such as on-site psychological services, multidisciplinary care teams, and telehealth solutions, is evaluated to propose a comprehensive model for integrating mental health care in urology. Results: Findings reveal a stark correlation between urological conditions and mental health challenges, with a significant percentage of men experiencing depression and anxiety as a result of their urological diagnosis. Societal stigma and traditional views on masculinity exacerbate the reluctance to seek help, leading to worse health outcomes. Integrated care models, including the incorporation of on-site psychological services and multidisciplinary teams, have shown promise in enhancing patient satisfaction and overall health outcomes. Early screening for mental health issues, continuous professional development in psychological aspects of urological care, and the utilization of telehealth services emerge as practical recommendations for urologists to adopt a holistic care approach. Conclusions: The integration of mental health support into urological care is imperative for addressing the comprehensive needs of men with urological disorders. By adopting integrated care models that encompass both physical and psychological health, urologists can significantly improve patient outcomes and quality of life. This study underscores the necessity for a paradigm shift in urological care towards a more holistic, patient-centred approach, advocating for the dismantlement of societal stigma, enhancement of professional training, and the implementation of innovative care practices.

5.27. Trauma

5.27.1. UP-27.01: Does Penile Fracture Surgery Affect Sexual Function?

• Zouari F, Bhouri A, Ben Kahla A, Fourati M, Samet A, Kammoun O, Mejdoub B, Chaabouni A, Smaoui W, Mseddi M, Rebai N and Hadj Slimen M
• Habib Bourguiba Academic Hospital, Sfax, Tunisia

Abstract: Introduction and Objectives: Penile fracture (PF) is a urological emergency. Surgery with suture of the albuginea is the reference treatment. Recovery of sexual function is the main outcome. The objective of our study is to evaluate sexual function after PF surgery. Materials and Methods: This is a retrospective analysis of patients who underwent PF surgery between January 2020 and April 2023 in the urology department of Sfax University Hospital. Erectile function (EF) was assessed with the IIEF-5. The change in EF was classified as worsening, maintaining, or improving. The presence of hypoesthesia of the glans and curvature of the penis, and palpation of penile nodules were also assessed. Self-satisfaction with the scar and self-perception of body image were rated from 0 to 10. Results: Data from 9 patients were collected. The average age was 44 years old. Sexual intercourse, masturbation and self-inflicted injuries were the cause of 6 cases, 2 cases and 1 case of PF, respectively. The lesion affected the right corpus cavernosum (CC) in 5 cases, the left CC in 3 cases and both CC in 1 case. The dorsal and ventral location of the lesion appeared in 4 and 5 cases, respectively, corresponding to 4 cases in the proximal third, 4 cases in the middle third and 1 case in the distal third. A curvature of the penis appeared in 2 cases, and none required correction. The median postoperative IIEF-5 was 24. EF deteriorated to the level of dysfunction in only 1 patient. The decrease in EF was noted in 1 patient who presented a curvature, and 1 patient who presented a distal lesion and who presented a hypoesthesia of the glans. The sensation of a penile nodule appeared in 1 patient who had a bilateral fracture. Recovery of sexual activity occurred in a median of 6 weeks. Self-satisfaction with body image had a median of 9. A median for scar self-satisfaction of 8 was obtained. Conclusions: A low incidence of complications and satisfactory functional results are reported after PF surgery. Close monitoring of the patient is essential. A larger series of PF is necessary to detect the factors associated with the complications that occurred.

5.27.2. UP-27.02: Integrated Approach in Management of Gunshot-Induced Urological Injuries: A Cross-Continental Case Series

• Chittibabu K and Ravi Kumar A
• Medicover Hospitals, Hitech City, Hyderabad, India

Abstract: Introduction and Objectives: Gunshot wounds to the urinary tract are a unique challenge, requiring a holistic and multidisciplinary approach for effective management. This case series of 14 patients airlifted between 2021 and 2024 from Somalia to Hyderabad, India for treatment provides insights into the integrated care pathway from initial assessment to postoperative rehabilitation. Materials and Methods: We retrospectively analyzed 14 male patients, with an average age of 34 years, who sustained gunshot injuries from country-made firearms. A detailed history and meticulous examination were pivotal in assessing the extent of trauma. Appropriate imaging, including CT scans and retrograde urethrography, facilitated precise injury localization. Collaboration with neurology, orthopaedics, and colorectal surgery was essential for addressing the multi-faceted nature of the injuries. Results: We analyzed 14 male patients with gunshot injuries, aged 24 to 44 years (mean age 32), all treated initially in Somalia. Upon sustaining their injuries, they immediately went to the emergency room. These injuries, caused by bullets likely from handguns, varied in location: eight in the anterior abdomen, two in the back or flank, two in the buttocks and two in the upper thighs. Furthermore, 8 patients had concurrent intra-abdominal injuries. The patients presented with complex urological injuries, including vesicocutaneous and urethral fistulas, and urethral strictures. One patient had a ureterocutaneous fistula which is very rare. The average hospital stay was 12 days. Individualized surgical interventions, informed by a comprehensive preoperative evaluation, were employed. These ranged from fistula repair to urethroplasty. Four patients had post-operative complications. The critical role of postoperative care, emphasizing rehabilitation and nutritional support, was underscored in the recovery and long-term outcomes of these patients. Conclusions: The effective management of gunshot-induced urological injuries necessitates a systematic, in-depth evaluative approach, and collaborative surgical strategy. The involvement of a broad spectrum of specialities, alongside focused postoperative care, is crucial for optimizing patient outcomes. This series highlights the importance of a multidisciplinary strategy in trauma care, offering valuable lessons for managing complex urological injuries in conflict-affected regions.

5.27.3. UP-27.03: Renal Trauma: Experience from a Trauma Centre

• Razi B, Kim P, Burns B and Vass J
• Royal North Shore Hospital, Sydney, Australia

Abstract: Introduction and Objectives: Trauma remains to be one of the highest causes of death in patients under the age of 40. In abdominal trauma, the third most commonly injured organ is the kidney. With the advancements in imaging and technology, there has been an increasing shift towards conservative or non-operative management. Renal trauma remains to be complex and challenging clinical entity. Incorporating the available current guidelines into clinical practice ensures a structured and evidence-based approach to renal trauma management. However, each case necessitates careful consideration of patient factors, injury severity, and associated injuries for an individualised treatment plan. There is a current paucity in the literature in regards to Australia trauma data, and no published literature from NSW. Materials and Methods: A retrospective data collection was performed for all trauma patients managed by Royal North Shore Hospital with a renal injury. Patients were identified using specific diagnosis related group codes. Data included demographics, mechanism, American Association for the Surgery and Trauma grade, associated symptoms and injuries, management and complications. Results: An initial 20 patients were identified, 75% male, with an average age of 36. Low-grade AAST Grade I–III injuries comprised of 65% of injuries, AAST Grade IV accounted for 10% and 25% were grade V. The most common mechanism of injury was road accidents accounting for 50%, followed by fall-related injuries (30%), gunshot wounds (15%) and assault (5%). Intervention was only required in grade V injury patients either radiological intervention or a nephrectomy, due to haemodynamic instability. Further data collection is ongoing, extending to a total 5 year time frame. Conclusions: The majority of renal trauma encountered has occurs in males, which is similar to the few other studies published. Road trauma is the leading cause of renal injury followed by fall related injuries. Haemodynamically stable patients were all managed conservatively, and only grade V injuries needed intervention.

5.28. Voiding Dysfunction

5.28.1. UP-28.01: Barrigel as a Novel Pain Management Solution for Sacral Neuromodulation Associated Battery Discomfort in Thin Individuals: A Proof-of-Concept Study

• Huynh T ¹ and Manohar P ²

¹ 

Monash Health, Melbourne, VIC, Australia

² 

Monash University, Melbourne, VIC, Australia

Abstract: Introduction and Objectives: Sacral neuromodulation (SNM) is a minimally invasive intervention for certain pelvic floor and urinary disorders. However, battery site pain poses a significant complication, particularly in individuals with lower body mass index (BMI). This study aims to address this issue by using Barrigel, a polyethylene glycol hydrogel spacer typically used in prostate cancer radiation therapy to maintain a protective space around the rectum. This study presents a proof of concept for the use of Barrigel as a potential pain management solution for thin individuals with SNM-related battery discomfort. Materials and Methods: A 46-year-old female of BMI 16 kg/m² with battery site pain following SNM for interstitial cystitis-associated frequency was selected as a study participant. The six-month follow-up period involved placement of Barrigel in the fat covering the implanted battery, with reinjection at three months. Pain intensity, measured using the Numerical Rating Pain Scale, was documented at regular intervals. Results: The participant reported a noticeable reduction in pain intensity from an initial baseline measurement of 10/10 to 1/10. Upon the second instillation of Barrigel at three months, a sustained reduction in pain intensity was observed. No adverse reactions or complications were reported during the follow-up period. Conclusions: Our findings suggest the application of Barrigel as a protective spacer in SNM for thin individuals enhances patient comfort. This is a promising solution to one of the recognised challenges associated with SNM in thin individuals. Further investigations and long-term follow-ups are warranted to validate the efficacy of Barrigel use in the context of SNM-related battery discomfort.

5.28.2. UP-28.02: Comparison of Success Rates of Internal Urethrotomy and Urethral Dilatation with Nelaton Catheter in Men with Urethral Stricture

• Hamidi Parsa M
• Shahid Sadoughi University, Yazd, Iran

Abstract: Introduction and Objectives: Stenosis of the urethra in men is one of the most common urological problems, and its treatment is a challenging issue. When the caliber of the lumen of the urethra reaches below 30 French and in the fossa navicularis below 22 to 24 French, the symptoms of urethral stricture can appear. Stenosis urethritis has various causes that differ in different geographical areas. In total, 51/67% trauma, 34/49% iatrogenic, 5/79% infection, and 4/22% lichen sclerosis are the leading causes of urethral stricture. The main treatments include internal urethrotomy in short strictures and urethroplasty in long strictures. There are other treatments such as dilatation and stenting of the urethra. Studies show that internal urethrotomy has a success rate of 50 to 80%. The most response to this treatment is in strictures below two centimeters of the bulbar stenosis. Dilatation with Nelaton catheter under the guidance of guidewire is a cheap and available method that has received attention in recent years. According to the study of Dr. Hosseini and his colleagues, the success rate of this method is 58% in the first attempt and 77.77% in the second attempt. Materials and Methods: In this prospective descriptive study, 150 men with bulbar stenosis who referred to Rahnamoon Hospital in Yazd in 2021 and 2022 were examined. 90 patients underwent dilatation with Nelaton catheter and 60 patients underwent internal urethrotomy. All patients were initially subjected to uroflowmetry, ultrasound, and retrograde urethrography. Patients were followed up in months 3, 6, and 12. In months 6 and 12, patients again underwent ultrasound to determine the amount of post voiding residue and uroflowmetry to determine Qmax. Patients had a Foley catheter for 10 to 14 days after surgery and then they underwent clean intermittent catheterization as planned. Results: In our study there was no significant difference in post voiding residue and Qmax and the rate of operative complications between two group. Conclusions: Considering the similar results between the two methods of dilatation with Nelaton catheter and internal urethrotomy, and considering the cheaper and more accessible method of dilatation with Nelaton, this method can be replaced by internal urethrotomy.

5.28.3. UP-28.03: Does Time in a Day Alters Uroflowmetery: A Prospective Experience with Population of Nepal

• Yadav D and Adhikari M
• Nepal Mediciti Hospital, Nepal, Kathmandu, Nepal

Abstract: Introduction and Objectives: Uroflowmetry is a non-invasive diagnostic tool utilized in urology to assess urinary function and diagnose various lower urinary tract conditions. This method measures the rate and volume of urine flow during voiding, providing valuable insights into bladder and urethral function. The time of day can indeed influence uroflowmetry results, as urinary patterns can vary due to factors such as fluid intake, activity level, and circadian rhythms among individuals and populations. The aim of this study is to evaluate the outcome of uroflowmetry in the same individual in the afternoon time with morning time. Materials and Methods: This is a prospective study conducted in Nepal Mediciti Hospital, Nepal in 2023 and 2024. A total of 52 patients are involved with lower urinary tract dysfunction. The age ranges from 19 years to 82 years with male 49 and female 3. All the patients had done uroflowmetry before 12 AM and after 3 PM. Results: The Q max, average flow, hesitancy after 3 pm ranges (5–17.5) mL/s; (1–8.4) mL/s; (2–89) s which improves to (9.2–28.5) mL/s; (1.6–17) mL/s; (1–30) s respectively before 12 pm. Conclusions: This outcome suggest that time of day can influence uroflowmetry results, the extent of this influence may vary among individuals and populations. Thus, clinicians should consider this factor when interpreting uroflowmetry data and take into account the timing of the test when assessing bladder function and diagnosing lower urinary tract disorders.

6. UNMODERATED VIDEO ePOSTERS

• Daily Viewing:
• Thursday, October 24—0930–1630
• Friday, October 25—0930–1630
• Saturday, October 26—0930–1500

6.1. Adrenals

UVP-01.01: Laparoscopic Adrenal Sparing Surgery

• Simforoosh N, Darzi M, Rabani S and Dadpour M
• Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract: Introduction and Objectives: To compare laparoscopic partial adrenalectomy with total laparoscopic adrenalectomy in managing adrenal tumors whit different etiologies. Two representative cases are presented in this video presentation. Materials and Methods: 191 patients with adrenal masses underwent laparoscopic partial (LPA), or total (LTA) clipless, sutureless adrenalectomy from March 2005 to February 2023. Functional outcomes and recurrences were reviewed. Results: Of 191 cases, 55 were done by partial and 136 with total laparoscopic adrenalectomy. In patients with pheochromocytoma, remission of hypertension, palpitations, and headaches did not differ between patients undergoing LPA and LTA (p > 0.05). Two recurrences were found in patients with pheochromocytoma who underwent LTA. In patients with Cushing’s disease, central obesity, overweight, and hypertension improved in all patients six months after treatment. Time to symptom resolution did not differ in patients undergoing LPA or LTA. In Conn’s disease, hypertension was treated in all patients and no patient required postoperative potassium and corticosteroids supplementation. During follow-up, no recurrence was detected in patients pathologically diagnosed as Cushing’s or Conn’s disease. Conclusions: Our study suggests that laparoscopic partial adrenalectomy can provide considerable symptoms relief similar to laparoscopic total adrenalectomy and there are no statistically significant differences in recurrence rate, which offers laparoscopic partial adrenalectomy as a less invasive approach in patients with functional adrenal tumors.

6.2. Bladder Cancer—Clinical

6.2.1. UVP-02.01: “STEP” Resector a Novel Design for En Bloc Resection of Bladder Tumor

• Pal M, Arora A, Godse S, Misra A and Prakash G
• Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India

Abstract: Introduction and Objectives: Significant worries about tumor spilling during transurethral resection of bladder tumor (TURBT) have been raised by the conventional resection of papillary tumors. En bloc resection is proposed to lessen tumor spillage and to improve the pathological analysis of bladder tumors less than 3 cm. Various methods of en bloc resection are available like LASER, hydrodissection, J loop and Zed scissors which need second step to obtain deep muscle. Here we present novel method “STEP” resector, by modifying design of Collins knife to perform for en bloc resection of bladder tumors. Materials and Methods: This is a pilot prospective study of 6 patients who had pedunculated lesion of urinary bladder, size less than or equal to 3 cm. Patients with endoscopic suspicion of carcinoma in situ, size > 3 cm, upper tract transitional cell carcinoma were excluded from the study. En bloc resection of the tumor carried out using “STEP” resector with standard resectoscope. Monopolar electro cautery was used to resection. Outcome measures were presence of detrusor muscle in specimen, bladder perforation, obturator jerk and recurrence. Patients were followed up at 3 months with check cystoscopy for recurrence. Results: Median age was 48 years. The median size was 2.6 cm (range: 1.5 cm–3 cm). The mean resection time was around 20 min. None of the patients had bladder perforation and obturator nerve reflex. Detrusor muscle was present in all specimens. All patients were discharged after 24 h of the procedure. At follow-up of 3 months none of patient had recurrence on check cystoscopy. Conclusions: This newly designed instrument “STEP” resector is an economical, safe and oncological equivalent to available armaments used to perform en bloc resection of bladder tumor.

6.2.2. UVP-02.02: Female Pelvic Organ-Preserving Robot Assisted Radical Cystectomy—A Video Demonstration

• Shah A, Singh A, Coelho V, Ganpule A, Sabnis R and Desai M
• Muljibhai Patel Urological Hospital (MPUH), Nadiad, India

Abstract: Introduction and Objectives: Anterior pelvic exenteration as a part of radical cystectomy can have a significant impact on quality of life as a result of decrease in sexual and urinary functions. In selected patients, pelvic organ preserving approach may be undertaken to improve postoperative functional outcomes. We demonstrate one such approach. Materials and Methods: The patient was positioned in a steep Trendelenburg position, and a six trocar approach was carried out. Following mobilisation of the ureters till the lower end, the vesico-vaginal plane was carefully opened to avoid damaging the anterior vaginal wall. The uterus, the cardinal ligaments containing the uterine arteries, and supporting ligaments were spared. This was followed by anterior dissection of the bladder by developing the space of Retzius. To preserve a functional urethral stump, urethra was divided close to the neck. Standard pelvic lymph node dissection was then performed. The bed for the neobladder was prepared by placing absorbable hemostat and a pedicled omental flap. Studer type of intracorporeal orthotopic neobladder was then constructed. Results: The patient recovered well postoperatively and was discharged on post operative day 8. Double J stents and catheter were removed on post operative day 25. The patient voids well with intermittent use of self cathetisation. Conclusions: Pelvic organ sparing radical cystectomy and neobladder formation can be selectively used in female patients who wish to preserve sexual function as an oncologically safe therapy with positive functional effects. The precise anatomical preservation of utero-vaginal components is critical to the rapid and effective recovery of physiological functions such as urine continence and sexual engagement. A meaningful comparison of outcomes to the usual radical cystectomy approach necessitates well-designed prospective randomised studies.

6.2.3. UVP-02.03: Partial Cystectomy in a Urachal Adenocarcinoma: A Combined Robotic and Endourological Approach

• Imran Q, Tamboli Z, Singh U, Hussain A, Singh S, Pathak A and Sureka S
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: Primary urachal adenocarcinoma of bladder is a rare entity with an aggressive nature. Radical cystectomy with excision of urachus and umbilicus has been mainstay of the treatment with significant morbidity. We describe our novel method of managing a patient with urachal adenocarcinoma with robotic partial cystectomy combined with endourological approach. Materials and Methods: A 56 year old female presented to us with gross haematuria with clots for 6 months. On MRI there was single endo-exophytic mass of size 4 × 3.6 × 0.9 cm with tubular projection along with urachal remnant for which she underwent TURBT. Histopathology was suggestive of adenocarcinoma with mixed type and invasion of muscle. She was planned for robotic partial cystectomy with on table cystoscopy. Results: Intraoperative cystoscopy was done to better delineate the tumour while avoiding any injury to the bladder dome. Firefly mode was used to mark the tumour with circumferential 2 cm margins and resected from the bladder. Standard bilateral pelvic lymph node dissection was done followed by en-bloc resection of urachus. Histopathology showed urachal adenocarcinoma with bladder and urachal margins were free and all dissected lymph nodes were negative. Conclusions: Robotic partial cystectomy combined with endourological approach is a novel method for managing these rare tumours with less perioperative complications along with acceptable functional and oncological outcomes.

6.2.4. UVP-02.04: Robotic Reconstruction of Ureteroenteric Anastomosis Stricture Through Transmesointestinal Ileal Segment Transpositioning Technique Following Robotic Radical Cystectomy and Ileal Loop

• Esen B, Aykanat İ, Canda A and Balbay M
• Koc University School of Medicine, Istanbul, Türkiye

Abstract: Introduction and Objectives: Ureteroenteric stricture formation is an unrare and challenging complication following robotic radical cystectomy (RARC). Especially in cases with limited left ureteral length, transposition of the afferent loop can be a practical solution to achieve tension-free ureteroenteric anastomosis. Materials and Methods: A 70-year-old male underwent RARC, bilateral extended pelvic lymph node dissection, and ileal loop for pT2 high grade squamous cell bladder cancer. Starting from postoperative 1st month, patient was admitted with left flank pain and had 2 episodes of pyelonephritis. Serum creatinine increased from 1.1 to 1.6 mg/dL. A left-sided hydronephrosis was documented, a nephrostomy was inserted and an antegrade nephrostogram revealed left-sided complete ureteroenteric stricture. Robotic reconstruction of the left ureteroenteric anastomosis was decided. Results: At 30° Trendelenburg position, 4 robotic 8 mm ports and one 12 mm AirSeal assistance port were placed. Intestinal adhesions over the ureters were released and both ureters and ileal loop was exposed. Left ureter was extremely stuck to the surrounding tissue and underlying vascular structures. Indocyanine green (ICG) was injected through nephrostomy to determine where the stricture begins. Initially ureteral dissection and transposition through the mesointestinal tunnel was planned. However, because of dense adhesion to underlying great vessels a limited dissection just enough to remove the strictured segment was done and free ileal segment was tunneled through the opening in the meso to achieve a tension-free anastomosis. The ureter was incised above the strictured segment. The normal-caliber ureter was spatulated and re-anastomosed to the afferent loop over a 6 Fr DJ stent. Total console time and estimated blood loss were 260 min and 50 mL. Patient was discharged on the postoperative 4th day. The antegrade nephrostogram at postoperative 1 month revealed smooth passage from left ureter to ileal loop. Current creatinine level is 1.2 mg/dL. Conclusions: Robotic reconstruction of ureteroenteric stricture is a feasible and reproducible procedure. Utilizing ICG through nephrostomy may facilitate determination of exact location of the stricture. Surgeons may consider mobilization and transmesointestinal transposition of the afferent loop to achieve tension-free ureteroenteric anastomosis, especially in cases with limited available ureteral length and difficult dissection.

6.3. BPO/LUTS

6.3.1. UVP-03.01: A Combined Technique of a Laparoscopic Transcapsular and Transvesical Simple Prostatectomy

• Capinha M, Cardoso A, Araújo A, Pinto L, Tinoco C, Rodrigues R, Alves M, Mendes M and Dias E
• Hospital de Braga, Braga, Portugal

Abstract: Introduction and Objectives: Benign prostatic hyperplasia (BPH) is one of the most prevalent diseases in older men being the most common benign neoplasm. Surgical options are presented to non responders to conservative treatment. Open prostatectomy is indicated for patients with prostates with more than 80 cc. Laparoscopic simple prostatectomy (LSP) is also feasible for patients with these prostate volumes and has been reported with encouraging outcomes. Nowadays, there are several technical nuances. For instance, for a laparoscopic transcapsular prostatectomy, one of the options is a transversal incision on the prostate capsule. Also, there is the laparoscopic transvesical approach with a longitudinal vesical incision. This video aims to demonstrate a combined laparoscopic transcapsular and transvesical prostatectomy technique in a patient with a large median lobe. Materials and Methods: The images of the surgery were edited to create this video. Results: This video shows a 74-year-old male patient referred to the urology department after being admitted to the hospital due to a clavicle fracture. During his stay, he had acute urinary retention and was discharged with the indication to remove the urinary catheter one week later without success. He had another attempt to remove it two weeks later but was unsuccessful. The patient was submitted to laparoscopic simple prostatectomy. The initial approach was to perform a transcapsular approach, but due to the dimensions of the median lobe, it was necessary to make a vertical transvesical incision to remove all the adenoma. As a result, the bladder was closed longitudinally, and the prostate capsule in a transverse way. The surgery was uneventful. The patient had the indication to maintain the catheter for two weeks after the surgery. Conclusions: Some researchers have demonstrated that LSP is safe and effective for treating significant BPH in men. This video shows a minimally invasive simple prostatectomy option in patients with a large median lobe.

6.3.2. UVP-03.02: A Novel and Simple Approach for Precise Localization of Puncture Site During Rezum Procedure

• Esen B ¹, Aykanat İ ², Madendere S ³, Karaarslan U ¹, Koseoglu E ² and Balbay M ²

¹ 

Koc University School of Medicine Department of Urology, Istanbul, Türkiye

² 

Koc University School of Medicine, Istanbul, Türkiye

³ 

American Hospital, Istanbul, Türkiye

Abstract: Introduction and Objectives: REZUM water vapor ablation of the prostate is an emerging minimally invasive treatment of benign prostate obstruction with promising results. The measurement of the distance from the bladder neck to proximal verumontanum, and therefore the number of punctures, as well as the puncture sites are recommended to be performed using the optical “visual field of view” which is very subjective and susceptible to error. Herein, a novel and easy method is proposed for the measurement of the distance from the bladder neck to the verumontanum as well as the precise localization of puncture sites during this procedure. Materials and Methods: A 79-year-old male presented with lower urinary tract symptoms with an IPSS of 25 despite using alpha-blockers for the last 1-year. Ultrasonography revealed a 42 mL-sized prostate and uroflowmetry revealed a maximum flow rate of 4 mL/s, an average flow rate of 2 mL/s, and a voided volume of 207 mL. Residual urinary volume was 22 mL. The treatment options were discussed with the patient, and the REZUM procedure was decided. Results: The patient was positioned in a lithotomy position and a cystourethroscopy revealed bilateral hypertrophic prostatic lateral lobes causing obstruction. No urethral stenosis was observed. Then REZUM water vaporization system was installed. Before initiating the procedure a 5 Fr ureteric stent was advanced through the urethra. Via using this ureteric stent, the distance from the bladder neck to the proximal verumontanum was measured as approximately 2.5 cm. Considering the measured distance, 1 puncture was decided for both lateral lobes. The puncture site was determined using the ureteric stent (1 cm distal from the bladder neck or 1 cm above verumontanum). Water vapor was delivered through a retractable vapor needle. Total operation time including cystourethroscopy was 7 min. The patient was discharged the same day. Conclusions: Herein, we describe a simple, cheap, and reproducible approach to measure the distance from the bladder neck to verumontanum as well as the precise localization of puncture sites while performing the REZUM procedure.

6.3.3. UVP-03.03: The Laparoscopic Bilateral Boari Flap in a Failed Case of Bilateral Ureteric Reimplantation

• Vaddi C
• Preeti Urology and Kidney Hospital, Hyderabad, India

Abstract: Introduction and Objectives: We present our experience, feasibility of laparoscopic bilateral boari flap in a failed case of bilateral ureteric reimplantation done elsewhere for bilateral ectopic ureters draining into prostatic urethra. Materials and Methods: A 40 year old gentleman presented with bilateral loin pain and increase in serum creatinine(2.7 > 0.8), he underwent bilateral ureteric reimplantation for ectopic bilateral ureteric orifice draining into prostatic urethra 3 months back, post surgery creatinine increased to 2.7, patient evaluated with MR urogram -shows bilateral lower ureteric obstruction. After evaluation bilateral PCN performed, creatinine came down to 1.3. Bilateral nephrostogram revealed bilateral lower ureteric obstruction at sacralbrim. patient underwent bilateral laparoscopic boari flap procedure with bilateral DJ stenting. Results: There is no intra and post operative complications, operative time 120 min, estimated blood loss 60 mL, serum creatinine came to 0.9 on 3rd POD, bilateral DJ and per urethral catheter removed on 3 weeks, MCUG at 3 weeks no leak and no reflux, bilateral nephrostogram at 4 weeks good drainage no obstruction B/L PCN removed at 4 weeks. Conclusions: The laparoscopic bilateral boari flap is safe and feasible technique in bilateral long segment stricture of lower ureter especially after failed reimplantation.

6.4. Infertility

UVP-04.01: Tips and Tricks for a Successful Ductular VasoEpididymal Anastomosis

• Kothari P ¹ and Vishwakarma R ²

¹ 

B.Y.L Nair Ch Hospital, Mumbai, India

² 

Lilavati Hospital & Research Center, Mumbai, India

Abstract: Introduction and Objectives: Vasoepididymal anastomosis (VEA) is a technically challenging surgery requiring microsurgical skills, patience and perfection with good assistance. Various techniques have been described in literature with the 2 commonly used ones being the conventional technique and Ductular technique. The success rate varies from case to case and from surgeon to surgeon. Best results can be obtained by selecting the right technique for the right case. Here we aim to demonstrate a case of ductular anastomosis highlighting the tips and tricks. Materials and Methods: 29 year old male married to a 27 year old female, were diagnosed with primary infertility with fructose positive azoospermia. Hormonal levels were normal. He was planned for vasoepididymal anastomosis on the right side as the epididymis was full on the right and firm to turgid on the left indicating absence of back pressure changes on the right. Patient underwent right ductular VEA at the level of mid body of epididymis. Results: Patient returned with semen count of 22 million/mL 9 months after the procedure. We have highlighted the essential steps starting from locating sperms within the epididymal tubules before proceeding with the anastomosis and the appropriate use of 10–0 Ethilon sutures for mucosal anastomosis and 8–0 sutures to reduce the tension. Tips and tricks essential for success have been highlighted. Conclusions: Selecting the technique of VEA should be based on the dilatation of the tubules and the level of the epididymis at which we find sperm in the aspirate. Conventional anastomosis should be done at the level of the Head and a ductular anastomosis can be attempted to dilated tubules in the body and tail. Meticulous suturing, assistance and surgeon experience is the key.

6.5. Kidney and Ureter, Benign Diseases

6.5.1. UVP-05.01: Combined Robot-Assisted Pyeloplasty (RAP) and Flexible Endoscopy to Treat Concurrent Ureteropelvic Junction Obstruction (UPJO) and Calyceal Stones

• SINGH A and Wadhwa P
• Medanta Medicity Gurugram, Gurgaon, India

Abstract: Introduction and Objectives: Laparoscopic pyeloplasty, both through a transperitoneal and a retroperitoneal approach, remains a challenging procedure and it requires high proficiency in laparoscopic skills especially due to the reconstructive part. Robot-assisted laparoscopic technique surpasses conventional laparoscopy with its three-dimensional vision, better tool dexterity, and improved precision. Materials and Methods: A 34-year-old female presented with left flank pain, on evaluation CT-urography showed right UPJO with multiple renal calculi (largest 9 mm size) and left renal pelvis calculus (12 mm). She underwent a combined robot-assisted pyeloplasty using the da Vinci Si^® to treat ureteropelvic junction obstruction and flexible endoscopy using flexible cystoscope introduced through assistant port for retrieving of right renal calculi. Procedure started with medial reflection of colon and mobilization of ureter with its sheath. Dissection is carried upward toward the pelvis and culminates in the complete mobilization of pelvis and UPJ in both the anterior and posterior aspects. A V-shaped flap is created at the most dependent part of the pelvis. Nephroscopy is performed using flexible cystoscope and stone extracted with a basket and placed in an endocatch bag. A double-J ureteral stent (6fr) is placed in antegrade fashion into the bladder. A 20 cm length of 4–0 polyglactin on a 20 mm needle (No.2304, Ethicon^®) is used for suturing. Ureter is spatulated on its posterior aspect. The new UPJ is reconstructed by placing running 4–0 absorbable sutures anteriorly. The posterior portion of the anastomosis is then sutured with another running 4–0 absorbable suture. The repair is retroperitonealized with 4–0 absorbable sutures. An abdominal tube drain was placed. The console time was 55 min. Results: Patient had an uneventful post op; urethral catheter removed on 1st day, drain removed on 2nd day, discharged on 4th day. Double-J ureteral stent was removed at 6th week post-op patient remains asymptomatic with DTPA renal scan at 12th week post-op showed bilaterally non obstructed drainage Conclusions: With use of robotic system, not only laparoscopic pyeloplasty becomes easier to perform, but also operational time is reduced, and intraoperative handling is more comfortable due to higher flexibility and 3D view and use of flexible nephroscopy is a convenient solution to examine renal pelvis and all calyxes

6.5.2. UVP-05.02: Robot-Assisted Partial Nephrectomy for Multiple Renal Tumors in a Patient with Tuberous Sclerosis: Precision in Complexity

• Kushwaha S, Kumar A, Chaturvedi S, Maheshwari R, Desai p, Kaushal R, Vasudeo V, Aggarwal A and Agrawal O
• Max Super Speciality Hospital, Saket, New Delhi, India

Abstract: Introduction and Objectives: Tuberous sclerosis is a rare hereditary syndrome characterized by the development of bilateral and multifocal benign renal tumors, often presenting at a young age. Significant emphasis is placed on preserving functional parenchyma through the application of nephron-sparing surgery (NSS). Performing minimally-invasive NSS in the setting of multiple tumors presents a unique challenge. In this video, we present key steps for performing robot-assisted partial nephrectomy (RAPN) in multiple renal tumors while preserving maximum renal parenchymal tissue. Materials and Methods: Patient is a 38-year-old female with tuberous sclerosis who presented with left-sided flank pain for one year. Contrast-enhanced computed tomography scan revealed multiple well-defined, heterogeneously enhancing, fat-containing lesions involving both kidneys. Pre-operative creatinine was 0.5 mg/dL. In this video, we highlighted three key steps in RAPN for multiple renal tumors. First is adequate kidney mobilization for providing optimal tumor exposure followed by the use of 4th arm for kidney retraction and flipping. Second, intraoperative ultrasound for accurate anatomical identification of margins. Finally, selective clamping with early unclamping after 1st layer of renorrhaphy to minimize ischemic damage to the kidney. Results: The patient underwent left RAPN using da Vinci Xi^® system. Eight tumors were removed in total, with the largest tumor measuring 4 × 4 cm. The estimated blood loss was 200 mL. The ischemia time was 35 min with total operative time of 310 min and console time of 240 h. She was discharged on the fourth post-operative day following an uneventful recovery. Creatinine levels at discharge were 0.9 mg/dL, remaining stable at 0.6 mg/dL during the follow-up, consistent with pre-surgery levels. Final histopathology determined all eight masses to be angiomyolipoma. She remained under follow-up for 6 months with well-preserved kidney function and no recurrence. Conclusions: Performing complex partial nephrectomies for multiple renal masses is technically challenging but feasible and safe, offering patients with tuberous sclerosis an excellent option who wish to preserve renal function. This case underscores the utility of RAPN in achieving complete resection in the setting of multiple tumors while minimizing the risk of renal impairment.

6.6. Kidney and Ureteral Cancer—Clinical

6.6.1. UVP-06.01: Bilateral Simultaneous Robot-Assisted Partial Nephrectomy: Feasibility, Technical Aspects and Outcomes

• Kushwaha S, Kumar A, Chaturvedi S, Maheshwari R, Desai P, Kaushal R, Vasudeo V, Aggarwal A and Agrawal O
• Max Super Speciality Hospital, Saket, New Delhi, India

Abstract: Introduction and Objectives: There is a lack of consensus on the staged versus simultaneous approach for treating patients with synchronous bilateral renal masses. Performing bilateral simultaneous robot-assisted partial nephrectomy (RAPN) presents a unique challenge. In this video, we demonstrate the technique of bilateral simultaneous RAPN and highlight its feasibility, technical aspects and outcomes. Materials and Methods: We reviewed our institutional nephrectomy registry to identify patients who underwent bilateral simultaneous RAPN. All patients were assessed with preoperative CECT abdomen and DTPA scan, and RENAL scores were calculated for both sides. Peri- and postoperative data were collected. The procedure was performed transperitoneally using 4-arms da Vinci Xi^® system. The side with the larger mass was approached first. After completing one side, the robot was undocked, and without interrupting the anesthesiological procedures, the patient was placed in a supine position and, after a 180° rotation of the surgical bed, was newly placed in a contralateral flank position. Using the previous ports, one other robotic trocar was placed in the contralateral iliac fossa for retraction. Results: Overall, 7 patients underwent bilateral simultaneous RAPN without the need for conversion. The mean operative time was 280 min, with 220 min of mean console time and a mean change-over time of 30 min. The mean ischemia times were 20 and 25 min on right and left side, respectively. The mean estimated blood loss was 150 mL. Histopathological examination revealed negative surgical margins in all cases. There were two complications: one patient developed fever in postoperative period, and another had hematuria, which was managed conservatively. Mean creatinine levels remained stable at 0.94 ± 0.14 mg/dL with no recurrence at a mean follow-up of 27.14 ± 9.49 months. Conclusions: In selected patients, bilateral simultaneous RAPN could be a safe and feasible procedure for bilateral synchronous renal masses in expert hands. This approach avoids two separate surgeries, thereby lowering expenses associated with consumables, additional anaesthesia, and hospitalization, all while maintaining functional and oncological outcomes.

6.6.2. UVP-06.02: Concurrent Renorrhaphy During Renal Mass Excision in Laparoscopic Nephron-Sparing Surgery: A Novel Surgical Technique

• Uzel T and Hamidi N
• Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye

Abstract: Introduction and Objectives: In the field of treating T1 renal masses, nephron-sparing surgery (NSS) is a recommended approach, even for more complicated cases. With advancements in technology and the understanding of renal anatomy, experienced surgeons can perform minimally invasive NSS, aiming to achieve complete tumor removal with negative margins while preserving renal function and minimizing complications and urinary collecting system injuries. This brief introduces an off-clamp NSS technique; renorrhaphy is performed simultaneously during mass excision. Materials and Methods: Ports were placed, followed by medialization of the ascending colon to locate the right ureter. The renal pedicle was dissected and the main renal artery secured with a vessel loop. After revealing the mass on the lower pole’s lateral side, the excision margin was determined using cautery. 3–0 V-Loc suture was anchored to the anterior abdominal wall just before mass excision. The renal parenchyma was incised along the margin with scissors, reaching a depth of 3 to 4 mm. Excision continued until sufficient space allowed for suture placement. Renorrhaphy commenced simultaneously with V-Loc suture to control bleeding. Suturing persisted until the specified excision limit was reached. If serious bleeding occurred, suturing was repeated; otherwise, excision concluded after securing the tumor base with sutures. Intraperitoneal air pressure reduction exposed any concealed bleeding, anti-bleeding powder was applied to the excision area. Results: Off-clamp NSS minimally affects glomerular filtration rate, unlike on-clamp NSS, where mannitol is often used to prevent reperfusion injury and minimize renal function loss. However, the use of mannitol has controversial results, in the literature and is associated with side effects, including heart failure, electrolyte imbalance, and metabolic acidosis. The main challenge with off-clamp NSS is the high bleeding risk, even with experienced surgeons. The described technique suggests excising the mass until there is enough space to pass a suture and then securing the tumor base with sutures before completing the excision. Conclusions: In laparoscopic nephron-sparing surgery, concurrent renorrhaphy during mass excision can be safely performed especially in small and exophytic renal masses.

6.6.3. UVP-06.03: Laparoscopic Excision of a Renal Tumor Recurrence

• Capinha M ¹, Furriel F ², Rolim N ², Eufrásio P ², Bollini S ², Moreira P ² and Borges R ²

¹ 

Hospital de Braga, Braga, Portugal

² 

Centro Hospitalar de Leiria, Leiria, Portugal

Abstract: Introduction and Objectives: Renal cancer ranks as the 15th most prevalent cancer worldwide. The standard curative approach for localized RCC is surgical intervention through radical or partial nephrectomy. The recurrence rates post-radical nephrectomy hover between 1–3%, particularly prevalent in cases classified as pT3–4. Diagnosis typically occurs through CT or MRI scans during follow-up appointments. The average time to recurrence spans approximately 19–36 months for isolated local recurrence. Surgical resection demonstrated treatment modality to enhance survival in recurrent cases. Advanced surgical techniques such as laparoscopy have facilitated successful interventions, resulting reduced severe complications and hastened recovery. Nonetheless, the optimal treatment approach for local recurrence of renal cell carcinoma remains undetermined. Among these options, surgical resection stands out as the sole therapeutic intervention linked to improved survival outcomes. This video aims to show a laparoscopic excision of a renal tumor recurrence. Materials and Methods: The images of the surgery were edited to create this video. Results: The authors present a case of a patient submitted to left radical nephrectomy in December 2019 due to a suspicious lesion of 66 × 66 × 60 mm (LxHxW) in the upper third of the left kidney (pT3a renal cell carcinoma). The follow-up CT in May 2023 indicated an expansive process compatible with local recurrence measuring 2.8 cm adjacent to the diaphragmatic pillar, the tail of the pancreas and the spleen. The patient was submitted 51 months after the initial surgery to a transperitoneal laparoscopic excision of the renal tumor recurrence without need to conversion. The technical approach was the same as for a radical nephrectomy. The port placement included a 10–mm supra-umbilical incision. Two trocars (10 and 5 mm) were positioned in the para-rectal plane. During the dissection it was necessary to be aware of all the structures adjacent of the mass such as the stomach, spleen, pancreas, left diaphragm and several major vessels. The operative time was 60 min, and the blood loss of 90 cc. The hospital stay was two days without post operative complications. The histology reported a clear Cell Renal cell carcinoma recurrence, ISUP 1. Conclusions: The laparoscopic approach is a safe and effective treatment option for renal tumor recurrence.

6.6.4. UVP-06.04: Managing Terminal Ureteric Tumors Protruding into the Bladder During Robotic Nephroureterectomy—Technical Modifications to Prioritize Oncological Safety

• Misra A, Pal M, Arora A, Godse S, Thimiri N, Shirke A, Menon S and Prakash G
• Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India

Abstract: Introduction and Objectives: Radical nephroureterectomy is the gold standard for high-risk upper tract urothelial carcinoma. The oncological outcomes of open and minimally invasive approaches are the same. The most crucial step in performing this procedure is successfully managing the distal ureter and the bladder cuff. Suboptimal management of the distal ureter may yield a 33–75% recurrence rate. Early clipping of the ureter distal to the tumor to prevent intraoperative spillage is a key principle. In terminal ureteric tumors, this step is not feasible, and we demonstrate technical modifications that can help us retain this step focused on oncological safety. Materials and Methods: A 64-year-old male with a previous history of high-risk, non-muscle invasive bladder cancer presented with a right terminal ureteric growth projecting into the bladder on cystoscopy. CT scan confirmed a tumor involving the distal ureter and protruding into the bladder with hydroureteronephrosis and renal parenchymal thinning. There was no evidence of any pelvic or retroperitoneal nodes. The kidney was nonfunctional on the renogram, and his urine cytology was positive for high-grade urothelial carcinoma. He was planned for a robotic right radical nephroureterectomy with bladder cuff excision and right pelvic lymph node dissection. Results: We used the da Vinci Xi^® system with dual docking for the pelvic and renal part of the surgery, performed in that sequence. Just before the main surgery, a trans urethral resection was done to excise the tumor protruding into the bladder, and continuous saline irrigation was started. This resection enabled occlusion of the terminal ureter before the bladder cuff excision was done, avoiding the tumor exposure to high pneumoperitoneum. Closure of the bladder was done by standard method using barbed suture. His histopathology came as high-grade urothelial carcinoma involving the muscularis propria with negative nodes (pT2N0). He was planned for adjuvant chemotherapy. Conclusions: A combination of prior transurethral resection and ureteric occlusion in a ureterectomy first approach is an easy modification of the traditional radical nephroureterectomy. It may help prevent the spillage of malignant cells and recurrence in terminal ureteric tumors protruding into the urinary bladder.

6.6.5. UVP-06.05: Robot Assisted Laparoscopic Partial Nephrectomy in a VHL Patient: Conquering New Battleground

• Imran Q, Ranjan A, Patel K, Singh S, Pathak A, Sureka S and Singh U
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: VHL syndrome usually presents with bilateral and multiple tumors requiring multiple surgeries rendering their management difficult. We describe a robot assisted partial nephrectomy for dealing of tumors in single setting in a patient of VHL syndrome. Materials and Methods: A 24-year-old male presented to us with incidentally diagnosed bilateral renal masses and on further evaluation was found to have VHL syndrome. CT angiography showed multiple heterogenous renal masses in bilateral kidneys with largest on right side of size 22 × 24 mm and left of size 31 × 22 mm. There was single renal artery and vein on both sides with no evidence of venous thrombus. Left robot assisted laparoscopic partial nephrectomy was planned. Results: Seven masses were removed, 3 at the upper pole and 2 at mid and lower pole each. Operative time was 220 min and warm ischemia time was 35 min. Blood loss was around 200 mL. Post operative course was uneventful. Histopathology was suggestive of clear cell RCC with all surgical margins were negative. Follow up at 3 months showed no evidence of residual disease or recurrence with comparable GFR. Conclusions: Robot assisted partial nephrectomy in complex renal masses is a feasible option with acceptable perioperative, functional and oncological outcomes. The experience of surgeon is one critical factor in these surgeries.

6.7. Minimally Invasive Surgery/Robotics

6.7.1. UVP-07.01: 2-Port Laparoscopic Nephrectomy with Simple Retraction Suture Technique

• Faustino K and Tantoco J
• Dr. Paulino J. Garcia Memorial Research and Medical Center, Cabanatuan City, Philippines

Abstract: Introduction and Objectives: The ureteropelvic junction is the most common site of obstruction in the pediatric upper urinary tract. UPJ obstruction results in inadequate urine drainage and hydrodistention of the collecting system. If not diagnosed and managed promptly, it could result in the loss of the affected kidney. The standard technique for laparoscopic nephrectomy utilizes 4-port success. This paper presents a 2-port laparoscopic nephrectomy utilizing a multiport access device and a simple retraction suture technique. Materials and Methods: Umbilical access is established via a midline vertical intra-umbilical incision. The multiport access device was inserted via the umbilical incision. A 5 mm secondary port was inserted in the left lower quadrant of the abdomen under laparoscopic vision. A simple suture retraction device, Vicryl 2–0, was used to aid retraction and exposure of the renal pedicle. Results: The total operating time was 160 min. The estimated blood loss was 60 mL. There were no intra-operative, or post-operative complications noted. The patient was discharged on post-operative day 3. OPD follow-up for three months has been completed without any issues identified. The two incisions were barely noticeable, and the needle-punctured sites were invisible. Conclusions: Laparoscopic nephrectomy utilizing a multiple port access device and a simple suture retraction technique is feasible and safe. The technique reduces the number of ports required to perform a nephrectomy without compromising exposure and dissection. Reduction in the number of ports required further improves the cosmesis already inherent in the laparoscopic approach.

6.7.2. UVP-07.02: A Retrograde Laparoscopic (Hedgehog) Approach Using a Suprapubic Camera Port for Extraperitoneal Robot Assisted Radical Prostatectomy: A Novel Solution for a Common Obstacle

• Krishnan J, Rechner R, Hamid S, Taylor L, Good D and McNeill A
• Western General Hospital Edinburgh, Edinburgh, United Kingdom

Abstract: Introduction and Objectives: Prostate cancer is one of the most common cancers in men, with 1 in 8 being diagnosed within their lifetime. RARP continues to be the most common surgical approach in the United Kingdom with over 8000 procedures per year. Previous abdominal surgery remains an important indicator of procedure difficulty. Port insertion can be the biggest challenge and can lead to procedure abandonment if unsuccessful. The aim of this case series is to describe and demonstrate a novel approach of retrograde dissection of bowel adhesions prior to extraperitoneal RARP in patients with complex abdomino-pelvic surgical histories. Materials and Methods: We have performed extraperitoneal RARP on many patients who have had previous abdominal surgery. Here we describe a cranial approach to develop the extraperitoneal space and guarantee safe port insertion in such patients. Some of the previous abdominal surgeries patients in the series underwent include: colectomy and ileostomy formation, anterior resection complicated by an anastomotic leak and subsequent reversal of the ileostomy, hernia repair and laparotomy due to lower GI bleed. Results: Table 1 demonstrates the previous surgeries involved in the series as well as any post-op complications. The technique involves a balloon device being inserted via an initial suprapubic port and the extraperitoneal space being developed in a cranial direction under direct vision. Two lateral ports are then inserted and adhesions freed from the anterior wall using dissecting forceps and laparoscopic scissors. This allows the safe placement of the other ports. The remainder of the procedure in each case was then completed in an extraperitoneal approach using the da Vinci^® robotic surgical system. Conclusions: Careful port insertion is essential to perform a successful RARP. Retrograde dissection with a suprapubic port is a novel approach to the development of the extraperitoneal space allowing safe insertion of all ports and ultimately achieving safe excision of the prostate.

6.7.3. UVP-07.03: Bilateral Simultaneous Robot-Assisted Partial Nephrectomy: Video Description of Our Technique

• Kushwaha S, Kumar A, Maheshwari R, Chaturvedi S, Desai P, Kaushal R, Vasudeo V, Agrawal O and Aggarwal A
• Max Super Speciality Hospital, Saket, New Delhi, India

Abstract: Introduction and Objectives: The robot-assisted partial nephrectomy (RAPN) is becoming an increasingly common procedure due to the published encouraging outcomes. Performing bilateral simultaneous RAPN presents a unique challenge. In this video, we share our experience with a case of bilateral simultaneous RAPN to demonstrate the feasibility of our technique for resecting renal tumors while preserving maximal renal parenchymal tissue and with minimal ischemia time. Materials and Methods: A 63-year-old female was incidentally diagnosed with bilateral renal tumors. CT scan revealed a 2.9 × 2.5 cm lesion involving upper pole of right kidney and a 5.4 × 3.2 cm lesion in mid pole of left kidney. Pre-operative creatinine was 0.8 mg/dL. Our technique is noteworthy in some aspects. During right RAPN, renorrhaphy sutures were taken before tumor resection. After resection of tumor, the preplaced sutures were tightened with sliding technique. After completing right side, the robot was undocked, and without interrupting the anesthesiological procedures, the patient was placed in a supine position and, after a 180° rotation of the surgical bed, was newly placed in a contralateral flank position. Using the previous midline ports, the assistant port was placed centred on the left renal tumour. The robot was then redocked, and a left RAPN was performed. Results: The total operative time was 320 min, with 250 min of console time and a change-over time of 30 min. Ischemia time was 21 min on the left side, with right side was done without clamping. Pelvicalyceal system was opened during tumor resection on left side and closed upon identification by preplaced ureteric catheter. Estimated blood loss was 200 mL. She was discharged on the fifth post-operative day following an uneventful recovery. Histopathological examination revealed clear-cell renal cell carcinoma (pT1bG2) on left and papillary renal call carcinoma (pT1a) type-I with negative surgical margins bilaterally. Creatinine levels remained stable at 0.9 mg/dL with no recurrence at 48 months of follow-up. Conclusions: In selected patients, bilateral simultaneous RAPN could be a safe and feasible procedure for bilateral synchronous renal masses, in expert hands. This approach avoids two separate surgeries, thereby lowering expenses associated with consumables, additional anaesthesia, and hospitalization, all while maintaining functional and oncological outcomes.

6.7.4. UVP-07.04: Endoscopic Fluoroscopic Trans Uretero-Ureteral Puncture for Recanalization of Complete Ureteral Stenosis

• Lezrek M ¹, Tazi H ¹, El Yazami O ¹, Yacoubi S ¹ and El Anzaoui J ²

¹ 

Al Ghassani Hospital, Fes, Morocco

² 

Military Hospital Moulay Ismail, Meknes, Morocco

Abstract: Introduction and Objectives: We present an endoscopic fluoroscopic trans-uretero-uretral puncture for recanalization of complete ureteral stenosis. Materials and Methods: 3 patients (36–48 years-old): 2 women with history of pelvic irradiation for localized cervical cancer, presented respectively left and right uretero-hydronephrosis. 1 man with history of bilateral multiple stones, presented right uretero-hydronephrosis. The patients are placed in a modified supine position. The lower limbs are placed in the lithotomy position. Retrograde uretero-pyelography showed a complete obstruction of the mid-ureter in 1 case and the distal ureter in 2 women. The kidney is punctured, with a 21-gauge needle. Contrast media is injected, then an upper calyx is punctured. A hydrophilic guidewire and then an 8-Fr ureteral catheter are advanced down the ureter, to the obstruction. All patients have a short complete stenosis. The rigid ureteroscope is advanced retrogradely. A longue transseptal needle (for cardiac-trans-atrial puncture) is introduced through the ureteroscope. Under fluoroscopy and endourology, the ureteroscope is oriented toward the opacified proximal ureteral tip. The needle is advanced through the ureteral wall, mobilizing the ureter. Then, the ureter is puncture. A hydrophilic guidewire is passed into the proximal ureter and the renal cavities. The tract is dilated and a 7-Fr double-J stent is inserted. Results: The endoscopic fluoroscopic puncture of the proximal ureteral-end through the ureteral wall was easily performed. It had allowed guidewire insertion into the ureter, and had oriented the endoureterotomy and recanalization. The mean operative time was 45 min. The mean postoperative hospital stay was 2 days. This technique is only possible for short stenosis. Follow up is performed using retrograde pyelography and/or ureteroscopy. If the ureteral lumen is wide open the J-stent is removed. If its patency is equivocal, balloon dilation is performed and a new double-J stent is placed. All the patients have a regular change of double-J stent, every 9 months, with a mean follow-up of 37 months. Conclusions: This new recanalization technique with endoscopic fluoroscopic trans-uretero-ureteral puncture for recanalization of complete ureteral stenosis, was possible, and it was easily performed. it had allowed insertion of at least of replaceable double-J stent in complete stenosis, where all the other endoscopic techniques had failed.

6.7.5. UVP-07.05: Endoscopic Trans-Ureteral Ureterovesical Reimplantation

• Lezrek M ¹, Tazi H ¹, Yacoubi S ¹, El Yazami O ¹ and El Anzaoui J ²

¹ 

Al Ghassani Hospital, Fes, Morocco

² 

Military Hospital Moulay Ismail, Meknes, Morocco

Abstract: Introduction and Objectives: To describe and present our experience of a new technique of endoscopic reimplantation of the ureter in the bladder through the ureteral orifice: Endoscopic trans-uretero-ureteral reimplantation. Materials and Methods: 2 women (36–41 years-old), presented per-operative, right complete ureteral section during hysterectomy for cervical cancer. 1 woman had open surgery for a small ureterovaginal fistula. All the patients were on supine position, and have an open lower midline incision. The lower limbs were split to allow cystoscopy, which is performed with nephroscope. A hydrophilic guidewire is inserted into the right ureteral orifice. Then, it is introduced into the proximal ureteral stump by the open team. A 2/0-Vicryl stay suture is placed on the proximal tip of the ureter. The ureteral orifice is balloon dilated to 18-Fr. An alligator forceps, introduced through the nephroscope, and the ureteral orifice, grasped the proximal ureteral tip, which is attracted through the dilated distal ureter and orifice. The stay suture is extracted outside the bladder through urethra. The ureter is secured to the bladder with 4 sutures, by open surgery. A 7 -Fr double-J-stent is placed into the ureter. The stay-suture is maintained on continuous traction on the inner face of the right thigh, with elastic-band. An 18-Fr Foley catheter is placed in the bladder. Results: The endoscopic trans uretero-ureteral reimplantation was possible in the 3 patients. The mean time of reimplantation, was 12 min. The Foley catheter was removed in 4 days. The double-J-stent was removed in 32 days. Control ultrasound showed no hydronephrosis. Intravenous urography showed a normal ureter. Cystoscopy showed a normal ureteral orifice. The bladder was not opened. The same anti-reflux mechanism of ureter is maintained. The ureteral orifice is in normal position, in the trigone, the fixed part of the bladder. Which is important for future endoscopic accesses. Conclusions: This endoscopic trans uretero-ureteral reimplantation was possible and quick. The bladder was not opened. The same anti-reflux mechanism of ureter is maintained. The ureteral orifice is in normal position. It can be used with laparoscopy. However, it is not feasible in higher ureteral sections.

6.7.6. UVP-07.06: Laparoscopic Augmentation Cystoplasty

• Vaddi C
• Preeti Urology and Kidney Hospital, Hyderabad, India

Abstract: Introduction and Objectives: Augmentation cystoplasty used in the treatment of poor compliant, low capacity, refractory ovminer active bladder, we present our experience of laparoscopic augmentation cystoplasty in a 11 years old female child with dysfunctional voiding and non compliant bladder with right solitary functioning kidney with right VUR. Materials and Methods: A 11 years old female child presented with storage LUTS and urge incontinence with recurrent UTIs, on evaluation MCUG suggestive of Right VVU grade 3, left poor functioning kidney. Urodynamic study—shows dysfunctional voiding, high pressure bladder with impaired compliance, she was treated with double anticholinergics, CIC, and long term antibiotics, due to breakthrough UTIs she was planned for augmentation cystoplasty operative technique; ileocystoplasty done using 30 cm ileum, 15 cm proximal to ileocecal value and reconfigurated into U shape, reconfigurated bowel anastomosed to bivalved native bladder. Results: There were no intra and post operative complications, operative time is 150 min, estimated blood loss 100 mL. postoperative ileus recovered on 3rd POD, drain removed on 3rd POD, foleys catheter removed after 2 weeks, post operative cystogram good capacity bladder with resolution of reflux and anticholinergics were stopped. Conclusions: Augmentation cystoplasty is a safe procedure to increase functional capacity of small contracted, poor compliant bladder, allow patient to preserve renal function to achieve continence enable reflux resolution and stoppage of anticholinergics in the patient.

6.7.7. UVP-07.07: Robot Assisted Partial Nephrectomy in Multifocal and Hereditary Renal Masses: Video Illustration and Outcomes

• Ali M, Rawal S, Singh A, Khanna A and Pratihaar S
• Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India

Abstract: Introduction and Objectives: Bilateral renal cell carcinoma is a rare entity and can present synchronously or asynchronously. The incidence of bilateral RCC is approximately 5%. Hereditary variant have aggressive behavior. Robotic surgery has expanded the feasibility of minimally invasive surgery. Partial nephrectomy was first used to remove small size exophytic renal tumors. Over time, this has enabled the safe and precise removal of larger, more endophytic lesions. We discuss our preliminary results RAPN in order to assess the value of minimally invasive surgery in the treatment of multifocal renal illness. Materials and Methods: We present the video illustration of a case who is a 28-year-old female and is a known case of Von Hippel Lindau disease with multifocal solid renal masses in both kidneys of largest size < 3 centimetres. In follow-up cross sectional imaging, there was an increase in size and number of masses in right kidney. CT allowed better understanding of the anatomy of renal masses with respect to the kidney parenchyma and collecting system. One of the mass of size 2.5 × 2 centimetre was completely endophytic, infiltrating the renal pelvis. She was planned for robotic-assisted partial nephrectomy of right kidney in view of bilateral renal masses. Results: The study was conducted on 20 patients who underwent robot assisted multiplex partial nephrectomy. Median age was 55 years and mean tumor size was 3.9 centimetres. Mean operative time was 181 min and warm ischemia time was 18 min. Overall and metastasis free survival was 90 and 95 percent. Mean increase in serum creatinine was 0.2. Postoperative complications were seen in two patients. Conclusions: Surgical management of both multifocal and hereditary renal masses can be technically and clinically challenging. Robot assisted partial nephrectomy is a valid and feasible option in patients of multiple renal masses with acceptable oncological and functional outcomes.

6.7.8. UVP-07.08: Robot-Assisted Partial Nephrectomy for a Renal Cell Carcinoma in a Horseshoe Kidney—Video Based Illustration

• Ali M, Rawal S, Singh A, Khanna A and Pratihaar S
• Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India

Abstract: Introduction and Objectives: Horseshoe kidney is the most common renal fusion anomaly. The number of cases of renal tumors associated with HSK as described in the literature, is less than 200. This condition poses unique challenges for surgical interventions, with kidney tumors due to limited mobilization, abnormal location, and complicated vascular anatomy. Robotic-assisted surgery has emerged as a valuable tool for managing renal tumors in such cases due to its precision. Materials and Methods: We describe our experience in two cases. The video demonstration is of a 62-year-old male patient who was diagnosed with a right renal mass. Preoperative planning involved CT angiography of the abdomen, which allowed a better understanding of the anatomy of the renal vessels, and on which 3D reconstructions were based. CT scan showed a right renal tumor of size 4 cm in the interpolar region between the middle and lower pole in a horseshoe kidney. CT angiography depicted the presence of multiple renal arteries supplying the kidney. On clamp partial nephrectomy was indicated according to the evaluation. Standard surgical steps were followed. Results: There was no intraoperative complication, and the mean operative time was 167 min. The mean warm is chemia time was 15 min. The mean estimated blood loss was 15 millilitres. One patient landed in AKI on postoperative day one which improved on conservative management. The mean hospital stay was 3 days. The biopsy came out to be clear cell renal cell carcinoma with margins free of tumor. Both patients came for regular follow-up and has preserved renal function in DTPA scan and oncological outcomes in CT scans. Conclusions: In conclusion, horse shoe kidney is usually associated with numerous challenges, including morphological and vascular abnormalities. Preoperative CT and 3D image reconstruction are valid and promising tools, and robot assisted partial nephrectomy is a feasible approach in managing cases of horse shoe kidney with renal mass. More cases are required to expand the body of information in order to make better decisions for treating patients with tumors in horse shoe kidney.

6.7.9. UVP-07.09: Robotic Assisted Simple Prostatectomy for “Large” BPH

• Rewari H, Wadhwa P, Sharma P, Talwar H, Gautam G and Ahlawat R
• Medanta, The Medicity, Gurugram, India

Abstract: Introduction and Objectives: Holmium laser enucleation of Prostate (HoLEP) is recommended for surgical treatment of BPH > 80 gm. Robotic assisted simple prostatectomy is another alternative in the urologists armamentarium for very large BPH in select cases. We present replication of the Freyer’s prostatectomy performed robotically for BPH~120 g in a patient with narrow calibre urethra. Materials and Methods: A 78-year male with hypertension, diabetes/CKD presented with refractory retention. Examination revealed grade 4 prostatomegaly. PSA was 5.09 ng/mL. MpMRI revealed 120 g prostate, intravesical extension and 6 mm PIRADS 3 nodule in left mid-transition zone. Urethral caliber was narrow with snug fitting 16Fr catheter. He underwent RASP using Freyer’s technique with da Vinci Xi^® Surgical System. A transperitoneal, transvesical approach done; circumferential dissection allowing enbloc enucleation of adenoma, using combination of sharp/blunt dissection. After hemostasis trigonisation of posterior prostatic fossa was done. 18 Fr catheter provided limited postop irrigation. Patient discharged in 48 h after drain removal, catheter on POD 5. Results: Patient had an uneventful recovery, no transfusions. Hemoglobin drop was 0.7 gm%. On catheter removal he had a good urine stream without stress incontinence. Histology revealed BPH with focal adenocarcinoma (Gleasons 3 + 3 = 6, GG 1) with free margins. At 1 month follow up, excellent flow rates with mild urgency, which resolved with solifenacin; PSA was 0.1 ng/mL; residual prostate was 7.5 gm. Conclusions: In last decade, we have performed 10 RASP of 3187 treated BPH. While this highlights the limited need for the procedure, availability/improved skill in robotic surgery has allowed replication of open techniques with minimal morbidity. While HoLEP continues to provide excellent outcomes for large glands, RASP presents an alternative for glands > 150 gm, unfavorable urethra precluding transurethral surgery, concurrent diverticulectomy and large bladder stones. RASP is a safe/effective procedure; confers benefits of minimal invasion, low postoperative complications in very large BPH.

6.7.10. UVP-07.10: Robotic Left Partial Nephrectomy for Intra-Hilar Tumor

• Taur P and Jain N
• Apollo Main Hospital, Chennai, India

Abstract: Introduction and Objectives: The objective of this video is to demonstrate a stepwise innovative method of robotic assisted partial nephrectomy for intra-hilar renal tumors. Materials and Methods: 56 year old gentleman was diagnosed with a 2.4 cm complete intra-hilar left renal tumour lying anterior to renal pelvis. Intraoperative ultrasound was used to localise the tumour as there was no exophytic component. Hilar dissection was done. A longitudinal nephrotomy incision was made over the marked renal parenchyma. Tumor was identified, dissected all around and excised. Two layer renorrhaphy was done. Results: Intraoperative blood loss was 100 mL with a clamp time of 23 min. The patient recovered well without any complications. Histopathology revealed grade 2 clear cell RCC with a negative margin. Conclusions: Robotic assistance can facilitate the advanced manipulations required for safe and successful partial nephrectomy. Three dimensional visualization allows precise tumor resection and renal reconstruction. This method can be used safely and effectively for intra hilar renal tumors.

6.7.11. UVP-07.11: Robotic Y-V Plasty Bladder Neck Reconstruction

• Mhaskar Z
• Yenepoya Medical College Hospital, Mangalore, India

Abstract: Introduction and Objectives: To demonstrate the technique and outcomes of robotic assisted Y-V plasty bladder neck reconstruction in cases of bladder neck contracture. Materials and Methods: We present our technique of Robotic assisted Y-V plasty bladder neck reconstruction. We have done about 10 cases of Y-V plasty, of which 3 cases will be presented in the video. All 3 patients had undergone TURP previously Indication for the procedure involved recurrent UTI, dysuria and voiding LUTS Procedure involved robotic assisted dissection in the space of retzius, cystotomy, excision of bladder neck scar, creation of Y-V flap on the anterior wall of bladder Abdominal drain and 22Fr Foleys catheter was placed. Results: Median time from TURP to performing procedure was 6 months average number of prior attempts of BNI was 1. All 3 patients underwent surgery without conversion to open surgery. Median operative time was 180 min. Patient were discharged on POD3. Foleys catheter removed after 3 weeks of surgery. All patients had post-op cystoscopy and Uroflowmetry. No patient had urinary incontinence. Conclusions: Robotic Y-V plasty bladder neck reconstruction is a safe and feasible technique for managing complex bladder neck contractures which have recurred even after bladder neck incision.

6.7.12. UVP-07.12: Tips and Tricks for Performing Robot Assisted Left Heminephrectomy for Complex T1b Renal Tumour: A Video Presentation of 2 Cases

• Kharade M, Mohan A and Sharma R
• Basavatarakam Indoamerican Cancer Hospital and Research Institute, Hyderabad, India

Abstract: Introduction and Objectives: The incidence of small renal masses (SRM) is increasing due to increased use of cross-sectional imaging for unrelated reasons. Partial nephrectomy is the current standard of care for the management of SRM in young healthy patients. Robot assisted approach provides 3-dimensional stereoscopic vision, attenuates tremors and 7 degree of wrist movements and this helps in doing partial nephrectomy efficiently. We present 2 cases of complex renal tumor managed with robot assisted left heminephrectomy. Materials and Methods: The first patient is a 40-year-old male patient diagnosed with left upper pole mass measuring 6.6 × 6 cm (endophytic). The 2nd is a 34-year-old gentleman with left lower pole mass measuring 5 × 4.5 cm (<50% exophytic). Both patients underwent robot assisted left heminephrectomy at Basavatarakam IndoAmerican Cancer Hospital on 20th March 2024 and 22nd February 2024 respectively. Da Vinci Si^® platform was used for the procedure. Results: The 1st patient was 40 years old with BMI of 23.03 kg/m². The RENAL score was 11. The operative time was around 200 min. Left adrenal gland was spared. Warm ischemia time was 25 min with vascular control taken with bull dogs. Early unclamping was done and renorrhaphy was done in 2 layers with V-loc 3-0 suture. Post operative course was uneventful. Length of stay was 3 days. The patient achieved trifecta with e GFR being 64 mL/min/1.73 m² in post operative period. The HPR was cc RCC, grade2 with negative margins. The 2nd patient was 34 years old with BMI of 25.19 kg/m². The nephrometry score was 11. The operative time was 180 min. The warm ischemia time was around 22 min. Inner and outer renorrhaphy done with absorbable suture. Blood loss was around 300 mL. Length of stay was 5 days. The patient achieved trifecta with e GFR being 121 mL/min/1.73 m² in post operative period. The HPR was cc RCC, grade1 with negative margins. Conclusions: Nephron sparing surgery is possible in highly complex renal tumors in expert hands at a high-volume center. Trifecta can be achieved successfully with robot assisted approach.

6.7.13. UVP-07.13: Troubleshooting in Robotic Intracorporeal Orthotopic Neobladder During Radical Cystectomy—Steps with Proposed Rectification

• Shetty R, Singh A and Sabnis R
• Muljibhai Patel Urological Hospital, Nadiad, India

Abstract: Introduction and Objectives: Radical cystectomy is the gold standard treatment for muscle invasive bladder cancer. The robotic intracorporeal neobladder (ICNB) rate has also recently increased as a minimally invasive alternative to open surgery. ICND remains technically demanding and time-consuming procedure. Due to its complexity, we faced many hurdles intraoperatively which ultimately lead to longer operative time which is a major concern in robotic neobladder. Our objective is to highlight the challenges we encountered during the procedure and ways to combat it. This video demonstrates 4 troubleshoot scenarios encountered by us during robot ICNB and the ways to rectify it. Materials and Methods: Patients who presented with muscle invasive bladder cancer and were considered fit for the procedure of robotic intracorporeal neobladder were included. In this video we have demonstrated 4 troubleshoot areas in the creation of robotic intracorporeal neobladder and ways to rectify it: Scenario 1: dusky bowel segment due to improper application of Endo GI Stapler. Scenario 2: Passage of per urethral catheter through the posterior urethral plate of urethro-ileal anastomosis. Scenario 3: Difficulty in deployment of DJS through the chimney into the neobladder. Scenario 4: Difficulty in removing DJS after 4 weeks through cystoscopy. Results: In all cases we completed the procedure successfully with no postoperative complication. These tips and tricks eventually led to reduced intraoperative time in the subsequent surgery as we knew the techniques/ manoeuvre to prevent them. Conclusions: Although it is a challenging technique, adequate experience with refinement of surgical technique helps in familiarising the steps involved in ICNB. Having a fastidious and reproducible step-by-step approach and guidance in troubleshoot will allow smooth progression of the procedure and timely completion.

6.8. Miscellaneous

6.8.1. UVP-08.01: How to Use a Standard Foley-Catheter for Bladder Washing (Irrigation/Drainage) when a 3-Ways Catheter is Not Available

• Lezrek M ¹, Tazi H ¹, El Yazami O ¹, Yacoubi S ¹ and El Anzaoui J ²

¹ 

Al Ghassani Hospital, Fes, Morocco

² 

Military Hospital Moulay Ismail, Meknes, Morocco

Abstract: Introduction and Objectives: You are stuck in the emergency room with a patient presenting hematuria, presenting acute clots urinary retention. You are in a dire need of a 3-ways catheter to perform bladder irrigation and drainage. But only a standard 2-ways Foley catheter is available. What will you do? We present a video of how to use the standard Foley catheter for irrigation and drainage. Materials and Methods: Three methods are reported using a standard Foley catheter for bladder irrigation/drainage: 1– The Foley catheter is inserted; with very frequent syringe bladder washing. 2– A 6 or 8-Fr aspiration or feeding tube is inserted beside the Foley catheter. Continuous drip irrigation is performed through the feeding tube. 3– The balloon channel will be used for irrigation. Preparation of the catheter: The balloon is inflated with air. The balloon is punctured, and the whole balloon wall is excised with scissors. Then, the balloon valve is removed. The irrigation tube is adapted to the balloon channel. The irrigation fluid is passing through the balloon orifice. The regular channel remains for drainage. The modified Foley catheter is introduced into the bladder, through urethra. The balloon is no longer available; thus, the catheter has to be tethered with medical adhesive tapes to the skin. Results: Multiple bladder washing through a Foley catheter is possible, but it is time and hand consuming. Only effective for mild hematuria without clots. Irrigation through a feeding tube, and drainage through the foley catheter, is very effective. The feeding tube channel is larger than the irrigation channel of a 3-ways-catheter. However, it is not always possible to insert it beside the Foley catheter, and might bulky and traumatic to the urethra. Using the balloon-channel for irrigation is effective. The balloon channel is not large so the irrigation flow might not be important. Thus, the patient has to be closely monitored, to detect any clotting of the catheter, in case of important hematuria. Conclusions: These are 3 options of bladder irrigation/drainage that are used when the regular 3-ways catheter is not available. The residents are taught these techniques, when they first come to the department.

6.8.2. UVP-08.02: Robotic Anderson-Hynes Dysmembered Pyeloplasty in Right Sided Pelvic Ectopic Kidney

• Khan U
• Max Hospital Saket, Delhi, India

Abstract: Introduction and Objectives: Pelvic ectopic kidney with pelviureteric junction (PUJ) obstruction presents a unique challenge in urological practice. Traditional surgical approach poses challenges owing to the rarity of the case. Robotic Anderson-Hynes dismembered pyeloplasty (RAHDP) has emerged as a promising minimally invasive approach for the treatment of PUJ obstruction. Materials and Methods: A comprehensive evaluation of a single case involving a young male patient with right sided pelvic ectopic kidney and symptomatic PUJ obstruction who underwent RAHDP was conducted. Preoperative assessment included clinical examination, CT scan, diuretic DTPA scan, and renal function tests. Surgical intervention was performed using the da Vinci^® robotic system, employing the Anderson-Hynes dismembered pyeloplasty technique. Postoperative follow-up included monitoring of renal function, imaging for hydronephrosis, and assessment of symptomatic relief. Results: The RAHDP procedure was successfully performed, achieving adequate drainage of the pelvic ectopic kidney after removal of the ureteric stent. The patient experienced significant improvement in symptoms postoperatively, with resolution of hydronephrosis. Follow-up imaging demonstrated patent anastomosis and sustained improvement in renal parameters. Conclusions: Robotic Anderson-Hynes dismembered pyeloplasty represents a feasible and effective approach for managing PUJ obstruction in pelvic ectopic kidneys. Despite the anatomical complexity associated with this condition, robotic assistance offers favorable outcomes with minimal morbidity.

6.8.3. UVP-08.03: Primary Urethral Cancer (PUC)—Tale of Two Cases (Post Urethroplasty), One with Phallus Preservation and Another with Radical Treatment—A Rare Entity

• Saurabh N ¹, Chatterjee A ¹, Bhagat S ² and Suresh A ³

¹ 

Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

² 

Lilavati Hospital and Research Centre, Mumbai, India

³ 

Belarusian State Medical University, Minsk, Belarus

Abstract: Introduction and Objectives: This unique series shows two cases of primary urethral carcinoma with the first one undergoing endoscopic management of urethral cancer (TURUT- transurethral resection of urethral tumour) in the penobulbar area with neoadjuvant chemotherapy and the second being treated with radical penectomy with bilateral inguinal and pelvic node dissection followed by chemoradiotherapy. Materials and Methods: A patient aged 51 years presented with a history of (h/o) voiding LUTS for 6 months (h/o Barbagli urethroplasty for pan urethral stricture 10 years back) with microscopic hematuria and was lost to follow-up. He presented with hematuria with retention. During urethroscopy, a urethral mass was seen in penile urethra almost completely obstructing the lumen. It was completely resected and sent for histopathological examination (HPE). On the 5th postoperative day, his catheter was removed. HPE showed moderately differentiated squamous cell carcinoma. MRI of the penis with perineal and inguinopelvic region showed heterogeneously enhancing mass lesion (8.6 × 4.8 × 4.0 cm) and necrotic areas involving the penile bulb, crura and proximal shaft of the penis with bilateral nodes (T3N2M0). Medical oncologist started him on neoadjuvant chemotherapy (NACT) (TIP regimen)– for 3 cycles and a repeat MRI showed partial response. Another patient (59 yrs) with penile mass and bilateral inguinal lymph nodes, underwent radical penectomy with bilateral inguinal and pelvic node dissection in 2022. HPE showed moderately differentiated squamous carcinoma. He underwent chemoradiotherapy and succumbed to metastatic disease this year. Results: First one treated by endoscopic resection with NACT succumbed to Covid infection and the second one treated by radical surgery with adjuvant chemoradiotherapy succumbed to metastasis. Conclusions: It is rare to see the development of urethral squamous cell carcinoma, particularly after urethroplasty and TURUT with phallus preservation with NACT may be an option in those who desperately want to preserve their sexual function whereas radical surgery with CT/RT may be the best treatment.

6.9. Pediatric Urology

6.9.1. UVP-09.01: Foley Tie Technique in Robotassisted Ureteric Tapering and Reimplantation

• Ansari M and Yadav P
• Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract: Introduction and Objectives: This study aimed to introduce and evaluate the feasibility and outcomes of a novel surgical technique, robotassisted Foley tie ureteric tapering (RAFUT) and reimplantation, specifically designed for intravesical ureteral tapering during pediatric roboticassisted ureteric reimplantation. Materials and Methods: A retrospective analysis was conducted on pediatric patients diagnosed with primary vesicoureteric reflux (VUR), who underwent RAFUT between January 2019 and July 2021. Patient records were reviewed to assess preoperative characteristics, operative details, and postoperative outcomes. RAFUT involved meticulous patient positioning, precise port placement with a 6 mm separation, and bladder anchoring to maintain pneumovesicum. Ureteric tapering was performed with the Foley tie technique to enhance surgical precision. The primary outcome measures included operative time, complications, and postoperative VUR resolution. Results: All four patients underwent successful intravesical RAFUT without any intraoperative or postoperative complications. The age of the patients ranged from 3 to 12 years, with varying bladder capacities (range: 210–550 mL). The operating times ranged from 180 to 210 min, and the estimated blood loss was 35–50 mL. None of the patients required conversion to open surgery. Patients demonstrated resolution of VUR on postoperative imaging, and none experienced recurrent urinary tract infections during followup, which ranged from 1.5 to nearly 4 years. Conclusions: RAFUT represents a safe and effective surgical technique for intravesical ureteral tapering during pediatric roboticassisted ureteric reimplantation. This innovative approach addresses the challenges posed by intravesical surgery for dilated ureters, maintains anatomical orientation, and offers precise excision and suturing capabilities.

6.9.2. UVP-09.02: Staged Repair of Proximal Hypospadias

• Kumar N and Chandra V
• All India Institute of Medical Sciences Patna, Patna, India

Abstract: Introduction and Objectives: We present a video of a case of proximal hypospadias with significant chordee which was managed in 2 stages with Byars flap and ventral corporotomy with tunica vaginalis graft. Materials and Methods: The patient had midpenile hypospadias with significant chordee after degloving which did not correct after urethral transection and urethral plate excision. Ventral corporotomy was done bilaterally at the point of maximum deviation and the defect was covered with tunica vaginalis graft. Byars flap was created and the meatus shifted to penoscrotal junction. Tubularisation was done after 6 months in 3 layers with local dartos as interposition tissue. Results: There were two urethrocutaneous fistulae one of which at penoscrotal junction closed spontaneously and the other required closure in 3 layers. Now the patient is voiding well without any leak and he’s having normal erections. His cosmetic appearance is also satisfactory. Conclusions: Staged repair of hypospadias may be performed if there is significant chordee. It provides good functional and cosmetic outcomes.

6.10. Penis/Testis: Benign Disease

UVP-10.01: Bilateral Orchiectomy Using a Single Median-Raphe Incision: Technical Highlights and Medical Benefits for Transgender Women Awaiting Gender-Affirming Vaginoplasty Surgery

• Stelmar J ¹, Sandhu S ², Mallavarapu S ², Smith S ², Yuan N ² and Garcia M ²

¹ 

University of California San Diego School of Medicine, San Diego, United States

² 

Cedars-Sinai Medical Center, Los Angeles, United States

Abstract: Introduction and Objectives: Transgender women who receive gender affirming feminizing hormone therapy (GAHT) experience significantly higher cardiovascular-disease related mortality compared to cisgender males. Patients also complain of anti-androgen side-effects (urinary frequency). Gender-affirming bilateral orchiectomy (GABO) can be undertaken if patients are waiting for their vaginoplasty (GAV). We present our technique for bilateral orchiectomy using a single median raphe incision for gender-affirmation. We also report our rates of GAHT before and after orchiectomy for our patients. Materials and Methods: We performed retrospective chart review of all patients who underwent pre-op GABO or vaginoplasty from 4/2017–12/2020 and queried pre- vs. post-op hormone meds and dosages. We also administered a questionnaire to capture patient’s satisfaction with GAHT side effects. Results: A total of 106 patients underwent GABO and 64 underwent GAV. 51.4% of GABO patients subsequently underwent GAV. We saw a significant reduction in hormone dosages for patients seeking GABO or GAV for estradiol (p < 0.001) and progesterone (p < 0.001 GABO and p < 0.03 GAV) (Figure 1). After both GABO and GAV, all patients (100%) discontinued Spironolactone (p < 0.001), and over 90% reported improved QoL related to elimination of Spironolactone’s diuretic function side-effects. Our surgical technique affords a single, well-hidden scar at the base of the penoscrotal junction. From this position, we are able to access both testicles and spermatic cords and ultimately, this skin is still usable when the patient undergoes vaginoplasty, and does not leave any additional scars. Conclusions: GABO appears to offer all transfeminine patients the benefits of significantly lower daily GAHT medications and dosages, and improved QOL. Our technique using a median-raphe incision provides excellent surgical access to remove the testicles and spermatic cords and can be offered by general urologic surgeons and those specializing in gender-affirming surgery.

6.11. Penis/Testis/Urethra: Cancer—Clinical

6.11.1. UVP-11.01: Advancing Testicular Cancer Treatment: The Role of Robotic Surgery

• S L, Sharma R, Mohan A and Reddy B
• Basavatarakam Indoamerican Cancer Hospital and Research Hospital, Hyderabad, India

Abstract: Introduction and Objectives: Testicular cancer represents a significant clinical challenge, especially in cases with post-chemotherapy residual nodal disease in the retroperitoneum. This case report aims to discuss the efficacy and advantages of robotic-assisted retroperitoneal lymph node dissection (R-RPLND) in managing a 29-year-old male with a mixed germ cell tumor, post right high inguinal orchidectomy, and significant residual nodal disease following three cycles of BEP chemotherapy. Materials and Methods: The patient, a 29-year-old male diagnosed with a mixed germ cell tumor exhibiting lymphovascular invasion and an 8.5 cm primary lesion, underwent three cycles of BEP chemotherapy post-right high inguinal orchidectomy. Imaging post-chemotherapy revealed significant residual nodal disease in the retroperitoneum. Considering the potential benefits in terms of precision, reduced morbidity, and faster recovery, a decision was made to proceed with R-RPLND. The procedure was performed using a state-of-the-art robotic surgical system, focusing on meticulous dissection and removal of residual nodes while preserving surrounding structures to minimize complications. Results: The R-RPLND was completed successfully with no intraoperative complications. The robotic system facilitated precise dissection and removal of residual nodal disease. Postoperatively, the patient demonstrated a favorable recovery profile, including reduced pain, minimal scarring, and a swift return to daily activities. Conclusions: Robotic-assisted RPLND represents a viable and advantageous surgical option for patients with testicular cancer and post-chemotherapy residual nodal disease. The precision of the robotic system, combined with its ability to minimize damage to surrounding structures, not only enhances the surgical outcomes but also preserves the patient’s quality of life post-treatment. This case underscores the importance of incorporating advanced surgical techniques into the management of complex oncological cases, particularly in younger patient populations where quality of life post-treatment is a critical consideration. Further studies are recommended to evaluate the long-term outcomes and potential benefits of robotic-assisted surgery in the oncological domain.

6.11.2. UVP-11.02: ICG Assisted Robotic Video Endoscopic Inguinal Lymph Node Dissection (R-VEIL)

• Yuvaraja T
• Kokilaben Dhirubhai Ambani Hospital Mumbai, Mumbai, India

Abstract: Introduction and Objectives: Open inguinal lymph node dissection (O-ILND) is the gold standard in the management of lymph nodes in carcinoma penis; however, video endoscopic inguinal lymphadenectomy (VEIL) is performed in some centers. We have done a series of cases of VEIL and also compared them with O-ILND. Materials and Methods: Surgical Technique—Here we demonstrate our surgical technique of robotic VEIL. We use ICG to demonstrate lymphatics. Results: We have compared about 60 cases of O-ILND and robotic VEIL and published them. A significant advantage of VEIL is reduced post-operative wound-related complications, due to smaller port incisions in the thigh at different levels away from the area of dissection, as opposed to much large incisions in groin severing the lymphatics and vasculature of the skin during O-ILND. The average number of lymph nodes dissected is similar between O-ILND and VEIL as no difference between the techniques as boundaries of the dissection remain the same; all the nodes in femoral triangle and up to 2 cm above the level of inguinal ligament. Conclusions: R-VEIL is safe and technically feasible. Oncological principles are maintained with avoidance of postoperative limb edema. Use of ICG reduces drain output.

6.11.3. UVP-11.03: RA-VEIL—Deep Dissection First with Increased Insufflation Pressure (20 mmHg)

• Tilva V ¹, Bakshi H ², Rajyaguru D ³ and Mohan S ²

¹ 

HCG Cancer Centre, Sola, Ahmedabad, India

² 

HCG Cancer Centre, Ahmedabad, India

³ 

Uro-care Hospital, Mehsana, India

Abstract: Introduction and Objectives: Open inguinal node dissection (O-ILND) has been the gold standard technique in the management of lymph nodes in penile cancer. The use of the minimally invasive approach in managing lymph node dissection, especially robotic inguinal node dissections (RA-VEIL) rapidly replaces the standard open method. Our primary objective was to compare per-operative and survival outcomes in patients undergoing O-ILND and RA-VEIL. in RA-VEIL, we have used modification in our new technique to increase Insufflation pressure after incision fascia lata, usually, pressure will be 20–25 mmhg to facilitate easy dissection, increase dissection speed and reduce blood loss. It will provide an excellent bloodless field. Materials and Methods: Analysed the patients who underwent O-ILND and RA-VEIL between January 2016 and January 2021. Descriptive statistics were used. We analysed 47 patients who underwent bilateral ILND (22 underwent RA-VEIL and 25 underwent OILND) with a minimum follow-up of 36 months (range: 36 to 68 months). In subset analysis, we applied the new technique with increased insufflation pressure between 20–25 mmHg. In 11 RA-VEIL standard vs. 11 RA-VEIL with higher insufflation. Vital parameters were observed for any change. Results: Wound complications were more common in OILND, particularly flap necrosis: 21 (42%) in OILND and 5 (26.5%) in RA-VEIL (p < 0.05). Median OS in open for was 42 months compared to 39 months in RA VEIL, while the 3-year survival was 72% and 77% in OILND and RA-VEIL respectively. There were 12 recurrences; 7 in OILND and 5 in the RA-VEIL group. In the higher insufflation group, less operative time of 22 mnutes, with negligible blood loss, an average of 25 mL. it didn’t show any perioperative complications like hypercarbia or postoperative bleeding. doesn’t change vital parameters. Camera cleaning was reduced 3 fold as compared to standard RA-VEIL. Conclusions: The recurrences were more related to pathological grade and lymph node status rather than technique used. Increased insufflation up to 20–25, mmHg will help in reduced operative time, bloodless field and prevent cavity collapse. It will not increase insufflation-related complications. Also reduced 3-fold intra-operative camera cleaning.

6.11.4. UVP-11.04: Robot Assisted Video Endoscopic Inguinal Lymphadenectomy (RA-VEIL) by Lateral Approach Using SSI Mantra: A Unique Approach with New Surgical Robotic System

• Pratihar S, Khanna A, Singh A, Rawal S, Saurabh N, Kumar B, Ali M and Malla I
• Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Abstract: Introduction and Objectives: Robot assisted video endoscopic inguinal lymphadenectomy (RA-VEIL) is being increasingly performed for inguinal lymph node staging in clinically node negative(cN0) and clinically node positive having low bulk. We were previously performing RA-VEIL via conventional approach but with modifications. Performing this difficult procedure in new robotic system is challenging. System cost and per procedure instrument, drape cost is significantly less than da Vinci^® surgical robotic system. In this video, we demonstrate our new unique technique of RA- VEIL by lateral approach using new surgical robotic system SSI Mantra. Materials and Methods: The conventionally described procedure begins with creation of a plane just below the Scarpa’s fascia with sharp/blunt (finger dissection) for port placement which we believe is difficult to create uniformly. We propose and demonstrate the following modifications: Lymph node dissection by lateral approach, creation of plane of initial entry just superficial to the fascia lata, performing deep inguinal lymph nodal dissection prior to superficial nodal dissection. We have done this approach in both da Vinci^® and SSI Mantra robotic surgical system. Here we present a case of RA VEIL left side using SSI Mantra system. Results: We are doing this new technique from November 2021. Since then up to February 2023 we performed this on 26 patients with median lymph node yield of 13 and lymph node positivity rate of 27%. VEIL was performed in 4 patients using SSI Mantra system with mean operative time of 110 min, median lymph node yield of 13 with no pathologically positive lymph node. With this system median drain duration was 32 days. No patient had flap necrosis and significant lymphedema. Conclusions: Our technique makes the procedure more reproducible, allows for uniform preservation of Scarpa’s fascia throughout the dimensions and enables the surgeon to perform the procedure with minimal assistance. RAVEIL with SSI Mantra robotic platform is technically safe and feasible. This system seems capable of delivering oncological and functional outcomes comparable to established surgical platforms. This system is affordable than da Vinci^® surgical system. In India and other developing nations where affordability is an issue and case volume is less in many hospitals this system can serve as good alternative.

6.11.5. UVP-11.05: Split and Roll Technique: A Modified Method of Video-Endoscopic Inguinal Lymphadenectomy (VEIL)

• Mohare S, Vaddi S, P L, Naidu Koneni B, Sampathi Rao G, Kadam A and G S
• Yashoda Hospital, Somajiguda, Hyderabad, India

Abstract: Introduction and Objectives: For Ca penis, radical inguinal lymphadenectomy provides local control of disease and has a survival advantage but is a morbid procedure. Video endoscopic inguinal lymphadenectomy (VEIL) is the procedure described to reduce the morbidity associated with open counterpart which has surgical morbidity up to 50% and is a minimally invasive approach, which reduces the pain ensures early recovery and gives cosmetically better outcome. Materials and Methods: 38 years old male came with an ulcerative growth over glans approx 4 × 3 cm extending from EUM to corona on both sides after he underwent a circumcision at an outside hospital and the biopsy was reported as high grade squamous cell carcinoma. On examination there were no palpable lymph nodes but on PET scan FDG avid bilateral inguinal lymph nodes largest measuring 11 × 5 mm. So an ultrasound guided FNAC was done which did not reveal any malignancy. Hence we planned for partial penectomy and on biopsy, the tumor was high grade and infiltrated into the corpus spongiosum (T2). We planned for laparoscopic VEIL (L-VEIL). Results: Patient underwent the procedure in an extended lithotomy position. The femoral triangle marked and 10 mm camera port placed just below the apex of the triangle and two 5 mm working ports placed as per ergonomics. Dissection carried out over the deep fascia which covers the muscles till the inguinal ligament. Splitting done of the tissue between scarpas and deep fascia from the apex towards base longitudinally and all tissue dissected with good lymph nodal yield along with saphenous vein preservation, frozen sections did not show any carcinoma. Postoperatively, no wound complications and was discharged on post-op day 4. Conclusions: The split and roll technique of laparoscopic VEIL has distinct advantages such as better ergonomic comfort while dissection, better preservation of scarpa’s fascia and easier saphenous vein identification and dissection from lymph nodal tissues when compared to standard VEIL.

6.12. Prostate Cancer—Clinical Localized

6.12.1. UVP-12.01: A Modified Hood Technique—Continence Preserving Robotic Radical Prostatectomy

• Yuvaraja T
• Kokilaben Dhirubhai Ambani Hospital Mumbai, Mumbai, India

Abstract: Introduction and Objectives: A common side effect following radical prostatectomy is urinary incontinence. While preservation of continence is multifactorial, we have aimed to meticulously perform all steps of HOOD technique and preserve the normal anatomy as much as possible to help preserve continence after robotic radical prostatectomy. Materials and Methods: Surgical Technique—We performed robotic radical prostatectomy with hood technique. Patients selected were localised prostate cancer with Gleason score < 9. Patients with anterior prostatic lesion and previous radiation were excluded. In the surgical technique we aimed at preservation of anatomical structures around the prostate muscles, puboprostatic ligament and arcus tendineus and preservation of neurovascular bundles. Also aimed were angulation between bladder neck and urethra and preservation of full functional length of urethra. Results: We have seen better continence rates since we have started using HOOD technique with continence at 1, 2, 4, 6, 12, 24, and 48 wk after catheter removal were 26%, 38%, 86%, 90%, 93%, 96%, and 97%, respectively. Positive surgical margin rate was comparable to routine technique of Robotic Radical Prostatectomy. Conclusions: Following meticulously all steps in HOOD technique has shown improved continence as it is aimed at retrieving the normal anatomy. HOOD technique of RARP should be offered to selected patient without affecting the oncological outcome.

6.12.2. UVP-12.02: Rectum Injury and Repair During Robotic Radical Prostatectomy in a Patient with Very High Prostate Volume

• Madendere S ¹, Kiliç M ¹, Aykanat I ², Esen B ², Musaoğlu A ¹, Kordan Y ² and Balbay M ²

¹ 

VKV American Hospital, Istanbul, Türkiye

² 

Koç University School of Medicine, Istanbul, Türkiye

Abstract: Introduction and Objectives: Nowadays, robotic surgery can be applied even in the most difficult cases in the treatment of prostate cancer. We aimed to highlight the rectum repair performed during robotic surgery in a patient with an extremely large prostate volume. Materials and Methods: The prostate volume was 335 mL in the multiparametric prostate MRI of a 77-year-old patient, whose total PSA level was 18.1 ng/mL and who was followed up with a urinary catheter due to retention. ISUP Grade Group 2 prostate cancer was detected in MRI-fusion biopsy performed on a 15 mm PIRADS 5 lesion with suspected extracapsular extension. After reviewing treatment options, the patient, who also had severe obstructive findings, underwent a robotic radical prostatectomy and lymph node dissection. Results: After the posterior dissection was completed, the rectum was examined using a rectal tube, and it was discovered that the tube protruded from the thinner rectal wall. Following that, the rectal mucosa and serosa were repaired separately and continuously. The lack of anastomotic leakage was confirmed by filling the rectum with methylene blue. A peritoneal flap was brought to the repair zone on the rectum and covered as a separate layer. Then, vesicourethral anastomosis was performed with a double-needle 3.0 Stratafix. It was confirmed that there was no leakage from the vesicourethral anastomosis. The patient was only offered a liquid diet for the first three days. On the seventh day, the creatinine level in the drain fluid was within normal ranges, thus the drain was removed. The patient was discharged. On the 14th day, a cystogram was performed and the urinary catheter was removed since no leakage was observed. Pathology revealed a prostate volume of 366 mL, pT2N0 prostate acinar adenocarcinoma of ISUP GG 2 with negative surgical margins, no metastases were seen in 20 lymph nodes. Conclusions: Challenging cases can be performed with minimally invasive methods, and complications can also be resolved with these methods.

6.12.3. UVP-12.03: Retzius Sparing Radical Prostatectomy: Pushing the Limits

• Pratihar S, Singh A, Khanna A, Rawal S, Kumar B, Saurabh N, Ali M and Malla I
• Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Abstract: Introduction and Objectives: Robot assisted retzius sparing radical prostatectomy (RSRARP) has been popularised by Bocciardi et al. It is done completely by posterior approach without violating the space of retzius. This procedure, compared to conventional anterior approach, results in early return of urinary continence. This technique is difficult to master. Although many surgeon has adopted this approach, still most refrain from doing it in patients with large prostate, post transurethral resection of prostate, prostate with median lobe, locally advanced and high risk prostate cancer. Here we are going to show videos of RSRARP beyond the conventional limits. Materials and Methods: In this presentation we are showing three videos of RSARP. All are localised prostate carcinoma. First patient had large prostate 140 cc, second patient had median lobe, third patient had history of prior transurethral resection of prostate. Results: Surgeon’s console time were similar like other patients with normal prostate anatomy. We were able to do all three procedures with ease without any technical and ergonomic difficulty. The three patients recovered well and was discharged on 3rd post operative day without any complications. On final histopathology all had prostate margin uninvolved by tumor. All the three patients were totally continent within three months. Conclusions: RSRARP in unusual prostate anatomy is technically safe and feasible. Although this approach seems difficult to master, proper meticulous dissection and sticking to the principles of surgical steps system seem capable of delivering good oncological and functional outcomes.

6.12.4. UVP-12.04: Sutureless Retzius Sparing Radical Prostatectomy for Ca Prostate

• Ramappa A, Puntambekar S and Kulkarni S
• UROKUL, Pune, India

Abstract: Introduction and Objectives: To describe sutureless retzius sparing laparoscopic radical prostatectomy. Materials and Methods: We describe a modification of Retzius sparing radical prostatectomy wherein vesicourethral anastomosis is not sutured, instead the foley catheter is kept on mild traction for first 48 h and removed on 14th post operative day after performing a pericatheter RGU. Continence was defined as usage of no pads per 24 h for urinary leak. Results: Over 10 months from December 2022 to September 2023 a total of 11 patients underwent sutureless retzius sparing laparoscopic radical prostatectomy at our institute. No patient had a leak. Conclusions: Sutureless vesicourethral anastomosis retzius sparing radical prostatectomy is a feasible technique with similar results in the short term regarding margin negativity, early continence as retzius sparing laparoscopic radical prostatectomy with sutured vesicourethral anastomosis. This technique has the added advantage of saving time thereby making the surgery faster which is an advantage to the patient in terms of shorter anaesthesia, shorter duration in Trendelenburg position.

6.12.5. UVP-12.05: The Posterior Sagittal Para-Rectal Approach to Open Radical Prostatectomy

• Khanna A, Singh A, Pratihar S, Sourabh N, Kumar B, Khan M, Malla I and Rawal S
• Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Abstract: Introduction and Objectives: Retzius spring radical prostatectomy has shown promise in terms of better early post-operative continence rates. However, currently it has not been replicated by open approach. Here we describe the posterior sagittal pararectal approach to open radical prostatectomy that maintains the integrity of the retzius space, provides direct visualisation of the entire prostate and has promise of early return of continence. Materials and Methods: A 56 year old gentleman (BMI 19 kg/m²) with no comorbidities presented with severe obstructive lower urinary tract symptoms for the past 4 months and serum PSA of 8 ng/mL. Rectal examination revealed a grade II prostate with hard nodule left base. mpMRI prostate showed a PIRADS 5 lesion left base. TRUS biopsy: 3 + 3 12/12 cores +. He was taken up for open radical prostatectomy by this approach. Results: The procedure was performed under general anaesthesia with epidural analgesia. The patient was placed in prone jackknife position with all pressure points padded. The procedure was accomplished as shown in the video. The operative time was 100 min with blood loss of approximately 50 mL. The patient had painless postoperative course (3 days). The patient was fully continent at catheter removal (POD 10). Final biopsy was GS 3 + 4 with focal EPE and negative margins. Conclusions: Open radical prostatectomy by posterior sagittal para-rectal approach makes it possible to perform retries sparing prostatectomy by open approach with direct access to the whole prostate. More experience is needed to define its role in today’s era of minimally invasive prostatectomy.

6.13. Reconstruction

6.13.1. UVP-13.01: New Nontransecting Anastomotic Urethroplasty with Ventral Approach Without Full Mobilization of the Posterior Semicircle of Urethra

• Bogdanov A ¹, Katibov M ², Veliev E ¹, Sokolov A ¹, Ivkin E ¹, Metelev A ¹, Tulinov M ¹, Vardanyan V ³, Loran O ⁴ and Pushkar D ¹

¹ 

Moscow Urological Center, S.P. Botkin’s State Clinical Hospital, Moscow, Russia

² 

Makhachkala City Clinical Hospital, Makhachkala, Russia

³ 

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

⁴ 

Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Abstract: Introduction and Objectives: We have proposed a new technique of non-transecting anastomotic urethroplasty using ventral access. Materials and Methods: 59 men with a bulbous strictures of different etiologies underwent anastomotic non-transecting operation without full mobilization and intersection of the dorsal semicircle of the spongy body by one surgeon from January 2016 to March 2023. Strictures were iatrogenic—27 (45.8%), post-infectious—26 (44.1%) and post-traumatic (blunt trauma of the perineum)—6 (10.1%). A significant proportion of patients, 37 (63%), had previously undergone surgical treatment of strictures. The average age was 56 years. Results: The average length of the strictures was 1.5 cm. The median volumetric maximum urination rate was estimated 3 months after surgeries and accounted for 18.1 mL/s. The average amount of points on the ICEF scale before and after surgical treatment did not change significantly, its median before surgery was 17 points, 3 months after surgery—16. During the 5 years period, only 3 patients 3 (5%) showed signs of constriction in the area of urethral anastomosis, confirmed by urethrography. Two patients already were operated with buccal graft, third still under observation. Moreover, two patients who underwent surgery more than 6 years ago and had already gone beyond the limits of observation were additionally examined. They have shown a decrease in maximal urination rate of less than 10 mL/s after control uroflowmetry. According to urethrography, a recurrence in the anastomosis zone was detected. However, patients found their urination as satisfactory. Conclusions: Considering the objective reduction in the volume of direct surgical trauma, partial preservation of innervation and blood supply to the urethra with maintaining the fixation of the posterior semicircle due to the absence of mobilization of the dorsal surface of the spongy body, the absence of early and late postoperative complications, satisfactory quality of urination (93.7%), preservation of the initial level of erectile function, a low number of relapses (6.3%) during 5 years follow–up period and 8.4% of relapses more than 5 years follow–up period—this variant of urethral plastic surgery after additional studies and significant observation periods can be useful.

6.13.2. UVP-13.02: Robotic Posterior Urethroplasty with VY Flap—A Precision Approach to Resolving Bladder Neck Contracture Challenges

• Geminiani J ¹, Krebs R ², Hidaka A ¹, Barbosa R ¹ and Soffner Cardoso P ¹

¹ 

Centro Universitário ABC, Santo André, Brazil

² 

Universidade Federal do Paraná, Santo André, Brazil

Abstract: Introduction and Objectives: Bladder neck contracture is a rare complication following transurethral resection involving the prostate. According to the European Association of Urology (EAU) Guidelines, the risk of developing this condition is approximately 4% after transurethral resection of the prostate. Secondary bladder neck sclerosis remains a significant issue in contemporary urological practice, necessitating effective approaches to prevent its recurrence. With the advancement of robotic surgery, increasingly less invasive techniques are being developed. The objective of this abstract is to present a step-by-step technique of robotic posterior urethroplasty with a VY flap. Materials and Methods: The video illustrates the surgical technique of robotic posterior urethroplasty in a 48-year-old male patient with complaints of progressive worsening of lower urinary tract symptoms (LUTS) six months after transurethral resection of the prostate (TURP). The patient reported progressive worsening and the need for multiple urethral dilations. Diagnosis was made with MRI and retrograde urethrocystography, showing bladder neck contracture. The video demonstrates the combined approach with flexible cystoscopy, highlighting the advantages of this procedure. Results: Surgery was performed using a minimally invasive robotic approach, with a two-hour operative time. The patient was discharged on the second postoperative day with a urinary catheter, which was removed after one week. On follow-up, the patient showed significant improvement in urinary pattern without the need for further dilations or surgical re-interventions. Urodynamic assessment showed no evidence of infra-vesical obstruction and good detrusor capacity (Schafer nomogram) three months after surgery. Conclusions: The robotic approach has facilitated the performance of complex surgeries in the pelvis. This technique in bladder neck contracture has yielded favorable outcomes in the postoperative period, preventing recurrence and enabling early return to daily activities. Further studies are needed to validate the technique as a choice in posterior urethroplasty with VY flap.

6.13.3. UVP-13.03: Surgical Technique and Outcome of Dorsal Onlay Buccal Mucosal Graft Urethroplasty

• Lua A ¹, Lee S ¹, Eardley I ² and Lau W ¹

¹ 

Khoo Teck Puat Hospital, Singapore

² 

Leeds Teaching Hospitals Trust, Leeds, United Kingdom

Abstract: Introduction and Objectives: Urethroplasty is a complex urethral reconstruction procedure. Usually short strictures can be managed initially with endoscopic techniques such as urethral dilatation or optical urethrotomy. Definitive surgical options for anterior urethral strictures include stricture excision and primary anastomosis, substitution urethroplasty in the form of a buccal mucosal graft with a single or staged procedure. This video presentation aims to demonstrate the surgical techniques involved in using dorsal onlay application of a buccal mucosal graft. Materials and Methods: A 52 year old gentleman with a background of type 2 diabetes mellitus was involved in a straddle injury (from a motorcycle) 3 years prior to his presentation to Khoo Teck Puat Urology department for voiding symptoms. Pre-operative evaluation with a uroflowmetry, flexible cystoscopy as well as a retrograde urethrogram conclusively revealed a bulbar urethral stricture. He subsequently underwent dorsal onlay buccal mucosal graft urethroplasty, was discharged on day 2 post-operatively. Subsequent follow up with a peri-catheter urethrogram revealed no leak and the patient was trial-ed off indwelling urinary catheter on post-op day 23 and his suprapubic catheter was removed on post-op day 37. Results: Post-operatively the gentleman in the video had significant improvement in his voiding symptoms with objective improvement in his uroflowmetry scores without the need to be dependent on a indwelling urinary catheter. Conclusions: Buccal mucosal graft urethroplasty provides a safe and positive outcome for patients undergoing the surgery. Subsequent follow up procedures have not been required and there are minimal post-operative morbidity from the patient undergoing such a surgery.

6.14. Renal Transplantation

6.14.1. UVP-14.01: Pediatric Renal Transplantation: An 8-Year Institutional Analysis

• Chawla A, Viswanath K, Pillai S and Hegde P
• Kasturba Medical College, Manipal, India

Abstract: Introduction and Objectives: Pediatric renal transplantation entails unique considerations: CAKUT prevalence, addressing malnutrition/growth issues, parental compliance, anesthetic challenges (vascular steal), technical hurdles (size/vessel mismatches), and post-op risks (graft thrombosis). This study provides an 8-year analysis at a tertiary care center. Materials and Methods: A retrospective analysis of pediatric kidney transplantations was conducted at Kasturba Medical College, Manipal, evaluating recipient characteristics, surgical intricacies, immunosuppression, post-transplant complications, and survival rates. Immunosuppressive therapy included ATG/basiliximab induction, and maintenance with tacrolimus, mycophenolate mofetil, and prednisolone. Results: Between 2015 and 2023, 14 patients (86% male, mean age 10 ± 2.7 years) underwent kidney transplantations. 8 patients had urological causes leading to ESRD, of which 5 were PUV and 3 were reflux nephropathy. 4 children were less than 15 kgs weight, with the least being 11 kgs. 12 children were already initiated on haemodialysis (3 peritoneal and 9 haemodialysis). 2 children underwent pre-emptive renal transplants. 13 were live related donor kidneys and 1 was a cadaveric transplant. Graft kidney was placed extraperitoneally in 13 patients and intraperitoneally in 1 patient. Postoperatively, perinephric hematoma was noted in 1 patient and another patient had persistent hypotension requiring prolonged inotrope support. On follow up, acute rejection was noted in 1 child and chronic rejection in 2 children. 1 patient died due to varicella zoster infection. Overall graft survival at 5 years was 74%. Conclusions: Pediatric renal transplantation demonstrates favourable patient and allograft survival. CAKUT emerges as a prevalent cause of CKD in pediatrics, emphasizing the unique challenges posed by congenital genitourinary anomalies. Notably, donor-recipient size mismatch, vascular anastomosis and Perioperative hemodynamic alterations stand out as distinctive factors differentiating pediatric from adult transplantation procedures.

6.14.2. UVP-14.02: Rapid Encrustation of DJ Stent: An Unusual Presentation of Asymptomatic Pretransplant Hyperuricemia in a Pediatric Renal Allograft Recipient: A Unique First Report and Endoscopic Management

• Bhagat S ¹, Saurabh N ², Suresh A ³, Chatterjee A ² and Rao R ⁴

¹ 

Lilavati Hospital and Research Centre, Mumbai, India

² 

Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

³ 

Belarusian State Medical University, Minsk, Belarus

⁴ 

SRL Raheja Hospital Mahim, Mumbai, India

Abstract: Introduction and Objectives: Renal transplant is an established gold standard treatment of chronic kidney disease stage 5. Hyperuricemia is common in CKD and there is no uniform consensus about treatment if asymptomatic. To safeguard the ureterovesical anastomosis, some surgeons opt for prophylactic DJ stenting during renal transplant. The objective of this study is to highlight the importance of asymptomatic hyperuricemia in patient with CKD stage 5 and its complications after pediatric renal transplant. How to intervene? Materials and Methods: A 12-year-old boy with CKD stage 5 was on maintenance hemodialysis for 6 months. Prior to hemodialysis, his serum uric acid level was 12 mg% which normalized after dialysis. He underwent a live renal transplant with DJ stenting with grandmother being the donor, although routine DJ stenting is not our practice. As per our protocol DJ stent removal is at 3 weeks. Due to unforeseen circumstances, the removal of the DJ stent in the case above was delayed and performed at 5 weeks post-transplant. Results: The boy presented to the emergency department with anuria and graft dysfunction with serum creatinine 3.19 mg%. USG of the allograft revealed moderate hydroureteronephrosis and plain CT KUB displayed multiple ureteric calculi. Underwent USG-guided percutaneous nephrostomy under anaesthesia, resulting in a normalization of the serum creatinine. Subsequently, he underwent endoscopic stone removal with complete clearance. Stone analysis revealed uric acid stones. He was put on allopurinol and oral sodium bicarbonate. Now his creatinine is normal with no recurrence. Conclusions: The management of asymptomatic hyperuricemia in CKD patients lacks consensus among medical professionals. Regarding the formation of stones over the stent, it is expected to be minimal due to the high urine output immediately after transplantation. However, in this case, a unique occurrence of rapid encrustation of the DJ stent was observed, which, to the best of our knowledge, has not been reported earlier. The prevention and treatment of urological complications remain significant concerns for renal transplant surgeons Therefore, in cases where hyperuricemia is present after a transplant, it is crucial to adequately treat hyperuricemia and prioritize the timely removal of the DJ stent. This proactive approach can contribute to reducing the likelihood of stone formation and associated complications.

6.14.3. UVP-14.03: Removing Double-J Stent with or without Cystoscopy Following Kidney Transplantation: A Video Presentation

• Simforoosh N ¹, Nadjafi Semnani M ², Dadpour M ¹, Basiri A ¹ and Tabibi A ¹

¹ 

Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

² 

Birjand University of Medical Sciences, Birjand, Iran

Abstract: Introduction and Objectives: The double-J stent (DJS) commonly employed to prevent ureteral complications post-transplantation. In order to avoid cystoscopy following kidney transplantation to remove DJS, we designed a study to connect distal end of DJ stent to the tip of Foley catheter. So when we remove Foley catheter, DJS will be removed simultaneously. Materials and Methods: 163 kidney transplantation recipients were included and randomized into two groups: intervention (n = 85) and control (n = 78). In the intervention group the DJS was attached to the Foley catheter and was removed simultaneously. In contrast, the control group underwent stent removal via cystoscopy. Results: The two groups were similar regarding age, BMI, sex, past medical and surgical history and any other confounding characteristics. The mean duration from transplantation to DJS removal for intervention and control groups were 8.08 ± 1.52 and 8.57 ± 1.58 days, respectively (p = 0.09). There was no difference between groups regarding major urologic complications (p = 0.679). Visual analog scale pain scores were significantly lower in the intervention group (p = 0.001). importantly, the non-operative technique reduced the cost of the procedure by 63–120 USD compared to cystoscopy. Conclusions: Attaching double-J stent to the Foley catheter during kidney transplantation and removing them together, represents a safe and less invasive approach. This technique decreases patient pain and discomfort and eliminate the need for cystoscopy and its related cost.

6.15. Stones—Surgical Treatment

6.15.1. UVP-15.01: Distal Ureteral Stone Advancement Around a Migrated Hem-O-Lock Clip Following Robot-Assisted Partial Nephrectomy

• Madendere S ¹, Kiliç M ², Musaoglu A ¹, Aykanat I ³, Kiremit M ¹ and Balbay M ³

¹ 

VKV American Hospital, Istanbul, Türkiye

² 

CKV American Hospital, Istanbul, Türkiye

³ 

Koç University School of Medicine, Istanbul, Türkiye

Abstract: Introduction and Objectives: We present our case with Hem-O-Lock clip migration into the collecting system and development of a distal ureteral stone following robot-assisted partial nephrectomy. Materials and Methods: A 64 years-old male underwent robot-assisted partial nephrectomy due to a 3 cm tumor on the right kidney (Figure 1). After 2 years, he presented with right flank pain. Abdomen CT reported 8 mm right ureteral stone (Figure 1). At the time of ureteroscopic laser lithotripsy, after disintegration of the outer surface of the stone Hem-O-Lock clips were visualized in the core of it which were removed successfully. Results: His operative video of partial nephrectomy was re-reviewed and confirmed that Hem-O-Lock clips were placed and stayed outside of the tumor bed after parenchymal repair. Conclusions: Despite being a rare event, Hem-O-Lock clips placed outside of the parenchymal defect may migrate and reach the collecting system postoperatively, which can lead to stone formation and passage through the ureters. Therefore such incidences should be kept in mind in patients presenting with ureteric stones after partial nephrectomy and these patients should be informed about this rare event.

6.15.2. UVP-15.02: JJ Stent Removal After 3 Years from the First Operation

• Uzel T, Duvarcı M, Başar H and Dağlı İ
• Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Türkiye

Abstract: Introduction and Objectives: JJ catheters, which we frequently use in endoscopic urinary system stone treatments, are foreign objects suitable for petrification. Once placed, it needs to be removed again at the right time. Although patients are given the necessary information, some patients may act irresponsibly. Materials and Methods: In 2020, a 52-year-old man with a 7 mm stone in the left distal ureter and a 1 cm stone in the right proximal ureter, bilateral JJ stents were placed after bilateral endoscopic ureteral stone treatment, and the patient did not come to his postoperative controls and was admitted to our clinic 3 years later. Bilateral grade 2 hydronephrosis was detected in the ultrasound. In the direct Urinary System X-ray, calcification areas were observed around the bilateral JJ stent, with dimensions of 44 × 25 mm on the right, 63 × 13 mm on the left, and 41 × 32 mm in the bladder. The patient was discussed at the department council and bilateral ureterorenoscopy and percutaneous nephrolithotomy were planned following bilateral nephrostomy placement. Results: In the patient’s first operation in August 2023, the stone at the lower end of the left JJ and the stone in the left renal pelvis were completely removed, and the petrified left JJ stent was released from the proximal end and removed. A new JJ stent was placed. After 2 weeks, the bladder stone and the stone in the right renal pelvis were completely cleared. Then, the petrified parts of the JJ stent were broken again and the JJ stent was released and removed. JJ stent was placed again. Bilateral nephrostomies were removed. After 2 weeks, JJ stents were removed and the patient was discharged. Conclusions: Telling patients to apply for stent extraction after JJ stent placement may sometimes be insufficient. Close follow-up of patients can prevent bad scenarios such as the scenario in this patient.

6.15.3. UVP-15.03: Mini PCNL Nephrostomy Stretched Latex Foley Catheter

• Lezrek M ¹, Tazi H ¹, Yacoubi S ¹, El Yazami O ¹, Mikou A ¹ and El Anzaoui J ²

¹ 

Al Ghassani Hospital, Fes, Morocco

² 

Military Hospital Moulay Ismail, Meknes, Morocco

Abstract: Introduction and Objectives: For exit strategy, in mini-PCNL, we prefer to leave a nephrostomy tube. A 14-Fr aspiration tube, or a latex Foley catheter, is inserted through the Amplatz sheath. Mostly, a 14-Fr. Foley catheter cannot pass through a 14-Fr Amplatz sheath, even though they are of the same diameter. We present a video of our technique to make the latex Foley catheter slender. Materials and Methods: The rigid distal-end of a stiff hydrophilic guidewire is introduced into the foley catheter. Until it is blocked on its tip. Then, the catheter is stretched over the guidewire. The catheter distal-end is clamped, with a forceps, over the guidewire. The catheter has become very long, and of course, thinner. Since now, the catheter tip is rigid due to the guidewire tip it must be introduced carefully. The Amplatz dilator is used to mark the exact length of Amplatz sheath on the catheter. The now thinner than 14-Fr catheter is easily introduced into the 14-Fr sheath, until reaching the mark, without over-advancement. Then, the sheath is retrieved, 4–5 cm, to put the catheter’s balloon outside the sheath. The balloon is inflated with 3–4 milliliters of water. The sheath is completely removed outside the tract. The forceps is opened and the guide wire is removed. the catheter returns to it its initial length and girth. The sheath is cut open and removed from the catheter. Results: This technique of elongating the latex Foley catheter is effective and allows the insertion of a 14-Fr latex catheter into an Amplatz sheath of the same diameter. The same technique can be used with a 16-French Catheter through a 16-Fr sheath, and even an 18-F catheter through a 16-Fr sheath. Limitations: Sometimes, depending on the catheter brand, the rigid tip of the guidewire might bore a hole and exit through the catheter tip. The rigid catheter tip must be introduced without passing beyond the tip of the Amplatz sheath. Over-advancement might perforate the renal pelvis wall. Conclusions: This technique is an effective solution for using a latex Foley catheter as a nephrostomy tube through the amplatz sheath in Mini-PCNL.

6.15.4. UVP-15.04: Relevance of Laparoscopic Retroperitoneal Pyelolithotomy in the Current Era

• Khan N, Khan M and Nazir S
• Kidney Hospital, Srinagar, India

Abstract: Introduction and Objectives: Most of the renal stones are managed by endoscopic techniques like RIRS and PCNL, but the question remains is the relevance of laparoscopic retroperitoneal pyelolithotomy in the current era. Materials and Methods: We present a video presentation of three cases who underwent laparoscopic retroperitoneal pyelolithotomy, in this, we demonstrate the standard technique of laparoscopic retroperitoneal pyelolithotomy. Initial space is created with the finger dissection followed by ballon dilatation and ports are created over finger guidance. Then the psoas muscle is identified and traced up to the pelvis where the pelvis is dissected and pyelolithotomy performed. Stone is then extracted and the pyelolithotomy is then closed over a stent and a drain is kept in. We describe three cases, in the first case the kidney is an ectopic pelvic kidney and the stone is extracted with this approach, the second is a staghorn calculus with secondary calyceal calculus which would require multiple tracts for complete stone clearance and was managed by stone extraction followed by flexible nephroscopy for the calyceal calculi, lastly in the third case we demonstrate pyelolithotomy in infective calculus with pus flakes which was contained in the retroperitoneal space with a decrease risk of sepsis in such cases. Results: Our results show that the procedure is safe and effective. With a mean operative time of 60–120 min. Minimal post-operative blood loss of less than 50 mL. Post-operative stay of 3 days and no serious complications were encountered. We did not encounter any post-op bleeding requiring transfusions as seen in staghorn horn calculus with multiple tracts. None of our patients developed sepsis even in infective cases. The retroperitoneal approach helped us in this as it is a contained cavity and no spillage was seen intraperitoneal. Conclusions: Our results show that the approach is safe and effective in comparison to other endoscopic techniques and can be a better alternative approach in some situations.

6.15.5. UVP-15.05: Zero-Exposure Ureteroscopy for Ureteral Stone and Renal Stone

• Tsujioka T, Hori K, Miyake T, Izumi K, Fujiwara A, Kawanishi Y and Yamanaka M
• Takamatsu Red Cross Hospital, Takamatsu, Japan

Abstract: Introduction and Objectives: Fluoroscopy is conventionally used for ureteroscopy (URS). Fluoroscopy exposes patients and medical staff to the health hazard of radiation. On the other hand, ultrasound techniques have increased precision and are not invasive. Therefore, we considered that zero-exposure URS could be performed for all types of patients by using ultrasound. The aim of this study is to determine the safety and effectiveness of zero-exposure URS for treating ureteral stones and renal stones. Materials and Methods: This study includes all patients (n = 515) who underwent zero-exposure URS for ureteral stones (n = 354, U) or renal stones (n = 161, R) at our institution between April 2018 and October 2023. Operative time, rates of zero exposure, stone-free rates, and perioperative complications were compared between the ureteral stone and renal stone groups. Ultrasound was used to place guidewires, insert ureteral access sheaths into the ureteral orifice, identify residual stone fragments, and place ureteral stents. Ultrasound operations were performed by an ultrasonography technician. Results: We completed zero-exposure URS in 510 cases, 99.0% (U:351 99.2% vs. R: 159 98.7%). The average operative time was 77.2 ± 37.2 min. (U: 70.3 ± 36.9 vs. R: 92.6 ± 33.3). Stone-free rate was 89.3% (U: 92.3 vs. R: 82.6). Complications developed in thirty-two patients, 6.2% (U: 20 vs. R: 13) and comprised of febrile urinary tract infection (n = 14, U: 8 vs. R: 6), ureteral mucosal injury (n = 13, U: 10 vs. R: 3), ureteral perforation (n = 1, U: 1 vs. R: 0), inability to position a ureteral stent (n = 1, U: 0 vs. R: 1), postoperative bleeding (n = 1, U: 1 vs. R: 0), deep vein thrombosis (n = 1, U: 0 vs. R: 1), and drug-induced liver dysfunction (n = 1, U: 0 vs. R: 1). Conclusions: Zero-exposure URS for ureteral and renal stones can be performed easily and safely. In addition, it has several advantages, which include confirmation of the proximal ureter in patients with impacted stones, and recognition of X-ray negative stones. Zero-exposure URS is safe, effective, and useful for treating both ureteral and renal stones.

6.16. Training and Education

6.16.1. UVP-16.01: Learning and Teaching Partial Nephrectomy on a Nephron Sparing Bovine Model

• Lezrek M ¹, Tazi H ¹, Yacoubi S ¹, El Yazami O ¹ and El Anzaoui J ²

¹ 

Al Ghassani Hospital, Fes, Morocco

² 

Military Hospital Moulay Ismail, Meknes, Morocco

Abstract: Introduction and Objectives: In our department, open nephron-sparing surgery is performed using progressive blunt dissection. We present a video of our learning/teaching model for nephron sparing surgery using a bovine model. Materials and Methods: For teaching partial nephrectomy, we use a model using a regular butcher’s veal kidney, whole with its capsule and vessels. Renal artery is perfused with a dyed solution. One of the kidney lobules is considered as a tumor. Resection of this lobule as a tumorectomy. 3–4 lobule resections can be performed on a kidney of about 300 g. The tumor borders are marked with electrocautery. Then renal parenchyma is progressively dissected using progressive scissors blunt dissection. Each vascular or calyceal structure, entering the tumor, is isolated, clamped with a clamp and transected, and ligated. We use early declamping and parenchyma hand pressure for parenchyma reconstruction. Using manual pressure, the parenchymal wound is shut to help the closure of the wound. Renal reconstruction is performed in a single parenchymal plane with figure-of-eight-sutures, mostly without bolsters. Results: This model is realistic. It reproduces our experience with partial nephrectomy. This model can be used to study and practice different nephron sparing surgery techniques: tumorectomy, wedge resection, hemi-nephrectomy... However, enucleation is not possible. Also, it is a good model for training on renal reconstruction. This model is used in the setting of open surgery. But we think that it can be used in laparoscopic training. This model has been used in 3 workshops, with about 40 participants. Evaluations submitted by training session participants revealed a high degree of satisfaction with model effectiveness in the application of nephron sparing surgery. Training on this model had given them more confidence in doing nephron sparing surgery. Conclusions: This model is realistic. It reproduces our experience with partial nephrectomy. This model is used in the setting of open surgery. It might be used with laparoscopy. It offers a low stress environment that provides an opportunity for supervised, repetitive performance of essential technical skills. However, further technical experience and comparative studies are necessary to evaluate this model.

6.16.2. UVP-16.02: Teaching/Learning Transurethral Resection of the Prostate on a Model Based on a Sheep Kidney

• Lezrek M ¹, Tazi H ¹, Yacoubi S ¹, El Yazami O ¹ and El Anzaoui J ²

¹ 

Al Ghassani Hospital, Fes, Morocco

² 

Military Hospital Moulay Ismail, Meknes, Morocco

Abstract: Introduction and Objectives: We present a video of our learning/teaching model for trans-urethral resection of the prostate (TURP) using a sheep kidney into a glove model. Materials and Methods: The TURP model is based on a surgical glove and a regular butcher’s sheep kidney, whole with its capsule and vessels. The sheep kidney is turned on itself to form a doughnut. Then, it is introduced and jammed into the base of the glove’s middle finger, which will be used as urethra. Its tip is opened and a 30-Fr Amplatz sheath is introduced into its first centimeters. All the other fingers are tied on their base. The glove’s cuff is closed with ligations. A 26-Fr Olympus TURIS bipolar resectoscope is used with saline irrigation. Introduction of the resectoscope until reaching the sheep kidney. The resection loop is pushed into the middle of the kidney; and a tunnel is created. Then progressive resection is performed starting into the tunnel, like starting in the urethra. The resected chips are gathered into the palm of the glove which act as a bladder. Results: TURP is possible on this model. it reproduces most of the skills needed in TURP. Short cuts and longue cuts are possible. The pieces of tissue are carried by the irrigating fluid into the bladder and then flushed out at the end of the procedure. The progression of the loop in the tissue is similar to prostate tissue. Limitations are it is a biologic model, so it needs special attention to hygiene and equipment sterilization. The normal endoscopic anatomy is not represented, especially, the verumontanum. It is possible only with bipolar resectoscopes. There is no hemorrhage. However, an irrigation of a red colorant might be performed through the renal artery. Evaluations submitted by training session participants revealed a high degree of satisfaction with model effectiveness in the application of TURP. Conclusions: This model has realistic tissue feeling. it reproduces most of the skills needed in TURP. It offers a low stress environment that provides an opportunity for supervised, repetitive performance of essential technical skills. However, further technical experience and comparative studies are necessary to evaluate this model.

6.17. Voiding Dysfunction

UVP-17.01: Sacral Anterior Root Stimulator: Surgical Technique for Extradural Implantation

• Gomez Illanes R and Opazo Marquez V
• Hospital del Trabajador, Santiago, Chile

Abstract: Introduction and Objectives: The anterior sacral root neurostimulator (SARS) is an electronic implantable device, which allows the suprasacral spinal cord injured patient to voluntarily control micturition, defecation, and erection. Intradural and extradural implant technique has been described. In this video we show the extradural approach. Materials and Methods: A completely rehabilitated and self-sufficient 49-year-old male with a complete T8 paraplegia was offered a SARS. He has urinary incontinence due to refractory neurogenic overactive bladder (NOAB). Urodynamics showed NOAB. Urethrocystoscopy was normal. Surgical technique: Under general anesthesia, the patient is placed in the prone position and with exposure of buttocks and feet. A sacral canal laminectomy is performed exposing the sacral roots. A careful dissection inside the S2–S4 roots in the vicinity of the spinal ganglion allows to separate the posterior (sensitive) from the anterior (motor) fibers. Intraoperative selective stimulation is performed, identifying and mapping peripheral (somatic) responses—plantar flexion (S2), big toe flexion (S3), perianal contraction (S4)—and visceral responses—bladder contraction and elevation of arterial blood pressure (S3–S4). A selective posterior rhizotomy is performed, placing the stimulating electrodes around the anterior motor roots. One electrode is placed encompassing both left S3–S4, another both the right S3–S4 and a double electrode around both S2 roots. Subsequently, with the patient in lateral decubitus position, the electrode wires are tunneled towards the receiving antenna, implanted in an infra-mammary subcutaneous pocket. Results: No intra or postoperative complications occurred. The first voiding test was performed on the 6th postoperative day, and on the 9th day a urodynamic evaluation with programming of the neurostimulator were performed, training the patient in the use of the device. In subsequent visits, programming adjustments were made according to the responses obtained. At 12 months of follow-up, the patient was continent, free of catheterizations and urinary tract infections, using the SARS for voiding every 4 h with physiological post-void residual and with a high degree of satisfaction. Conclusions: Selective posterior sacral rhizotomy associated with the SARS implant using the extradural technique is a feasible, safe and effective procedure for the suprasacral spinal cord injured patient to achieve satisfactory voluntary control of urination.

Correction Statement

This article has been republished with a minor correction to resolve spelling errors. This change does not affect the scientific content of the article.