KSS/SouthThamesUrologyMeetingAgenda/AbstractsBooklet

Ashford&StPetersNHSHospital,

Educationcentre

Monday,24thApril2017

KSS/SouthThamesUrologyMeetingAshford&StPetersNHSHospital,Educationcentre

Monday,24thApril2017Introduction: Welcome to Chertsey, the home of the third stump in cricket! Yes, the town of Chertsey has a place in the history of cricket. “Lumpy” Stevens, the gardener of Lord Tankerville, was an outstanding bowler. He could deliver the ball between the 2 stumps frequently and caused disputes, as the bails were not knocked out. This led to the introduction of the third stump in the game of cricket in 1776. With this in mind, we have arranged this STC meeting at St Peter’s hospital to kindle new ideas and concepts for the future of urology that might perhaps create history. We have the usual business meeting in the morning followed by the presentations from the trainees from both, KSS and the London deanery. A large number of high quality presentations were received and we were simply spoilt for choice! We have selected some thought provoking papers, which will hopefully generate good discussions. There will be the usual prizes for the best paper, which will be selected by independent judges. We hope you will spend some time with the exhibitors in the postgraduate centre, as our sponsors have been very supportive. We are also very grateful to our secretary Jo Mucklow for helping as part of the organising committee. Hope you enjoy this academic event at Ashford and St Peter’s Hospital. Ravi Kulkarni & Sachin Agrawal.

KSS/SouthThamesUrologyMeeting

Ashford&StPetersNHSHospital,EducationcentreMonday,24thApril2017

Programme1000–1200 SouthThamesDeaneryMeeting 1000–1200 KSSDeanerymeeting 1200–1230 Jointmeeting 1230pm–1330 Lunch 1330-1500 AcademicSession1 1500–1530 Tea 1530–1540 College&RegionalUpdate 1540–1650 AcademicSession21650–1700 UrologyCatheterProject AwardofDerekPackhamMedal1700-1730 STCUpdate1730 Meeting,Close1800 Dinner Thecompanieskindlysupportingthemeetingarelistedbelow:BostonScientific,Astellas,BespokeMedicalProtection,KarlStorz,Allergan,Ferring,CookMedical,PierreFabre,Olympus,Takeda,WolfRichard(UK),KyowaKirin,Genesis,HitachiOursponsorshavehadnoinvolvementregardingtheeducationalcontentnorhastherebeenanyinvolvementoranysupportprovidedforthecontent,logistics,selectionofvenueoranyothermeetingarrangements.

Academic sessions: 1330- 1500 Academic Session 1: 7mins per presentation, 3 mins questions

1. A change in UTI incidence in our intradetrusor Botox patient cohort following changes in pre-operative protocol and antibiotic prophylaxis. A Brewin, E White, R Walker, T Nitkunan. Presenting author: Dr. Anna Brewin

2. Internet use in patients attending urology outpatient clinics and

undergoing urological surgery- friend or foe? Amelia Kerr, Amy Burrows, Patrick Olaniyi, Niyati Lobo, Charles Coker. Presenting author: Amelia Kerr

3. Red Patches Detected at Flexible Cystoscopy: Are We Getting It Right?

Niyati Lobo, Ahmed Ali and Tim Larner. Presenting author: Niyati Lobo

4. Rectal swab cultures and targeted prophylactic antimicrobial regimes do not reduce the risk of sepsis following transrectal prostate biopsy: Marios Hadjipavlou, Waseem Mulhem, Mazin Eragat, Charlotte Kenny, Chris Wood, Martino Dall’Antonia, Mohamed Y Hammadeh. Presenting author: Marios Hadjipavlou.

5. Audit on the antibiotic management of upper urinary tract infections.

Olivia Jones, Christopher de Souza, Jade Harrison, Denosshan Sri, Rashmi Singh, Sarbjinder Sandhu. Presenting author: Olivia Jones

6. Medium term outcomes and safety profile of Botulinum Toxin Type A

intra-vesical injections in men with idiopathic detrusor overactivity. Nicholas Faure Walker, Jane Watkins, Christopher Dowson, Sachin Malde, Claire

7. Maximising Income from PCNL. H Warren, K Keen, A Khan, S Willis, J

Glass, G Noble, K Thomas, M Bultitude. Presenting author: Hannah Warren

8. Factors affecting intrarenal pressure during flexible ureteroscopy and Laser lithotripsy. Neophytos Petrides, Rajesh Krishnan. Presenting author: Neophytos petrides

9. Point of Care INR testing on the day of surgery: a small prick with BIG

results. Kamran Haq, Donald Choi, Andrew Chetwood, Nimalan Arumainayagam. Presenting author: Kamran Haq

1530- 1640 Academic Session 2: 7mins per presentation, 3 mins questions

10. Internet use in patients attending urology outpatient clinics and undergoing urological surgery- friend or foe? Amelia Kerr, Amy Burrows, Patrick Olaniyi, Niyati Lobo, Charles Coker. Presenting author: Amelia Kerr

11. Home and away: comparing mechanism of renal trauma and subsequent

management in two major trauma centres in London and Adelaide. S Rintoul-Hoad, J Makanjuola, C Brown, R Catterwell. Presenting author: S Rintoul-hoad

12. Renal function loss after Cryoablation of Small Renal Masses in Solitary

Kidneys - European Registry for Renal Cryoablation (EuRECA) multi institutional study. Rudd I, Farrag K, Neilsen TK, Lagerveld BW, Keeley F, Guazzoni, G, Barber NJ, Sriprasad S. Presenting author: Iain Rudd

13. Salvage robot assisted radical cystectomy (sRARC): a demonstration of

our experience in technical feasibility and perioperative outcomes. Kawa Omar , Parsons B, Rajesh Nair, Ramesh Thurairaja , Shamim Khan. Presenting author: Kawa Omar

14. Exploring patient readmissions following Robot-Assisted Radical

Cystectomy at a Tertiary Bladder Cancer Service. Dimitrios Moschonas, Pavlos Pavlakis, Jamie Lindsay, Annelisse Ashton, Alison Roodhouse, Chris Jones, Ricardo Soares, Murthy Kusuma, Simon Woodhams, Michael Swinn, Hugh Mostafid, Matthew Perry, Krishna Patil Presenting author: Jamie Lindsay

15. Evaluating prognostic factors for recurrence and mortality from upper

tract urothelial carcinoma (UTUC) after nephroureterectomy (NU) from a 16 year experience. P Brousil, M Ager, A Coscione, R Macarthur, S Sandhu, K Anson, B Ayres, P Le Roux, C Anderson. Presenting author: P Brousil

16. The Prostate Cancer Diagnosis Pathway; Quality Improvement Against

CWT Targets. Philip James, Nimalan Aruminayagam, Senthy Sellaturay, Sachin Agrawal. Presenting author:Philip James

17. New haematuria NICE guidelines: what about the under 40s? Ola Blach,

Ahmed Ali, Tim Larner. Presenting author: Ola Blach

Abstracts

Academic Session 1

Mr Nimalan Arumainayagam Mr Jai Seth

TitleofpresentationAchangeinUTIincidenceinourintradetrusorBotoxpatientcohortfollowingchangesinpre-operativeprotocolandantibioticprophylaxis.AuthorsDr.ABrewin,MissEWhite,MrRWalker,MissTNitkunan,EpsomandStHelierUniversityHospitalsNHSTrustContactemailaddress:A.E.Brewin@doctors.org.ukAbstractIntroductionTheincidenceofUTIfollowingintradetrusorBotox®inourTrustwaspreviouslyfoundtobe33%.Thisledtochangesinantibioticprophylaxisandproceduralprotocol.Oralco-amoxiclavisnowgivenforlocalanaestheticcases.Theprotocolinvolvesaurinespecimensentforculture2weeksprior,andanonthedaycheckforUTIsymptomsandurinedipstick.Theaimofthisre-auditwastodeterminewhethertheUTIratehadalteredsincethesechanges.PatientsandMethodsDatawasgatheredfromthe42patientswhowereplannedtoreceiveintradetrusorBotox®betweenJanuaryandJune2016.InformationfromourBotox®database,clinicletters,operationnotesandmicrobiologyresultswerereviewed.ResultsOneofthe42plannedprocedureswascancelledduetoUTIsymptomsandpositiveurinedipstickonproceduralday.24/41(59%)wereunderlocal.Idiopathic:neurogeniccaseswere29:12.10/37(27%)pre-procedureurinecultureswerepositive(>10^8cfu/l).ThepercentageofallorganismssensitivetoTrimethoprimwas78%.Allpre-procedureUTIsweretreatedwithappropriateantibiotics.8/41(20%)patientshadaprovenUTIfollowingintradetrusorBotox®.ThepercentageofallorganismssensitivetoTrimethoprimwas43%.Apositiveurineculturewasunrelatedtocleanintermittentself-catheterisationordiabetes.ConclusionTherehasbeenareductionofpost-Botox®UTIincidencefrom33%to20%followingchangesintheprotocol.ChangesinbacterialresistancepatternsareseenpostBotox®andthiswarrantsfurtherstudy

TitleofpresentationInternetuseinpatientsattendingurologyoutpatientclinicsandundergoingurologicalsurgery-friendorfoe?AmeliaKerr,AmyBurrows,PatrickOlaniyi,NiyatiLobo,CharlesCokerBrightonandSussexUniversityHospitalsNHSTrustEmail:Amelia.kerr@bsuh.nhs.ukIntroductionPatientsareincreasinglyusingtheInternetformedicalinformation,whichmaybeofvariablequalityandcauseunnecessaryanxiety.ThisstudyaimstoexaminetheuseoftheInternetanditsimpactamongpatientsattendingurologyclinicsandundergoingurologicalsurgery.MethodsPatientsattendingurologyclinicsorundergoingelectivesurgeryatateachinghospitalweresurveyedregardingtheiruseoftheInternetforinformationovera2-monthperiod.Results

• 364questionnaireswerecompleted(162patientsattendingclinicand202undergoingsurgery).

• PatientsattendingclinicweremorelikelytousetheInternettoseek

informationthanthoseundergoingsurgery(47%vs24%)andmorelikelytodiscusstheirfindingswiththeirurologist(58%vs21%).

• TheNHSandWikipaediawebsitesweremostcommonlyusedbybothgroups.TheBAUSwebsitewasleastcommonlyused.

• ThemajorityofpatientsinbothgroupsfoundthatusingtheInternetledto

animprovedunderstandingoftheircondition,bettercommunicationwiththeirurologistandanimprovedabilitytomaketreatmentdecisions.

• Femalepatients,those<65yearsandthosewithmalignantdiagnosesinbothgroupsweremorelikelytofeelanxiousaftersearchingtheInternet.

ConclusionsInternetuseinpatientsattendingoutpatienturologyclinicsandundergoingelectiveurologicalsurgeryiscommonand,inmostcases,allowspatientstobetterunderstandandmanagetheircondition.

TitleofpresentationRedPatchesDetectedatFlexibleCystoscopy:AreWeGettingItRight?NiyatiLobo,AhmedAliandTimLarnerBrightonandSussexUniversityHospitalsNHSTrustEmail:niyatilobo@gmail.comIntroductionRedpatchesofurotheliumarecommonlyseenduringflexiblecystoscopyandfrequentlybiopsiedtoexcludeCIS.Atourinstitution,biopsiesareperformedundergeneralanaesthesia.TheobjectiveofthisstudywastoquantifythediagnosticyieldofbiopsyforredpatchesdetectedatflexiblecystoscopyandtodeterminetheassociationbetweentraineeexperienceandfrequencyofGAbiopsy.MethodsWeretrospectivelyreviewedallGAcystoscopies+/-biopsiesperformedforredpatchesdetectedatflexiblecystoscopybetween30/11/15and30/11/16.Results70patientsunderwentaGAcystoscopy+/-biopsyforaredpatchdetectedatflexiblecystoscopy.32/70(46%)weretwo-weekwaitreferrals.Meanage69.5±14.1years30%wereASA318/70(26%)witharedpatchatflexiblecystoscopyhadanormalGAcystoscopy;72%ofthesecaseswerebookedbyjuniortrainees.Table1.HistologicaldiagnosesinredpatchbiopsiesIndicationforflexiblecystoscopy

n Malignantpathology

Benignpathology

Normalmucosa

TCCsurveillance 30 2/30 19/30 3/30Haematuria 29 1/29 14/29 4/29RecurrentUTI 6 1/6 4/6 0/6StorageLUTS 3 0/3 2/3 0/3Other 2 0/2 2/2 0/2Total 70 4/70(6%) 41/70(57%) 7/70(10%)Complicationsoccurredin3/70(4%),includingoneon-tablearrest.ConclusionsRedpatchbiopsyhasalowdiagnosticyieldofmalignancy.JuniortraineesaremorelikelytolistpatientswithredpatchesforGAcystoscopy±biopsy.Approximately25%ofpatientshadnormalGAcystoscopies;thisrepresentspoortheatreutilizationandexposespatientstounnecessaryperioperativerisk.Basedonthesefindings,wehaveintroducedadepartmentalpolicyofarepeatflexiblecystoscopybyaseniortrainee.

TitleofpresentationRectalswabculturesandtargetedprophylacticantimicrobialregimesdonotreducetheriskofsepsisfollowingtransrectalprostatebiopsyMariosHadjipavlou,WaseemMulhem,MazinEragat,CharlotteKenny,ChrisWood,MartinoDall’Antonia,MohamedYHammadehIntroduction:Sepsisisasignificantcomplicationfollowingtransrectalultrasound-guidedprostatebiopsy(TRUSBx).Ciprofloxaciniscommonlyusedforprophylaxis,howeverthereisemergingevidenceforanincreaseinincidenceofresistantentericorganismsworldwide.WeinvestigatetheeffectofrectalswabculturesandsensitivitiesfortargetedprophylacticantimicrobialregimesinreducingtheriskofsepsisfollowingTRUSBx.Methodology:Allpatientshadconfirmednegativeurinalysispriortobiopsy.609patients(GroupA)receivedaprophylacticantimicrobialregimeofasingleintravenousdoseofgentamicin240mg,rectalmetronidazole1gandoralciprofloxacin500mgtwicedailyfor3days.DuetoasignificantincidenceofciprofloxacinandgentamicinresistanceinpatientsadmittedwithsepsisfollowingTRUBx,ourlocalantibioticrecommendationschanged.Thesubsequent314patients(GroupB)hadrectalswabculturesandsensitivitiesperformedpriortobiopsy.Patientswithrectalfloraorganismsresistanttociprofloxacinorgentamicinreceivedtargetedantimicrobialprophylaxisconsistingofasingledoseoralfosfomycin3g,intravenousamikacin750mgandrectalmetronidazole1g.Datawascollectedforrectalswabcultures,antibioticregimeused,readmissionwithsepsiswithin14daysandbloodorurineculturesresultsonadmission.Results:IngroupA(standardciprofloxacin-basedregime),12of609(2.0%)patientswereadmittedwithsepsisfollowingbiopsy.E.coliwasthemostcommonpathogendetected.Ofthe7patientswithpositiveurineorbloodcultures,4(57%)wereciprofloxacin-andgentamicin-resistantand2(29%)wereciprofloxacin-resistantonly.IngroupB,57of314(18.2%)patientshadciprofloxacinorgentamicinresistantrectalfloraandreceivedthetargetedantimicrobialprophylaxisregime(36ciprofloxacin-resistantonly,8gentamicin-resistantonly,13ciprofloxacin-andgentamicin-resistant).OverallingroupB,5of314(1.6%)patientswerereadmittedwithsepsisdespitereceivingtargetedcombinationofprophylacticantibioticsbasedontheirrectalswabcultures.Ofthesepatients,2hadgrownciprofloxacin-resistantorganismsonrectalswabandreceivedtheappropriateantimicrobialprophylaxisregime.Thedifferencebetweenthetwogroupswasnotstatisticallysignificant(p=0.69).Conclusions:Theincidenceofciprofloxacin-resistantflorainourcommunityissignificant(18.2%).TheriskofsepsisfollowingTRUSBxwasoveralllow,howevertheuseofrectalswabculturesandtargetedcombinationofantibioticregimesdidnotseemtoreducetheriskanyfurther.

TitleofpresentationAuditontheantibioticmanagementofupperurinarytractinfectionsAuthors:OJones,CdeSouza,JHarrison,DSri,RSingh,SSandhuDepartmentofUrology,KingstonHospitalContactemailaddress:oliviajones@doctors.org.ukIntroductionPyelonephritisisacommonurologicaladmissionandtreatmentwithappropriateantibioticsisessentialinpreventingitscomplications,promptdischargeandavoidreadmission.Weauditedourtrustsantimicrobialpracticeinpyelonephritisagainstnationalguidanceandlocalantimicrobialresistanceprofiles.Weexploredouradherencetoantimicrobialstewardshipandimplementedimprovementstoensureappropriateprescribing.MethodsAclosedloopretrospectiveauditofpatientsadmittedundertheurologyteamduetopyelonephritiswascarriedout,evaluatingtheirantibiotictreatmentduringadmissionanddischargeagainsttheircultures.Thefirstcyclewasbetween1/3/16–1/6/16andfollowingimplementations,asecondcycleconductedbetween7/12/16–7/3/17.Results71patientswereincludedintotal(33and38incycle1and2respectively),withameanageof41.Thefirstcycledemonstratedasignificantnumberofpatientsdischargedwithinappropriateantibiotics(19%)duetoantimicrobialresistance.Subsequentchangestotheantibioticsatdischargeweremadeandmethodsforensuringresultsofdelayedculturesareactionedappropriatelysawadecreaseininappropriateantibioticprescribingatdischarge(6%).WenotedanincreaseinresistancetoourfirstlineantibioticsAmoxicillinandTrimethoprimof188%and240%respectivelyacrossthetwocycles.Interestinglynosignificantrelationshipwasnotedbetweendischargeoninappropriateantibioticswithreadmissions(p=1.00).ConclusionAntibioticstewardshipisimportantinattemptingtoreducetheincidenceofresistantorganisms.Wehavenotedanincreaseinresistancepatternsinthecontextofinappropriateantibioticprescribing.Adaptingmethodsforreviewingcultureresultshasshownaclearimprovementinantibioticprescribing.

TitleofpresentationMediumtermoutcomesandsafetyprofileofBotulinumToxinTypeAintra-vesicalinjectionsinmenwithidiopathicdetrusoroveractivityAuthors:NicholasFaureWalker,JaneWatkins,ChristopherDowson,SachinMalde,ClaireTaylor&ArunSahaiGuys&StThomasNHSFoundationTrustContactemailaddress:nicholas.faure.walker@gmail.comAbstractIntroduction:IntravesicalBotulinumtoxininjectionsforidiopathicdetrusoroveractivity(IDO)issupportedbylevel1evidencebutthereislessdataavailableformenthanwomen.Methods:Patientsreceivedbetween100and200UOnabotulinumtoxinA.Outcomeswereassessedfromaprospectivedatabaseusingtheincontinenceimpactquestionnaire7(IIQ7)andurogenitaldistressinventory6(UDI6)scores.Urinarytractinfection(UTI)wasdefinedasurinarysymptomsrequiringtreatmentwithantibiotics.RESULTS:Of628documentedinjections,493wereforIDO.Ofthese112(22.7%)wereformen.60menhad1injection,25had2,9had3,7had4,3had5,2had6,and1patienthad7,8,9,10,11and12injections.Meanageformenwassimilarforwomen(54.1yvs56.7y,p=0.41).MeanIIQ7andUDI6scorechangesfrombaselineto4-12weekfollowupwas-6.8and-4.1(p<0.01)formenand-11.0and-5.9forwomen(p<0.01).However,nostatisticallysignificantdifferencebetweengenderswasobservedatfollowup(IIQ7,p=0.137;UDI6,p=0.23).Denovointermittentself-catheterization(ISC)wasrequiredby20/65(30.8%)menwithfollowupdatato4/15(26.7%)ofwomen(p=0.04).UTIwasreportedin5(7.8%)menand3(17.6%)ofwomenwithfollowupdata(p=0.175).Conclusion:IntravesicalBotulinumToxininjectionsforIDOaresimilarlyefficaciousatimprovingqualityoflifescoresinmenandwomen.AlthoughtheISCratewassimilarformenandwomen,UTIwasreportedlessofteninmen.

TitleofpresentationMaximisingIncomefromPCNLAuthors:HWarren,KKeen,AKhan,SWillis,JGlass,GNoble,KThomas,MBultitudeGuy'sandStThomas'NHSFoundationTrustContactemailaddress:hannahwarren@doctors.org.ukIntroductionHospitalsreceivepaymentforservicesbasedclinicalcoding,representingthehealthresourcesconsumed.RemunerationforPCNLvariedsignificantlyandoftendidnotcorrelatewithcasecomplexity.WethereforesetouttoensurewewerecodingaccuratelyforPCNL.MethodsConsecutiveadultsundergoingPCNLprocedureswereidentifiedfromcodingdepartmentrecordsfrom1stJanuary-14thAugust2016andcross-checkedwithoperatingdiaries.Codingdatawascomparedtoelectronicpatientrecords,operationnotesanddischargesummaries.CodingdataforSeptemberwasretrospectivelycorrectedandthedifferenceinincomemeasured.ResultsDatafrom50PCNLprocedureswereanalysed.Themeanpatientagewas58(range23–85)years,medianpost-operativelengthofstaywas3days(range1–14),andmeanincomepercase£3494(range£1,154-£7,829).Itwasnotedthatproceduralcode‘M16.5RemovalofNephrostomyTube’wasresponsibleforupgradingtheHRGcodefrom‘intermediateintervention’to‘majorprocedure’.Allpatientshavenephrostomytubesremovedpriortodischargeeitheronthewardorintheinterventionalsuite,butthiswasinconsistentlycapturedincodingdata,resultinginlostincome.UpdatingcodinginformationforSeptember2016resultedina£19,769upliftinincome.ConclusionImprovingaccuracyofcodingcanleadtosignificantlyincreasedtariffsforPCNL.WeintroducedalocalcodingpolicytooptimisetheaccuracyofclinicalcodingforPCNL,withoutincreasingadministrativeburdenforclinicians.Weadvocateregularmeetingsbetweencliniciansandcoderstoidentifyopportunitiesforcodingimprovement

TitleofpresentationFactorsaffectingintra-renalpressureduringflexibleureteroscopyandLaserlithotripsyAuthors:NeophytosPetrides,RajeshKrishnanKentandCanterburyHospitalContactemailaddress:np262@cantab.netIntroductionPelvicpressureduringrenalsurgeryhasbeenstudiedinanimalmodelsbuthasnotbeenexaminedextensivelyinclinicalstudies.Ouraimwastoinvestigatetheeffectofaccesssheaths,preoperativestentingandirrigationmethodsonpelvicpressuresandtoassessthecorrelationbetweenintra-operativeintra-pelvicpressuresandpost-operativepainorsepsis.MethodsDatawereprospectivelycollectedfor82patientsundergoingureterorenoscopyandlaserlithotripsy.Initialandendpressuresweremeasuredusinganarterialtransducerconnectedtoaflexibleureteroscope.Avisualanaloguescalewasusedtoassesspost-operativepain.ResultsMeanfinalpressurewithasyringeinjectionwas20.3cmH2O,andwithno-pressureirrigation21.6cmH2O.Thepeakpressureforsyringeinjectionwas43cmH2O,whereasforno-pressurecontinuousflow56cmH2O.Therenalpelvicpressureswere14.29mmHgwithasheathand18.78mmHgwithout(p=0.08).Howeverifthepressuredifferencewastakenintoaccounttherewasasignificantdropp=0.002.Therewasnocorrelationbetweeninitialorfinalrenalpelvicpressuresandpost-operativepainscores,andnocasesofpost-operativesepsis.Therewasnosignificantdifferenceinmeanpost-operativepainscoresbetweenthosewhohadpost-operativestentdrainage(mean2.2)versusuretericcatheterdrainage(mean2.8).ConclusionNoneofthefactorsassessedinourstudycausedadifferenceinrenalpelvicpressures,apartfromaccesssheathspossibleleadingtoareduction.Increasedrenalpelvicpressuresdonotseemtobeassociatedwithpostoperativesepsisorincreasedpainscores.

TitleofpresentationPointofCareINRtestingonthedayofsurgery:asmallprickwithBIGresultsAuthors:KamranHaq,DonaldChoi,AndrewChetwood,NimalanArumainayagamStPeter'sHospitalChertseyContactemailaddress:kamranhaq@doctors.org.ukAbstractTheNationalHealthServiceisexperiencingaperiodoffinancialpressure.Trustsareincreasinglylookingtocutcostswhilstmaintainingorimprovingpatientcare.Achievingthesegoalssimultaneouslyischallenging,leadingmanytruststofocusonmaximizingtheutilizationofexistingresourcestoprovideabetterservicewithoutincurringextracosts.ThisprojectidentifiedPOCTINRtestingasaservicethatcouldimprovetheefficiencyofthepatientpathwayforelectivesurgicalprocedures.Indoingso,itcoulddeliverafinanciallyviableservicewithincreasedpatientsafetyandsatisfactionrates.Prospectivedataanalysisidentified190patientssuitableforPOCTannually.CalculationsshowedthatcheckingINRresultsinthismannerwouldbetimeeffective,saving238hoursperannumcomparedtotheestablishedmethod.Thistimesavingcorrelatedtoasignificantfinancialsavingwhentranslatedtoincreasedtheatreutilizationandtheremovalofadditionalcostsincurredbycancellationsandoverrunninglists.Theservicewouldalsoresultinasafer,morepredictablepatientexperience.Basedonthisdata,abusinesscasewassubmittedtothetrustproposingtheinstallationofaPOCTINRmachineintheadmissionslounge.ThiswasapprovedandtheservicewasestablishedinFebruary2017.Reassessmentofthepathwayrevealedanimprovedservicebeingusedbyahigherthanprojectedcaseload.AuditofthePOCTaccuracyversusformallaboratorytestingrevealednodiscrepancy.Introductionofthisservicehasstreamlinedapreviouslyinefficientprocessresultinginthedeliveryofasafer,morepredictablepatientpathwaywithclearfinancialbenefits

AbstractsAcademic Session 2

Ms Tharani Nitkunan

Ms Katie Chan

TitleofpresentationHomeandaway:comparingmechanismofrenaltraumaandsubsequentmanagementintwomajortraumacentresinLondonandAdelaideAuthors:SRintoul-Hoad,JMakanjuola,CBrown,RCatterwellInstitution:King'sCollegeHospitalContactemailaddress:S.rintoul-hoad@doctors.org.ukAbstractIntroductionandObjective:Thekidneyisaffectedin1-5%ofalltraumas,therebyrepresentingasignificanturologicalworkloadintraumacentres.Wewantedtocomparethepatternoftrauma,severityofinjuryandmanagementattwodifferenttraumacentresintwodifferentcontinents.Methods:8yearsofrenaltraumadatawascomparedbetweentwomajortraumacentres:London2009-2016,Adelaide2004-2012.Results:119patientswereanalysedfromLondon,89%male(n=106),averageage32years;comparedto180patientsfromAdelaide,86%male(n=154),averageage37years.Mechanismofinjurydifferedbetweenmalesandfemales.ThecommonestcauseoftraumainLondonwasassault(37%,n=44);comparedtoAdelaide(10%,n=18).ThecommentcauseoftraumainAdelaidewasmotorvehicleaccident(36%,n=65)(excludingmotorbikes),comparedtoLondon(18%,n=22).Motorbikerelatedtraumaaccountedfor25%(n=42)oftraumainAdelaidecomparedto13%(n=15)inLondon.Sportinginjuryasthecauseofrenaltraumawassimilar;13%(n=16)London,14%(n=26)Adelaide.Bothcentreshadisolatedrenaltraumain25%ofcases.13%ofpatientshadembolisationinLondon(grade2-4),comparedto5%inAdelaide(allgrade4-5);howeverAdelaidehadahigherlaparotomyrateof1:5comparedtoLondon1:10.Thegrade5injuryratewassimilar,butLondonhadpredominatelygrade3-4injuries(33%and38%respectively),whereasAdelaidehadsimilarproportionofgrade1-4injuries.Conclusion:Renaltraumapatternsvarywhichleadstointerestingcomparisonsincludingtheirmanagemente.g.embolisationvslaparotomy.Standardisedrenalgradingallowsforinternationallearning.

TitleofpresentationRenalfunctionlossafterCryoablationofSmallRenalMassesinSolitaryKidneys-EuropeanRegistryforRenalCryoablation(EuRECA)multiinstitutionalstudy.RuddI1,FarragK1,NeilsenTK2,LagerveldBW3,KeeleyF4,Guazzoni,G5,BarberNJ6,SriprasadS11:DepartmentofUrology,DarentValleyHospital,Kent,UK2.DepartmentofUrology,AarhusUniversityHospital,Aarhus,Denmark3:DepartmentofUrology,St.LucasAndreasHospital,Amsterdam,TheNetherlands4:DepartmentofUrology,SouthmeadHospital,Bristol,UK5:DepartmentofUrology,IstitutoClinicoHumanitasIRCCS,ClinicalandResearchHospital,Milano,Rozzano,Italy6:DepartmentofUrology,FrimleyParkHospital,Camberley,UKIntroductionandobjectives:Thepresenceofasmallrenaltumour(SRM)inasolitarykidneymakesnephronsparingsurgeryandpreservationofrenalfunctionimperative.TheobjectiveofthisstudywastoestimateandquantifythelossofkidneyfunctioninsolitarykidneyswithSRMsafterlaparoscopicassistedcryotherapy(LAC)andtoexaminewhetheranyofthesepatientsrequiredrenalreplacementtherapy,fromtheEuropeanRegistryforRenalCryoablation(EuRECA)database.MaterialandMethods:Ofthe808patientsfromeightEuropeancentresinthedatabase,102patientshadSRMsinsolitarykidneys.Patientdemographics,BodyMassIndex,ASAgradeandtheirtumourparticularswerecollected.Renalfunctiondataintheformofestimatedglomerularfiltrationrate(eGFR)andchronickidneydisease(CKD)stratificationbothpreoperativelyandat3monthspostoperativelywereanalysed.Results:Themedian(IQR)agewas67(59-81)years,themedian(IQR)BMIwas26(23.9-28.9)kg/m2andthemedian(IQR)ASAscorewas2(2-3).Themedian(IQR)tumoursizeincross-sectionalimagingwas26(19-38)mm.Themeanpre-operativeeGFRwas55.0(SD18.1)andthepost-operativeeGFRwas51.8(SD18.8).Thechangewas-3.1(-5.2,-1.0)(95%CI)units,whichwasstatisticallysignificant(P=0.004).ThechangeintheCKDstagescomparingbeforeandafterLCAwasnotsignificant(paired2tailt-test,P=0.06).ThedecreaseintheeGFRdidnottranslatetoanysignificantadverseoutcomeandnoneofthesepatientsneededanyformofrenalreplacementtherapyatanytimeaftersurgery.Conclusion:ToourknowledgethisisthelargeststudyofrenalfunctionfollowingcryotherapyinSRMsinsolitarykidneys.Cryotherapyinthisimperativesituationissafeandmaybeatreatmentoptiontoavoiddialysis.

TitleofpresentationSalvagerobotassistedradicalcystectomy(sRARC):ademonstrationofourexperienceintechnicalfeasibilityandperioperativeoutcomesAuthors:KawaOmar,ParsonsB,RajeshNair,RameshThurairaja,ShamimKhanDepartmentofUrology,Guy’sandStThomas’NHSFoundationTrustContactemailaddress:kawaomar@doctors.org.ukObjectiveTodemonstratetechnicalfeasibilityofrobotic-assistedsalvagecystectomyanddescribeperi-operativeoutcomes.MaterialsandMethodsReviewof245patientsfromaprospectivelymaintainedradialcystectomydatabasebetweenNovember2013andOctober2016wasperformed.sRARCwasdefinedinpatientswhounderwentpreviousexternalbeamradiotherapyorbrachytherapyeitherforprimarybladderorprostatecancer.Results:12patientsmettheinclusioncriteria(12-male);medianage72years(range54-88),medianBMI27kg/m2(22-37)andASAscorewas2(2-3)).Sevenpatientsunderwentradicalexternalbeamradiotherapyand2hadbrachytherapyforprostatecancerand3underwentchemo-radiotherapyformuscleinvasivebladdercancer.Diversiontechniquesincludedilealconduit(n=10)andcutaneousureterostomies(n=2).Themeanoperatingtimewas320minutes(range240-480)andlengthofstaywas8days(range6-30).Themeanestimatedbloodlosswas360ml(range:200-600).Onepatientsustainedanintraoperativerectalinjuryrequiringadefunctioningcolostomy.Medianpostoperativefollow-upwas90-days(range:29-1067).TwopatientssustainedClavien-3complications,tworequiredpost-operativere-admissionwithin90days.Positivesurgicalmarginswereidentifiedintwopatientswithprostatecancer.Therewere3recurrencesinthefollow-upperiod(2pelvicrecurrences1inprostatecancerand1bladdercancer,1urethralrecurrence).Conclusion:WedemonstratetechnicalfeasibilityofsRARCandacceptableshort-termcomplicationrates

TitleofpresentationExploringpatientreadmissionsfollowingRobot-AssistedRadicalCystectomyataTertiaryBladderCancerServiceDimitriosMoschonas,PavlosPavlakis,JamieLindsay,AnnelisseAshton,AlisonRoodhouse,ChrisJones,RicardoSoares,MurthyKusuma,SimonWoodhams,MichaelSwinn,HughMostafid,MatthewPerry,KrishnaPatilRoyalSurreyCountyHospital,UrologyDepartmentIntroductionandObjectiveRehospitalisationrateisacarequalityindicatoraftermajorcanceroperations.Weaimtoexaminetheincidenceandcausesofearlyandlatereadmissionstohospitalfollowingrobot-assistedradicalcystectomy(RARC).MethodAretrospectiveanalysiswasperformedof158consecutivepatientswhounderwentRARCatRoyalSurreyCountyHospitalsincetheformationofatertiarybladdercancerserviceinApril2013.Demographic,operativeandpostoperativedatawerecollectedforallcasesandanalysisoflengthofstayandpatientreadmissionwithin90dayswasperformed.ResultsMedianlengthofhospitalstaywas5days(3-28).Theincidenceof90-dayreadmissiontohospitalwas16%(26of158)andwefoundtreatmentcomplicationstobetheonlyfactorsignificantlyassociatedwithreadmission(Table5).Threepatientshadmorethanonereadmission.Thirty-twopercentofreadmissionswereinfectionrelated(urinary,pelviccollection,lymphocele)and24%gastrointestinal(ileus,smallbowelobstruction).Fourpatientsrequiredanintervention,includingtworequiringgeneralanaesthesia.Ofthe30incidents,8wereconsideredaspotentiallyavoidable(backpain,scrotaloedema,oralcandidiasis).ConclusionTheresultsfromourcentredemonstrateashortlengthofhospitalstaywithlowearlyandlatereadmissionrates.Thisillustratesafavourablepatientoutcomeforaprocedureassociatedwithinherentmorbidityasaresultofminimallyinvasiveapproachandmultimodalenhancedrecoveryprotocol.Theoptimisationofthepost-dischargenetworkcanfurtherreducerehospitalisationandminimisetheservicefragmentationthatcanexistwithinatertiaryreferralfacility.

TitleofpresentationEvaluatingprognosticfactorsforrecurrenceandmortalityfromuppertracturothelialcarcinoma(UTUC)afternephroureterectomy(NU)froma16yearexperienceAuthors:PBrousil,MAger,ACoscione,RMacarthur,SSandhu,KAnson,BAyres,PLeRoux,CAndersonStGeorge'sHospital,EpsomandStHelierHospital,KingstonHospitalContactemailaddress:philbrousil@gmail.comIntroductionUTUCisararebutimportantdisease,whichlacksarobustevidencetogenerateconsensusinmanagement.Ouranalysisseekstoidentifyprognosticfactorsregardingrecurrence,deathandinformmanagementafterNU.MethodsAretrospectiveanalysiswasconductedon121NUpatientswithameanfollow-upof37months.Tumourcharacteristics,mortalityandtheeffectofuretero-renoscopyonrecurrenceweredetermined.32patientswereexcludedduetoinadequatedata.ResultsOverall28(38%)patientshadintra-vesicalrecurrence(IVR)atmediantimeof7mths.IVRwasseenin16patients(28%)whodidn’thavepriorbladdercancer(pBC).Ofthese,systemicrecurrencewasseenin11%(medianrecurrencetime15months).IntheIVRgroup,thepresenceofT2-3andmulti-focaldiseaseintheNUspecimenwassignificantlyhigher(p=0.04,0.02respectively).ThepresenceofG3,CIS,lympho-vascularinvasion(LVI)wasproportionatelyhigherbutnotstatisticallysignificant.UreterictumourlocationdidnotpredictIVR.Pre-operativeuretero-renoscopywasnotassociatedwithrecurrenceordeath.Overallmortalitywas52%withmediansurvival19mths;24%ofpatientsdiedofUTUC(mediansurvival13mths).StatisticallysignificantlyhigherratesofG3,T3,T4,CIS,LVIwereseenintheUTUCdeathgroup.Multi-focalitywasnotsignificantlyhigherintheUTUCdeathgroup.pBCandURSwerenotriskfactorsforUTUCdeath.ConclusionUTUCisanaggressivedisease.Morerigorousbladdersurveillanceisneededwheremulti-focalityandinvasivediseasearepresent.Theabovementionedprognosticfactorsmandatecloserpost-operativeradiographicsurveillanceandpossiblyintervention.

TitleofpresentationTheProstateCancerDiagnosisPathway;QualityImprovementAgainstCWTTargetsAuthors:PJames,TVasileva,NAruminayagam,SSellaturay,SAgrawalAshfordandSt.Peter'sNHSFoundationTrustContactemailaddress:Philly_james@msn.comIntroduction:TheOperationalStandard(OS)forpatientsreferredunderthe“twoweekwait”dictatesthat85%ofpatientsshouldundergotreatment(orbedischargedfromthepathway)within62daysofreferral.Duetoincreasingcomplexityofthediagnosticpathwayofprostatecancer,thisisdifficulttoachieveAtASPH,wehavemitigatedthisproblemwiththeintroductionofthe“ProstatePathway”.Method:RootCauseAnalysis(RCA)wasperformedagainstallbreachesin2016,providingtimelinedataforReferraltoMpMRI,andTRUSBx.Thiswascomparedto2017data(followingtheintroductionofthenewpathway).TheProstatePathwaywillreducethewaitingtimesforMpMRIandsubsequentTRUSbiopsy,bypre-bookingtheinvestigationsafterreceiptofreferral.EightslotshavebeenreservedforbothMRIandTRUSbiopsyeachweek.Thesegoaheadafterclinicianapproval.ThiswillimproveperformanceagainsttheOS.Results:In2016,50outof57breaches(88%)relatedtotheprostatecancer.Medianof23daysfromReferraltoMRI,andamedianof32daysfromReferraltoTRUSbiopsy.In2017,onlyoneprostatecancerbreachhasbeenrecorded(8daysfromReferraltoMRI,9daystoTRUSBiopsy.)Conclusion:Theprospectivedatasofarislimited,yetpromising.RCAhasrevealedmuchimprovedperformanceinthetimetakentoreachadiagnosis,andwelookwellsettoachievetheoperationalstandardssetbyNationalCWTmonitoring.

TitleofpresentationNewhaematuriaNICEguidelines:whatabouttheunder40s?Authors:OlaBlach,AhmedAli,TimLarnerBrighton&SussexUniversityHospitalsContactemailaddress:ola.blach@doctors.org.ukIntroduction:Visiblehaematuria(VH)isacardinalpresentingsymptomofurinarytractmalignancy.Thecurrent2015NICEguidelineonSuspectedcancerrecommendsreferraltoUrologyusingthesuspectedbladdercancerpathwayinpatientsaged45andoverwithVH.Thisrepresentaconsiderablechangefrompreviousrecommendations.Wesoughttodeterminehowmanydiagnosesofbladdercancerwouldhavebeenmissedinpatientsagedunder40atBSUHhadthecurrentNICEguidelinebeenfollowed.Methods:Aretrospectivereviewofbladdercancersdiagnosedinpatientsunder40yearsofageatBSUHsince2005wasundertaken.Results:14patients(11menand3women)diagnosedwithbladdertumourwereidentified.Only1hadsymptomaticNVH,theresthadVH.Medianageatdiagnosiswas34(range20-39,IQR11).13hadcancerdiagnosis(1G1Ta,9G2Ta,2G3T1,and1CIS),and1invertedpapilloma.Recurrenceswereobservedin3cases(allG2Ta),ofwhichoneprogressedtoG3Ta.2patientsunderwentradicalcystectomy.Conclusion:13casesofbladdercancerwouldhavebeenmissedinpatientsagedunder40hadthecurrentNICEguidelinebeenfollowed.Assuch,webelievethatallpatientswithunexplainedhaematuriashouldbereferredviathecancerwait2weekrole.

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